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Gordon T, Golin AP, Anzarut A. Keystone Flap for Closure of Skin Cancer Defects on the Upper Extremity. Plast Surg (Oakv) 2024; 32:47-53. [PMID: 38433798 PMCID: PMC10902476 DOI: 10.1177/22925503221094106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Background: We sought to examine the efficacy of the Keystone Design Perforator Island Flap (KDPIF) for the reconstruction of skin cancer excision defects isolated to the upper extremity. In particular, to examine the size of defects repaired and the complications associated with the keystone flap procedure isolated to the upper extremity. Methods: This is a retrospective chart review including all patients older than 18 years of age who received a KDPIF procedure between February 2013 and February 2019 for the oncologic reconstruction of skin cancer defects isolated to the upper extremities by a single surgeon. All procedures were done according to the original description by Behan. Results: A total of 32 patients, 18 (56%) male and 14 (44%) female, received 35 keystone flaps between February 2013 and February 2019. The mean age of the males and females was 70.5 and 79.7 years of age, respectively. Thirty-five lesions suspicious for cancer were excised and 14 (40%) basal cell carcinoma (BCC), 11 (31%) squamous cell carcinoma (SCC), 9 (26%) melanoma, and 1 (3%) actinic keratoses diagnoses were histopathologically determined. Skin defect excisions varied from 3.53 cm2 to 31.42 cm2. No intraoperative or postoperative complications occurred. Conclusions: The keystone flap is a successful versatile flap procedure with a low or absent complication rate for the reconstruction of skin cancer excision defects of various locations (eg arm, hand, elbow, forearm, shoulder, and wrist), cancer pathologies, and sizes on the upper extremity. When needed, a Doppler may successfully identify adequate perforating blood vessels for the relatively larger flaps.
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Affiliation(s)
- Travis Gordon
- Division of Plastic Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew P. Golin
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Anzarut
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
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Park H, Kim YC, Choi JW, Kim DH. Efficacy and feasibility of a forehead flap surgical guide for nasal reconstruction. J Craniomaxillofac Surg 2024; 52:14-22. [PMID: 37880042 DOI: 10.1016/j.jcms.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023] Open
Abstract
For successful nasal reconstruction using a forehead flap, three-dimensional (3D) nasal defects need to be translated into a two-dimensional (2D) forehead surface. For this study, a patient-specific 3D-printed forehead flap guide that could precisely translate a virtually simulated nasal shape into a 2D flap template was developed. The study aimed to evaluate the feasibility and efficacy of a 3D-printed forehead flap guide for nasal reconstructions. The 3D nasal surface was scanned using a 3D camera, and a 'digital clay' process was performed to correct the nasal deformity. The 3D morphology was flattened into a 2D forehead flap guide. The guide was 3D-printed and used for the forehead flap design. Photographic records were used to conduct anthropometric and aesthetic evaluations. Between October 2016 and August 2020, forehead flaps were performed using the forehead flap guide (guide group) and traditional templating method (control group) in 16 and 15 patients, respectively. The alar shape was more symmetric in the guide group than in the control group, with smaller right-to-left differences in alar width (p = 0.01) and height (p = 0.05). Regarding aesthetic evaluations, nose contour (p = 0.02) and nasal symmetry (p = 0.033) were better in the guide group than in the control group. The mean operative time was significantly shorter (91.9 ± 10.7 min) in the guide group than in the control group (116.4 ± 13.6 min) (p = 0.001). Our findings suggest that a 3D-printed forehead flap surgical guide can be effectively used in nasal reconstruction to reduce operative time and improve aesthetic outcomes.
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Affiliation(s)
- Hojin Park
- Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - Don Han Kim
- Department of Digital Contents, College of Architecture and Design, University of Ulsan, Seoul, South Korea
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Li G, Huang Y, Song M, Lu M. What are optimum cycles for immediate primary closure of large cutaneous defects? Sci Prog 2024; 107:368504231223037. [PMID: 38439712 PMCID: PMC10916480 DOI: 10.1177/00368504231223037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND In the reconstruction of large complex cutaneous wounds, a myriad of mechanical devices has been designed to facilitate primary wound closure. However, there is a dearth of studies elucidating how best to achieve optimum use and efficiency of skin stretching (SS) when using the device for immediate primary closure of defects. METHODS Skin defect wounds (7 × 7 cm) were prepared on the back of three Bama miniature pigs. A total of 15 cycles of SS (cycle loading) were subsequently performed on the skin edges of the wound by EASApprox® SS system. Then, the changes in equidistant points were recorded after each cycle. After the SS test, all wounds were sutured under low tension. RESULTS Skin elongation was observed at all equidistant points on the back wounds of three Bama miniature pigs. Up to an additional 1.10 to 3.75 cm of tissue was garnered. The maximum skin elongation was typically achieved within eight cycles of stretching and relaxation. Beyond this range, additional stretching cycles did not result in further skin extension. CONCLUSION There may be a close link between mobilization range and the times of acute cyclic stretching (cycle loading) during the process of primary wound closure. However, larger studies are required to further evaluate the accuracy and effectiveness.
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Affiliation(s)
- Gang Li
- Department of Orthopaedics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
- Department of Orthopaedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China
| | - Yajun Huang
- Department of Plastic Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China
| | - Mingzhi Song
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Ming Lu
- Department of Orthopaedics, Dalian Municipal Central Hospital, Dalian, People's Republic of China
- State Key Laboratory of Structural Analysis, Optimization and CAE Software for Industrial Equipment, Dalian University of Technology, Dalian, People's Republic of China
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Riccio M, Bondioli E, Senesi L, Zingaretti N, Gargiulo P, De Francesco F, Parodi PC, Zavan B. Fragmented Dermo-Epidermal Units (FdeU) as an Emerging Strategy to Improve Wound Healing Process: An In Vitro Evaluation and a Pilot Clinical Study. J Clin Med 2023; 12:6165. [PMID: 37834809 PMCID: PMC10573238 DOI: 10.3390/jcm12196165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Innovative strategies have shown beneficial effects in healing wound management involving, however, a time-consuming and arduous process in clinical contexts. Micro-fragmented skin tissue acts as a slow-released natural scaffold and continuously delivers growth factors, and much other modulatory information, into the microenvironment surrounding damaged wounds by a paracrine function on the resident cells which supports the regenerative process. In this study, in vitro and in vivo investigations were conducted to ascertain improved effectiveness and velocity of the wound healing process with the application of fragmented dermo-epidermal units (FdeU), acquired via a novel medical device (Hy-Tissue® Micrograft Technology). MTT test; LDH test; ELISA for growth factor investigation (IL) IL-2, IL-6, IL-7 IL-8, IL-10; IGF-1; adiponectin; Fibroblast Growth Factor (FGF); Vascular Endothelial Growth Factor (VEGF); and Tumor Necrosis Factor (TNF) were assessed. Therefore, clinical evaluation in 11 patients affected by Chronic Wounds (CW) and treated with FdeU were investigated. Functional outcome was assessed pre-operatory, 2 months after treatment (T0), and 6 months after treatment (T1) using the Wound Bed Score (WBS) and Vancouver Scar Scale (VSS). In this current study, we demonstrate the potential of resident cells to proliferate from the clusters of FdeU seeded in a monolayer that efficiently propagate the chronic wound. Furthermore, in this study we report how the discharge of trophic/reparative proteins are able to mediate the in vitro paracrine function of proliferation, migration, and contraction rate in fibroblasts and keratinocytes. Our investigations recommend FdeU as a favorable tool in wound healing, displaying in vitro growth-promoting potential to enhance current therapeutic mechanisms.
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Affiliation(s)
- Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, University Hospital (AOU Ospedali Riuniti di Ancona), Via Conca 71, Torrette di Ancona, 60123 Ancona, Italy; (M.R.); (L.S.); (F.D.F.)
| | - Elena Bondioli
- Burn Center and Emilia Romagna Regional Skin Bank, Bufalini Hospital, AUSL della Romagna, 47521 Cesena, Italy;
| | - Letizia Senesi
- Department of Reconstructive Surgery and Hand Surgery, University Hospital (AOU Ospedali Riuniti di Ancona), Via Conca 71, Torrette di Ancona, 60123 Ancona, Italy; (M.R.); (L.S.); (F.D.F.)
| | - Nicola Zingaretti
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy; (N.Z.); (P.C.P.)
| | - Paolo Gargiulo
- Engineering Department, King’s College, London WC2R 2LS, UK;
- Institute for Biomedical and Neural Engineering, Reykjavík University, 101 Reykjavík, Iceland
| | - Francesco De Francesco
- Department of Reconstructive Surgery and Hand Surgery, University Hospital (AOU Ospedali Riuniti di Ancona), Via Conca 71, Torrette di Ancona, 60123 Ancona, Italy; (M.R.); (L.S.); (F.D.F.)
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy; (N.Z.); (P.C.P.)
| | - Barbara Zavan
- Department of Translational Medicine, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
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Ciucur E, Boukhenouna H, Guena B, Garrido-Stowhas I, Herlin C, Chaput B. How to Transform a Perforator Propeller Flap into a Keystone Flap in Case of Unsatisfying Perforator Vessel Local Perforator Flap Coverage in Limbs. Arch Plast Surg 2023; 50:194-199. [PMID: 36999145 PMCID: PMC10049830 DOI: 10.1055/s-0042-1744416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/30/2021] [Indexed: 03/30/2023] Open
Abstract
Moderate soft-tissue defects need stable coverage, ideally with tissue of similar characteristics and low donor site morbidity. We propose a simple technique for the coverage of moderate skin defects in the limbs. It allows intraoperative transformation of a propeller perforator flap (PPF) into a keystone design perforator flap (KDPF) in cases of unsatisfying perforator vessel or in cases of unpredictable intraoperative events. Between March 2013 and July 2019, nine patients with moderate soft-tissue defects (mean defect size 4.5 × 7.6 cm) in the limbs (two on the upper limbs and seven on the lower limbs) were covered using this technique. We performed four PPFs and five KDPFs. The mean follow-up was 5 months. There was one complication, partial distal tip necrosis in a PPF located in the leg, which healed by secondary intention within 3 weeks. The donor site was closed directly in all cases. No functional impairments were noted regardless of the perforator flap utilized. This technique enables us to employ flexible surgical strategies and allows us to make adjustments based on the patient's vascular anatomy.
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Affiliation(s)
- Elena Ciucur
- Department of Plastic Reconstructive Surgery and Burns, Lapeyronie University Hospital, Montpellier, France
- Address for correspondence Elena Ciucur, MD Department of Plastic Reconstructive Surgery and Burns, Lapeyronie University Hospital371 Av. du Doyen Gaston Giraud, Montpellier 34090France
| | - Hadj Boukhenouna
- Department of Plastic Reconstructive Surgery and Burns, Lapeyronie University Hospital, Montpellier, France
| | - Benjamin Guena
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - I. Garrido-Stowhas
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - Christian Herlin
- Department of Plastic Reconstructive Surgery and Burns, Lapeyronie University Hospital, Montpellier, France
| | - Benoit Chaput
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Discuss the natural history and pathophysiology of sarcoma. 2. Summarize the most up-to-date multidisciplinary management of soft-tissue sarcoma. 3. Provide a synopsis of reconstructive modalities based on anatomical location. 4. Highlight some novel strategies for treatment of lymphedema and phantom limb pain that are common sequelae following treatment and resection of soft-tissue sarcomas. SUMMARY The management of soft-tissue sarcoma presents unique challenges to the reconstructive surgeon. The optimal management mandates a multidisciplinary approach; however, reconstruction must take into account the extent of the resection and exposed vital structures, but often occurs in the setting of adjuvant treatments including chemotherapy and radiation therapy. Reconstruction is based on the extent of the defect and the location of the primary tumor. As such, an evidence-based, algorithmic approach following the reconstructive ladder is warranted to minimize the risks of complications and maximize success, which varies from head and neck to torso to breast to extremity sarcomas. Aside from reconstruction of the defect, advances in the surgical treatment of lymphedema and neuropathic pain resulting from treatment and extirpation of soft-tissue sarcoma are critical to maintain function and patients' quality of life.
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Affiliation(s)
- David M Aten
- From the Departments of Medical Graphics and Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Edward I Chang
- From the Departments of Medical Graphics and Plastic Surgery, University of Texas M. D. Anderson Cancer Center
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Weinberg M, Heiman AJ, DeSanti R, Lanni MA, Kouwenberg EV, Patel A. Outcomes of the Keystone Island Perforator Flap: A Systematic Review. J Reconstr Microsurg 2022; 38:727-733. [PMID: 35477115 DOI: 10.1055/s-0042-1745744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Keystone Design Perforator Island Flap (KDPIF), first described by Behan in 2003, has been demonstrated as a versatile, safe, and straightforward reconstructive option for various soft tissue defects. The purpose of this systematic review is to evaluate the indications, variations, and overall complication profile of the keystone flap in reconstructive surgery. METHODS A literature review was conducted in accordance with PRISMA guidelines using MeSH term "surgical flaps" with the keyword "keystone flap." Empirical studies with at least 15 patients who underwent keystone flap reconstruction were assessed for quantitative analysis. Outcomes of interest included patient demographics, indications, anatomic location, flap design, and complications. RESULTS Database search produced 135 articles, of which 25 were selected for full-text review. Out of 23 studies selected qualitative analysis and 22 met criteria for quantitative analysis. Overall success rate of this flap was 98%. Wound complications were highest in extremity flaps. Several modifications of this flap were described. CONCLUSION Keystone reconstruction demonstrates excellent success rates and versatility. However, further studies with more standard reporting are needed to determine guidelines for patient specific surgical planning.
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Affiliation(s)
- Maxene Weinberg
- Division of Plastic Surgery, Albany Medical College, Albany, New York
| | - Adee J Heiman
- Division of Plastic Surgery, Albany Medical College, Albany, New York
| | - Rebecca DeSanti
- Division of Plastic Surgery, University of Washington, Seattle, Washington
| | - Michael A Lanni
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Van Kouwenberg
- Division of Plastic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ashit Patel
- Division of Plastic Surgery, Albany Medical College, Albany, New York
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Reconstruction of the Defect at Temporal Hairline by a Scalp Keystone Island Flap: Clinical Experience on 14 Cases. J Craniofac Surg 2022; 33:e515-e519. [PMID: 35119399 DOI: 10.1097/scs.0000000000008500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/11/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The reconstructions of defects at the temporal hairline always require more complicated designs and higher surgical skills to acquire better aesthetic results. By taking advantage of the unique anatomy of the temporal region, the authors designed a scalp keystone island flap pedicled by superficial temporal fascia to repair defects on the temporal hairline. METHODS The authors retrospectively analyzed the clinical data of 14 patients who had lesions adjacent to the temporal hairline between April 2018 and June 2020. Patients were diagnosed with basal cell carcinoma, squamous-cell carcinoma, or seborrheic keratosis. These lesions were resected and reconstructed by scalp keystone island flaps. The defects ranged from 2.0 cm × 1.5 cm to 3.0 cm× 3.5 cm. RESULTS All patients were satisfied with postoperative morphology and reported no recurrence at the 6 to 24 months follow-up. Flaps in two patients were partially necrosed but eventually healed by dressing changes. The rest had the first intention of healing. CONCLUSIONS The scalp keystone island flap is a very useful method to repair small or medium defects at the temporal hairline. This flap can be flexibly designed and easily performed with a high survival rate and good aesthetic results. It provides another surgical option for complicated reconstruction.
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Lo Torto F, Frattaroli JM, Kaciulyte J, Mori FLR, Troisi L, Ciudad P, Manrique OJ, Marcasciano M, Pajardi GE, Casella D, Cigna E, Ribuffo D. The Keystone Flap: A Multi-centric Experience in Elderly Patients Treatment. J Plast Reconstr Aesthet Surg 2021; 75:226-239. [PMID: 34642063 DOI: 10.1016/j.bjps.2021.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/03/2021] [Accepted: 08/26/2021] [Indexed: 12/19/2022]
Abstract
Soft tissue reconstruction in elderly patients must be rapid and reliable. The keystone island flap (KF) offers an effective solution, with low complication rates and quick recovery. This multi-centric study aims to show authors' experience with KFs in treating soft tissue defects of trunk and limbs. Patients with soft tissue defects suitable for KF reconstruction were recruited from March 2019 to December 2019. Active inflammation and previous surgeries in the same region were considered exclusion criteria. Complications that occurred during follow-up were recorded, and their incidence pattern was assessed with the Fisher test. Seventy-two patients with mean age of 76.2 years old were selected. They presented lesions in torso (46; 63.9%) or in upper (4; 5.6%) or lower (22; 30.6%) limb regions. Fifteen (20.8%) wounds were non-oncologic lesions, and the others were oncologic lesions, mostly non-melanoma skin cancers. KF type I was carried out in 42 (58.3%) cases, KF type II-A in 13 (18%) cases, double opposed type III KF in 16 (22.2%) patients, and 1 (1.4%) case required partial flap's undermining (IV KF). Mean post-operative recovery period was 4.3 days (range, 1-9 days). Post-surgical complications occurred in 15 (20.8%) cases, 7 (9.7%) of them were considered major complications. No statistically significant difference in complications' incidence, nor among different surgical sites nor among KF types, was registered. Reconstructive surgeons have to adapt their work to elderly patients. The KF allows rapid operative times, low morbidity rates, and short post-operative recovery time, thus appearing as a feasible solution.
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Affiliation(s)
- Federico Lo Torto
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy.
| | - Jacopo M Frattaroli
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
| | - Juste Kaciulyte
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
| | - Francesco L R Mori
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
| | - Luigi Troisi
- University Department of Hand Surgery and Rehabilitation - San Giuseppe Hospital - IRCCS MultiMedica Group, Milano, Italy
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, United States
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, "Breast Unit" Integrata di Livorno Cecina, Piombino Elba, Azienda USL Toscana Nord Ovest, Livorno, Italy
| | - Giorgio E Pajardi
- University Department of Hand Surgery and Rehabilitation - San Giuseppe Hospital - IRCCS MultiMedica Group, Milano, Italy
| | - Donato Casella
- Azienda Ospedaliera Universitaria Senese, UOC Chirurgia Oncologica della Mammella, Siena, Italy
| | - Emanuele Cigna
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Diego Ribuffo
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
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Use of Keystone Flaps in Consideration of the Facial Aesthetic Subunit Concept as an Alternative Reconstructive Option for Nasal Defect Coverage. J Craniofac Surg 2021; 32:1864-1869. [PMID: 33351545 DOI: 10.1097/scs.0000000000007359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Nasal defect coverage has some challenging aspects for plastic surgeons because of the midfacial location of the nose and the relationship between convexities and concavities of nasal subunits. The authors described our experience with performing keystone flap (KF) nasal reconstruction in accordance with the facial aesthetic subunit concept and demonstrated the expanding versatility of KFs in nasal reconstruction. Between January 2017 and February 2020, 15 patients (average age, 72.07 ± 13.00 years, range: 38-88 years) underwent KF reconstruction for nasal defects. We performed KF reconstruction in accordance with the facial aesthetic subunit concept. Data, including the defect causes and locations, defect sizes, flap sites and sizes, types of KFs, flap survival, complications, and follow-up period for each patient were reviewed retrospectively. Cosmetic outcomes were evaluated by independent plastic surgeons and patients through satisfactory postoperative surveys. Sixteen defects occurred in 15 patients. The defect sizes ranged from 0.8 × 1 cm to 2.5 × 3 cm. The flap sizes ranged from 1.5 × 3.5 cm to 4 × 6 cm. All defects were successfully covered with KFs from adjacent subunits. All flaps survived without any postoperative complications. At the mean follow-up period of 8.33 ± 2.92 months, the objective cosmetic outcomes were rated favorably, and the average subjective patient satisfaction score was 7.93 ± 1.28 on a scale of 1 to 10. We suggest that using KF reconstruction in consideration of the facial aesthetic subunit concept can be a promising alternative modality for covering nasal defects with outstanding aesthetic outcomes.
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Keystone Flaps for Coverage of Defects in the Posterior Neck and Lower Occipital Scalp: A Retrospective Clinical Study. J Craniofac Surg 2021; 32:1813-1816. [PMID: 33654029 DOI: 10.1097/scs.0000000000007581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The coverage of the posterior neck and lower occipital scalp defects should be approached carefully. Thick, stiff, and inelastic skin properties of these areas tend to make coverage of even small defects difficult. Herein, the authors present a retrospective review of our experience with posterior neck and lower occipital scalp reconstruction using the keystone flap (KF) and describe the expanding versatility of KF reconstruction. The medical records of 17 patients who underwent KF reconstruction to cover the posterior neck and lower occipital defect from April 2017 to May 2020 were reviewed. Clinical and operative data were collected. All defects were successfully covered with the KFs. The defect sizes ranged from 2.5 × 3.5 cm to 6 × 11 cm, and the flap sizes ranged from 3 × 5.5 cm to 9 × 18 cm. All flaps fully survived, although marginal maceration developed in one case; however, it healed with conservative management. The final results were favorable, and all patients were satisfied with their final outcomes. Consequently, the KF can be considered as a good reconstruction modality with few complications and provides an alternative to other reconstructive options for coverage of the posterior neck and lower occipital defects.
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12
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Wu Q, Shao Z, Li Y, Rai S, Cui M, Yang Y, Wang B. A novel skin-stretching device for closing large skin-soft tissue defects after soft tissue sarcoma resection. World J Surg Oncol 2020; 18:247. [PMID: 32943050 PMCID: PMC7499963 DOI: 10.1186/s12957-020-02022-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/08/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Closure of large skin-soft tissue defects following soft tissue sarcoma (STS) resection has been a great challenge. The objective of this study was to evaluate the effectiveness of a novel, simple, and cheap skin-stretching device (bidirectional regulation-hook skin closure system, BHS) for closing large skin-soft tissue defects resulting from the removal of STS and the complications associated with the use of the BHS. METHODS From January 2017 to September 2018, 25 patients with STS underwent BHS therapy after tumor resection. BHS was used for two main clinical applications: securing wound closure after high-tension suture closure and delayed wound closure. We described a detailed reconstruction procedure regarding this therapy. Wound closure and complications associated with BHS therapy were recorded. We also analyzed tumor recurrence and metastases. RESULTS All patients were observed for 16-36 months with an average follow-up of 25.6 months. During the follow-up period, no significant functional restriction was observed and the final scar was aesthetically acceptable. Superficial wound infection occurred in six patients, wound edge ischemia in two patients, and small skin tears in two patients. Two patients developed pulmonary metastasis, two patients had a local recurrence, and one patient died of pulmonary metastasis. CONCLUSIONS BHS therapy can effectively close large skin-soft tissue defects following STS resection and obtain acceptable functional results, without severe complications. However, larger studies are required to further evaluate the effectiveness, indications, and complications of BHS therapy.
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Affiliation(s)
- Qiang Wu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zengwu Shao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yubin Li
- Department of Orthopedics, Linqing City people's Hospital, Linqing, 252600, Shandong, China
| | - Saroj Rai
- National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Min Cui
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ying Yang
- Department of Operation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Baichuan Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Huayllani MT, Sarabia-Estrada R, Restrepo DJ, Boczar D, Sisti A, Nguyen JH, Rinker BD, Moran SL, Quiñones-Hinojosa A, Forte AJ. Adipose-derived stem cells in wound healing of full-thickness skin defects: a review of the literature . J Plast Surg Hand Surg 2020; 54:263-279. [PMID: 32427016 DOI: 10.1080/2000656x.2020.1767116] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The complex process of wound healing can be delayed in circumstances when the natural niche is extremely altered. Adipose-derived stem cells (ADSC) seem to be a promising therapy for these type of wounds. We aim to describe the studies that used ADSC for wound healing after a full-thickness skin defect, the ADSC mechanisms of action, and the outcomes of the different ADSC therapies applied to date. We performed a review by querying PubMed database for studies that evaluated the use of ADSC for wound healing. The Mesh terms, adipose stem cells AND (skin injury OR wound healing) and synonyms were used for the search. Our search recorded 312 articles. A total of 30 articles met the inclusion criteria. All were experimental in nature. ADSC was applied directly (5 [16.7%]), in sheets (2 [6.7%]), scaffolds (14 [46.7%]), skin grafts (3 [10%]), skin flaps (1 [3.3%]), as microvesicles or exosomes (4 [13.3%]), with adhesives for wound closure (1 [3.3%]), and in a concentrated conditioned hypoxia-preconditioned medium (1 [3.3%]). Most of the studies reported a benefit of ADSC and improvement of wound healing with all types of ADSC therapy. ADSC applied along with extracellular matrix, stromal cell-derived factor (SDF-1) or keratinocytes, or ADSC seeded in scaffolds showed better outcomes in wound healing than ADSC alone. ADSC have shown to promote angiogenesis, fibroblast migration, and up-regulation of macrophages chemotaxis to enhance the wound healing process. Further studies should be conducted to assure the efficacy and safety of the different ADSC therapies.
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Affiliation(s)
| | | | | | - Daniel Boczar
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Andrea Sisti
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Justin H Nguyen
- Department of Transplantation Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Brian D Rinker
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Steven L Moran
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
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Jovic TH, Dobbs TD, Jessop ZM, Whitaker IS. Keystone island flaps for reconstruction following lower leg skin cancer resection: A comparison with split-thickness skin grafts. J Plast Reconstr Aesthet Surg 2019; 72:1856-1871. [PMID: 31300219 DOI: 10.1016/j.bjps.2019.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas H Jovic
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences 2, Swansea University, SA2 8QA, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
| | - Thomas D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences 2, Swansea University, SA2 8QA, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Zita M Jessop
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences 2, Swansea University, SA2 8QA, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences 2, Swansea University, SA2 8QA, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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