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Yanagishita S, Otani N, Seike S, Tomita K, Kubo T. Reconstruction of a Spinal Accessory Nerve Defect Using Vascularized Vastus Lateralis Motor Nerve Graft. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5174. [PMID: 37621917 PMCID: PMC10445781 DOI: 10.1097/gox.0000000000005174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/23/2023] [Indexed: 08/26/2023]
Abstract
Massive resection of a malignant tumor of the head and neck region often requires loss of critical nerves, including the spinal accessory nerve. Recently, vascularized nerve grafts (VNGs) have been used to repair facial and other nerve defects with successful outcomes, even in cases involving factors that can inhibit nerve regeneration, such as radiotherapy. However, the effectiveness of these nerve grafts against postoperative radiotherapy has yet to be explored. We report the first successful case in reconstructing a spinal accessory nerve defect after total left parotidectomy with radical neck dissection, using a vascularized vastus lateralis motor nerve graft and an anterolateral thigh flap based on the lateral circumflex femoral system, with great shoulder function outcomes even after postoperative radiotherapy. A branch of vastus lateralis motor nerve perfused by the accompanying descending branch of lateral femoral circumflex vessel was used as a nerve graft, and was repaired in an end-to-end manner. The patient underwent postoperative radiotherapy to the area of operation. At 6-months follow-up, the patient was capable of 90 degrees lateral shoulder abduction, and at 18 months, achieved full-range shoulder abduction and reported neither functional limitations of the shoulder nor complaints of any shoulder pain (Disabilities of Arm, Shoulder, and Hand score 0). Although further study is necessary to fully understand the superiority of VNGs over postoperative radiotherapy, immediate nerve reconstruction using VNG for accessory nerve defects in patients scheduled for radiotherapy postoperation may be extremely beneficial for preserving shoulder motor function and sustaining the patient's quality of life.
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Affiliation(s)
- Shiori Yanagishita
- From the Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Plastic and Reconstructive Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Naoya Otani
- From the Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shien Seike
- From the Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Tomita
- From the Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Plastic and Reconstructive Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tateki Kubo
- From the Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Hopeless Neuroma-The Neurotized Free Flap Tissue Augmentation as Salvage Therapy-A Concept and Clinical Demonstration. J Pers Med 2023; 13:jpm13020313. [PMID: 36836547 PMCID: PMC9966363 DOI: 10.3390/jpm13020313] [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] [Received: 12/06/2022] [Revised: 01/28/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Therapy-resistant neuroma pain is a devastating condition for patients and surgeons. Although various methods are described to surgically deal with neuromas, some discontinuity and stump neuroma therapies have anatomical limitations. It is widely known that a neurotizable target for axon ingrowth is beneficial for dealing with neuromas. The nerve needs "something to do". Furthermore, sufficient soft tissue coverage plays a major role in sufficient neuroma therapy. We aimed, therefore, to demonstrate our approach for therapy of resistant neuromas with insufficient tissue coverage using free flaps, which are sensory neurotized via anatomical constant branches. The central idea is to provide a new target, a new "to do" for the painful mislead axons, as well as an augmentation of deficient soft tissues. As indication is key, we furthermore demonstrate clinical cases and common neurotizable workhorse flaps.
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Abstract
OBJECTIVE Meralgia paresthetica is a common condition that is usually diagnosed by its classical clinical presentation and by exclusion of a spinal origin of pain, sensory loss, and/or paresthesias in the anterolateral thigh. Treatment modalities include conservative management, local injections, and surgical therapy. To date, no level 1 evidence exists about treatment options for idiopathic meralgia paresthetica. This review article aims to give a structured overview of epidemiology, history, anatomy, diagnostics, and treatment. It focuses on the existing literature and current developments in clinical management. METHODS A literature search on PubMed/MEDLINE was performed on 20 December 2021, yielding 1412 results. Abstracts were screened and classified in terms of epidemiology, anatomy, diagnostics, and treatment. RESULTS High-quality observational data that was included in recent meta-analyses showed satisfactory results for conservative management, injections, and surgical decompression or neurectomy, but there is some major methodological criticism. For idiopathic meralgia paresthetica, the results of surgical decompression have never been compared to those of neurectomy in a randomized setup. The only study protocol published so far does not consider any extended decompression techniques (dynamic, circumferent, proximal, and distal to the inguinal ligament). A multicenter, prospective design has never been proposed. DISCUSSION Reliable high-quality evidence on the treatment of idiopathic meralgia paresthetica is lacking at the current state, and challenges in clinical decision-making remain.
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Affiliation(s)
- Nora F. Dengler
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Dong R, Tian S, Bai J, Yu K, Liu C, Liu L, Tian D. Electrospun Polycaprolactone (PCL)-Amnion Nanofibrous Membrane Promotes Nerve Repair after Neurolysis. J Biomater Appl 2022; 36:1390-1399. [PMID: 34995155 DOI: 10.1177/08853282211060598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripheral nerve adhesion after neurolysis leads to nerve dysfunction, limiting nerve regeneration and functional recovery. We previously developed an electrospun polycaprolactone (PCL)-amnion nanofibrous membrane for preventing adhesion formation. In this study, we investigated the effect of protective nerve wrapping and promoting nerve regeneration in a rat sciatic nerve compression model. A total of 96 SD rats after sciatic nerve chronic compression were randomly divided into three groups: the PCL-amniotic group, in which nerves were wrapped with a PCL-amniotic membrane for treatment; the chitosan group, in which nerves were wrapped with a clinically used chitosan hydrogel; the control group, which involved neurolysis alone without treatment. Twelve weeks postoperatively, the nerve regeneration was evaluated by general and ultrastructure observation, as well as the expressions of neuronal regeneration and inflammatory reaction biomarkers. The nerve functions were assessed with gastrocnemius muscle measurement, hot-plate test, and walking track analysis. Compared with the chitosan hydrogel, the PCL-amnion nanofibrous membrane significantly reduced peripheral nerve adhesion and promoted nerve regeneration. The morphological properties of axons in the nerve wrap group were preserved. Intraneural macrophage invasion, as assessed by the number of CD68-positive cells, was less severe in the PCL-amnion group than in the other groups. Additionally, the gastrocnemius muscle weight and muscle bundle area were significantly higher in the PCL-amnion group than those in the chitosan group. The abilities of sense and movement of the rats in the PCL-amnion group were significantly improved compared to the other groups. In summary, electrospun PCL-amnion nanofibrous membranes effectively prevented post-neurolysis peripheral nerves from developing adhesion, whereas promoted nerve repair and regeneration, which make PCL-amnion nanofibrous membranes a promising biomaterial for clinical application.
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Affiliation(s)
- Ruiyi Dong
- Department of Hand Surgery, 74725The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Orthopedics, 159363Cangzhou Hospital of Integrated TCM-WM Hebei, Cangzhou, Hebei, China
| | - Siyu Tian
- Department of Hand Surgery, 74725The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiangbo Bai
- Department of Hand Surgery, 74725The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kunlun Yu
- Department of Hand Surgery, 74725The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chunjie Liu
- Department of Orthopedics, Tangshan Workers Hospital, Tangshan, Hebei, China
| | - Lei Liu
- Department of Orthopedics, Changping District Hospital, Beijing, China
| | - Dehu Tian
- Department of Hand Surgery, 74725The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Subdermal Dissection for Elevation of Pure Skin Perforator Flaps and Superthin Flaps: The Dermis as a Landmark for the Most Superficial Dissection Plane. Plast Reconstr Surg 2021; 147:470-478. [PMID: 33620945 DOI: 10.1097/prs.0000000000007689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pure skin perforator and superthin flaps have been reported and are becoming popular, as they allow one-stage thin skin reconstruction even from a thick donor site. However, currently reported elevation procedures use proximal-to-distal dissection requiring free-style perforator selection and primary thinning procedures. With distal-to-proximal dissection using the dermis as a landmark for dissection plane, it is expected that elevation of pure skin perforator or superthin flaps can be simplified. METHODS Patients who underwent pure skin perforator or superthin flap transfers with the subdermal dissection technique were included. Flaps were designed based on location of pure skin perforators visualized on color Doppler ultrasound, and elevated just below the dermis under an operating microscope. Medical charts were reviewed to obtain clinical and intraoperative findings. Characteristics of the patients, flaps, and postoperative courses were evaluated. RESULTS Thirty-six flaps were transferred in 34 patients, all of which were elevated as true perforator flaps (superficial circumflex iliac artery perforator flap in 29 cases, other perforator flaps in seven cases). Mean ± SD flap thickness was 2.24 ± 0.77 mm (range, 1.0 to 4.0 mm). Skin flap size ranged from 3.5 × 2 cm to 27 × 8 cm. Time for flap elevation was 27.4 ± 11.6 minutes. All flaps survived without flap atrophy/contracture 6 months after surgery, except for two cases of partial necrosis. CONCLUSION The subdermal elevation technique allows straightforward and direct elevation of a pure skin perforator or superthin flap within 30 minutes on average without the necessity of primary thinning. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Miyazaki T, Tsukuura R, Yamamoto T, Daniel BW. Nerve vascularity in free vascularized nerve flaps. Glob Health Med 2020; 2:263-264. [PMID: 33330818 DOI: 10.35772/ghm.2020.01027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 11/08/2022]
Abstract
The blood supply of peripheral nerves consists of a complex internal vessels' network, feeding external vessels and the interlinking vasa nervorum. Patients with nerve damage may require nerve substitution. While the commonly performed avascular nerve grafts obtain vascularization only from random and slow inosculation into the vasa nervorum, their insufficient revascularization causes loss of the graft's potential due to central necrosis. This gets more relevant with the larger diameter of nerves injured. Examples for neurovascular flaps are the lateral femoral cutaneous nerve vascularized via the superficial circumflex iliac artery perforator (LFCN-SCIP) flap or the iliohypogastric nerve graft vascularized via the superficial inferior epigastric artery (SIEA). LFCN-SCIP shows a well concealed donor scar site with a maintained vascularization and a minor donor site morbidity. Therefore, the guaranteed axial nerve vascularity in LFCN-SCIP makes it a preferred autologous vascularized nerve therapy for peripheral nerve defects. A further option example is the anterior lateral thigh (ALT) flap with the LFCN.
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Affiliation(s)
- Toko Miyazaki
- Department of Medical Education, National Center for Global Health and Medicine, Tokyo, Japan
| | - Reiko Tsukuura
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Bassem W Daniel
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
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Kim S, Lee KT. Abdominal wall reconstruction using anterolateral thigh flap with microsurgical pedicle lengthening technique: A case report. Microsurgery 2020; 40:700-703. [PMID: 32716524 DOI: 10.1002/micr.30626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/26/2020] [Accepted: 06/19/2020] [Indexed: 11/05/2022]
Abstract
Pedicled anterolateral thigh (ALT) flap has been employed for coverage of low abdominal wall defects. However, its use is limited for defects located more on the cranial side because of insufficient pedicle length. We present a case of successful reconstruction of mid-abdominal wall defect using pedicled ALT flap, overcoming the issue of pedicle length shortage with a microsurgical pedicle lengthening technique. A 75-year-old man suffered from a 12 × 8 cm full-thickness soft tissue defect on his mid-abdominal wall originated from colon anastomosis site leakage after ileostomy takedown surgery. A pedicled ALT flap was planned for the defect coverage. After we performed debridement to prepare the wound bed, a 14 × 8.5 cm sized ALT flap based on two lateral circumflex femoral artery (LCFA) perforators was elevated. During intramuscular dissection of perforators, we dissected the distal portion of the LCFA descending branch. After full dissection of the pedicle to source vessels, we attempted to transfer the flap, but still the flap had short pedicle. We transected the pedicle just distal to the bifurcating point and reconnected it to the distal end of the dissected descending LCFA branch with microsurgical anastomosis. We passed the flap through a subcutaneous tunnel and conducted smooth flap insetting without any tension on the lengthened pedicle. Postoperatively, the wound healed successfully without complications. The patient was discharged 2 weeks after surgery and followed up at postoperative 3 months without adverse events. A local ALT flap with pedicle lengthened might be a reliable option for reconstruction of supraumbilical abdominal defects.
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Affiliation(s)
- Suhwan Kim
- Department of Plastic Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Yamamoto T, Yamamoto N, Kageyama T, Sakai H, Fuse Y, Tsuihiji K, Tsukuura R. Supermicrosurgery for oncologic reconstructions. Glob Health Med 2020; 2:18-23. [PMID: 33330769 DOI: 10.35772/ghm.2019.01019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 11/08/2022]
Abstract
With advancement of microsurgical techniques, supermicrosurgery has been developed. Supermicrosurgery allows manipulation (dissection and anastomosis) of vessels and nerves with an external diameter of 0.5 mm or smaller. Because quality of life of cancer survivors is becoming a major issue, less invasive and functionally-better oncological reconstruction using supermicrosurgical techniques attracts attention. Conventional free flap reconstruction usually sacrifices major vessels and muscle functions, whereas supermicrosurgical free flaps can be transferred from anywhere using innominate vessels without sacrifice of major vessel/muscle. Since a 0.1-0.5 mm vessel can be anastomosed, patient-oriented least invasive reconstruction can be accomplished with supermicrosurgery. Another important technique is lymphatic anastomosis. Only with supermicrosurgery, lymph vessels can be securely anastomosed, because lymph vessel diameter is usually smaller than 0.5 mm. With clinical application of lymphatic supermicrosurgery, various least invasive lymphatic reconstruction has become possible. Lymphatic reconstruction plays an important role in prevention and treatment of lymphatic diseases following oncologic surgery such as lymphedema, lymphorrhea, and lymphocyst. With supermicrosurgery, various tissues such as skin/fat, fascia, bone, tendon, ligament, muscle, and nerves can be used in combination to reconstruct complicated defects; including 3-dimensional inset with multi-component tissue transfer.
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Affiliation(s)
- Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nana Yamamoto
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takashi Kageyama
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hayahito Sakai
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuma Fuse
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kanako Tsuihiji
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Reiko Tsukuura
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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Uemura T, Takamatsu K, Okada M, Yokoi T, Onode E, Miyashima Y, Konishi S, Nakamura H. A case series of seven patients with recurrent median nerve neuropathy treated by the revision surgery of median nerve neurolysis and wrapping with radial artery perforator adipose flap. J Plast Reconstr Aesthet Surg 2019; 73:453-459. [PMID: 31757685 DOI: 10.1016/j.bjps.2019.09.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/09/2019] [Accepted: 09/28/2019] [Indexed: 11/19/2022]
Abstract
Adhesion neuropathy of the median nerve with persistent pain can be a challenging problem. Currently, coverage of the median nerve with a well-vascularized soft tissue is deemed necessary after secondary neurolysis. Herein, we reviewed the outcomes of seven patients with a persistent median nerve neuropathy after a primary open carpal tunnel release or a median nerve repair, treated with neurolysis and median nerve wrapping with radial artery perforator adipose flaps. During the revision surgery, after a careful and complete neurolysis of the scarred median nerve, the distally based radial artery perforator adipose flap without its fascia was raised and rotated to wrap the median nerve. The mean size of the perforator flap was 1146 mm2, which was enough to wrap the median nerve in all patients. At 26 months postsurgery, both the visual analog scale score for pain with tingling, and the patient-reported outcome measures improved. There was no recurrence of the median nerve adhesion neuropathy and no major complications were noted. Tinel's sign at the palmar wrist completely disappeared in four patients and was relieved in three patients. The median distal motor latency becomes recordable, and closer to a normal compound motor action potential postoperatively in all patients. Secondary neurolysis and median nerve wrapping with a radial artery perforator adipose flap, which was modified to be softer and thinner than the radial artery perforator adipofascial flap, was a successful treatment for the recurrent median nerve neuropathy in terms of both pain relief and restoration of the hand function.
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Affiliation(s)
- Takuya Uemura
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzakicho, Abeno-ku, Osaka 545-0053, Japan; Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
| | - Kiyohito Takamatsu
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan
| | - Mitsuhiro Okada
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Takuya Yokoi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Ema Onode
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Yusuke Miyashima
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzakicho, Abeno-ku, Osaka 545-0053, Japan
| | - Sadahiko Konishi
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzakicho, Abeno-ku, Osaka 545-0053, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan
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Choi J, Kim DS, Kim J, Jeong W, Lee HW, Park SW, Kim J. Better nerve regeneration with distally based fascicular turnover flap than with conventional autologous nerve graft in a rat sciatic nerve defect model. J Plast Reconstr Aesthet Surg 2019; 73:214-221. [PMID: 31690543 DOI: 10.1016/j.bjps.2019.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/17/2019] [Accepted: 09/25/2019] [Indexed: 11/17/2022]
Abstract
The authors hypothesize that a fascicular turnover flap will achieve better nerve regeneration in nerve gap repair than a conventional nerve graft in a rat sciatic nerve defect model. Seven-millimeter-long sciatic nerve defects were repaired with an autologous nerve graft, a proximal fascicular turnover flap, or a distal fascicular turnover flap. Following walking footprint analysis 8 weeks after the surgery, the gastrocnemius-soleus muscles of the hind limbs, nerve graft, and flaps were harvested for wet muscle weight assessment, immunohistochemistry, and transmission electron microscopy. The distal fascicular turnover flap exhibited improvement in the sciatic function index similar as that observed for the autologous nerve graft. Histologically, cross sections showed a higher staining intensity for S-100 in the distal fascicular turnover flap group than for S-100 in the nerve graft group (p = 0.01). In the longitudinal sections, the staining intensity for NF-200 was higher in the distal fascicular turnover flap group than in the nerve graft (p = 0.009) and proximal fascicular turnover flap (p = 0.004) groups. More mature capillaries were observed in the proximal (p < 0.001) and distal (p = 0.029) fascicular turnover flap groups than in the nerve graft group. Transmission electron microscopy results showed a compact, regular myelin sheath around the myelinated nerve fibers in the distal fascicular turnover flap group, unlike observations in the nerve graft and proximal fascicular turnover flap groups. This study demonstrates better nerve regeneration in nerve gap repair with the distal fascicular turnover flap than with the conventional nerve graft.
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Affiliation(s)
- Jaehoon Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Institute for Medical Science, Keimyung University, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Dong Seok Kim
- Department of Plastic and Reconstructive Surgery, School of Medicine, Institute for Medical Science, Keimyung University, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Jinhan Kim
- BL Plastic Surgery, Daegu, Republic of Korea
| | - Woonhyeok Jeong
- Department of Plastic and Reconstructive Surgery, School of Medicine, Institute for Medical Science, Keimyung University, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Hyoun Wook Lee
- Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Sang Woo Park
- Department of Plastic and Reconstructive Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Junhyung Kim
- Department of Plastic and Reconstructive Surgery, School of Medicine, Institute for Medical Science, Keimyung University, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea.
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Uehara M, Wei Min W, Satoh M, Shimizu F. Fascicular turnover flap in the reconstruction of facial nerve defects: an experimental study in rats. J Plast Surg Hand Surg 2019; 53:155-160. [DOI: 10.1080/2000656x.2018.1562458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Miyuki Uehara
- Department of Plastic Surgery, Oita University Hospital, Oita, Japan
| | - Wu Wei Min
- Department of Plastic Surgery, Oita University Hospital, Oita, Japan
| | - Moriaki Satoh
- Department of Plastic Surgery, Oita University Hospital, Oita, Japan
| | - Fumiaki Shimizu
- Department of Plastic Surgery, Oita University Hospital, Oita, Japan
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Irifune H, Takahashi N, Hirayama S, Narimatsu E, Yamashita T. Treatment of Hand Allodynia Resulting from Wrist Cutting with Radial and Ulnar Artery Perforator Adipofascial Flaps. J Hand Surg Asian Pac Vol 2018; 23:116-120. [PMID: 29409421 DOI: 10.1142/s2424835518720025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this article, we report two cases in which recurrent adhesive hand neuropathy with allodynia were successfully treated with radial and ulnar artery adipofascial perforator flap coverage. Treatment of recurrent neuropathy, such as recurrent carpal tunnel syndrome and re-adhesion after neurolysis using free and pedicle flaps to cover the nerves, has been reported to show good results. However, for severe painful nerve disorders, such as complex regional pain syndrome, the efficacy of this treatment was unclear. We present two cases diagnosed with recurrent adhesive hand neuropathy with allodynia, resulting from wrist cutting; these cases were treated with neurolysis and flap coverage with good results and no recurrence. This suggests that neurolysis and flap coverage are effective methods for treating complex regional pain syndrome.
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Affiliation(s)
- Hideto Irifune
- * Departments of Emergency Medicine, Sapporo Medical University, Sapporo, Japan.,† Departments of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Nobuyuki Takahashi
- * Departments of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Suguru Hirayama
- * Departments of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Eichi Narimatsu
- * Departments of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Toshihiko Yamashita
- † Departments of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
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Zuo L, Yu J, Zhou X, Dai J, Tian H, Shan Z, Hu J, Chen X, Wang H, Cai X, Gao S. [Application of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:346-349. [PMID: 29806286 DOI: 10.7507/1002-1892.201711046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection. Methods Between December 2012 and December 2016,18 patients with large scalp defect after malignant tumor resection were treated. There were 16 males and 2 females with an average age of 52.6 years (range, 43-62 years). There were 17 cases of squamous carcinoma and 1 case of dermatofibrilsarcoma protuberan. The size of scalp defect ranged from 15 cm×10 cm to 17 cm×12 cm after resection of tumors. The scalp defects were repaired with the free anterolateral thigh Kiss flap. And the size of flap ranged from 15 cm×6 cm to 20 cm×8 cm. The skull was completely resected in 2 cases, and repaired with Titanium mesh. The sizes of skull defects were 12 cm×10 cm and 10 cm×8 cm. The donor site was sutured directly. Results Eighteen flaps survived with primary healing of wounds; and healing by first intention was obtained at the donor sites. One patient died because of intracranial metastasis at 5 months after operation, and no local recurrence occurred in the other 17 patients. The follow-up time ranged from 6 months to 4 years (mean, 26.6 months). The results of both appearance and function were satisfactory, without ulceration during follow-up. No obvious scar was found at donor sites and no obvious impairment was observed after harvesting free anterolateral thigh flap. Conclusion Large scalp defects after malignant tumor resection can be effectively repaired by free anterolateral thigh Kiss flap. The donor site can be sutured directly, without skin grafting, thus avoiding the secondary donor site.
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Affiliation(s)
- Liang Zuo
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China
| | - Jianjun Yu
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013,
| | - Xiao Zhou
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China
| | - Jie Dai
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China
| | - Hao Tian
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China
| | - Zhenfeng Shan
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China
| | - Jie Hu
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China
| | - Xing Chen
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China
| | - Honghan Wang
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China
| | - Xu Cai
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China
| | - Shuichao Gao
- The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R.China
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14
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Lemke A, Ferguson J, Gross K, Penzenstadler C, Bradl M, Mayer RL, Gerner C, Redl H, Wolbank S. Transplantation of human amnion prevents recurring adhesions and ameliorates fibrosis in a rat model of sciatic nerve scarring. Acta Biomater 2018; 66:335-349. [PMID: 29191510 DOI: 10.1016/j.actbio.2017.11.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 12/12/2022]
Abstract
Peripheral nerve fibrosis and painful adhesions are common, recurring pathological sequelae following injury. In this study, vital human amnion (hAM), an increasingly interesting biomaterial for regenerative medicine, was investigated as a novel therapy. hAM was first analyzed in vitro regarding its anti-adhesive characteristics. Then, the reflected region of hAM which was identified as more suitable, was transplanted into female Sprague Dawley rats with recurring sciatic nerve scarring (n = 24) and compared with untreated controls (n = 30) at one, four and twelve weeks. Immune response and fibrosis were investigated by (immuno)histochemical analysis. Nerve structure was examined and function determined using electrophysiology and gait analysis. Here we identified strongly reduced adhesions in the hAM-treated rats, displaying a significant difference at four weeks post transplantation compared to untreated controls (p = .0052). This correlated with the in vitro cell attachment test on hAM explants, which demonstrated a distinctly limited ability of fibroblasts to adhere to amniotic epithelial cells. Upon hAM transplantation, significantly less intraneural fibrosis was identified at the later time points. Moreover, hAM-treated rats exhibited a significantly higher sciatic functional index (SFI) after four weeks compared to controls (p < .05), which indicated a potentially pro-regenerative effect of hAM. As a possible explanation, an impact of hAM on the endogenous immune response, including T cell and macrophage subsets, was indicated. We conclude that hAM is strongly effective against recurring nerve scarring and induces an anti-fibrotic and pro-regenerative effect, making it highly promising for treating adhesion-related disorders. STATEMENT OF SIGNIFICANCE Abnormal fibrotic bonding of tissues, frequently involving peripheral nerves, affects millions of people worldwide. These so-called adhesions usually cause severe pain and drastically reduce quality of life. To date, no adequate treatment exists and none is routinely used in the clinical practice. In this study, vital human amnion, the innermost of the fetal membranes, was transplanted in a rat model of peripheral nerve scarring and recurring adhesions as novel therapeutic approach. Amniotic cells have already demonstrated to feature stem-cell like properties and produce pro-regenerative factors, which makes the amnion an increasingly promising biomaterial for regenerative medicine. We identified that its transplantation was very effective against peripheral nerve scarring and distinctly reduced recurring adhesions. Moreover, we identified a pro-regenerative effect. This study showed that the amnion is a highly promising novel therapeutic approach for adhesion-related disorders.
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Affiliation(s)
- Angela Lemke
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Austria.
| | - James Ferguson
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Austria
| | - Kelly Gross
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, 1200 Vienna, Austria
| | - Carina Penzenstadler
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, 1200 Vienna, Austria
| | - Monika Bradl
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Spitalgasse 4, 1090 Vienna, Austria
| | - Rupert Laurenz Mayer
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090 Vienna, Austria
| | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090 Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Austria
| | - Susanne Wolbank
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, 1200 Vienna, Austria; Austrian Cluster for Tissue Regeneration, Austria
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15
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Karakawa R, Narushima M, Ogishima S, Hara H, Karino S, Iida T, Kakigi A, Koshima I. Free anterolateral thigh full-thickness skin flap with vascularized lateral femoral cutaneous nerve for the reconstruction of facial nerve and external auditory canal after the resection of facial nerve schwannoma. SAGE Open Med Case Rep 2017; 5:2050313X17741825. [PMID: 29201373 PMCID: PMC5697583 DOI: 10.1177/2050313x17741825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022] Open
Abstract
The complex reconstruction of nerves and soft tissue in the head and neck region is still challenging, especially in cases requiring external auditory canal reconstruction with facial nerve reconstruction. We report a case of left facial schwannoma extending into the external auditory canal beyond the tympanic membrane with facial paralysis in which the reconstruction of both the facial nerve and external auditory canal was successfully performed using an anterolateral thigh flap as a super-thin full-thickness skin flap, including vascularized lateral femoral cutaneous nerve. Resection of 20 mm × 46 mm facial schwannoma, including the skin of the external auditory canal, tympanic membrane, incus and malleus, was performed. The 8-cm nerve gap was repaired using a vascularized lateral femoral cutaneous nerve included in the anterolateral thigh flap. An 8 cm × 2 cm super-thin, free anterolateral thigh flap was then rolled up as a sac (diameter of 2 cm, height of 2 cm) and inset to the external auditory canal defect. The postoperative course was uneventful, and the flap survived completely. One year and nine months after the surgery, the patient’s facial movement has improved to the pre-surgery level.
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Affiliation(s)
- Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, The Mie University, Mie, Japan
| | - Shinya Ogishima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - Hisako Hara
- Department of Lymphatic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Shotaro Karino
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - Akinobu Kakigi
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
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16
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Comparison of Lymphovenous Shunt Methods in a Rat Model: Supermicrosurgical Lymphaticovenular Anastomosis versus Microsurgical Lymphaticovenous Implantation. Plast Reconstr Surg 2017; 139:1407-1413. [PMID: 28538568 DOI: 10.1097/prs.0000000000003354] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lymphaticovenular anastomosis and lymphaticovenous implantation are the most popular lymphovenous shunt operations for the treatment of obstructive lymphedema. However, no study has been reported regarding direct comparison between lymphaticovenular anastomosis and lymphaticovenous implantation. This study aimed to compare postoperative patency of lymphaticovenular anastomosis and lymphaticovenous implantation using a rat model. METHODS Twelve Wistar rats were used for the study. The rats were randomized into the lymphaticovenular anastomosis group (n = 6) or the lymphaticovenous implantation group (n = 6). In the lymphaticovenular anastomosis group, the largest femoral lymphatic vessel was anastomosed to a similar-size vein in an end-to-end intima-to-intima coaptation manner, and the other lymphatics were ligated. In the lymphaticovenous implantation group, the femoral lymphatic vessel and surrounding tissue were inserted into the short saphenous vein with a telescopic anastomosis technique. Patency was evaluated intraoperatively and 1 week postoperatively with patent blue dye and indocyanine green lymphography. RESULTS The mean diameters of the lymphatic vessels and the veins were 0.242 mm (range, 0.20 to 0.35 mm) and 0.471 mm (range, 0.30 to 0.75 mm), respectively. Intraoperative patency was 100 percent (six of six) in both groups (p = 1.000). Postoperative patency was significantly higher in the lymphaticovenular anastomosis group compared with the lymphaticovenous implantation group [100 percent (six of six) versus 33.3 percent (two of six); p = 0.014] CONCLUSION:: Postoperative patency of the lymphaticovenular anastomosis group was higher than that of the lymphaticovenous implantation group, although intraoperative patency rates of the lymphaticovenular anastomosis and lymphaticovenous implantation groups were comparable.
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17
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Han HH, Jun D, Mun GH, Moon SH. Modification of pedicle lengthening through perforator transposition in free anterolateral thigh flaps with pedicle size discrepancy: A case report. Microsurgery 2017; 38:94-97. [DOI: 10.1002/micr.30207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 05/24/2017] [Accepted: 07/12/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Hyun Ho Han
- Department of Plastic Surgery; Asan Medical Center, University of Ulsan; Seoul Republic of Korea
| | - Daiwon Jun
- Department of Plastic and Reconstructive Surgery; College of Medicine, The Catholic University of Korea; Seoul Republic of Korea
| | - Goo Hyun Mun
- Department of Plastic Surgery; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Suk-Ho Moon
- Department of Plastic and Reconstructive Surgery; College of Medicine, The Catholic University of Korea; Seoul Republic of Korea
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18
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Urano H, Iwatsuki K, Yamamoto M, Ohnisi T, Kurimoto S, Endo N, Hirata H. Novel Anti-Adhesive CMC-PE Hydrogel Significantly Enhanced Morphological and Physiological Recovery after Surgical Decompression in an Animal Model of Entrapment Neuropathy. PLoS One 2016; 11:e0164572. [PMID: 27741280 PMCID: PMC5065226 DOI: 10.1371/journal.pone.0164572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 09/27/2016] [Indexed: 12/31/2022] Open
Abstract
We developed a novel hydrogel derived from sodium carboxymethylcellulose (CMC) in which phosphatidylethanolamine (PE) was introduced into the carboxyl groups of CMC to prevent perineural adhesions. This hydrogel has previously shown excellent anti-adhesive effects even after aggressive internal neurolysis in a rat model. Here, we confirmed the effects of the hydrogel on morphological and physiological recovery after nerve decompression. We prepared a rat model of chronic sciatic nerve compression using silicone tubing. Morphological and physiological recovery was confirmed at one, two, and three months after nerve decompression by assessing motor conduction velocity (MCV), the wet weight of the tibialis anterior muscle and morphometric evaluations of nerves. Electrophysiology showed significantly quicker recovery in the CMC-PE group than in the control group (24.0 ± 3.1 vs. 21.0± 2.1 m/s (p < 0.05) at one months and MCV continued to be significantly faster thereafter. Wet muscle weight at one month significantly differed between the CMC-PE (BW) and control groups (0.148 ± 0.020 vs. 0.108 ± 0.019%BW). The mean wet muscle weight was constantly higher in the CMC-PE group than in the control group throughout the experimental period. The axon area at one month was twice as large in the CMC-PE group compared with the control group (24.1 ± 17.3 vs. 12.3 ± 9 μm2) due to the higher ratio of axons with a larger diameter. Although the trend continued throughout the experimental period, the difference decreased after two months and was not statistically significant at three months. Although anti-adhesives can reduce adhesion after nerve injury, their effects on morphological and physiological recovery after surgical decompression of chronic entrapment neuropathy have not been investigated in detail. The present study showed that the new anti-adhesive CMC-PE gel can accelerate morphological and physiological recovery of nerves after decompression surgery.
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Affiliation(s)
- Hideki Urano
- Department of Orthopaedic Surgery, Yokkaichi municipal hospital, 2-2-37 Shibata-cho, Yokkaichi, Mie, 510–8567, Japan
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466–8550, Japan
- * E-mail:
| | - Katsuyuki Iwatsuki
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466–8550, Japan
| | - Michiro Yamamoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466–8550, Japan
| | - Tetsuro Ohnisi
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466–8550, Japan
| | - Shigeru Kurimoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466–8550, Japan
| | - Nobuyuki Endo
- Healthcare Business Development, Teijin Limited, 4-3-2 Asahigaoka Hino, Tokyo, 191–8512, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466–8550, Japan
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19
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Hayashida K, Saijo H, Fujioka M. Peroneal perforator-based peroneus longus tendon and sural neurofasciocutaneous composite flap transfer for a large soft-tissue defect of the forearm: A case report. Microsurgery 2016; 38:85-88. [PMID: 27592132 DOI: 10.1002/micr.30104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/21/2016] [Accepted: 08/26/2016] [Indexed: 01/09/2023]
Abstract
We describe the use of a composite flap composed of a sural neurofasciocutaneous flap and a vascularized peroneus longus tendon for the reconstruction of severe composite forearm tissue defects in a patient. A 43-year-old man had his left arm caught in a conveyor belt resulting in a large soft-tissue defect of 18 × 11 cm over the dorsum forearm. The extensor carpi radialis, superficial radial nerve, and radial artery were severely damaged. A free neurofasciocutaneous composite flap measuring 16 × 11 cm was outlined on the patient's left lower leg to allow simultaneous skin, tendon, nerve, and artery reconstruction. The flap, which included the peroneus longus tendon, was elevated on the subfascial plane. After the flap was transferred to the recipient site, the peroneal artery was anastomosed to the radial artery in a flow-through manner. The vascularized tendon graft with 15 cm in length was used to reconstruct the extensor carpi radialis longus tendon defect using an interlacing suture technique. As the skin paddle of the sural neurofasciocutaneous flap and the vascularized peroneus longus tendon graft were linked by the perforator and minimal fascial tissue, the skin paddle was able to rotate and slide with comparative ease. The flap survived completely without any complications. The length of follow-up was 12 months and was uneventful. Range of motion of his left wrist joint was slightly limited to 75 degrees. This novel composite flap may be useful for reconstructing long tendon defects associated with extensive forearm soft tissue defects.
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Affiliation(s)
- Kenji Hayashida
- Faculty of Medicine, Division of Plastic and Reconstructive Surgery, Department of Dermatology, Shimane University, Shimane, 693-8501, Japan.,Division of Plastic and Reconstructive Surgery, National Nagasaki Medical Center, Nagasaki, 856-8562, Japan
| | - Hiroto Saijo
- Division of Plastic and Reconstructive Surgery, National Nagasaki Medical Center, Nagasaki, 856-8562, Japan
| | - Masaki Fujioka
- Division of Plastic and Reconstructive Surgery, National Nagasaki Medical Center, Nagasaki, 856-8562, Japan
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Abstract
Carpal tunnel release for compression of the median nerve at the wrist is one of the most common and successful procedures in hand surgery. Complications, though rare, are potentially devastating and may include intraoperative technical errors, postoperative infection and pain, and persistent or recurrent symptoms. Patients with continued complaints after carpal tunnel release should be carefully evaluated with detailed history and physical examination in addition to electrodiagnostic testing. For those with persistent or recurrent symptoms, a course of nonoperative management including splinting, injections, occupational therapy, and desensitization should be considered prior to revision surgery.
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Affiliation(s)
- John W Karl
- Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, USA
| | - Stephanie M Gancarczyk
- Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, USA
| | - Robert J Strauch
- Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, USA.
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21
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Nerve reconstruction after sural nerve biopsy with supermicrosurgical fascicular turnover flap. J Plast Reconstr Aesthet Surg 2016; 69:146. [DOI: 10.1016/j.bjps.2015.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 07/30/2015] [Accepted: 08/07/2015] [Indexed: 11/20/2022]
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22
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Yamamoto R, Motomiya M, Sakurai K, Sekiguchi H, Funakoshi T, Iwasaki N. Application of free temporoparietal fascial flap for recurrent neural adhesion of superficial radial nerve--A case report. Microsurgery 2015; 35:489-93. [PMID: 26178298 DOI: 10.1002/micr.22446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/28/2015] [Accepted: 06/11/2015] [Indexed: 12/31/2022]
Abstract
Because of its anatomical location, the superficial radial nerve is vulnerable to trauma as well as injury during various surgical procedures. Once the nerve adheres to surrounding scar tissue, radiating pain often occurs due to nerve traction caused by loss of smooth gliding. Since it has been reported that the success rate with neurolysis only is lower, additional preventive procedures for recurrent neural readhesion are recommended. In the current report, we describe our experience performing neurolysis followed by nerve coverage using a free temporoparietal fascial flap for recurrent neural adhesion of the superficial radial nerve. A 45-year-old male complained of motion pain of the left wrist and thumb joints caused by recurrent neural adhesion of the superficial radial nerve after a chain saw trauma and following multiple reconstructive procedures. The radiating pain completely disappeared after neurolysis performed by a previous surgeon; however, it recurred 4 weeks later. Four months after the previous neurolysis the patient underwent external neurolysis and covering of the nerve with a free temporoparietal fascial flap to prevent neural readhesion because local soft tissue could not be used due to the massive scar tissues on the forearm. One year after the secondary neurolysis, the symptoms of radiating pain during wrist and thumb motion were drastically improved. A free adipofascial flap such as a temporoparietal flap may be an option for prevention of neural readhesion after neurolysis of the superficial radial nerve in cases where a local flap cannot be used on the forearm.
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Affiliation(s)
- Reiji Yamamoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Makoto Motomiya
- Department of Orthopedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan.,Department of Orthopaedic Surgery, Obihiro-Kosei General Hospital, Obihiro, 080-0016, Japan
| | - Keisuke Sakurai
- Department of Traumatology and Critical Care Medicine, Sapporo City General Hospital, Sapporo, 060-8604, Japan
| | - Hirotake Sekiguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Tadanao Funakoshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
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23
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Karonidis A, Bouloumpasis S, Apostolou K, Tsoutsos D. The use of the ALT Flap and Lateral Femoral Cutaneous Nerve for the Reconstruction of Carpal Soft Tissue and Ulnar Nerve Defects: a Case Report. J Hand Microsurg 2015; 7:182-6. [PMID: 26078538 DOI: 10.1007/s12593-014-0146-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 07/01/2014] [Indexed: 10/24/2022] Open
Abstract
The anterolateral thigh (ALT) flap has become one of the workhorse flaps, with indications including diverse reconstructive problems. The lateral thigh area is also a useful donor site for nerve grafts. The lateral femoral cutaneous (LFC) nerve can be dissected along with the ALT flap for a substantial length, depending on the requirements of the recipient site. The LFC nerve can be used as a vascularized or non-vascularized nerve graft. The technique offers advantages and it can find clinical applications, satisfying the functional and aesthetic reconstructive requirements of a complex defect. We report the case of a patient who presented with traumatic soft tissue defect of the volar aspect of the wrist and ulnar nerve defect as a complication of a fracture of distal radius. An ALT flap was used to reconstruct the soft tissue defect. The ulnar nerve was resected due to necrosis and the gap was repaired with non-vascularized grafts of the anterior branch of the LFC nerve. The soft tissues were resurfaced successfully without complications. Functional recovery was good for the superficial branch of the ulnar nerve, whereas it was variable for the deep branch of the ulnar nerve. The anterolateral thigh area offers significant advantages as donor site in the reconstruction of complex soft tissue defects being a large source of vascularized skin, fat, fascia, muscle and nerve. This availability allows for single donor site dissection, minimizing the operating time and the associated morbidity.
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Affiliation(s)
- Athanasios Karonidis
- Department of Plastic Surgery, Burns Unit, Microsurgery and Hand Surgery, General Hospital of Athens 'G. GENNIMATAS', Sifnou 33 Agia Paraskevi, 15343 Athens, Greece
| | - Serafeim Bouloumpasis
- Department of Plastic Surgery, Burns Unit, Microsurgery and Hand Surgery, General Hospital of Athens 'G. GENNIMATAS', Sifnou 33 Agia Paraskevi, 15343 Athens, Greece
| | - Konstantinos Apostolou
- Department of Plastic Surgery, Burns Unit, Microsurgery and Hand Surgery, General Hospital of Athens 'G. GENNIMATAS', Sifnou 33 Agia Paraskevi, 15343 Athens, Greece
| | - Dimosthenis Tsoutsos
- Department of Plastic Surgery, Burns Unit, Microsurgery and Hand Surgery, General Hospital of Athens 'G. GENNIMATAS', Sifnou 33 Agia Paraskevi, 15343 Athens, Greece
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24
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Trignano E, Fallico N, Chen HC, Faenza M, Bolognini A, Armenti A, Santanelli Di Pompeo F, Rubino C, Campus GV. Evaluation of peripheral microcirculation improvement of foot after tarsal tunnel release in diabetic patients by transcutaneous oximetry. Microsurgery 2015; 36:37-41. [PMID: 25641727 DOI: 10.1002/micr.22378] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND According to recent studies, peripheral nerve decompression in diabetic patients seems to not only improve nerve function, but also to increase microcirculation; thus decreasing the incidence of diabetic foot wounds and amputations. However, while the postoperative improvement of nerve function is demonstrated, the changes in peripheral microcirculation have not been demonstrated yet. The aim of this study is to assess the degree of microcirculation improvement of foot after the tarsal tunnel release in the diabetic patients by using transcutaneous oximetry. PATIENTS AND METHODS Twenty diabetic male patients aged between 43 and 72 years old (mean age 61.2 years old) suffering from diabetic peripheral neuropathy with superimposed nerve compression underwent transcutaneous oximetry (PtcO2) before and after tarsal tunnel release by placing an electrode on the skin at the level of the dorsum of the foot. Eight lower extremities presented diabetic foot wound preoperatively. Thirty-six lower extremities underwent surgical release of the tibialis posterior nerve only, whereas four lower extremities underwent the combined release of common peroneal nerve, anterior tibialis nerve, and posterior tibialis nerve. RESULTS Preoperative values of transcutaneous oximetry were below the critical threshold, that is, lower than 40 mmHg (29.1 ± 5.4 mmHg). PtcO2 values at one month after surgery (45.8 ± 6.4 mmHg) were significantly higher than the preoperative ones (P = 0.01). CONCLUSIONS The results of postoperative increase in PtcO2 values demonstrate that the release of the tarsal tunnel determines a relevant increase in microcirculation in the feet of diabetic patients.
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Affiliation(s)
- Emilio Trignano
- Department of Plastic and Reconstructive Surgery, University of Sassari, Sassari, Italy.,Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Nefer Fallico
- Department of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Mario Faenza
- Department of Plastic and Reconstructive Surgery, University of Sassari, Sassari, Italy
| | - Alfonso Bolognini
- Department of Plastic and Reconstructive Surgery, University of Sassari, Sassari, Italy
| | - Andrea Armenti
- Department of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy
| | | | - Corrado Rubino
- Department of Plastic and Reconstructive Surgery, University of Salerno, Fisciano Salerno, Italy
| | - Gian Vittorio Campus
- Department of Plastic and Reconstructive Surgery, University of Sassari, Sassari, Italy
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25
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Hayashida K, Hiroto S, Morooka S, Kuwabara K, Fujioka M. The vascularized sural nerve graft based on a peroneal artery perforator for reconstruction of the inferior alveolar nerve defect. Microsurgery 2014; 35:244-8. [PMID: 25346479 DOI: 10.1002/micr.22346] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 11/11/2022]
Abstract
The sural nerve has been described for nerve reconstruction of the maxillofacial region since it provides many advantages. We report a case of a vascularized sural nerve graft based on a peroneal artery perforator for immediate reconstruction after the removal of intraosseous neuroma originating in the inferior alveolar nerve. The patient had a neuroma caused by iatrogenic injury to the inferior alveolar nerve. A 4-cm long neuroma existed in the inferior alveolar nerve and was resected. A peroneal perforator was chosen as the pedicle of the vascularized sural nerve graft for the nerve gap. The graft including the skin paddle for monitoring the perfusion supplied by this perforator was transferred to the lesion. The nerve gap between the two stumps of the inferior alveolar nerve was repaired using the 6-cm long vascularized sural nerve. The perforator of the peroneal artery was anastomosed to the branch of the facial artery in a perforator-to-perforator fashion. There was no need to sacrifice any main arteries. The skin paddle with 1 cm × 3 cm in size was inset into the incised medial neck. Perceptual function tests with a Semmes-Weinstein pressure esthesiometer and two-point discrimination in the lower lip and chin at 10 months after surgery showed recovery almost to the level of the normal side. This free vascularized sural nerve graft based on a peroneal artery perforator may be a good alternative for reconstruction of inferior alveolar nerve defects.
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Affiliation(s)
- Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, National Nagasaki Medical Center, Ohmura City, Japan
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Agrogiannis N, Rozen S, Reddy G, Audolfsson T, Rodriguez-Lorenzo A. Vastus lateralis vascularized nerve graft in facial nerve reconstruction: An anatomical cadaveric study and clinical implications. Microsurgery 2014; 35:135-9. [DOI: 10.1002/micr.22311] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Nikolaos Agrogiannis
- Department of Plastic and Maxillofacial Surgery; Uppsala University Hospital and Department of Surgical Sciences, Uppsala University; Sweden
| | - Shai Rozen
- Department of Plastic Surgery; UT Southwestern Medical Center; Dallas Texas
| | - Gangadasu Reddy
- Department of Plastic Surgery; UT Southwestern Medical Center; Dallas Texas
| | - Thorir Audolfsson
- Department of Plastic and Maxillofacial Surgery; Uppsala University Hospital and Department of Surgical Sciences, Uppsala University; Sweden
| | - Andres Rodriguez-Lorenzo
- Department of Plastic and Maxillofacial Surgery; Uppsala University Hospital and Department of Surgical Sciences, Uppsala University; Sweden
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Sekiguchi H, Motomiya M, Sakurai K, Matsumoto D, Funakoshi T, Iwasaki N. Brachial artery perforator-based propeller flap coverage for prevention of readhesion after ulnar nerve neurolysis. Microsurgery 2014; 35:158-62. [DOI: 10.1002/micr.22303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/26/2014] [Accepted: 07/18/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Hirotake Sekiguchi
- Department of Orthopaedic Surgery; Kushiro Rosai Hospital Hand Center; Kushiro Japan
| | - Makoto Motomiya
- Department of Orthopaedic Surgery; Kushiro Rosai Hospital Hand Center; Kushiro Japan
- Department of Orthopedic Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Japan
| | - Keisuke Sakurai
- Department of Plastic Surgery; Kushiro Rosai Hospital; Kushiro Japan
| | - Dai Matsumoto
- Department of Orthopaedic Surgery; Kushiro Rosai Hospital Hand Center; Kushiro Japan
| | - Tadanao Funakoshi
- Department of Orthopedic Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Japan
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