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Sharp O, Johal KS, Morgan M, Ramakrishnan VV. Primary lipofilling as an adjunct in transverse upper gracilis flap breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 86:1-7. [PMID: 37634487 DOI: 10.1016/j.bjps.2023.07.043] [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: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023]
Abstract
In many centres, the myocutaneous transverse upper gracilis (TUG) flap represents an alternative choice in autologous breast reconstruction when abdominal tissue is unavailable. However, a single TUG flap may be volume deficient, particularly in the upper pole. We describe the application of simultaneous lipofilling to the pectoralis major muscle at the index procedure and present our decision-making algorithm, technique and outcomes. A retrospective review of all TUG flaps between January 2011 and May 2021 was conducted. Patient demographics, volume of primary and any subsequent fat grafting and complications were recorded. A total of 183 patients (242 TUG flaps) were included in this study. Of these; 130 patients were reconstructed with single TUG flaps, 16 patients received a single TUG flap with immediate lipofilling, and 37 patients underwent stacked, double TUG flap reconstructions. Of the 242 flaps, there were 2 flap losses (<1%), neither of which occurred in the immediate lipofilling cohort. Among the 130 single TUG patients, 28 (21.5%) required a cumulative total of 40, and a mean of 1.4, secondary lipofilling procedures. The immediate lipofilling patients were injected with a mean of 42 ml fat (range: 20-80 ml). In this group, only 2 of 16 patients required secondary lipofilling. The mean follow-up was 67 months (17-141). Primary lipofilling may reduce the need for secondary revisional procedures and appears safe at the index operation, adds little operative time and has negligible donor site morbidity. In patients where a second (stacked) flap would add unnecessary volume and complexity, it can be considered a useful adjunct.
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Affiliation(s)
- O Sharp
- St Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom.
| | - K S Johal
- St Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom
| | - M Morgan
- St Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom
| | - V V Ramakrishnan
- St Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom
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Unilateral breast reconstruction using double transverse upper gracilis (TUG) flaps. J Plast Reconstr Aesthet Surg 2021; 75:1164-1170. [PMID: 34896045 DOI: 10.1016/j.bjps.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/04/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION When the deep inferior epigastric perforator (DIEP) flap is unavailable, autologous reconstruction of a moderate-to-large breast presents a surgical challenge. We retrospectively review our experience of unilateral breast reconstruction using double transverse upper gracilis (TUG) flaps and highlight specific technical considerations. METHODS Thirty-four patients underwent double TUG flaps for unilateral breast reconstruction between 2012 and 2020. The average patient age was 50 years and the average body mass index (BMI) was 23.1 kg/m2. In all cases, the indication for surgery was breast cancer: 31 patients had immediate reconstruction, 11 had simultaneous axillary surgery and eight had primary contralateral symmetrising surgery. RESULTS Of the 68 TUG flaps, 67 (98.5%) were successful. The mean operative time was 5 h 50 min (195-460 min) and the mean combined flap weight was 551 g (279-916 g). Eight patients returned to the operating theatre in the early post-operative period and five patients underwent secondary lipofilling to address contour deformities. Most commonly (n = 22), the flaps were oriented horizontally/obliquely, with one flap anastomosed medially to the internal mammary axis and the other anastomosed lateral to the subscapular system. The internal mammary artery perforators and serratus anterior artery provided the best vessel calibre match with the TUG vessels. CONCLUSIONS Double TUG reconstruction is a safe and reliable option for unilateral breast reconstruction and is an important option when the DIEP flap is unavailable.
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The Conjoined TUGPAP Flap for Breast Reconstruction: Systematic Review and Illustrative Anatomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3512. [PMID: 33889470 PMCID: PMC8057755 DOI: 10.1097/gox.0000000000003512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/29/2021] [Indexed: 11/25/2022]
Abstract
Background: Although abdominally based flaps continue to be the gold standard for autologous breast reconstruction, alternative donor sites are necessary when the abdominal region is unavailable or inadequate for flap harvest. In this case, thigh-based flaps, such as the profunda artery perforator (PAP), transverse upper gracilis (TUG), or newly described TUGPAP, are thought to be reliable with low morbidity and satisfactory cosmesis. The objective of this study was to perform a systematic review of breast reconstruction with PAP, TUG, or TUGPAP, and present anatomy and surgical techniques through illustrative examples. Methods: A systematic review of the literature was conducted using PubMed, Embase, and Cochrane Library. Articles were included if they used a PAP, TUG, or TUGPAP flap for oncologic, traumatic, or congenital breast reconstruction in patients 18 years or older. Results: Forty-nine studies met inclusion criteria. Seven hundred five patients underwent 906 breast reconstructions with 1037 flaps (755 TUG, 230 PAP, and 52 TUGPAP). Mean patient age was 45.9 years. The mean flap weight for TUG, PAP, and TUGPAP flaps were 323.4, 346.9, and 437.0 g, respectively. The most common recipient vessel was the internal mammary artery in 821 flaps. The overall flap survival rate was 97.2% (1008/1037). TUG flaps had a significantly higher recipient and donor complication rate compared with both PAP (recipient: 18.1% versus 7.8%, P = 0.0001; donor: 25.8% versus 7.0%, P < 0.00001) and TUGPAP flaps (recipient: 18.1% versus 2.0%, P < 0.001; donor: 25.8% versus 7.7%, P < 0.01). Conclusion: The TUGPAP flap is a safe and effective alternative for autologous breast reconstruction when the abdominal donor site is unavailable.
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A Critical Analysis of Prosthetic Augmentation of Autologous Microvascular Breast Reconstruction. Ann Plast Surg 2019; 84:717-721. [PMID: 31663940 DOI: 10.1097/sap.0000000000002085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The combined approach using both an implant and autologous tissue for breast reconstruction has become more common over the last 10 years. We sought to provide a systematic review and outcomes analysis of this technique. METHODS We searched PubMed and the Cochrane Library database to identify studies that described implant augmentation of autologous flaps for breast reconstruction. The references of selected articles were also reviewed to identify any additional pertinent articles. RESULTS We identified 11 articles, which included 230 patients and 378 flaps. Implants used ranged in size from 90 to 510 cc, with an average size of 198 cc. Implants were more frequently placed at the time of autologous reconstruction and in the subpectoral plane. There were no total flap losses, and partial flap loss occurred in 3 patients (1%). There were no cases of venous or arterial thrombosis and no early return to the operating room for flap compromise. Eight implants (2%) were lost because of infection or extrusion, and capsular contracture occurred in 9 breasts (3%). When stratified by the timing of implant placement (immediate vs delayed), there were no significant differences in any postoperative outcomes except the immediate group had a higher infection rate. CONCLUSIONS The criteria for women to be candidates for autologous tissue breast reconstruction can be expanded by adding an implant underneath the flap. We found the overall flap loss rate is comparable with standard autologous flap reconstruction, and the implant loss rate is lower than that in patients who undergo prosthetic reconstruction alone.
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Trignano E, Fallico N, Fiorot L, Bolletta A, Maffei M, Ciudad P, Maruccia M, Chen HC, Campus GV. Flap monitoring with continuous oxygen partial tension measurement in breast reconstructive surgery: A preliminary report. Microsurgery 2017; 38:402-406. [DOI: 10.1002/micr.30256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 08/14/2017] [Accepted: 10/03/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Emilio Trignano
- Department of Plastic and Reconstructive Surgery; University of Sassari; Sassari 07100 Italy
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung 40447 Taiwan Republic of China
| | - Nefer Fallico
- Department of Plastic and Reconstructive Surgery; “Sapienza” University of Rome; Rome 00161 Italy
| | - Luca Fiorot
- Department of Plastic and Reconstructive Surgery; University of Sassari; Sassari 07100 Italy
| | - Alberto Bolletta
- Department of Plastic and Reconstructive Surgery; University of Sassari; Sassari 07100 Italy
| | - Matteo Maffei
- Department of Plastic and Reconstructive Surgery; University of Sassari; Sassari 07100 Italy
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung 40447 Taiwan Republic of China
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung 40447 Taiwan Republic of China
- Department of Plastic and Reconstructive Surgery; “Sapienza” University of Rome; Rome 00161 Italy
- Department of Emergency and Organ Transplantation, Plastic and Reconstructive Surgery and Burns Unit; “Aldo Moro” University of Bari; Bari Italy
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung 40447 Taiwan Republic of China
| | - Gian Vittorio Campus
- Department of Plastic and Reconstructive Surgery; University of Sassari; Sassari 07100 Italy
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Dessy LA, Fallico N, Serratore F, Ribuffo D, Mazzocchi M. The use of the Alexis(®) device in breast augmentation to improve outcomes: a comparative randomized case-control survey. Gland Surg 2016; 5:287-94. [PMID: 27294035 DOI: 10.21037/gs.2015.09.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We present our experience in using a disposable wound retractor commonly used in abdominal surgery named Alexis(®) (Applied Medical Resources Corporation, Rancho Santa Margarita, CA, USA), during breast augmentation in order to improve outcomes, particularly final scar length. METHODS Between January 2010 and November 2012, 40 patients undergoing breast augmentation with an inframammary approach were enrolled in the present study. Patients were randomly assigned to two groups: group 1 underwent breast augmentation with the standard technique; group 2 underwent breast augmentation by using the Alexis(®) (Applied Medical Resources Corporation) device. Patients were followed-up for a 12-month period. The time of surgery, the days of drain duration and the length of the incisions were recorded for both groups and statistical significance was evaluated with the Wilcoxon rank sum test. Also, final scar appearance was evaluated using a visual analogue scale (VAS). RESULTS Patients in group 2 reported a lower incidence of hematomas and had shorter drain duration. The difference in scar length between the two groups was statistically significant (P<0.05). Surgeons and patients were mostly satisfied with the final appearance of the scar. CONCLUSIONS The use of the Alexis(®) (Applied Medical Resources Corporation) device has proven useful in reducing the length of the inframammary incision. Interestingly, the increased visibility obtained with the use of the Alexis device allowed a better hemostasis, as suggested by the shorter drain duration and lower incidence of hematomas. However, its use prolongs the operative time, for which we recommend surgeons to allow themselves some time to become familiar with the device. LEVEL OF EVIDENCE level I, evidence obtained from at least one properly designed randomized controlled trial.
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Affiliation(s)
- Luca Andrea Dessy
- 1 Department of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy ; 2 Department of Plastic and Reconstructive Surgery, University of Perugia, Via S. Andrea delle Fratte, Perugia, Italy
| | - Nefer Fallico
- 1 Department of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy ; 2 Department of Plastic and Reconstructive Surgery, University of Perugia, Via S. Andrea delle Fratte, Perugia, Italy
| | - Francesco Serratore
- 1 Department of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy ; 2 Department of Plastic and Reconstructive Surgery, University of Perugia, Via S. Andrea delle Fratte, Perugia, Italy
| | - Diego Ribuffo
- 1 Department of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy ; 2 Department of Plastic and Reconstructive Surgery, University of Perugia, Via S. Andrea delle Fratte, Perugia, Italy
| | - Marco Mazzocchi
- 1 Department of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy ; 2 Department of Plastic and Reconstructive Surgery, University of Perugia, Via S. Andrea delle Fratte, Perugia, Italy
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Ciudad P, Maruccia M, Orfaniotis G, Weng HC, Constantinescu T, Nicoli F, Cigna E, Socas J, Sirimahachaiyakul P, Sapountzis S, Kiranantawat K, Lin SP, Wang GJ, Chen HC. The combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for breast reconstruction. Microsurgery 2015; 36:359-366. [PMID: 26440546 DOI: 10.1002/micr.22459] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/04/2015] [Accepted: 07/09/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- PhD Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University; Taichung Taiwan
- Graduate Institute of Biomedical Engineering; National Chung Hsing University; Taichung Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic Surgery; Reconstructive and Aesthetic Surgery, ‘Sapienza’ University; Rome Italy
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Hui-Ching Weng
- Institute of Gerontology, College Of Medicine, Cheng Kung Kung University; Tainan Taiwan
| | - Thomas Constantinescu
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Emanuele Cigna
- Department of Plastic Surgery; Reconstructive and Aesthetic Surgery, ‘Sapienza’ University; Rome Italy
| | - Juan Socas
- Department of Plastic and Reconstructive Surgery; Indiana University School of Medicine; Indianapolis USA
| | | | - Stamatis Sapountzis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Department of Surgery; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Shu-Ping Lin
- Graduate Institute of Biomedical Engineering; National Chung Hsing University; Taichung Taiwan
| | - Gou-Jen Wang
- PhD Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University; Taichung Taiwan
- Graduate Institute of Biomedical Engineering; National Chung Hsing University; Taichung Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
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Coskunfirat OK, Bektas G, Cinpolat A, Unal K, Coskunfirat N. Experiences with functional gracilis muscle flap in lower lip reconstruction. Microsurgery 2015; 37:487-493. [DOI: 10.1002/micr.22431] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 05/10/2015] [Accepted: 05/12/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Osman Koray Coskunfirat
- Department of Plastic, Reconstructive and Aesthetic Surgery; Akdeniz University School of Medicine; Antalya Turkey
| | - Gamze Bektas
- Department of Plastic, Reconstructive and Aesthetic Surgery; Akdeniz University School of Medicine; Antalya Turkey
| | - Ani Cinpolat
- Department of Plastic, Reconstructive and Aesthetic Surgery; Akdeniz University School of Medicine; Antalya Turkey
| | - Kerim Unal
- Department of Plastic, Reconstructive and Aesthetic Surgery; Akdeniz University School of Medicine; Antalya Turkey
| | - Nesil Coskunfirat
- Department of Anesthesiology; Akdeniz University School of Medicine; Antalya Turkey
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Werdin F, Haug DM, Amr A, Schoeller T. Double transverse myocutaneous gracilis free flaps for unilateral breast reconstruction. Microsurgery 2015; 36:539-545. [PMID: 26069092 DOI: 10.1002/micr.22397] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/29/2014] [Accepted: 02/13/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND In cases were the deep inferior epigastric perforator flap (DIEP flap) is not available and unilateral transverse myocutaneous gracilis flap (TMG flap) is not sufficient for breast reconstruction, we perform double TMG flaps as a reconstructive method. In this report, we present our results of the use of double TMG free-flap-transfer for unilateral breast reconstruction. PATIENTS AND METHODS Between August 2004 and June 2012 we performed 58 TMG flaps in 29 patients for unilateral breast reconstruction. Patient data were analyzed and operative outcome (operation time, complication rate and aesthetic results) were investigated. Aesthetic outcome was evaluated retrospectively via photo documentation by an independent plastic surgeon. The results were classified in;unsatisfactory, satisfactory, good and very good. RESULTS The average operating time was 6 hours 55 minutes (295 - 650 minutes). Of 58 TMG flaps, 57 (98.3%) were successful. Thrombosis occurred in seven (12%) cases (1 arterial, 6 venous). Flap salvage was successful in six cases and flap failure occurred in one (1.7%) case. The results of 25 patients were graded as good and very good. Three patients showed satisfying and one patient unsatisfying results. CONCLUSION Double TMG flaps in unilateral breast reconstruction could lead to good operative results. This method further expands the range of options with autologous tissue in reconstructive breast surgery. © 2015 Wiley Periodicals, Inc. Microsurgery 36:539-545, 2016.
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Affiliation(s)
- Frank Werdin
- Department of Plastic Surgery, Microsurgery and Reconstructive Breastsurgery, Marienhospital Stuttgart, Germany.
| | - Daniel M Haug
- Department of Plastic Surgery, Microsurgery and Reconstructive Breastsurgery, Marienhospital Stuttgart, Germany
| | - Amro Amr
- Department of Plastic Surgery, Microsurgery and Reconstructive Breastsurgery, Marienhospital Stuttgart, Germany
| | - Thomas Schoeller
- Department of Plastic Surgery, Microsurgery and Reconstructive Breastsurgery, Marienhospital Stuttgart, Germany
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Kagen AC, Hossain R, Dayan E, Maddula S, Samson W, Dayan J, Smith ML. Modern Perforator Flap Imaging with High-Resolution Blood Pool MR Angiography. Radiographics 2015; 35:901-15. [DOI: 10.1148/rg.2015140133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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11
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Bodin F, Dissaux C, Dupret-Bories A, Schohn T, Fiquet C, Bruant-Rodier C. The transverse musculo-cutaneous gracilis flap for breast reconstruction: How to avoid complications. Microsurgery 2015; 36:42-8. [PMID: 25732779 DOI: 10.1002/micr.22394] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/27/2015] [Accepted: 02/16/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND The transverse musculocutaneous gracilis (TMG) flap has become a common solution for breast reconstruction. However, the safe skin paddle limits are not yet understood. In this study, we attempted to address this issue based on our experiences with inferior and posterior skin paddle extension. METHODS Forty-four breast reconstructions with TMG flaps performed between November 2010 and January 2014 were analyzed retrospectively. For the first 20 cases, the flap skin paddle was extended 3 cm posteriorly to the middle thigh (group 1). For the next 20 flaps (group 2), the posterior tip was limited to this line, whereas more fat was recruited inferiorly. In the four cases of group 3, the skin flap was extended posteriorly with a second vascular pedicle from the profunda artery perforator (PAP) flap. The weights and the dimensions of the flaps, operating durations, and postoperative complications of the entire series were analyzed. Groups 1 and 2 were statistically compared. RESULTS Flap complications were statistically more frequent in group 1 compared with group 2 (45 vs. 0%, P = 0.0012); 40% posterior flap tip necrosis was observed in group 1. Conversely, donor site complications were statistically more frequent in group 2 than in group 1 (40 vs. 5%, P = 0.019) with 35% inner thigh dehiscence. In the TMG with extended PAP flap group, the operating duration was 77 min longer compared with the rest of the series with no donor site complications. In one case, limited necrosis occurred at the anterior skin tip. CONCLUSIONS Harvesting the posterior portion of the TMG up to the middle of the posterior thigh may lead to partial flap necrosis. Extending subcutaneous fat removal under the inferior skin incision may increase the risk of donor site complications. Adding a second vascular pedicle from the PAP flap may improve posterior TMG tip perfusion at the expense of a longer operation.
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Affiliation(s)
- Frédéric Bodin
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Caroline Dissaux
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Agnes Dupret-Bories
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Thomas Schohn
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Caroline Fiquet
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
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12
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El-Gammal TA, El-Sayed A, Kotb MM, Saleh WR, Ragheb YF, Refai O, Morsy MM. Free functioning gracilis transplantation for reconstruction of elbow and hand functions in late obstetric brachial plexus palsy. Microsurgery 2015; 35:350-5. [PMID: 25643924 DOI: 10.1002/micr.22373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND In late obstetric brachial plexus palsy (OBPP), restoration of elbow and hand functions is a difficult challenge. The use of free functioning muscle transplantation in late OBPP was very scarcely reported. In this study, we present our experience on the use of free functioning gracilis transfer for restoration of elbow and hand functions in late cases of OBPP. PATIENTS AND METHODS Eighteen patients with late OBPP underwent free gracilis transfer for reconstruction of elbow and/or hand functions. The procedure was indicated when there was no evidence of reinnervation on EMG and in the absence of local donors. Average age at surgery was 102.5 months. Patients were evaluated using the British Medical Research Council (MRC) grading system and the Toronto Active Movement Scale. Hand function was evaluated by the Raimondi scoring system. RESULTS The average follow-up was 65.8 ± 41.7 months. Contraction of the transferred gracilis started at an average of 4.5 ± 1.03 months. Average range of elbow flexion significantly improved from 30 ± 55.7 to 104 ± 31.6 degrees (P <0.001). Elbow flexion power significantly increased with an average of 3.8 grades (P = 0.000147). Passive elbow range of motion significantly decreased from an average of 147 to 117 degrees (P = 0.003). Active finger flexion significantly improved from 5 ± 8.3 to 63 ± 39.9 degrees (P < 0.001). Finger flexion power significantly increased with an average 2.7 grades (P < 0.001). Only 17% achieved useful hand (grade 3) on Raimondi hand score. Triceps reconstruction resulted in an average of M4 power and 45 degrees elbow extension. CONCLUSION Free gracilis transfer may be a useful option for reconstruction of elbow and/or hand functions in late OBPP.
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Affiliation(s)
- Tarek A El-Gammal
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University School of Medicine, Assiut, Egypt
| | - Amr El-Sayed
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University School of Medicine, Assiut, Egypt
| | - Mohamed M Kotb
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University School of Medicine, Assiut, Egypt
| | - Waleed Riad Saleh
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University School of Medicine, Assiut, Egypt
| | - Yasser Farouk Ragheb
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University School of Medicine, Assiut, Egypt
| | - Omar Refai
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University School of Medicine, Assiut, Egypt
| | - Mohamed Mohamed Morsy
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University School of Medicine, Assiut, Egypt
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Nicoli F, Chilgar RM, Sapountzis S, Yeo MS, Lazzeri D, Ciudad P, Kiranantawat K, Sönmez TT, Maruccia M, Lim SY, Constantinides J, Chen HC. Reconstruction after orbital exenteration using gracilis muscle free flap. Microsurgery 2014; 35:169-76. [DOI: 10.1002/micr.22339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 09/24/2014] [Accepted: 09/29/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Fabio Nicoli
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Plastic and Reconstructive SurgeryUniversity of Rome “Tor Vergata”Rome Italy
| | - Ram M. Chilgar
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Plastic and Reconstructive SurgeryMaharashtra University of Health SciencesNashik Maharashtra India
| | - Stamatis Sapountzis
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Matthew Sze‐Wei Yeo
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic SurgeryVilla Salaria ClinicRome Italy
| | - Pedro Ciudad
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Maxillofacial SurgeryFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkok Thailand
| | - Tolga Taha Sönmez
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Oral and Maxillofacial SurgeryMedical FacultyRWTH Aachen UniversityAachen Germany
| | - Michele Maruccia
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Seong Yoon Lim
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
| | - Joannis Constantinides
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
- Department of Plastic and Reconstructive SurgerySt. Thomas' HospitalLondonUK
| | - Hung Chi Chen
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung Taiwan
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