1
|
Zhao J, Wang Z, Long C, He H, Zhao W, Zhang J. Using 3D printing-assisted shaping titanium cages and Masquelet techniques to reconstruct calcaneal osteomyelitis complicated by extensive soft tissue and uncontrolled defects. Injury 2023; 54:110977. [PMID: 37684116 DOI: 10.1016/j.injury.2023.110977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy of three-dimensional (3D) printing-assisted shaping titanium cage combined with Masquelet technology in the treatment of calcaneal infectious defects. METHODS A retrospective analysis was performed of the data from nine patients with chronic calcaneal infection defects treated with distal gastronal flap coverage and one patient with free anterolateral thigh flap coverage, also using a 3D printing-assisted shaping titanium cage combined with both mask technology and rib autografting from January 2017 to January 2019. There were seven males and three females, with a mean age of 37 years (range, 17-52 years). The injury mechanism of the 10 patients included four motor vehicle incidents, four high fall injuries, and two rolling compactions. All patients were treated by two⁃stage procedures. The first stage included debridement, polymethyl methacrylate (PMMA) filling, and regional flap coverage. The soft tissue defect of the 10 cases included 80 cm2 in four cases and 56 cm2, 40 cm2, and 15 cm2 in each of two cases. The bone defect was 24 cm3 and 18 cm3 in each of four cases and 3 cm3 in two cases. The second stage was the mask technology of 3D printing-assisted shaping titanium cage combined with rib autografting. Time of bone union, calcaneus morphology, implant position, and the Maryland and AOFAS hind foot scores were recorded to evaluate the clinical outcome. RESULTS All 10 patients were followed up for a mean of 18.5 months (range, 12-30 months). Infection occurred in two patients 2 months after the first stage operation and were successfully treated by debridement and PMMA replacement. The incision of the other eight cases all healed successfully. Cultures from the 10 cases included five cases of methicillin-resistant Staphylococcus aureus, three cases of S. aureus, and one case each of Escherichia coli and Pseudomonas aeruginosa. All 10 patients exhibited calcaneus bone union after the second stage operation. The mean time for bone union was 4.32 (range, 3-8) months. Bone trabeculae were observed in a CT scan 13 (range, 10-22) months post-operation. The mean Maryland score at 12 months post-operation was 92 (range, 86-98) and the mean AOFAS ankle hind foot score was 89.8 (range, 83-100). CONCLUSION Three-dimensional printing-assisted shaping titanium cages and Masquelet technology may be effective methods for the treatment of infectious calcaneal defects.
Collapse
Affiliation(s)
- Jianwen Zhao
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese Academy of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Zhifeng Wang
- First Orthopedic Surgery Department, Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Cheng Long
- Xiangya Hospital, Central South University, Department of Orthopedics, Changsha 410008, China
| | - Hongying He
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese Academy of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Wei Zhao
- First Orthopedic Surgery Department, Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Jianzheng Zhang
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese Academy of Orthopedics, PLA General Hospital, Beijing 100048, China.
| |
Collapse
|
2
|
Ryoo HJ, Park SH, Park JA, Kim YH, Shim HS. Multiple digit resurfacing with a lateral thoracic free flap: Two-stage mitten hand and division procedures. Microsurgery 2023; 43:570-579. [PMID: 37415509 DOI: 10.1002/micr.31090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE The conventional abdominal and groin flaps for resurfacing the defect have several disadvantages, including the risk of flap failure due to accidental traction or detachment, immobilization of the arm before division, and aesthetic dissatisfaction because of the flap bulkiness. The aim of this study was to share our experiences with the free lateral thoracic flap and elucidate the optimal timing of division in complex hand reconstruction, which yielded favorable outcomes in terms of both functionality and aesthetics. METHODS This article is a retrospective review of multiple digit resurfacing using free tissue transfer from 2012 to 2022. Patients who underwent two-stage operation including mitten hand creation using superthin thoracodorsal artery perforator (TDAp) free flap and secondary division were included. A flap was elevated over the superficial fascia layer the midportion between the anterior border of the latissimus dorsi and pectoralis major muscles and once the pedicle was found, an outline that matched the defect was created. A process named "pushing with pressure and cutting" was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Two cases (18%) involved defects of the entire fingers reconstructed by TDAp flap with anterolateral thigh flap. Six cases (55%) had a super-thin TDAp flap only. In two cases (18%), non-vascularized iliac bone grafting was required for finger lengthening. One case (9%) was resurfaced with a TDAp chimeric flap including a skin paddle with the serratus anterior muscle. The primary outcome was defined as the survival or failure of the flap, while the secondary outcomes associated complications such as infection and partial flap necrosis. A statistical analysis was not performed due to the size of the case series. RESULTS All 13 flaps survived completely without any complications. Flap dimension ranged from 12 cm × 7 cm to 30 cm × 15 cm. Mitten hand duration prior to division was 41.9 days on average which was essential for the optimal result. During the division procedures, there were nine cases of debulking (82%), six cases of split-thickness skin graft (STSG) (55%), and three cases of Z-plasty performed on the first web space (27%). The mean follow-up period was 20.2 months. Mean Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire score was 10.76. CONCLUSIONS We resurfaced severe soft tissue defects of multiple fingers with thin to super-thin free flaps, mainly TDAp flaps. Surgeons can restore original hand shape using a two-stage reconstructive strategy of mitten hand creation and proper division timing to create a 3-dimensional hand structure, even in severely injured hands with multiple soft tissue defects of the digits.
Collapse
Affiliation(s)
- Hyun Jung Ryoo
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang Hyun Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Ji Ah Park
- Design Lab of Technology Commercialization Center, Industry-University Cooperation Foundation of Hanyang University, Seoul, South Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Hyung-Sup Shim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
3
|
Kaur A, Ang KL, Ali S, Dobbs T, Pope-Jones S, Harry L, Whitaker I, Emam A, Marsden N. Free flaps for lower limb soft tissue reconstruction - A systematic review of complications in 'Silver Trauma' patients. Injury 2023:S0020-1383(23)00294-2. [PMID: 37032183 DOI: 10.1016/j.injury.2023.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND There are 12.5 million people aged 65 years and older living in the UK. The annual incidence of open fracture is 30.7 per 10,000 person-years. In females, 42.9% of all open fractures occur in patients ≥ 65 years. METHODS AND MATERIALS Preferred Reporting for Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study is registered with PROSPERO (CRD42020209149). The aim was to compare the complication profiles of free fasciocutaneous flaps and free muscular flaps in patients aged over 60 years undergoing lower limb soft tissue reconstruction following an open lower limb fracture. The search strategy based on strict inclusion criteria included PubMed, Embase and Google Scholar. RESULTS 15 papers were identified, including 46 patients with 10 free fasciocutaneous flaps and 41 free muscle flaps. There were 3 complications in the fasciocutaneous group (30%) and 9 complications in the muscle group (22%). There was a total of 1 secondary procedure in the fasciocutaneous group and 4 in the muscle group. DISCUSSION There is insufficient data to provide statistical comparison between free fasciocutaneous versus free muscle flaps for lower limb reconstruction performed in those aged over 60 years. This systematic review highlights evidence for the successful use of free tissue transfer in the older population following an open fracture injury and requiring lower limb reconstruction. There is no evidence to suggest the superiority of one tissue type over the other, with the inference that well vascularised tissue is the most significant factor impacting outcome.
Collapse
Affiliation(s)
- Anjana Kaur
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK.
| | - Ky-Leigh Ang
- University of Cardiff, Cardiff CF10 3AT, Wales, United Kingdom
| | - Stephen Ali
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK; Reconstructive Surgery & Regenerative Medicine Research Centre (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, SA2 8PP, UK
| | - Tom Dobbs
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK; Reconstructive Surgery & Regenerative Medicine Research Centre (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, SA2 8PP, UK
| | - Sophie Pope-Jones
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK
| | - Lorraine Harry
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK
| | - Iain Whitaker
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK; Reconstructive Surgery & Regenerative Medicine Research Centre (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, SA2 8PP, UK
| | - Ahmed Emam
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK
| | - Nicholas Marsden
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK
| |
Collapse
|
4
|
Koster IT, Borgdorff MP, Jamaludin FS, de Jong T, Botman M, Driessen C. Strategies following free flap failure in lower extremity trauma: a systematic review. JPRAS Open 2023; 36:94-104. [DOI: 10.1016/j.jpra.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/19/2023] [Indexed: 03/31/2023] Open
|
5
|
Trignano E, Serra PL, Grieco F, Rodio M, Rampazzo S, Pili N, Trignano C, Rubino C. Heel reconstruction with ALT free flap in a 4-year-old patient after a severe lawnmower injury. A case report. Case Reports Plast Surg Hand Surg 2022; 10:2157280. [PMID: 36605818 PMCID: PMC9809361 DOI: 10.1080/23320885.2022.2157280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Lawnmowers represent a danger in pediatric population. Frequently, traumas involve limbs. Among the different reconstructive techniques, a free flap is often needed. We discuss the first case of heel reconstruction with an anterolateral thigh flap in a 4-years-old patient after a lawnmower's trauma.
Collapse
Affiliation(s)
- Emilio Trignano
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Pietro Luciano Serra
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, Sassari University Hospital Trust, University of Sassari, Sassari, Italy,CONTACT Pietro Luciano Serra Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Federica Grieco
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Manuela Rodio
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Silvia Rampazzo
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Nicola Pili
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Claudia Trignano
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Corrado Rubino
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| |
Collapse
|
6
|
莫 小, 常 树, 魏 在, 周 健, 曾 可, 陈 伟, 聂 开, 李 书, 邓 呈. [Clinical application of microdissected thin thoracodorsal artery perforator flaps for repair of diabetic foot ulcers]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1266-1272. [PMID: 36310465 PMCID: PMC9626267 DOI: 10.7507/1002-1892.202201037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/18/2022] [Indexed: 01/25/2023]
Abstract
Objective To explore the effectiveness of microdissected thin thoracodorsal arterial perforator flap (TDAP) in repairing diabetic foot ulcers (DFUs). Methods The clinical data of 11 patients with DFUs admitted between March 2020 and February 2021 were retrospectively analyzed, including 5 males and 6 females, aged from 22 to 67 years, with an average of 49.3 years. There were 10 cases of type 2 diabetes and 1 case of type 1 diabetes; the duration of diabetes ranged from 3 months to 25 years (median, 8 months). The duration of DFUs ranged from 6 days to 120 months (median, 1 month). There were 6 cases of grade 3 and 5 cases of grade 4 according to Wagner classification. The tissue necrosis and purulent secretions were found in all ulcer wounds, as well as different degrees of tendon and bone exposure; skin defects ranged from 5 cm×3 cm to 17 cm×6 cm. The DFUs were repaired by microdissected thin TDAP, including 6 cases of flaps (including 1 case of lobulated flap), ranging from 10.0 cm×4.5 cm to 26.0 cm×7.0 cm; 5 cases of chimeric perforator flaps, the range of the flap was 10.0 cm×4.5 cm to 16.0 cm×5.5 cm, and the range of the muscle flap was 6 cm×2 cm to 10 cm×3 cm. The donor site was sutured directly. Results The operation time ranged from 3.42 to 11.17 hours, with an average of 5.92 hours. All 11 flaps survived and no vascular crisis occurred; 1 patient had a sinus at the edge of the flap, and the surgical area healed well after dressing change. All 11 patients were followed up 6-12 months, with an average of 9 months. The flap texture was good, the recipient site was in good shape, and there was no swelling; the foot contour was good, the shoes were comfortable to wear, and the movement was good. The incision at the donor site healed by first intention, leaving only linear and concealed scar, without obvious depression deformity, and the shoulder joint function was good. Conclusion On the premise of ensuring sufficient blood supply to the lower extremities and strengthening perioperative management, the microdissected thin TDAP to repair DFUs wounds can achieve better effectiveness and appearance; however, the prolonged operation time increases the probability of anesthesia and surgical risks in patients with DFUs.
Collapse
Affiliation(s)
- 小金 莫
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 树森 常
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 在荣 魏
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 健 周
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 可为 曾
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 伟 陈
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 开瑜 聂
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 书俊 李
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 呈亮 邓
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| |
Collapse
|
7
|
He J, Guliyeva G, Wu P, Yu F, Qing L, Tang J. Reconstruction of Complex Soft Tissue Defects of the Heel With Versatile Double Skin Paddle Anterolateral Thigh Perforator Flaps: An Innovative Way to Restore Heel Shape. Front Surg 2022; 9:836505. [PMID: 35237651 PMCID: PMC8884269 DOI: 10.3389/fsurg.2022.836505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Complex heel defects constitute a significant challenge for plastic surgeons. Objectives In this study, versatilities of free double skin paddle ALT flaps in the reconstruction of complex soft tissue defects of heels were explored. Methods From January 2010 to December 2019, 16 patients (13 male and 3 females) aged 16–74 years underwent double skin paddle ALT flap reconstruction in our department. All the patients had large defects located at the heel, and 5 had a dead space. Underlying structures such as vessels, bones, and tendons were exposed in all cases. Results Flap survival rate was 100% after the reconstruction. Eleven double skin paddle ALT flaps and 5 vastus lateralis muscle-chimeric double skin paddle ALT flaps were used. The size of the skin flap ranged from 9.5 × 4.5 cm2 to 22 × 10 cm2, and the size of a muscle segment ranged from 6 × 3 × 1 cm3 to 10 × 3 × 2 cm3. The mean follow-up was 22.6 months (range: 10–81 months). The wounds healed well, providing reliable soft tissue coverage and good heel contour. All the patients ambulated independently during the follow-up period. Most of them regained protective sensation. The average two-point discrimination was 32.7 mm (range: 27–37 mm). Conclusion Double skin paddle ALT flaps are a feasible option for the reconstruction of complex heel defects, with good functional and aesthetic results. Nonetheless, further studies comparing double skin paddle ALT flaps to other flap techniques are needed.
Collapse
Affiliation(s)
- Jiqiang He
- Xiangya Hospital, Central South University, Changsha, China
| | - Gunel Guliyeva
- The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Panfeng Wu
- Xiangya Hospital, Central South University, Changsha, China
| | - Fang Yu
- Xiangya Hospital, Central South University, Changsha, China
| | - Liming Qing
- Xiangya Hospital, Central South University, Changsha, China
| | - Juyu Tang
- Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Juyu Tang
| |
Collapse
|
8
|
Liu Y, Cai P, Cheng L, Li Y. Local Random Pattern Flap Coverage for Implant Exposure following Open Reduction Internal Fixation via Extensile Lateral Approach to the Calcaneus. BMC Musculoskelet Disord 2021; 22:567. [PMID: 34154601 PMCID: PMC8218457 DOI: 10.1186/s12891-021-04427-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Skin necrosis and implant exposure most often appear at the corner of Extensile Lateral Approach for open reduction and internal fixation (ORIF) for displaced intra-articular fracture of the calcaneus. Flap transfer is often used for coverage of this implant exposure. We introduced a new simple local random pattern flap to cover the implant exposure. Methods From March 2017 to March 2020, 12 patients with implant exposure after ORIF for displaced intra-articular fracture of the calcaneus were treated with this procedure. The sizes of the defects ranged from 2 × 2 cm2 to 5 × 2 cm2. A local random pattern flap was designed according to the defect size. The lower edge of the flap was along with the wound upper edge and extended distally. The upper horizontal incision of the flap was made at the lateral malleolus level with a length of 5–7 cm depending on the wound defect. Then the random pattern flap was elevated and transferred to cover the defect area. Results The mean follow-up duration was 6.3 months (ranging 4–13 months). All 12 flaps were uneventfully healed and all patients were able to wear shoes, and no debulking procedures were required. Conclusion The local random pattern flap could be a choice for surgeons when implant exposure at the corner of Extensile Lateral Approach to the Calcaneus occurs.
Collapse
Affiliation(s)
- Yingjie Liu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan road, Shanghai, 200233, China
| | - Peihua Cai
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan road, Shanghai, 200233, China
| | - Liang Cheng
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan road, Shanghai, 200233, China.
| | - Yanfeng Li
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan road, Shanghai, 200233, China
| |
Collapse
|
9
|
Chang LS, Kim YH, Kim SW. Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps. ANZ J Surg 2021; 91:E578-E583. [PMID: 33792136 DOI: 10.1111/ans.16640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Severe burn scar contracture of the extremities, especially the joint areas, causes aesthetic problems and functional limitation. Release of burn scar contractures requires complete removal of the scars and resurfacing of the resulting defects. Here, we describe thoracodorsal artery perforator (TDAP) free flaps for reconstructing burn scar contractures. METHODS Between August 2013 and July 2018, 25 patients with severe burn scar contractures of the extremities underwent reconstruction using TDAP free flaps. Twelve were men and the mean age of the patients was 38.1 years (range, 12-66 years). Five patients had upper extremity contractures and 20 had lower extremity contractures. RESULTS Twenty-one patients underwent reconstruction with a TDAP flap alone, while three received two perforator flaps, a TDAP and an anterolateral thigh flap or deep inferior epigastric artery perforator (DIEP) flap. The remaining patient received three perforator flaps, two TDAP and an anterolateral thigh flap. Fourteen patients had an improved range of motion after reconstruction. All the flaps survived except in the case of four patients who suffered partial loss of a TDAP flap. In one patient, there was partial skin graft loss at the donor site. The mean follow-up was 17.2 months (range 6-36 months). CONCLUSION Ideal reconstruction of burn scar contracture yielding functional and aesthetic results involves complete removal of scar tissue and reconstruction. Depending on the extent of the defect, the TDAP flap, with its thin and pliable tissue and minimal donor site morbidity, may be the best option for reconstruction of burn scar contracture.
Collapse
Affiliation(s)
- Lan Sook Chang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, South Korea
| |
Collapse
|
10
|
A case of ankle osteoarthritis associated with lateral premalleolar bursitis caused by chronic ankle instability. Int J Surg Case Rep 2021; 80:105671. [PMID: 33676290 PMCID: PMC7933740 DOI: 10.1016/j.ijscr.2021.105671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/20/2022] Open
Abstract
Lateral premalleolar bursitis was caused by check valve mechanism of instability. Bursitis with ankle osteoarthritis was treated with arthroscopic arthrodesis. It is importance to stop the communication between the bursa and ankle joint.
Introduction Lateral premalleolar bursitis develops on the dorsolateral aspect of the foot anterior to the lateral malleolus, distinct from lateral malleolar bursitis located just around the lateral malleolus. Presentation of case A 71-year-old woman visited an orthopedic clinic about 40 years after an episode of ankle sprain and was diagnosed with lateral premalleolar bursitis and osteoarthritis of the left ankle. Stress radiography revealed left ankle anterolateral malleolar bursitis with varus and anterior instability. We opted for less invasive arthroscopic ankle arthrodesis over open resection to stop the communication of the bursitis with the ankle joint. The lateral premalleolar bursitis was located just over the anterolateral portal. The remaining cartilage in the talotibial joint was removed and the subchondral surface was exposed and curetted down to a bleeding surface by ankle arthroscopy. The talotibial joint was fixed with 3 6.0-mm cannulated cancellous screws. The foot and ankle were immobilized by cast for 4 weeks. Bony union was achieved about 8 weeks postoperatively. The patient could perform daily activities without pain and with no recurrence of the lateral premalleolar bursitis at the 1.5-year follow-up. Discussion To our knowledge, this is the first report on arthroscopic arthrodesis for ankle osteoarthritis with recalcitrant lateral premalleolar bursitis caused by the check valve mechanism of chronic ankle instability after old ankle sprain. Conclusion We report a case of arthroscopic arthrodesis for osteoarthritis of the ankle associated with lateral premalleolar bursitis caused by the check valve mechanism of chronic ankle instability after old ankle sprain.
Collapse
|
11
|
Zhang W, Li X, Li X. A systematic review and meta-analysis of perforator flaps in plantar defects: Risk analysis of complications. Int Wound J 2021; 18:525-535. [PMID: 33675188 PMCID: PMC8273610 DOI: 10.1111/iwj.13552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/15/2021] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study was to identify the risk factors for complications of perforator flaps in plantar reconstruction. A systematic review was performed by searching the PubMed, Cochrane Library, MEDLINE, and EMBASE databases from their inception date up to October 2020. Only studies on reconstructing plantar defects with perforator flaps were included, and specific data were required for each patient in the included studies. A total of 14 studies involving 111 flaps were identified and included in the meta‐analysis. Our meta‐analysis identified two risk factors for postoperative complications: flap size over 50 cm2 (risk ratio [RR] = 3.12; P = .02), diabetes mellitus foot (RR = 3.26; P = .03). No significant differences were found regarding heel defects (P = .34), single perforator (P = .57), age older than 60 years (P = .19), chronic aetiology (P = .13), trauma (P = .33), tumour resection (P = .60), ulcer (P = .84), and burn (P = .76). Although more high‐quality studies with adequate sample sizes are needed, this meta‐analysis indicated that flap size over 50 cm2 and diabetes mellitus foot were significant risk factors for postoperative complications of perforator flaps in plantar reconstruction.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinyi Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaojing Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
12
|
Tsuihiji K, Daniel BW, Kageyama T, Sakai H, Fuse Y, Tsukuura R, Yamamoto T. Free tensor fascia lata true-perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol-induced Charcot foot: A case report and literature review. Microsurgery 2021; 41:473-479. [PMID: 33595121 DOI: 10.1002/micr.30724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 01/06/2021] [Accepted: 02/05/2021] [Indexed: 11/07/2022]
Abstract
Charcot foot is can result in bone deformities and soft tissue defects. We report a case of alcohol-induced Charcot (AIC) foot with soft tissue defect including the weight-bearing zone of the heel and osteomyelitis, which was successfully reconstructed with free tensor fascia lata true-perforator flap (TFLtp). A 56-year-old male suffered from AIC foot with an 18 × 6 cm defect. Based on the preoperative ultrasound, we identified the overlying upper thigh area offering one of the thickest dermis. A TFLtp flap was raised sparing the TFL muscle based on one perforator without including the main trunk of the transverse/ascending branch of the lateral femoral circumflex vessel. The TFLtp flap was transferred to the heel and anastomosed to the posterior tibial artery in an end-to-side fashion. The patient complained no postoperative discomfort of the donor site and was able to walk on his foot after 5 weeks. This case report highlights that the TFLtp flap may offer thick dermis, faster surgery due to perforator level dissection and a concealed donor site.
Collapse
Affiliation(s)
- Kanako Tsuihiji
- 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
| | - 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
| | - 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
| |
Collapse
|
13
|
|
14
|
Candy Closure Technique for Chronic Open Infective Lateral Malleolus Bursitis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5490139. [PMID: 31008107 PMCID: PMC6441521 DOI: 10.1155/2019/5490139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 11/17/2022]
Abstract
The aim of this study was to report the effectiveness of the Candy closure technique as a treatment for chronic open infective lateral malleolus bursitis. From June 2014 to March 2018, we performed the Candy closure technique as a treatment for chronic open infective lateral malleolus bursitis in nine patients without secondary operation. We first performed infectious tissue debridement to control infection, and if primary closure was not possible, we performed the Candy closure technique for small wounds. The duration of the wound prior to surgery varied from 4 weeks to 2 years. Seven cases were due to infection on the bursa and two cases were ulcer-type bursitis. All the wounds were small (average, 3.80 cm2; range, 2.25-4 cm2) and circular. Seven wounds showed complete healing at 4 weeks after surgery, one wound showed complete healing at 8 weeks after surgery, and one wound with infected state was lost to missing follow-up. Of the seven wounds that showed complete healing, one wound recurred 6 months after surgery. The Candy closure technique is a simple method for ensuring healing and coverage of chronic open lateral malleolus bursitis, especially for small wounds with dead space.
Collapse
|
15
|
Anatomical Understanding of Target Subcutaneous Tissue Layer for Thinning Procedures in Thoracodorsal Artery Perforator, Superficial Circumflex Iliac Artery Perforator, and Anterolateral Thigh Perforator Flaps. Plast Reconstr Surg 2019; 142:521-534. [PMID: 29889740 DOI: 10.1097/prs.0000000000004619] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thinned perforator flaps, reported techniques, and degree of thinning differ by study. This study investigated the anatomy of subcutaneous tissue according to the varying fattiness and identified which component and how much of the subcutaneous tissue layer needed to be excluded to meet target flap thickness using computed tomography. METHODS Three stratified fattiness groups consisting of 30 donors were formed for thoracodorsal artery perforator, superficial circumflex iliac artery perforator, and anterolateral thigh flaps. Thickness of the superficial fat and the deep fat layers was measured at specific points in donor sites of the three flaps and the proportion of superficial and deep fat layers to exclude to reach the target flap thickness (4, 6, and 8 mm) was calculated. RESULT The median proportion for the superficial fat layer varies depending on donor fattiness. The estimated percentage reduction of thickness after thin flap elevation along superficial fascia was approximately one-third of the whole layer. A variable proportion of each fat layer needs to be excluded to obtain required thinness and in very thick groups, part of the superficial fat layer must be removed to reach any of the target thicknesses for the three flaps. CONCLUSIONS The present study demonstrated the frequent need for superficial fat layer manipulation when obtaining a thin perforator flap. To cope with various combinations of donor-site fattiness and different required thicknesses effectively, an appropriate thinning method should have increased adaptability, including the ability to control superficial fat layer thickness.
Collapse
|
16
|
Lower Extremity Salvage with Thoracodorsal Artery Perforator Free Flap in Condition of Symmetrical Peripheral Gangrene. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6508607. [PMID: 29854775 PMCID: PMC5964422 DOI: 10.1155/2018/6508607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/28/2018] [Accepted: 03/27/2018] [Indexed: 11/18/2022]
Abstract
Symmetrical peripheral gangrene (SPG) is rare but devastating complication which is characterized by symmetrical ischemic change of the distal extremities. In this report, we describe our management protocol for SPG, focusing on surgical approaches. Between January 2007 and February 2016, 10 thoracodorsal artery perforator (TDAP) free flaps were performed in 6 patients with SPG. Three patients were male and mean age was 56 (range, 44-69) years. All the patients were in shock. The causes of shock were sepsis in 4 cases, respiratory arrest in 1 case, and hypovolemia in 1 case. Eight transmetatarsal amputations and 2 Lisfranc amputations were performed. Flap sizes ranged from 7 × 11 cm to 25 × 15 cm. There were 3 cases of partial necrosis of the flap: two healed conservatively with dressings and one required skin graft. Three of the patients were later able to walk independently at Functional Ambulation Classification (FAC) level 6, one patient could walk independently on level surfaces at FAC level 5, and 2 could walk independently using walking aids, classified at FAC level 4. The average follow-up period was 18 (range, 6-54) months. In patients with SPG, minimal bone amputation and foot salvage with TDAP flaps were successful. Separate reconstruction of bone and soft tissue had good outcomes.
Collapse
|
17
|
Sung IH, Jang DW, Kim SW, Kim YH, Kim SW. Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps. Microsurgery 2018; 38:674-681. [DOI: 10.1002/micr.30314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 02/06/2018] [Accepted: 02/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Il Hoon Sung
- Department of Orthopaedic Surgery, College of Medicine; Hanyang University; Seoul Korea
| | - Dong Woo Jang
- Shanghai MK Medical Cosmetic Surgery Clinic; Shanghai China
| | | | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine; Hanyang University; Seoul Korea
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine; Seoul National University, Seoul National University Hospital; Seoul Korea
| |
Collapse
|
18
|
Chou CY, Chiao HY, Wang CY, Sun YS, Lin CT, Dai NT, Chen SG, Chang SC. Functional results of free tissue transfer for complex heel-calcaneal defects. Microsurgery 2017; 38:381-387. [DOI: 10.1002/micr.30253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 08/20/2017] [Accepted: 09/18/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Chang-Yi Chou
- Division of Plastic Surgery, Department of Surgery; Tri-Service General Hospital, National Defense Medical Center; Neihu District, Taipei City Taiwan
- Department of Surgery; Taoyuan Armed Forces General Hospital; Taoyuan City Taiwan
| | - Hao-Yu Chiao
- Division of Plastic Surgery, Department of Surgery; Tri-Service General Hospital, National Defense Medical Center; Neihu District, Taipei City Taiwan
| | - Chi-Yu Wang
- Division of Plastic Surgery, Department of Surgery; Tri-Service General Hospital, National Defense Medical Center; Neihu District, Taipei City Taiwan
| | - Yu-Shan Sun
- Department of Family and Community Health; Tri-Service General Hospital; Taipei City Taiwan
| | - Chin-Ta Lin
- Division of Plastic Surgery, Department of Surgery; Tri-Service General Hospital, National Defense Medical Center; Neihu District, Taipei City Taiwan
| | - Niann-Tzyy Dai
- Division of Plastic Surgery, Department of Surgery; Tri-Service General Hospital, National Defense Medical Center; Neihu District, Taipei City Taiwan
| | - Shyi-Gen Chen
- Division of Plastic Surgery, Department of Surgery; Tri-Service General Hospital, National Defense Medical Center; Neihu District, Taipei City Taiwan
| | - Shun-Cheng Chang
- Division of Plastic Surgery, Department of Surgery; Tri-Service General Hospital, National Defense Medical Center; Neihu District, Taipei City Taiwan
- Division of Plastic Surgery, Department of Surgery, Shuang-Ho Hospital, Department of Surgery, School of Medicine, College of Medicine; Taipei Medical University; Taipei City Taiwan
| |
Collapse
|
19
|
Kim SW, Sung IH, Kim YH. Reconstruction of severe atherosclerotic and obstructive diabetic feet using thoracodorsal artery perforator flaps with long vascular pedicles. Microsurgery 2017; 38:287-294. [DOI: 10.1002/micr.30251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/26/2017] [Accepted: 09/18/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine; Seoul National University, Seoul National University Hospital; Seoul Korea
| | - Il Hoon Sung
- Department of Orthopaedic surgery, College of medicine; Hanyang University; Seoul Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine; Hanyang University; Seoul Korea
| |
Collapse
|
20
|
Woo KJ, Park JW, Mun GH. The lateral calcaneal artery as an alternative recipient vessel option for heel and lateral foot reconstruction. Microsurgery 2017; 38:164-171. [PMID: 28052381 DOI: 10.1002/micr.30148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/01/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Clinical outcomes of consecutive use of the lateral calcaneal artery (LCA) as a recipient vessel for microsurgical reconstruction have not been reported. This study aimed to evaluate the feasibility and safety of the LCA as a recipient vessel for microsurgical foot reconstruction based on anatomical study of CT angiography and clinical results of using this vessel as the recipient. METHODS Anatomic study was performed using CT angiography of 61 lower extremities (31 patients). The emerging point, course, and diameter of the LCA were evaluated using 3-D reconstructed images. The LCA was used as the recipient artery in 17 consecutive patients with a mean age of 59 years (range: 23-77 years). Thoracodorsal artery perforator flap was used in most cases (16 of 17), and clinical outcomes were evaluated. RESULTS The LCA emerged 31.1 ± 9.8 mm proximal and 14.7 ± 5.0 mm posterior to the tip of the fibula and traversed 13.9 ± 2.7 mm posterior to the posterior margin of the lateral malleolus. The accompanying vein was used for venous outflow in five patients and the small saphenous vein was used in the remaining cases. Emergent re-operation was performed in one case due to venous thrombosis, and salvage was successful. All flaps except for one with partial flap necrosis completely survived. During a mean follow-up of 13 months, all but one of the patients were able to wear shoes and walk. CONCLUSIONS The LCA may be safely used as a recipient vessel for microsurgical heel and lateral foot reconstruction. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Kyong-Je Woo
- Department of Plastic Surgery, College of Medicine, Ewha Womans University, Seoul, South Korea.,Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul, 135-710, S. Korea
| | - Jin-Woo Park
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul, 135-710, S. Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul, 135-710, S. Korea
| |
Collapse
|
21
|
Kim EJ, Lee KT, Lim SY, Pyon JK, Bang SI, Oh KS, Mun GH. Reconstructing facial contour deformities using stereoscopic thoracodorsal artery perforator adipofascial flaps. Microsurgery 2015; 37:300-306. [PMID: 26234692 DOI: 10.1002/micr.22462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/28/2015] [Accepted: 07/13/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE Correcting facial contour deformities is a challenge, as it demands thoughtful planning on design, composition of flap, and secondary procedures. The thoracodorsal artery perforator (TDAP) flap has become a workhorse flap for various reconstructions. In this report, we present our experience of reconstructing facial contour deformities using the free TDAP adipofascial flap, focusing on its customized design. PATIENTS AND METHOD Sixteen patients underwent correction of a facial contour deformity with free TDAP adipofascial flaps from 2002 to 2012. The causes of defects were Romberg disease (n = 7), oncological defects (n = 5), craniofacial microsomia (n = 3), and trauma (n = 1). The flaps were three-dimensionally designed in a contour map fashion to have different thickness according to the defects by adjusting the height of adipose tissue and varying tissue composition. Customized dimension of flaps having reliable perfusion were harvested with minimized sacrifice of overlying skin. RESULTS Flap size ranged from 6 × 3 cm to 25 × 25 cm. Six flaps were based on two perforators and the other 10 on one. Five flaps were harvested in a chimeric fashion. All flaps survived completely. No donor morbidity developed in any case. Seven patients underwent secondary corrections including fat injection or liposuction. Improved contour and symmetry were achieved in all patients and was confirmed by a photographic evaluation. Mean follow-up period was 37.8months. CONCLUSIONS Our results suggest that the stereoscopic TDAP adipofascial flaps with diligent secondary approaches may be a reliable alternative for aesthetic reconstruction of facial contour deformities. © 2015 Wiley Periodicals, Inc. Microsurgery 37:300-306, 2017.
Collapse
Affiliation(s)
- Eun-Ji Kim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - So-Young Lim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jai-Kyung Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sa-Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kap Sung Oh
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|