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Scaglioni MF, Meroni M, Fuchs B. Combination of four pedicled flaps for multilayer reconstruction of massive pelvic defect: A case report. Microsurgery 2023; 43:842-846. [PMID: 37088915 DOI: 10.1002/micr.31051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/01/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
Tumors affecting the perineal region are a subtle and difficult to diagnose type of malignancy. In particular, soft tissue sarcomas (STS) may be already very large at time of diagnosis, thus impairing a normal life. In such severe cases, debulking surgery is the only possibility to offer the patient an acceptable quality of life again. These procedures inevitably result in massive defects. Depending on the affected area, there are different reconstructive options available so far, and sometimes a combination of multiple flaps is required. With the present report, we would like to share our experience with a complex genital and perineal defect. A 75-year-old patient presenting a massive epithelioid sarcoma in the ischio-rectal and anal fossae underwent a surgical excision with safe margins, which included the resection of the external genitalia, the pubis, and the rectum. The end result of this procedure was a massive defect measuring 31 cm (length) × 8 cm (width) × 6 cm (depth). To accomplish the requirements of this particular case we planned to utilize mostly the nearby tissues. The reconstruction was performed layer by layer. We resorted to a pedicled chimeric anterolateral thigh (ALT) flap measuring 8 cm × 6 cm, with a large amount of the vastus lateralis (20 cm × 8 cm) to fill the deeper defect, and a duplicated fascia lata (20 cm × 6 cm) to restore the abdominal support of the pubis. Then the external coverage was completed combining a pedicled superficial circumflex (SCIP) flap measuring 9 cm × 8 cm, a pedicled gracilis flap measuring 27 cm × 4 cm and a pedicled posteromedial thigh (PMT) flap measuring 22 cm × 8 cm harvested in vertical fashion. The postoperative course was uneventful, and at 6 months follow up the reconstructive result was successful with a stable soft tissue coverage and no complaints from the patient. With the present case report, we would like to show the importance of mastering different reconstructive procedures, whose combination might be the only solution to cover very large and complex defects.
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Affiliation(s)
- Mario F Scaglioni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matteo Meroni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bruno Fuchs
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Orthopedic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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Kwon HJ, Seo JH, Choi JY, Seo BF, Kwon H, Jung SN. Propeller posteromedial thigh perforator flaps for coverage of extensive perineal defects. Microsurgery 2021; 41:335-340. [PMID: 33675678 DOI: 10.1002/micr.30726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/08/2021] [Accepted: 02/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Reconstruction of perineal defect is challenging. The goal of reconstruction is to maintain normal function with good esthetic outcomes. Coverage of the perineal defect is often difficult with one loco-regional flap when the size of defect is very extensive. In this article, clinical applications of the propeller posteromedial thigh perforator (PMTP) flap for extensive perineal defects were described. PATIENTS AND METHODS Eight patients underwent perineal reconstruction with propeller PMTP flaps from March 2013 to December 2018. The average age of the patients was 65 years (range: 52-80 years). The causes of the defects included infection and skin cancers. The perforator was a branch of deep femoral artery. The flap was harvested as a perforator-based flap and rotated 180° to the defect area (propeller flap design). RESULTS The average flap size was 256.5 cm2 (range: 136-400 cm2 ) and average follow-up period was 22.4 months (range: 6-48 months). All flaps survived after surgery without major complications. The donor sites were all primarily closed and the patients were all satisfied during the follow-up period. CONCLUSION The propeller PMTP flap is an adequate new option for reconstructing extensive perineal defects. The flap avoids the need for microanastomosis and replaces the defect with similar tissue.
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Affiliation(s)
- Hyo Jeong Kwon
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jeong Hwa Seo
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong Yun Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Bommie Florence Seo
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ho Kwon
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-No Jung
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Assi H, Persson A, Palmquist I, Öberg M, Buchwald P, Lydrup ML. Sexual and functional long-term outcomes following advanced pelvic cancer and reconstruction using vertical rectus abdominis myocutaneous and gluteal myocutaneous flap. Eur J Surg Oncol 2020; 47:858-865. [PMID: 33008672 DOI: 10.1016/j.ejso.2020.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 08/13/2020] [Accepted: 09/21/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION After extensive pelvic surgery for cancer two flap types are used at Skåne University Hospital (SUS), Sweden for perineal reconstruction: vertical rectus abdominis myocutaneous flap and gluteal flap with or without vaginal reconstruction. The objective was to study the long-term outcomes in patients treated for advanced pelvic cancer receiving a flap. METHOD Patients with pelvic cancer subjected to surgery including perineal reconstruction between January 2010 and August 2016 at SUS were included retrospectively. Participating patients were scheduled for an out-patient visit. Questionnaires addressing quality of life, (QLQ-C30 and EQ-5D) and sexual function (FSFI and IIEF) were filled in. Sensitivity test, using monofilaments on the gluteal/posterior thigh area, neovaginal measurements using silicon gauges and muscular functionality tests (timed stands test and stairs test) were performed. RESULTS Thirty-six (24 women, 12 males) out of 71 invited patients conceded participation. Patients scored a median of 85/100 regarding global health using EQ-5D. All women reported sexual dysfunction and 75% (9/12) of men reported severe erectile dysfunction. Neovaginal measurements showed adequate reconstructions. Sensitivity test implied decreased sensitivity on the operated side compared to the unoperated side in patients with gluteal flap. Both physical tests demonstrated adequate muscular functionality in everyday life activities after reconstructions using gluteal flap. CONCLUSION This long-term follow up after extensive surgery treating pelvic cancer with perineal flap reconstruction implies high quality of life, good muscular functionality and adequate neovaginal measurements. However sexual function is impaired among both sexes and sensitivity in the surgical area of the gluteal flap is decreased.
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Affiliation(s)
- Hanin Assi
- Department of AT/ST, Skåne University Hospital, Malmö, Lund University, Sweden.
| | - Anna Persson
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Ingrid Palmquist
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Martin Öberg
- Department of Plastic Surgery, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Marie-Louise Lydrup
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Sweden
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Pignatti M, Ogawa R, Mateev M, Georgescu AV, Balakrishnan G, Ono S, Cubison T, Pinto V, D'Arpa S, Koshima I, Hyakusoku H, Hallock GG. Our Definition of Propeller Flaps and Their Classification. Semin Plast Surg 2020; 34:139-144. [PMID: 33041682 PMCID: PMC7542214 DOI: 10.1055/s-0040-1715158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The term propeller flap was introduced for the first time by Hyakusoku to define an island flap, based on a subcutaneous pedicle hub, that was rotated 90 degrees to correct scar contractures due to burns. With the popularization of perforator flaps, the propeller movement was applied for the first time to a skin island vascularized only by an isolated perforator, and the terms propeller and perforator flap were used together. Thereafter, the surgical technique of propeller flaps evolved and new applications developed. With the "Tokyo consensus," we proposed a definition and a classification schema for propeller flaps. A propeller flap was defined as an "island flap that reaches the recipient site through an axial rotation." The classification included the SPP (SPP) flap, the perforator pedicled propeller (PPP) flap, and the supercharged PPP (SCP) flap. A recent update added a new category, the axial pedicled propeller (APP) flap. Here we propose our updated and comprehensive classification of propeller flaps, taking into account the previous classification and subsequent publications. Based on their vascular pedicle, we consider the following five types of propellers: (1) SPP flap, 2.PPP flap, its subtype (2a) SCP flap, (3) APP flap, (4) muscle propeller flap, and (5) chimeric propeller flap. The variables that can be taken into account in the classification are as follows: type of nourishing pedicle, degrees of skin island rotation, position of the nourishing pedicle, artery of origin of the pedicle, and flap shape.
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Affiliation(s)
- Marco Pignatti
- Department of Plastic Surgery, Policlinico di Sant'Orsola - DIMES, University of Bologna, Bologna, Italy
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Musa Mateev
- Department of Plastic Surgery, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Alexandru V. Georgescu
- Department of Plastic Surgery and Reconstructive Microsurgery, Clinical Hospital of Rehabilitation, University of Medicine Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Govindasamy Balakrishnan
- Plastic, Hand & Microvascular Surgery, Right Hospitals, Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
| | - Shimpei Ono
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Tania Cubison
- Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Valentina Pinto
- Department of Plastic Surgery, Policlinico di Sant'Orsola - DIMES, University of Bologna, Bologna, Italy
| | - Salvatore D'Arpa
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences (DICHIORONS), University of Palermo, Palermo, Italy
| | - Isao Koshima
- International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiko Hyakusoku
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Geoffrey G. Hallock
- Division of Plastic Surgery, Sacred Heart Campus, St. Luke's Hospital, Allentown, Pennsylvania
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