1
|
Tang L, Zhou X, Huang S, Huang T. Reconstruction of the extensor tendon on the dorsal pedis with a chimeric skin-aponeurosis flap from the groin region. Injury 2024; 55:111660. [PMID: 38875897 DOI: 10.1016/j.injury.2024.111660] [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: 03/12/2024] [Revised: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Complex defects involving the extensor tendon on the dorsal pedis have been reconstructed using multiple procedures. Skin coverage and tendon transfers have also been performed. This study aimed to present our experience using a chimeric skin-aponeurosis flap for one-stage reconstruction of composite soft-tissue defects on the dorsal pedis. METHODS Between May 2017 and September 2020, 12 patients with these defects received total treatment using a chimeric groin flap. Based on the superficial circumflex iliac vessels, the skin paddle resurfaced the cutaneous defect, and the vascularised external oblique aponeurosis was rolled to form a tendon-like structure to simultaneously replace the absent segment of the extensor tendons. A suitable "Y" bifurcation was dissected to enlarge the vessel diameter. Single-stage reconstruction was performed using a set of vascular anastomoses at the recipient site. RESULTS Flap survival was achieved without significant complications. The hammertoe deformity was completely removed. The average dimension of the skin paddle was 8.0 × 13.0 cm (range, 6.5 × 11.0-10.0 × 14.0 cm), and the mean size of the aponeurosis was 8.0 × 4.0 cm (range, 6.0 × 3.0-10.0 × 5.0 cm). At the last follow-up visit, no morbidity was observed at the donor site. Natural shapes and walking functions were successfully achieved with a protective sensation. CONCLUSION The chimeric groin flap with sheets of external oblique aponeurosis is a great candidate for one-stage reconstruction of composite soft tissue loss on the dorsal pedis. This approach provides cosmetic coverage, allowing faster wound healing and reduced tendon adhesions.
Collapse
Affiliation(s)
- Lin Tang
- Department of Orthopedic of Jiangbei Campus, The First Affiliated Hospital of Army Medical University, Chongqing, 400020, PR China
| | - Xin Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital of Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, China
| | - Shuqing Huang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital of Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, China
| | - Tianyu Huang
- Department of Orthopedic, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Chunhui Avenue, Longma Tan District, Luzhou, 646000, China.
| |
Collapse
|
2
|
Ma L, Song JJ, Cui ZN, Niu ZY, Tian SB, Liu M, Wang M, Zhang RP. Application of flow-through flaps for replantation after traumatic limb amputation according to the angiosome concept. Clin Hemorheol Microcirc 2024:CH242179. [PMID: 39058441 DOI: 10.3233/ch-242179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
OBJECTIVE This study was performed to explore the treatment of the injury caused by traumatic limb amputation. METHODS From October 2002 to October 2021, 30 cases were enrolled in the present study. The reasons for injury were as follows: 8 cases with single hydraulic column crush injury, 12 cases with gear and wire rope stranding, 6 cases with belt avulsion injury, and 4 cases with carbon block smash injury. The present study application of a free or small saphenous vein bypass to reconstruct the injured artery and vein according to the concept of the angiosome model. The defective vessels were bridged with the axial vessels of a flow-through flap, such as a medial calf flap or anterolateral femoral flap, to construct an additional blood supply and drainage vein for the severed limb. The clinical data of 30 cases with traumatic limb amputation of the lower leg and ankle were retrospectively analyzed. RESULTS In all 30 cases of traumatic limb amputation, the replantation via the adoption of a flow-through flap was successful, and 85.6% of the patients remained in good postoperative condition. There were no symptoms of ischemia in the marginal segment after blood supply reconstruction of the transected limb by axial vascular bridging within the flap. CONCLUSION Via the adoption of microsurgical techniques, the blood supply to the transected limb can be reconstructed by bridging the defective vessels with the adoption of the axial vessels of the flow-through flap is a feasible and advanced treatment option.
Collapse
Affiliation(s)
- Lin Ma
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Jun-Jie Song
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Zhong-Ning Cui
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Zhi-Yong Niu
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Shao-Bin Tian
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Ming Liu
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Min Wang
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| | - Rong-Ping Zhang
- Department of Orthopedics, Jincheng General Hospital, Jincheng, China
| |
Collapse
|
3
|
Sơn TT, Dung PTV, Thúy TTH, Nghĩa PT, Chiến VH. Using Free Chimeric Anterolateral Thigh Flap For Reconstruction Of Composite Dorsal Hand Defect. JPRAS Open 2024; 39:106-113. [PMID: 38186380 PMCID: PMC10767008 DOI: 10.1016/j.jpra.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/18/2023] [Indexed: 01/09/2024] Open
Abstract
Background Simultaneous repair of the extensor tendons and soft tissues in hand injuries remains challenging. The free chimeric anterolateral thigh (ALT) flap with fascia lata (FL) flap represents an alternative for hand reconstruction. This report describes the reconstruction of the extensor tendon and skin defects using free chimeric ALT flaps with FL. Methods Eight patients (one female and seven male) underwent reconstruction of complex hand defects with free chimeric ALT and FL flaps. The defects were caused by crushing injuries, burns, snakebite scars, and animal bite wounds. The average skin defect was 116 cm2. Perforators were selected for the skin paddle and the FL flap. The thinning procedure was performed microsurgically. Results The skin paddle size ranged from 12 to 23 cm in length and 6 to 11 cm in width, and the FL flaps ranged from 3 × 5 to 12 × 5 cm. The mean pedicle length was 7.88 cm. Nine extensor tendons were repaired with FL flaps. The flap thickness after thinning was only 3-6 mm. The donor site was closed primarily in six patients, and skin grafts were used in two cases. All flaps survived without complications. The follow-up period lasted from 17 to 80 months. Range of motion was achieved with satisfaction. Conclusion The chimeric-thinned ALT and FL flap is a valuable material, and it should be considered a reconstructive option for hand soft tissue and extensor tendon reconstruction. This technique allows us to achieve a good appearance and extensor function without donor-site morbidity.
Collapse
Affiliation(s)
- Trần Thiết Sơn
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Plastic Surgery, Saint Paul Hospital, Hanoi, Vietnam
- Department of Plastic and Aesthetic Surgery, University of Medicine and Pharmacy, Vietnam National University
| | - Phạm Thị Việt Dung
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Plastic Surgery, Saint Paul Hospital, Hanoi, Vietnam
| | - Tạ Thị Hồng Thúy
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Plastic Surgery, Saint Paul Hospital, Hanoi, Vietnam
| | - Phan Tuấn Nghĩa
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Vũ Hồng Chiến
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Plastic Surgery, Saint Paul Hospital, Hanoi, Vietnam
| |
Collapse
|
4
|
Ahmed Z, Cook H, Anadkat M, Ioannidi L, Marmery H, Nikkhah D. ALT in combination with triple-rolled TFL for reconstruction of a complex tendoachilles defect: technical details and rehabilitation regime. BMJ Case Rep 2024; 17:e258355. [PMID: 38296509 PMCID: PMC10831452 DOI: 10.1136/bcr-2023-258355] [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] [Indexed: 02/05/2024] Open
Abstract
A fit man in his 60s presented with an infected Achilles tendon (AT) following two failed repairs for a traumatic rupture. Initial debridement of necrotic tissue resulted in a large soft tissue defect requiring robust coverage. Following aggressive wound management, an anterolateral thigh flap was elevated with tensor fasciae latae (TFL) which was triple-rolled to provide soft tissue coverage and tendon reconstruction.The flap remained healthy and was monitored with a flow coupler device. Initially, the foot was placed in plantarflexion before gradually increasing the angle to neutral and a thermoplastic splint was used to offload pressure on the flap. Following 1 month of non-weight-bearing, gentle mobilisation began. Three months postoperatively, the patient could walk, had resumed indoor cycling and demonstrated a comparable heel raise with the contralateral side. MRI showed a taut TFL attached to the distal AT and ultrasound showed a smoothly gliding TFL.
Collapse
Affiliation(s)
- Zahra Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Hannah Cook
- Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Meera Anadkat
- Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Lydia Ioannidi
- Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| | | | - Dariush Nikkhah
- Division of Surgery and Interventional Science, University College London, London, UK
- Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Cho K, Kang J, Eun S. Various soft tissue defect reconstructions using anterolateral thigh and vascularized fascia lata composite free flap. Medicine (Baltimore) 2023; 102:e36578. [PMID: 38115317 PMCID: PMC10727578 DOI: 10.1097/md.0000000000036578] [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: 07/07/2023] [Revised: 11/04/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
The anterolateral thigh flap (ALT) is versatile for soft-tissue reconstruction of various body defects because of its thick and vascularized fascia component. We present our clinical experience with the functional one-stage reconstruction of complicated soft-tissue defects using ALTs with vascularized fascia lata (FL). Between April 2018 and February 2022, we transferred ALTs with FL components for various soft-tissue defects in 15 patients. The FL component was used for reconstruction of hand & forearm tendon, medial and lateral patellar synovial membrane, plantar aponeurosis, abdominal wall, dura and Achilles tendon. Functional outcomes were evaluated in each patient. Partial flap necrosis occurred in 2 patients and were treated successfully with minimal surgical debridement and dressing. The vascularized fascia could replace a tendon and fascial component and all the patients achieved satisfactory results without major postoperative complications. Anterolateral thigh flaps with vascularized FL provide reliable fascial and tendon components for single-stage reconstruction of complex soft tissue defects.
Collapse
Affiliation(s)
- Kyusang Cho
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Jiwon Kang
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Seokchan Eun
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| |
Collapse
|