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Dong ETC, Martineau J, Kalbermatten DF, Oranges CM. Indications, Postoperative Outcomes, and Complications of the Lateral Arm Free Flap: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6247. [PMID: 39399810 PMCID: PMC11469903 DOI: 10.1097/gox.0000000000006247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/29/2024] [Indexed: 10/15/2024]
Abstract
Background The lateral arm free flap (LA-FF) has become an increasingly popular choice in the reconstruction of soft tissue defect in many anatomical regions. However, there is a paucity of literature regarding its safety and efficacy. The aim of this study is to analyze its different applications along with their surgical outcomes. Methods A systematic review including all studies assessing the surgical outcomes of the LA-FF and proportional meta-analysis using a random-effect DerSimonian-Laird model was performed to assess the postsurgical complications and flap failures. Results Twenty-five articles were included in the final analysis, representing a total of 1272 flaps in 1256 patients. Indications were mainly defects following tumoral resection and trauma. Across the different studies, the reported flap size range varied from 2 × 4 cm to 12 × 16 cm. The overall pooled flap failure rate across all indications was 3% [95% confidence interval (CI), 0.01-0.04], with a pooled failure rate of 2% (95% CI, 0.01-0.04) in the head and neck region, 3% (95% CI, 0.01-0.06) in the upper limb region, and 3% (95% CI, 0.01-0.06) in studies evaluating its use in different anatomical locations. The overall donor site complication rate was 11% (95% CI, 0.03-0.21), with no major complications described. Conclusions This meta-analysis demonstrates safety and efficacy of the LA-FF in reconstructing moderate to large soft tissue defects. It is mainly used for head and neck posttumoral resection and upper and lower limb posttraumatic reconstruction.
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Affiliation(s)
- Edward T C Dong
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - Jérôme Martineau
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - Daniel F Kalbermatten
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - Carlo M Oranges
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
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Xiong Y, Xiong Q, Qing LM, Wu PF, Tang JY, Yu F. Special-form radial collateral artery perforator flaps for the reconstruction of complex hand defects. J Orthop Surg Res 2024; 19:533. [PMID: 39218944 PMCID: PMC11367745 DOI: 10.1186/s13018-024-05024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications. METHODS From June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases. RESULTS Altogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps. CONCLUSIONS The free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.
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Affiliation(s)
- Yu Xiong
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410000, China
| | - Qin Xiong
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410000, China
| | - Li-Ming Qing
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410000, China
| | - Pan-Feng Wu
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410000, China
| | - Ju-Yu Tang
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410000, China
| | - Fang Yu
- Department of Hand and Microsurgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410000, China.
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Tweel M, Dow T, Greene B, Leblanc M. Anatomy, surgical techniques, and clinical outcomes for the medial arm flap: A systematic review. J Plast Reconstr Aesthet Surg 2024; 92:130-144. [PMID: 38518625 DOI: 10.1016/j.bjps.2024.02.060] [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: 11/22/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND The medial arm flap (MAF) has been used as a pedicle flap and free flap to reconstruct various deformities, including those of the head and neck, axilla, elbow, chest, and hand. This study reviews the anatomy of the flap, the technique of flap harvest, its clinical applications, and a systematic review of the current published literature. METHODS An online systematic review of MEDLINE, EMBASE, PubMed, and The Cochrane Library from inception to September 30, 2023, was completed. Studies that investigate the anatomy, technique or clinical outcomes of medial arm flaps were included. Clinical data extracted includes patient, defect, flap characteristics, complications, and take-back procedures. Anatomic data extracted includes anatomical variations, and vascular characteristics and patterns. RESULTS Between 1980 and 2023, 50 papers were published outlining the medial arm flap. Anatomic studies detail the anatomy of 384 medial arms, and outcomes are reported for 283 MAFs (75 free flaps and 208 pedicle flaps). The superior ulnar collateral artery is most commonly cited as the dominant arterial supply to the middle third of the medial arm. The majority of patients required reconstruction post-burn (39.2%), trauma (17.7%), and tumor excision (12.4%). MAFs were mostly used to reconstruct defects of the head and neck (41.7%), the hand and wrist (21.9%), and the elbow (16.3%). Eleven flaps (4.1%) suffered partial flap failure, and two flaps (0.7%) suffered total flap failure. CONCLUSION This manuscript demonstrates that the MAF is a reliable and underutilized flap option with a well-hidden donor scar and a low complication rate.
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Affiliation(s)
- Madeline Tweel
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd Dow
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Bradley Greene
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Leblanc
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Hollins AW, Mithani SK. Advances in Soft Tissue Injuries Associated with Open Fractures. Hand Clin 2023; 39:605-616. [PMID: 37827613 DOI: 10.1016/j.hcl.2023.05.008] [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] [Indexed: 10/14/2023]
Abstract
Management of soft tissue injury is a key component in the overall treatment of upper extremity fractures. Hand surgeons must rely on their armamentarium for treating soft tissue deficits for functional outcomes. Understanding the role of fracture fixation and wound adjuncts, including negative pressure wound therapy and dermal regenerative templates, is the keys to success. In addition, detailed knowledge of local and free tissue options is essential for hand reconstruction.
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Affiliation(s)
- Andrew W Hollins
- Division of Plastic Surgery, Department of Surgery, Duke University Medical Center, Box 3974 Duke Medical Center, Durham, NC 27710, USA
| | - Suhail K Mithani
- Division of Plastic Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27705, USA.
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Xu H, Guo L, Wang X, Pan J. An Updated Surgical Approach of Using Flap and Cutaneous Nerve in the Lateral Arm to Reconstruct Complex Injuries of the Forearm and Hand: A Case Series Study. Ann Plast Surg 2023; 91:468-472. [PMID: 37556581 DOI: 10.1097/sap.0000000000003649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Complex injuries involving the nerves and other soft tissues in the forearm and hand lead to functional and aesthetic defects. In such situations, multiple types of nerve autografts and flap donor sites are available. However, multiple donor sites cause donor morbidity in different locations and may lead to awkward operational positions. Therefore, based on the anatomical characterization, we aimed to modify the utilization of the lateral arm donor site for reconstruction, which restricts donor morbidity in the affected upper extremity. METHODS We report a case series (N = 6) using a lateral arm flap (LAF) to reconstruct complex soft tissue defects in the forearm, palm, and finger. The posterior antebrachial cutaneous nerve (PACN) is the primary option for nerve bridging, whereas the LAF can carry the lower lateral brachial cutaneous nerve (LBCN) as a sensory flap. Once the PACN was insufficient, the LBCN was harvested simultaneously. All the cases included in this study were performed between January 2012 and August 2021. Demographic information, flap and nerve characteristics, complications, and hand function were analyzed. RESULTS The LAF plus PACN or plus LBCN as nerve autograft, both successfully repaired 6 complex injuries: 2 cases in the forearm side, 1 in the hand palm, and 3 in the finger defects. Posterior antebrachial cutaneous nerve was the most used (8-15 cm), and LBCN plus PACN was used to bridge nerve defects when necessary (in total, 20 and 21 cm). The average follow-up time was 19.7 months. The disabilities of the arm, shoulder and hand score ranged between 6 and 12, and the mean 2-point discrimination values ranged between 6 and 12. The Semmes-Weinstein monofilament test result was under 5.46. In addition, 2 patients underwent a secondary debulking surgery. The average length of hospital stay was 10.4 days. Hematoma occurred in 2 cases, and all patients reported numbness in the donor nerve innervated areas. CONCLUSIONS This surgical refinement can reconstruct complex injuries in the forearm and hand. In addition, this approach restricts donor morbidity in the affected limb, comforts the operational position, and is achieved under brachial plexus anesthesia.
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Affiliation(s)
- Heng Xu
- From the Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Linxiumei Guo
- From the Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Xin Wang
- Department of Hand Surgery, Ningbo Sixth Hospital, Zhejiang, China
| | - Jiadong Pan
- Department of Hand Surgery, Ningbo Sixth Hospital, Zhejiang, China
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Martin J, Taqatqeh F, Dragu A, Notov D, Fritzsche H, Grigorescu O, Bota O. Thumb reconstruction after radical tumor resection using free osteocutaneous lateral arm flap with secondary humerus fracture-a case report. Arch Orthop Trauma Surg 2023; 143:1725-1729. [PMID: 36151479 PMCID: PMC9957847 DOI: 10.1007/s00402-022-04623-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/11/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Malignant diseases with infiltration of bony structures in the area of the phalanges or metacarpals require either amputation or complex reconstruction. The decision for reconstruction means to restore length, mobility, sensibility, stability as well as aesthetics. METHODS We present a case of complex first ray reconstruction of the left hand using a free osteocutaneous lateral arm flap from the ipsilateral side. The reconstruction was performed after radical resection of an exulcerated squamous cell carcinoma, including the first metacarpal bone, trapezium, partial trapezoid and distal scaphoid as well as partial resection of the extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus and flexor carpi radialis tendons. The osteosynthetic restoration was achieved distally by a double wire cerclage and a proximally by temporary K-wire suspension. Moreover, to reconstruct the extensor pollicis longus tendon the ipsilateral palmaris longus tendon was harvested and used. Postoperatively, a secondary humerus fracture occurred, which was initially attended by plate osteosynthesis. The fracture showed delayed healing, which was treated by re-plating and autologous cancellous bone. RESULTS 12 months postoperatively, the patient showed an excellent outcome with length preservation and good range of motion, sensibility, stability and aesthetic of the thumb. Furthermore, the quarterly tumor aftercare showed no evidence of recurrence. CONCLUSION This case report showed that the free osteocutaneous lateral arm flap is a reliable solution for the reconstruction of the first ray with a great functional and aesthetic outcome. To prevent a secondary humerus fracture, a preventive plate osteosynthesis simultaneous with the osteocutaneous flap elevation should be considered.
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Affiliation(s)
- Judy Martin
- Faculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic Surgery, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Feras Taqatqeh
- grid.4488.00000 0001 2111 7257Faculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic Surgery, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Adrian Dragu
- grid.4488.00000 0001 2111 7257Faculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic Surgery, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Dmitry Notov
- grid.4488.00000 0001 2111 7257Faculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic Surgery, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Hagen Fritzsche
- grid.4488.00000 0001 2111 7257Faculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic Surgery, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Oana Grigorescu
- grid.4488.00000 0001 2111 7257Faculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic Surgery, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Olimpiu Bota
- grid.4488.00000 0001 2111 7257Faculty of Medicine Carl Gustav Carus, University Center for Orthopedics, Trauma and Plastic Surgery, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
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Bertelli JA, Goklani MS, Patel N, Duarte ECW. Triceps and cutaneous radial nerve branches investigated via an axillary anterior arm approach: new findings in a fresh-cadaver anatomical study. J Neurosurg 2022; 136:1424-1433. [PMID: 34624848 DOI: 10.3171/2021.4.jns2169] [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: 01/10/2021] [Accepted: 04/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to describe the anatomy of the radial nerve and its branches when exposed through an axillary anterior arm approach. METHODS Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. RESULTS Via the anterior arm approach, all triceps muscle heads could be dissected and individualized. The radial nerve overlaid the latissimus dorsi tendon, bounded by the axillar artery on its superior surface, then passed around the humerus, together with the lower lateral arm and posterior antebrachial cutaneous nerve, between the lateral and medial heads of the triceps. No triceps motor branch accompanied the radial nerve's trajectory. Over the latissimus dorsi tendon, an antero-inferior bundle, containing all radial nerve branches to the triceps, was consistently observed. In the majority of the dissections, a single branch to the long head and dual innervations for the lateral and medial heads were observed. The triceps long and proximal lateral head branches entered the triceps muscle close to the latissimus dorsi tendon. The second branch to the lateral head stemmed from the triceps lower head motor branch. The triceps medial head was innervated by the upper medial head motor branch, which followed the ulnar nerve to enter the medial head on its anterior surface. The distal branch to the triceps medial head also originated near the distal border of the latissimus dorsi tendon. After a short trajectory, a branch went out that penetrated the medial head on its posterior surface. The triceps lower medial head motor branch ended in the anconeus muscle, after traveling inside the triceps medial head. The lower lateral arm and posterior antebrachial cutaneous nerve followed the radial nerve within the torsion canal. The lower lateral brachial cutaneous nerve innervated the skin over the biceps, while the posterior antebrachial cutaneous nerve innervated the skin over the lateral epicondyle and posterior surface of the forearm. The average numbers of myelinated fibers were 926 in the long and 439 in the upper lateral head and 658 in the upper and 1137 in the lower medial head motor branches. CONCLUSIONS The new understanding of radial nerve anatomy delineated in this study should aid surgeons during reconstructive surgery to treat upper-limb paralysis.
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Affiliation(s)
- Jayme A Bertelli
- 1Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil
| | - Mayur Sureshlal Goklani
- 2Department of Plastic Surgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India
| | - Neehar Patel
- 3Department of Plastic Surgery, Wockhardt Hospital, The Umrao IMSR, Mumbai, Maharashtra, India; and
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8
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Scaglioni MF, Meroni M, Knobe M, Fritsche E. Versatility of perforator flaps for lower extremity defect coverage: Technical highlights and single center experience with 87 consecutive cases. Microsurgery 2022; 42:548-556. [PMID: 35475523 DOI: 10.1002/micr.30892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/09/2022] [Accepted: 04/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lower extremity defects have been and remain one of the greatest challenges in reconstructive surgery. Perforator flaps have been accepted as a valid procedure to cover such a defect. Different techniques have been described and nowadays many options are available. However, there were not studies that comprehensively review the most modern techniques and clinical application of the use of perforator flaps in the lower extremity reconstruction. In the present report, we gathered most of them, presenting an updated and large case series where different pedicled and free perforators flaps were employed in simple and complex scenarios in a large series of cases. PATIENTS AND METHODS Eighty-seven patients presenting soft tissue defects of the lower extremities were treated by means of different perforator-based flaps, in either free or pedicled fashion. The flaps were based on different perforator vessels, namely deep lateral circumflex femoral artery, profunda femoris artery, superficial femoral artery, medial sural artery, peroneal artery, posterior tibial artery, anterior tibial artery, and medial plantar artery. Patients' mean age was 61.9 years old (range 21-87 years old), 58 were males and 29 females. The 12 patients received sequential flaps and 9 received double free flaps, for a total sum of 106 flaps. The causes of the defects were trauma in 41 patients and tumors in 46 patients, located throughout the lower limbs. Size of the defect ranged from 3 cm × 4 cm to 25 cm × 9 cm. RESULTS The dimensions of the flap skin paddles ranged from 3 cm × 4 cm to 16 cm × 5 cm for the pedicled flaps (42 cases) and from 6 cm × 4 cm to 25 cm × 8 cm for the free ones (45 cases). Mean flap's size was 48 cm2 (range 12-80 cm2 ) for the pedicle flaps and 104 cm2 (range 24-200 cm2 ) for free flaps. In two pedicled cases, a distal congestion was encountered, requiring a second surgery. Debulking procedures were performed in 2 patients. All the patients were successfully treated and no flaps were lost. Mean follow-up period was 8.4 months (range 3-12 months). No range of motion impairment was encountered after surgery and all the patients were able to return to habitual life. CONCLUSIONS The present case series highlights the reliability and versatility of perforator flaps for lower extremity defect coverage. Following careful consideration of the etiology, dimensions, location, patient comorbidities, and presence of adequate perforators, a pedicled or free perforator flap can be potentially successful in the most disparate circumstances.
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Affiliation(s)
- Mario F Scaglioni
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matteo Meroni
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Knobe
- Department of Orthopedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Elmar Fritsche
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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9
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Horen SR, Hamidian Jahromi A, Konofaos P. Temporoparietal Fascial Free Flap: A Systematic Review. Ann Plast Surg 2021; 87:e189-e200. [PMID: 34387574 DOI: 10.1097/sap.0000000000002961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The temporoparietal fascial flap (TPFF) is a versatile tool used in head and neck reconstructive surgeries as well as distal upper and lower extremity reconstructions. Depending on the anatomical location and characteristics of the recipient site soft tissue defects, harvesting techniques for TPFF retrieval may include elevation as a pedicle or a free flap, inclusion of the temporalis muscle and/or adjacent calvarial bone as a composite flap. The TPFF as a free flap is not only used for soft tissue coverage of various defects, and it can be used as a joint gliding surface with coverage of nerve and tendons after repair or trauma. This article includes a systematic search of the medical literature for indications, historical background, techniques, current perspective, and complications along with the pros and cons of the free TPFF compared with other potential reconstructive options.
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Affiliation(s)
- Sydney R Horen
- From the Department of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Alireza Hamidian Jahromi
- From the Department of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Petros Konofaos
- Department of Plastic Surgery, University of Tennessee Health Science Center (UTHSC), Memphis, TN
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Moysich H, Jehn P, Zimmerer RM, Gellrich NC, Lentge F, Tavassol F. Reduction in perioperative blood loss using ultrasound-activated scissors during tumour surgery. Int J Oral Maxillofac Surg 2021; 51:1115-1122. [PMID: 34815167 DOI: 10.1016/j.ijom.2021.11.004] [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: 04/08/2021] [Revised: 09/01/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022]
Abstract
The aim of this study was to compare the effectiveness of Harmonic Focus+ scissors with the conventional surgical method regarding surgical blood loss and transfusion of blood products in the surgical treatment of head and neck tumours. In a retrospective study, the intraoperative blood loss, number of units of transfusion products given, operating time, and inpatient length of stay of 74 patients with squamous cell carcinoma were compared. Patients who underwent classic tumour surgery were compared with a group treated with Harmonic Focus+ scissors. A significantly lower intraoperative blood loss (496.15 ml vs 1096.0 ml, respectively; P = 0.002) and shorter operation time (436.89 minutes vs 493.13 minutes, respectively; P = 0.030) were achieved using the Harmonic Focus+ scissors when compared to the classic tumour surgery. Additionally, fewer units of blood products needed to be transfused (administration of red cell concentrates, P < 0.001) and the length of stay in the intensive care unit was shorter for patients treated with the Harmonic Focus+ scissors (P = 0.009). The study results indicate that the use of Harmonic Focus+ scissors during surgery for cancer of the oral cavity and pharynx is a safe and cost-effective method. This is of paramount importance during a pandemic when medical resources are scarce, including access to blood reserves.
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Affiliation(s)
- H Moysich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - P Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - R M Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - N-C Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - F Lentge
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - F Tavassol
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
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11
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Reconstruction of Foot and Ankle Defects Using Free Lateral Arm Flap: A Retrospective Review of Its Versatile Application. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4128827. [PMID: 34754880 PMCID: PMC8572601 DOI: 10.1155/2021/4128827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/14/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
Background Successful reconstruction of the feet and ankles remains challenging due to limited quantities of soft tissue and laxity. The free lateral arm flap (LAF) is an alternative to conventional flaps and has been widely used due to advancements in its flap characteristics. This study is aimed at utilizing the advantages of this flap to validate its increased applications for foot and ankle defects. Methods Twenty patients with various LAF types between May 2011 and May 2020 were enrolled. Clinical data was retrospectively collected, and defect sites were classified according to the subunit principle. We utilized various LAF types, such as LAFs with sensate, extended, osteomyocutaneous, or myocutaneous flaps, as necessary. A two-point discrimination test was performed, and results were statistically compared between flaps. Results Among the diverse etiologies of skin defects, chronic inflammation was the most common cause of defects. Various LAF types, including LAFs with fasciocutaneous, extended fasciocutaneous, musculocutaneous, and osteomyocutaneous flaps, were used. The versatility of free LAF helped successfully cover various defects in all cases. Results of the two-point discrimination test were statistically significant between groups. Conclusions Free LAF is a unique soft tissue free flap that is more versatile than other flaps, allowing flaps to be continuously modified and applied to various foot and ankle defects under different clinical conditions.
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12
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Prakash D, Balakrishnan TM, Jaganmohan J. Function-Preserving Neurotized Lateral Arm Free Flap in the Reconstruction of Hemiglossectomy Defects. Indian J Plast Surg 2021; 54:144-151. [PMID: 34239235 PMCID: PMC8257321 DOI: 10.1055/s-0041-1729507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction and Methods
The glabrous, thin, and pliable texture of lateral arm flap with no loss of any axial vessel of the limb renders it a good choice for hemiglossectomy defect reconstruction. The main caveat of this flap harvest is the loss of sensation in the distribution of posterior antebrachial cutaneous nerve (PABCN). In this article, we present two strategic sites and techniques to preserve the integrity of PABCN and at the same time harvesting lateral arm flap with a lengthy lower lateral cutaneous nerve of arm for the neurotization. The outcome of this function-preserving neurotized lateral arm free flap in the reconstruction of hemiglossectomy defects is analyzed and presented in this article.
Results
Ninety percent of the patients attained grade 3 score in objective assessment, leading to a significant
p
-value of 0.02 with this technique. All had preservation of sensation in the distribution of PABCN.
Conclusion
Our technique of harvest and neurotization has brought good functional recovery of the oral cavity with preservation of PABCN.
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Affiliation(s)
- Divya Prakash
- Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, India
| | - T M Balakrishnan
- Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, India
| | - J Jaganmohan
- Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, India
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Abstract
The arm is less often concerned by reconstructive surgeries than more distal parts of the upper extremity. However, when affected, the arm is frequently part of complex mutilating injuries involving composite defects. For a given traumatic or oncologic defect, there are several reconstructive options and choosing the right sequence may pose a challenge even to the most experienced surgeon. The latter must integrate not only functional and esthetic requirements, but also the surgeon's habits, especially in situations of emergency. Once life-threatening conditions are averted, wound debridement, bony stabilization, neurovascular, and cutaneous reconstruction tailored to the defects should be performed in a single-stage procedure. Functionally, prompt bony stabilization is necessary to allow early mobilization. Diaphyseal shortening of the humerus can be a salvage procedure to avoid nerve and vascular grafting, with good biomechanical tolerance up to 5cm. Restoration of adequate elbow motion sometimes requires muscle transfer and should be a main concern, as proper positioning of the hand during daily activities demands a functional elbow joint. Esthetically, the surgeon must choose the most cosmetic skin coverage option whilst limiting morbidity of the donor site area. The flaps vascularized by the sub- scapular or thoraco-dorsal vessels are the most useful flaps for arm reconstruction. This paper discusses the reconstructive sequence of complex defects of the arm and provides a review of commonly used reconstructive techniques supported with illustrative cases.
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Kokkalis ZT, Papanikos E, Mazis GA, Panagopoulos A, Konofaos P. Lateral arm flap: indications and techniques. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1323. [PMID: 32556580 DOI: 10.1007/s00590-020-02719-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Zinon T Kokkalis
- Department of Orthopaedics, School of Medicine, University Hospital of Patras, University of Patras, Papanikolaou 1, 26504, Rio, Patras, Greece.
| | - Efstratios Papanikos
- Department of Orthopaedics, School of Medicine, University Hospital of Patras, University of Patras, Papanikolaou 1, 26504, Rio, Patras, Greece
| | | | - Andreas Panagopoulos
- Department of Orthopaedics, School of Medicine, University Hospital of Patras, University of Patras, Papanikolaou 1, 26504, Rio, Patras, Greece
| | - Petros Konofaos
- Department of Plastic Surgery, University of Tennessee Health Sciences Center, Memphis, TN, USA
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Yu F, Tang J. Revisiting vascular and venous drainage of lateral arm flap from anatomy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1321-1322. [PMID: 32377920 DOI: 10.1007/s00590-020-02687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Fang Yu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Juyu Tang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.
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