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Ma Z, Qin T, Liu X, Li Z. Clinical outcomes of different muscle flap reconstruction after inguinal tumor resection: A case series. Injury 2023; 54:110960. [PMID: 37517903 DOI: 10.1016/j.injury.2023.110960] [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: 06/15/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To introduce the clinical outcomes of adductor longus and sartorius muscle transfer alone and combined application for reconstruction of the inguinal region. METHODS This is a retrospective study of patients between January 2019 and December 2022 who underwent adductor longus flap transfer, sartorius muscle flap transfer, and combined transfer of adductor longus and sartorius muscle. The demographic data and surgical details were recorded. RESULTS Sixteen patients were included, with a mean age of 57.5 years. Nine patients performed adductor longus flap transfers, three patients performed sartorius muscle flap transfers, and four patients performed combined transfers. The average operation time was 238 min. The average length of stay was 6.7 days. The average follow-up period was 9.6 months (range 6-16). The overall early postoperative complication rate was 12.5% (one patient had excessive wound exudation and one patient had a wound infection). No delayed postoperative complications occurred during the follow-up. CONCLUSION The sartorius muscle flap, the adductor longus flap, and the combined application are suitable techniques for inguinal region reconstruction under different conditions. The combined application of the two flaps can fill the dead space and cover the neurovascular bundle efficaciously.
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Affiliation(s)
- Zhihao Ma
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China; Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Tao Qin
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China; Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China; Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Zhenfeng Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China; Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
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Sim NHS, Ngaserin S, Feng JJ, Kok YO, Chua HW, Gaviria-Pinzon J, Chew KY, Wong AW. Reconstruction of a massive chest wall defect using a free anterolateral-lower medial thigh flaps: a case report. J Surg Case Rep 2023; 2023:rjad264. [PMID: 37215623 PMCID: PMC10198644 DOI: 10.1093/jscr/rjad264] [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: 02/09/2023] [Revised: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Critical defects of the chest wall require robust soft tissue coverage to protect the thoracic viscera. We define massive chest wall defects as larger than two-thirds of the chest wall. For such defects, classic flaps like the omentum, latissimus dorsi and anterolateral thigh flaps are usually insufficient. In our patient, a bilateral total mastectomy for locally advanced breast cancer resulted in a massive chest wall defect (40 by 30 cm). Soft tissue coverage was achieved with a combined anterolateral-lower medial thigh flaps. Revascularization of the anterolateral thigh and lower medial thigh components was via the internal mammary and thoracoacromial vessels, respectively. Post-operative recovery was uneventful and the patient received adjuvant chemoradiotherapy in a timely manner. The total follow up was 24-months. We illustrate the novel use of the lower medial thigh territory in extending the size of the anterolateral thigh flap to reconstruct massive chest wall defects.
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Affiliation(s)
- Nadia Hui Shan Sim
- Plastic, Reconstructive & Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Sabrina Ngaserin
- Breast Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Jia Jun Feng
- Plastic, Reconstructive & Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Yee Onn Kok
- Plastic, Reconstructive & Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Hui Wen Chua
- Breast Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Jorge Gaviria-Pinzon
- Department of Plastic, Reconstructive & Aesthetic Surgery, Hospital San Juan de Dios, Armenia, Columbia
| | - Khong Yik Chew
- Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Allen WeiJiat Wong
- Correspondence address. Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, 110 Sengkang E Way, Singapore 544886, Singapore. E-mail:
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Zhang H, Li Z, Li J, Zhu B, Xu Q. Comparison of Pedicled Adductor Longus and Pedicled Sartorius Flap in Inguinal Reconstruction, a Fresh Cadaver Study. J Pers Med 2023; 13:jpm13010143. [PMID: 36675804 PMCID: PMC9860770 DOI: 10.3390/jpm13010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Reconstruction surgeries in the inguinal area are challenging for vascular surgeons, oncologists, orthopedists, and others. The pedicled sartorius flap is the most commonly used flap for reconstruction. The pedicled adductor longus is reported as a new method to reconstruct the inguinal region. The related anatomic study is rare. This work aims to make a comparison of pedicled adductor longus and pedicled sartorius on cadavers for better use. Out of the 12 thighs in the 6 cadavers analyzed, the author compares two surgical methods in terms of surgical details, exposure of vascular and nerve pedicle, flap harvesting, flap transposition and flap volume, etc. Through the course of this study, it is showed that the adductor longus flap had a sizable advantage over the sartorius flap in terms of exposure, harvesting, and flap volume.
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Affiliation(s)
- Hong Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Zhenfeng Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jianmin Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Binghong Zhu
- Department of Gynecology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Qingjia Xu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan 250012, China
- Correspondence: ; Tel.: +86-18560082691
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Geber B, Landscheidt K, Goertz O, Hernekamp JF. Die gestielte DIEP-Lappenplastik zur Weichteilrekonstruktion eines großen Leistendefektes nach komplikativer gefäßchirurgischer Vorversorgung. GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zhang H, Li Z, Li J, Zhu L, Ibrahim Y. The Pedicled Flap of Adductor Longus, a New Technique for Inguinal Reconstruction. Front Surg 2022; 8:639893. [PMID: 34977135 PMCID: PMC8717469 DOI: 10.3389/fsurg.2021.639893] [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: 01/07/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Reconstruction surgeries of the inguinal area pose a challenge for oncological and orthopedic surgeons, especially after radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both. Although numerous surgical procedures have been reported, there is no report about a pedicle adductor longus flap method. The aim of this work is to show our experience about inguinal reconstruction with pedicled adductor longus flap and associated outcomes. Patients and Methods: A retrospective study of 16 patients with localized inguinal region interventions and reconstructed by adductor longus flap from March 2016 to July 2020. Patients' average age was 60.0 years (range = 38-79 years) and had postoperative follow-up of 10 months (ranging 2-19 months). All patients had unilateral inguinal region involvement-seven cases on the left and nine cases on the right. The patients' clinical course, operative course, and postoperative follow-up data were evaluated. Results: All 16 patients recovered well post-operatively and did not require any re-intervention. Four patients experienced negligible discomfort around the groin area. Five patients experienced a minor strength deficit in thigh adduction compared with that of preoperative strength in the same or contralateral leg. The aforementioned complications resolved during the postoperative course and had no functional impact on their activity of daily living. All adductor longus flaps survived, completely filled the inguinal dead space, and wounds healed uneventfully within 3 weeks except for three patients who suffered delayed wound healing for more than 4 weeks. Other common complications such as infection, seroma, or wound dehiscence were not encountered in this series. Conclusion: The adductor longus flap is a reliable alternative method for inguinal region reconstruction following radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both.
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Affiliation(s)
- Hong Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Zhenfeng Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Jianmin Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Zhu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Yakubu Ibrahim
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
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Vertical Rectus Abdominis Myocutaneous Flap to Reconstruct Thigh and Groin Defects: A Retrospective Cohort and Systematic Review. J Plast Reconstr Aesthet Surg 2022; 75:1893-1901. [DOI: 10.1016/j.bjps.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/07/2021] [Accepted: 01/08/2022] [Indexed: 11/20/2022]
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Azevedo RA, Roxo AC, Alvares SHB, Baptista DP, Favorito LA. Use of flaps in inguinal lymphadenectomy in metastatic penile cancer. Int Braz J Urol 2021; 47:1108-1119. [PMID: 34115457 PMCID: PMC8486440 DOI: 10.1590/s1677-5538.ibju.2021.99.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/20/2021] [Indexed: 04/04/2024] Open
Abstract
PURPOSE Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer. MATERIAL AND METHODS We reviewed the current literature of the Pubmed database according to PRISMA guidelines. The search terms used were "advanced penile cancer", "groin reconstruction", and "inguinal reconstruction", both alone and in combination. The bibliographic references used in the selected articles were also analyzed to include recent articles into our research. RESULTS A total of 54 studies were included in this review. About one third of penile cancers are diagnosed with locally advanced disease, often presenting with large lymph node involvement. Defects in the inguinal region resulting from the treatment of metastatic penile cancer are challenging for the surgeon and cause high patient morbidity, rendering primary closure unfeasible. Several fasciocutaneous and myocutaneous flaps of the abdomen and thigh can be used for the reconstruction of the inguinal region, transferring tissue to the affected area, and enabling tensionless closure. CONCLUSIONS The reconstruction of defects in the inguinal region with the aid of flaps allows for faster postoperative recovery and reduces the risk of complications. Thus, the patient will be able to undergo potential necessary adjuvant treatments sooner.
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Affiliation(s)
- Roberta Alvares Azevedo
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
- Universidade do Estado do Rio de JaneiroDepartamento de Cirurgia GeralRio de JaneiroRJBrasilDepartamento de Cirurgia Geral, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| | - Ana Claudia Roxo
- Universidade do Estado do Rio de JaneiroDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Departamento de Cirurgia Geral, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| | - Silvia Helena Baima Alvares
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
| | - Daniel Pereira Baptista
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
| | - Luciano A. Favorito
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
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Correa AF. Technical management of inguinal lymph-nodes in penile cancer: open versus minimal invasive. Transl Androl Urol 2021; 10:2264-2271. [PMID: 34159108 PMCID: PMC8185661 DOI: 10.21037/tau.2020.04.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Inguinal lymphadenectomy (ILND) remains the standard of care for patients with invasive squamous cell carcinoma of the penis, dictating patient prognosis, adjuvant therapies, and surveillance strategies. Importantly the performance of an ILND has been shown to improve cancer-specific outcomes, providing a modifiable factor for patients with an aggressive malignancy. Surprisingly, the procedure remains underutilized, mainly due to the high surgical morbidity associated with the procedure. The open lymphadenectomy technique has undergone several modifications over the last 30 years to minimize its associated surgical morbidity, but wound-related complications remain significant. Minimally invasive surgery (MIS) techniques have been recently introduced to help mitigate wound-related complications associated with open lymphadenectomy, with promising results. In this review, we highlight the importance of ILND, present a detail review of the surgical and oncological outcomes associated with open, laparoscopic and robotic ILND for patients with penile cancer.
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Affiliation(s)
- Andres Felipe Correa
- Department of Surgery, Division of Urology, Cooper University Hospital, Camden, NJ, USA
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Boro SS, Das AK, Purakayastha J, Mathew AK, Mamidala V. Locoregional Flaps in Oncoreconstruction at a Tertiary Cancer Centre in North East India: a Review Through a Plastic Surgeon's Eye. Indian J Surg Oncol 2020; 11:486-491. [PMID: 33013133 DOI: 10.1007/s13193-020-01151-1] [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: 03/05/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022] Open
Abstract
Local flaps are important parts of oncoreconstruction. The idea of writing this article is to give knowledge to my fellow aspiring plastic surgeons about the common locoregional flaps that are essentially done in a tertiary cancer centre. This is a retrospective study carried out in the Department of Plastic Surgery, Dr. B Borooah Cancer Institute, Guwahati, from May 2018 to April 2019. Musculoskeletal and soft tissue, head and neck and thorax and gynaecological malignancies which required locoregional flaps for reconstruction were taken up for the study. Flap reconstructions performed by oncosurgeons are not included in the study. We have done a total of 74 locoregional reconstructions during this 12-month period apart from 43 free tissue transfers. In our study, age ranged from 12 to 84 years. Most commonly performed flap during this time was pectoralis major myocutaneous flap. Complications of various flaps were assessed. Out of the 74 flaps, total necrosis of one flap occurred, and re-surgery was required in one case. Most of the oncosurgeons have a good idea of locoregional reconstructions in cancer centres. In such centres, the need of plastic surgeon for locoregional reconstruction is mainly for complex reconstructions and unfamiliar anatomic locations, for second flap after initial local flap failure or after free flap-related complications.
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Affiliation(s)
- Sumanjit S Boro
- Department of Plastic Surgery, Dr B. Borooah Cancer Institute, H/N-73, Bikrampur path, Japorigog, PO-Dispur, Guwahati, Assam 781005 India
| | - Ashok Kumar Das
- Department of Head and Neck Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam India
| | - Joydeep Purakayastha
- Department of Surgical Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam India
| | - Anil K Mathew
- Department of Head and Neck Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam India
| | - Vinay Mamidala
- Department of Surgical Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam India
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10
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Summer T, Bota O, Armbruster R, Münchow S, Dragu A. [Soft tissue defects following tumor resection in the limbs and trunk : Plastic reconstructive soft tissue and revision concepts]. DER ORTHOPADE 2020; 49:169-176. [PMID: 31974632 DOI: 10.1007/s00132-020-03871-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Tissue defects of the trunk and limbs after oncologic surgery and radiation require plastic reconstructive tissue coverage. Depending on the location and size of the wound as well as the interdisciplinary treatment concept, different reconstructive procedures are performed. These range from skin transplantation to local and pedicle flaps, to perforator flaps and free microsurgical tissue transfer. METHODS The modern "reconstructive ladder" can be regarded as an orientation for the sequence of the reconstructive options. Considering the patient's wishes and risk profile, an individual reconstructive concept must be devised. The best functional and simultaneously safest procedure with the smallest secondary defect is to be chosen. Wound preconditioning via vacuum-assisted closure can precede definitive tissue coverage in order to optimize local conditions. CONCLUSION Safe tissue coverage can be achieved even in advanced stages of oncologic disease and after extensive surgery by performing wound preconditioning and arteriovenous loop grafting to induce safe de novo recipient vessels for two-stage free tissue transfer. The choice between maximum plastic reconstructive options for a curative approach or limited palliative surgery is to be harmonized and balanced with therapeutic goals and the patient's biologic resources. Preservation and restoration of quality of life and functionality is the plastic surgeon's dictum.
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Affiliation(s)
- T Summer
- Abteilung für Plastische und Handchirurgie, UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - O Bota
- Abteilung für Plastische und Handchirurgie, UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - R Armbruster
- Abteilung für Plastische und Handchirurgie, UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - S Münchow
- Abteilung für Plastische und Handchirurgie, UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - A Dragu
- Abteilung für Plastische und Handchirurgie, UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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11
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Sörelius K, Schiraldi L, Giordano S, Oranges CM, Raffoul W, DI Summa PG. Reconstructive Surgery of Inguinal Defects: A Systematic Literature Review of Surgical Etiology and Reconstructive Technique. In Vivo 2019; 33:1-9. [PMID: 30587595 DOI: 10.21873/invivo.11431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to evaluate the literature regarding surgical etiology demanding inguinal reconstructive surgery, associated reconstructive techniques and outcomes. MATERIALS AND METHODS A systematic literature search was performed according to the PRISMA statement between 1996-2016. RESULTS A total of 64 articles were included, comprising 816 patients. Two main subgroups of patients were identified: Oncological resections (n=255, 31%), and vascular surgery (n=538, 66%). Oncological resection inguinal defects were treated with pedicled myocutaneous flaps (n=166, 65%), fasciocutaneous flaps (77, 31%), muscle flaps (7, 3%) and direct closure (3, 1%). Vascular surgery complications were treated with muscle flaps (n=513, 95%). Complications for the respective subgroup (oncological resections, vascular surgery) were: infection (24%, 14%), seroma (34%, 7.5%), flap dehiscence/delayed healing (20.6%, 40.8%,). The total reintervention rate was 20%. CONCLUSION Reconstruction of inguinal defects should be addressed on a case-by-case basis. Myocutaneous flaps were favoured after oncological resections, while muscle flaps were preferred after vascular surgery.
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Affiliation(s)
- Karl Sörelius
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Luigi Schiraldi
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Salvatore Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Carlo M Oranges
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pietro G DI Summa
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Santiago G, Wolff A, Huang J, Weingart J, Brem H, Gordon CR. Dural Reconstruction With Autologous Rectus Fascia. J Craniofac Surg 2019; 30:326-329. [DOI: 10.1097/scs.0000000000004895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Reali C, Guy R, Darby C, Cogswell L, Hompes R. Complex Reconstruction with Flaps After Abdominoperineal Resection and Groin Dissection for Anal Squamous Cell Carcinoma: A Difficult Case Involving Many Specialities. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:61-67. [PMID: 29339717 PMCID: PMC5782837 DOI: 10.12659/ajcr.906818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anal squamous cell carcinoma accounts for about 2-4% of all lower gastrointestinal malignancies, with a distant disease reported in less than 5%. Although surgical treatment is rarely necessary, this often involve large dissections and difficult reconstructive procedures. CASE REPORT We present a complex but successful case of double-flap reconstruction after abdominoperineal resection and groin dissection for anal squamous cell carcinoma (cT3N3M0) with metastatic right inguinal lymph nodes and ipsilateral threatening of femoral vessels. A multi-specialty team was involved in the operation. A vascular and plastic surgeon performed the inguinal dissection with en bloc excision of the saphenous magna and a cuff of the femoral vein, while colorectal surgeons carried out the abdominoperineal excision. The 2 large tissue gaps at the groin and perineum were covered with an oblique rectus abdominis myocutaneous flap and a gluteal lotus flap, respectively. A partially absorbable mesh was placed at the level of the anterior sheath in order to reinforce the abdominal wall, whereas an absorbable mesh was used as a bridge for the dissected pelvic floor muscles. The post-operative period was uneventful and the follow-up at 5 months showed good results. CONCLUSIONS An early diagnosis along with new techniques of radiochemotherapy allow patients to preserve their sphincter function. However, a persistent or recurrent disease needs major operations, which often involve a complex reconstruction. Good team-work and experience in specialized fields give the opportunity to make the best choices to perform critical steps during the management of complex cases.
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Affiliation(s)
- Claudia Reali
- Colorectal Unit, Oxford University Hospital, Headington, Oxford, U.K
| | - Richard Guy
- Colorectal Unit, Oxford University Hospital, Headington, Oxford, U.K
| | - Chris Darby
- Department of Vascular Surgery, Oxford University Hospitals, Headington, Oxford, U.K
| | - Lucy Cogswell
- Department of Plastic Surgery, Oxford University Hospitals, Headington, Oxford, U.K
| | - Roel Hompes
- Colorectal Unit, Oxford University Hospital, Headington, Oxford, U.K
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14
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Uzun H, Bitik O, Baltu Y, Dadaci M, Kayikçioğlu AU. Groin and thigh reconstructions with pedicled rectus abdominis myocutaneous flaps. Turk J Med Sci 2017; 47:883-890. [PMID: 28618738 DOI: 10.3906/sag-1604-46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/12/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Resection of tumors from the groin and thigh regions with safe margins often results in significant soft tissue defects, which preclude primary closure. This study presents a series of rectus abdominis myocutaneous flaps for irradiated thigh and groin wounds with the purpose of evaluating the efficacy and outcomes of these flaps in this population. MATERIALS AND METHODS From 2008 to 2015, all patients who underwent resection of thigh or groin region tumors and reconstruction with an inferiorly based rectus abdominis myocutaneous flap were retrospectively identified. Medical records of the patients were reviewed. RESULTS A total of 27 patients, aged 20-67 years, were operated on for defects in the groin and upper thigh region. Nine patients underwent immediate reconstruction. The remaining 18 patients underwent late reconstruction. There was neither total flap loss nor partial flap loss. We chose to utilize 15 ipsilateral and 12 contralateral pedicles. The mean length of stay in hospital was 13.7 days. CONCLUSION A rectus abdominis myocutaneous flap can be successfully used in patients with groin and upper thigh defects due to its predictable and robust vascular supply, bulky muscle content, wide arc of rotation, and large skin island.
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Affiliation(s)
- Hakan Uzun
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozan Bitik
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yahya Baltu
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Ankara Oncology Hospital, Ankara, Turkey
| | - Mehmet Dadaci
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Aycan Uğur Kayikçioğlu
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Cerny M, Harder Y, Zimmermann A, Eckstein HH, Machens HG, Schantz JT, Schenck TL. [Locoregional solutions for groin defects : Coverage after vascular surgery]. Chirurg 2016; 88:43-49. [PMID: 27435247 DOI: 10.1007/s00104-016-0244-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Vascular surgery through a groin incision may be associated with severe wound healing disorders in this sensitive area. There are many options to reconstruct the defect surgically. The choice of surgical reconstruction depends mainly on the individual status of vasculature, which is most often compromised in these patients. There are random pattern flaps, as well as perforator, pedicled flaps or microvascular flaps to choose from. AIM We give an overview of plastic surgical solutions for groin defects, with a special focus on complex wounds after vascular surgical complications. We discuss advantages and disadvantages of different flaps with two case reports and also show alternatives. PATIENTS AND METHODS We demonstrate in two cases how the reconstruction of the groin defect was planned, taking into account the vascular status, and why we chose an innovative and seldom-used option in each case. RESULTS The selected flaps, a pedicled fasciocutaneous ALT propeller flap and a perforator-based, pedicled abdominal advancement flap reconstructed the defects successfully. DISCUSSION The surgical therapy for the reconstruction of groin defects should be chosen according to the individual vascular status to ensure safe and reliable blood supply. To guarantee the best possible reconstruction and avoid postoperative healing disorders and infections, less common flaps should also be considered.
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Affiliation(s)
- M Cerny
- Klinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
| | - Y Harder
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano, Sede Italiano (OIL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz
| | - A Zimmermann
- Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - H-H Eckstein
- Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - H-G Machens
- Klinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - J-T Schantz
- Klinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - T L Schenck
- Abteilung für Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, Ludwig-Maximilians-Universität München, München, Deutschland
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