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Dong K, Zhou Y, Xu YQ, Xu XY, He XQ. Anterolateral thigh flow-through flap: A versatile method for reconstruction of complex extremity defects. Microsurgery 2023; 43:685-693. [PMID: 37477288 DOI: 10.1002/micr.31095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 06/16/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Flow-through flaps have been widely applied only for the reconstruction of complex defects in the extremities because they can be used for arterial reconstruction and soft tissue coverage simultaneously. This report attempts to fully demonstrate the role of the anterolateral thigh (ALT) flow-through flap as a versatile method for reconstructing complex defects in the extremities. METHODS From February 2011 to March 2017, we retrospectively analyzed the use of a reconstructive surgical technique based on the ALT flow-through flap to treat complex extremity defects in 87 patients (trauma, n = 79; diabetic ulcers, n = 5; squamous cell carcinoma, n = 3). Emergency surgery was performed in 12 patients to bridge a major artery gap and was followed by elective reconstruction in the remaining patients. Applications of the ALT flow-through flap included bridging major artery gaps, preserving recipient blood vessel integrity, reconstructing blood vessel continuity, protecting vascular anastomoses, avoiding difficult end-to-side anastomoses in the recipient area, and balancing blood flow, as well as combined application with an additional flap. RESULTS The flap size ranged from 6 × 3 cm to 17 × 9 cm. ALT flow-through flaps were used in combination with an additional flap (n = 4) and in vascular reconstruction (n = 83). Three patients required of the microvascular anastomostic reexploration for venous congestion, total necrosis occurred in two patients, and partial necrosis occurred in one patient. At the donor site, there were three cases of infection and two cases of wound dehiscence. At the recipient site, one case of infection and two cases of wound dehiscence were observed. One patient presented with deep infection secondary to renal failure and underwent amputation. During the follow-up period (range, 1-33 months), all other flaps (84 cases) survived uneventfully, with normal texture and color. CONCLUSION The ALT flow-through flap plays many roles as it is a versatile method for reconstructing complex defects of the extremities and serves various other clinical purposes.
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Affiliation(s)
- Kaixuan Dong
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Ya Zhou
- School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Yong-Qing Xu
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistic Support Force, Kunming, China
| | - Xiao-Yan Xu
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistic Support Force, Kunming, China
| | - Xiao-Qing He
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistic Support Force, Kunming, China
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Kuenlen A, Waked K, Eisenburger M, Oramary A, Alsherawi A, Ninkovic M. Influence of VAC Therapy on Perfusion and Edema of Gracilis Flaps: Prospective Case-control Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4964. [PMID: 37124381 PMCID: PMC10145892 DOI: 10.1097/gox.0000000000004964] [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: 01/25/2023] [Accepted: 03/09/2023] [Indexed: 05/02/2023]
Abstract
The gracilis muscle flap is a popular choice in reconstructive surgery to repair soft tissue defects or for functional restoration. Little is known on the influence of postoperative application of VAC (vacuum-assisted closure; Kinetic Concepts Inc., San Antonio, Tex.) therapy on perfusion and postoperative flap edema of free gracilis muscle flaps. Methods In total, 26 patients with soft tissue defects of lower extremity underwent gracilis muscle flap reconstruction. The study group (VAC, n = 13) was supplied with postoperative negative pressure therapy as a dressing; the control group (NVAC, n = 13) was supplied with conventional fat gauze dressing. Postoperative measurements of micro- and macroperfusion were performed intraoperatively, on postoperative day (POD) 3 and POD 5. Flap edema measurement was performed intraoperatively, on POD 5 and 2 weeks after operation. Results The VAC group showed significantly better macroflow during intraoperative VAC treatment, as well on POD 3 and POD 5. Venous outflow was also better with lower hemoglobin levels. Microflow was better in the NVAC group with higher measured oxygen levels. All gracilis muscle flaps of the VAC group showed significantly less flap edema compared with the control group. Conclusions VAC application on free gracilis muscle flaps leads to significantly less postoperative flap edema, improved arterial macroflow, and improved venous outflow. VAC therapy can be used without any danger for patient's safety, as flap survival is not endangered, and presents an easy to handle and pleasant dressing regimen for nursing staff and patients.
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Affiliation(s)
- Anian Kuenlen
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Karl Waked
- Department of Plastic and Reconstructive Surgery, Brussels University Hospital, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Michael Eisenburger
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Alan Oramary
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Abeer Alsherawi
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Milomir Ninkovic
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
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Kagaya Y, Arikawa M, Akazawa S, Miyamoto S. A Quantitative Evaluation of the Flow-Increasing Effect of Flow-Through Arterial Anastomosis in the Vascular Pedicle of Free Flaps: A Prospective Clinical Before-and-After Study. Plast Reconstr Surg 2021; 148:871-881. [PMID: 34415882 DOI: 10.1097/prs.0000000000008354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The clinical application of flow-through anastomosis has been reported in various studies; however, no studies have quantitatively evaluated and compared the actual hemodynamics in flow-through anastomosis and end-to-end anastomosis. This study quantitatively evaluated the blood inflow (volumetric flow rate) and vascular resistance (pulsatility index) of flow-through arterial anastomosis using an ultrasonic flowmeter, and compared these values with those of end-to-end anastomosis in actual clinical settings. In addition, factors affecting the outcomes have also been examined. METHODS Twenty-eight patients who underwent free flap reconstruction after tumor resection were subjected to flow-through arterial anastomosis and flow examination. First, in the end-to-end state, the proximal anastomotic site was measured. This was followed by the opening of the distal arterial clamp, and measurement was then continued (in the flow-through state). RESULTS In flow-through arterial anastomosis compared with end-to-end anastomosis, the volumetric flow rate was significantly increased (18.9 ± 14.1 ml/minute versus 6.0 ± 6.3 ml/minute) and the pulsatility index was significantly decreased (5.2 ± 3.7 versus 13.6 ± 10.2), when comparing paired data. Multiple regression analyses revealed that a perforator flap (versus a musculocutaneous flap) was independently associated with both reduced volumetric flow rate and increased pulsatility index in end-to-end anastomosis, and that hypertension was independently associated with an increased pulsatility index in end-to-end anastomosis. However, no factors in flow-through anastomosis were significantly associated with those values. CONCLUSION In terms of blood flow and vascular resistance, flow-through arterial anastomosis was considered to have promising quantitative effects and should be performed when the conditions of both the donor and recipient vessels meet the requirements. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Yu Kagaya
- From the Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital
| | - Masaki Arikawa
- From the Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital
| | - Satoshi Akazawa
- From the Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital
| | - Shimpei Miyamoto
- From the Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital
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Lee JH, Choi HJ, Kwak SH, Lee DW, Tak MS, Kang JS. Anterolateral thigh free flaps with T-shaped pedicles and multiple venous anastomosis for extremity reconstruction. Medicine (Baltimore) 2021; 100:e26575. [PMID: 34232203 PMCID: PMC8270583 DOI: 10.1097/md.0000000000026575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 06/10/2021] [Indexed: 01/04/2023] Open
Abstract
The anterolateral thigh free flap is one of the most preferred options for reconstructing soft tissues of the extremities and vascular anastomosis is one of the most important factors for flaps survival. T-anastomosis and double venous anastomosis have been widely used for increasing flap survival. This report shows both application of T-shape pedicle and multiple venous anastomosis to each 43 cases for extremity reconstruction that have not been described so far in the literature and it showed the necessity of multiple anastomosis. The locations of the lesions were 8 upper extremities (4 hands, 3 forearms, and 1 upper arm) and 35 lower extremities (5 forefeet, 6 dorsal feet, 4 plantar feet, 11 ankles, and 9 lower legs). We applied T-shaped arterial pedicle to limited anatomical area that had 2 or more major arterial communication sites to overcome the obstruction by reverse flow from communication vessels when 1 of the 2 anastomosis was obstructed. We classified multiple venous anastomosis according to flow direction and the vascular connections between the superficial and deep veins. In result, 37 cases survived completely but 2 flaps developed severe necrosis (>50%) because of infection and hematoma and 4 flaps developed partial necrosis due to wound infection. In conclusion, T-shaped pedicle and multiple venous anastomosis is a method to improve free flap survival and useful in cases where sacrificing a dominant vessel is inevitable or those in which only 1 vessel remains.
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Affiliation(s)
- Jun Ho Lee
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan
| | - Si Hyun Kwak
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan
| | - Da Woon Lee
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan
| | - Min Sung Tak
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, South Korea
| | - Jin Seok Kang
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, South Korea
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Li R, Zeng C, Yuan S, Chen Y, Zhao S, Ren GH. Free flap transplantation combined with Ilizarov bone transport for the treatment of severe composite tibial and soft tissue defects. J Int Med Res 2021; 49:3000605211017618. [PMID: 34044634 PMCID: PMC8168033 DOI: 10.1177/03000605211017618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the clinical efficacy of free flap transplantation combined with Ilizarov bone transport in the treatment of severe composite tibial and soft tissue defects. Methods We retrospectively analyzed the clinical data of 40 patients with severe composite tibial and soft tissue defects who underwent free flap transplantation combined with Ilizarov bone transport. The clinical efficacy was evaluated according to the following criteria: success rate of wound repair by free flap transplantation, incidence or recurrence rate of deep infection, healing rate of bone defects and external fixation index, incidence of complications, and functional score of affected extremities. Results All infections were generally well controlled by radical debridement and negative-pressure therapy, and all 40 patients’ wounds healed after repair and reconstruction of the tibia and soft tissues. Postoperative complications were alleviated by active treatment. The mean external fixation time was 12.83 ± 2.85 months, and the external fixation index was 1.55 m/cm. According to the Association for the Study and Application of Methods of Ilizarov (ASAMI) score, an excellent or good functional outcome was attained in 85% of patients. Conclusion Free flap transplantation combined with Ilizarov bone transport is an effective treatment for severe composite tibial and soft tissue defects.
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Affiliation(s)
- Runguang Li
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,Orthopaedic Hospital of Guangdong Province, Guangzhou, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degenerative Diseases, Guangzhou, China.,Department of Orthopedics, Linzhi People's Hospital, Linzhi, China
| | - Canjun Zeng
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,Orthopaedic Hospital of Guangdong Province, Guangzhou, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degenerative Diseases, Guangzhou, China
| | - Song Yuan
- Department of Orthopedics, Linzhi People's Hospital, Linzhi, China
| | - Yirong Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shanwen Zhao
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,Orthopaedic Hospital of Guangdong Province, Guangzhou, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degenerative Diseases, Guangzhou, China
| | - Gao-Hong Ren
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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6
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Abstract
Supplemental digital content is available in the text. This study aimed to present the use of flow-through free anterolateral thigh (ALT) flap for the reconstruction of severe limb injury.
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7
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Hong JP, Park CJ, Suh HP. Importance of Vascularity and Selecting the Recipient Vessels of Lower Extremity Reconstruction. J Reconstr Microsurg 2020; 37:83-88. [PMID: 32252097 DOI: 10.1055/s-0040-1708835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Successful lower extremity reconstruction using free flaps begins by identifying a good recipient vessel and understanding the surrounding environment of the defect. METHODS One should consider multiple factors when selecting the recipient vessel such as the status of the axial arteries, trying to preserve flow as much as possible, extent and severity of the defect, and ultimately what type of anastomosis will be ideal. RESULTS Multiple factors of importance are reviewed and show the relevance in decision making and provide an algorithm. CONCLUSION In addition to the multiple factors to be considered, the ultimate decision should be made on the table during surgery when the actual artery or vein is exposed and shows signs of good pulsation and flow.
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Affiliation(s)
- Joon Pio Hong
- Department of Plastic Surgery, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Changsik John Park
- Department of Plastic Surgery, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyunsuk Peter Suh
- Department of Plastic Surgery, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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8
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Qing L, Wu P, Yu F, Zhou Z, Tang J. Sequential chimeric deep circumflex iliac artery perforator flap and flow-through anterolateral thigh perforator flap for one-stage reconstruction of complex tissue defects. J Plast Reconstr Aesthet Surg 2019; 72:1091-1099. [DOI: 10.1016/j.bjps.2019.02.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 01/14/2019] [Accepted: 02/12/2019] [Indexed: 11/15/2022]
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9
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Kim KN, Kim SI, Ha W, Yoon CS. Popliteal fossa reconstruction with a medial sural artery perforator free flap using the medial sural vessel as the recipient. J Plast Surg Hand Surg 2017; 51:387-392. [PMID: 28125322 DOI: 10.1080/2000656x.2017.1279622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Reconstruction of the popliteal fossa using a free flap is challenging. Therefore, to facilitate easier free flap reconstruction of the popliteal fossa, we use a medial sural artery perforator (MSAP) free flap with a medial sural vessel as the recipient vessel, as it provides several advantages based on many reports. METHODS This report describes the authors' experience and outcomes with this technique. Between October 2010 and January 2015, 10 patients with medium-sized defects in their popliteal fossa underwent MSAP free flap reconstruction using the medial sural vessel as the recipient vessel. The flap size and thickness were evaluated, as well as the pedicle length, for each case. RESULTS The skin flap sizes ranged from 60-112 cm2. The average flap thickness was 6 mm (range = 4-8 mm), and the average pedicle length was 7.5 cm (range = 6-9 cm). Full flap survival was observed in nine cases, and flap tip necrosis was observed in one case during a mean follow-up of 15 months (range = 3-36 months). MSAP free flap reconstruction was performed for moderate-sized defects in the popliteal fossa, using the medial sural vessel as the recipient vessel. CONCLUSION The obvious advantages of this technique included simple vascular anastomosis (minimal size discrepancy), no intraoperative position changes, and good aesthetic outcomes (replacing like with like).
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Affiliation(s)
- Kyu Nam Kim
- a Department of Plastic and Reconstructive Surgery , Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center , Daejeon , South Korea
| | - Sang Il Kim
- a Department of Plastic and Reconstructive Surgery , Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center , Daejeon , South Korea
| | - Won Ha
- b Department of Plastic and Reconstructive Surgery , Ulsan University Hospital, University of Ulsan College of Medicine , Ulsan , South Korea
| | - Chi Sun Yoon
- b Department of Plastic and Reconstructive Surgery , Ulsan University Hospital, University of Ulsan College of Medicine , Ulsan , South Korea
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10
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The Role of the Distal Runoff Vessel of the Descending Branch of the Lateral Circumflex Femoral System in Anterolateral Thigh Flap Surgery. Ann Plast Surg 2016; 77:72-9. [DOI: 10.1097/sap.0000000000000351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Shetty N, Mashalkar NS, Ellur SR, Kagodu K. Double free-flap for a bimalleolar defect of lower leg and ankle. Indian J Plast Surg 2016; 49:95-8. [PMID: 27274130 PMCID: PMC4878253 DOI: 10.4103/0970-0358.182250] [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] [Indexed: 11/09/2022] Open
Abstract
Double free-flaps are necessary when tissue cover cannot be sufficed with a single flap. The other factors to be considered when using two free flaps for resurfacing of distal limb defects are the availability of more than one recipient vessel, the risk of distal limb ischaemia and the donor site morbidity of double flap harvest. If these factors are adequately addressed, double free-flaps can be safely executed for resurfacing distal limb defects with minimal morbidity. We report the simultaneous harvest and transfer of the anterolateral and anteromedial thigh flaps inset and vascularised as double free-flaps to resurface a large bimalleolar defect in a 14-year-old boy with no additional morbidity as compared to that of a single free tissue transfer.
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Affiliation(s)
- Naren Shetty
- Department of Plastic Surgery, St. John's Medical College, Bengaluru, Karnataka, India
| | - Narendra S Mashalkar
- Department of Plastic Surgery, St. John's Medical College, Bengaluru, Karnataka, India
| | - Sunder Raj Ellur
- Department of Plastic Surgery, St. John's Medical College, Bengaluru, Karnataka, India
| | - Karishma Kagodu
- Department of Plastic Surgery, Columbia Asia Hospital, Bengaluru, Karnataka, India
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Han HH, Choi EJ, Oh DY, Moon SH. The usefulness of microsurgical pedicle lengthening in free anterolateral thigh flaps. Microsurgery 2016; 36:559-566. [DOI: 10.1002/micr.30042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Hyun Ho Han
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
| | - Eun Jeong Choi
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
| | - Suk Ho Moon
- Department of Plastic and Reconstructive Surgery; The Catholic University of Korea; 222, Banpodaero Seocho-gu Seoul 137-701 Republic of Korea
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Miyamoto S, Fujiki M, Sakuraba M. Clinical analysis of 33 flow-through latissimus dorsi flaps. J Plast Reconstr Aesthet Surg 2015; 68:1425-31. [DOI: 10.1016/j.bjps.2015.05.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/29/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022]
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14
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Fujiki M, Miyamoto S, Sakuraba M. Flow-through anastomosis for both the artery and vein in leg free flap transfer. Microsurgery 2015; 35:536-40. [DOI: 10.1002/micr.22476] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/27/2015] [Accepted: 08/03/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Masahide Fujiki
- Division of Plastic and Reconstructive Surgery; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-Ku Tokyo Japan
| | - Shimpei Miyamoto
- Division of Plastic and Reconstructive Surgery; National Cancer Center Hospital; 5-1-1 Tsukiji, Chuo-Ku Tokyo Japan
| | - Minoru Sakuraba
- Division of Plastic and Reconstructive Surgery; National Cancer Center Hospital East; 6-5-1 Kashiwanoha Kashiwa, Chiba Japan
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15
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What Is the Ideal Free Flap for Soft Tissue Reconstruction? A Ten-Year Experience of Microsurgical Reconstruction Using 334 Latissimus Dorsi Flaps From a Universal Donor Site. Ann Plast Surg 2015; 75:49-54. [DOI: 10.1097/sap.0000000000000010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Miyamoto S, Fujiki M, Fukunaga Y, Sakuraba M. Y-shaped flow-through anastomosis during a flow-through flap transfer. Microsurgery 2015; 36:89-90. [PMID: 25580595 DOI: 10.1002/micr.22374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/25/2014] [Accepted: 12/17/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Shimpei Miyamoto
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masahide Fujiki
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Fukunaga
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Minoru Sakuraba
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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17
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Hwang KT, Kim YH. Double skin perforator flaps for aesthetic resurfacing of extensive limb defects. J Plast Reconstr Aesthet Surg 2014; 68:e47-9. [PMID: 25434493 DOI: 10.1016/j.bjps.2014.10.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/05/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Kyu Tae Hwang
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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18
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Fujioka M, Hayashida K, Senju C. Reconstruction of lateral forefoot using reversed medial plantar flap with free anterolateral thigh flap. J Foot Ankle Surg 2014; 53:324-7. [PMID: 24534560 DOI: 10.1053/j.jfas.2013.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Indexed: 02/03/2023]
Abstract
Skin defects of the heel have frequently been reconstructed using the medial plantar flap; however, forefoot coverage has remained a challenge, because the alternatives for flap coverage have been very limited. We describe a case of malignant melanoma on the lateral forefoot that was radically removed and reconstructed successfully with a distally based medial plantar flap, together with a free anterolateral thigh flap. The advantages of this flap include that it does not reduce the vascular supply to the foot owing to reconstruction of the medial plantar vascular systems, reduces the risk of flap congestion, minimizes donor site morbidity, and enables the transport of structurally similar tissues to the plantar forefoot. We believe this technique is a reasonable reconstructive option for large lateral plantar forefoot defects.
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Affiliation(s)
- Masaki Fujioka
- Clinical Professor, Department of Plastic and Reconstructive Surgery, Nagasaki University, Nagasaki, Japan; Director, Department of Plastic and Reconstructive Surgery, Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.
| | - Kenji Hayashida
- Staff Surgeon, Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Chikako Senju
- Staff Surgeon, Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
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19
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Li RG, Ren GH, Tan XJ, Yu B, Hu JJ. Free flap transplantation combined with skin grafting and vacuum sealing drainage for repair of circumferential or sub-circumferential soft-tissue wounds of the lower leg. Med Sci Monit 2013; 19:510-7. [PMID: 23807087 PMCID: PMC3699537 DOI: 10.12659/msm.883963] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background This study is aimed at evaluating the operation techniques and clinical significance of free flap transplantation combined with skin grafting and vacuum sealing drainage (VSD) in repairing severe traumatic extensive circumferential or semi-circumferential soft-tissue defects of the lower leg. Material/Methods Thirty patients with severe lower leg injuries were treated by free flap transplantation combined with skin grafting and VSD from January 2008 to June 2011. The size of the wounds ranged from 23×8 cm to 44×28 cm and all affected more 70% of the low leg circumferential area. Wounds were complicated by exposure, necrosis, or infection of deep tissues. The wounds were first debrided and covered by VSD. When the condition of the wound had improved (5 to 7 days later), free flaps were harvested to reconstruct damaged tissue and skin grafts and VSD was used to cover granulation tissues around the transplanted flap. Results Granulation tissues developed and the area requiring flap cover decreased in all 30 patients after debridement and VSD. In 28 of 30 cases, the transplanted flaps grew well without complication. Peripheral necrosis was observed in only 2 cases, which required a second debridement and skin graft. Ten wound areas covered by grafts were left with scattered peripheral wounds, which healed with the help of 1 more skin graft or dressing change. Morphological appearance and functional recovery were satisfactory in all 30 cases. Conclusions Initial debridement and the temporary VSD cover followed after several days by free flap transplantation combined with skin grafting and VSD protection is a reliable treatment regimen for traumatic large circumferential or sub-circumferential soft tissue wounds of the lower leg with deep tissue exposure.
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Affiliation(s)
- Run-guang Li
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Hwang KT, Youn S, Kim JT, Lee SH, Ng SW, Kim YH. Use of latissimus dorsi flap pedicle as a T-junction to facilitate simultaneous free fibular flap inset in lower extremity salvage. J Plast Reconstr Aesthet Surg 2012; 65:517-20. [DOI: 10.1016/j.bjps.2011.08.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 07/10/2011] [Accepted: 08/19/2011] [Indexed: 10/17/2022]
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Kim JT, Kim YH. Breast reconstruction using deep inferior epigastric artery perforator flap. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jeong Tae Kim
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea
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Chai YM, Wang CY, Wen G, Zeng BF, Cai PH, Han P. Combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle for reconstruction of complex soft tissue defects in the hand. Microsurgery 2010; 31:45-50. [DOI: 10.1002/micr.20817] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 05/28/2010] [Indexed: 11/10/2022]
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