Groin defect reconstruction with perforator flaps: Considerations after a retrospective single-center analysis of 54 consecutive cases

Reconstruction of a septic femoral triangle fistula with a pedicled DIEP flap: A case report and mini-review

Flap-based reconstruction techniques have shown promise in preventing scar contractures and enhancing healing in fold areas by providing vascularized and thick tissue. We report a septic rupture of the superficial femoral artery treated with an arterial allograft and covered with a contralateral pedicled Deep Inferior Epigastric Artery Perforator (DIEP) flap. The patient presented favorable outcomes, including optimal healing at 8 months, with no functional limitation. A literature review also discusses alternative pedicled perforator flaps. These modern techniques present several advantages, including reliability, and can be of great interest in complex vascular surgery cases.

Pedicled double-paddle vertical posteromedial thigh flap for double-layer closure and reconstruction of upper thigh defect after sarcoma resection: A case report

Large soft tissue defects in the anterior upper thigh region represent a challenging problem in reconstructive surgery. Sarcomas are rather commonly localized in this area and they may reach extensive dimensions before surgery. The debulking procedures must be radical, which often leads to a displacement of major neurovascular structures. In the present work, we report the use of a pedicled double-paddle vertical posteromedial thigh (vPMT) flap to reconstruct a 16 cm × 8 cm soft tissue defect with exposure of the superficial and deep femoral vessels after resection of a myxoid liposarcoma. The vPMT flap was based on two perforators of the profunda femoris artery. Therefore, the cutaneous island could be split into two islands measuring 12 cm × 6 cm and 9 cm × 6 cm, which were exploited to fill the dead space below and over the vessels, reaching a satisfactory volume restoration and tension-free skin closure. The further post-operative course was uneventful. The perforator dissection might be complex and requires a good experience, however, we believe that in similar cases the pedicled double-paddle vPMT flap can be a valid solution when other options are not feasible. Moreover, this allows avoiding a free microsurgical transfer and fulfills the dictum of replacing "like-with-like tissue". No characterizations of the employment of a pedicled chimeric vPMT flap for locoregional multilayer reconstruction are available so far.

[Coverage of an infected Deep femoral arteria vascular graft bypass by pediculated chimeric antero- lateral thigh flap associated with a vastus lateral muscle]

Scarpa triangle defects with exposure of femoral bypass are challenging to treat. The authors present the case of a 46 years-old male with a groin defect of 10×18cm with an exposure on 5cm of an allograft of the deep femoral artery. Bypass was performed in emergency because of a limb ischemia with deep femoral artery thrombosis and aneurysm of the superficial femoral artery. The reconstructive surgery may propose a large musculo-cutaneous flap to fill the dead spaces surrounding the infected bypass, the flap should be vascularized by the deep femoral arteria, could not be the rectus abdominals flap because of the precedent abdominal incision. The homolateral pediculated ALT-flap with vastus lateral component appeared to be a good solution because of its versatility and the low morbidity of the donor site.

Application of the Jigsaw Puzzle Flap Based on Freestyle Perforators to Repair Large and Deep Ulcers on the Buttocks

Background

Decubitus ulcers are common skin injuries in plastic and burn surgery departments, usually occur in patients with a long disease course and poor underlying health. Designing a reconstruction procedure with safety blood supply to a large volume soft tissue and resulting in minimal trauma is a priority for surgeons.

Methods

The free-style perforators on the potential donor sites surrounding the ulcers were detected by Doppler, and the area of the ulcer was divided into several sections based on the location of pre-design perforator flaps. According to the insertion point of the perforators, small V-Y advancement flaps, propeller flaps and rotation flaps pedicled with freestyle perforators were formed and moderately modified during surgery. All of the small flaps were transplanted from donor sites to the defect and reassembled into a new composite flap to repair the ulcer. The donor sites were directly closed. The area of the flaps ranged from 7.0 × 10.5 cm to 8.0 × 22.0 cm and the diameter of the pedicle perforators ranged from 0.5 to 4.0 mm.

Results

In 30 patients, 65 flaps were constructed, and all of the flaps survived with direct closure of all donor sites. One case with effusion healed 1 month postoperatively through draining and application of a mild pressure dressing. After a 3–24 months follow-up period, all of the patients were satisfied with post-operative function and appearance, and only one case had a local recurrence 6 months postoperatively.

Conclusion

The jigsaw puzzle flap based on freestyle perforators can repair the large skin and soft tissue defects caused by decubitus ulcers on the buttocks, with direct donor flap area closure. This method is easy to perform with a safe blood supply and minimal trauma resulting from the avoidance of microvascular anastomosis and the conventional myocutaneous flap.

Use of flaps in inguinal lymphadenectomy in metastatic penile cancer

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.

Combination of Lymph Node Embolization and Musculocutaneous Flap Operation for Managing Groin Lymphorrhea

Lymphorrhea complications are common following femoral exposure for endovascular procedures. In patients unresponsive to either non-operative or operative therapy, treatment can be complicated. A 86-year-old male patient experienced lymphorrhea after stent graft to treat an abdominal aortic aneurysm, and five operative debridement attempts failed. Intranodal lymphangiography revealed leakage points from two lymph nodes directly into the wound, which were resolved by lymph node embolization using glue. Because the wound was large, a pedicled anterolateral thigh flap (ALT) operation was indicated. Percutaneous lymph node embolization combined with ALT operation may be effective for patients with large wounds and high-flow lymphatic leaks.

Reconstruction of firearm and blast injuries in Syrian war refugees

BACKGROUND

War injuries differ from other injuries owing to the large tissue defects they cause and their high risk of contamination. As fragments scattered by high-energy firearms and explosives cause serious composite tissue damage, repair of such injuries is difficult and requires a long treatment period. We discuss the treatment methods used for injured Syrian War refugees admitted to our clinic and present the most effective repair methods for war-related tissue defects for each region of the body.

METHODS

A total of 61 patients treated between June 2012 and April 2015 were retrospectively evaluated in terms of age, gender, duration of hospitalisation, injury site and repair method employed. The patients were grouped by region injured (head/neck, extremities and trunk).

RESULTS

The female-to-male ratio of the patients was 16/45, and their mean age was 25.2 (range, 3-51) years. Twenty-two patients were under the age of 18. The mean duration of hospitalisation was 28.5 days. A total of 130 operations were performed on the patients, including debridement and revisions. Repairs were conducted with free flaps in 17 patients (6 on the head/neck region, 11 on extremities) and with pedicle flaps in 28 patients (11 on the head/neck region, 12 on extremities, 5 on the trunk). Two patients experienced flap loss without other complications, and other patients experienced complications including bleeding, infection, flap detachment, hematoma and seroma.

CONCLUSIONS

War injuries cause tissue damage of a composite and extensive nature. Most affect the extremities, followed by the head/neck and trunk regions. They are primarily sustained by the young population, not usually easy to treat, and require long hospitalisation periods. A variety of methods may be preferred to treat these injuries.