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Wang N, Taliat G, Lin TS. One-stage secondary debulking procedure: A unique technique to restore the differential contour of digit after groin flap reconstruction. J Plast Reconstr Aesthet Surg 2024; 93:149-156. [PMID: 38691952 DOI: 10.1016/j.bjps.2024.03.005] [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: 11/06/2023] [Revised: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Pedicled groin flap is a reliable reconstructive method for digits. However, problems with the contour, mobility, and sensation, especially while providing strict thin skin coverage still exist. PATIENTS AND METHODS A total of 17 cases with 36 digits injured by trauma were identified. One-stage secondary debulking procedure was adopted for flap revision. The skin over the flap was harvested as a full-thickness graft. At the dorsal side of the reconstructed digit, the subcutaneous tissue and fat were debulked till the deep fascial layer. At the volar side, the flap was debulked till the superficial fascial layer. The skin was then re-grafted. The outcomes were reviewed after 12 months follow-up. RESULTS The average timing for debulking procedure after flap reconstruction was 116 days. After removal of bolster dressing 7 days after debulking, all the grafted skin took well. A mean length of 2.5 cm of digit was preserved for the non-replantable digits. The reconstructed digits achieved comparable diameter and contour with that of the contralateral side. The two-point discrimination of the injured digits of adults was 10.4 ± 1.6 mm. Using a 5-point Likert scale, post-debulking digits showed statistically significant improvement compared to pre-debulking digits. The evaluation of the patients' satisfactory outcomes of the reconstructed digits was judged as "very satisfying" in 12 patients (75 %) and "good" in 4 patients (25 %). CONCLUSIONS One-stage secondary debulking procedure resulted in excellent functional and esthetic outcomes for digits according to different structures of the dorsal and volar sides. LEVEL OF EVIDENCE IV, Retrospective.
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Affiliation(s)
- Ning Wang
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - George Taliat
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Tsan-Shiun Lin
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
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Woo SJ, Park KH, Woo SH. Simultaneous or Delayed Free Tissue Transfer in Combination with Replantation Surgery. Hand Clin 2024; 40:301-313. [PMID: 38553101 DOI: 10.1016/j.hcl.2023.08.013] [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: 04/02/2024]
Abstract
In hand and upper extremity replantation surgery, simultaneous free flap reconstruction restores the physiologic circulation to the amputated part, ensuring its survival, and promotes wound healing through anatomic restoration. Especially in digit replantation, an arterialized venous flap serves to reconstruct both vessel and soft tissue defects simultaneously. Delayed free flap reconstruction aims to enhance both functional improvement and cosmetic acceptance in a successfully replanted part using flaps that include functioning muscle, bone, joint, nerve, and soft tissue.
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Affiliation(s)
- Soo Jin Woo
- W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, South Korea
| | - Kwang Hyun Park
- W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, South Korea
| | - Sang Hyun Woo
- W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, South Korea.
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Burke CE, Mundy LR, Gupta J, Wong AL, Enobun B, O'Hara NN, Bangura A, O'Connor KC, Jauregui JJ, Miller NF, O'Toole RV, Pensy RA. Secondary Bony Defects after Soft Tissue Reconstruction in Limb-Threatening Lower Extremity Injuries: Does the Approach to Flap Elevation Matter? J Reconstr Microsurg 2024; 40:59-69. [PMID: 37186096 DOI: 10.1055/s-0043-1768219] [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: 05/17/2023]
Abstract
BACKGROUND Limb-threatening lower extremity injuries often require secondary bone grafting after soft tissue reconstruction. We hypothesized that there would be fewer wound complications when performing secondary bone grafting via a remote surgical approach rather than direct flap elevation. METHODS A retrospective cohort study was performed at a single Level 1 trauma center comparing complications after secondary bone grafting in patients who had undergone previous soft tissue reconstruction after open tibia fractures between 2006 and 2020. Comparing bone grafting via a remote surgical incision versus direct flap elevation, we evaluated wound dehiscence requiring return to the operating room as the primary outcome. Secondary outcomes were deep infection and delayed amputation. RESULTS We identified 129 patients (mean age: 40 years, 82% male) with 159 secondary bone grafting procedures. Secondary bone grafting was performed via a remote surgical approach in 54% (n = 86) and direct flap elevation in 46% (n = 73) of cases. Wound dehiscence requiring return to the operating room occurred in one patient in the flap elevation group (1%) and none of the patients in the remote surgical approach. The odds of deep wound infection (OR, 1.77; p = 0.31) or amputation (OR, 1.43; p = 0.73) did not significantly differ between surgical approaches. No significant differences were found in complications between the reconstructive surgeon elevating and re-insetting the flap and the orthopaedic trauma surgeon performing the flap elevation and re-inset. CONCLUSION Direct flap elevation for secondary bone grafting after soft tissue reconstruction for open tibia fractures did not result in more complications than bone grafting via a remote surgical approach. These findings should reassure surgeons to allow other clinical factors to influence the surgical approach for bone grafting.
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Affiliation(s)
- Cynthia E Burke
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lily R Mundy
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jayesh Gupta
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alison L Wong
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Blessing Enobun
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan N O'Hara
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Abdulai Bangura
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Katherine C O'Connor
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Julio J Jauregui
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan F Miller
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert V O'Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Raymond A Pensy
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
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Hao Y, Song K, Zhang M, Liu H, Qi Z, Feng C, Wang Y. Investigation of transcriptome profile of ischemia/reperfusion injury of abdominal skin flaps in rats after methane-rich saline treatment using RNA-seq. Clin Hemorheol Microcirc 2021; 78:127-138. [PMID: 33554891 DOI: 10.3233/ch-201046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Here we examined the influence of methane-rich saline treatment (MS) on the whole transcriptome of the skin flaps during the ischemia/reperfusion (I/R) injuryusing RNA-sequence (RNA-seq). METHODS The rats were divided into three groups: the sham surgery group (SH),the I/R surgery group treated with physiological saline (I/R-P) or the I/R surgery group treated with the methane-rich saline (I/R-M) respectively. On the 72 hours after operation, the perfusion and the distribution of micro-circulatoryblood flow in skin flaps were observed by laser doppler flowmeters. The whole transcriptome alteration of the skin flaps was examined using RNA-seq. Moreover, the responses of the skin flaps to MRS treatment were examined using bio-informatic and q-PCR approaches after I/R injury. RESULTS The methane-rich saline (MS) treatment could expand survival area and improve the blood perfusion of the skin flaps after l/R injury. Compared to the I/R-P group, 474 genes significantly altered in the I/R-M group. These genes were mainly associated the development, the cell adhesion and migration. In addition, the PI3K-Akt signal pathway was meaningfully related to regulation of MS treatment. Q-PCR results confirmed that MS treatment positively regulated PI3K-Akt signal pathway relative genes and inhibited the cell adhesion relative genes. CONCLUSION These results proved that methane-rich saline may alleviate I/R injury and improve flap survival rate by regulating cell adhesion and PI3K-Akt signal pathway.
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Affiliation(s)
- Yan Hao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Kexin Song
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Mingzi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Hao Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zheng Qi
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Cheng Feng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Youbin Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
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Hu W, Kerfant N, Henry AS, Trimaille A, Monnerie C, Artz M, Rouanet M, Perruisseau-Carrier A, Ta P. Aesthetic functional reconstruction of the mutilated hand: Indications and selection of reconstructive techniques. ANN CHIR PLAST ESTH 2020; 65:635-654. [PMID: 32891463 DOI: 10.1016/j.anplas.2020.07.011] [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: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022]
Abstract
Advances in microsurgery together with improvements in reconstructive surgical techniques over recent decades have enlarged the scope of available techniques for mutilated hand reconstruction, shifting the reconstructive paradigm from restoring hand function to providing the best functional and aesthetic results with minimal donor-site morbidity. Successful reconstruction of a mutilated hand should no longer be measured only by the degree of improvement of hand function but also by a more aesthetic hand appearance as well as by improved psychological well-being. In this article, the authors present their concept of aesthetic functional reconstruction of the mutilated hand with a focus on the indications and selection of reconstructive techniques. They emphasize that in order to select the most appropriate technique, providing the best functional and aesthetic outcomes with minimal donor-site morbidity for each individual patient, it is imperative for the reconstructive hand surgeon to possess perfect mastery of all available surgical techniques, thorough understanding of functional and aesthetic requirements and accurate appreciation of multidimensional reconstruction of a given defect of the hand. They have concluded that in precisely indicated cases, successful replantation of an amputated hand or digits remains the best reconstructive procedure designed to obtain a more functional and more normal-appearing hand, whereas, toe-to-hand transplantation, in cases of failed or impossible digit replantation, provides better results than any other digit reconstruction techniques aimed at achieving functioning digits with good appearance. Although skin graft and various distant pedicled flaps and free flaps may be valid options for coverage of some soft tissue defects of the hand, reverse flow forearm flaps, especially those based on the secondary arteries of the forearm, are often the best-suited reconstructive options for like-with-like hand reconstruction. They can provide the best matching of color, texture, soft-tissue volume, donor-recipient tissue interface and fulfill all the aesthetic and functional reconstruction requirements of moderate-sized or even large soft tissue defects of the hand, with acceptable donor site morbidity.
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Affiliation(s)
- W Hu
- Department of plastic, reconstructive and aesthetic surgery, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France; Hand surgery center, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - N Kerfant
- Department of plastic, reconstructive and aesthetic surgery, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France; Hand surgery center, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France
| | - A S Henry
- Department of plastic, reconstructive and aesthetic surgery, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France; Hand surgery center, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France
| | - A Trimaille
- Department of plastic, reconstructive and aesthetic surgery, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France; Hand surgery center, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France
| | - C Monnerie
- Department of plastic, reconstructive and aesthetic surgery, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France; Hand surgery center, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France
| | - M Artz
- Department of plastic, reconstructive and aesthetic surgery, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France; Hand surgery center, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France
| | - M Rouanet
- Department of plastic, reconstructive and aesthetic surgery, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France; Hand surgery center, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France
| | - A Perruisseau-Carrier
- Department of plastic, reconstructive and aesthetic surgery, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France; Hand surgery center, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France
| | - P Ta
- Department of plastic, reconstructive and aesthetic surgery, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France; Hand surgery center, CHRU de Brest, Brest University, boulevard Tanguy-Prigent, 29200 Brest, France
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Ng ZY, Salgado CJ, Moran SL, Chim H. Soft tissue coverage of the mangled upper extremity. Semin Plast Surg 2015; 29:48-54. [PMID: 25685103 DOI: 10.1055/s-0035-1544170] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mangled upper extremity injuries usually involve high-impact trauma with crushing and tearing of the limb and its associated soft tissue structures. Such trauma is particularly mutilating because of the nature of the injury and the involvement of structures vital for proper function. Although advancements in flap technique and improvements in bone fixation methods have enabled good functional and clinical outcomes in limb salvage reconstruction, this remains a challenging area. Attempts at limb preservation should be fully exhausted before consideration is given for amputation, which results in significantly decreased function. Here the authors focus on the various modalities of soft tissue coverage available including allogenic substitutes, the adjunctive use of negative pressure wound therapy, and the design and utilization of flaps to address various defect configurations for the goals of wound healing, aesthetics, and functional restoration in the mangled upper extremity.
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Affiliation(s)
- Zhi Yang Ng
- Department of Orthopaedic Surgery, Alexandra Hospital, Singapore
| | | | - Steven L Moran
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Harvey Chim
- Division of Plastic Surgery, University of Miami Miller School of Medicine, Florida
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