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Ince B, Uyanik O, Ismayilzade M, Yildirim MEC, Dadaci M. The effect of dobutamine treatment on salvage of digital replantation and revascularization. Eur J Trauma Emerg Surg 2023; 49:2113-2120. [PMID: 37367969 DOI: 10.1007/s00068-023-02312-x] [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: 01/28/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE One of the most common causes of a failure after replantation and revascularization surgeries is 'no reflow' from proximal artery that occurs, especially following crush and avulsion injuries. In this study, we aimed to evaluate the effect of dobutamine treatment on salvage of replanted and revascularized digits. METHODS The patients with no reflow phenomenon detected in the salvage operations of replanted/revascularized digits between the years 2017 and 2020 were included in the study. Dobutamine treatment was infused at a rate of 4 µg·kg-1·min-1 intraoperatively and of 2 µg·kg-1 min-1 postoperatively. Demographic data (age, sex), digit survival rate, ischemia time, and level of injury were retrospectively analysed. Pre-infusion, intraoperative and postoperative values of cardiac index (CI), mean arterial pressure (MAP), and heart rate (HR) were recorded. RESULTS The phenomenon of 'no reflow' was encountered in 35 digits of 22 patients who underwent salvage surgery due to vascular compromise. The survival rate in the revascularization group was 75%, while it was 42.1% in the replanted digits. Metaphysis level of proximal phalanx was the most common localization for 'no reflow' phenomenon. The least values of CI, MAP and HR to obtain sufficient perfusion in salvaged digits were as follows: 4.2 l.min-1.m-2, 76 mm Hg, and 83 beat·min-1, respectively. CONCLUSIONS It was demonstrated that dobutamine infusion at a rate of 4 µg·kg-1·min-1 intraoperatively and at 2 µg·kg-1·min-1 postoperatively has favorable effects on the vascular compromise derived from no reflow of proximal artery.
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Affiliation(s)
- Bilsev Ince
- Department of Plastic, Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Orkun Uyanik
- Department of Plastic, Reconstructive and Aesthetic Surgery, Basaksehir Cam and Sakura State Hospital, Istanbul, Turkey
| | - Majid Ismayilzade
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Istinye University, Istanbul, Turkey.
| | | | - Mehmet Dadaci
- Department of Plastic, Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Florczynski M, Khan S, Retrouvey H, Solaja O, Baltzer H. Factors associated with early and late digital revascularization and replantation failure: a retrospective cohort study. J Hand Surg Eur Vol 2022; 47:446-452. [PMID: 34384294 DOI: 10.1177/17531934211028155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Factors associated with failure of digital revascularization and replantation procedures have been well characterized, but studies have not investigated failures occurring beyond the early postoperative period. A single-centre retrospective chart review included 284 patients (434 digits) who underwent digital revascularization or replantation. Patient-, injury- and surgery-related characteristics were compared among successful procedures, digits that failed while in hospital (early failure), and initially viable digits that failed after hospital discharge (late failure). Overall, 202 patients had successful procedures (71%). There were 51 early failures (18%) and 31 late failures (11%). Crush injuries and vein grafting were associated with early failure only. Complete amputations and leeching were strongly associated with both early and late failure. This study revealed that a substantial proportion of initially viable digits fail after discharge from hospital. Patients with signs of venous congestion may benefit from longer observation periods in hospital to avoid late failure.Level of evidence: IV.
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Affiliation(s)
| | - Shawn Khan
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Canada
| | - Helene Retrouvey
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Canada
| | - Ogi Solaja
- Department of Plastic and Reconstructive Surgery, McMaster University, Hamilton, Canada
| | - Heather Baltzer
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Canada
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Lempert M, Halvachizadeh S, Salfelder CC, Neuhaus V, Pape HC, Jukema GN. Long-term experience with a collagen-elastin scaffold in combination with split-thickness skin grafts for the treatment of full-thickness soft tissue defects: improvements in outcome-a retrospective cohort study and case report. Langenbecks Arch Surg 2021; 407:327-335. [PMID: 34480629 PMCID: PMC8847203 DOI: 10.1007/s00423-021-02224-7] [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] [Received: 07/24/2020] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
Purpose The management of severe soft tissue injuries to the extremities with full-thickness wounds poses a challenge to the patient and surgeon. Dermal substitutes are used increasingly in these defects. The aim of this study was to investigate the impact of the type of injury on the success rate of Matriderm® (MD)-augmented split-thickness skin grafting, as well as the role of negative pressure wound therapy (NPWT) in preconditioning of the wounds, with a special focus on the reduction of the bioburden. Methods In this study, 45 wounds (44 affecting lower extremities (97.7%)), resulting from different types of injuries: soft tissue (ST), soft tissue complications from closed fracture (F), and open fracture (OF) in 43 patients (age 55.0 ± 18.2 years, 46.7% female), were treated with the simultaneous application of MD and split-thickness skin grafting. The study was designed as a retrospective cohort study from March 2013 to March 2020. Patients were stratified into three groups: ST, F, and OF. Outcome variables were defined as the recurrence of treated wound defects, which required revision surgery, and the reduction of bioburden in terms of reduction of number of different bacterial strains. For statistical analysis, Student’s t-test, analysis of variance (ANOVA), Mann–Whitney U test, and Pearson’s chi-squared test were used. Results There was no significant difference in the rate of recurrence in the different groups (F: 0%; OF: 11.1%; ST: 9.5%). The duration of VAC therapy significantly differed between the groups (F: 10.8 days; OF: 22.7 days; ST: 12.6 days (p < 0.05)). A clinically significant reduction of bioburden was achieved with NPWT (bacterial shift (mean (SD), F: − 2.25 (1.89); OF: − 1.9 (1.37); ST: − 2.6 (2.2)). Conclusion MD-augmented split-thickness skin grafting is an appropriate treatment option for full-thickness wounds with take rates of about 90%. The complexity of an injury significantly impacts the duration of the soft tissue treatment but does not have an influence on the take rate. NPWT leads to a relevant reduction of bioburden and is therefore an important part in the preconditioning of full-thickness wounds.
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Affiliation(s)
- Maximilian Lempert
- Department of Trauma, University Hospital Zurich, Raemistr. 100, 8091, Zürich, Switzerland.
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistr. 100, 8091, Zürich, Switzerland
| | | | - Valentin Neuhaus
- Department of Trauma, University Hospital Zurich, Raemistr. 100, 8091, Zürich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistr. 100, 8091, Zürich, Switzerland
| | - Gerrolt Nico Jukema
- Department of Trauma, University Hospital Zurich, Raemistr. 100, 8091, Zürich, Switzerland
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Günay AE, Çavuş M, Okur KT, Kahraman M, Altun İ. Failure of Major Upper Extremity Replantation Due to COVID-19-Related Arterial Thrombosis. Cureus 2021; 13:e14721. [PMID: 34055559 PMCID: PMC8158073 DOI: 10.7759/cureus.14721] [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] [Indexed: 12/03/2022] Open
Abstract
Coronavirus disease of 2019 (COVID-19), caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in Wuhan, was declared a pandemic by the World Health Organization. COVID-19 has many different clinical manifestations. One of them is arterial hypercoagulopathy. Although its mechanism is not fully explained, acute thrombosis and thromboembolism can be seen in patients. In this study, we present a case who was amputated due to the development of arterial thrombosis on the 10th day following infection with coronavirus, despite successful replantation after traumatic above-elbow amputation. After replantation on the seventh day, it was learned that the patient’s husband was positive for COVID-19 and had come to visit the patient. For this reason, we performed reverse transcription polymerase chain reaction (RT-PCR) to confirm the patient’s COVID-19 status. We found that the patient, who was asymptomatic, was positive by RT-PCR for COVID-19. On the 10th day after the operation, it was observed that the blood circulation of the replanted extremity was impaired, although it had been perfect until that day. Emergency embolectomy and vascular reanastomosis were planned for the patient. Although we generally observe thrombosis at an end-to-end anastomosis site, massive axillary arterial thrombosis was detected at the proximal end of the vascular anastomosis. Upon development of tachycardia, hypotension, and metabolic acidosis after embolectomy and vascular reanastomosis, the decision was made to amputate the replanted limb to reduce the risk of life-threatening complications. To our knowledge, this is the first such COVID-19-related complication on upper extremity replantation in the literature.
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Affiliation(s)
- Ali Eray Günay
- Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, TUR
| | - Mehmet Çavuş
- Hand Surgery, Kayseri City Hospital, Kayseri, TUR
| | | | - Murat Kahraman
- Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, TUR
| | - İbrahim Altun
- Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, TUR
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Lee DC, Kim JS, Roh SY, Lee KJ, Kim YW. Flap Coverage of Dysvascular Digits Including Venous Flow-Through Flaps. Hand Clin 2019; 35:185-197. [PMID: 30928050 DOI: 10.1016/j.hcl.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A dysvascular digit is defined as a threatened circulatory condition of a digit caused owing to multiple reasons, such as medical illness or trauma. A dysvascular digit always needs surgical manipulation of the vessel in trauma cases. The revascularization of the digit is a priority in such conditions, after which reconstruction of the defect is performed. In this article, the authors present and discuss the venous free flap, thenar free flap, toe plantar free flap, free style perforator flap, hypothenar free flap, and anconeus muscle free flap.
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Affiliation(s)
- Dong Chul Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36, Digital-road, Gwangmyeong, Gyeonggi-do 14241, South Korea.
| | - Jin Soo Kim
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36, Digital-road, Gwangmyeong, Gyeonggi-do 14241, South Korea
| | - Si Young Roh
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36, Digital-road, Gwangmyeong, Gyeonggi-do 14241, South Korea
| | - Kyung Jin Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36, Digital-road, Gwangmyeong, Gyeonggi-do 14241, South Korea
| | - Yong Woo Kim
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36, Digital-road, Gwangmyeong, Gyeonggi-do 14241, South Korea
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Lee ZH, Cohen JM, Daar D, Anzai L, Hacquebord J, Thanik V. Quantifying outcomes for leech therapy in digit revascularization and replantation. J Hand Surg Eur Vol 2019; 44:414-418. [PMID: 30636508 DOI: 10.1177/1753193418823595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively reviewed 201 digit replantations or revascularizations that were performed between August 2007 and June 2015. Leeching therapy was used in 48 digits and was more commonly required in replanted digits. In revascularized digits, leeching was used significantly more frequently in avulsion injuries and injuries associated with fractures. Digits that were leeched for more than 4.5 days had significantly higher rates of survival of digits after replantation or revascularization. Leeching was associated with higher incidence of transfusion, higher mean number of transfusions, and longer length of stay. We conclude from this study that leeching is used more frequently after digital replantation than revascularizaion, and in revascularized digits, leeching is used more often in avulsion injury and in patients with fractures. In patients requiring leeching therapy, leaching for more than 4.5 days leads to higher rate of digital survival. Level of evidence: IV.
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Affiliation(s)
- Z-Hye Lee
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Joshua M Cohen
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - David Daar
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Lavinia Anzai
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Jacques Hacquebord
- 2 Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Vishal Thanik
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
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7
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Abstract
Level of injury plays a significant role in decisions to perform replantation, with improved function, nerve regeneration, and decreased rate of reperfusion injury for injuries at the distal forearm or wrist compared with proximal injuries. The principles of a functional and sensate outcome dictate replantable parts, whereas patient comorbidity, expectations, and safety dictate patient candidacy. Vascular grafts are an expected part of the operation, and the contralateral arm or a lower extremity should be prepped into the surgical field. Despite diminished function, patient satisfaction and independence remain high after a major upper extremity replantation.
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Affiliation(s)
- Matthew L Iorio
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Colorado, Anschutz Medical Center, 12631 East 17th Avenue, C309 (Room 6414), Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado, Anschutz Medical Center, 12631 East 17th Avenue, C309 (Room 6414), Aurora, CO 80045, USA.
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Hatchell AC, Sandre AR, McRae M, Farrokhyar F, Avram R. The success of salvage procedures for failing digital replants: A retrospective cohort study. Microsurgery 2018; 39:200-206. [PMID: 30496615 DOI: 10.1002/micr.30379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/07/2018] [Accepted: 08/28/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The success of salvage procedures for failing digital replants (FR) is poorly documented. We sought to evaluate the success of salvage procedures for FR and factors contributing to successes and failures of replants. METHODS Adult patients who presented to our center between January 1, 2000 and December 31, 2015, suffered ≥1 digital amputation(s), and underwent digital replantation were included. Preoperative, perioperative, and postoperative details were recorded. Digits were monitored postoperatively via nursing and physician assessments. The presumed reason for failure, details, and outcomes of salvage attempts were recorded for FR. Length of hospital stay and complications were also recorded. RESULTS Fifty-two patients and 83 digits were included. Fifty-two digits (63%) were compromised (arterial ischemia in 15 digits; venous congestion in 37 digits) and 48 digits had salvage therapy. Twenty-one FR (44%) were salvaged via operative (1 of 2; 50%), nonoperative (19 of 43; 44%), and combined (1 of 3; 33%) therapies. FR patients were more likely than those with successful replants to receive a blood transfusion (52 vs. 23%; p = .009) with more transfused units (3.45 ± 3.30 vs. 0.86 ± 0.95; p = .001). Length of stay was prolonged for FR patients (9 [range: 2-22] vs. 7 [range: 3-19] days; p = .039). Ultimately, 59% (49 of 83) of replants were successful, where 25% (21 of 83) were successfully salvaged. CONCLUSION Nonoperative and operative salvage therapies improve the rate of replant survival. We suggest close postoperative monitoring of all replants and active salvage interventions for compromised replants in the postoperative period.
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Affiliation(s)
- Alexandra C Hatchell
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Anthony R Sandre
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthew McRae
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Departments of Surgery & Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ronen Avram
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Zhao Y, Fan J, Bai S. Biocompatibility of injectable hydrogel from decellularized human adipose tissue in vitro and in vivo. J Biomed Mater Res B Appl Biomater 2018; 107:1684-1694. [PMID: 30352138 DOI: 10.1002/jbm.b.34261] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/18/2018] [Accepted: 09/23/2018] [Indexed: 12/23/2022]
Abstract
Adipose tissue engineering is considered as a promising treatment for repairing soft tissue defects. The decellularized extracellular matrix (ECM) is becoming the research focus in tissue engineering for its tissue specificity. In this study, the human adipose tissue liposucted from healthy people were decellularized by a series of mechanical, chemical, and enzymatic methods. The components of cell and lipid were effectively removed, whereas the collagens and other ingredients in adipose tissue were retained in the human decellularized adipose tissue (hDAT). Then the extracted hDAT was further fabricated into injectable hydrogel, which could be self-assembled to form gel under certain condition. The hDAT hydrogel was nontoxic to human adipose-derived stem cells (ADSCs) and could spontaneously induce adipogenic differentiation in vitro. It was highly biocompatible and could not cause inflammation and rejection after being implanted subcutaneously. The hDAT hydrogel developed in this study will be one of the available choices for soft tissue enlargement and cosmetic fillers because of its noninvasive in collection and implantation process. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1684-1694, 2019.
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Affiliation(s)
- Yu Zhao
- Department of Plastic Surgery, Shengjing Hospital, Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110004, China.,Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning, 110122, China
| | - Jun Fan
- Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning, 110122, China
| | - Shuling Bai
- Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning, 110122, China
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Tas S, Ozkan OF, Ocakli MM, Arslan E, Kiraz A, Karaayvaz M. MANAGEMENT OF FLAP DEHISCENCE AFTER LıMBERG PROCEDURE FOR RECURRENT PıLONıDAL DıSEASE BY NEGATıVE PRESSURE WOUND THERAPY (NPWT). ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 30:73-74. [PMID: 28489177 PMCID: PMC5424695 DOI: 10.1590/0102-6720201700010021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sukru Tas
- Canakkale Onsekiz Mart University, Faculty of Medicine, Department of General Surgery, Canakkale, Turkey
| | - Omer Faruk Ozkan
- Canakkale Onsekiz Mart University, Faculty of Medicine, Department of General Surgery, Canakkale, Turkey
| | - Muzaffer Muazzez Ocakli
- Canakkale Onsekiz Mart University, Faculty of Medicine, Department of General Surgery, Canakkale, Turkey
| | - Emrah Arslan
- Canakkale Onsekiz Mart University, Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Canakkale, Turkey
| | - Asli Kiraz
- Canakkale Onsekiz Mart University, Faculty of Medicine, Department of Medical Microbiology, Canakkale, Turkey
| | - Muammer Karaayvaz
- Canakkale Onsekiz Mart University, Faculty of Medicine, Department of General Surgery, Canakkale, Turkey
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Tremp M, Haumer A, Wettstein R, Zhang YX, Honigmann P, Schaefer DJ, Kalbermatten DF. The medial femoral trochlea flap with a monitor skin island-Report of two cases. Microsurgery 2016; 37:431-435. [PMID: 27571547 DOI: 10.1002/micr.30093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/25/2016] [Accepted: 08/04/2016] [Indexed: 11/05/2022]
Abstract
In this report, we present two cases of the bony reconstruction with the medial trochlea (MFT) flap including a skin island that was used to monitor the perfusion of flap in the postoperative period. Between March 2013 and April 2015, we performed surgery on two patients who suffered from scaphoid and talus non-union after trauma and initial treatment by osteosynthesis. A skin island (1 cm × 1 cm and 3 cm × 1 cm, respectively) was included with the osseous flap (1.6 cm × 1 cm × 1 cm and 2 cm × 3 cm × 2 cm, respectively) to assess the perfusion of the flap. The design of the skin island was based on either the saphenous artery perforator or a cutaneous perforator of the descending genicular artery. Both flaps remained viable throughout the postoperative period, and there were no donor site complications. After a follow-up of 36 and 11 months, bony union was observed in both patients with a high degree of satisfaction. Thus, a MFT flap with a skin island could be a tool to assess the perfusion of the flap in the early postoperative period. © 2016 Wiley Periodicals, Inc. Microsurgery 37:431-435, 2017.
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Affiliation(s)
- M Tremp
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland
| | - A Haumer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland
| | - R Wettstein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland
| | - Y X Zhang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - P Honigmann
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland.,Department of Hand Surgery, Kantonsspital Baselland Liestal, Rheinstrasse 26, Liestal, 4410, Switzerland
| | - D J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland
| | - D F Kalbermatten
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland
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