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Escobar-Domingo MJ, Bustos VP, Akintayo R, Mahmoud AA, Fanning JE, Foppiani JA, Miller AS, Cauley RP, Lin SJ, Lee BT. The versatility of the scapular free flap: A workhorse flap? A systematic review and meta-analysis. Microsurgery 2024; 44:e31203. [PMID: 38887104 DOI: 10.1002/micr.31203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/03/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The scapular free flap (SFF) is essential in complex reconstructive surgery and often indicated in complex defects with compromised or poor local tissue integrity. This review aims to assess the versatility and reliability of the SFF during reconstruction. METHODS A comprehensive literature review of multiple databases was conducted following the PRISMA guidelines. An analysis of pooled data was performed to evaluate flap failure rate for any anatomical unit using SFF as the primary endpoints. Secondary endpoints included other complication rates after reconstruction such as partial flap loss, revision surgery, fistula, hematoma, and infection. RESULTS A total of 110 articles were included, with 1447 pooled flaps. The main recipient site was the head and neck region (89.0%). Major indications for reconstruction were malignancy (55.3%), burns (19.2%), and trauma (9.3%). The most common types of flaps were osteocutaneous (23.3%), cutaneous (22.6%), and chimeric (18.0%). The pooled flap failure rate was 2% (95%CI: 1%-4%). No significant heterogeneity was present across studies (Q statistic 20.2, p = .69; I2 .00%, p = .685). Nonscapular supplementary flaps and grafts were required in 61 cases. The average length and surface area of bone flaps were 7.2 cm and 24.8cm2, respectively. The average skin paddle area was 134.2cm2. CONCLUSION The SFF is a useful adjunct in the reconstructive surgeon's armamentarium as evidence by its intrinsic versatility and diverse clinical indications. Our data suggest a low failure rate in multicomponent defect reconstruction, especially in head and neck surgery. SFFs enable incorporation of multiple tissue types and customizable dimensions-both for vascularized bone and cutaneous skin-augmenting its value in the microsurgeon's repertoire as a chimeric flap. Further research is necessary to overcome the conventional barriers to SFF utilization and to better comprehend the specific scenarios in which the SFF can serve as the preferred alternative workhorse flap.
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Affiliation(s)
- Maria J Escobar-Domingo
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Valeria P Bustos
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami, Miami, Florida, United States
| | - Rachel Akintayo
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amir-Ala Mahmoud
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James E Fanning
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose A Foppiani
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amitai S Miller
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Nataraj G, Jagadeesan G, Manoharan AL, Muniyandi K, Sathyanarayanan S, Thangaraj P. Ipomoea pes-tigridis L. extract accelerates wound healing in Wistar albino rats in excision and incision models. JOURNAL OF ETHNOPHARMACOLOGY 2023; 317:116808. [PMID: 37343652 DOI: 10.1016/j.jep.2023.116808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE An annual herb, Ipomoea pes-tigridis L. (Convolvulaceae) is widely used for its anti-inflammatory and anti-spasmodic properties in traditional medicine. As well as treating wounds, fever, skin disorders, and other ailments, it is also used for other purposes. AIM OF THE STUDY This study investigated polyphenolic content, antioxidant activity, RP-HPLC, wound healing, and antioxidant enzyme activity. In terms of I. pes-tigridis potential for healing wounds, there is no scientific data available. Hence this study is designed to use animal models to investigate the ethnopharmacological report. MATERIALS METHODS The crude extracts of stem and leaf were subjected to phytochemicals, TPC, TTC, TFC, and free radical scavenging assays (DPPH, ABTS, etc). Excision and incision models were used to assess wound healing using the screened extracts (IPLEA, IPLM, IPSEA, and IPSM). Various tissue parameters (hydroxyproline, hexosamine, hexuronic acid content), as well as antioxidant enzyme activity (SOD, Catalase, GPX, LPO), were also examined. RESULTS The maximum amount of polyphenolic content was found in IPLM (TPC- 118.86 ± 5.94 mg GAE/g, TTC - 75.25 ± 2.64 mg TAE/g, and TFC-25.73 ± 0.99 mg GAE/g) with significant IC50 value of 1.65 ± 0.87 μg/mL among all the extracts. Coumaric acid was reported high (92.86 mg/g) in RP-HPLC analysis of crude extract in IPLEA. The in vivo excision wound healing model revealed that 1% IPLM had better healing property with the maximum wound healing area (0.098 ± 0.03 cm) and wound concentration (95.56 ± 1.95%) was reported with the significance level of ***P < 0.001, **P < 0.01, *P < 0.05. In the incision model, IPLM represented maximum tensile strength (27500 gf). A significant functional effect of the granulation tissue parameters and enzyme antioxidants on the wound-healed area of dry tissue was also observed. Finally, the histopathological analysis showed enhanced re-epithelialization, fibroblast proliferation, and collagen synthesis in wound-treated animal tissue in both models. CONCLUSION According to the present study, antioxidant-rich I. pes-tigridis promotes healthy cell regeneration while reducing inflammation and oxidative stress for wound healing. Additionally, it also enhances circulation and promotes healing.
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Affiliation(s)
- Gayathri Nataraj
- Bioprospecting Laboratory, Department of Botany, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Gayathri Jagadeesan
- Bioprospecting Laboratory, Department of Botany, Bharathiar University, Coimbatore, Tamil Nadu, India; BRAINS Research Group, Department of Neurology, McGovern Medical School, The University of Texas Health Science at Houston 6431 Fannin St., Houston, TX, 77030, USA
| | - Ashwini Lydia Manoharan
- Bioprospecting Laboratory, Department of Botany, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Kasipandi Muniyandi
- Bioprospecting Laboratory, Department of Botany, Bharathiar University, Coimbatore, Tamil Nadu, India; Department of Postharvest Science, Agricultural Research Organisation, The Volcani Center, HaMaccabim Rd 68, POB 15159, Rishon LeZion, 7528809, Israel
| | | | - Parimelazhagan Thangaraj
- Bioprospecting Laboratory, Department of Botany, Bharathiar University, Coimbatore, Tamil Nadu, India.
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Wang L, Yang B, Jiang H, Yu G, Feng M, Lu X, Luo Q, Wu H, Zhang S, Liu H. The molecular mechanism study of insulin in promoting wound healing under high-glucose conditions. J Cell Biochem 2019; 120:16244-16253. [PMID: 31081255 DOI: 10.1002/jcb.28905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/15/2019] [Accepted: 03/22/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Wound healing is a complex process in bone development. The aim of this study was to explore the molecular mechanism study of insulin in promoting wound healing. METHODS Firstly, the acute human monocyte leukemia cell lines were induced to differentiate into macrophages. Secondly, the porphyromonas gingivalis was applied to mix with the differentiated macrophages. Thirdly, the effect of different concentrations of insulin (0 ng/mL, 5 ng/mL, 50 ng/mL, 100 ng/mL, 200 ng/mL, 500 ng/mL, and 1,000 ng/mL) on the phagocytosis of macrophages and production of reactive oxygen species was investigated. Depending on these experiments, the optimal insulin concentration was used to treat the macrophages at different time points (0 hours and 0.5 hours) to identify the differentially expressed mRNAs. Finally, functional analysis including gene ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) and protein-protein interaction (PPI) analysis was carried out to explore the biological function of these differentially expressed mRNAs. RESULTS The test of phagocytosis function and production of reactive oxygen species showed that 200 ng/mL insulin treatment had a significant influence on antibacterial and production of reactive oxygen species. In RNA sequencing, a total of 415 (245 upregulated and 170 downregulated) differentially expressed mRNAs were identified between different time points. Two important signaling pathways including endocytosis and systemic lupus erythematosus were found in the KEGG enrichment analysis. In the PPI network, several hub proteins encoded by differentially expressed mRNA including ALB, HIP1R, RAB5A, HIST1H2BJ, HIST1H3G, and HIST1H2BO were identified. CONCLUSION Our work demonstrated that several differentially expressed mRNAs, such as EGR1, RAB34, ALB, HIP1R, RAB5A, HIST1H2BJ, HIST1H3G, and HIST1H2BO and two important signaling pathways including endocytosis and systemic lupus erythematosus may play important roles in the bone wound healing.
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Affiliation(s)
- Lin Wang
- Department of Stomatology, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Bai Yang
- Department of Stomatology, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Hua Jiang
- Department of Stomatology, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Guo Yu
- Department of Stomatology, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Mi Feng
- Department of applied chemistry, Chinese Academy of sciences key Laboratory of Green Process and Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China.,Department of applied chemistry, College of Chemical and Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Xingmei Lu
- Department of chemical engineering and technology, Chinese Academy of sciences key Laboratory of Green Process and Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China.,Department of chemical engineering and technology, College of Chemical and Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Qiang Luo
- Department of Stomatology, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Hao Wu
- Department of Stomatology, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Shuo Zhang
- Department of Stomatology, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Hongchen Liu
- Department of Stomatology, General Hospital of Chinese People's Liberation Army, Beijing, China
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Oryan A, Alemzadeh E, Moshiri A. Potential role of propolis in wound healing: Biological properties and therapeutic activities. Biomed Pharmacother 2017; 98:469-483. [PMID: 29287194 DOI: 10.1016/j.biopha.2017.12.069] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/28/2017] [Accepted: 12/15/2017] [Indexed: 12/16/2022] Open
Abstract
Propolis is a resinous mixture that honey bees collect from the tree buds, sap flows, or other botanical sources. The chemical composition of propolis varies and depends on the geographical area, time of collection, seasonality, illumination, altitude, and food availability during propolis exploitation. The goal of this review is to discuss important concepts including mechanisms of action and therapeutic activities of propolis. The PubMed, ScienceDirect, and Cochrane Library databases were searched for the literature published from January the 1st 2000 to October the 1st 2017. Sixteen animals and three clinical studies were included. A quantitative and qualitative review was performed on the clinical trials and the animal studies were comprehensively overviewed. In this study, the clinical trials have been combined and the results were provided as meta-analysis. Propolis is a non-toxic natural product; however some cases of allergy and contact dermatitis to this compound have been described mainly among beekeepers. An important factor in impaired wound healing is biofilm formation; propolis as an anti-microbial agent can reduce biofilm generation and result in accelerated healing processes. Most of the in vivo studies on various wound models suggested the beneficial roles of propolis on experimental wound healing and this has also been approved in the clinical trial studies. However, there is a lack of information concerning, dose, side effects and clinical effectiveness of propolis on wounds. As the effectiveness of propolis between different products is variable, more characterizations should be done and future investigations comparing different propolis based products and characterization of their specific roles on different models of wounds are highly appreciated.
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Affiliation(s)
- Ahmad Oryan
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
| | - Esmat Alemzadeh
- Department of Biotechnology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Ali Moshiri
- Department of Surgery and Radiology, Dr. Moshiri Veterinary Clinic, Tehran, Iran
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Oryan A, Alemzadeh E. Effects of insulin on wound healing: A review of animal and human evidences. Life Sci 2017; 174:59-67. [PMID: 28263805 DOI: 10.1016/j.lfs.2017.02.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/02/2017] [Accepted: 02/28/2017] [Indexed: 12/11/2022]
Abstract
AIMS Several studies have indicated that insulin that is used in reducing blood glucose is also affective on wound healing by various mechanisms. To understand the outcomes of insulin therapy on wound healing, a meta-analysis and systematic review was performed. MAIN METHODS The Cochrane library, PubMed, and Science Direct were searched for the literature published from January the 1st 1990 to September the 30th 2016. Twelve animals and nine clinical studies were included. A quantitative and qualitative review was performed on the clinical trials and the animal studies were comprehensively overviewed. Statistical analysis for development of granulation tissue, microvessel density, and time of healing was conducted in this systematic review. KEY FINDINGS The animal studies revealed that treatment with topical insulin lead to faster wound contraction and re-epithelialization. Meta-analysis of wound studies revealed that insulin therapy is significantly favored for growth of granulation tissue. Based on these findings, insulin enhanced development of granulation tissue on day 7 after treatment. The meta-analysis studies indicated significant reduction in time of healing in the patients treated with insulin. These studies also disclosed that the new vessels were observable from five days after injection in the treated group, compared to the control animals that developed significantly at later stage. SIGNIFICANCE Insulin is a low cost growth factor and can be considered as a therapeutic agent in wound healing. However, further studies are necessary to gain a better understanding of the role of insulin in wound healing.
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Affiliation(s)
- Ahmad Oryan
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
| | - Esmat Alemzadeh
- Department of Biotechnology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
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Clinical Experiences with the Scapular Fascial Free Flap. Arch Plast Surg 2016; 43:438-45. [PMID: 27689051 PMCID: PMC5040846 DOI: 10.5999/aps.2016.43.5.438] [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: 04/05/2016] [Revised: 07/23/2016] [Accepted: 09/02/2016] [Indexed: 11/10/2022] Open
Abstract
Background The goal of reconstruction is to provide coverage of exposed vital structures with well-vascularized tissue for optimal restoration of form and function. Here, we present our clinical experience with the use of the scapular fascial free flap to correct facial asymmetry and to reconstruct soft tissue defects of the extremities. Methods We used a scapular fascial free flap in 12 cases for soft tissue coverage of the extremities or facial soft tissue augmentation. Results The flaps ranged in size from 3×12 to 13×23 cm. No cases of total loss of the flap occurred. Partial loss of the flap occurred in 1 patient, who was treated with a turnover flap using the adjacent scapular fascial flap and a skin graft. Partial loss of the skin graft occurred in 4 patients due to infection or hematoma beneath the graft, and these patients underwent another skin graft. Four cases of seroma at the donor site occurred, and these cases were treated with conservative management or capsulectomy and quilting sutures. Conclusions The scapular fascial free flap has many advantages, including a durable surface for restoration of form and contours, a large size with a constant pedicle, adequate surface for tendon gliding, and minimal donor-site scarring. We conclude that despite the occurrence of a small number of complications, the scapular fascial free flap should be considered to be a viable option for soft tissue coverage of the extremities and facial soft tissue augmentation.
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Chen B, Song H, Gao Q, Xu M. Pedicled fasciocutaneous flaps for correcting scar contracture in pediatric patients-a retrospective study of 22 cases. J Pediatr Surg 2016; 51:1207-15. [PMID: 26777888 DOI: 10.1016/j.jpedsurg.2015.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pediatric scar contractures in rapidly-growing regions require timely correction. Compared to flaps, skin grafts are characterized by scarring and retraction. More complex reconstructions are especially challenging in pediatric cases. Pedicled fasciocutaneous flaps are simple, durable, and able grow with the patient. METHODS A series of 22 pediatric burn scar cases, with an average age of 6years, underwent treatment with pedicled fasciocutaneous flaps. They comprised 17 patients with scars involving the chest and axilla, and 5 patients with scars involving the groin and perineum. RESULTS Patient follow-up ranged from 3months to 2years, and included every patient. In total, 25 flaps were performed, comprising 4 lateral thoracic flaps, 5 superficial inferior epigastric artery flaps, and 16 scapular/expanded scapular flaps. Adjunctive skin grafts were used in 3 cases; the remaining 19 cases' donor sites were closed primarily. No flap loss or necrosis was observed. CONCLUSIONS Pedicled fasciocutaneous flaps are robust treatment options for burn scar contractures. Accompanied by tissue expander, it can be raised to repair larger area of contracture.
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Affiliation(s)
- Baoguo Chen
- The first hospital affiliated to the People's Literative Army Hospital, 51#, Fucheng Road, Haidian District, Beijing, 100048
| | - Huifeng Song
- The first hospital affiliated to the People's Literative Army Hospital, 51#, Fucheng Road, Haidian District, Beijing, 100048.
| | - Quanwen Gao
- The first hospital affiliated to the People's Literative Army Hospital, 51#, Fucheng Road, Haidian District, Beijing, 100048
| | - Minghuo Xu
- The first hospital affiliated to the People's Literative Army Hospital, 51#, Fucheng Road, Haidian District, Beijing, 100048
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Chen B, Xu M, Chai J, Song H, Gao Q. Surgical treatment of severe or moderate axillary burn scar contracture with transverse island scapular flap and expanded transverse island scapular flap in adult and pediatric patients—A clinical experience of 15 cases. Burns 2015; 41:872-80. [DOI: 10.1016/j.burns.2014.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
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Houdek MT, Wagner ER, Wyles CC, Nanos GP, Moran SL. New options for vascularized bone reconstruction in the upper extremity. Semin Plast Surg 2015; 29:20-9. [PMID: 25685100 DOI: 10.1055/s-0035-1544167] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Originally described in the 1970s, vascularized bone grafting has become a critical component in the treatment of bony defects and non-unions. Although well established in the lower extremity, recent years have seen many novel techniques described to treat a variety of challenging upper extremity pathologies. Here the authors review the use of different techniques of vascularized bone grafts for the upper extremity bone pathologies. The vascularized fibula remains the gold standard for the treatment of large bone defects of the humerus and forearm, while also playing a role in carpal reconstruction; however, two other important options for larger defects include the vascularized scapula graft and the Capanna technique. Smaller upper extremity bone defects and non-unions can be treated with the medial femoral condyle (MFC) free flap or a vascularized rib transfer. In carpal non-unions, both pedicled distal radius flaps and free MFC flaps are viable options. Finally, in skeletally immature patients, vascularized fibular head epiphyseal transfer can provide growth potential in addition to skeletal reconstruction.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - George P Nanos
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota ; Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
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Abstract
Successful soft tissue reconstruction of the upper extremity must provide stable coverage and restore function to the injured hand. To ensure the best possible outcome after traumatic upper extremity injuries, early radical debridement and early flap coverage that restores all missing tissue components is critical to allow early mobilization. Free flaps provide extraordinary versatility in reconstructing defects of soft tissue, muscle, tendon, and bone.
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Affiliation(s)
- Elizabeth A King
- Department of Orthopaedic Surgery, University of Michigan, 2098 South Main Street, Ann Arbor, MI 48103, USA
| | - Kagan Ozer
- Department of Orthopaedic Surgery, University of Michigan, 2098 South Main Street, Ann Arbor, MI 48103, USA.
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Biswas D, Wysocki RW, Fernandez JJ, Cohen MS. Local and regional flaps for hand coverage. J Hand Surg Am 2014; 39:992-1004. [PMID: 24766831 DOI: 10.1016/j.jhsa.2013.09.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 08/26/2013] [Accepted: 09/16/2013] [Indexed: 02/02/2023]
Abstract
Hand surgeons are frequently challenged by the unique requirements of soft tissue coverage of the hand. Whereas many smaller soft tissue defects without involvement of deep structures are amenable to healing by secondary intention or skin grafting, larger lesions and those with exposed tendon, bone, or joint often require vascularized coverage that allows rapid healing without wound contraction. The purpose of this review was to present an overview of local and regional flaps commonly used for soft tissue reconstruction within the hand.
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Affiliation(s)
- Debdut Biswas
- Section of Hand and Elbow Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Robert W Wysocki
- Section of Hand and Elbow Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - John J Fernandez
- Section of Hand and Elbow Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Mark S Cohen
- Section of Hand and Elbow Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
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Revisiting the scapular flap: applications in extremity coverage for our U.S. combat casualties. Plast Reconstr Surg 2013; 132:577e-585e. [PMID: 24076705 DOI: 10.1097/prs.0b013e31829f4a08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Combat injuries commonly result in massive bony and soft-tissue destruction within the extremities. These extremity wounds often require large free tissue transfers and/or composite flaps for definitive reconstruction. In U.S. military war trauma experience, the authors' practice has found the scapular flap increasingly useful for reconstruction of complex extremity injuries. The purpose of this study is to report the authors' experience using the scapular flap in extremity reconstruction and evaluate the indications for use in the authors' patient population. METHODS All consecutive limb salvage cases requiring free flaps from 2009 to 2012 at Walter Reed National Military Medical Center were reviewed retrospectively. Scapular flap cases were identified. Data collected included Injury Severity Score, flap characteristics, and complications. RESULTS Twelve scapular free flaps were performed for extremity reconstruction for combat-related trauma, representing 16.2 percent of all microsurgical reconstructions during that period. Cases included eight traditional scapular flaps, two osteocutaneous scapular flaps, one chimeric latissimus/scapular flap, and one chimeric parascapular/scapular/scapula bone flap. The complication rate was 17 percent, consisting of one flap hematoma and one donor-site dehiscence. Complication rates were similar between scapular flaps, other fasciocutaneous flaps, and muscle flaps. CONCLUSIONS In a decade of war trauma, the authors' practice has found the scapular flap useful for reconstruction of complex extremity injuries. This flap is uniquely suited to the authors' patients, given the severity of their injuries and rehabilitation needs. The scapular flap continues to have various indications in injuries seen within the authors' military population that may be applicable to the authors' civilian patient counterparts. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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