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Jian J, Ji-Qiu C, Zheng-Li C, Shen-Jun S, Lei L, Jie Z, Ming-Yi M, Shi-Jie B, Zai-Fang Z, Shi-Hui Z. Automatic wound closure system: closure of large wounds by stretching the skin around the wound. Updates Surg 2024:10.1007/s13304-024-01850-2. [PMID: 39162930 DOI: 10.1007/s13304-024-01850-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/10/2024] [Indexed: 08/21/2024]
Abstract
Large-wound treatment often requires autologous skin grafting or skin flap transfer, causing iatrogenic secondary injuries. Thus, we have developed an automatic wound closure system that consists of a stretch module, microcontroller, and touch screen. Full-thickness wounds (8 × 14 cm) on Bama miniature pigs were manually closed by direct suture in control animals and with three different tension levels performed by the automatic device in the experimental animals. Wound-closure conditions, post-closure healing, and scars were evaluated. Post-operative microscopic changes in collagen fibers, local cell apoptosis, and changes in vascular density were compared between the two wound-closure techniques. In the control group and the first experimental group, which used a traction force of 15 N, primary wound closure could not be achieved. The other two experimental groups used a traction force of 30 N and 60 N and all wounds achieved primary closure. Collagen-fiber stretching was observed histologically in all groups and collagen-fiber breakdown occurred in some wounds when the traction force was 60 N. Scar hyperplasia was significantly reduced in the automatic wound closure system groups. The collagen content decreased, cell apoptosis increased, and vascular density decreased in local tissues in the early post-closure stage, but eventually recovered to normal-skin levels. In summary, we developed an automatic wound closure system that effectively and safely stretches dermal-collagen fibers under an appropriate traction force (30 N) and stretch wound-peripheral skin to cover the wound, achieve primary closure, and reduce scar hyperplasia.
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Affiliation(s)
- Jin Jian
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, People's Republic of China
- Shanghai Depeac Biotechnology Co., Ltd, Shanghai, People's Republic of China
| | - Chen Ji-Qiu
- Department of Burn Surgery, First Affiliated Hospital of Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Chen Zheng-Li
- Department of Burn Surgery, First Affiliated Hospital of Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Sheng Shen-Jun
- Department of Electromechanical Engineering and Automation, Shanghai University, 99 Shangda Road, Shanghai, 200438, People's Republic of China
| | - Liu Lei
- Department of Burn Surgery, First Affiliated Hospital of Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Zhu Jie
- Shanghai Depeac Biotechnology Co., Ltd, Shanghai, People's Republic of China
| | - Mao Ming-Yi
- Shanghai Depeac Biotechnology Co., Ltd, Shanghai, People's Republic of China
| | - Bai Shi-Jie
- Shanghai Depeac Biotechnology Co., Ltd, Shanghai, People's Republic of China
| | - Zhang Zai-Fang
- Department of Electromechanical Engineering and Automation, Shanghai University, 99 Shangda Road, Shanghai, 200438, People's Republic of China.
| | - Zhu Shi-Hui
- Department of Burn Surgery, First Affiliated Hospital of Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
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Martínez JGO, Lamberti EMB, Perea PRP, Avendaño AMR, Barrero MJN. Limb salvage versus amputation: Experience of a young patient at a university hospital. Trauma Case Rep 2024; 52:101062. [PMID: 38957172 PMCID: PMC11217748 DOI: 10.1016/j.tcr.2024.101062] [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] [Accepted: 06/04/2024] [Indexed: 07/04/2024] Open
Abstract
Decision-making regarding limb amputation represents a significant clinical challenge, especially when the initial evaluation does not coincide with the criteria established in scales used worldwide, as is the case of the MESS scale. This article presents the case of a 24-year-old female patient who was transferred to a university hospital after a road traffic accident with severe and large lesions in the left lower limb. Despite a poor initial prognosis and in-hospital complications, including multiple surgical procedures and foot drop, a favorable recovery was achieved with complete anatomical salvage of the limb at risk. The multidisciplinary approach and intensive rehabilitation were instrumental in achieving a satisfactory functional recovery. This case highlights the importance of considering factors beyond amputation scale scores, as well as the need for comprehensive care to improve outcomes in patients with complex extremity injuries.
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Tao S, Dong Z, Wei J, Liu L, Zhang L, Shi S. Modified medial gastrocnemius myocutaneous flap with extended anterior, inferior and/or posterior boundaries: Anatomical observation and report of a clinical series of 33 flaps. Injury 2024; 55:111491. [PMID: 38490053 DOI: 10.1016/j.injury.2024.111491] [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] [Received: 01/04/2024] [Revised: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Reports on medial gastrocnemius myocutaneous (MGM) flaps with extended inferior and posterior boundaries are rare, and information about the MGM flaps with extended anterior boundaries is unavailable. Thus, this study aimed to investigate the vascular anatomical basis and clinical reliability of the modified MGM flap with extended anterior, inferior and/or posterior boundaries. METHODS Five fresh lower limb specimens from patients with recurrent tumours in the thigh were immediately irrigated and perfused. The stripped integuments were radiographed. The pretibial skin was equally divided into nine zones. The reconstruction outcomes of the modified MGM flaps were documented in 33 patients. RESULTS True anastomotic connections existed among the branches of the saphenous artery, the perforator from the inferior medial genicular artery and 3-5 (mean, 4.5) perforators from the posterior tibial artery in the upper two-thirds of the leg. A total of 33 modified MGM flaps were applied. The anterior margins of 26 modified flaps with extended anterior boundaries exceeded the medial edge of the tibia by 1.0-4.5 cm (mean, 2.1 cm). Fourteen modified MGM flaps were used to repair the defects involving the lower third leg, whose distal edges were located in the seventh (n = 8) or eighth (n = 6) zone. A 1-169-month (median, 9 months) follow-up was conducted for 33 patients. Of the 33 flaps, 29 (87.9 %) survived completely, partial necrosis occurred in four flaps with extended anterior (n = 2) or inferior (n = 2) boundaries. CONCLUSIONS Multiple source vessels are the vascular anatomical basis of the modified MGM flap with extended anterior, posterior and/or inferior boundaries. The modification of the MGM flap is feasible and reliable, broadening the applicable scope of the flap. The modified MGM flap can be applied to repair more distal, wider and larger-area defects with a simpler design and procedure.
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Affiliation(s)
- Shibin Tao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
| | - Zhonggen Dong
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Jianwei Wei
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
| | - Lihong Liu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Lijun Zhang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Shimu Shi
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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Dong KX, Zhou Y, Cheng YY, Luo HT, Duan JZ, Yang X, Xu YQ, Lu S, He XQ. Clinical application of digital technology in the use of anterolateral thigh lobulated perforator flaps to repair complex soft tissue defects of the limbs. BURNS & TRAUMA 2024; 12:tkae011. [PMID: 38737342 PMCID: PMC11087825 DOI: 10.1093/burnst/tkae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/04/2023] [Accepted: 02/25/2024] [Indexed: 05/14/2024]
Abstract
Background It is challenging to repair wide or irregular defects with traditional skin flaps, and anterolateral thigh (ALT) lobulated perforator flaps are an ideal choice for such defects. However, there are many variations in perforators, so good preoperative planning is very important. This study attempted to explore the feasibility and clinical effect of digital technology in the use of ALT lobulated perforator flaps for repairing complex soft tissue defects in limbs. Methods Computed tomography angiography (CTA) was performed on 28 patients with complex soft tissue defects of the limbs, and the CTA data were imported into Mimics 20.0 software in DICOM format. According to the perforation condition of the lateral circumflex femoral artery and the size of the limb defect, one thigh that had two or more perforators from the same source vessel was selected for 3D reconstruction of the ALT lobulated perforator flap model. Mimics 20.0 software was used to visualize the vascular anatomy, virtual design and harvest of the flap before surgery. The intraoperative design and excision of the ALT lobulated perforator flap were guided by the preoperative digital design, and the actual anatomical observations and measurements were recorded. Results Digital reconstruction was successfully performed in all patients before surgery; this reconstruction dynamically displayed the anatomical structure of the flap vasculature and accurately guided the design and harvest of the flap during surgery. The parameters of the harvested flaps were consistent with the preoperative parameters. Postoperative complications occurred in 7 patients, but all flaps survived uneventfully. All of the donor sites were closed directly. All patients were followed up for 13-27 months (mean, 19.75 months). The color and texture of each flap were satisfactory and each donor site exhibited a linear scar. Conclusions Digital technology can effectively and precisely assist in the design and harvest of ALT lobulated perforator flaps, provide an effective approach for individualized evaluation and flap design and reduce the risk and difficulty of surgery.
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Affiliation(s)
- Kai-xuan Dong
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Key Laboratory of Digital Orthopedics of Yunnan Province, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, China
| | - Ya Zhou
- School of Rehabilitation, Kunming Medical University, 1168 Chunrong west Road, Yuhua Street, Chenggong District, Kunming, Yunnan 650504, China
| | - Yao-yu Cheng
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Key Laboratory of Digital Orthopedics of Yunnan Province, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, China
| | - Hao-tian Luo
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Key Laboratory of Digital Orthopedics of Yunnan Province, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, China
| | - Jia-zhang Duan
- Affiliated Hospital of Yunnan University, 176 Qinnian Road, Wuhua District, Kunming, Yunnan 650032, China
| | - Xi Yang
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, People's Liberation Army of China, 212 Road, Daguan District, Kunming, Yunnan 650032, China
| | - Yong-qing Xu
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, People's Liberation Army of China, 212 Road, Daguan District, Kunming, Yunnan 650032, China
| | - Sheng Lu
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Key Laboratory of Digital Orthopedics of Yunnan Province, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, China
| | - Xiao-qing He
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, People's Liberation Army of China, 212 Road, Daguan District, Kunming, Yunnan 650032, China
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Elkholy YA, Mahboub T, Zaki AA, ElSharkawy OA, Noaman A. Lower Third Leg Trauma Management Algorithm; Kasr Alainy Protocol. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5754. [PMID: 38756955 PMCID: PMC11098258 DOI: 10.1097/gox.0000000000005754] [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: 12/16/2023] [Accepted: 02/28/2024] [Indexed: 05/18/2024]
Abstract
Background Soft tissue defects in the lower third of the leg present significant challenges for surgeons. Despite various options available for soft tissue coverage, selecting the most suitable option is limited by potential complications. In response to this challenge, some surgeons have sought to develop algorithms to guide decision-making in the management of lower leg trauma. Methods This prospective observational cross-sectional study included 53 patients with traumatic injuries to the lower third leg and ankle regions. Each patient underwent a management plan based on our proposed algorithm, which incorporated the utilization of negative pressure wound therapy and dermal substitutes. Outcomes were assessed in terms of the ability to achieve complete coverage, complication rates, duration of hospital stay, and return to normal daily activity. Results The proposed algorithm proved to be comprehensive and easily applicable, achieving complete coverage in 98.1% of cases. The mean duration for definitive coverage was 21.89 ± 12.84 days, and the majority of cases (81.1%) returned to normal daily activity within a mean duration of 60.69 ± 56.7 days. The use of dermal substitutes resulted in achieving coverage in wounds with exposed structures, with favorable outcomes in cases with a mean size of 11.39 ± 10.05 cm². Conclusions Our algorithm provides a safe and effective approach to manage traumatic defects of the lower third leg and ankle, considering the patient's general condition and the complexity of the wound. Proper utilization of dermal substitutes and negative pressure wound therapy is emphasized in the algorithm.
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Affiliation(s)
- Yusuf A. Elkholy
- From the Department of Plastic and Reconstruction Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Tarek Mahboub
- From the Department of Plastic and Reconstruction Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Amr A. Zaki
- From the Department of Plastic and Reconstruction Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Omar A. ElSharkawy
- From the Department of Plastic and Reconstruction Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Ayman Noaman
- From the Department of Plastic and Reconstruction Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
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Marra C, Pentangelo P, Losco L, Ceccaroni A, Barbato A, Alfano C. Lower Extremity Trauma: A Multidimensional Reconstructive Approach with Hyperbaric Oxygen Therapy. J Clin Med 2024; 13:1407. [PMID: 38592225 PMCID: PMC10931990 DOI: 10.3390/jcm13051407] [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: 11/03/2023] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Distal lower extremity reconstruction is challenging. This study aims to propose a protocol for the treatment of traumatic soft tissue defects. The key concept is to combine the surgical armamentarium of the reconstructive surgeon with the advantages provided by hyperbaric oxygen therapy. Methods: This retrospective study analyzed data of 57 patients affected with unilateral or bilateral lower extremity trauma distal to the knee and involving soft tissues with no indication of immediate reconstruction between 2010 and 2021. Before the reconstructive procedure, all the patients underwent a stick swab procedure for the collection of microbiological samples and debridement. Patients were divided into two treatment groups and only one group underwent a combined therapeutic procedure with hyperbaric oxygen therapy. Negative pressure wound therapy (NPWT) was employed only if deemed necessary according to the defect's depth and wound exudate. Surgical techniques, outcomes, and complications were discussed. Results: All patients achieved a complete recovery with no major complications and only minor complications observed. The study group treated with HBOT had a lower complication rate and lower percentages of minimal and partial graft loss compared with the same complications observed in the control group. No patients experienced HBOT-related complications. Significant reductions in the time to complete healing and the time from reconstruction to healing were found (p = 0.002 and p < 0.00001, respectively). Conclusions: A lower complication rate was observed in the group treated with HBOT. The administration of HBOT prior to soft tissue reconstruction significantly reduced the time to complete healing and the time interval from skin grafting to healing. However, prospective studies and randomized trials with larger cohorts should be designed to investigate the efficacy of HBOT for the treatment of lower extremity injuries with extensive soft tissue defects.
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Affiliation(s)
- Caterina Marra
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy; (C.M.); (P.P.)
| | - Paola Pentangelo
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy; (C.M.); (P.P.)
| | - Luigi Losco
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy; (C.M.); (P.P.)
| | - Alessandra Ceccaroni
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy; (C.M.); (P.P.)
| | - Alfonso Barbato
- Plastic Surgery Unit, Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, SA, Italy
| | - Carmine Alfano
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy; (C.M.); (P.P.)
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Shahriar SMS, Polavoram NS, Andrabi SM, Su Y, Lee D, Tran HQ, Schindler SJ, Xie J. Transforming layered 2D mats into multiphasic 3D nanofiber scaffolds with tailored gradient features for tissue regeneration. BMEMAT 2024; 2:e12065. [PMID: 38586163 PMCID: PMC10997325 DOI: 10.1002/bmm2.12065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/27/2023] [Indexed: 04/09/2024]
Abstract
Multiphasic scaffolds with tailored gradient features hold significant promise for tissue regeneration applications. Herein, this work reports the transformation of two-dimensional (2D) layered fiber mats into three dimensional (3D) multiphasic scaffolds using a 'solids-of-revolution' inspired gas-foaming expansion technology. These scaffolds feature precise control over fiber alignment, pore size, and regional structure. Manipulating nanofiber mat layers and Pluronic F127 concentrations allows further customization of pore size and fiber alignment within different scaffold regions. The cellular response to multiphasic scaffolds demonstrates the number of cells migrated and proliferated onto the scaffolds are mainly dependent on the pore size rather than fiber alignment. In vivo subcutaneous implantation of multiphasic scaffolds to rats reveals substantial cell infiltration, neo tissue formation, collagen deposition, and new vessel formation within scaffolds, greatly surpassing the capabilities of traditional nanofiber mats. Histological examination indicates the importance of optimizing pore size and fiber alignment for promotion of cell infiltration and tissue regeneration. Overall, these scaffolds have potential applications in tissue modeling, studying tissue-tissue interactions, interface tissue engineering, and high-throughput screening for optimized tissue regeneration.
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Affiliation(s)
- S. M. Shatil Shahriar
- Department of Surgery – Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Eppley Institute for Research in Cancer and Allied Diseases, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Navatha Shree Polavoram
- Department of Surgery – Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Syed Muntazir Andrabi
- Department of Surgery – Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yajuan Su
- Department of Surgery – Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Donghee Lee
- Department of Surgery – Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Huy Quang Tran
- Department of Surgery – Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Samantha J. Schindler
- Department of Surgery – Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Jingwei Xie
- Department of Surgery – Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Department of Mechanical and Materials Engineering, University of Nebraska Lincoln, Lincoln, NE, 68588, USA
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Sosa-Vazquez AA, Suro Santos Y, Serrato-Ruiz JA, Herrera-Valenzuela JA, Becerril-Pazara AA, Hayakawa-Davila VC. Lower Limb Degloving Trauma Reconstruction: A Case Report. Cureus 2023; 15:e48904. [PMID: 38106715 PMCID: PMC10725276 DOI: 10.7759/cureus.48904] [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] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Degloving injuries are caused by trauma with shear mechanisms, usually secondary to being run over in traffic accidents. It is characterized by the avulsion of skin and subcutaneous tissue, generating coverage deficit, and in severe cases, loss of the affected limb. Herein, we discuss a case of a six-year-old male run over by a truck, receiving a direct impact on the left lower extremity with a rubber tire. Debridement and surgical cleaning were performed and a negative pressure system was placed. Subsequently, dermal matrix and partial-thickness skin grafts were placed as coverage after the creation of a viable grafting bed.
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Affiliation(s)
- Alan Armando Sosa-Vazquez
- Plastic and Reconstructive Surgery, Instituto Mexicano Del Seguro Social, Unidad Medica de Alta Especialidad 71, Universidad Autonoma de Coahuila, Torreon, MEX
| | - Yeudiel Suro Santos
- General Surgery, Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Monterrey, MEX
| | - Jorge Alejandro Serrato-Ruiz
- Plastic and Reconstructive Surgery, Instituto Mexicano del Seguro Social, Unidad Medica de Alta Especialidad 71, Universidad Autonoma de Coahuila, Torreon, MEX
| | - Jaime Aaron Herrera-Valenzuela
- Plastic and Reconstructive Surgery, Instituto Mexicano del Seguro Social, Unidad Medica de Alta Especialidad 71, Universidad Autonoma de Coahuila, Torreon, MEX
| | - Agustin Arturo Becerril-Pazara
- Plastic and Reconstructive Surgery, Instituto Mexicano del Seguro Social, Unidad Medica de Alta Especialidad 71, Universidad Autonoma de Coahuila, Torreon, MEX
| | - Victor Carlos Hayakawa-Davila
- Plastic and Reconstructive Surgery, Instituto Mexicano del Seguro Social, Unidad Medica de Alta Especialidad 71, Universidad Autonoma de Coahuila, Torreon, MEX
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Cormican MT, Creel NJ, Bosque BA, Dowling SG, Rideout PP, Vassy WM. Ovine Forestomach Matrix in the Surgical Management of Complex Volumetric Soft Tissue Defects: A Retrospective Pilot Case Series. EPLASTY 2023; 23:e66. [PMID: 38045101 PMCID: PMC10690777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Volumetric soft tissue loss is an urgent surgical issue and can frequently lead to suboptimal outcomes for patients due to significant soft tissue loss, compromised vital structures, and contamination. Ovine forestomach matrix (OFM) has demonstrated clinical success in the surgical management of soft tissue defects, especially in contaminated fields, and provides an effective option for immediate coverage of exposed vital structures before definitive closure. Methods This retrospective pilot case series (n = 13 defects) evaluated the clinical effectiveness of OFM (graft and/or particulate formats) in the surgical management of contaminated volumetric soft tissue defects. Patients presented with significant soft tissue loss, often with exposed viscera, tendon, bone, or muscle, and were treated with OFM as part of their inpatient surgical management. All patients had at least 1 significant comorbidity with the potential to complicate their healing trajectory. The primary study endpoint was time to 100% granulation tissue coverage (days), and the secondary endpoint was any device-related postoperative complications. Results A total of 13 volumetric soft tissue defects were evaluated in 10 patients who underwent surgical reconstruction. Mean defect age was 3.5 ± 5.6 weeks, and mean area was 217.3 ± 77.9 cm2. Most defects had exposed structures (85%), and all defects were Centers for Disease Control and Prevention grade 2 or higher. Mean time to 100% granulation tissue formation was 23.4 ± 9.2 days, with a median product application of 1.0. Staged reconstruction was used in 7 of 13 defects, with the remainder (6 of 13) left to heal via secondary intention using standard wound care protocols. There were no major postoperative infections or adverse events (mean follow-up, 7.4 ± 2.4 weeks.). Conclusions This retrospective pilot case series builds on a growing body of evidence that OFM can be utilized to facilitate the formation of functional, well-vascularized soft tissue in large contaminated volumetric soft tissue defects.
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Affiliation(s)
- Michael T Cormican
- Northeast Georgia Medical Center, Department of Trauma and Acute Care Surgery, Gainesville, Georgia
| | - Nathan J Creel
- Northeast Georgia Medical Center, Department of Trauma and Acute Care Surgery, Gainesville, Georgia
| | | | | | - Phillip P Rideout
- Northeast Georgia Medical Center, Northeast Georgia Physicians Group Vascular Center, Gainesville, Georgia
| | - William M Vassy
- Northeast Georgia Medical Center, Department of Trauma and Acute Care Surgery, Gainesville, Georgia
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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11
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Management of the Mangled Extremity. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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12
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Hassan B, Abou Koura A, Makarem A, Abi Mosleh K, Dimassi H, Tamim H, Ibrahim A. Predictors of surgical site infection following reconstructive flap surgery: A multi-institutional analysis of 37,177 patients. Front Surg 2023; 10:1080143. [PMID: 36793316 PMCID: PMC9923723 DOI: 10.3389/fsurg.2023.1080143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/02/2023] [Indexed: 01/31/2023] Open
Abstract
Purpose Rates of surgical site infection (SSI) following reconstructive flap surgeries (RFS) vary according to flap recipient site, potentially leading to flap failure. This is the largest study to determine predictors of SSI following RFS across recipient sites. Methods The National Surgical Quality Improvement Program database was queried for patients undergoing any flap procedure from years 2005 to 2020. RFS involving grafts, skin flaps, or flaps with unknown recipient site were excluded. Patients were stratified according to recipient site: breast, trunk, head and neck (H&N), upper and lower extremities (UE&LE). The primary outcome was the incidence of SSI within 30 days following surgery. Descriptive statistics were calculated. Bivariate analysis and multivariate logistic regression were performed to determine predictors of SSI following RFS. Results 37,177 patients underwent RFS, of whom 7.5% (n = 2,776) developed SSI. A significantly greater proportion of patients who underwent LE (n = 318, 10.7%) and trunk (n = 1,091, 10.4%) reconstruction developed SSI compared to those who underwent breast (n = 1,201, 6.3%), UE (n = 32, 4.4%), and H&N (n = 100, 4.2%) reconstruction (p < .001). Longer operating times were significant predictors of SSI following RFS across all sites. The strongest predictors of SSI were presence of open wound following trunk and H&N reconstruction [adjusted odds ratio (aOR) 95% confidence interval (CI) 1.82 (1.57-2.11) and 1.75 (1.57-1.95)], disseminated cancer following LE reconstruction [aOR (CI) 3.58 (2.324-5.53)], and history of cardiovascular accident or stroke following breast reconstruction [aOR (CI) 16.97 (2.72-105.82)]. Conclusion Longer operating time was a significant predictor of SSI regardless of reconstruction site. Reducing operating times through proper surgical planning might help mitigate the risk of SSI following RFS. Our findings should be used to guide patient selection, counseling, and surgical planning prior to RFS.
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Affiliation(s)
- Bashar Hassan
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdulghani Abou Koura
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon
| | - Adham Makarem
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon
| | - Kamal Abi Mosleh
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Hani Tamim
- Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Amir Ibrahim
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon,Correspondence: Amir Ibrahim
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13
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Benedetti F, Kafury P, Reyes-Arceo F, Lizardo C, Reina F, Zuluaga M. Use of Propeller Flaps for the Reconstruction of Defects around the Ankle. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2023. [DOI: 10.1055/s-0043-1762894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Abstract
Background This article describes the clinical results of the use of propeller flaps during reconstruction of coverage defects around the ankle.
Methods A retrospective study of all patients with bone and soft tissue defects around the ankle reconstruction using propeller flap between January 2021 and December 2022 was conducted. Flap survival rate and complications were the outcomes variables.
Results A total of 14 reconstructions in 13 patients (mean age: 45.8 ± 16.7 years) using propeller flaps were performed in the study period. The medial malleolus was the most affected area (n = 5) and the defect size ranged from 12 to 33.7 cm2. The posterior tibial artery was used as a perforator in 11 flaps. Complications were identified in five flaps, four developed venous congestion and one case, reactivation of infection. Only one propeller flap presented complete failure associated with necrosis. Good soft tissue coverage was achieved in 13 of 14 flaps.
Conclusion Propeller flaps proved to be a valid management option during reconstruction of bone and soft tissue defects around the ankle, offering adequate coverage in most cases. Adequate patient selection is important to decrease the risk of complications.
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Affiliation(s)
- Fernando Benedetti
- Limb Lengthening and Reconstruction Unit, Clínica Imbanaco Grupo Quirón salud, Cali, Colombia
- Faculty of Health Sciences, Pontificia Universidad Javeriana Cali, Colombia
| | - Paola Kafury
- Department of Plastic and Reconstructive Surgery, Clínica Imbanaco Grupo Quirón Salud, Cali, Colombia
| | - Fabiola Reyes-Arceo
- Limb Lengthening and Reconstruction Unit, Clínica Imbanaco Grupo Quirón salud, Cali, Colombia
| | - Carmelo Lizardo
- Limb Lengthening and Reconstruction Unit, Clínica Imbanaco Grupo Quirón salud, Cali, Colombia
| | - Federico Reina
- Limb Lengthening and Reconstruction Unit, Clínica Imbanaco Grupo Quirón salud, Cali, Colombia
| | - Mauricio Zuluaga
- Limb Lengthening and Reconstruction Unit, Clínica Imbanaco Grupo Quirón salud, Cali, Colombia
- Faculty of Health Sciences, Pontificia Universidad Javeriana Cali, Colombia
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14
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Collagen scaffolds derived from bovine skin loaded with
MSC
optimized
M1
macrophages remodeling and chronic diabetic wounds healing. Bioeng Transl Med 2022; 8:e10467. [DOI: 10.1002/btm2.10467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/25/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
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15
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Bøkset MI, Söderman M, Thomsen JB, Sørensen JA. Reconstruction of a knee defect in a morbidly obese patient with a pedicled reverse anterolateral thigh flap. BMJ Case Rep 2022; 15:e249365. [PMID: 35858737 PMCID: PMC9305823 DOI: 10.1136/bcr-2022-249365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/03/2022] Open
Abstract
The anterolateral thigh (ALT) flap is widely used in the reconstruction of a variety of soft tissue defects. Descriptions of patients with severe obesity in the literature are scarce. We report a case where a reverse pedicled fasciocutaneous ALT flap was successfully used for resurfacing of a knee defect measuring 12×6 cm in a patient with a body mass index (BMI) of 47.3. The flap was supercharged to the greater saphenous vein to optimise flap survival. Reconstruction of the soft tissue of the knee was achieved as planned. There were no flap or donor site complications.
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Affiliation(s)
- Mari Irgens Bøkset
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Martin Söderman
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Syddanmark, Denmark
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16
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Blair JA, Puneky GA, Dickerson TE, Faith HD, Davis JM. Posttraumatic Soft Tissue Coverage of the Lower Leg for the Orthopedic Surgeon. Orthop Clin North Am 2022; 53:297-310. [PMID: 35725038 DOI: 10.1016/j.ocl.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Soft tissue reconstructive techniques are powerful tools for the orthopedic surgeon caring for lower extremity trauma. This article seeks to inform orthopedic surgeons about useful techniques for skin closure, secondary wound closure techniques, and rotational flaps of the lower leg. Split thickness skin grafting, piecrusting, and the use of negative pressure wound therapy for skin closure, as well as rotational gastrocnemius, soleus, and reverse sural artery flaps are discussed with emphasis on techniques for the nonvascular and nonmicrovascular orthopedic surgeon.
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Affiliation(s)
- James A Blair
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, 1120 15th St., BA 3300, Augusta, GA 30912, USA.
| | - George A Puneky
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, 1120 15th St., BA 3300, Augusta, GA 30912, USA
| | - Thomas E Dickerson
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Hayden D Faith
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Jana M Davis
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, 1120 15th St., BA 3300, Augusta, GA 30912, USA. https://twitter.com/janadavisMD
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17
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Khoong YM, Huang X, Gu S, Zan T. Imaging for thinned perforator flap harvest: current status and future perspectives. BURNS & TRAUMA 2021; 9:tkab042. [PMID: 34926708 PMCID: PMC8677592 DOI: 10.1093/burnst/tkab042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/24/2021] [Indexed: 11/12/2022]
Abstract
With advances in anatomical knowledge and technology, increased interest has been directed towards reconstruction with enhanced aesthetic and functional outcomes. A myriad of thinned perforator flap harvest approaches have been developed for this purpose; however, concerns about jeopardizing their vascularity remain. To ensure optimum reconstructive outcome without hampering the flap's microcirculation, it is important to make good use of the existing advanced imaging modalities that can provide clear visualization of perforator branches, particularly in the adipose layer, and an accurate assessment of flap perfusion. Therefore, this review will highlight the imaging modalities that have been utilized for harvesting a thinned perforator flap from these two perspectives, along with future insights into creating both functionally and aesthetically satisfying, yet simultaneously safe, thinned perforator flaps for the best reconstructive outcomes for patients.
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Affiliation(s)
- Yi Min Khoong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shuchen Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Tao Zan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
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