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Macionis V. Neurovascular Compression-Induced Intracranial Allodynia May Be the True Nature of Migraine Headache: an Interpretative Review. Curr Pain Headache Rep 2023; 27:775-791. [PMID: 37837483 DOI: 10.1007/s11916-023-01174-7] [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] [Accepted: 09/15/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW Surgical deactivation of migraine trigger sites by extracranial neurovascular decompression has produced encouraging results and challenged previous understanding of primary headaches. However, there is a lack of in-depth discussions on the pathophysiological basis of migraine surgery. This narrative review provides interpretation of relevant literature from the perspective of compressive neuropathic etiology, pathogenesis, and pathophysiology of migraine. RECENT FINDINGS Vasodilation, which can be asymptomatic in healthy subjects, may produce compression of cranial nerves in migraineurs at both extracranial and intracranial entrapment-prone sites. This may be predetermined by inherited and acquired anatomical factors and may include double crush-type lesions. Neurovascular compression can lead to sensitization of the trigeminal pathways and resultant cephalic hypersensitivity. While descending (central) trigeminal activation is possible, symptomatic intracranial sensitization can probably only occur in subjects who develop neurovascular entrapment of cranial nerves, which can explain why migraine does not invariably afflict everyone. Nerve compression-induced focal neuroinflammation and sensitization of any cranial nerve may neurogenically spread to other cranial nerves, which can explain the clinical complexity of migraine. Trigger dose-dependent alternating intensity of sensitization and its synchrony with cyclic central neural activities, including asymmetric nasal vasomotor oscillations, may explain the laterality and phasic nature of migraine pain. Intracranial allodynia, i.e., pain sensation upon non-painful stimulation, may better explain migraine pain than merely nociceptive mechanisms, because migraine cannot be associated with considerable intracranial structural changes and consequent painful stimuli. Understanding migraine as an intracranial allodynia could stimulate research aimed at elucidating the possible neuropathic compressive etiology of migraine and other primary headaches.
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Özkan B, Albayati A, Tatar BE, Uysal CA. The use of mathematically standardized bilobed design perforator flaps for coverage of sacral pressure ulcers. Microsurgery 2023; 43:229-237. [PMID: 36205233 DOI: 10.1002/micr.30973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/25/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sacral pressure ulcer reconstruction is frequently applied in plastic surgery practice. Although perforator flaps are frequently used, recurrence is not uncommon in patients. For this reason, using the as little area as possible during the reconstruction is vital. Therefore, we aimed to describe a mathematically standardized bilobed perforator flap design for sacral pressure ulcer reconstruction with a certain proportion and angle relation between limbs. METHODS A total of 17 patients (5 female/12 male)were included in this report. The mean age of the patients was 50.4 years (Ranging from 32 to 79 years). The patients with grade 3-4 sacral pressure ulcers were included in the report. The patients have grade 1-2 sacral ulcers or the other areas of pressure ulcer excluded. The size of the defects ranged from 8 × 14 cm to 5 x 16 cm. For ulcers in the sacral region, we used bilobed flaps that we mathematically standardized. The length of the first limb of the flap was planned 90° vertically oriented according to the distance between the perforator zone to the distal lateral border of the defect. The width of the first limb was kept equal to the length of the defect. The orientation of the second limb of the flap was designed 90 degrees horizontally according to the first limb. Therefore, the lengths of second limbs were calculated as half of the first limb's width, and the widths of second limbs were calculated as ¾ width of the first limb's width. RESULTS A total of 10 flaps were elevated based on superior gluteal artery perforators, and seven flaps were nourished by inferior gluteal artery perforators. The mean size of the first limb of the flaps was 14.7 × 7.2 cm (Ranging from 8 to 20 × 6 to 13 cm). The mean size of the second limb of the flaps was 6.7 × 5.3 cm (Ranging from 5 to 12 × 4 to 8 cm). The mean size of defects was 10.5 × 7.3 cm (Ranging from 8 to 14 × 5 to 16). The mean rotation angle was 91.7° (ranging from 90 to 100). In the early postoperative period, the hematoma was detected in three patients and evacuated in one patient, resulting in wound separation. Tip necrosis was seen in a patient that was healed by wound care. No total flap loss was encountered. No late-term recurrence was seen during the follow-up. The mean follow-up time was 13.1 months (Ranging from 4 to 24 months). CONCLUSION Unilateral standardized bilobed perforator can reliably be preferred in medium to large size sacral pressure ulcer defects.
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Affiliation(s)
- Burak Özkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
| | - Abbas Albayati
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
| | - Burak Ergün Tatar
- Department of Plastic Surgery, Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cagri Ahmet Uysal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
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Prasath V, Naides AI, Weisberger JS, Quinn PL, Ayyala HS, Lee ES, Girard AO, Chokshi RJ. Perineal reconstruction after radical pelvic surgery: A cost-effectiveness analysis. Surgery 2023; 173:521-528. [PMID: 36418205 DOI: 10.1016/j.surg.2022.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/25/2022] [Accepted: 09/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Radical resection of pelvic and low rectal malignancies leads to complex reconstructive challenges. Many pelvic reconstruction options have been described including primary closure, omental flaps, and various fasciocutaneous and myocutaneous flaps. Little consensus exists in the literature on which of the various options in the reconstructive armamentarium provides a superior outcome. The authors of this study set out to determine the costs and quality-of-life outcomes of primary closure, vertical rectus abdominus muscle flap, gluteal thigh flap, and gracilis flap to aid surgeons in identifying an optimal reconstructive algorithm. METHODS A decision tree analysis was performed to analyze the cost, complications, and quality-of-life associated with reconstruction by primary closure, gluteal thigh flap, vertical rectus abdominus muscle flap, and gracilis flap. Costs were derived from Medicare reimbursement rates (FY2021), while quality-adjusted life-years were obtained from the literature. RESULTS Gluteal thigh flap was the most cost-effective treatment strategy with an overall cost of $62,078.28 with 6.54 quality-adjusted life-years and an incremental cost-effectiveness ratio of $5,649.43. Gluteal thigh flap was always favored as the most cost-effective treatment strategy in our 1-way sensitivity analysis. Gracilis flap became more cost-effective than gluteal thigh flap, in the scenario where gluteal thigh flap complication rates increased by roughly 4% higher than gracilis flap complication rates. CONCLUSION Our data suggest that, when available, gluteal thigh flap be the first-line option for reconstruction of pelvic defects as it provides the best quality-of-life at the most cost-effective price point. However, future studies directly comparing outcomes of gluteal thigh flap to vertical rectus abdominus muscle and gracilis flap are needed to further delineate superiority.
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Affiliation(s)
| | | | - Joseph S Weisberger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Patrick L Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Haripriya S Ayyala
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Edward S Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Alisa O Girard
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
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The Versatility of the Fasciocutaneous Infragluteal (FCI) Flaps for locoregional or free flap reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:2493-2500. [PMID: 35393262 DOI: 10.1016/j.bjps.2022.02.077] [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: 04/15/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The wide range of reconstructive purposes requires specific demands and considerations for appropriate flap selection. One versatile and reliable option, which is rarely reported in current literature, is the fasciocutaneous infragluteal (FCI) flap. In this study, we present our results of performing the FCI flap for different clinical indications. PATIENTS AND METHODS This retrospectively study was conducted between September 2011 and September 2019. We included 30 patients (21 females and 9 males) who underwent reconstruction with either pedicled or free FCI flap. Indications for performing FCI flap were uni- or bilateral autologous breast reconstruction, perineal reconstruction, congenital thoracic deformity, lower extremity coverage, and vulva reconstruction. RESULTS Forty-one FCI flaps were performed (34 free and 7 pedicled flaps). The average flap dimension was 7 × 20 cm (range, 7-8 × 19-21) and the mean length of the pedicle was 13.4 cm (range, 10.5-15.5). The mean diameter of the artery was 2.5 mm (range, 2.2-3.2), the mean diameter of the accompanying vein was 3 mm (range, 2.4-3.3). The flap survival rate was 97.6% (one flap loss). The most common minor complications were infragluteal wound healing disorders and hematoma. CONCLUSION The FCI flap provides constant and reliable anatomy with a long vascular pedicle as well as enough soft tissue bulk and a well-hidden scar. In our clinical practice, this flap has emerged as a first choice in perineal/vulvar reconstruction and a reliable alternative in breast reconstruction if the gold standard procedure cannot be performed. LEVEL OF EVIDENCE IV (Therapeutic).
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Arikrishnan D, Balakrishnan TM, Janardhanam J. Pedicled Chimeric Perforator Flap Based on Inferior Gluteal Vessel Axis for the Reconstruction of Stage-Four Primary Ischial Pressure Sores-A New Design. Indian J Plast Surg 2021; 54:177-185. [PMID: 34239241 PMCID: PMC8257320 DOI: 10.1055/s-0041-1729505] [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] [Indexed: 11/23/2022] Open
Abstract
Background
“Subfascial void reconstruction” in ischial pressure sores (IPSs) goes a long way in the amelioration of the common complications like persistent drainage, infection, wound dehiscence, and late recurrence. No locoregional flaps suffice this requirement. So we have designed a chimeric pedicled flap based on the inferior gluteal vessel axis (IGVA) perforators with two tissue components: (1) Pacman-style fasciocutaneous flap on a perforator and (2) gluteus maximus muscle (inferior portion) on another independent perforator.
Aim and Methods
After confirming the feasibility of novel design of chimeric pedicled IGVA perforator flap with cadaver study, we embarked on the clinical study with this chimeric flap. In this prospective cohort study, the study and the control existed in the same patient so that the biological factors affecting the wound healing would be the same.
Results
Twenty-one patients were included whose mean age was 39 years. Late recurrence occurred in one patient (4.8%) of chimeric flap while the control group (who had undergone conventional reconstruction) had recurrence in 11 patients (52.4%). On assessment with overall institutional score, grade A was observed in 18 patients of the chimeric IGVA flap group (
p
< 0.045), and in only 3 patients of the control group.
Conclusions
This anatomically construed flap, a new addendum in the armamentarium of reconstruction of IPSs, with its potential to congruently fill the ischiogluteal subfascial void may provide a lasting solution for preventing recurrences.
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Affiliation(s)
| | | | - Jaganmohan Janardhanam
- Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, India
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Ordenana C, Dalla Pozza E, Rampazzo A, Said S, McBride J, Kessler H, Bassiri Gharb B. Wide posterior gluteal-thigh propeller flap for reconstruction of perineal defects. Microsurgery 2020; 41:146-156. [PMID: 33030284 DOI: 10.1002/micr.30666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 07/11/2020] [Accepted: 09/18/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION With increasing popularity of minimally invasive approaches to abdominoperineal resection (APR), thigh-based flaps are becoming the preferred option for reconstruction. The gluteal-thigh flap provides sufficient bulk, albeit with a high complication rate. We reevaluated the vascularization and design of the gluteal-thigh flap. The purpose of this study is to highlight the importance of the vascularization of the posterior thigh skin by the descending branch of the inferior gluteal artery (IGA) and the profunda femoris artery (PFA) perforators to design a more reliable and versatile gluteal thigh flap. This flap is indicated in selected cases in which use of vertical rectus abdominis musculocutaneous flap is not feasible. METHODS Eleven fresh cadavers were used. The course, distribution, and diameter of IGA and PFA perforators were recorded. A wide posterior gluteal-thigh propeller flap (WPGTPF) was designed including the distance between the ischiatic tuberosity and greater trochanter; and extending it to within 8 cm of the popliteal fossa to improve flap reliability. Ten patients (mean age of 58.7 ± 10.6 years) underwent APR due to anal cancer (2) and rectal cancer (8); the approach was open in 3, laparoscopic in 6, and robotic in 1. All 10 patients received unilateral flap with a width of 12 ± 3.3 cm and surface of 405.5 ± 175.9 cm2 . RESULTS The descending branch of the IGA was dominant in 72.7% of the specimens. In 22.7% of the specimens, the pedicle of the flap derived from the first or second PFA perforators. In one case, there was a double vascularization. Descending branch of the IGA was mapped at 46 ± 7.96 mm on the X-axis (horizontal line from the ischial tuberosity [IT] to the greater trochanter) and -12.1 ± 17.9 mm on the Y-axis (vertical line from the IT to the Medial Femoral condyle). Its average caliber measured 2.18 ± 0.3 mm. The first and second PFA perforators were located at 101.6 ± 17.9 mm and 104.5 ± 15.5 mm on the X-axis; 35.9 ± 27.1 mm and 89.2 ± 37.6 mm on the Y-axis. Their average diameters were 1.84 ± 0.41 mm and 1.48 ± 0.3 mm. In two cases, the flap was based on the first PFA perforator, the rest were on the descending branch of the IGA. Neither complete nor partial flap necrosis was observed. One patient developed coccyx osteomyelitis treated and resolved with bone debridement and one patient developed a seroma of the lateral thigh that was treated conservatively. Three patients underwent a debulking procedure by a combination of liposuction and resection to improve the gluteal symmetry. All ten flaps survived completely. CONCLUSIONS Harvest of a wide flap that includes the PFA perforators and implementation of the propeller design increase the survival and versatility of the flap.
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Affiliation(s)
- Carlos Ordenana
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Edoardo Dalla Pozza
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Antonio Rampazzo
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sayf Said
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jennifer McBride
- Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bahar Bassiri Gharb
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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A Head-to-Head Comparison of the Vascular Basis of the Transverse Myocutaneous Gracilis, Profunda Artery Perforator, and Fasciocutaneous Infragluteal Flaps. Plast Reconstr Surg 2019; 143:381-390. [DOI: 10.1097/prs.0000000000005276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chiang IH, Wang CH, Tzeng YS. Surgical treatment and strategy in patients with multiple pressure sores. Int Wound J 2018; 15:900-908. [PMID: 29956467 DOI: 10.1111/iwj.12942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/10/2018] [Indexed: 02/03/2023] Open
Abstract
Pressure sores remain a common health problem, particularly among the physically limited or bedridden elderly, and can cause significant morbidity and mortality. This study aimed to present our surgical treatment and strategy for patients with multiple pressure sores. Between January 2010 and December 2016, 18 patients were enrolled. After adequate debridement, pressure sores were managed based on our treatment protocol. Patients' age, aetiology, defect size and location, flap reconstruction, outcome, and follow-up period were reviewed. A total of 10 men and 8 women (average age, 82.3 years) with a mean follow-up period of 28.3 months (6-72 months) were included. The mean defect area was 63.7 cm2 . The most common aetiology of the bedridden state was cerebrovascular accident (38.89%), and the most frequent sores were trochanteric pressure sores (53.57%). The average operative time and blood loss were 105.5 minutes and 100.8 mL, respectively. No haemodynamic variation or blood transfusion was noted during the surgery. The complication rate for each sore was 10.7%, including late recurrence. In conclusion, treating pressure ulcers requires careful patient education, intensive multidisciplinary optimisation, and meticulous wound care, and our treatment protocol ensures a shorter surgery time, less bleeding, and low complication rate.
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Affiliation(s)
- I-Han Chiang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chih-Hsin Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Kelahmetoglu O, Van Landuyt K, Yagmur C, Sommeling CE, Keles MK, Tayfur V, Simsek T, Demirtas Y, Guneren E. A simple concept for covering pressure sores: wound edge-based propeller perforator flap. Int Wound J 2017; 14:1183-1188. [PMID: 28707450 DOI: 10.1111/iwj.12783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/17/2017] [Accepted: 05/31/2017] [Indexed: 11/30/2022] Open
Abstract
We present a new surgical modification to allow propeller perforator flaps to cover pressure sores at various locations. We used a propeller perforator flap concept based on the detection of newly formed perforator vessels located 1 cm from the wound margin and stimulated by the chronic inflammation process. Between January 2009 and January 2017, 33 wound edge-based propeller perforator flaps were used to cover pressure sores at various locations in 28 patients. In four cases more than one flap was used on the same patient. The patients comprised 18 males and 10 females with a mean age of 41·25 (range, 16-70) years. All patients underwent follow-up for 0-12 months. The mean follow-up duration was 5·03 months. Venous congestion was observed in three flaps that were rotated by 180° (9·1%). However, there was a significant difference between flaps rotated by 90° and 180° according to the complication rate (P = 0·034). Out of 33 flaps, 29 flaps healed uneventfully. Patients were able to sit and lie on their flaps three weeks after surgery. In our study, we were able to obtain satisfying final results using these novel flaps.
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Affiliation(s)
- Osman Kelahmetoglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Koenraad Van Landuyt
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Caglayan Yagmur
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Casper E Sommeling
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Musa K Keles
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Konya Numune Hospital, Konya, Turkey
| | - Volkan Tayfur
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Tekin Simsek
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Yener Demirtas
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Ethem Guneren
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
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Djedovic G, Morandi EM, Metzler J, Wirthmann A, Matiasek J, Bauer T, Rieger UM. The posterior thigh flap for defect coverage of ischial pressure sores - a critical single-centre analysis. Int Wound J 2017; 14:1154-1159. [PMID: 28661069 DOI: 10.1111/iwj.12776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 05/17/2017] [Indexed: 12/30/2022] Open
Abstract
The development of pressure sores is still not only an enormous economical but also a medical burden. Especially in the ischial region, the local defect coverage remains demanding as it is the main weight-bearing area in wheelchair-mobilised patients and is prone to high mobility. The purpose of our study was to report our long-time experience with the reconstruction of ischial pressure ulcers with the medially based posterior thigh flap. A retrospective analysis of all primary pressure sores grade III-IV in the ischial area, which were covered with a medially based posterior thigh flap between January 2008 and December 2014, at our department was conducted. A total of 28 patients underwent defect coverage of an ischial pressure sore with the aforementioned flap. The subgroup with complications showed a statistically significant longer hospital stay. A statistically significant correlation between age and the coincidence of comorbidities could be seen. Older patients showed significantly higher grades of pressure sores. The medially based posterior thigh flap is a safe and reliable flap design. Complication rates are comparable to other flaps. Nevertheless, in case of complications, a significantly longer duration of hospitalisation has to be taken into account.
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Affiliation(s)
- Gabriel Djedovic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Julia Metzler
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Anna Wirthmann
- Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, AGAPLESION Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt, Germany
| | - Johannes Matiasek
- Department of Plastic and Reconstructive Surgery, St. Josef Hospital Vienna, Vienna, Austria
| | - Thomas Bauer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Ulrich M Rieger
- Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, AGAPLESION Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt, Germany
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Island Posterior Thigh Flap Revisited in Covering Extensive Sacral Wounds: Our Experience with Two Patients. Case Rep Surg 2017; 2017:2084695. [PMID: 28321356 PMCID: PMC5340937 DOI: 10.1155/2017/2084695] [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: 11/02/2016] [Accepted: 01/26/2017] [Indexed: 11/17/2022] Open
Abstract
Deep sacral wounds are best covered by flaps. Posterior thigh flaps have routinely been used to cover such wounds. The flap can however be modified as an island flap. Two patients with extensive sacral wounds were managed with island posterior thigh flaps. Both patients were admitted secondary to road traffic accident with subsequent soft tissue loss of the sacral area. The sacral defects in both patients were approximately 17 cm by 23 cm in dimensions. Unilateral island posterior thigh flap was raised and used to cover the wounds. Postoperatively both patients did well; the donor site and recipient sites healed without any complications. Island posterior thigh flap is thus an option in covering extensive defects of the sacral area. The flap is reliable and easy to raise and has minimal donor site morbidity. By raising it as an island flap the dog ear defect is avoided and the flap is able to be tunneled under the gluteal muscle. This maneuver enables the flap to be advanced further allowing it to cover more distal and extensive defects.
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12
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Djedovic G, Metzler J, Morandi EM, Wachter T, Kühn S, Pierer G, Rieger UM. Comparison of fasciocutaneous V-Y and rotational flaps for defect coverage of sacral pressure sores: a critical single-centre appraisal. Int Wound J 2017; 14:945-949. [PMID: 28261939 DOI: 10.1111/iwj.12736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/10/2017] [Indexed: 11/30/2022] Open
Abstract
Pressure sore rates remain high in both nursing homes as well as in hospitals. Numerous surgical options are available for defect coverage in the sacral region. However, objective data is scarce as to whether a specific flap design is superior to another. Here, we aim to compare two fasciocutaneous flap designs for sacral defect coverage: the gluteal rotation flap and the gluteal V-Y flap. All primary sacral pressure sores of grades III-IV that were being covered with gluteal fasciocutaneous rotational or V-Y flaps between January 2008 and December 2014 at our institution were analysed. A total of 41 patients received a total of 52 flaps. Of these, 18 patients received 20 gluteal rotational flaps, and 23 patients received 32 V-Y flaps. Both groups were comparable with regards to demographics, comorbidities and complications. Significantly more V-Y flaps were needed to cover smaller defects. Mean length of hospital stay was significantly prolonged when surgical revision had to be carried out. Both flap designs have proven safe and reliable for defect coverage after sacral pressure sores. Gluteal rotational flaps appear to be more useful for larger defects. Both flap designs facilitate their reuse in case of pressure sore recurrence. Complication rates appear to be comparable in both designs and to the current literature.
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Affiliation(s)
- Gabriel Djedovic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria.,Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, AGAPLESION Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt am Main, Germany
| | - Julia Metzler
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Tanja Wachter
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Shafreena Kühn
- Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, AGAPLESION Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt am Main, Germany
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Ulrich M Rieger
- Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, AGAPLESION Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt am Main, Germany
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13
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Kehrer A, Lamby P, Miranda BH, Prantl L, Dolderer JH. Flap design and perfusion are keys of success: Axial fasciocutaneous posterior thigh flaps for deep small pelvic defect reconstruction. Clin Hemorheol Microcirc 2017; 64:305-318. [DOI: 10.3233/ch-168105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andreas Kehrer
- Department of Plastic, Hand- and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - Philipp Lamby
- Department of Plastic, Hand- and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - Benjamin H. Miranda
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - Juergen H. Dolderer
- Department of Plastic, Hand- and Reconstructive Surgery, University Medical Center Regensburg, Germany
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Tremp M, di Summa PG, Oranges CM, Schaefer DJ, Kalbermatten DF. Reconstruction of gluteal deformities: a systematic review and experience of four cases. J Plast Surg Hand Surg 2016; 51:313-322. [PMID: 27928936 DOI: 10.1080/2000656x.2016.1263203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The reconstruction of gluteal deformities remains a major challenge. The aim of this article is to provide a systematic review of the literature concerned, and to present a case series with representative defects from various zones. METHODS A review of the literature was performed using PubMed, EMBASE, and The Cochrane Library, in accordance with the PRISMA statement. Quality of evidence was rated according to GRADE. Patients with various buttock deformities were included and, depending on the defect, the reconstructive techniques applied consisted of lipoinjection, local fasciocutaneous flap, or pedicled gracilis muscle flap. Complications, patient's pain assessment, impairment in everyday-life activities, aesthetic outcome, objective assessment of sensitivity, and recurrence were considered. RESULTS A total of 498 records were identified in the literature search. Of those, 12 studies met the PICOS (participants, interventions, comparators, outcomes, and study design) criteria. Overall, 41 patients were analysed, the evidence of which was of low quality. In this study, four patients (three female and one male) with a mean age of 44 ± 15 years were operated on between 2010-2014. The mean operation time was 83 ± 30 minutes. One patient required revision due to persistent seroma and recurrence, and one patient required neurolysis and gracilis denervation due to neuroma and scarring. After a mean follow-up of 40 ± 21 months, the results were functionally and cosmetically satisfactory. CONCLUSIONS Reconstruction of buttock deformities using an integrated approach can lead to a long-lasting, functionally and aesthetically satisfactory result. However, evidence is limited due to the lack of good-quality studies.
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Affiliation(s)
- Mathias Tremp
- a Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery , University Hospital Basel , Basel , Switzerland
| | - Pietro Giovanni di Summa
- b Division of Plastic, Reconstructive, Aesthetic, and Hand Surgery, CHUV , University Hospital of Lausanne , Lausanne , Switzerland
| | - Carlo M Oranges
- a Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery , University Hospital Basel , Basel , Switzerland
| | - Dirk J Schaefer
- a Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery , University Hospital Basel , Basel , Switzerland
| | - Daniel Felix Kalbermatten
- a Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery , University Hospital Basel , Basel , Switzerland.,b Division of Plastic, Reconstructive, Aesthetic, and Hand Surgery, CHUV , University Hospital of Lausanne , Lausanne , Switzerland
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15
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Affiliation(s)
- David Ross
- Department of Plastic Surgery, St Thomas' Hospital London and St Marks Hospital, London, UK
| | - Omar Faiz
- St Marks Hospital and Academic Institute & Imperial College, Harrow, London, UK
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Struckmann V, Peek A, Wingenbach O, Harhaus L, Kneser U, Holle G. The free fasciocutaneous infragluteal (FCI) flap: Outcome and patient satisfaction after 142 breast reconstructions. J Plast Reconstr Aesthet Surg 2016; 69:461-9. [DOI: 10.1016/j.bjps.2015.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 02/05/2023]
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17
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Niranjan NS, Fox P, Mittermiller P, Lee GK, Evans K, Mushtaq I. Genitourinary and perineal reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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18
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Treatment of ischial pressure sores. Our experience of 99 patients with 108 sores. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-1014-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Eun HK, Chung HS, Yoon SP. Uncommon branching pattern with a prominent articular ramus of the inferior gluteal artery in a Korean male cadaver. Anat Cell Biol 2014; 47:141-3. [PMID: 24987553 PMCID: PMC4076423 DOI: 10.5115/acb.2014.47.2.141] [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: 02/19/2013] [Revised: 01/12/2014] [Accepted: 03/19/2014] [Indexed: 11/27/2022] Open
Abstract
We found a rare case of uncommon branching pattern with a prominent articular ramus of the inferior gluteal artery in a 39-year-old Korean male cadaver, whose cause of death was rectal carcinoma. The inferior gluteal artery branches off downwards at a time, the muscular rami ran in parallel with one another, and the articular ramus gave another muscular branch and has an anastomosis with the medial circumflex femoral artery. Knowledge of vascular variations in the gluteal region may give useful information of versatile flaps for reconstruction and the prominent articular ramus found in this case is good enough to consider the existence of the anastomosis between the medial circumflex femoral artery and the inferior gluteal artery as normal, not rudimentary.
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Affiliation(s)
- Heung Kee Eun
- Jeju National University School of Medicine, Jeju, Korea
| | - Hee Sup Chung
- Jeju National University School of Medicine, Jeju, Korea
| | - Sang Pil Yoon
- Department of Anatomy, Jeju National University School of Medicine, Jeju, Korea
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20
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Saito A, Minakawa H, Saito N, Isu K, Hiraga H, Osanai T. The posterior thigh flap revisited: clinical use in oncology patients. Surg Today 2013; 44:1013-7. [DOI: 10.1007/s00595-013-0635-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 04/30/2013] [Indexed: 11/30/2022]
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21
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Reconstruction of the sacral region using the lumbo-gluteal sensory flap. J Plast Reconstr Aesthet Surg 2013; 66:239-42. [DOI: 10.1016/j.bjps.2012.08.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 08/22/2012] [Accepted: 08/29/2012] [Indexed: 11/21/2022]
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22
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Use of Inferior Gluteal Artery and Posterior Thigh Perforators in Management of Ischial Pressure Sores With Limited Donor Sites for Flap Coverage. Ann Plast Surg 2012; 69:67-72. [DOI: 10.1097/sap.0b013e31821ee432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Hainsworth A, Al Akash M, Roblin P, Mohanna P, Ross D, George ML. Perineal reconstruction after abdominoperineal excision using inferior gluteal artery perforator flaps2. Br J Surg 2012; 99:584-8. [PMID: 22231559 DOI: 10.1002/bjs.7822] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2011] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Perineal wound complications following abdominoperineal excision (APE) for low rectal tumours remain an important cause of morbidity and prolonged hospital stay, particularly after chemoradiotherapy. The aim was to assess outcomes after using inferior gluteal artery perforator (IGAP) flaps for immediate perineal reconstruction, and to compare these with the authors' previous experience and published literature on myocutaneous flaps.
Methods
A series of patients who underwent immediate IGAP flap reconstruction after APE between April 2008 and December 2010 were examined retrospectively to determine patient demographics, length of operation, complications (perineal wound and general) and length of hospital stay.
Results
Forty patients with rectal adenocarcinoma (33 primary and 7 recurrent disease) underwent immediate IGAP flap reconstruction following APE. Median follow-up was 9 months. Neoadjuvant chemoradiotherapy was received by 98 per cent of the patients. Thirty-two patients underwent APE plus IGAP flaps (25 open, 7 laparoscopic), with a median operating time of 402 min, and eight patients had multivisceral resection (MVR) plus IGAP flaps (7 total pelvic exenteration (TPE), 1 abdominosacral resection), with a median duration of surgery of 561 min. There was one death (fatal stroke) and four major flap complications (10 per cent) (1 enteroperineal fistula, and 3 deep wound infections). Median length of hospital stay was 13 days after APE plus IGAP flaps and 27 days following MVR plus IGAP flaps. Late complications occurred in two patients who had vaginal reconstruction and developed perineal hernias requiring revisional surgery.
Conclusion
Although operating times are long, the IGAP flap is robust, with no flap necrosis observed in this series.
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Affiliation(s)
- A Hainsworth
- Department of Colorectal, St Thomas' Hospital, London, UK
| | - M Al Akash
- Department of Colorectal, St Thomas' Hospital, London, UK
| | - P Roblin
- Department of Plastic Surgery, St Thomas' Hospital, London, UK
| | - P Mohanna
- Department of Plastic Surgery, St Thomas' Hospital, London, UK
| | - D Ross
- Department of Plastic Surgery, St Thomas' Hospital, London, UK
| | - M L George
- Department of Colorectal, St Thomas' Hospital, London, UK
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Ismail HEDA. Versatility of perforator sparing buttock rotation flap in repair of pressure sores. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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El Omari M, Casoli V, Pinsolle V. [Inferior gluteal artery perforator flap: anatomical study for its application in breast reconstruction]. ANN CHIR PLAST ESTH 2011; 56:287-97. [PMID: 21636198 DOI: 10.1016/j.anplas.2011.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/14/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE The inferior gluteal artery perforator flap, which is vascularised by perforator branches of the inferior gluteal artery (formerly ischiatic artery) is harvested in the gluteal crease. The purpose of this anatomical study was to clarify the anatomical features of this flap and locate the perforators of the inferior gluteal artery destined to the flap, in view to facilitate its surgical removal, as free flap for breast reconstruction. MATERIALS AND METHOD We performed 12 dissections on fresh cadavers, after selective injection of the inferior gluteal artery with a gelified solution. During harvesting, we located the perforators which arise from the inferior gluteal artery and perfuse the flap. RESULTS We distinguished four zones, defined relatively to anatomical landmarks of the region, according to the frequency of perforators. CONCLUSION This anatomical study makes possible an improvement of the technique to raise this flap in its free shape with view to use it for breast autologus reconstruction especially given its numerous advantages: a constant volume of fat even in thin patients and minimal donor site morbidity.
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Affiliation(s)
- M El Omari
- Service de chirurgie plastique, CHU Ibn Sina, Rabat, Maroc.
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Abstract
The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications, with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented.
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Rozen WM, Ting JWC, Grinsell D, Ashton MW. Superior and inferior gluteal artery perforators: In-vivo anatomical study and planning for breast reconstruction. J Plast Reconstr Aesthet Surg 2011; 64:217-25. [PMID: 20462823 DOI: 10.1016/j.bjps.2010.04.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 04/15/2010] [Accepted: 04/16/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Warren M Rozen
- Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Room E533, Department of Anatomy and Cell Biology, The University of Melbourne, Parkville, Victoria 3050, Australia.
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Boccola MA, Rozen WM, Ek EW, Teh BM, Croxford M, Grinsell D. Inferior gluteal artery myocutaneous island transposition flap reconstruction of irradiated perineal defects. J Plast Reconstr Aesthet Surg 2010; 63:1169-75. [DOI: 10.1016/j.bjps.2009.05.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 05/20/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
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Reconstruction in the buttock region using the local fasciocutaneous infragluteal (FCI) flap. J Plast Reconstr Aesthet Surg 2010; 63:126-32. [DOI: 10.1016/j.bjps.2008.08.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 07/29/2008] [Accepted: 08/18/2008] [Indexed: 11/22/2022]
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Management of recurrent ischial pressure sore with gracilis muscle flap and V-Y profunda femoris artery perforator-based flap. J Plast Reconstr Aesthet Surg 2008; 62:1339-46. [PMID: 18595789 DOI: 10.1016/j.bjps.2007.12.092] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 12/20/2007] [Accepted: 12/24/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inappropriate seating has been implicated as a major contributing factor in ischial pressure-sore recurrence. During their lifetime, paraplegic patients may require several flaps for closure of the same or some other adjacent pressure sore. Despite a wide variety of flap reconstruction options being described, the ischium remains the most difficult pressure-sore site to treat. METHODS From June 1998 to July 2006, there were 253 pressure-sore patients operated upon at Kaohsiung Medical University Hospital. Ten patients (eight men and two women) suffered from recurrent ischial pressure sores, and all of them received more than one flap reconstruction for the ischial defect. For the treatment of the recurrent ischial pressure sore, gracilis muscle flap and readvancement of the V-Y profunda femoris artery perforator-based flap were used to fill the dead space as well as cover the defect. RESULTS Among these 10 recurrent ischial pressure-sore patients, six of them had suffered bilateral ischial ulcers. Eight of them had previous sacral pressure sores. In all, 32 flap reconstruction procedures were performed on these 10 patients. Unfortunately, one patient had recurrent grade II bilateral ischial pressure sores after 11 months of ulcer-free period. The other nine patients had no recurrence noted, and enjoyed their lives with an average 27.2 months ulcer-free period (range 9-53 months). CONCLUSIONS The fasciocutaneous flap provides a higher mechanical resistance than the detached and transposed muscle. However, for the recurrent ischial ulcer patients, readvancement of the perforator-based fasciocutaneous flap alone cannot provide adequate bulk to obliterate the 'dead space' after debridement of the bursa and the surrounding necrotic tissue. By combining the readvancement of V-Y profunda femoris artery perforator-based fasciocutaneous flap and gracilis muscle flap, these recurrent ischial ulcers will heal without complication. Recurrence of ulceration often develops despite successful flap closure. Patients and their relatives have to be educated regarding pressure relief, personal skin, and self-care. Surgeons must collaborate with the rehabilitation department, nursing staffs, and social workers to improve long-term results.
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32
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Dubuisson J, Golfier F, Bouillot A, Raudrant D. [Vulvoperineal reconstruction after extended radical vulvectomy: two reconstructive procedures]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2008; 36:325-9. [PMID: 18494149 DOI: 10.1016/j.gyobfe.2008.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Poor perineal healing is often a major complication of extended radical vulvectomy in case of vulvar carcinoma. Procedures of vulvoperineal reconstruction require several criteria of quality for their use. The chosen technique should be: (1) reliable; (2) reproducible; (3) with minimal morbidity; (4) not much invasive with good anatomical and functional results. We describe two procedures of perineal reconstruction that correspond to the previous criteria: a local fasciocutaneous flap with lateral transposition and a regional musculocutaneous flap using the gluteus maximus muscle.
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Affiliation(s)
- J Dubuisson
- Service d'oncologie et de chirurgie gynécologique, centre hospitalier Lyon-Sud, Pierre-Bénite, France.
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