1
|
Liu Z, Liu S, Yang L, Cheng J, Zhang T, Gao Q, Yang C, Huang Y, Sun F, Ju J. Reconstruction of large-area wounds in limbs using two flow-through anterolateral thigh perforator flaps. Injury 2023; 54:110979. [PMID: 37598071 DOI: 10.1016/j.injury.2023.110979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/07/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Limb salvage in large wounds is difficult because the disrupted blood supply does not support a flap. This study evaluated the clinical efficacy of using two flow-through anterolateral thigh perforator flaps for reconstructing large-area limb wounds. METHODS This retrospective study included 45 patients who underwent reconstruction of large limb wounds using two flow-through anterolateral thigh perforator flaps at Ruihua Hospital between January 2015 and December 2020. Wound areas ranged from 15 cm × 13 cm to 46 cm × 18 cm. Single flap areas ranged from 16 cm × 8 cm to 46 cm × 9 cm. Blood supply locations were identified using color Doppler ultrasound or digital subtraction angiography (DSA) images. Primary outcomes were flap survival and complications at recipient or donor sites during at least 6-months follow-up. RESULTS The overall flap survival rate was 97% (87/90). All donor sites healed by first intention. Three cases developed vascular crises, which were alleviated by reoperation. One case had flexor contracture in left toes, relieved by cutting flexor tendons; 13 cases had flap bloat, relieved by flap thinning at 6 months. All cases showed properly healed wounds and functional reconstruction. CONCLUSIONS Reconstruction of large-area limb wounds using two flow-through anterolateral thigh perforator flaps provides safe and satisfactory effects without donor-site morbidity, and with proper healing and restored function.
Collapse
Affiliation(s)
- Zhijin Liu
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Shengzhe Liu
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Lin Yang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Junnan Cheng
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Tao Zhang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Qinfeng Gao
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Chengpeng Yang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Yongtao Huang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Fengwen Sun
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Jihui Ju
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, China.
| |
Collapse
|
2
|
Kim RS, Yi C, Kim HS, Jeong HY, Bae YC. Reconstruction of large facial defects using a combination of forehead flap and other procedures. Arch Craniofac Surg 2022; 23:17-22. [PMID: 35012243 PMCID: PMC8901596 DOI: 10.7181/acfs.2021.00381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/16/2021] [Indexed: 11/11/2022] Open
Abstract
Background Reconstruction of large facial defects is challenging as both functional and cosmetic results must be considered. Reconstruction with forehead flaps on the face is advantageous; nonetheless, reconstruction of large defects with forehead flaps alone results in extensive scarring on the donor site. In our study, the results of reconstruction using a combination of forehead flaps and other techniques for large facial defects were evaluated. Methods A total of 63 patients underwent reconstructive surgery using forehead flaps between February 2005 and June 2020 at our institution. Reconstruction of a large defect with forehead flaps alone has limitations; because of this, 22 patients underwent a combination of procedures and were selected as the subjects of this study. This study was retrospectively conducted by reviewing the patients’ medical records. Additional procedures included orbicularis oculi musculocutaneous (OOMC) V-Y advancement flap, cheek advancement flap, nasolabial V-Y advancement flap, grafting, and simultaneous application of two different techniques. Flap survival, complications, and recurrence of skin cancer were analyzed. Patient satisfaction was evaluated using questionnaires. Results Along with reconstructive surgery using forehead flaps, nasolabial V-Y advancement flap was performed in nine patients, local advancement flap in three, OOMC V-Y advancement flap in two, grafting in five, and two different techniques in three patients. No patient developed flap loss; however, cancer recurred in two patients. The overall patient satisfaction was high. Conclusion Reconstruction with a combination of forehead flaps and other techniques for large facial defects can be considered as both functionally and cosmetically reliable.
Collapse
Affiliation(s)
- Ryuck Seong Kim
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Changryul Yi
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hoon Soo Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Ho Yoon Jeong
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Yong Chan Bae
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
3
|
Teklebrhan F, Mahir G, Clark S, Shanthakumar D, Patten DK, Ullah MZ. Reverse Abdominoplasty: A Novel Practical Approach Using Oncoplastic Reconstruction in Managing Major Chest Wall Defects for Patients With Loco-Regional Recurrence Following Breast Cancer Surgery. Cureus 2021; 13:e19983. [PMID: 34868796 PMCID: PMC8628270 DOI: 10.7759/cureus.19983] [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] [Accepted: 11/29/2021] [Indexed: 11/05/2022] Open
Abstract
Background Loco-regional recurrence of breast cancer in patients with large chest wall defects following mastectomy poses significant oncoplastic challenges. Reverse abdominoplasty is most commonly used to treat patients with excess upper abdominal soft tissue and laxity following massive weight loss. Widely employed as a technique for aesthetic contouring of the upper anterior trunk, as well as in augmentation mammoplasty, its use to date for reconstructive purposes is mainly limited to burns and large site surgical tumour ablation. Method Here we review our experience of using reverse abdominoplasty as a novel approach to filling major anterior chest wall defects in patients with cutaneous manifestations of loco-regional or distant recurrence of breast cancer. Results Seven patients with metastatic breast cancer underwent reverse abdominoplasty for disease recurrence following mastectomy, with good patient-reported outcomes, and minimal surgical complications. Moreover, follow-up data in the patients surveyed also showed minimal to no limitations on their activities of daily living following the procedure. Conclusion Here we demonstrate the successful employment of reverse abdominoplasty - a technique not usually reserved in breast oncoplastic surgery - to treat fungating breast lesions and/or other manifestations of loco-regional recurrence in metastatic breast cancer. This may herald a paradigm shift in the way surgeons approach breast cancer recurrence in patients with pre-existing major chest wall defects.
Collapse
Affiliation(s)
- Fiori Teklebrhan
- Department of Breast Surgery, Whipps Cross University Hospital - Barts Health NHS Trust, London, GBR
| | - Gheed Mahir
- Department of Breast Surgery, Whipps Cross University Hospital - Barts Health NHS Trust, London, GBR
| | - Stephanie Clark
- Department of Breast Surgery, Whipps Cross University Hospital - Barts Health NHS Trust, London, GBR
| | - Dhurka Shanthakumar
- Department of Breast Surgery, Whipps Cross University Hospital - Barts Health NHS Trust, London, GBR
| | - Darren K Patten
- Department of Breast Surgery, Whipps Cross University Hospital - Barts Health NHS Trust, London, GBR
| | - M Z Ullah
- Department of Breast Surgery, Whipps Cross University Hospital - Barts Health NHS Trust, London, GBR
| |
Collapse
|
4
|
Liraglutide, a TFEB-Mediated Autophagy Agonist, Promotes the Viability of Random-Pattern Skin Flaps. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6610603. [PMID: 33868571 PMCID: PMC8032515 DOI: 10.1155/2021/6610603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
Random skin flaps are commonly used in reconstruction surgery. However, distal necrosis of the skin flap remains a difficult problem in plastic surgery. Many studies have shown that activation of autophagy is an important means of maintaining cell homeostasis and can improve the survival rate of flaps. In the current study, we investigated whether liraglutide can promote the survival of random flaps by stimulating autophagy. Our results show that liraglutide can significantly improve flap viability, increase blood flow, and reduce tissue oedema. In addition, we demonstrated that liraglutide can stimulate angiogenesis and reduce pyroptosis and oxidative stress. Through immunohistochemistry analysis and Western blotting, we verified that liraglutide can enhance autophagy, while the 3-methylladenine- (3MA-) mediated inhibition of autophagy enhancement can significantly reduce the benefits of liraglutide described above. Mechanistically, we showed that the ability of liraglutide to enhance autophagy is mediated by the activation of transcription factor EB (TFEB) and its subsequent entry into the nucleus to activate autophagy genes, a phenomenon that may result from AMPK-MCOLN1-calcineurin signalling pathway activation. Taken together, our results show that liraglutide is an effective drug that can significantly improve the survival rate of random flaps by enhancing autophagy, inhibiting oxidative stress in tissues, reducing pyroptosis, and promoting angiogenesis, which may be due to the activation of TFEB via the AMPK-MCOLN1-calcineurin signalling pathway.
Collapse
|
5
|
Scaglioni MF, Grufman V, Meroni M, Fritsche E. Soft tissue coverage of a total gluteal defect with a combination of perforator-based flaps: A case report. Microsurgery 2020; 40:797-801. [PMID: 32412685 DOI: 10.1002/micr.30605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/01/2020] [Accepted: 05/04/2020] [Indexed: 11/09/2022]
Abstract
Soft tissue defects in the buttock area are often related to decubitus ulcers, which are usually small to medium-large size and can be regularly treated with local flaps. However, when the defects have bigger size, such as those involving the whole gluteal region, the coverage can become more challenging, since this specific area needs both a good resistance to pressure and an acceptable functional result. The most common solution for similar cases is the use of multiple local flaps, or, in extreme situations, a free flap. In particular, local flaps based on perforator vessels are, in selected cases, a consolidated alternative to free flap allowing an efficient reconstruction of soft tissue defects using adjacent similar tissues, providing the benefit of "like with like" coverage. Here we present a case of a large mycosis fungoides nidus of the gluteal region measuring 25 cm × 18 cm reconstructed using two large perforator flaps adjacent to the defect combined with a remote one for coverage of the donor site. The cranial flap was designed based on a perforator arising from the superior gluteal artery and transferred into the defect by means of a V-Y advancement, while the two caudal propeller flaps in the posterior thigh were both based on perforators of the profunda femoris artery and rotated 180°, respectively. To obtain a tension-free cover of the donor site defect we applied the concept of "sequential" propeller flaps. Post-operative course was uneventful and the patient was ambulatory with assistive devices after 1 week. At 6 months follow-up, wounds were completely healed without complications and a good functional result was obtained. This report showed the great coverage potential of multiple perforator-based local flaps when properly combined allowing primary closure of the donor site. In particular, we managed to reconstruct a total gluteal defect using just ipsilateral side tissue, reducing morbidity, and obtaining a stable result.
Collapse
Affiliation(s)
- Mario F Scaglioni
- Depatment of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Vendela Grufman
- Depatment of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Matteo Meroni
- Depatment of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Elmar Fritsche
- Depatment of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| |
Collapse
|
6
|
Luca‐Pozner V, Boissiere F, Rodriguez T, Karra A, Herlin C, Chaput B. Complex abdominopelvic reconstruction by combined tensor fascia latae and superficial circumflex iliac artery perforator flaps. Microsurgery 2018; 40:25-31. [DOI: 10.1002/micr.30391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/24/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022]
Affiliation(s)
- V Luca‐Pozner
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - F Boissiere
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - T Rodriguez
- Department of Orthopedic and Trauma Surgery, Upper Limb and Spine Surgery UnitCHU Lapeyronie Montpellier France
| | - A Karra
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - C Herlin
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - B Chaput
- Department of Plastic, Reconstructive, Aesthetic Surgery and BurnsCHRU Rangueil Toulouse France
| |
Collapse
|
7
|
Cheng L, Chen T, Tu Q, Li H, Feng Z, Li Z, Lin D. Naringin improves random skin flap survival in rats. Oncotarget 2017; 8:94142-94150. [PMID: 29212216 PMCID: PMC5706862 DOI: 10.18632/oncotarget.21589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/18/2017] [Indexed: 12/29/2022] Open
Abstract
Background Random-pattern flap transfer is commonly used to treat soft-tissue defects. However, flap necrosis remains a serious problem. Naringin accelerates angiogenesis by activating the expression of vascular endothelial growth factor (VEGF). In the present study, we investigated whether naringin improves the survival of random skin flaps. Results Compared with controls, the naringin-treated groups exhibited significantly larger mean areas of flap survival, significantly increased SOD activity and VEGF expression, and significantly reduced MDA level. Hematoxylin and eosin (HE) staining revealed that naringin promoted angiogenesis and inhibited inflammation. Materials and Methods “McFarlane flap” models were established in 90 male Sprague-Dawley (SD) rats divided into three groups: a 40 mg/kg control group (0.5 % sodium carboxymethylcellulose), a 40 mg/kg naringin-treated group, and an 80 mg/kg naringin-treated group. The extent of necrosis was measured 7 days later, and tissue samples were subjected to histological analysis. Angiogenesis was evaluated via lead oxide–gelatin angiography, immunohistochemistry, and laser Doppler imaging. Inflammation was evaluated by measurement of serum TNF-α (tumor necrosis factor-α) and IL-6 (interleukin-6) levels. Oxidative stress was assessed by measuring superoxide dismutase (SOD) activity and the malondialdehyde (MDA) level. Conclusion Naringin improved random skin flap survival.
Collapse
Affiliation(s)
- Liang Cheng
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tingxiang Chen
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiming Tu
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hang Li
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhenghua Feng
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhijie Li
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dingsheng Lin
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| |
Collapse
|