Outcomes of using a modified anteromedial thigh perforator flap for repairing the anterolateral thigh free flap donor site: A retrospective clinical review

IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch promotes angiogenesis in transplanted flap and inhibits inflammatory response

Skin flap transplantation is one of the most common tissue transplantation methods for wound repair and organ reconstruction in plastic surgery. During the transplantation process, the inflammatory response of transplanted flap and angiogenesis are critical to the successful rate of skin flap transplantation. In recent years, to improve the biocompatibility and cell affinity of biomedical materials, the modified biomaterials have gradually become a popular subject in scientific researches. In our study, the IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch IL4-e-PTFE was prepared, and the rat skin flap transplantation model was constructed. The results of cell experiment prove that IL-4 has potentiation in the angiogenesis of human umbilical vein endothelial cell (HUVEC) induced by monocyte, and IL-4 can also promote angiogenesis by inducing the M2 macrophages. According to the results of in vivo experiment, the apoptosis level of transplanted flap cells of rats in the IL4-e-PTFE group was lower than that in the e-PTFE group, and in the IL4-e-PTFE group, the expression levels of pro-inflammatory cytokines IL-1β, IL-6 and TNF-α showed significantly decline compared to the e-PTFE group, while the expression levels of anti-inflammatory cytokines IL-1Ra, IL-10 and TGF-β presented significant increase compared to the e-PTFE group; the immunofluorescence staining results show that the number of M2 macrophages in transplanted flap area of rats in the IL4-e-PTFE group was significantly higher than that in the e-PTFE group, and the angiogenesis level was remarkably improved. In this study, by preparing IL4-e-PTFE and carrying out the cell and in vivo experiments, a reference method is proposed, which can reduce the inflammatory response during skin transplantation process using e-PTFE and optimize the long-term effects of flap blood vessels, hoping to provide a broader space for the applications of e-PTFE in medicine.

The Superficial Inferior Epigastric Artery Interpolated Flap for Closure of Large Anterolateral Thigh Flap Donor Site Defects

ABSTRACT

The Anterolateral Thigh (ALT) flap has a critical role in head, neck, and extremity reconstruction. Unfortunately, when the ALT flap is dimensionally large, it leaves an open donor site that may not respond optimally to primary or secondary closure. Traditionally, skin grafting has been used to close large ALT flap donor site defects. However, skin grafting offers less than desirable aesthetic and functional results. The purpose of this article is to present the first reported case of a 70-year-old woman with a large ATL donor site defect, not responsive to direct primary closure, which was successfully reconstructed using a superficial inferior epigastric artery (SIEA) interpolated flap. After 3 weeks, the SIEA interpolated flap was divided, with the patient reporting good outcomes after a 3-month follow-up. The authors suggest that a SIEA interpolated flap as a novel potential approach to optimally repair large ALT donor site defects.

The effects of platelet-rich plasma combined with a skin flap transplant on open foot fractures with soft tissue defects

OBJECTIVE

This study aimed to explore the therapeutic effect of surgery using platelet-rich plasma combined with a skin flap transplant on open foot fractures with a soft tissue defect.

METHODS

From February 2017 to March 2020, 72 patients with open foot fractures and soft tissue defects were recruited as the study cohort. The patients who underwent surgery with just a flap transplant were placed in the control group (the CG) (35 cases), and the patients who underwent surgery using platelet-rich plasma combined with a flap transplant were placed in the research group (the RG) (37 cases). The wound volume changes before and after the treatment, the wound healing times, the fracture healing times, and any adverse prognostic reactions were observed. The pre- and post-treatment VAS and SF-36 scores were observed and recorded.

RESULTS

The total effective rate in the RG (100.00%) was significantly higher than the total effective rate in the CG (88.57%) (P=0.034). After the treatment, the wound volumes were lower in both groups, and the volume in the RG was smaller than it was in the CG at 3 weeks and 6 weeks after the treatment (P < 0.05). The average wound healing time in the RG (22.40 ± 2.10 days) was significantly lower than it was in the CG (32.20 ± 3.30 days) (P > 0.05). The average fracture healing time in the RG (6.50 ± 2.20 months) was significantly lower than it was in the RG (7.51 ± 2.33 months) (P > 0.05). The total incidence of adverse reactions to the treatment in the RG was 2.70%, and in the CG it was 11.43%. After the treatment, the VAS scores in the RG were significantly lower than they were in the CG (P < 0.05), and the SF-36 scores in the RG were significantly higher than the SF-36 scores in the CG (P < 0.05).

CONCLUSION

Platelet-rich plasma combined with a skin flap transplant can accelerate the healing times of wounds and fractures and lessen the occurrence of adverse reactions during the patients' treatment.

Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

BACKGROUND

 After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap.

METHODS

 We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent).

RESULTS

 In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group.

CONCLUSION

 In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

Reconstruction of extensive plantar forefoot defects with free anterolateral thigh flap

PURPOSE

The aim of the soft tissue reconstruction of plantar forefoot should yield weight-bearing function and aesthetic contour, which poses a significant challenge for reconstructive surgeons to provide an appropriate flap according to the "like for like" reconstructive principle. Local flaps and pedicled flaps have been described for the reconstruction of small- to medium-sized defects of plantar forefoot and achieved optimal results. However, reconstruction of extensive defects of plantar forefoot is rarely investigated. In this study, we present our experience using the free anterolateral thigh (ALT) flap in the reconstruction of extensive defects of plantar forefoot.

METHODS

Between November 2011 and April 2017, 9 patients were treated for extensive soft tissue defects in the plantar forefoot areas with ALT flaps. The mean age at the time of surgery was 39.3 years (range, 25-64 years).

RESULTS

The follow-up period ranged from 12 to 77 months, with a mean of 31 months. All flaps survived well, and the patients were satisfied with the aesthetic and functional results. The size of the flaps ranged from 63 to 455 cm, with a mean of 197.7 cm. Seven patients with no bony involvement began to gradually weight-bear at 3 weeks postoperatively. During the follow-up time, postoperative ulceration at the reconstructed weight-bearing areas was not encountered.

CONCLUSION

The ALT flap is a reliable option for treatment of extensive defects of plantar forefoot, resulting in an optimal functional and aesthetic outcome. Even when a total plantar loss exits, excellent results can be achieved.

Comparison of the modified direct closure method and skin grafting for wounds at the anterolateral thigh flap donor site

OBJECTIVE

This study was performed to compare the modified direct closure method and traditional skin grafting for wounds at the anterolateral thigh (ALT) flap donor site.

METHODS

Among 29 consecutive patients with wounds at the ALT flap donor site, 14 underwent the modified direct closure method (MDC group) and 15 underwent traditional skin grafting (SG group). The operative time, follow-up time, complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score of the two groups were statistically analyzed.

RESULTS

The mean follow-up times in the MDC and SG group were 16.1 and 16.7 months, respectively. Two patients showed partial skin necrosis after skin grafting, but the remaining patients' wounds healed uneventfully. The operative time in the MDC group was an average of about 64 minutes shorter than that in the SG group. The average VSS and SCAR scores in the MDC group were 2.1 and 3.0 points lower, respectively, than those in the SG group.

CONCLUSIONS

Compared with traditional skin grafting, the modified direct closure method is more efficient for repair of wounds at the ALT flap donor site because of its shorter operative time, better postoperative appearance of the donor site, and higher patient satisfaction.

Effect of Autologous Platelet-Rich Plasma Gel on Skin Flap Survival

BACKGROUND Skin flap grafting is one of the most common tissue transplantations for wound repair and organ reconstruction. Thus, improving the survival rate of the transplanted skin flap is important. Platelet-rich plasma (PRP) is an autologous platelet concentrate obtained from whole blood. It has been widely used in repairing tissue defects. Considering that the PRP gel has similar biological characteristics, this study used PRP gel for skin flap transplantation. MATERIAL AND METHODS PRP gel from Sprague-Dawley (SD) rats was prepared and the growth factor concentration was determined. A rat skin flap model was established to evaluate the survival rate of skin flap. Morphologic evaluation was also done. RESULTS We found that the PRP gel increased the survival rate of the skin flap. In addition, it reduces the inflammation response in skin flap transplantation and has better effects in terms of generating new soft tissue. CONCLUSIONS The effectiveness PRP gel in skin flap transplantation is satisfactory. The possible mechanisms by which PRP gel promotes the survival of the skin flap includes platelets, growth factors, immune activity factor, and fibrin. PRP could be a new clinical method for promoting skin flap survival.