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Ring A, Beutel H, Kirchhoff P, Bushart SU, Dellmann NC, Farzaliyev F. [Reconstruction of posttraumatic soft tissue defects of the ankle using free fascial flaps from the anterolateral thigh]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:136-144. [PMID: 34686888 PMCID: PMC8533668 DOI: 10.1007/s00113-021-01100-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Free fascial flaps from the anterolateral thigh (ALT) were used to reconstruct soft tissue defects after trauma to the ankle. This modification was compared to the conventional fasciocutaneous method. MATERIAL AND METHODS The defect size, the thickness of the subcutaneous fat layer on the thigh and the extent of the soft tissue covering the ankle were determined retrospectively. The evaluations were compared between fascial (Fo) and fasciocutaneous flaps (Fc). The foot and ankle outcome score (FAOS) was used. Esthetic outcome surveys were carried out. RESULTS A total of 18 isolated fractures of the ankle were evaluated. In 94% of the cases a closed soft tissue damage predominated. After fracture fixation using a plate, soft tissue defects with a mean area of 40.4 ± 13.1 cm2 (28-76 cm2) developed. The thickness of the soft tissue covering over the affected malleoli increased significantly in both groups as a result of the flap surgery (4.5 ± 0.7 vs. 21.1 ± 6.4 mm, p < 0.05). A significant difference was found when comparing the body mass index (BMI) between the groups (Fc 26.3 ± 3.4 kg/m2 vs. Fo 30.1 ± 4.2 kg/m2, p < 0.05). For both groups there was a positive correlation (r = 0.843) between the BMI and the thickness of the epifascial fat layer of the thigh. The FOAS survey revealed 75.9 ± 28.9 and 47.9 ± 32.4 points, respectively, for "function in daily life" and "foot and ankle-related quality of life". The esthetic reconstruction result was rated as "acceptable" by 55% and as "good" by 45%. DISCUSSION The modified method of a free fascial flap from the ALT can be useful in situations where a bulky flap makes it difficult to fit it into the defect.
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Affiliation(s)
- Andrej Ring
- Klinik für Plastische Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland.
- Ruhr-Universität Bochum, Bochum, Deutschland.
| | - Hendrik Beutel
- Klinik für Plastische Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland
- Ruhr-Universität Bochum, Bochum, Deutschland
| | - Pascal Kirchhoff
- Klinik für Plastische Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland
| | - Sebastian Ulrich Bushart
- Klinik für Plastische Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland
| | - Niklas-Chris Dellmann
- Klinik für Plastische Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland
| | - Farhad Farzaliyev
- Klinik für Allgemein‑, Viszeral und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland
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[Neurovascular interpositional femoral periosteal flap for accidental bolt gun injury of the hand]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:750-752. [PMID: 35781732 PMCID: PMC9411097 DOI: 10.1007/s00113-022-01209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 02/07/2023]
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Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction. Cancers (Basel) 2021; 13:cancers13174373. [PMID: 34503183 PMCID: PMC8431391 DOI: 10.3390/cancers13174373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary Head and neck bone reconstruction with revascularized free periosteal flaps and scaffold is an overlooked option in the literature. Aim of the present paper was to systematically analyse the results of maxillary and mandibular reconstruction with this technique. We found a total of 7 studies with 55 patients fitting with our inclusion criteria. The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Our paper therefore highlighted that maxillary and mandibular reconstruction with revascularized free periosteal flaps and scaffold is a possible alternative in patient unable to bone free flap complex reconstruction, with a success rate higher to that of other secondary options. Abstract Introduction: Head and neck bone reconstruction is a challenging surgical scenario. Although several strategies have been described in the literature, bone free flaps (BFFs) have become the preferred technique for large defects. Revascularized free periosteal flaps (FPFs) with support scaffold represents a possible alternative in compromised patient, BFF failure, or relapsing cancers as salvage treatment. However, only few clinical applications in head and neck are reported in literature. Purpose of the study was to systematically analyse the results of functional and oncologic maxillary and mandibular reconstruction with FPF with scaffold. Materials and Methods: A comprehensive review of the dedicated literature was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, Embase, Researchgate and Google Scholar databases using relevant keywords, phrases and medical subject headings (MeSH) terms. An excursus on the most valuable FPF’ harvesting sites was also carried out. Results: A total of 7 studies with 55 patients were included. Overall, the majority of the patients (n = 54, 98.1%) underwent an FPF reconstruction of the mandibular site. The most used technique was the radial forearm FPF with autologous frozen bone as scaffold (n = 40, 72.7%). The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Conclusions: Maxillary and mandibular reconstruction with FPF and scaffold is a possible alternative in patient unfit for complex BFF reconstruction and it should be considered as a valid alternative in the sequential salvage surgery for locally advanced cancer. Moreover, it opens future scenarios in head and neck reconstructive surgery, as a promising tool that can be modelled to tailor complex 3D defects, with less morbidities to the donor site.
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Ring A, Beutel H, Udrescu GA, Farzaliyev F. [Microvascular reconstruction of foot defects using a free femoral periostal flap]. DER ORTHOPADE 2021; 50:306-311. [PMID: 33416924 DOI: 10.1007/s00132-020-04064-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The reconstruction of defects in the foot region is a challenge due to the anatomical peculiarities of the soft tissue covering. OBJECTIVE This article presents the results of the reconstruction of postoperative foot defects using the free femoral periosteal flap (FFPF). MATERIAL AND METHODS In a patient collective (n = 10) with postoperative wound healing disorders of the foot, the defect zone was covered using a vascularized FFPF from the distal femoral region. The wound healing process was retrospectively analyzed. RESULTS The mean follow-up time was 20.2 ± 8.22 months (7-35 months). All patients had a soft tissue defect in the foot region with a mean area of 17.9 ± 3.72 cm2 (12-24 cm2). On average, a wound healing disorder occurred 2 weeks after the primary surgery. In the group of patients followed up the vascularized FFPF enabled a stable, definitive and aesthetically pleasing reconstruction and contributed to the bony consolidation. The duration of inpatient care after defect closure was 8-10 days and was significantly less than the duration of wound management prior to transplantation of the FFPF. CONCLUSION The FFPF is an effective and elegant method for the regenerative reconstruction of defects with accompanying osseous components in the foot region. The FFPF has the advantage of instant thin and pliable tissue coverage in contrast to many other reconstructive methods. The FFPF can promote wound consolidation through the regenerative properties of a vascularized periosteal sheath in the context of a one-step and permanent infection control.
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Affiliation(s)
- Andrej Ring
- Klinik für Plastische und Rekonstruktive Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland. .,Ruhr-Universität Bochum, Bochum, Deutschland.
| | - Hendrik Beutel
- Klinik für Plastische und Rekonstruktive Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland.,Ruhr-Universität Bochum, Bochum, Deutschland
| | - George Augustin Udrescu
- Klinik für Plastische und Rekonstruktive Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland
| | - Farhad Farzaliyev
- Klinik für Plastische und Rekonstruktive Chirurgie, St. Rochus Hospital, Glückaufstraße 10, 44575, Castrop-Rauxel, Deutschland.,Klinik für Allgemein- Viszeral und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland
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di Summa PG, Sapino G, Higgins GC, Guillier D. Freestyle superficial femoral artery perforator (SFAp) free flap combined with a free periosteal medial condyle flap in Gustillo IIb fracture: Overkill or ideal treatment? J Plast Reconstr Aesthet Surg 2020; 73:1253-1254. [PMID: 32241739 DOI: 10.1016/j.bjps.2020.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- P G di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Suisse.
| | - G Sapino
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Suisse; Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Largo del Pozzo 71, 41100 Modena, Italy
| | - G C Higgins
- Canniesburn Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G40SF, United Kingdom
| | - D Guillier
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Suisse; Department of Plastic Reconstructive and Hand Surgery, University Hospital, Boulevard de Lattre de Tassigny, F-21000 Dijon, France; Department of Oral and Maxillofacial Surgery, University Hospital, Boulevard de Lattre de Tassigny, F-21000 Dijon, France
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Ye SM, Yu Y, Jing JH, Zhou Y, Zhang JS, Teng XF, Xu CG, Cheng WD, Li ZY, Xu YJ. One-stage reconstruction of complex soft tissue defects in the hands using multidigit, chimeric, lateral arm, perforator flaps. J Plast Reconstr Aesthet Surg 2018; 72:902-908. [PMID: 30630749 DOI: 10.1016/j.bjps.2018.12.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/21/2018] [Accepted: 12/02/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe our experience using microsurgically fabricated, multilobed, chimeric, lateral arm (LA) flaps to reconstruct hand injuries with complex, multidigit, soft tissue defects and to evaluate the morbidity and esthetic and functional outcomes of the donor sites. METHODS We performed a single center, retrospective analysis of 21 patients with hand wounds treated from October 2013 to February 2016. All patients underwent reconstruction using multilobed, chimeric, free, LA flaps. A self-reported questionnaire was used to assess donor site morbidity and satisfaction with the esthetic and overall functional result. Outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) score, static 2-point discrimination score, and visual analogue scale. RESULTS The study included 21 patients (20 males and 1 female), with an average age of 32.14 years (range 18-45 years), who sustained traumatic injuries in road traffic accidents (n = 2) or industrial devices (n = 19). The average DASH score was 28.25 ± 2.3, the average 2-PD score was 7.20 ± 1.30, and the average visual analogue scale (VAS) was 0.38 ± 0.40. All 21 patients had sensory disorders at the donor site. Postoperative donor site complications comprised wound dehiscence (n = 1) and hematoma (n = 3). The patient-rated satisfaction score for the donor site was 5.40 ± 0.90, and 70% of the patients would undergo the same surgery again. CONCLUSION Microsurgical fabrication of multilobed, chimeric, LA flaps can exhibit sensory recovery and minimal pain but may cause hematoma and sensory disorders at the donor site. The flaps are a viable alternative for the reconstruction of complex, multidigit, soft tissue defects of the hands.
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Affiliation(s)
- Shu-Ming Ye
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Soochow University, SuZhou, 235131, Jiangsu, China; Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Yue Yu
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Jue-Hua Jing
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Yun Zhou
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Ji-Sen Zhang
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Xiao-Feng Teng
- Department of Orthopaedics Surgery, the Sixth Hospital of Ningbo, Ningbo, 315000, Zhejiang, China
| | - Chun-Gui Xu
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Wen-Dan Cheng
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Zi-Yu Li
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - You-Jia Xu
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Soochow University, SuZhou, 235131, Jiangsu, China.
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