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Uslu AB, Ünlü RE. Heel Reconstruction With Bipedicled Flap: A Salvage Procedure. INT J LOW EXTR WOUND 2020; 19:377-381. [PMID: 32089023 DOI: 10.1177/1534734620905738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reconstruction of the heel region poses great challenge to plastic surgeons not only due to calcaneal bone lying just deep to the subdermal fat pad but also due to easily exposed Achilles tendon. In order to achieve permanent closure of the heel defect, exposed bone or tendon-or both-should be covered with durable, preferably sensate, well-vascularized, thin skin flaps. Even though fasciocutaneous free flaps remain the gold standard in the reconstruction of heel defects with exposed bone or tendon, a significant number of these patients are older individuals with multiple comorbidities such as diabetes mellitus, hypertension, atherosclerosis, and peripheral vascular disease. In this study, with a clinic series consisting of 6 patients (1 female, 5 males), we present a new technique of reconstruction with a bipedicled flap as a safe, reliable, and efficient reconstructive modality in the treatment of heel defects in cases where free flaps and other more sophisticated reconstructive options are either not feasible or have failed. Achieving complete reconstruction of defects in all 6 patients, this technique proves to be successful as a salvage procedure in reconstruction of heel defects.
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Hackenberg RK, Täger S, Prangenberg C, Kabir K, Welle K. Reconstruction of Complicated Achilles Tendon Ruptures with Soft Tissue Defects - a Systematic Overview and Development of a Treatment Algorithm. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:314-322. [PMID: 31958851 DOI: 10.1055/a-1073-8516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Achilles tendon ruptures are among the most common ruptures of large tendons. Due to the vulnerable soft tissue there is a high risk of soft tissue defects. The combination of Achilles tendon ruptures and soft-tissue defects remains a challenge for the surgeon. Despite different treatment options there is a lack of structured treatment recommendation. By means of a systematic literature review and experience from our own clinic standard, an overview of the stepwise treatment options is presented. A treatment algorithm for reconstructive measures of Achilles tendon ruptures accompanied by soft-tissue defects according to the length of defect of the Achilles tendon, the size of the soft-tissue defect and patient-individual factors is developed. This is intended to serve the surgeon as a basis for decision making prior to application of therapy.
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Affiliation(s)
- Roslind Karolina Hackenberg
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Stefan Täger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Christian Prangenberg
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Koroush Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Kristian Welle
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
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Melandri D, Marongiu F, Carboni A, Rubino C, Razzano S, Purpura V, Minghetti P, Bondioli E. A New Human-Derived Acellular Dermal Matrix for 1-Stage Coverage of Exposed Tendons in the Foot. INT J LOW EXTR WOUND 2019; 19:78-85. [DOI: 10.1177/1534734619884422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The closure of wounds associated with soft tissue defects is surgically challenging, frequently requiring extensive plastic surgery and free flaps. The combination of ADM and STSG is an innovative method used to cover such wounds. The human-derived ADMs (H-ADMs) are the most described in the literature but according to European legislations, Companies H-ADMs outside the EC are not allowed to commercialize them in Europe, H-ADMs being “human products” and not “medical devices”, so being ruled by European legislations on transplants. The Skin Bank of the Bufalini Hospital (Cesena, Italy) obtained in 2009 the approval for the production and distribution of the first human cadaver-donor derived ADM from the Italian National Transplant Center and National Health Institute, we called with the Italian acronym M.O.D.A. (Matrice Omologa Dermica Acellulata). We present here the first use of a new H-ADM for treatment of distal lower extremity wounds with exposed tendons managed in one-stage pocedure with STSG. The excellent performance suggests that in cases where autologous tissue is unavailable or undesirable, the use of M.O.D.A. in one-stage procedure represents a promising alternative for covering wounds associated with tendons exposition.
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Deng C, Wu B, Wei Z, Zhang Z, Zhang T, Wang D. A Systematic Study of Vascular Distribution Characteristics and Axis Design of Various Flap Types. Med Sci Monit 2019; 25:721-729. [PMID: 30679415 PMCID: PMC6357821 DOI: 10.12659/msm.911940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this study was to define blood flow characteristics of multiple types of flaps and the theoretical basis of flap axis design. Material/Methods Sixty Sprague-Dawley (SD) rats were randomly divided into 6 groups: a normal skin group, and 5 groups with different types of flap: abdominal flap group, dorsal flap group, single-perforator flap group, double-perforators flap group, and delayed cutaneous nerve flap group. The vascular distribution characteristics of normal skin and various flap types were observed by gross morphology of specimens and X-ray after perfusion. Results There were distinct differences in vascular anastomosis and density in dorsal and ventral SD rats. The area of flap survival in the dorsal flap group was superior to that in the abdominal flap group, but the flap axis of the 2 groups passed straight through the middle of the pedicle. The flap surviving area in the double-perforators flap group was remarkably larger than in the single-perforator flap group, while the flap axis in the single-perforator flap group passed straight through the perforators, and in the double-perforators flap group there was a linking vessel between the 2 perforators. There were linking and reticulate vessels, in addition, linking vessels and cutaneous nerves were concomitant in the delayed cutaneous nerve flap group. The flap axis was the travel route of the cutaneous nerve. Conclusions Variations in flap blood supply patterns and axes with alterations based on flap types have implications for flap survival. Understanding blood flow characteristics within each flap type and accurately designing the flap axis is essential for flap survival.
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Affiliation(s)
- Chengliang Deng
- Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China (mainland)
| | - Bihua Wu
- Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China (mainland)
| | - Zairong Wei
- Department of Plastic Surgery, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China (mainland)
| | - Ziyang Zhang
- Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China (mainland)
| | - Tianhua Zhang
- Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China (mainland)
| | - Dali Wang
- Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China (mainland)
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Zhao F, Chen W, Zhao H, Zhang H, Chen Z, Luo Y, Chen T. Therapeutic effects of anterolateral thigh flap transfer in repairing oral and maxillofacial defects after ablative surgery of neoplasms. MINERVA CHIR 2019; 74:452-457. [PMID: 30600961 DOI: 10.23736/s0026-4733.18.07820-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To investigate the therapeutic effects of anterolateral thigh flap transfer in repairing oral and maxillofacial defects after ablative surgery of neoplasms and to discuss perioperative psychological care. METHODS A total of 80 patients who received oral and maxillofacial surgery for tumor resection in Nanfang Hospital from October 2014 to August 2016 were selected. Patients were randomly divided into control group and observation group, 40 patients in each group. Patients in control group received forearm flap transfer, while patients in observation group were treated with anterolateral thigh flap transfer. RESULTS The survival rate of flap, food intake ability, quality of life and incidence of complication were compared between groups. There was no significant difference in survival rate of the flaps between two groups (P>0.05). No significant difference in food intake was found between groups at 3 months after operation (P>0.05). The UW-QOL scores of the two groups at 1 year after operation were significantly higher than those before operation (P<0.05), and no significant differences in UW-QOL scores were found between two groups at 1 year after operation (P>0.05). Incidence of temporary dysfunction, hyperplastic scar, permanent dysfunction, pigmentation and pruritus was significantly lower in observation group than in control group (P<0.05). There was no significant difference in the incidence of necrosis between two groups (P>0.05). CONCLUSIONS The results showed that anterolateral thigh flap transfer has similar therapeutic effects to those of forearm flap transfer in repairing oral and maxillofacial defects after ablative surgery of neoplasms and improving food intake and quality of life. But Anterolateral thigh flap transfer can reduce the incidence of postoperative complications, so this treatment should be popularized.
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Affiliation(s)
- Fang Zhao
- Department of Stomatology, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China -
| | - Wei Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Hui Zhao
- Department of Blood Transfusion, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China
| | - Hongxia Zhang
- Department of Stomatology, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China
| | - Zhifeng Chen
- Department of Stomatology, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China
| | - Yuling Luo
- Department of Oncology, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China
| | - Ting Chen
- Department of Nephrology, Nanfang Hospital (The First School of Clinical Medicine), Southern Medical University, Guangzhou, China
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Single-Stage Reconstruction of Achilles Tendon and Overlying Tissue With the Extended Temporoparietal Fasciagaleal Flap—23-Year Follow-Up and the Review of the Literature. Ann Plast Surg 2016; 76 Suppl 3:S165-70. [DOI: 10.1097/sap.0000000000000789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Innocenti M, Tani M, Carulli C, Ghezzi S, Raspanti A, Menichini G. Radial forearm flap plus Flexor Carpi Radialis tendon in Achilles tendon reconstruction: Surgical technique, functional results, and gait analysis. Microsurgery 2015; 35:608-14. [DOI: 10.1002/micr.22481] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/30/2015] [Accepted: 08/14/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Marco Innocenti
- Plastic Surgery and Reconstructive Microsurgery Unit, Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Massimiliano Tani
- Orthopaedic Clinic, Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Christian Carulli
- Orthopaedic Clinic, Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Serena Ghezzi
- Plastic Surgery and Reconstructive Microsurgery Unit, Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Andrea Raspanti
- Plastic Surgery and Reconstructive Microsurgery Unit, Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Giulio Menichini
- Plastic Surgery and Reconstructive Microsurgery Unit, Department of Surgery and Translational Medicine; University of Florence; Florence Italy
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