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Fauconnet R, Heitz A, Walch A, Druel T, Gazarian A, Cambon A, Mathieu L. Elbow coverage by the descending superficial radial artery flap: a clinical series and literature review. Eur J Trauma Emerg Surg 2024; 50:1733-1740. [PMID: 38609715 DOI: 10.1007/s00068-024-02527-6] [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] [Received: 02/17/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Soft tissue coverage of the posterior aspect of the elbow requires thin and flexible flaps to adapt to movements without constraining them. The authors report a clinical series of reconstruction by the descending superficial radial artery (DSRA) flap, a proximal forearm perforator flap which use is rarely reported in the literature. METHODS Seven patients with a mean age of 50 years (range 24-88 years) were treated for a posterior elbow defect using the DSRA flap with an adipofascial pedicle. The flap was tunneled to the defect in the subcutaneous tissue or raised using the racket-like technique to avoid any pedicle compression. RESULTS The mean follow-up was 3.3 months (range 1-12 months). A partial necrosis of the skin paddle occurred in an 88-year-old patient. In the other cases, the flap evolution was straightforward. At the last follow-up, the appearance of the flaps was satisfactory in terms of color, texture, and thickness. No complications were observed at the donor site. CONCLUSION The DSRA flap with an adipofascial pedicle is a simple, reliable, and reproducible method for reconstruction of small to moderate-sized defect on the posterior aspect of the elbow. Its use is easier for defects on the posterolateral side, but it can reach the medial olecranon.
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Affiliation(s)
- Robin Fauconnet
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Arthémon Heitz
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Arnauld Walch
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Thibault Druel
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Aram Gazarian
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Adeline Cambon
- Department of Hand and Upper Extremity Surgery, Saint-Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Laurent Mathieu
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France.
- Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Paris, Clamart, France.
- Department of Surgery, French Military Health Service Academy, 1 Place Alphonse Laveran, 75005, Paris, France.
- Military Biomedical Research Institute (IRBA), 1 Place Général Valérie André, 91220, Brétigny-Sur-Orge, France.
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Bruyere A, Ollivier I, Antoni M, Bodin F, Clavert P. Musculocutaneous flap of the medial head of the triceps brachii: pedicled flap to cover the posterior cubital region. Surg Radiol Anat 2022; 44:479-484. [DOI: 10.1007/s00276-022-02900-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 01/28/2022] [Indexed: 11/25/2022]
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Gao YS, Liu CY, Zhu HN, Zhou F, Zhang YF, Hu DQ, Li QF, Lin J. Antecubital Fossa Perforator Flaps for Soft-Tissue Defect Repair of the Anterior Elbow: Anatomical Study and Clinical Application. World J Surg 2022; 46:949-956. [PMID: 35031837 DOI: 10.1007/s00268-021-06412-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The antecubital fossa is a main perforator cluster region located beside the anterior elbow defect, rendering it crucial to harvest the perforator pedicled flaps for the anterior elbow defects. PATIENTS AND METHODS A total of 30 preserved cadaveric forearms were dissected in order to describe the perforator anatomy in the antecubital fossa. For each perforator, the number, the site of origin, the diameter at its origin, and the trajectory were recorded. In addition, all the patients treated for anterior elbow defects using inferior cubital artery (ICA) perforator pedicled flaps between June 2013 and June 2018 were reviewed in this retrospective study. RESULTS A total of 85 perforators were dissected in the antecubital fossa area from the 30 specimens. Among these, 65 perforators originated from the radial artery, 6 from the recurrent radial artery, 13 from the brachial artery, and 1 from the ulnar artery. Each forearm specimen had a constant and large ICA perforator. All perforators originated from source vessels 2-5 cm distal from the interepicondylar line and could be harvested as perforator pedicled flap for anterior elbow reconstruction. In the clinical study, 11 patients with anterior elbow defects were treated with ICA perforator pedicled flaps with satisfactory functional and aesthetic outcomes. CONCLUSION The antecubital fossa has a constant and dominant ICA perforator and many other perforators. The pedicled antecubital fossa perforator flaps could be harvested flexibly with a reliable blood supply for anterior elbow reconstruction.
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Affiliation(s)
- Ya-Shan Gao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Cai-Yue Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. .,Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University, Shanghai, 200003, China.
| | - Hai-Nan Zhu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Feng Zhou
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University, Shanghai, 200003, China
| | - Ying-Fan Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - De-Qing Hu
- Department of Orthopedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Qing-Feng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Jian Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. .,Department of Orthopedics, Xinhua Hospital (Chongming) Affiliated To Medical College, Shanghai Jiao Tong University, Shanghai, 202150, China.
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Cegarra-Escolano M, Jaloux C, Poumellec MA, Balaguer T, Baqué P, Bronsard N, Camuzard O. Vascularization of the lateral and medial antebrachial cutaneous nerves by cutaneous perforator arteries: An anatomical study. HAND SURGERY & REHABILITATION 2021; 40:241-249. [PMID: 33757862 DOI: 10.1016/j.hansur.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
The forearm is an interesting donor site for non-vascularized nerve grafts, especially hand surgeons. Very few studies have described the use of the lateral and medial antebrachial cutaneous nerves (LABCN and MABCN, respectively) as vascularized nerve grafts (VNGs). The aim of this anatomical study was to analyze the characteristics and vascularization of these nerves to describe new potential donor sites for VNGs. Twelve forearms were dissected from fresh cadavers injected with red latex. The number of terminal branches, lengths, and proximal and distal diameters of both the LABCN and MABCN were studied. An anatomical description of the cutaneous perforator arteries from the radial and ulnar arteries that vascularized the nerve was also recorded: number of perforators, length, type of perforator (septo- or musculocutaneous), and location within the forearm (proximal, middle, and distal third). In over 80% of the specimens, the cutaneous perforator arteries from the radial and ulnar artery vascularized the LABCN and the MABCN, respectively. These arteries, found mostly in the proximal third of the forearm, had diameters >0.5mm. Most of them came from the radial and ulnar arteries (for LABCN and MABCN vascularization, respectively). In over 75% of the specimens, the nutrient arteries of both nerves also vascularized the superficial veins and the skin. We found that these nerves are vascularized by perforators arteries, which also participate in vein and skin vascularization. Altogether, this anatomical study shows that reconstructive surgeons could use new VNGs based on the perforator artery of the forearm.
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Affiliation(s)
- M Cegarra-Escolano
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - C Jaloux
- Department of Plastic and Reconstructive Surgery, La Conception Hospital, Marseille, France
| | - M-A Poumellec
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - T Balaguer
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - P Baqué
- Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France; Service de Chirurgie viscérale d'urgence, Hôpital Pasteur 2, University of Côte d'Azur, 30 Voie romaine, 06000 Nice, France
| | - N Bronsard
- Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France; Department of Orthopedic Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - O Camuzard
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France; Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France; UMR E-4320 TIRO-MATOs CEA/DRF/BIAM, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France.
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5
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Remy H, Locatelli F, Maertens A, Balaguer T, Baqué P, Bronsard N, Camuzard O. Arterial grafts for proper palmar digital artery reconstruction: An anatomical study. HAND SURGERY & REHABILITATION 2020; 40:69-74. [PMID: 33137466 DOI: 10.1016/j.hansur.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
Digital ischemia due to arterial defects need urgent surgical management. The traditional treatment consists of vascular reconstruction using a reversed autologous venous graft as a bypass. Very few studies have described the use of arterial grafts for digital artery reconstruction. This cadaver study characterized the forearm perforator arteries to assess the potential feasibility of using them as donor grafts for digital artery reconstruction. Eleven forearms and twenty hands were dissected from freshly injected cadavers. All clinically significant perforators (>0.5 mm) derived from radial or ulnar arteries and digital arteries were evaluated. The digital palmar arteries were measured at three points: metacarpophalangeal (MCP) joint, proximal interphalangeal (PIP) joint, and distal interphalangeal (PIP) joint. In the 11 forearms analyzed, 5.5 ± 1.3 perforators from radial or ulnar arteries with a diameter of at least 0.5 mm were found per dissection. The mean diameters were 0.9 ± 0.18 mm proximally and 0.8 ± 0.15 mm distally; the mean length was 35.6 ± 11.35 mm. The mean diameters for the dominant and non-dominant arteries were 1.5 and 1.3 mm at the MCP, 1.3 and 1.0 mm at the PIP, 0.8 and 0.7 mm at the DIP, respectively. The forearms are good donor sites as they have large-diameter arteries of suitable length for arterial grafting. These new arterial grafts may be suitable for vascular reconstruction of digital arteries starting from the PIP joint.
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Affiliation(s)
- H Remy
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France
| | - F Locatelli
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France; Microchirurgia e Chirurgia della mano, ASST Gaetano Pini-CTO, Università di Milano, Milano, Italia
| | - A Maertens
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France
| | - T Balaguer
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France
| | - P Baqué
- Laboratoire d'Anatomie humaine, Faculté de Médecine de Nice, Université Côte d'Azur, Nice, France; Service de Chirurgie viscérale d'urgence, Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - N Bronsard
- IULS, Service de Traumatologie et d'Orthopédie, CHU de Nice, Hôpital Pasteur 2, Nice, France; Laboratoire d'Anatomie humaine, Faculté de Médecine de Nice, Université Côte d'Azur, Nice, France
| | - O Camuzard
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France; Laboratoire d'Anatomie humaine, Faculté de Médecine de Nice, Université Côte d'Azur, Nice, France.
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Zhu Z, Yuan ZQ, Huang C, Jin R, Sun D, Yang J, Luo XS. Construction of a dermis-fat composite in vivo: Optimizing heterogeneous acellular dermal matrix with in vitro pretreatment. J Tissue Eng Regen Med 2019; 14:215-228. [PMID: 31729841 DOI: 10.1002/term.2986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/22/2019] [Accepted: 10/05/2019] [Indexed: 12/14/2022]
Abstract
Dermis-fat composite tissues have been widely used in plastic and reconstructive surgery and were previously constructed using hydrogel-type scaffolds. The constructs can be used for in vitro cosmetic and pharmaceutical testing but are not mechanically strong enough for in vivo applications. In this study, we used heterogeneous (porcine) acellular dermal matrix (PADM) as dermal layer scaffold. PADM was pretreated with the laser micropore technique and then precultured with rat adipose-derived stem cells (rADSCs) in vitro. rADSCs proliferated well on pretreated/unpretreated PADM, showing increased expression of genes associated with inflammatory regulation, proangiogenesis, and stemness, indicating that pretreated/unpretreated PADM both provide a beneficial microenvironment for rADSCs to exert their paracrine function. After in vitro processing, the rADSCs-polyporous PADM and PADM without pretreatments were implanted into the back of rats respectively, followed by adipose tissue transplantation. After implantation, the inflammation induced by pretreated PADM was significantly attenuated and localized compared to the unpretreated group. Moreover, the vascularization was faster, and more adipose tissue was formed in the pretreated group. Sound dermis-fat composite tissue was constructed with sufficient strength, which can potentially be used for actual repair application.
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Affiliation(s)
- Zhu Zhu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhao-Qi Yuan
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Cheng Huang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Rui Jin
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Di Sun
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xu-Song Luo
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Zhan Y, Zhu H, Li W, Su Q, Liu XL, Qi J. Saphenous Artery Perforator Flaps in Minipigs: Anatomical Study and a New Experimental Model. J INVEST SURG 2019; 34:486-494. [PMID: 31456447 DOI: 10.1080/08941939.2019.1654570] [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: 10/26/2022]
Abstract
This study describes the anatomy of the saphenous artery (SA) perforators in minipigs and the development of a new animal model. First, the anatomic characteristics of the SA and perforators in minipigs were examined after latex-lead oxide perfusion. Subsequently, the right hind limbs of 10 minipigs were used to generate capillary perforator flaps (group A; utilizing the SA and 5.5 cm of deep fascia above the knee), while all perforators of the left hind limbs were reserved (group B). Four additional minipigs were used to evaluate SA perforator flaps with capillary perforators plus sarcolemma and a small amount of muscle (group C). Preoperative and postoperative CTA of both hind limbs confirmed that all perforators were ligated in groups A and C. The average length of the SA was 14.86 ± 0.76 mm. The diameters of the SA at initiation, the medial tibial condyle, and the medial malleolus were 1.73 ± 0.15 mm, 1.50 ± 0.12 mm, and 1.30 ± 0.13 mm, respectively. There were 7.09 ± 1.16 perforators per hind limb, with an average diameter of 0.40 ± 0.13 mm (range, 0.10-0.78 mm), and the majority (96.2%) had a diameter >0.2 mm. The survival rates of the flaps in groups A, B, and C were 32 ± 39%, 100%, and 60.2 ± 17%, respectively. The position of the SA in minipigs is constant, its diameter is relatively large, and it has many perforators, allowing it to be used as a reliable model of perforator flaps, including capillary perforator flaps.
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Affiliation(s)
- Yi Zhan
- Department of Microsurgery and Orthopedic Trauma, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hongzhang Zhu
- Department of Medical Imaging, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wenwen Li
- Laboratory Animal Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiao Su
- Laboratory Animal Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Lin Liu
- Department of Microsurgery and Orthopedic Trauma, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jian Qi
- Department of Microsurgery and Orthopedic Trauma, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Brachioradialis muscle flap for posterior elbow defects: a simple and effective solution for the upper limb surgeon. J Shoulder Elbow Surg 2019; 28:1476-1483. [PMID: 31227467 DOI: 10.1016/j.jse.2019.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Trauma, infection, and posterior surgical approach are the most frequent causes of soft tissue defects of posterior elbow. The brachioradialis (BR) muscle flap is a rotational muscular pedicled flap, and the dominant vascular pedicle arises from the radial recurrent artery in the proximal portion of the muscle. The aim of the study was to present the BR muscle flap as a simple, safe, and effective solution for the treatment of soft tissue defects of the posterior elbow. METHODS Five patients (3 males; mean age, 61.4 years; range, 40-73 years) with soft tissue defects of the posterior elbow underwent surgical treatment with the BR muscle flap. The causes of the defects were total elbow arthroplasty and postsurgical infection (n = 2), 1 patient with elbow arthrodesis due to neuropathic arthropathy, and postsurgical infection after open reduction and internal fixation of olecranon fractures (n = 2). All patients had a BR muscle flap and skin grafting. Orthopedic hardware was removed in 3 cases. RESULTS At the mean follow-up of 45 months (range, 26-61 months), all patients had viable and functional soft tissue coverage. All patients were free of infection, whereas 1 patient had a posterior elbow discomfort in daily activities. None of the patients reported wrist problems. CONCLUSIONS The BR muscle flap is a reliable solution, easy to harvest without requiring microsurgical expertise for small-size posterior elbow defects. It is a 1-stage procedure with no morbidity to the harvest site that provides stable and adequate coverage even in cases with postoperative infection.
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Gandolfi S, Auquit-Auckbur I, Poirot Y, Bonmarchand A, Mouton J, Carloni R, Nseir I, Duparc F. Focus on anatomical aspects of soft tissue coverage options in elbow reconstruction: an updating review. Surg Radiol Anat 2018; 40:943-954. [DOI: 10.1007/s00276-018-2066-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/05/2018] [Indexed: 11/30/2022]
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A new local muscle flap for elbow coverage-the medial triceps brachii flap: anatomy, surgical technique, and preliminary outcomes. J Shoulder Elbow Surg 2018; 27:733-738. [PMID: 29396099 DOI: 10.1016/j.jse.2017.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The medial triceps brachii is vascularized by the middle collateral artery and the arterial circle of the elbow. This vascularization allows a distal pedicled use to cover soft tissue defects of the elbow. We report our experience using this flap to cover traumatic and postsurgical wounds. METHODS Patients who underwent a pedicled medial triceps brachii flap procedure between 2008 and 2015 were included. Data concerning characteristics of the patients, wound size, surgical technique, and complications were retrospectively reviewed. An independent observer examined patients and assessed outcome of the coverage procedure: wound healing, scar length, range of elbow motion, and patient satisfaction. RESULTS Eight patients were included (70.6 ± 17.7 years old at the time of surgery). All patients had serious comorbidities and risk factors of poor wound healing. Defects were due to postoperative healing complications (5 patients), skin necrosis secondary to an underlying olecranon fracture (1 patient), and direct open fractures (2 patients). Soft tissue defects had a median surface of 17 (14-22) cm2. The olecranon was exposed in 7 cases and the medial humeral epicondyle in 1 case. Mean procedure duration was 83 ± 14 minutes. There was no intraoperative or postoperative complication. All patients healed properly at 3 weeks of follow-up. No wound recurrence or surgery-related complication was reported after a median follow-up of 40.5 (21.5-69.5) months. CONCLUSION Favorable outcomes in all of our 8 patients make this flap an interesting option to cover small to medium-sized defects of the posterior aspect of the elbow.
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Ling BM, Wettstein R, Staub D, Schaefer DJ, Kalbermatten DF. The Medial Sural Artery Perforator Flap: The First Choice for Soft-Tissue Reconstruction About the Knee. J Bone Joint Surg Am 2018; 100:211-217. [PMID: 29406342 DOI: 10.2106/jbjs.16.01401] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The gastrocnemius muscle flap may be considered the first choice in many cases of soft-tissue reconstruction about the knee. Limited arc of rotation and reach of the flap as well as unsightly muscle bulk are major disadvantages and were the impetus to look for a local alternative. The aim of this study is to present a consecutive series of patients with a reconstruction about the knee involving the medial sural artery perforator flap (MSAPF). METHODS A consecutive series of 17 cases of defect reconstructions about the knee using the MSAPF is described, with an emphasis on early postoperative complications. RESULTS No major flap-related complications occurred except 1 case of tip necrosis that healed uneventfully after excision and secondary suture. Two patients with direct donor-site closure had a minor complication that required no revision, and 2 had partial skin-graft loss. CONCLUSIONS In summary, use of this pedicled perforator flap represents a reliable technique for soft-tissue reconstruction about the knee with an acceptable complication rate and optimal contour reconstruction without the need for a skin graft and secondary debulking procedures. The range of motion associated with the MSAPF in comparison to the range associated with the gastrocnemius muscle flap is increased so that more proximal and lateral defects can be covered. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Barbara M Ling
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery (B.M.L., R.W., D.J.S., and D.F.K.) and Department of Angiology (D.S.), University Hospital Basel, Basel, Switzerland
| | - Reto Wettstein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery (B.M.L., R.W., D.J.S., and D.F.K.) and Department of Angiology (D.S.), University Hospital Basel, Basel, Switzerland
| | - Daniel Staub
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery (B.M.L., R.W., D.J.S., and D.F.K.) and Department of Angiology (D.S.), University Hospital Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery (B.M.L., R.W., D.J.S., and D.F.K.) and Department of Angiology (D.S.), University Hospital Basel, Basel, Switzerland
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery (B.M.L., R.W., D.J.S., and D.F.K.) and Department of Angiology (D.S.), University Hospital Basel, Basel, Switzerland
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