1
|
Zaussinger M, Pommer G, Freller K, Schmidt M, Huemer GM. Bilateral Superior Gluteal Artery Perforator (SGAP) Flap: Modified Concept in Perineal Reconstruction. J Clin Med 2024; 13:3825. [PMID: 38999391 PMCID: PMC11242694 DOI: 10.3390/jcm13133825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Perineal reconstruction after abdominoperineal excision often requires complex closures and is fraught with wound healing complications. Flap-based approaches introduce non-irradiated vascularized tissue to the area of resection to fill a large soft-tissue defect and dead space, reduce the risk of infection, and facilitate wound healing. Employing perforator flaps with their beneficial donor site properties, the authors have developed a concept of bilateral superior gluteal artery perforator (SGAP) flaps to restore extensive perineal defects. Methods: This retrospective case series was conducted between September 2015 and December 2019. We included three patients who received bilateral SGAP flap reconstruction after oncological resection. One deepithelialized SGAP flap was used for obliteration of dead space, combined with the contralateral SGAP flap for superficial defect reconstruction and wound closure. Results: Within this patient population, two male and one female patient, with a median age of 62 years (range, 52-76 years), were included. Six pedicled SGAP flaps were performed with average flap dimensions of 9 × 20 cm (range 7-9 × 19 × 21). No flap loss or no local recurrence were documented. In one case, partial tip necrosis with prolonged serous drainage was observed, which was managed by surgical debridement. No further complications were detected. Conclusions: The combination of two SGAP flaps provides maximal soft tissue for defect reconstruction and obliteration of dead space, while maintaining a very inconspicuous donor site, even with bilateral harvesting. Given these advantages, the authors recommend this promising approach for successful reconstruction of perineal defects.
Collapse
Affiliation(s)
- Maximilian Zaussinger
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital, Krankenhausstrasse 9, 4020 Linz, Austria; (M.Z.); (G.P.); (K.F.)
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria;
- Doctoral Degree Program in Medical Science, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Gabriele Pommer
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital, Krankenhausstrasse 9, 4020 Linz, Austria; (M.Z.); (G.P.); (K.F.)
| | - Katrin Freller
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital, Krankenhausstrasse 9, 4020 Linz, Austria; (M.Z.); (G.P.); (K.F.)
| | - Manfred Schmidt
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital, Krankenhausstrasse 9, 4020 Linz, Austria; (M.Z.); (G.P.); (K.F.)
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria;
| | - Georg M. Huemer
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria;
| |
Collapse
|
2
|
van Orten A, Goetz W, Bilhan H. A Novel Prehydrated Porcine-Derived Acellular Dermal Matrix: A Histological and Clinical Evaluation. Int J Biomater 2024; 2024:7322223. [PMID: 38966862 PMCID: PMC11223909 DOI: 10.1155/2024/7322223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/22/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024] Open
Abstract
It is well known that soft tissue quality and quantity around dental implants is of paramount importance for later peri-implant health. For this purpose, the clinical and histological outcomes of the peri-implant mucosa, following soft tissue augmentation for soft tissue improvement with a novel prehydrated porcine acellular dermal matrix graft (PPADMG) in conjunction with simultaneous implant placement, were evaluated in this case series. Twenty-two patients were included in the study. They underwent a late implant placement protocol combined with PPADMG for soft tissue augmentation. A punch biopsy was taken at the time of uncovery of the submerged healed implant after a mean of 157 days healing time. Supracrestal soft tissue height (STH) was measured at the time of implant placement and uncovery. All sites showed a clinical increase in STH. The histological structure of the biopsies resembled a similar structure as found in the healthy oral mucosa. No unexpected tissue reactions could be found. Within the limits of this clinical and histological study, it may be concluded that STH improvement with this novel porcine-derived acellular dermal matrix, in combination with simultaneous implant placement, is a viable option to create a peri-implant tissue thickness and stability.
Collapse
Affiliation(s)
- Andreas van Orten
- Private Dental Practice Do24, Dortmunder Str. 24–28, 45731 Waltrop, Germany
| | - Werner Goetz
- Policlinic of OrthodonticsCentre for Dental CareBasic Science Research in Oral BiologyFriedrich-Wilhelms University, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - Hakan Bilhan
- Department of PeriodontologySchool for Health SciencesWitten/Herdecke University, Alfred-Herrhausen-Str. 45, 58448 Witten, Germany
| |
Collapse
|
3
|
Woo SS, Gwak H, Kim KH, Lee JW, Choi JK, Suh I, Kim SH. Evaluation of Esthetic Results after Mass Removal with Elliptical Skin Excision Using Ultrasonography to Measure Skin Thickness. J Clin Med 2024; 13:1467. [PMID: 38592681 PMCID: PMC10935000 DOI: 10.3390/jcm13051467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The growth of benign cutaneous masses causes the overlaying skin to expand and become thinner, especially at the central, most projected point. In this retrospective study, a surgical technique comprising an elliptical skin excision was employed to account for these skin changes. Methods: This retrospective study enrolled 980 patients with benign masses. Preoperatively, all patients underwent ultrasonography to evaluate the mass depth and thickness of the attached skin, and mass excision was performed using the elliptical skin-excision method. The operative time was recorded, and complications and esthetic outcomes were assessed using the Cutometer® and the modified Vancouver Scar Scale (mVSS) during 1- and 3-month follow-up visits. Results: The mean operative time (17.48 ± 3.46 min) was significantly shorter than that of conventional methods (p < 0.05). Cutometer parameters showed no significant differences from those of intact skin. The average mVSS scores were 5.21 ± 1.42 and 3.50 ± 1.79 at 1- and 3-month follow-ups, respectively. Conclusions: Mass excision with an elliptical skin attachment resulted in improved esthetic results and easy removal. The attached skin enabled convenient handling without damaging the capsule or other adjacent structures, leaving a thick dermis on both wound edges. Thus, this technique resulted in minimal scarring.
Collapse
Affiliation(s)
- Sang Seok Woo
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (S.S.W.); (K.H.K.); (J.W.L.); (J.K.C.); (I.S.)
| | - Hongki Gwak
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, Hwahong Hospital, Suwon 16630, Republic of Korea;
| | - Ki Hyun Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (S.S.W.); (K.H.K.); (J.W.L.); (J.K.C.); (I.S.)
| | - Jun Won Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (S.S.W.); (K.H.K.); (J.W.L.); (J.K.C.); (I.S.)
| | - Jai Koo Choi
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (S.S.W.); (K.H.K.); (J.W.L.); (J.K.C.); (I.S.)
| | - Insuck Suh
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (S.S.W.); (K.H.K.); (J.W.L.); (J.K.C.); (I.S.)
| | - Seong Hwan Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (S.S.W.); (K.H.K.); (J.W.L.); (J.K.C.); (I.S.)
| |
Collapse
|
4
|
Cao Y, Harvey BP, Jin L, Westmoreland S, Wang J, Puri M, Yang Y, Robb HM, Tanriverdi S, Hu C, Wang X, Xin X, Liu Y, Macoritto MP, Smith KM, Tian Y, White K, Radstake TR, Kaymakcalan Z. Therapeutic TNF Inhibitors Exhibit Differential Levels of Efficacy in Accelerating Cutaneous Wound Healing. JID INNOVATIONS 2024; 4:100250. [PMID: 38226320 PMCID: PMC10788510 DOI: 10.1016/j.xjidi.2023.100250] [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] [Received: 02/13/2023] [Revised: 10/21/2023] [Accepted: 11/16/2023] [Indexed: 01/17/2024] Open
Abstract
Adalimumab but neither etanercept nor certolizumab-pegol has been reported to induce a wound-healing profile in vitro by regulating macrophage differentiation and matrix metalloproteinase expression, which may underlie the differences in efficacy between various TNF-α inhibitors in impaired wound healing in patients with hidradenitis suppurativa, a chronic inflammatory skin disease. To examine and compare the efficacy of various TNF inhibitors in cutaneous wound healing in vivo, a human TNF knock-in Leprdb/db mouse model was established to model the impaired cutaneous wound healing as seen in hidradenitis suppurativa. The vehicle group exhibited severe impairments in cutaneous wound healing. In contrast, adalimumab significantly accelerated healing, confirmed by both histologic assessment and a unique healing transcriptional profile. Moreover, adalimumab and infliximab showed similar levels of efficacy, but golimumab was less effective, along with etanercept and certolizumab-pegol. In line with histologic assessments, proteomics analyses from healing wounds exposed to various TNF inhibitors revealed distinct and differential wound-healing signatures that may underlie the differential efficacy of these inhibitors in accelerating cutaneous wound healing. Taken together, these data revealed that TNF inhibitors exhibited differential levels of efficacy in accelerating cutaneous wound healing in the impaired wound-healing model in vivo.
Collapse
Affiliation(s)
- Yonghao Cao
- Transformational and Translational Immunology Discovery, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Bohdan P. Harvey
- Transformational and Translational Immunology Discovery, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Liang Jin
- DMPK-BA, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Susan Westmoreland
- Phamacology and Pathology, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Jing Wang
- Immunology Computational Biology, AbbVie Cambridge Research Center, Cambridge, Massachusetts, USA
| | - Munish Puri
- Phamacology and Pathology, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Yingli Yang
- Phamacology and Pathology, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Holly M. Robb
- Discovery Research, AbbVie, North Chicago, Illinois, USA
| | - Sultan Tanriverdi
- Transformational and Translational Immunology Discovery, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Chenqi Hu
- DMPK-BA, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Xue Wang
- DMPK-BA, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Xiaofeng Xin
- Global Biologics, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Yingchun Liu
- Immunology Computational Biology, AbbVie Cambridge Research Center, Cambridge, Massachusetts, USA
| | - Michael P. Macoritto
- Immunology Computational Biology, AbbVie Cambridge Research Center, Cambridge, Massachusetts, USA
| | - Kathleen M. Smith
- Immunology Computational Biology, AbbVie Cambridge Research Center, Cambridge, Massachusetts, USA
| | - Yu Tian
- DMPK-BA, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Kevin White
- Transformational and Translational Immunology Discovery, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Timothy R.D.J. Radstake
- Transformational and Translational Immunology Discovery, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | - Zehra Kaymakcalan
- Transformational and Translational Immunology Discovery, AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| |
Collapse
|
5
|
Lee YJ, Kim J, Lee CR, Kim JH, Oh DY, Jun YJ, Moon SH. Anterolateral Thigh Chimeric Flap: An Alternative Reconstructive Option to Free Flaps for Large Soft Tissue Defects. J Clin Med 2023; 12:6723. [PMID: 37959189 PMCID: PMC10648588 DOI: 10.3390/jcm12216723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
The anterolateral thigh (ALT) skin flap provides abundant, thin, pliable skin coverage with adequate pedicle length and calibre, and tolerable donor site morbidity. However, coverage of relatively large defects using the ALT flap alone is limited. We present our experience of using the ALT flap coupled with the vastus lateralis (VL) flap supplied by the same pedicle for large defect reconstruction. Between 2016 and 2020, ten patients with extensive lower-extremity or trunk defects were treated using the ALT/VL chimeric flap. The ALT portion was used to cover the cutaneous and joint defect while the VL part was used to resurface remnant defects, and a skin graft was performed. All flaps were based on the common descending pedicle, and branches to separate the components were individually dissected. All defects were successfully reconstructed using the ALT/VL chimeric flap. No surgery-related acute complications were observed, and the patients had no clinical issues with ambulation or running activities during the long-term follow-up period. With the separate components supplied by a common vascular pedicle, the ALT/VL chimeric flap allows us to reconstruct extensive defects with joint involvement or posterior trunk lesions. Thus, the ALT/VL chimeric flap may be a suitable alternative for extensive tissue defect reconstruction.
Collapse
Affiliation(s)
- Yoon Jae Lee
- Department of Plastic and Reconstructive Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea; (Y.J.L.); (J.H.K.)
| | - Junnyeon Kim
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.K.); (C.R.L.); (D.Y.O.); (Y.J.J.)
| | - Chae Rim Lee
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.K.); (C.R.L.); (D.Y.O.); (Y.J.J.)
| | - Jun Hyeok Kim
- Department of Plastic and Reconstructive Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea; (Y.J.L.); (J.H.K.)
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.K.); (C.R.L.); (D.Y.O.); (Y.J.J.)
| | - Young Joon Jun
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.K.); (C.R.L.); (D.Y.O.); (Y.J.J.)
| | - Suk-Ho Moon
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.K.); (C.R.L.); (D.Y.O.); (Y.J.J.)
| |
Collapse
|
6
|
Nowak-Liduk A, Kitala D, Ochała-Gierek G, Łabuś W, Bergler-Czop B, Pietrauszka K, Niemiec P, Szyluk K, Gierek M. Hidradenitis Suppurativa: An Interdisciplinary Problem in Dermatology, Gynecology, and Surgery-Pathogenesis, Comorbidities, and Current Treatments. Life (Basel) 2023; 13:1895. [PMID: 37763299 PMCID: PMC10532726 DOI: 10.3390/life13091895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory disease that manifests as painful nodules, abscesses, draining dermal tunnels, and scarring in intertriginous areas such as the axillae, groin, and breasts. The nature of the disease and its chronicity have a destructive impact on mental health and quality of life. HS has an estimated global prevalence of 0.00033-4.1% and it disproportionately affects females compared to males. HS involving the female anogenital regions is reported rarely in the gynecological literature, and it can often be mistaken for other vulvar diseases. The distinct phenotypes and HS rarity cause delayed diagnosis and the implementation of effective treatment. Acne inversa is associated with several comorbidities, including metabolic disease, diabetes mellitus, inflammatory bowel diseases, and spondyloarthropathies. Although HS etiology and pathogenesis remain unclear, studies have shown that lifestyle, immunological processes, genetics, and hormonal predispositions may promote follicular hyperkeratosis, dilatation, and rupture, leading to the development of chronic tissue inflammation. This article provides updated information on HS pathogenesis, comorbidities, and treatment methods. Furthermore, we share our experience in the surgical treatment of the disease, which often proves most effective, and highlight that an interdisciplinary management approach ensures optimal outcomes.
Collapse
Affiliation(s)
- Agnieszka Nowak-Liduk
- Department of Perinatology, Gynaecology and Obstetrics, General Hospital in Ruda Śląska, Wincentego Lipa Street 2, 41-703 Ruda Śląska, Poland;
| | - Diana Kitala
- Dr. Stanislaw Sakiel Centre for Burns Treatment, Siemianowice Ślaskie, Jana Pawła II Street 2, 43-100 Siemianowice Śląskie, Poland; (D.K.); (W.Ł.)
| | - Gabriela Ochała-Gierek
- Department of Dermatology and Venerology, City Hospital in Sosnowiec, Zegadlowicza Street 3, 41-200 Sosnowiec, Poland;
| | - Wojciech Łabuś
- Dr. Stanislaw Sakiel Centre for Burns Treatment, Siemianowice Ślaskie, Jana Pawła II Street 2, 43-100 Siemianowice Śląskie, Poland; (D.K.); (W.Ł.)
| | - Beata Bergler-Czop
- Department of Dermatology, Medical University of Silesia in Katowice, Francuska Street 20-24, 40-027 Katowice, Poland; (B.B.-C.); (K.P.)
| | - Kornelia Pietrauszka
- Department of Dermatology, Medical University of Silesia in Katowice, Francuska Street 20-24, 40-027 Katowice, Poland; (B.B.-C.); (K.P.)
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Street 18, 40-752 Katowice, Poland;
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 Street, 41-940 Piekary Slaskie, Poland
| | - Marcin Gierek
- Dr. Stanislaw Sakiel Centre for Burns Treatment, Siemianowice Ślaskie, Jana Pawła II Street 2, 43-100 Siemianowice Śląskie, Poland; (D.K.); (W.Ł.)
| |
Collapse
|
7
|
Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Bangcoy MLS, Taniguchi Y, Morinaga S, Asano Y, Tsuchiya H. Graft Survivals after Reconstruction Using Tumor-Bearing Frozen Bone in the Extremities. Cancers (Basel) 2023; 15:3926. [PMID: 37568742 PMCID: PMC10417529 DOI: 10.3390/cancers15153926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Tumor-bearing frozen autografts have been widely used for reconstruction of bone defects caused by tumor resection. However, some patients undergo removal of the grafted bone due to surgical site infection, tumor recurrence, or fractures of the grafted bone. In this retrospective cohort study, predictive factors for graft survival were investigated in 123 patients who underwent reconstructions using a tumor-bearing frozen autograft after bone tumor resection of the extremities. To determine the independent predictors of graft survival, the association between various parameters and graft survival was investigated. The graft survival rates were 83.2% at 5 years and 70.2% at 10 years. Among the 123 frozen autografts, 25 (20.3%) were removed because of complications. In univariate analyses, male sex, BMI of ≥23.6, tibia, and chemotherapy were significantly associated with poor graft survival, whereas the pedicle/hemicortical freezing procedure was significantly associated with better graft survival. Multivariate analysis using the Cox proportional hazards regression model revealed that BMI of ≥23.6 (HR, 3.4; p = 0.005), tibia (HR, 2.3; p = 0.047), and freezing procedure (HR, 0.3; p = 0.016) were independently associated with graft survival. Based on the results, pedicle or hemicortical freezing techniques are recommended in cases where these techniques can be applied.
Collapse
Affiliation(s)
- Shinji Miwa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Chrelias T, Berkane Y, Rousson E, Uygun K, Meunier B, Kartheuser A, Watier E, Duisit J, Bertheuil N. Gluteal Propeller Perforator Flaps: A Paradigm Shift in Abdominoperineal Amputation Reconstruction. J Clin Med 2023; 12:4014. [PMID: 37373707 DOI: 10.3390/jcm12124014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Abdominoperineal amputation (AAP) is a gold standard procedure treating advanced abdominal and pelvic cancers. The defect resulting from this extensive surgery must be reconstructed to avoid complications, such as infection, dehiscence, delayed healing, or even death. Several approaches can be chosen depending on the patient. Muscle-based reconstructions are a reliable solution but are responsible for additional morbidity for these fragile patients. We present and discuss our experience in AAP reconstruction using gluteal-artery-based propeller perforator flaps (G-PPF) in a case series. Between January 2017 and March 2021, 20 patients received G-PPF reconstruction in two centers. Either superior gluteal artery (SGAP)- or inferior artery (IGAP)-based perforator flaps were performed depending on the best configuration. Preoperative, intraoperative, and postoperative data were collected. A total of 23 G-PPF were performed-12 SGAP and 11 IGAP flaps. Final defect coverage was achieved in 100% of cases. Eleven patients experienced at least one complication (55%), amongst whom six patients (30%) had delayed healing, and three patients (15%) had at least one flap complication. One patient underwent a new surgery at 4 months for a perineal abscess under the flap, and three patients died from disease recurrence. Gluteal-artery-based propeller perforator flaps are an effective and modern surgical procedure for AAP reconstruction. Their mechanic properties, in addition to their low morbidity, make them an optimal technique for this purpose; however, technical skills are needed, and closer surveillance with patient compliance is critical to ensure success. G-PPF should be widely used in specialized centers and considered a modern alternative to muscle-based reconstructions.
Collapse
Affiliation(s)
- Theodoros Chrelias
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Yanis Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston, MA 02115, USA
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
- MICMAC, UMR INSERM U1236, Rennes University Hospital, 35033 Rennes, France
| | - Etienne Rousson
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Korkut Uygun
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston, MA 02115, USA
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Bernard Meunier
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Alex Kartheuser
- Colorectal Surgery Unit, Department of Surgery, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Jérôme Duisit
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
- Department of Plastic and Reconstructive Surgery, Hôpitaux IRIS Sud, 1050 Brussels, Belgium
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston, MA 02115, USA
- MICMAC, UMR INSERM U1236, Rennes University Hospital, 35033 Rennes, France
| |
Collapse
|