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Lin Wu ZQ, Bulla A, Aguilera Sáez J, Serracanta Domènech J, Barret JP, Rivas Nicolls DA. Subdermal dissection technique for pure skin SCIA and ALT perforator flaps in burns and trauma defects: Clinical experience. Microsurgery 2024; 44:e31189. [PMID: 38798132 DOI: 10.1002/micr.31189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 03/21/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The pure skin perforator (PSP) flap is gaining popularity for its remarkable thinness. The subdermal dissection technique was recently introduced, allowing for a quicker elevation of a PSP flap. In this report, we present our two-year experience utilizing subdermal dissection for harvesting PSP flaps. METHODS All patients who had undergone PSP flap reconstruction at our hospital from February 2021 to February 2023 were included. Demographic data, intraoperative variables, flap characteristics, and postoperative outcomes were collected. Surgical planning involved locating the perforator using ultrasound and harvesting the flap using the subdermal dissection technique. RESULTS A total of 26 PSP flap reconstructions were conducted on 24 patients aged between 15 and 86 years. The flaps were based on perforators issuing from the superficial circumflex iliac artery in 24 cases, and from the descending branch of the lateral circumflex femoral artery in 2 cases. Flap sizes ranged from 3 × 1.5 cm to 19 × 6 cm, with a mean thickness of 3.48 mm. The average time for flap harvest was 131.92 min. Postoperatively, we observed four cases of partial necrosis, 1 total flap loss, and 2 instances of vascular thrombosis at the anastomosis site. The flaps exhibited good pliability without contracture, and no debulking procedures were required during the follow-up period (minimum 6 months, range 6-24; mean 9.4615). CONCLUSION The subdermal dissection technique is a safe and efficient approach for elevating PSP flaps. Our initial experience with this technique has been encouraging, and it currently serves as our preferred reconstructive option for defects requiring thin reconstruction.
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Affiliation(s)
- Zhan Q Lin Wu
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Antonio Bulla
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Jorge Aguilera Sáez
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Jordi Serracanta Domènech
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Juan P Barret
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
- Department of Surgery, School of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Danilo A Rivas Nicolls
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
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Lee JK, Lee KT. Coverage of radial forearm free flap donor site defect using another free flap. Microsurgery 2023; 43:775-781. [PMID: 37415398 DOI: 10.1002/micr.31082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 05/02/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Donor site defects following the radial forearm flap (RFF) harvest have been usually covered with skin grafting, which often lead to suboptimal outcomes and donor morbidities, including delayed healing and scar contractures. The present report aimed to evaluate the outcomes of using another free flap, the domino flap, for coverage of donor site defects following RFFF harvest. METHODS Five patients (two males and three females) who underwent coverage of donor defects of RFFF using another free flap between 2019 and 2021 were reviewed. Their mean age was 74 years and the mean dimension of the defect of the RFF donor site was 8.7 × 5.6 cm. Four patients used an anterolateral thigh flap and one used a superficial circumflex iliac artery perforator flap. RESULTS The mean size of the domino flaps were 12.2 × 5.8 cm. Distal stumps of radial vessels adopting retrograde flow were used as recipients in four cases, and proximal ones adopting anterograde in one. The donor site of the domino flaps was primarily closed. All patients recovered well without any postoperative complications. Aesthetically pleasing outcomes with no functional impairment related to scar contractures were observed in the donor site of RFF during the mean follow-up of 15.7 months. CONCLUSIONS Use of another free flap for coverage of RFFF donor defects may provide rapid wound healing and satisfactory outcomes, and may be considered an alternative option in cases with large-sized defects that are expected to take a long time to achieve complete healing with skin grafting.
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Affiliation(s)
- Jong-Koo Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Lin Z, Zhang X, Chen Y, Tian Y, Yang X, Zhao Z. Negative pressure wound therapy for flap closed-incisions after 3D-printed prosthesis implantation in patients with chronic osteomyelitis with soft tissue defects. BMC Musculoskelet Disord 2023; 24:827. [PMID: 37858142 PMCID: PMC10585842 DOI: 10.1186/s12891-023-06970-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The flap closed-incisions healing after 3D-printed prosthesis implantation in Chronic Osteomyelitis with Soft Tissue Defects (COSTD) is critical. This study aimed to explore the safety and effectiveness of Negative Pressure Wound Therapy (NPWT) in promoting flap closed-incisions healing. METHODS Retrospective analysis of clinical data was performed, including baseline, surgical and hospitalization information. The efficacy of NPWT was assessed by comparing the ASEPSIS scores, Visual Analogue Scale (VAS), Activity of Daily Living Scale (ADLS), and Lower Extremity Functional Scale (LEFS), as well as the major postoperative complications. RESULTS The study included 20 patients, 13 received conventional dressing (Control group) and 7 received NPWT treatment (NPWT group). These two groups exhibited a notable disparity in the distribution of ASEPSIS scores, and the median scores were 24 in Control group and 9 in NPWT group (p = 0.001). Eight patients in the Control group experienced major incisional complications, including 7 cases of exudation, 3 cases of infection, 2 cases of non-healing, and 1 case of dehiscence, while none were observed in the NPWT group (p = 0.015). The VAS, ADLS, and LEFS scores were significantly improved in the NPWT group compared to the Control group (p = 0.003, 0.017, and 0.043, respectively). CONCLUSIONS The study findings suggest that NPWT applied to the healing process of flap closed-incisions after 3D prosthesis implantation in patients with COSTD can reduce the occurrence of postoperative major complications and promote the recovery of lower limb function and daily activities, which should be recommended for clinical practice.
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Affiliation(s)
- Zhiyu Lin
- Department of Plastic Surgery , Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xinling Zhang
- Department of Plastic Surgery, Beijing Hospital, Beijing, China
| | - Yujie Chen
- Department of Plastic Surgery , Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yun Tian
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xin Yang
- Department of Plastic Surgery , Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Zhenmin Zhao
- Department of Plastic Surgery , Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Tripathi M, Saha S, Vineet K, Gj P, Modi S. Extended Use of McGregor Pedicled Groin Flap for Forearm: A Case Series. Cureus 2023; 15:e42375. [PMID: 37621833 PMCID: PMC10445551 DOI: 10.7759/cureus.42375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Tissue loss in the forearm is a common entity. There are various etiologies to tissue loss like trauma, burn, post-surgery, etc. Coverage of defect or tissue loss of the forearm is a surgical challenge and options available for forearm coverage are limited. To bypass this difficulty, McGregor pedicled groin flap is used by us to cover large forearm defects with successful outcomes in this case series.
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Affiliation(s)
- Mayank Tripathi
- Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) & Homi Bhabha Cancer Hospital (HBCH), Varanasi, IND
| | - Soumitra Saha
- Pediatric Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) & Homi Bhabha Cancer Hospital (HBCH), Varanasi, IND
| | - Kumar Vineet
- Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) & Homi Bhabha Cancer Hospital (HBCH), Varanasi, IND
| | - Pavithira Gj
- Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) & Homi Bhabha Cancer Hospital (HBCH), Varanasi, IND
| | - Shraddha Modi
- Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) & Homi Bhabha Cancer Hospital (HBCH), Varanasi, IND
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Kwon JG, Brown E, Suh HP, Pak CJ, Hong JP. Planes for Perforator/Skin Flap Elevation-Definition, Classification, and Techniques. J Reconstr Microsurg 2023; 39:179-186. [PMID: 36413994 DOI: 10.1055/s-0042-1750127] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Elevation in different layers achieving thin flaps are becoming relatively common practice for perforator flaps. Although postreconstruction debulking achieves pleasing aesthetic results and is widely practiced, customized approach during elevation to achieve the ideal thickness will increase efficiency while achieving the best possible aesthetic outcome. Multiple planes for elevation have been reported along with different techniques but it is quite confusing and may lack correspondence to the innate anatomy of the skin and subcutaneous tissue. METHODS This article reviews the different planes of elevation and aims to clarify the definition and classification in accordance to anatomy and present the pros and cons of elevation based on the different layers and provide technical tips for elevation. RESULTS Five different planes of elevation for perforator flaps are identified: subfascial, suprafacial, superthin, ultrathin, and subdermal (pure skin) layers based on experience, literature, and anatomy. CONCLUSION These planes all have their unique properties and challenges. Understanding the benefits and limits along with the technical aspect will allow the surgeon to better apply the perforator flaps.
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Affiliation(s)
- Jin Geun Kwon
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan Collage of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Erin Brown
- Department of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia
| | - Hyunsuk Peter Suh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan Collage of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Changsik John Pak
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan Collage of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan Collage of Medicine, Songpa-gu, Seoul, Republic of Korea
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Lumley ES, Kwon JG, Kushida-Conteras BH, Brown E, Viste J, Aulia I, Pak CJ, Suh HP, Hong JP. Free Tissue Transfer after Open Transmetatarsal Amputation in Diabetic Patients. J Reconstr Microsurg 2021; 37:728-734. [PMID: 33792004 DOI: 10.1055/s-0041-1726394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transmetatarsal amputation (TMA) preserves functional gait while avoiding the need for prosthesis. However, when primary closure is not possible after amputation, higher level amputation is recommended. We hypothesize that reconstruction of the amputation stump using free tissue transfer when closure is not possible can achieve similar benefits as primarily closed TMAs. METHODS Twenty-eight TMAs with free flap reconstruction were retrospectively reviewed in 27 diabetic patients with a median age of 61.5 years from 2004 to 2018. The primary outcome was limb salvage rate, with additional evaluation of flap survival, ambulatory status, time until ambulation, and further amputation rate. In addition, subgroup analysis was performed based on the microanastomosis type. RESULTS Flap survival was 93% (26 of 28 flaps) and limb salvage rate of 93% (25 of 27 limbs) was achieved. One patient underwent a second free flap reconstruction. In the two failed cases, higher level amputation was required. Thirteen flaps had partial loss or other complications which were salvaged with secondary intension or skin grafts. Median time until ambulation was 14 days following reconstruction (range: 9-20 days). Patients were followed-up for a median of 344 days (range: 142-594 days). Also, 88% of patients reported good ambulatory function, with a median ambulation score of 4 out of 5 at follow-up. There was no significant difference between the subgroups based on the microanastomosis type. CONCLUSION TMA with free flap reconstruction is an effective method for diabetic limb salvage, yielding good functional outcomes and healing results.
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Affiliation(s)
- Eleanor S Lumley
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.,Department of Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Jin Geun Kwon
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
| | | | - Erin Brown
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.,Department of Plastic Surgery, University of British Columbia, Canada
| | - Julian Viste
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Indri Aulia
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.,Department of Surgery, Plastic Reconstructive and Aesthetic Surgery Division, Universitas Indonesia, Jakarta, Indonesia
| | - Changsik John Pak
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Hyunsuk Peter Suh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
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Baek W, Song SY, Roh TS, Lee WJ. Microsurgical reconstruction of posttraumatic large soft tissue defects on face. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.12.724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Wooyeol Baek
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Yong Song
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Tai Suk Roh
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Lee
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
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