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Meena S, Kumar R, Meena RK. Comparative Analysis of Various Materials Used for Mastoid Cavity Obliteration in Canal Wall Down Mastoid Surgery. Indian J Otolaryngol Head Neck Surg 2024; 76:1586-1594. [PMID: 38566632 PMCID: PMC10982262 DOI: 10.1007/s12070-023-04364-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/14/2023] [Indexed: 04/04/2024] Open
Abstract
To study the surgical result and efficacy of different methods of mastoid obliteration with cavity care. This prospective study included 60 patients who had cholesteatoma, conducted in the Department of Ear Nose and Throat (ENT), Institute of Medical Sciences, Banaras Hindu University, Varanasi from July 2015 to July 2017. The mastoid cavity was obliterated with either muscle flap/bone dust/hydroxyapatite. detailed history otoscopic examination was done pre-operatively and follow up were recorded at 1 month and 3 months in postoperative period. 60 patients were included, who underwent canal wall down mastoid surgery. each group muscle flap (group 1), bone dust (group 2) and hydroxyapatite (group 3) included 20 patients, age group 31-40 year with its maximum incidence of 43.3%, Preop PTA value were almost equal in all group but on comparison at 1 month in postoperative period significant improvement was present in group 1 versus 2(0.021) and group 2 versus 3(0.003) but not in group 1 versus 3. Although at 3 month there were significant improvement was present in all groups. The incidence of pain, discharge, giddiness and wax formation were markedly reduced and healing of cavities was early and better in obliterated cavities done by muscle flap and bone dust material as compared to hydroxyapatite cavities, at the end of 3 months. outcome and quality of life was better and almost equal in muscle flap and bone dust material group as compared to hydroxyapatite group.
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Affiliation(s)
- Sunita Meena
- Department of Otorhinolaryngology and Head and Neck Surgery, Pacific Institute of Medical Sciences, Udaipur, Rajasthan 313015 India
| | - Rajesh Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Rakesh Kumar Meena
- Department of Neurosurgery, Pacific Institute of Medical Sciences, Udaipur, Rajasthan 313015 India
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Marais LC, Hungerer S, Eckardt H, Zalavras C, Obremskey WT, Ramsden A, McNally MA, Morgenstern M, Metsemakers WJ. Key aspects of soft tissue management in fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg 2024; 144:259-268. [PMID: 37921993 PMCID: PMC10774153 DOI: 10.1007/s00402-023-05073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/11/2023] [Indexed: 11/05/2023]
Abstract
A judicious, well-planned bone and soft tissue debridement remains one of the cornerstones of state-of-the-art treatment of fracture-related infection (FRI). Meticulous surgical excision of all non-viable tissue can, however, lead to the creation of large soft tissue defects. The management of these defects is complex and numerous factors need to be considered when selecting the most appropriate approach. This narrative review summarizes the current evidence with respect to soft tissue management in patients diagnosed with FRI. Specifically we discuss the optimal timing for tissue closure following debridement in cases of FRI, the need for negative microbiological culture results from the surgical site as a prerequisite for definitive wound closure, the optimal type of flap in case of large soft tissue defects caused by FRI and the role of negative pressure wound therapy (NPWT) in FRI. Finally, recommendations are made with regard to soft tissue management in FRI that should be useful for clinicians in daily clinical practice.Level of evidence Level V.
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Affiliation(s)
- Leonard C Marais
- Department of Orthopaedics, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sven Hungerer
- Department of Joint Surgery and Arthroplasty, Trauma Center Murnau, Murnau Germany and Paracelsus Medical University (PMU) Salzburg, Salzburg, Austria
| | - Henrik Eckardt
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Charalampos Zalavras
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - William T Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alex Ramsden
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Martin A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Mario Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
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Crigger CB, Harris TGW, Sholklapper TN, Haffar A, Morrill CC, Nasr IW, Yang R, Redett RJ, Gearhart JP. Mucosal Violations and Their Effect on Successful Bladder Neck Closure in Cloacal Exstrophy. J Pediatr Surg 2023; 58:2313-2318. [PMID: 37302866 DOI: 10.1016/j.jpedsurg.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/14/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cloacal exstrophy (CE) is rare and challenging to reconstruct. In the majority of CE patients voided continence cannot be achieved and so patients often undergo bladder neck closure (BNC). Prior mucosal violations (MVs), a surgical event when the bladder mucosa was opened or closed, significantly predicted failed BNC in classic bladder exstrophy with an increased likelihood of failure after 3 or more MVs. The aim of this study was to assess predictors for failed BNC in CE. METHODS CE patients who underwent BNC were reviewed for risk factors for failure including osteotomy use, successful primary closure, and number of MVs. Chi-squared and Fisher's exact tests were used for comparing baseline characteristics and surgical details. RESULTS Thirty-five patients underwent BNC. Eleven patients (31.4%) failed BNC including a vesicoperineal fistula in nine, vesicourethral and vesicocutaneous fistula in one each. The fistula rate in patients with 2 or more MVs was 47.4% (p = 0.0252). Two patients subsequently developed a vesicocutaneous fistula after undergoing repeated cystolithotomies. A rectus abdominis or gracilis muscle flap were used to close the fistula in 11 and 2 patients, respectively. CONCLUSIONS MVs have a greater impact in CE with an increased risk of failed BNC after 2 MVs. CE patients are most likely to develop a vesicoperineal fistula while a vesicocutaneous fistula is more likely after repeat cystolithotomy. A prophylactic muscle flap should be considered at time of BNC in patients with 2 or more MVs. LEVELS OF EVIDENCE Prognosis Study, Level III.
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Affiliation(s)
- Chad B Crigger
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas G W Harris
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tamir N Sholklapper
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmad Haffar
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian C Morrill
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Isam W Nasr
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Gearhart
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Giunta G, Kapila A, Brussaard C, Nistor A, De Baerdemaeker R, Zeltzer A, Hamdi M. Redefining the vascular anatomy of the medial gastrocnemius muscle: A computed tomography angiography study. J Plast Reconstr Aesthet Surg 2023; 83:165-171. [PMID: 37276735 DOI: 10.1016/j.bjps.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The medial gastrocnemius (GN) muscle flap is a historical reconstructive option in lower limb reconstruction. The flap is proximally based on the medial sural artery, and it is assumed not possible to harvest a distally based flap because of the absence of other minor pedicles. The aim of this study is to investigate the presence and the anatomy of a distal secondary pedicle given off by the posterior tibial artery (PTA). METHODS A retrospective CTA study was performed of 120 limbs between April 2018 and June 2020. 3D reconstruction was performed to delineate the anatomy of the distal secondary pedicle, if present. The distance of the pedicle, if found, from the intermalleolar line to the patella was noted. The number of pedicles, if multiple, was documented, as well as branches to the soleus muscle and the skin. RESULTS A distal pedicle to the gastrocnemius muscle was found in 64% of limbs. The average location from the intermalleolar line is 168 mm. The branching pattern from the PTA showed an isolated vessel going to the distal medial gastrocnemius (32.8%), two branches to the medial gastrocnemius and skin (39.3%), two branches to the medial gastrocnemius and soleus (24.6%), and three branches to the medial gastrocnemius, soleus, and the skin (3.3%). CONCLUSIONS This study confirms the presence of the secondary axial distal pedicle of the GN muscle. Furthermore, this study confirms that there is a likely association between the distal medial gastrocnemius pedicle and the PTA skin perforators.
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Affiliation(s)
- Gabriele Giunta
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Ayush Kapila
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carola Brussaard
- Department of Radiology, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alexandru Nistor
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Randy De Baerdemaeker
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Assaf Zeltzer
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Moustapha Hamdi
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
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Harris TGW, Crigger CB, Sholklapper TN, Haffar A, Yang R, Redett RJ, Gearhart JP. The impact of repeated bladder surgery on successful bladder neck closure in classic bladder exstrophy: The role of mucosal violations. J Pediatr Urol 2023:S1477-5131(23)00151-1. [PMID: 37149474 DOI: 10.1016/j.jpurol.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Restoration of genitourinary anatomy with functional urinary continence is the reconstruction aim is the exstrophy-epispadias complex (EEC). In patients who do not achieve urinary continence or those who are not a candidate for bladder neck reconstruction (BNR), bladder neck closure (BNC) is considered. Interposing layers including human acellular dermis (HAD) and pedicled adipose tissue are routinely placed between the transected bladder neck and distal urethral stump to reinforce the BNC and minimize failure due to fistula development from the bladder. OBJECTIVE The aim of this study was to review classic bladder exstrophy (CBE) patients who underwent BNC to identify predictors of BNC failure. Specifically, we hypothesize that increased operations on the bladder urothelium leads to a higher rate of urinary fistula. STUDY DESIGN CBE patients who underwent BNC were reviewed for predictors of failed BNC which was defined as bladder fistula development. Predictors included prior osteotomy, interposing tissue layer use and number of previous bladder mucosal violations (MV). A MV was defined as a procedure when the bladder mucosa was opened or closed for: exstrophy closure(s), BNR, augmentation cystoplasty or ureteral re-implantation. Predictors were evaluated using multivariate logistic regression. RESULTS A total of 192 patients underwent BNC of which 23 failed. Patients were more likely to develop a fistula with a wider pubic diastasis at time of primary exstrophy closure (4.4 vs 4.0 cm, p=0.0016), have failed exstrophy closure (p=0.0084), or have 3 or more MVs before BNC (p=0.0002). Kaplan-Meier analysis of fistula-free survival after BNC, demonstrated an increased fistula rate with additional MVs (p=0.0004, Figure 1). MVs remained significant on multivariate logistic regression analysis with a per-violation odds ratio of 5.1 (p<0.0001). Of the 23 failed BNC's, 16 were surgically closed including 9 using a pedicled rectus abdominis muscle flap which was secured to the bladder and pelvic floor. CONCLUSION This study conceptualized MVs and their role in bladder viability. Increased MVs confer an increased risk of failed BNC. When considering BNC, CBE patients with 3 or more prior MVs may benefit from a pedicled muscle flap, in addition to HAD and pedicled adipose tissue, to prevent fistula development by providing wellvascularized coverage to further reinforce the BNC.
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Affiliation(s)
- Thomas G W Harris
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chad B Crigger
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tamir N Sholklapper
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmad Haffar
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Gearhart
- James Buchanan Brady Urological Institute, Jeffs Division of Pediatric Urology, Douglas A. Canning M.D. Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Kuhara Y, Hotei H, Hashimoto T, Seo S, Amioka A, Murao N, Kuwada A, Nakashima A, Sakabe R, Tahara K. Successful omental flap coverage repair of a rectovaginal fistula after low anterior resection: a case report. Surg Case Rep 2023; 9:61. [PMID: 37071261 PMCID: PMC10113401 DOI: 10.1186/s40792-023-01642-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/10/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Rectovaginal fistula (RVF) is a troublesome and refractory complication after low anterior resection (LAR) for rectal cancer. An omental flap repair was performed for the RVF caused due to Crohn's disease and childbirth trauma. However, there are few cases of an omental flap repair for RVF after LAR. Herein, we present a successfully repaired case of RVF by omental flap coverage after LAR for rectal cancer. CASE PRESENTATION A 50-year-old female patient with advanced rectal cancer underwent laparoscopic LAR with double-stapling technique anastomosis and achieved curative resection. She complained of a stool from the vagina and was diagnosed with RVF on the postoperative day (POD) 18. Conservative therapy was ineffective. We performed laparoscopic fistula resection and direct closure of the vagina and rectum, designed the omentum that could reach the pelvis, repaired RVF by omental flap coverage, and performed transverse colostomy on POD 25. She was discharged on initial POD 48. Seven months after the initial operation, colostomy closure was administered. There was no recurrence of RVF found 1 year after the initial operation. CONCLUSIONS The patient achieved an omental flap coverage for RVF. We successfully performed the omental flap coverage repair in patients with RVF after the leakage of LAR. An omental flap may become an alternative treatment for muscle flap or an effective treatment for RVF.
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Affiliation(s)
- Yuta Kuhara
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan.
| | - Hiroshi Hotei
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Tatsunori Hashimoto
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Shingo Seo
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Ai Amioka
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Naoki Murao
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Aki Kuwada
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Akira Nakashima
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Ryutaro Sakabe
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Kou Tahara
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
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Sheridan GA, Lennox PA, Masri BA. Soft Tissue Procedures in the Multiply Operated on Knee Replacement Patient. Orthop Clin North Am 2022; 53:267-276. [PMID: 35725035 DOI: 10.1016/j.ocl.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the multiply operated on knee replacement, no one soft tissue procedure is vastly superior to another. The most extensive literature available is in relation to muscle flaps, which will continue to be the workhorse technique for orthopedic and plastic reconstructive surgeons for the foreseeable future. Closed incision negative pressure wound therapy may prove to be a superior method in time but further large-scale studies are required to expand our understanding of this technique. The continued use of a combination of these techniques, tailored to the specific patient, is likely to be the best approach to the multiply operated on knee into the future.
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Affiliation(s)
- Gerard A Sheridan
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Peter A Lennox
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Zhu H, Gao Y, Wang C, Chen Z, Yu X, Qi X, Sun Q, Zhang W, Song W. A nomogram for decision-making assistance on surgical treatment of chronic osteomyelitis in long bones: Establishment and validation based on a retrospective multicenter cohort. Int J Surg 2022; 99:106267. [PMID: 35202861 DOI: 10.1016/j.ijsu.2022.106267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/04/2022] [Accepted: 02/15/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic osteomyelitis remains a major challenge for orthopedic surgeons due to its high recurrence rate. Surgeons currently have few tools to estimate the likelihood of individual recurrence. We here aimed to develop a nomogram to better estimate individual recurrence rate after surgical treatment of chronic osteomyelitis in long bones. METHODS We first retrospectively identified patients as training cohort who had received surgical treatment of chronic osteomyelitis in long bones between January 2010 and January 2016 from four hospitals. Patient demographic, microbiological, clinical, and therapeutic variables were collected and analyzed. Univariate and multivariate analyses were performed successively to identify independently predictive factors for recurrence. To reduce overfitting, the Bayesian information criterion was used to reduce variables in the original model. Nomograms were created with the reduced model after model selection. The nomogram was then internally validated with bootstrap resampling. We then further validated the performance of the established nomogram in validation cohort (data from two distinct institutions). RESULTS Recurrence was found in 136 of 655 (20.8%) and 52 of 201 patients (25.9%) in training and validation cohorts respectively. We included six independent prognostic factors for recurrence in our prediction model: number of previous recurrences, epiphysial involvement, preoperative serum albumin level, axial length of the infectious lesion, lesion-removal method, and application of a muscular flap. After incorporating these six factors, the nomogram achieved good discrimination, with concordance indexes of 0.82 (95% CI, 0.79-0.85) and 0.80 (95% CI, 0.78-0.83) in predicting recurrence in the training and validation cohorts, respectively. Calibration curves were well fitted for both training and validation cohorts. CONCLUSIONS Our nomogram achieved good preoperative prediction of recurrence in chronic osteomyelitis of long bones. Using this nomogram, the recurrence risk can be confidently predicted for each patient and treatment plan. After considering and discussing the functional prognosis with patients, physicians can establish a rational therapeutic plan. LEVEL OF EVIDENCE Prognostic, Level III.
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Affiliation(s)
- Hongyi Zhu
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China Shanghai Eighth People's Hospital, Shanghai, China Shanghai Minhang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China Shanghai Zhujiajiao People's Hospital, Shanghai, China The Fifth Hospital of Wuhan City, Wuhan, Hubei, China Jinghong First People's Hospital, Xishuangbanna, Yunnan, China
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Woussen A, Feuvrier D, Woussen É, Fageot J, Sergent P, Leclerc G, Obert L, Pluvy I. Extensor digitorum brevis muscle flap for lower extremity coverage in a context of posttraumatic sepsis. Orthop Traumatol Surg Res 2021; 107:102901. [PMID: 33766678 DOI: 10.1016/j.otsr.2021.102901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 07/20/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Traumatic injuries to the distal quarter of the leg present a significant risk of skin necrosis and exposure of the underlying fracture site or the osteosynthesis material that often result in bone and joint infection. In the case of small or medium-sized bone exposure, local muscles may be one of the best options for lower extremity coverage. We describe our experience using the extensor digitorum brevis muscle flap in a context of posttraumatic bone and joint infection in fourteen patients. Our main objective was to assess the outcomes and the donor-site morbidity of the extensor digitorum brevis muscle flap. MATERIALS AND METHODS A single-center retrospective study in a French reference center for bone and joint infection from 2014 to 2018 reviewed cases of traumatic injuries with skin complications and bone and joint infection that required an extensor digitorum brevis muscle flap coverage. Fourteen patients were evaluated for early and late complications, 11 men and three women with a mean age of 51.4±17.72 (19-71) years. Seven of these were open fractures and nine cases were pilon fractures. Donor-site morbidity was assessed in nine patients. RESULTS Early flap complications included two cases (14.2%) of hematoma, one case (7.1%) of partial necrosis and four cases (28.5%) of donor-site dehiscence. Late complications caused by persistent infection were found in two patients (14.2%), with one case (7.1%) of chronic osteoarthritis and one case (7.1%) of septic pseudarthrosis. From a functional and cosmetic point of view, eight patients (89%) were satisfied, to very satisfied. CONCLUSION Experience and a multidisciplinary approach are keys in providing an optimal treatment strategy for complex cases of bone and joint infection. The extensor digitorum brevis muscle is a reliable flap for small defects with underlying infection. Being made up of muscle tissue, this flap offers good resistance to infection and enables satisfactory distribution of antibiotics. LEVEL OF EVIDENCE IV.
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Jiga LP, Jandali Z, Merwart B, Skibinska K. The free vastus lateralis muscle flap. A smart less used flap for soft tissue reconstruction of the weight-bearing foot. Injury 2020; 51 Suppl 4:S34-S40. [PMID: 32276725 DOI: 10.1016/j.injury.2020.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/20/2020] [Accepted: 03/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The lateral circumflex femoral artery one of the most favoured donor-site for a wide array of free flaps including either cutaneous, fascial and muscle components or a combination thereof. Here, we provide evidence on the safe use of the free vastus lateralis muscle flap and its feasibility for optimal soft tissue coverage of the weight-bearing foot. METHODS Eighteen consecutive patients with soft tissue defects of the heel (n = 3, 16.6%) and plantar aspect of the mid- and forefoot (n = 15, 83.3%) of either post traumatic (n = 10), diabetic (n = 6) or ischemic (n = 2) etiology, received nineteen free vastus lateralis muscle free flaps covered with split-thickness skin grafts. The postoperative results in terms of wound healing, weight-bearing function, patient satisfaction were evaluated. In patients with chronic conditions (n = 8) the AOFAS (American Orthopaedic Foot and Ankle Society) scoring system was used preoperatively and 6 months postoperatively for evaluation of reconstruction outcomes. RESULTS All flaps survived. Their complete anatomical integration allowed regaining normal walking in all patients. In five patients, partial loss of the skin graft which either healed spontaneously or necessitated a redo skin grafting was noted. One patient developed a late flap-skin interface ulcer, which was solved by primary excision and direct closure. Compared with the preoperative values, the mean AOFAS score in the evaluated patients (n = 8) improved significantly (34.13 vs. 77.63, p < 0.001). CONCLUSION The skin-grafted free vastus lateralis muscle flap can safely be used as a "smart" tool for coverage of weight-bearing foot providing optimal cushioning and functional results without fearing donor-side morbidity.
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Affiliation(s)
- Lucian P Jiga
- Department for Plastic, Reconstructive and Hand Surgery, Evangelisches Hospital, Oldenburg, Germany.
| | - Zaher Jandali
- Department for Plastic, Reconstructive and Hand Surgery, Evangelisches Hospital, Oldenburg, Germany
| | - Benedikt Merwart
- Department for Plastic, Reconstructive and Hand Surgery, Evangelisches Hospital, Oldenburg, Germany
| | - Katarzyna Skibinska
- Department for Plastic, Reconstructive and Hand Surgery, Evangelisches Hospital, Oldenburg, Germany
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11
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Elbawab H, Aljehani Y, AlReshaid FT, Almusabeh HA, Al-Harbi TM, Alghamdi R. Sternoclavicular joint osteomyelitis; delayed bone resection with muscle flap: A case report. Int J Surg Case Rep 2020; 77:426-429. [PMID: 33227690 PMCID: PMC7691679 DOI: 10.1016/j.ijscr.2020.10.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Sternoclavicular joint (SCJ) osteomyelitis is a very rare condition. Here, we report an uncommon case of a complicated SCJ osteomyelitis in a patient with an anterior chest wall trauma. PRESENTATION OF CASE A 61-year-old male a known case of dyslipidemia, hypertension (HTN), and type II diabetes mellitus (T2DM). The patient presented with pain and erythema over the right SCJ following trauma to the same location. Two weeks later, the patient presented with erythematous swelling with a sinus discharging pus, although he was discharged on oral antibiotics, analgesics, and had underwent an incisional drainage. Computerized Tomography (CT) of the chest showed fluid collection surrounding the right SCJ together with joint effusion suggestive of SCJ osteomyelitis. The patient underwent initial debridement and a definitive bone resection with pectoralis muscle flap two weeks following. Five months later, the patient was seen in the outpatient clinic, the wound was completely healed, and he has a normal function of the right arm. DISCUSSION The management of SCJ osteomyelitis is not well established, yet it can be approached medically, surgically, or both. CONCLUSION Surgical intervention is indicated in cases of SCJ osteomyelitis after the failure of antibiotic therapy trial. This is especially the case in the presence of abscess and bone destruction. SCJ debridement followed by delayed resection and pectoralis muscle flap might offer better results than merely debridement alone or with resection of the joint.
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Affiliation(s)
- Hatem Elbawab
- Thoracic Unit, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
| | - Yasser Aljehani
- Thoracic Unit, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Farouk T AlReshaid
- Thoracic Unit, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | | | | | - Rizam Alghamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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12
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Fisal AA, Abdel-Hamid Romeih M, Younes LM, El-Rosasy M, Rodriguez P, Liette MD, Masadeh S. Distally Based Medial Hemisoleus Muscle Flap for Wound Coverage in the Distal Third of the Leg. Clin Podiatr Med Surg 2020; 37:631-647. [PMID: 32919595 DOI: 10.1016/j.cpm.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Wound healing and coverage of soft tissue defects of distal tibia are challenging. Free tissue transfer is treatment of choice for distal tibial defects. However, resources for free tissue transfer are not readily available and they increase morbidity to host. Local and regional flaps play a key role in management of these defects with less demanding or specialized requirements. The soleus muscle flap is the workhorse flap for midtibia soft tissue defects and is used in reverse fashion to reach the distal third of the tibia. Despite minor complications, distally based medial hemisoleus flap is reliable in limb salvage cases.
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Affiliation(s)
- Ahmed Ashraf Fisal
- Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta University Hospital, AlGeish Street, Tanta 31511, Egypt
| | - Mohamed Abdel-Hamid Romeih
- Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta University Hospital, AlGeish Street, Tanta 31511, Egypt
| | - Lotfy Mohamed Younes
- Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta University Hospital, AlGeish Street, Tanta 31511, Egypt
| | - Mahmoud El-Rosasy
- Limb Lengthening & Reconstruction and Pediatric Orthopedics, Department of Orthopedic Surgery, Tanta University Hospital, Faculty of Medicine, Tanta University, AlGeish Street, Tanta 31511, Egypt
| | - Pedro Rodriguez
- Plastic and Reconstructive Surgery, OSF Saint Anthony Medical Center, University of Illinois, 698 Featherstone Road, Rockford, IL 61107, USA
| | - Michael D Liette
- University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA
| | - Suhail Masadeh
- University of Cincinnati Medical Center, Cincinnati Veteran Affairs Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA.
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13
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Craig GC. Intrinsic Muscle Flaps for Coverage of Small Defects in the Foot. Clin Podiatr Med Surg 2020; 37:789-802. [PMID: 32919605 DOI: 10.1016/j.cpm.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Exposure of critical structures such as joints, bones, ligaments, and tendons necessitates expeditious closure. The longer these structures remain open to the environment, the higher the risk is for that patient developing osteomyelitis and an amputation. Muscle flaps remain often first choice when dealing with bone infections associated with osteomyelitis, soft tissue infections, and large cavities. Foot defects are a challenge especially in the absence of microsurgical expertise. Intrinsic local flaps of the foot can be an option to cover defects. This article describes local intrinsic muscle flaps for coverage of foot defects.
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Affiliation(s)
- Grace Chuang Craig
- Elevate Foot and Ankle, 2880 Plymouth Avenue, Rocky River, OH 44116, USA.
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14
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Abstract
Chronic ulcerations of the lower extremity centered around the lateral malleolus, medial malleolus, Achilles tendon, or anterior ankle are complex and difficult to heal with conventional treatment modalities. With the evolution of orthoplastics and microsurgery techniques, the peroneus brevis muscle flap has been shown to be simple, versatile, and effective in management of small to medium-sized soft tissue defects that may or may not have exposed bone, tendon, or both. This article reviews the peroneus brevis muscle flap in lower extremity reconstruction and presents pertinent real-world cases of its applications as a tool for limb salvage and orthoplastic reconstruction.
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Affiliation(s)
- Phuoc V Bui
- Department of Podiatric Surgery, TriHealth - Bethesda North Hospital, Montgomery, OH, USA
| | - Dominic A Rizzo
- Department of Podiatric Surgery, TriHealth - Bethesda North Hospital, Montgomery, OH, USA; Cincinnati Lower Extremity Reconstructive Institute, Foot and Ankle Specialists of Cincinnati.
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15
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Delgado Perez JA, Rodriguez P, Liette MD, Masadeh S. Medial Hemisoleus Flap for Middle Third of the Tibia Defects. Clin Podiatr Med Surg 2020; 37:621-630. [PMID: 32919594 DOI: 10.1016/j.cpm.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Covering soft tissue defects of the tibia is challenging, especially in the presence of underlying osseous trauma. The soleus muscle flap remains the treatment of choice for soft tissue defects in the middle third of the tibia. The flap is reliable and requires a relatively short operative time while maintaining minimal donor site morbidity. However, when the muscle flap is performed without a modified fasciocutaneous composite, it requires a split-thickness skin graft. Muscle flaps have the additional advantage of improving vascularity and fighting infection.
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Affiliation(s)
| | - Pedro Rodriguez
- Plastic and Reconstructive Surgery, OSF Saint Anthony Medical Center, 698 Featherstone Road, Rockford, IL 61107, USA
| | - Michael D Liette
- University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA
| | - Suhail Masadeh
- University of Cincinnati Medical Center, Cincinnati Veteran Affairs Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA.
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Miyata K, Fukaya M, Nagino M. Repair of gastro-tracheobronchial fistula after esophagectomy for esophageal cancer using intercostal muscle and latissimus dorsi muscle flaps: a case report. Surg Case Rep 2020; 6:172. [PMID: 32666163 PMCID: PMC7359967 DOI: 10.1186/s40792-020-00936-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastro-tracheobronchial fistula after esophagectomy is a rare but life-threatening complication associated with high mortality. Several authors reported postoperative management of tracheobronchial fistula. However, treatment is demanding and challenging, and the strategy is still controversial. CASE PRESENTATION A 64-year-old man underwent thoracoscopic esophagectomy with two-field lymph node dissection and gastric conduit reconstruction by an intrathoracic anastomosis for esophageal cancer at a local hospital in June 2013. After surgery, a gastro-tracheal fistula and a gastro-bronchial fistula of the left main bronchus were diagnosed, and the patient was referred to our hospital for the management of the gastro-tracheobronchial fistula. CT and bronchoscopy and esophagogastroduodenoscopy performed at our hospital revealed that the gastro-bronchial fistula of the left main bronchus was cured by packing with the omentum from the gastric conduit and the gastro-tracheal fistula located 3 cm above the carina remained open. We concluded that the fistula would not resolve without further surgical procedure. However, such an operation was expected to be difficult and to need much time due to severe adhesion among the gastric conduit and/or trachea, bronchus, lung, and chest wall. Therefore, a two-stage operation was planned for safety and outcome certainty. The first operation was performed to close the fistula in October 2013. The gastric conduit was separated from the trachea and resected; then, the fistula was sutured and covered by intercostal muscle and latissimus dorsi muscle flaps. A month after the first operation, reconstruction with pedunculated jejunum was performed via the percutaneous route. The patient's postoperative course was uneventful. CONCLUSION If the omentum is not observed between the gastric conduit and the tracheobronchus when a gastro-tracheobronchial fistula occurs after esophagectomy, surgeons should perform surgical treatment because conservative treatment is unlikely to cure. During surgery, the use of two types of muscle flaps, such as the intercostal muscle and the latissimus dorsi muscle flaps, is helpful for the closure of gastro-tracheobronchial fistulas.
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Affiliation(s)
- Kazushi Miyata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Masahide Fukaya
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Asaad M, Van Handel A, Akhavan AA, Huang TTC, Rajesh A, Allen MA, Shen KR, Sharaf B, Moran SL. Intrathoracic Muscle Flap Transposition for the Management of Chronic Pulmonary Aspergillosis. J Plast Reconstr Aesthet Surg 2020; 73:1815-1824. [PMID: 32593571 DOI: 10.1016/j.bjps.2020.05.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/04/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The management of chronic pulmonary aspergillosis remains a challenge for thoracic and reconstructive surgeons. Different management options have been proposed with no consensus regarding the best treatment modality. The goal of this study is to report our experience with the use of intrathoracic muscle flaps for the management of pulmonary aspergillosis. METHODS We retrospectively reviewed all patients who underwent intrathoracic muscle flap transposition for the management of pulmonary aspergillosis between 1990 and 2010. Demographics, surgical characteristics, and treatment outcomes were collected and analyzed. RESULTS A total of 39 patients who underwent 48 muscle flaps were identified. The majority were classified as ASA 3 (n=30, 77%) or ASA 4 (n=8, 21%). Serratus anterior was the most common flap used (n=34), followed by latissimus dorsi (n=6) and pectoralis major (n=5). Flap loss was encountered in three (8%) patients (2 partial, 1 total). Bronchopleural fistula and empyema comprised the two most common intrathoracic complications (26%, 29% respectively). Median follow-up was 33 months (range, 0-216). Successful treatment was achieved in 77% of patients, while operative mortality was 23%. CONCLUSION The use of intrathoracic muscle flaps can be a helpful adjunct to surgical resection in the treatment of chronic pulmonary aspergillosis with low rates of flap loss.
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Affiliation(s)
- Malke Asaad
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW Rochester, MN
| | | | - Arya A Akhavan
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Tony T C Huang
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW Rochester, MN
| | - Aashish Rajesh
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark A Allen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - K Robert Shen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Basel Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW Rochester, MN
| | - Steven L Moran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW Rochester, MN.
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18
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Wei J, Deng N, Herrler T, Zhang Y, Li Q, Hua C, Dai C. Short term results of philtrum reconstruction with an orbicularis oris muscle flap in cleft patients. J Craniomaxillofac Surg 2020; 48:569-573. [PMID: 32340907 DOI: 10.1016/j.jcms.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/15/2020] [Accepted: 03/19/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In the treatment of philtral ridge deficiency in cleft lip patients, optimal results are difficult to obtain due to visible scarring following surgery. The purpose of this article is to introduce a novel strategy for philtrum reconstruction along with an evaluation of postoperative outcomes of this technique. METHOD All patients with a deficiency of the philtrum underwent reconstruction of the philtral ridge and upper lip using an orbicularis oris muscle flap with a specific re-suturing technique in our study. The convexity of the philtral ridge was evaluated pre- and postoperatively at rest and while puckering using patient photography as well as three-dimensional simulation technology. Postoperative outcomes and complications were assessed during follow-up, including a patient satisfaction survey. RESULTS Thirty cleft lip patients underwent treatment in this study using a specific orbicularis oris muscle re-suturing technique. The average age of the 13 male and 17 female patients was 31.5 years. The follow-up period ranged from 6 months to 3.5 years with an average of 10.3 months. Postoperative results showed an aesthetic reconstructed philtral ridge with stable outcome. Complications included acute infection (1 case) and temporary stiffness of smile (3 cases). No systemic complications occurred. All patients were satisfied with their results, and none required further surgery. CONCLUSION We propose a simple, effective, and reproducible technique involving an orbicularis oris muscle flap for the creation of the philtral column in secondary cleft lip deformity. Our approach allowed aesthetically pleasing and stable outcomes. Although the short-term results of the philtrum reconstruction seem to be adequate there is no information on the long-term situation, and therefore no general recommendation to adopt this method can be given.
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Affiliation(s)
- Jiao Wei
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd. Shanghai, 200011, PR China
| | - Ning Deng
- Department of Breast Surgery, LiaoNing Cancer Hospital & Institute, PR China
| | - Tanja Herrler
- Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Yi Zhang
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd. Shanghai, 200011, PR China
| | - Qingfeng Li
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd. Shanghai, 200011, PR China
| | - Chenqing Hua
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd. Shanghai, 200011, PR China
| | - Chuanchang Dai
- Department of Plastic & Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, 639 Zhi Zao Ju Rd. Shanghai, 200011, PR China.
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19
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Tremp M, Waldkircher NJ, Wang W, Oranges CM, di Summa PG, Zhang Y, Wang W, Schaefer DJ, Kalbermatten DF. Sensory assessment of meshed skin grafts over free gracilis muscle flaps without nerve coaptation for lower extremity reconstruction. Arch Plast Surg 2021; 48:224-30. [PMID: 32268659 DOI: 10.5999/aps.2019.00584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/24/2019] [Indexed: 11/27/2022] Open
Abstract
Background Little is known about the sensate recovery of skin grafts over free non-neurotized muscle flaps. The aim of this study was to evaluate the sensitivity of free gracilis muscle flaps and meshed skin grafts without nerve coaptation. Methods Thirteen consecutive patients with a median age of 55 years (range, 21–70 years) who underwent lower extremity reconstruction between September 2014 and October 2016 were included. Complications, flap contour, skin perception, and sensate recovery were assessed. Results All flaps survived completely. In one patient, wound dehiscence and infection occurred 1 month after surgery. After a median follow-up of 14 months (range, 10–51 months), a satisfactory contour and skin perception were achieved. The Semmes-Weinstein (SW) monofilament test (154.8±22 g) and static two-point discrimination (2-PD) (12.6±0.7 mm) showed intermediate recovery compared to the surrounding site (41% and 76%, respectively). There was an intermediate correlation between flap size and sensate recovery (2-PD: r=0.27, P=0.36; SW test: r=0.45, P=0.12). Vibration sensation recovered to 60%, whereas thermal sensation remained poor (19% at 5°C and 25% at 25°C). Conclusions Finer sensation could be partially restored. However, thermal sensation remained poor.
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20
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Aydın E, Nolan H, Peiró JL, Burns P, Rymeski B, Lim FY. When primary repair is not enough: a comparison of synthetic patch and muscle flap closure in congenital diaphragmatic hernia? Pediatr Surg Int 2020; 36:485-491. [PMID: 32130491 DOI: 10.1007/s00383-020-04634-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Primary closure is often inadequate for large congenital diaphragmatic hernia (CDH) and necessitates repair by prosthetic patch or autologous muscle flap. Our aim was to evaluate outcomes of open patch versus flap repair, specifically diaphragmatic reherniation. METHODS A retrospective review (IRB #2017-6361) was performed on all CDH patients repaired from 2005 to 2016 at a single academic children's hospital. Patients were excluded from final analysis if they had primary or minimally invasive repair, expired, or were lost to follow-up. RESULTS Of 171 patients, 151 (88.3%) survived to discharge, 9 expired after discharge and 11 were lost to follow up, leaving 131 (86.8%) long-term survivors. Median follow-up was 5 years. Open repair was performed in 119 (90.8%) of which 28 (23.5%) underwent primary repair, 34 (28.6%) patch repair, and 57 (47.9%) flap repair. Overall, 6/119 (5%) patients reherniated, 1/28 (3.6%) in the primary group, 3/34 (8.8%) in the patch group, and 2/57 (3.5%) in the flap group. Comparing prosthetic patch to muscle flap repair, there was no significant difference in the number of patients who recurred nor time to reherniation (3 vs. 2, p = 0.295; 5.5 ± 0.00 months vs. 53.75 ± 71.06 months, p = 0.288). One patient in the patch group recurred twice. CONCLUSIONS Both muscle flap and patch repair of large CDH are feasible and durable with a relatively low risk of recurrence.
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Affiliation(s)
- Emrah Aydın
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA.
| | - Heather Nolan
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Jose Luis Peiró
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Patricia Burns
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Beth Rymeski
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Foong-Yen Lim
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
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21
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Liu R, Tan Z, Li J, Yan Y, Ren W, Zhang M, Yang S, Zhao H. Improvements to the retractor and muscle flap design for minimally invasive cochlear implantation. J Otol 2020; 15:41-44. [PMID: 32110240 PMCID: PMC7033583 DOI: 10.1016/j.joto.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 09/07/2019] [Accepted: 09/12/2019] [Indexed: 11/03/2022] Open
Abstract
Objective The aim of this study was to improve muscle flaps and to evaluate surgical outcomes with the use of a novel specialized retractor, which is a surgical instrument used to locate and shape a bony seat for minimally invasive cochlear implantation. Methods 50 patients aged 1-75 years with sensorineural hearing loss who required cochlear implantation were recruited. A small incision (<3 cm) was made, and the novel specialized retractor was used in the study group during cochlear implantation. The incision length, surgical outcomes and operative time were recorded and analyzed. Results The incision length, total operative time and drilling bony time were shorter in the study group than in the control group (P < 0.05, respectively). All patients recovered well after the surgery without any severe complications. Conclusion The use of a novel specialized retractor standardized the surgical processes of cochlear implantation. The retractor helped locate and control the size of the bony well during bone drilling. The tool reduced the technical difficulty and improved the efficacy of this minimally invasive operation.
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Affiliation(s)
- Riyuan Liu
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Zhiping Tan
- Zhejiang Nurotron Biotechnology Company Limited, Hangzhou, Zhejiang, 311121, China
| | - Jianan Li
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Yan Yan
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Wei Ren
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Miao Zhang
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Shiming Yang
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
| | - Hui Zhao
- Department of Otolaryngology Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, China National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100853, China
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Abstract
AIM With the advancement in the treatment strategies of congenital diaphragmatic hernia (CDH), there is an increase in the survival rates. This fact leads to an increase in the morbidity and extrapulmonary complications in the long term such as failure to thrive, hernia recurrence, neurodevelopmental delay, gastrointestinal problems, and musculoskeletal anomalies. Herein, we aim to investigate the association between the long-term musculoskeletal complications in CDH patients regarding the defect size, repair type, and perinatal parameters. METHODS After Institutional Review Board approval was obtained (2017-6361), a retrospective chart review was performed on CDH patients from 2003 to 2016. Patients who were operated due to left-sided isolated congenital diaphragmatic hernia and survived to date were included in the study. Data were collected on demographics, preoperative characteristics, operative interventions, and postoperative outcomes. Statistical analysis was performed with IBM SPSS Statistics 20.0.0 (Chicago, IL). RESULTS There were 98 patients with left CDH of whom 33 (33.7%) had primary repair, 25 (25.5%) had patch repair, and 40 (40.8%) had muscle flap repair. The median age of the patients was 6.00 ± 3.83 years. 45 patients (45.9%) had large diaphragmatic defects, 28 patients (28.6%) had at least one type of musculoskeletal deformities, 2 of which were pectus carinatum, 16 were pectus excavatum, and 18 were scoliosis. CDH patients who had small diaphragmatic defects and repaired with a patch were less likely develop musculoskeletal deformities while who had primary abdominal closure after ventral hernia significantly have more pectus excavatum. CONCLUSION Although there was a trend towards an increased risk of the pectus deformity and scoliosis in patients repaired with muscle flap, it did not reach statistical significance. There is a correlation between musculoskeletal deformities and the severity of the CDH.
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Affiliation(s)
- Emrah Aydın
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA. .,Department of Pediatric Surgery, Koç University School of Medicine, Istanbul, Turkey.
| | - Oğuz Özler
- Department of Pediatric Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Patricia Burns
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Foong-Yen Lim
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Jose Luis Peiró
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
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23
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Nolan H, Aydin E, Frischer JS, Peiro JL, Rymeski B, Lim FY. Hemorrhage after on-ECMO repair of CDH is equivalent for muscle flap and prosthetic patch. J Pediatr Surg 2019; 54:2044-2047. [PMID: 31103273 DOI: 10.1016/j.jpedsurg.2019.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE Prosthetic patch (patch) and muscle flap (flap) techniques are utilized for severe congenital diaphragmatic hernia (CDH) repair; however, when performed on extracorporeal membrane oxygenation (ECMO), the risk of hemorrhage increases. We sought to compare bleeding complications between repair types. METHODS We retrospectively reviewed 2010-2016 on-ECMO CDH repairs. RESULTS Twenty-nine patients met criteria: 13 patch (44.8%) and 16 flap (55.2%). Eight patch (61.5%) and 13 flap (81.2%) patients had left-sided defects (p = 0.223). All defects were Type C or D (Type C: patch 53.8%, flap 56.2%, p = 0.596). There was no difference in gestational age at delivery (patch 37.5 ± 0.9 weeks, flap 37.2 ± 1.3 weeks, p = 0.390) or age at repair (patch 7.46 ± 6.6 days, flap 6.00 ± 4.3 days, p = 0.476). Seven patch (53.8%) and 9 flap (56.2%) patients survived to discharge (p = 0.596). Estimated intraoperative blood loss was equivalent (patch 35.3 ± 53.9 mL, flap 24.2 ± 18.4 mL, p = 0.443). One patch patient (7.6%) and two (12.5%) flap patients required reoperation in the first 48 h for bleeding (p = 0.580). 48-h postoperative transfusions were the same for those that required reoperation (patch 282.0 mL/kg, flap 208.5 ± 21.9 mL/kg, p = 0.054) and those that did not (patch 120.7 ± 111.7 mL/kg, flap 118.4 ± 89.9 mL/kg, p = 0.561). CONCLUSIONS On-ECMO bleeding complications are equivalent for both flap and patch CDH repair. LEVEL OF EVIDENCE Type III (retrospective comparative study).
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Affiliation(s)
- Heather Nolan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Emrah Aydin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Jason S Frischer
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Jose L Peiro
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Beth Rymeski
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Foong-Yen Lim
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Ryer EJ, Garvin RP, Kapadia RN, Jorgensen BD, Green JO, Fluck M, Orlova K, Cindric MC, Elmore JR. Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions. J Vasc Surg 2019; 71:905-911. [PMID: 31471237 DOI: 10.1016/j.jvs.2019.05.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/18/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Groin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative débridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported. METHODS Clinical data between 2012 and 2018 were retrospectively analyzed. Data were summarized, and standard statistical analysis was performed. RESULTS There were 23 patients who underwent 24 RFFs for coverage of complex groin wounds after femoral artery reconstructions. One of the 23 patients underwent bilateral RFFs. In this study cohort, patients had a median age of 67.5 years, and 79% (n = 19) were male. Median body mass index was 28.0 kg/m2, and 38% of patients were classified as obese on the basis of body mass index criteria. A history of tobacco use was present in 88%; however, only 29% were current smokers. Diabetes was present in 38% of patients and chronic kidney disease in 29%. Of the 24 RFFs, 14 (58%) were constructed in patients with reoperative groin surgery resulting in the need for muscle flap coverage. Femoral endarterectomy was the most common index procedure (46%), followed by infrainguinal leg bypass surgery (17%) and aortobifemoral bypass (17%). Grafts used during the original reconstruction included 12 bovine pericardial patches (50%), 6 Dacron grafts (25%), 4 PTFE grafts (17%), and 2 autogenous reconstructions (8%). Microbiology data identified 33% of patients (n = 8) to have gram-positive bacterial infections alone, 21% (n = 5) to have gram-negative infections alone, and 29% (n = 7) to have polymicrobial infections; 4 patients (13%) had negative intraoperative culture data. Median hospital stay after RFF was 8 days, and median follow-up time was 29.3 months. Major amputation was avoided in 20 of 24 limbs (83%) undergoing RFF. Eight patients underwent intentional graft or patch explantation (33%) before RFF, whereas 14 of the remaining 15 patients (93%) had successful salvage of the graft or patch after RFF. Two of the patients (13%) who underwent RFF with the intention of salvaging a prosthetic graft or patch required later graft excision. After RFF, 30-day and 1-year survival was 96% and 87%, respectively. CONCLUSIONS RFF coverage of complex groin wounds after femoral artery reconstructions may safely be performed by vascular surgeons with excellent outcomes.
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Affiliation(s)
- Evan J Ryer
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa.
| | - Robert P Garvin
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Ravi N Kapadia
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Benjamin D Jorgensen
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Jessica O Green
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Marcus Fluck
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Ksenia Orlova
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Matthew C Cindric
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - James R Elmore
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
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Yu D, Zhou Z, Zhang X. Surgical treatment of the severe thoracic gastrocutaneous fistula by pedicled muscle flap filling and thoracoplasty after oesophagectomy for oesophageal squamous cell carcinoma: A case report. Int J Surg Case Rep 2019; 55:76-79. [PMID: 30711886 PMCID: PMC6360347 DOI: 10.1016/j.ijscr.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/01/2019] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thoracic anastomotic fistula (TAF) is a severe postoperative complication of oesophagectomy, and its occurrence coupled with a thoracic gastrocutaneous fistula (TGCF) and tracheostenosis is very unusual and may lead to a fatal consequence. CASE PRESENTATION We describe a case of an old female diagnosed with mid-oesophageal carcinoma, who presented with a TAF after oesophagectomy, which was healed by an effective treatment, while a severe TGCF and tracheostenosis appeared one month postoperation. The complications were detected by gastroscopy, barium oesophagogram and thoracic computed tomography (CT). Through surgical treatments, including pedicled muscle flap filling and thoracoplasty, and a correlated corrective procedure, the patient completely recovered and was discharged six months after the admission. CONCLUSION Treatment by pedicled muscle flap filling and thoracoplasty after oesophagectomy for oesophageal squamous cell carcinoma can be a curative alternative for the severe thoracic gastrocutaneous fistula.
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Affiliation(s)
- Dongmin Yu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Zizi Zhou
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital, Shenzhen, China; Department of Plastic and Reconstructive Surgery, BG Unfallklinik Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Xiaoming Zhang
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital, Shenzhen, China.
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Wannaz L, Roumy A, Letovanec I, Lovis A, Beigelman C, Ris HB, Gonzalez M. Non-circumferential membranous resection of the trachea for paraganglioma: A case report. Int J Surg Case Rep 2018; 51:288-291. [PMID: 30243261 PMCID: PMC6148838 DOI: 10.1016/j.ijscr.2018.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/27/2018] [Accepted: 09/13/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Paraganglioma is a rare neuroendocrine tumor and may sometimes be located in the membranous part of the trachea. PRESENTATION OF CASE We report the case of a 52-year-old man presenting a paraganglioma just above the carina with obstructive symptoms. The patient successfully underwent a non-circumferential tracheal membranous resection, followed by latissimus dorsi muscle flap repair, under peripheral extra-corporeal membrane oxygenation (ECMO). DISCUSSION Complex carinal resection can be avoided for tracheal membranous tumors and replaced with non-circumferential resection and direct reconstruction with a muscle flap. In addition, ECMO support may be used for airway resection and reconstruction. CONCLUSION Tracheal membranous tumors can be managed without circumferential resection or direct anastomosis.
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Affiliation(s)
- Laure Wannaz
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Aurélien Roumy
- Service of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Igor Letovanec
- Service of Pathology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Alban Lovis
- Service of Pneumology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Catherine Beigelman
- Service of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hans-Beat Ris
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Abstract
Lumbar hernias are rare occurrences, with only 300 cases reported in the literature. We present a unique case of a superior lumbar hernia secondary to penetrating trauma to the right flank. We performed a herniorrhaphy using porcine mesh, and provided additional support by mobilizing the external oblique and latissimus dorsi into the defect. At follow up three months after repair, the patient was asymptomatic and exam revealed an intact lumbar abdominal wall with normal contour. Although literature displays a consensus on the need for lumbar hernia repair, specific repair techniques must be tailored to defect etiology, size, location, and contents.
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Affiliation(s)
- Serena J Day
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, United States
| | - Paige L Myers
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Rochester Medical Center, United States
| | - Derek E Bell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Rochester Medical Center, United States
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28
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Friedlander DA, Lue KM, Michaud JE, Gearhart JP, Redett RJ, Di Carlo HN. Repair of Vesicocutaneous and Urethrocutaneous Fistulae with Rectus Muscle Flap in a Bladder Exstrophy Patient. Urol Case Rep 2017; 13:42-44. [PMID: 28443240 PMCID: PMC5397601 DOI: 10.1016/j.eucr.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/24/2022] Open
Abstract
Urinary continence can be achieved in up to 90% of patients with bladder exstrophy. However, select patients remain incontinent despite modern reconstruction. Repeat operations for continence combined with the congenital pelvic abnormalities of exstrophy put patients at risk for urinary fistula formation. We report the use of a rectus muscle flap in the repair of two concomitant vesicocutaneous and urethrocutaneous fistulae in a patient with classic bladder exstrophy.
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Affiliation(s)
- Daniel A Friedlander
- Division of Pediatric Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathy M Lue
- Division of Pediatric Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason E Michaud
- Division of Pediatric Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Gearhart
- Division of Pediatric Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heather N Di Carlo
- Division of Pediatric Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jordan SW, De la Garza M, Lewis VL. Two-stage treatment of ischial pressure ulcers in spinal cord injury patients: Technique and outcomes over 8 years. J Plast Reconstr Aesthet Surg 2017; 70:959-966. [PMID: 28285012 DOI: 10.1016/j.bjps.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 11/29/2016] [Accepted: 01/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite newly introduced techniques, reconstruction of ischial pressure ulcers remains a difficult problem with high-reported failure rates. METHODS A retrospective chart review was performed on all spinal cord injury patients who underwent ischial pressure ulcer reconstruction by the senior author (V.L.) between 2004 and 2012. The two-stage procedure consisted of debridement and bone biopsy, followed by bursectomy, partial ischiectomy, fascial release, and gluteus maximus and hamstring advancement flaps. Postoperative care included 2-week supine bed rest on an air-fluidized bed, sitting tolerance rehabilitation, and thorough behavioral training. RESULTS Sixty-five patients (74 flaps) were identified. A 45.9% had a previous attempt at reconstruction. The median follow-up period was 622 days. Overall, 67.6% of flaps were intact at the last follow-up. Superficial and deep dehiscence rates were 16.2 and 28.4%, respectively. Seven out of 35 flaps suffered late recurrence after being well healed for more than 1 year. History of previous reconstruction was found to be associated with increased odds of superficial (OR 6.02, 95% CI 1.55-23.3) and deep dehiscence (OR 12.3, 95% CI 1.99-76.9). CONCLUSIONS The evolution of the senior author's decades of practice has led to the development of a simpler repair, which relies on plane-by-plane release of scarred tissues to improve the mobility of muscle and skin flaps without large tissue movements, even in the setting of apparent extensive tissue loss. This technique is a reliable option, particularly for the primary ischial pressure ulcer.
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Affiliation(s)
- Sumanas W Jordan
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mauricio De la Garza
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Victor L Lewis
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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30
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Cui H, Xiao H, He K, Peng Y, Bian Z, Wang H. [V-Y ADVANCEMENT OF MEDIAL GASTROCNEMIUS MUSCLE FLAP FOR REPAIRING SOFT TISSUE DEFECTS IN MIDDLE AND LOWER SEGMENTS OF ANTERIOR TIBIA]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2016; 30:1122-1126. [PMID: 29786367 DOI: 10.7507/1002-1892.20160228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the effectiveness of V-Y advanced medial gastrocnemius muscle flap to repair soft tissue defects in the middle and lower segments of the anterior tibia. METHODS Between March 2008 and March 2014, 8 patients with skin and soft tissue defects of the anterior tibia were treated, including 6 males and 2 females with an average age of 36.2 years (range, 28-47 years). The soft tissue defects located at the left leg in 5 cases and at the right leg in 3 cases. The causes included traffic accident injury in 6 cases, and heavy pound injury in 2 cases. Three cases had simple soft tissue defects, and the disease course was 5 hours, 6 days, and 14 days, respectively. Five cases had soft tissue defects and fractures, including 1 case of Pilon fracture, and 4 cases of middle and distal tibial fracture; open reduction and internal fixation were performed in 3 cases, the implementation of external fixation in 2 cases; 1 case had chronic osteomyelitis at 11 months after operation, and 4 cases had skin necrosis and wound infection at 1 to 2 weeks after operation; the duration was 1-12 months (mean, 3.4 months). The skin and soft tissue defect area was 5.2 cm×2.5 cm to 13.0 cm×5.5 cm. Debridement was given, and vacuum sealing drainage was used in 6 cases, and then V-Y advancement of medial gastrocnemius muscle flap was used to cover the wound. Because of light wound contamination, the wound was repaired by the flap after emergency debridement in 1 case; 1 patient with osteomyelitis underwent flap repair at immediate after sensitive antibiotics use and debridement. The size of medial gastrocnemius muscle flaps ranged from 15 cm×6 cm to 26 cm×15 cm. The donor site was sutured in 3 cases or repaired with skin graft in 5 cases. RESULTS One case had tension blisters in the distal flap, which was cured after symptomatic treatment. The flap and skin graft survived, and primary healing was obtained in the other cases. Seven patients were followed up 6-18 months (mean, 9 months). The texture and appearance of the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 12 to 18 mm (mean, 16 mm). The plantar flexion was weaker than that of normal side, but the patients could normally walk and had normal gait. CONCLUSIONS The V-Y advancement of medial gastrocnemius muscle flap is recommendable to repair soft tissue defects in the middle and lower segments of the anterior tibia for the advantages of reliable blood supply, simple operation, high survival rate of the flap, and satisfactory appearance.
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Affiliation(s)
- Haojie Cui
- The Second Department of Orthopedics, People's Hospital of Renqiu, Renqiu Hebei, 062550, P. R. China
| | - Haitao Xiao
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University
| | - Kuile He
- The Second Department of Orthopedics, People's Hospital of Renqiu, Renqiu Hebei, 062550, P. R. China
| | - Yongli Peng
- The Second Department of Orthopedics, People's Hospital of Renqiu, Renqiu Hebei, 062550, P. R. China
| | - Zhaohui Bian
- The Second Department of Orthopedics, People's Hospital of Renqiu, Renqiu Hebei, 062550, P. R. China
| | - Hongye Wang
- Department of Hand Surgery, Beijing Jishuitan Hospital
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Chang JW, Lee JH, Choi MSS. Perforator-based island flap with a peripheral muscle patch for coverage of sacral sores. J Plast Reconstr Aesthet Surg 2016; 69:777-782. [PMID: 27068663 DOI: 10.1016/j.bjps.2016.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/22/2016] [Accepted: 03/06/2016] [Indexed: 11/26/2022]
Abstract
Despite numerous therapeutic advances, the treatment of pressure sores remains a challenge. The increased use of perforator flaps enables surgeons to minimize donor-site morbidity by sparing the underlying muscle. In the presence of focal deep spaces, however, the inclusion of muscle would be beneficial. The goal of this study was to introduce a method for including a muscle patch at the periphery of a perforator-based island flap for coverage of sacral pressure sores. Between March 2010 and February 2015, 26 patients with stage IV sacral sores underwent perforator-based island flap reconstruction with a peripheral muscle patch. Patient characteristics, including sex, age, defect size, and postoperative complications, were recorded. All flaps survived without major complications. No flap necrosis was noted. The present study shows that a muscle patch incorporated into the periphery of a perforator-based flap can be transferred safely. This can be a good surgical option in cases where infection control or more volume is needed.
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Affiliation(s)
- Jung Woo Chang
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jang Hyun Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Matthew Seung Suk Choi
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.
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Abstract
Acquired non-malignant tracheo-oesophageal fistula (TOF) most commonly develops after prolonged intubation or tracheostomy. It may also develop after trauma, oesophagectomy, laryngectomy and other disparate conditions. TOF leads to respiratory compromise secondary to chronic aspiration and pulmonary sepsis. Difficulty with oral intake usually leads to nutritional compromise. After diagnosis, the goals are to eliminate or reduce ongoing pulmonary contamination and to restore proper nutrition. Operative repair of benign TOF is generally performed through a cervical approach. The majority of patients require tracheal resection and reconstruction to address concomitant tracheal or laryngotracheal stenosis. Muscle flap interposition between tracheal and oesophageal repairs reduces the risk of fistula recurrence. Operative repair of the fistula is associated with generally good outcomes with a minimal risk of mortality.
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Affiliation(s)
- Ashok Muniappan
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Repo JP, Barner-Rasmussen I, Roine RP, Sintonen H, Tukiainen EJ. Treatment of compound tibia fracture with microvascular latissimus dorsi flap and the Ilizarov technique: A cross-sectional study of long-term outcomes. J Plast Reconstr Aesthet Surg 2016; 69:524-32. [PMID: 26843265 DOI: 10.1016/j.bjps.2015.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/13/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Extensive compound tibial fractures present reconstructive challenges. The present study aimed to assess the outcomes of microvascular latissimus dorsi (LD) flap combined with the Ilizarov technique for extensive compound tibial fractures with bone loss and bone healing complications. METHODS Patient records were reviewed retrospectively. The Lower Extremity Functional Scale (LEFS), the Disabilities of the Arm, Hand and Shoulder (DASH), and the 15D health-related quality of life (HRQoL) instrument were applied. RESULTS Between 1989 and 2014, 16 patients underwent reconstruction with a microvascular LD flap and bone transport (11/16) or late bone lengthening (5/16). The mean clinical follow-up time was 6.6 (standard deviation (SD): 6.5) years. Three patients had minor complications requiring reoperation. Partial necrosis of one flap required late flap reconstruction in one case. Late bone grafting was used to enhance union in eight of 16 cases. The mean new bone gain was 3.8 cm (SD: 2.5). Overall, 11 patients completed the questionnaires in a mean of 22.3 years (SD: 2.4) after surgery. The main findings revealed a relatively good function of the reconstructed limb and good shoulder function. The mean HRQoL was comparable to that of an age-standardized sample of the general population. CONCLUSION Segmental tibia transport and lengthening to correct limb length discrepancy do not compromise the microvascular muscle flap. Combined microvascular LD flap reconstruction and the Ilizarov technique can be used in treating acute compound tibial defects, pseudoarthrosis, and osteitis, all associated with significant amputation risk. Fair long-term functional outcomes and HRQoL are achieved when these combined techniques are used.
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Affiliation(s)
- J P Repo
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland.
| | - I Barner-Rasmussen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland
| | - R P Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E J Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland
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Weizhong L, Zuojun Z, Junling W, Hongmei A. The combination application of space filling and closed irrigation suction in reconstruction of sacral decubitus ulcer. Int Surg 2014; 99:623-7. [PMID: 25216432 DOI: 10.9738/INTSURG-D-13-00033.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dead space and poor drainage are the main reasons for intractable sacral decubitus ulcers. The objective of this study was to investigate the effects of treatment for sacral decubitus ulcer using space filling through muscle flap and closed irrigation. A total of 22 patients with serious sacral decubitus ulcer were treated with space filling through muscle flap and closed irrigation. After debridement of the decubitus ulcer, the infected areas over the bony prominence and osseous prominences were debrided. We elevated biceps femoris long head or semitendinosus and semimembranosus muscle. Pedicled by proximal part of muscle, the muscle flap was elevated to cover the ischial tuberosity. Transfusion systems of inflow and outflow drainage were placed between the muscle flap and ischial tuberosity. Wound healing and complications were observed. One wound dehiscence healed after secondary suturing. One wound gradually healed by dressing change after 3 weeks. The other cases had good results. Space filling and closed irrigation were complementary. The use of these two methods simultaneously is useful for the management of sacral decubitus ulcers.
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Hishida M, Toriyama K, Yagi S, Ebisawa K, Morishita T, Takanari K, Kamei Y. Does a muscle flap accelerate wound healing of gastric wall defects compared with an omental flap? Int J Surg 2015; 18:41-7. [PMID: 25865082 DOI: 10.1016/j.ijsu.2015.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 03/14/2015] [Accepted: 03/25/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Most often used for reconstruction at superficial sites, a muscle flap recently was reported to promote clinical wound healing in a duodenal defect. We therefore examined whether a muscle flap could promote wound healing comparably to an omental flap in rats with gastric wall defects. METHODS After perforation of the centre of the anterior gastric wall, rats were divided into 2 groups. In the muscle group, a muscle flap was fixed to the defect; in the omentum group, an omental flap was placed over the defect. We histopathologically compared tissue responses during gastric wall healing. RESULTS While stratified villi had completely covered the defect by day 7 in both groups, scar maturation differed. Scar tissue persisted in the muscle group, but was gradually replaced by adipose tissue in the omentum group. DISCUSSION Both muscle and omental flaps accelerated gastric wall wound healing. CONCLUSION A muscle flap is an excellent alternative for repair of gastric defects when no omental flap is available.
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Affiliation(s)
- Masashi Hishida
- Department of Plastic and Reconstructive Surgery, Kasugai Municipal Hospital, 1-1-1 Takagi-cho, Kasugai 486-8510, Japan; Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Kazuhiro Toriyama
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Shunjiro Yagi
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Katsumi Ebisawa
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Tsuyoshi Morishita
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Sakai M, Yamaoka M, Goto Y, Sato Y. Subscapularis muscle flap for reconstruction of posterior chest wall skeletal defect. Int J Surg Case Rep 2015; 10:198-200. [PMID: 25863995 PMCID: PMC4430181 DOI: 10.1016/j.ijscr.2015.03.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Chest wall skeletal defects are usually closed using muscle flaps or prosthetic materials. Postoperative prosthetic infections are critical complications and often require plastic surgery support. We report a new surgical technique, involving a subscapular muscle flap, for covering posterior chest wall defect. PRESENTATION OF CASE A 75-year-old man was admitted to our hospital. We performed a right upper lobectomy with posterior chest wall resection between the third and sixth ribs. The resulting chest wall defect was covered with a polytetrafluoroethylene mesh that became infected postoperatively. We removed the infected mesh and used the subscapularis muscle, the nearest muscle to the defect, to cover the chest wall defect. The scapular tip was lifted and the lower half of the muscle was dissected. The free end of the flap was sutured to the stumps of the anterior serratus and rhomboid major muscles. Computed tomography, 1 month later, revealed that the flap was engrafted to the chest wall. DISCUSSION No previous study has reported the use of a subscapularis muscle flap for chest wall reconstruction. The lower third of the scapula was excised since blood supply to the scapula tip may be reduced after dissection of the subscapularis muscle, and to prevent the scapula tip from falling into the thoracic cavity. CONCLUSION The use of a subscapularis muscle flap to repair chest wall defect is a simple and safe technique that can be conducted in the same surgical field as the initial reconstruction surgery and does not require plastic surgery support.
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Affiliation(s)
- Mitsuaki Sakai
- Department of Thoracic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki 305-8558, Japan; Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
| | - Masatoshi Yamaoka
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
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Abstract
Congenital diaphragmatic hernia is a birth defect that affects about one in 2500 live births. Although the overall survival has improved over the last several decades thanks to advancements in postnatal resuscitation and intensive care treatment, morbidity and mortality remain high. The surgical management of these infants is far from being standardized, and many aspects are still disputed among experts. The timing of surgical repair remains controversial and the indications for the ideal time for surgery have not been validated. The main novelty in the surgical treatment is related to the use of minimally invasive techniques, although these have been associated with intraoperative blood gas disturbances and higher recurrence rates. Herein, we report and comment on the main controversies of postnatal CDH repair in this rapidly evolving field.
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Affiliation(s)
- Augusto Zani
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elke Zani-Ruttenstock
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Sirasanagnadla SR, Bhat KM, Nayak SB, Shetty P, Thangarajan R. A rare case of variant morphology of peroneus tertius muscle. J Clin Diagn Res 2014; 8:AD01-2. [PMID: 25478329 DOI: 10.7860/jcdr/2014/8683.4934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/25/2014] [Indexed: 11/24/2022]
Abstract
Peroneus tertius (PT) is frequently used as a free muscle flap to treat the soft tissue defects and osteomyelitis, in the lower limb as it is functionally insignificant while balancing the foot during walking. The morphology of the PT is highly variable. In the present case we report a rare case of unusual morphology of the PT in a formalin embalmed male cadaver. At the level of ankle, PT divided into three tendons; two of them were inserted to the base of the distal phalanx of the fifth toe and base of the fifth metatarsal bone respectively. The smaller third tendon was attached to the fascia covering the capsule of the ankle joint. Further, extensor digitorum longus (EDL) gave only three tendinous slips for the second, third and fourth toes.
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Affiliation(s)
- Srinivasa Rao Sirasanagnadla
- Lecturer, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University , Madhav Nagar, Manipal, Karnataka State, India
| | - Kumar Mr Bhat
- Additional Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) , Manipal University, Madhav Nagar, Manipal, Karnataka State, India
| | - Satheesha B Nayak
- Professor and Head, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University , Madhav Nagar, Manipal, Karnataka State, India
| | - Prakashchandra Shetty
- Associate Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University , Madhav Nagar, Manipal, Karnataka State, India
| | - Rajesh Thangarajan
- Lecturer, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University , Madhav Nagar, Manipal, Karnataka State, India
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Caronia FP, Fiorelli A, Zanchini F, Santini M, Lo Monte AI, Castorina S. Reconstruction with a pectoralis major myocutaneous flap after left first rib and clavicular chest wall resection for a metastasis from laryngeal cancer. Gen Thorac Cardiovasc Surg 2014; 64:294-7. [PMID: 25319560 DOI: 10.1007/s11748-014-0485-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/03/2014] [Indexed: 11/28/2022]
Abstract
We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clavicle of a patient with a history of laryngeal cancer treated on April 2005 with extended hemilaryngectomy, neck dissection and chemoradiation therapy. On September 2008, he developed a left clavicular metastasis. The disease was initially well controlled by chemoradiotherapy but it recurred 17 months later. The optimal treatment plan was established by several multidisciplinary meetings and the patient subsequently underwent an en bloc resection of the left clavicle, first rib and all the other involved structures. Coverage of the thoracic defect was achieved using pectoralis major myocutaneous flap. The patient had a successful surgical outcome. At 1-year follow-up, he had no evidence of disease, a good cosmetic result and returned to normal daily activity. He died for bone metastasis with an overall 21 months post-surgical survival.
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Affiliation(s)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia 3, 80138, Naples, Italy.
| | - Fabio Zanchini
- Orthopedic Unit, Second University of Naples, 80138, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia 3, 80138, Naples, Italy
| | | | - Sergio Castorina
- G.B. Morgagni Foundation, Department of Bio-Medical Sciences, University of Catania, Catania, Italy
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