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Shimbo K, Kawamoto H, Koshima I. Use of Muscle Flaps for Salvage of Groin Wound Infection Following Vascular Surgery: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2022; 56:401-407. [PMID: 35050812 DOI: 10.1177/15385744211068342] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Groin wound infections in vascular surgery are still a common complication and challenging problem. This systematic review aimed to establish a complete view of patient characteristics and clinical outcomes for infected groin wounds following vascular surgery reconstruction using muscle flaps and to evaluate the differences in outcomes between the sartorius muscle flap (SMF), rectus femoris muscle flap (RFF), and gracilis muscle flap (GMF). METHODS PubMed, Scopus, and Web of Science were systematically searched from inception to April 2021. Random-effects meta-analysis for comorbidities and outcomes and subgroup analyses for outcomes were performed. RESULTS Thirty studies were included in qualitative and quantitative syntheses. Overall pooled data showed the following outcome rates: 4.5% muscle flap necrosis (95% confidence interval [CI], -3.4-12.3%; I2 = 0%), 21.8% overall complications (95% CI, 15.8-27.7%; I2 = 0%), 8.0% limb loss (95% CI, 1.9-14.1%; I2 = 0%), 15.4% graft loss (95% CI, 5.0-25.3%; I2 = 37.9%), and 7.4% 30-day mortality (95% CI, -.9-15.6%; I2 = 0%). The rates of overall complications were 20.3% (95% CI, 12.1-28.2%; I2 = 0%), 23.2% (95% CI, 11.2-34.5%; I2 = 10.2%), and 18.0% (95% CI, -3.537.8%; I2 = 0%) for the SMF, RFF, and GMF, respectively. The rate of limb loss was highest for the GMF (17.2%; 95% CI, -4.237.2%; I2 = 0%). The rate of graft loss for the RFF was the highest (20.7%; 95% CI, .6-39.1%; I2 = 53.9%). The rate of 30-day mortality was the lowest for the SMF (5.3%; 95% CI, -6.1-16.6%; I2 = 0%). CONCLUSIONS The effectiveness and safety of muscle flap reconstruction for infected groin wounds following vascular surgery are clearly positive. This review indicated a tendency for lower complication rates with the SMF than with other muscle flaps.
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Affiliation(s)
- Keisuke Shimbo
- Department of Plastic and Reconstructive Surgery, 37102Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Haruka Kawamoto
- Department of Plastic and Reconstructive Surgery, 37102Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, 37102Hiroshima Prefectural Hospital, Hiroshima, Japan.,International Center for Lymphedema, 68272Hiroshima University Hospital, Hiroshima, Japan
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Rauchenwald T, Dejaco D, Henninger B, Morandi EM, Pülzl P, Pierer G, Riechelmann H, Wolfram D. Simple, but effective: Nasal splinting for airway securement in free flap reconstruction following orbital exenteration. Head Neck 2021; 43:3238-3244. [PMID: 34268827 PMCID: PMC8457228 DOI: 10.1002/hed.26815] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/17/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022] Open
Abstract
Orbital exenteration is a disfiguring procedure that often results in free tissue transfer for reconstructive purposes. The reconstructive focus is the obliteration of dead space while sparing the nasal airway, particularly if the medial orbital wall was resected. Prolapse of transferred tissue into the nasal airway may cause breathing difficulties drastically compromising quality of life. The objective of this study was to demonstrate the effectiveness and feasibility of temporary nasal septum splints as mechanical support for transferred tissue, to prevent airway obstruction. This novel application technique was employed in three patients between 2017 and 2018. No flap loss or sino‐orbital fistulas were observed. On postoperative MRI and endoscopy, a patent nasal airway was observed at all times. Temporary nasal splinting in combination with free tissue transfer proved to be a simple, but effective reconstructive option for securing the nasal airway following orbital exenteration with resection of the medial orbital wall.
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Affiliation(s)
- Tina Rauchenwald
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Petra Pülzl
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Valenzuela CD, Finlay D, Sabry Z, Mariadason JG, Wallack MK. Gracilis Muscle Flap After Superficial Inguinal Lymphadenectomy in an Irradiated Inguinal Field. Am Surg 2021:3134820982850. [PMID: 33502213 DOI: 10.1177/0003134820982850] [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
The sartorius muscle transposition flap is the traditional method of femoral vessel coverage after superficial inguinal lymphadenectomy for regionally-metastatic cancers to the inguinal lymph nodes. However, if the groin has undergone radiotherapy, the sartorius muscle is contained within the irradiated field, and may be problematic for wound healing, in addition to being thin at its insertion and intimately related to several nerves. The gracilis muscle has been used for soft tissue defects and vascular graft infections, but its utility as an alternative to the sartorius muscle flap in the setting of radiation has never been reported. Here, we report the successful use of the retroflexed gracilis muscle flap for femoral vessel coverage after superficial inguinal lymphadenectomy, in a patient who previously underwent chemoradiation for locally-metastatic anal squamous cell carcinoma to the groin. An 86-year old female presented with Stage IIIB anal squamous cell carcinoma metastatic to one left inguinal lymph node. She underwent modified Nigro protocol chemoradiation treatment, which included radiation to the inguinal node basins. A left superficial inguinal lymphadenectomy was performed with a retroflexed gracilis muscle flap to cover the femoral vessels. This was chosen over a sartorius flap because the gracilis muscle was not located within the field of radiation. Despite a subsequent groin wound infection, the gracilis muscle flap remained viable and successfully protected the major vessels. We report the gracilis muscle flap as a viable alternative to the sartorius transposition muscle flap for femoral vessel coverage after oncologic superficial inguinal lymphadenectomy in the irradiated groin.
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Affiliation(s)
| | - David Finlay
- Department of Surgery, 25063Metropolitan Hospital Center, New York, NY, USA
| | - Zakir Sabry
- Department of Surgery, 25063Metropolitan Hospital Center, New York, NY, USA
| | - James G Mariadason
- Department of Surgery, 25063Metropolitan Hospital Center, New York, NY, USA
| | - Marc K Wallack
- Department of Surgery, 25063Metropolitan Hospital Center, New York, NY, USA
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Umek N, Skamagkoulis L, Cvetko E. Variant course of the submental vein. Folia Morphol (Warsz) 2019; 79:176-178. [PMID: 31106846 DOI: 10.5603/fm.a2019.0056] [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: 03/28/2019] [Accepted: 04/22/2019] [Indexed: 11/25/2022]
Abstract
Superficial head and neck vessels are increasingly used in surgical procedures and are especially important in facial transplantation surgeries. We report a variant course of the submental vein observed during a dissection of a 79-year-old-male embalmed cadaver: a left submental vein running caudally across the intermediate tendon of the digastric muscle, separating from the course of the submental artery and emptying directly into the common facial vein in the carotid triangle. Such course may complicate submental island flap harvesting, as well as the graft manipulations and reattachment, since the vein could be damaged during the conventional procedure. This report therefore extends current knowledge of the variations of the vascular anatomy of the head and neck.
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Affiliation(s)
- N Umek
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Slovenia.
| | - L Skamagkoulis
- Department of Maxillofacial and Oral Surgery, General Hospital Celje, Slovenia
| | - E Cvetko
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Slovenia
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Ehrl D, Brueggemann A, Broer PN, Koban K, Giunta R, Thon N. Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm. J Neurol Surg B Skull Base 2019; 81:149-157. [PMID: 32206533 DOI: 10.1055/s-0039-1683371] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/12/2019] [Indexed: 01/22/2023] Open
Abstract
Background An oncologic tumor resection of the scalp can result in complex wounds that result in challenging scalp reconstructions. This study aimed to evaluate the outcomes of microvascular-based scalp reconstructions (MSR) in oncologic patients and to propose an algorithmic treatment approach. Methods Within a 5-year period, 38 patients having undergone 41 MSR (15 anterolateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections fulfilled inclusion criteria for this study. Results Malignant skin disease included superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. In case of bone replacement (24 patients), MSR was done concomitant, otherwise MSR was performed after pathological confirmation of tumor-free margins. LDM flaps were used in cases with defect sizes of 400 to 1250cm 2 , whereas ALT- and GM flaps were chosen for defects ranging from 40 to 350cm 2 . The average length of the pedicle was comparable in ALT- and LDM flaps and longer than in GM flaps. Total flap loss with need for revision surgery and minor donor site morbidity occurred in four and three patients, respectively. Conclusion Microsurgical reconstruction of moderate-to-extensive scalp defects remains a reliable method with overall low risks and satisfactory aesthetic results, while, according to our experience, muscle flaps show the best functional and aesthetic results. However, in cases of central scalp defects and in situations when a long vascular pedicle of the flap is important, the ALT flap seems to be the best solution.
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Affiliation(s)
- Denis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexandra Brueggemann
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - P Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - Konstantin Koban
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Riccardo Giunta
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
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Prabha V, Kadeli V. Repair of recto-urethral fistula with urethral augmentation by buccal mucosal graft and gracilis muscle flap interposition - our experience. Cent European J Urol 2018; 71:121-128. [PMID: 29732218 PMCID: PMC5926628 DOI: 10.5173/ceju.2018.1353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/16/2017] [Accepted: 11/13/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Recto-urethral fistula (RUF) is a relatively rare surgical condition, the treatment of which is quite challenging. There are many causes of RUF, but 60% of them are iatrogenic following open prostatectomies, radiotherapy, brachytherapy, urethral instrumentation etc. We present a series of six cases treated at our institution. Material and methods A retrospective study of all six patients with recto-urethral fistula treated at our centre between 2011 and 2016 was performed. The study included charting of information like age, etiology, clinical presentation, diagnostic modalities, treatment protocols, complications and recurrence. All the patients had simple direct fistulas with no previous history of repair. One patient had history of pelvic fracture following road traffic accident, one patient had a penetrating perineal injury following road traffic accident; two patients had history of Freyer's prostatectomy for benign prostatic hypertrophy; two patients had history of open radical prostatectomy performed at other centres. All patients were treated with an initial double diversion (suprapubic cystostomy and colostomy) followed by definitive surgical repair three months later. The surgical technique used was fistula excision, urethral augmentation by buccal mucosal graft, primary rectal defect repair and gracilis muscle flap interposition between the rectum and urethra. Results The patients were followed up ranging from after 6 to 48 months with a mean follow-up period of 27 months. There were minimal complications such as main wound site infections, seroma at the harvested site of gracilis muscle flap, urethral stricture. There was no report of recurrence. Conclusions From our experience, we conclude that this method of repair is a very efficient one without any recurrence and with minimal complications. The results were on par with all the other successful methods of recto-urethral fistula repair described in the literature.
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Affiliation(s)
- Vikram Prabha
- KLE University's JN Medical College, KLES Dr. Prabhakar Kore Hospital & MRC, Department of Urology, Belgaum, India
| | - Vishal Kadeli
- KLE University's JN Medical College, KLES Dr. Prabhakar Kore Hospital & MRC, Department of Urology, Belgaum, India.,Department of Urology, KLES Kidney Foundation, KLE University's JN Medical College, KLES Dr. Prabhakar Kore Hospital & MRC, Belgaum, India
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Abstract
BACKGROUND The treatment of long-standing facial palsy represents a challenge for the reconstructive surgeon. Treatment is based on dynamic procedures such as functional muscle flaps. The benefit of added axonal load has recently been reported. This study describes a two stage technique involving dual innervation of a gracilis muscle flap with initial cross-facial nerve graft (CFNG) followed by free muscle transfer co-apted to both the CFNG and a masseter nerve for facial reanimation. METHODS A total of nine patients from August 2008-July 2011 were operated on with the double innervated gracilis muscle flap. Pre- and postoperative electromyography was documented, and video analysis with the five-stage classification of reanimation outcomes was performed. RESULTS All patients recovered voluntary and spontaneous smile abilities, with an average of 70% motor unit recruitment. Based on the Terzis reanimation outcome classification, four patients had an excellent result, four good, and one moderate. CONCLUSIONS The double innervated gracilis muscle flap is a viable technique for the treatment of long-standing facial palsy. It enables a fast recovery with fast muscle activity, and allows an emotional smile and aesthetic symmetry.
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Affiliation(s)
- Alexander Cardenas-Mejia
- Division of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea Gonzalez , Mexico City , Mexico
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