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Marchica P, Oieni S, David M, Coppola F, Rossi M, Cammarata E, Cordova A, Gebbia V, D'Arpa S. Latissimus Dorsi Flap and Thoracodorsal Artery Perforator Flap with Immediate Fat Transfer (LIFT and TIFT): A Retrospective Study about Total Breast Reconstruction in High-Risk Patients. Aesthetic Plast Surg 2024; 48:1745-1758. [PMID: 37580568 DOI: 10.1007/s00266-023-03528-3] [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] [Received: 04/02/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Microsurgical breast reconstruction has become popular over the past twenty years and allows a tailor-tuck approach to each patient. However, smoking or coagulation disorders may switch surgeon's choice towards alternative options. When facing these risk factors, we performed pedicled latissimus dorsi (LD) flap and thoracodorsal artery perforator (TDAP) flap reconstruction with immediate fat transfer (LIFT and TIFT), achieving satisfactory surgical outcomes. Hence, we aim to present our seven-years case-series and discuss our decisional algorithm. MATERIALS AND METHODS Thirty smoker women and seven women affected by coagulation disorder (n = 37) respectively had LIFT and TIFT surgery and were retrospectively evaluated. Patients' demographics and outcomes were recorded and compared. RESULTS LIFT patients received higher volumes of immediate fat grafting compared to TIFT patients (p < 0.05), which required additional lipofilling to provide adequate volume amount, since the TDAP flap was not immediately grafted. However, the additional lipofilling procedures and fat volume were similar (p > 0.05). Flap survival reached 100%, and flap necrosis or loss did not occur. Few minor complications were evidenced in the LIFT group only (p > 0.05). CONCLUSION Based on our experience, we support the reliability of pedicled LD and TDAP flaps with immediate fat transfer in breast reconstruction as valuable alternative to microsurgery in smokers (LIFT) and patients with coagulation disorders (TIFT). However, the results of our study are not conclusive since still must be clarified the role of the smoking and coagulation disorders in microsurgery and the real benefit of a non-microsurgical procedure. LEVEL OF EVIDENCE IV Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Paolo Marchica
- Department of Plastic and Reconstructive Surgery, Treviso General Hospital, Piazzale dell'Ospedale, 1, 31100, Treviso, Italy.
| | - Sebastiano Oieni
- Plastic Surgery and Breast Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Massimo David
- Breast Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Federico Coppola
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Matteo Rossi
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Emanuele Cammarata
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Vittorio Gebbia
- Department of Medical Oncology, University of Enna "Kore", Enna, Italy
| | - Salvatore D'Arpa
- Plastic Surgery and Breast Unit, La Maddalena Cancer Center, Palermo, Italy
- Residency School in Plastic and Reconstructive Surgery, International University of Goražde, Goražde, Bosnia and Herzegovina
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Usami S, Sonoki K, Inami K, Murakami K. Application of extended ulnar parametacarpal perforator free flap for the reconstruction of total pulp defect of the thumb: A case report. Microsurgery 2024; 44:e31180. [PMID: 38656663 DOI: 10.1002/micr.31180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/17/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
Many procedures are available for the coverage of thumb pulp defects; however, to gain thumb function and esthetics, a similar tissue is desirable. If the length of the longitudinal defect is <2 cm, a volar advancement flap is appropriate; however, if the flap is >2 cm long or wider, retrograde or free flaps are required. Here, we present a case of thumb pulp reconstruction using an extended ulnar parametacarpal perforator (UPM) flap, which achieved excellent functional and esthetic outcomes. A 46-year-old man underwent reconstruction surgery of his thumb, which was a degloved total pulp. A sensate 5.2 × 3.2 cm UPM flap was designed on the ulnar side of the right palm and transferred to his thumb. The flap donor site was covered with a V-Y advancement flap on the dorsal side of the right hand. At 12 months postoperatively, the patient achieved a functional and natural thumb appearance with high satisfaction. The UPM flap can offer soft tissue similar to the pulp region in the digit without a palm scar at the donor site. This extended application is suitable for the reconstruction of a total pulp defect of the digit and is an alternative option for a hemi-pulp flap from the toe area.
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Affiliation(s)
- Satoshi Usami
- Department of Hand Surgery, Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopaedic Hospital, Tokyo, Japan
| | - Kentaro Sonoki
- Department of Hand Surgery, Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopaedic Hospital, Tokyo, Japan
| | - Kohei Inami
- Department of Hand Surgery, Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopaedic Hospital, Tokyo, Japan
| | - Kyoichi Murakami
- Department of Hand Surgery, Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopaedic Hospital, Tokyo, Japan
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Haddock NT, Ercan A, Teotia SS. Bilateral Simultaneous Lumbar Artery Perforator Flaps in Breast Reconstruction: Perioperative Outcomes Addressing Safety and Feasibility. Plast Reconstr Surg 2024; 153:895e-901e. [PMID: 37335548 DOI: 10.1097/prs.0000000000010830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND The lumbar artery perforator (LAP) flap has emerged as an excellent option for breast reconstruction, but its steep learning curve makes it less approachable. Furthermore, length of the operation, flap ischemia time, need for composite vascular grafts, complex microsurgery, multiple position changes, and general concern for safety has led experienced surgeons to stage bilateral reconstructions. In the authors' experience, simultaneous bilateral LAP flaps are feasible, but overall perioperative safety has not been fully explored. METHODS Thirty-one patients (62 flaps) underwent simultaneous bilateral LAP flaps and were included in the study (excluding stacked four-flaps and unilateral flaps). Patients underwent two position changes in the operating room: supine to prone and then supine again. A retrospective review of patient demographics, intraoperative details, and complications was performed. RESULTS The overall flap success rate was 96.8%. Five flaps were compromised postoperatively. The intraoperative anastomotic revision rate was 24.1% per flap (4.3% per anastomosis). The significant complication rate was 22.6%. The number of sustained hypothermic episodes and hypotensive episodes correlated with intraoperative arterial thrombosis ( P < 0.05). The number of hypotensive episodes and increased intraoperative fluid correlated with flap compromise ( P < 0.05). High body mass index correlated with overall complications ( P < 0.05). The presence of diabetes correlated with intraoperative arterial thrombosis ( P < 0.05). CONCLUSIONS Simultaneous bilateral LAP flaps can be performed safely with an experienced and trained microsurgical team. Hypothermia and hypotension negatively affect the initial anastomotic success. In this complex operation, a coordinated approach between the anesthesia and nursing team is paramount for patient safety. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Nicholas T Haddock
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center
| | - Alp Ercan
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center
| | - Sumeet S Teotia
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center
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Tomczak S, Abellan-Lopez M, de Villeneuve Bargemon JB, Bertrand B, Casanova D. Reconstruction of penile skin loss by superficial circumflex iliac perforator (SCIP) pedicled flap after Fournier's gangrene. ANN CHIR PLAST ESTH 2024; 69:217-221. [PMID: 37429802 DOI: 10.1016/j.anplas.2023.06.012] [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] [Received: 05/18/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Fournier's gangrene is a serious pathology with a high mortality rate. Treatment requires a large debridement of necrotized tissues, conducing to a skin loss, requiring a reconstruction, which may involve different surgical techniques, depending on the context as well as the size and location of the skin loss. The most common covering technique uses split-thickness skin grafting, which however presents a risk of contracture. CASE Our 63 years old patient presented a Fournier's gangrene, leading to pubic and circular penile skin defects after multiple debridements. We decided to practice a right superficial circumflex iliac perforator (SCIP) pedicled flap to reconstruct the penile skin sheath. The flap was rotated 180 degrees and rolled around the penis. DISCUSSION The inguinal pedicle flap is described for penile reconstruction, the SCIP flap for perineal reconstruction, and even bilateral SCIP flaps for performing phalloplasty, but SCIP pedicled flap is not already described for isolated penile skin sheath reconstruction. Skin loss in our patient was not extensive, permitting us to perform this surgical technique. To go further, note the possibility of carrying out this reconstruction by a super-thin SCIP flap, as a pure skin graft flap. CONCLUSION The SCIP pedicled flap seems us to be a safe technique for penile skin reconstruction and a good alternative to the usual skin grafts, especially regarding the lower risk of contracture, and low donor-site morbidity.
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Affiliation(s)
- S Tomczak
- Plastic and Reconstructive Surgery, hôpital Conception, 147, boulevard Baille, 13005 Marseille, France; Hand and Limb Reconstructive Surgery, hôpital Timone, 270, rue Saint-Pierre, 13005, Marseille, France.
| | - M Abellan-Lopez
- Plastic and Reconstructive Surgery, hôpital Conception, 147, boulevard Baille, 13005 Marseille, France.
| | | | - B Bertrand
- Plastic and Reconstructive Surgery, hôpital Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - D Casanova
- Plastic and Reconstructive Surgery, hôpital Conception, 147, boulevard Baille, 13005 Marseille, France.
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Hohenstein AA, Kraus D, Zeller J, Schneider LA, Liakos N, Gratzke C, Juhasz-Böss I, Eisenhardt S. [Robotic-Assisted DIEP Flap Harvest for Autologous Breast Reconstruction: Case Report, Technical Aspects and Identification of Suitable Patients]. HANDCHIR MIKROCHIR P 2024; 56:147-155. [PMID: 38417810 DOI: 10.1055/a-2239-6513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Robotic-assisted harvest of the deep inferior epigastric perforator (DIEP) flap is an innovative modification of the traditional open preparation for autologous breast reconstruction. It is assumed that donor-site morbidity (herniae, bulging) is reduced by minimising the fascial incision length in robotic-assisted DIEP flap harvest. MATERIAL & METHODS This is the first report of a robotic-assisted DIEP harvest in Germany, which was performed in April 2023 at the University Hospital of Freiburg in an interdisciplinary approach of the Departments of Plastic Surgery, Urology and Gynaecology. To determine the value of this novel technique, we assessed the demand by retrospectively performing an analysis of potential patients and conducted a cost analysis based on the breast reconstructions with DIEP flap harvest performed between April 2021 and May 2023 at the Department of Plastic Surgery at Freiburg University Hospital. To this end, we carried out a retrospective analysis of preoperative CT angiographies to determine the proportion of patients suitable for a robotic-assisted procedure in a post-hoc analysis. Furthermore, we describe the basic robotic-assisted techniques and discuss the TEP and TAPP laparoscopic approaches. RESULTS In line with the previously published literature, a short intramuscular course (≤25 mm) and a perforator diameter of≥1.5 mm and≥2.7 mm (subgroup) were defined as a crucial condition for the robotic-assisted procedure. We analysed 65 DIEP flaps harvested in 51 patients, of which 26 DIEP flaps in 22 patients met both criteria, i. e.≤25 mm intramuscular course and≥1.5 mm diameter of the perforator, while 10 DIEP flaps in 10 patients additionally met the criteria of the subgroup (≥2.7 mm diameter). Based on the intramuscular course of the perforators in the CT angiographies of those 26 DIEP flaps, a potential reduction of the fascial incision of 96.8±25.21 mm (mean±standard deviation) compared with the conventional surgical approach was calculated. The additional material costs in our case were EUR 986.01. However, ischaemia time was 33,5 minutes longer than the median of the comparative cohort. CONCLUSION The robotic-assisted procedure has already proven to be a feasible alternative in a suitable patient population. However, further studies are needed to confirm that robotic-assisted DIEP flap harvest actually reduces harvest site morbidity and thereby justifies the additional costs and complexity.
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Affiliation(s)
| | - Daniel Kraus
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Johannes Zeller
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Laura Anna Schneider
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Nikolaos Liakos
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Christian Gratzke
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Ingolf Juhasz-Böss
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Steffen Eisenhardt
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg, Freiburg, Germany
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Dhar LK, Jahan I, Kaiser A, Razia S, Talukder A, Alam MJ. Developments in Hand Surgery: Experience from a Tertiary Hospital of Northern Bangladesh. Mymensingh Med J 2024; 33:393-401. [PMID: 38557517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Hand Surgery is a specialized branch of Plastic and Reconstructive surgery. There are many conditions that require hand surgery, for example, congenital deformity, electric or flame burn, mechanical or road traffic injury, and post burn or post traumatic deformity. A retrospective observational study was conducted in the department of Burn and Plastic surgery, Mymensingh Medical College Hospital, Bangladesh during a 2 years period extending from 9th September 2021 to 8th September 2023. The objective of this study was to see the hand surgery status in a tertiary hospital of Bangladesh during the post Covid pandemic period. During this period 236 hand surgery procedures were performed in 176 patients. The age of the patients ranged from 02 to 78 years (Mean 31.14±1.52). One hundred and four (59.0%) were male and 72(41.0%) were female. Thirty-four (19.32%) patients had co-morbidities e.g., Epilepsy, Diabetes Mellitus, Chronic Kidney Diseases and HBsAg +ve. Causes of surgery included, wound due to electric burn 49(27.84%), flame burn 36(20.45%), post traumatic 24(13.64%), post infective 11(06.25%), tumor excision 02(2.24%), Dupuytren's contracture 03(1.70%), congenital anomalies 06(3.41%), post burn scar contractures 41(23.29%), nerve injury 01(00.57%) and carpal tunnel syndrome 01 (00.57%). Procedures were performed: post burn scar contracture release 41(17.37%), syndactly release 06(2.54%), release of post traumatic contracture 06(2.54%), carpal tunnel release 01(00.42%), release of Dupuytren's contracture 03(01.27%), nerve repair 01(00.42%), debridement, amputation and Fillet flap 29(12.29%), split thickness skin graft 46 (19.49%), V-Y advancement flap 06(2.54%), transposition flap 18(07.63%), cross finger flap 16 (06.78%), reverse cross finger flap 02 (00.85%), first dorsal metacarpal artery (FDMA) flap 05 (02.12%), reverse FDMA flap 01 (00.42%), metacarpal artery perforator flap 08(3.39%), radial artery perforator flap 04(01.69%), posterior interosseous artery flap 05(2.12%), abdominal flap 11(04.46%) and flap division and insetting 27(11.44%). Outcome of surgery was satisfactory in 225(95.34%) and 11(04.46%) cases had complications (p value 0.453), which was not significant. So, it can be concluded that the outcome of various types of hand surgery procedures in tertiary hospital of northern Bangladesh during the post Covid period was satisfactory overall.
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Affiliation(s)
- L K Dhar
- Dr Liman Kumar Dhar, Associate Professor and Head, Department of Burn and Plastic Surgery, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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陈 新, 黄 广. [Clinical diagnosis and treatment of 14 cases of scar cancer ulcer wound on head and face]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:342-347. [PMID: 38500429 PMCID: PMC10982035 DOI: 10.7507/1002-1892.202312020] [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] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/08/2024] [Indexed: 03/20/2024]
Abstract
Objective To analyze the clinical characteristics of scar cancer ulcer wound of head and face, and to investigate its diagnosis and treatment. Methods The clinical data of 14 patients with head and facial scar cancer ulcer wounds who met the selection criteria and admitted between January 2021 and March 2022 were retrospectively analyzed. There were 8 males and 6 females. The age of onset ranged from 21 to 81 years with an average age of 61.6 years. The incubation period ranged from 1 month to 70 years, with a median of 4 years. Site of the disease included 7 cases of head, 6 cases of maxillofacial region, and 1 case of neck region. Injury factors included trauma in 5 cases, scratch in 5 cases, scalding in 2 cases, burn in 1 case, and needle puncture in 1 case. Pathological results showed squamous cell carcinoma in 9 cases, basal cell carcinoma in 3 cases, sebaceous adenocarcinoma in 1 case, papillary sweat duct cystadenoma combined with tubular apocrine sweat gland adenoma in 1 case. There was 1 case of simple extensive tumor resection, 1 case of extensive tumor resection and skin grafting repair, 7 cases of extensive tumor resection and local flap repair, and 5 cases of extensive tumor resection and free flap repair. Results All the 14 patients were followed up 16-33 months (mean, 27.8 months). Two patients (14.29%) had scar cancer ulcer wound recurrence, of which 1 patient recurred at 2 years after 2 courses of postoperative chemotherapy, and was still alive after oral traditional Chinese medicine treatment. One patient relapsed at 1 year after operation and died after 2 courses of chemotherapy. One patient underwent extensive resection of the left eye and periocular tumor and the transfer and repair of the chimaeric muscle axial flap with the perforating branch of the descending branch of the left lateral circumflex femoral artery, but the incision healing was poor after operation, and healed well after anti-infection and debridement suture. The wounds of other patients with scar cancer ulcer did not recur, and the wounds healed well. Conclusion Scar cancer ulcer wound of the head and face is common in the middle-aged and elderly male, and the main pathological type is squamous cell carcinoma. Local extensive resection, skin grafting, or flap transfer repair are the main treatment methods. Early active treatment of wounds after various injuries to avoid scar repeated rupture and infection is the foundamental prevention of scar cancer.
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Affiliation(s)
- 新冲 陈
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563000)Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P. R. China
| | - 广涛 黄
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563000)Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P. R. China
- 深圳大学第一附属医院(深圳市第二人民医院)烧伤整形外科(广东深圳 518000)Department of Burn and Plastic Surgery, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P. R. China
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Liu WJ, Zhang HY, Liu DW. [Clinical effects of different types of tissue flaps in repairing the wounds with steel plate exposure and infection after proximal tibial fracture surgery]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:1140-1148. [PMID: 38129300 DOI: 10.3760/cma.j.cn501225-20231101-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective: To investigate the clinical effects of different types of tissue flaps in repairing the wounds with steel plate exposure and infection after proximal tibial fracture surgery. Methods: A retrospective observational study was conducted. From January 2015 to December 2021, 11 patients with steel plate exposure and infected wounds after proximal tibial fracture surgery who met the inclusion criteria were admitted to Jiangxi Provincial General Hospital of Armed Police, including 9 males and 2 females, aged 26 to 61 years. The wounds were located on the lateral side of the proximal leg in 5 cases, on the medial side of the proximal leg in 2 cases, and on the medial side of the proximal leg and the anterior tibia below the knee in 4 cases. After debridement, the wound area was 14 cm×6 cm-22 cm×11 cm. The wounds were repaired with different types of tissue flaps, and the steel plates were removed immediately if necessary, according to the infection around the steel plates. The reverse anterolateral thigh myocutaneous flap pedicled with the muscle containing the terminal small branch of the descending branch of the lateral circumflex femoral artery was used in 3 cases; the medial gastrocnemius muscle flap combined with the medial half of soleus muscle flap was used in 6 cases, and the lateral gastrocnemius muscle flap combined with the anterior tibial muscle flap was used in 2 cases. After the muscle flaps had stable blood supply, the wounds were closed with thin intermediate thickness skin graft from the healthy thigh. The area of myocutaneous flap ranged from 15 cm×7 cm to 18 cm×8 cm, and the area of muscle flap ranged from 6.0 cm×4.0 cm to 18.0 cm×12.0 cm. Among the 3 patients who were treated with reverse anterolateral thigh myocutaneous flap, the wounds of flap donor site on thighs were closed by direct suturing in 2 cases, and the wound in the flap donor site of thigh in 1 case that was not closed after suture was repaired with thin intermediate thickness skin graft from healthy thigh. The incisions in the flap donor sites of 8 cases treated with calf muscle flaps were sutured directly. After surgery, the survivals of tissue flap and skin graft on the muscle flap, wound healing status and wound healing time in recipient sites of tissue flaps, suture site healing in flap donor site, and survival of skin graft were observed and recorded. Whether the steel plate was removed after operation and during follow-up was recorded. During follow-up, the shape and texture of tissue flap, whether the recipient site of tissue flap had redness, swelling, ulceration, or sinus formation were observed, the fracture healing time was recorded. At the last follow-up, the knee joint flexion and extension range of motion was measured and the knee joint function was evaluated according to Hohl's knee joint function evaluation criteria; the plantar flexor muscle strength of ankle joint was measured in 8 patients who were treated with calf muscle flaps for wound repair; the Vancouver scar scale (VSS) was used to evaluate the scar condition in the flap donor site, and whether the scar affected the movement of the affected limbs was observed. Results: Tissue flaps of 11 patients all survived after surgery. The distal end of the reverse anterolateral thigh myocutaneous flaps was necrotic in 1 patient, and the wound was healed after dressing change and grafting with thin intermediate thickness skin from healthy thigh. The distal muscle necrosis of the medial gastrocnemius muscle flap was observed in 2 patients, and the granulation tissue grew well after dressing change. The skin graft on the muscle flap survived well. All the wounds in the recipient sites of tissue flaps were healed, and the healing time was 13 to 42 days after tissue flap transplantation. The suture site of flap donor site healed, and the skin graft survived well. In 1 patient, the steel plate was removed when the wound was repaired with the medial gastrocnemius muscle flap combined with the medial half of soleus muscle flap. One patient still had exudation after 3 weeks of wound repair with the reverse anterolateral thigh myocutaneous flap pedicled with the muscle containing the terminal small branch of the descending branch of the lateral circumflex femoral artery, and the wound was healed after removing the steel plate. The steel plates of the other patients were preserved. During the follow-up of 6-25 months, except for 1 reverse anterolateral thigh myocutaneous flap had bloated pedicle, the other tissue flaps had good appearance and texture. One patient had redness and swelling in the recipient site of the tissue flap at 6 weeks after discharge, and the redness and swelling subsided without recurrence after anti-infection treatment. In 1 patient, repeated rupture and exudation occurred in the recipient site of tissue flap in 3 months after discharge, resulting in sinus tract formation, which was healed after the removing of steel plate. The fracture healing time of patients ranged from 6 to 15 months after injury. At the last follow-up, the knee joint function was evaluated as excellent in 4 cases, good in 6 cases, and poor in 1 case. Among the 8 patients who were treated with calf muscle flaps for wound repair, 7 patients had ankle joint plantar flexor muscle strength of grade Ⅵ, and 1 patient had ankle plantar flexor muscle strength of grade Ⅴ. The VSS scores of scars in the flap donor sites ranged from 2 to 7, and scars did not significantly affect the movement of the affected limbs. Conclusions: The reverse anterolateral thigh myocutaneous flap pedicled with the muscle containing the terminal small branch of the descending branch of the lateral circumflex femoral artery and the gastrocnemius muscle flap combined with soleus muscle flap or anterior tibial muscle flap are the derived types of the commonly used reverse anterolateral thigh myocutaneous flap and gastrocnemius muscle flap. Using them to repair the wounds with steel plate exposure and infection after proximal tibial fracture surgery can not only ensure the smooth operation, but also preserve the steel plate and promote fracture healing as much as possible, without significantly affecting the function of the affected limb.
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Affiliation(s)
- W J Liu
- Department of Burns and Plastic Surgery, Jiangxi Provincial General Hospital of Armed Police, Nanchang 330030, China
| | - H Y Zhang
- Medical Center of Burn Plastic and Wound Repair, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - D W Liu
- Medical Center of Burn Plastic and Wound Repair, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
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Fricke A, Rassner M, Kiefer J, Eisenhardt SU. The esthetic outcome of recipient sites of gracilis muscle flaps versus anterolateral thigh flaps: A retrospective study. Microsurgery 2023; 43:800-808. [PMID: 36922726 DOI: 10.1002/micr.31035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 01/30/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Anterolateral thigh (ALT) and gracilis muscle flaps have been described as comparable reconstructive options regarding maximal flap dimension and indications. However, split-thickness skin-grafted muscle flaps are generally believed to be inferior to perforator flaps regarding the esthetic outcome of the recipient site. The purpose of this study was to challenge this assumption, comparing the long-term esthetic outcome of the gracilis and the ALT flap. METHODS One hundred forty-eight patients who had undergone free flap reconstruction with either free split-thickness skin-grafted gracilis muscle flaps (n = 86) or ALT flaps (n = 62) were evaluated in the study. Patients' satisfaction with the esthetic outcome, rates of flap loss, wound healing disorders and the necessity for thinning the flap or scar correction procedures were assessed. RESULTS Flap loss occurred in 4 of 86 gracilis flaps (4.7%) and 2 of 62 (3.2%) ALT flaps (p > .9999). Thinning or scar correction procedures were necessary for 6 of 86 gracilis (7.0%) and 4 of 62 (6.5%; p > .9999) ALT flap recipient sites. Regarding the overall patients' satisfaction with the esthetic outcome, scores were similar in both groups (2.667 [ALT] vs. 2.348 [gracilis]; p = .3739). Contour deformity, scar hypertrophy, and difference in flap color/texture in relation to the surrounding skin were comparable throughout the ALT and gracilis group (2.667 vs. 2.174, p = .2099; 3.333 vs. 2.739, p = .0912 and 2.500 vs. 2.174, p = .3159, respectively). CONCLUSION The gracilis and ALT flap are two equivalent reconstructive options regarding the esthetic outcome of the recipient site and long-term patient satisfaction.
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Affiliation(s)
- A Fricke
- Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Centre, Freiburg, Germany
| | - M Rassner
- Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Centre, Freiburg, Germany
| | - J Kiefer
- Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Centre, Freiburg, Germany
| | - S U Eisenhardt
- Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Centre, Freiburg, Germany
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10
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Di HP, Xing PP, Zheng JJ, Ma C, Huang WX, Liu L, Xue JD, Guo HN, Yang GY, Xia CD, Zhou C. [Curative effects of ultrathin anterolateral femoral flap in one-stage split-finger repair of palmar combined with multiple finger wounds]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:835-841. [PMID: 37805799 DOI: 10.3760/cma.j.cn501225-20221129-00514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To explore the curative effects of ultrathin anterolateral femoral flap in one-stage split-finger repair of palmar combined with multiple finger wounds. Methods: A retrospective observational study was conducted. From October 2016 to June 2018, 20 patients with wounds on palms and multiple fingers who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 15 males and 5 females, aged 18 to 77 years. After debridement, the wound area was 8 cm×4 cm-17 cm×12 cm. The wound was repaired by ultrathin anterolateral femoral flap with area of 9 cm×5 cm to 19 cm×13 cm. According to the wound condition of finger, the finger division was performed in one stage, and the length-to-width ratio of the split-finger flap was 2.0:1.0-2.5:1.0. During the surgery, the descending branches of lateral circumflex femoral artery and accompanying vein of flap were anastomosed end-to-end to the radial artery and vein in the recipient area, respectively, and the anterolateral femoral cutaneous nerve of flap was bridged with the superficial branch of radial nerve in the recipient area. The wounds in the donor area of flap in 14 patients were sutured directly, the wounds in the donor area of flap in 3 patients were repaired by relay superficial iliac circumflex artery perforator flap, and the wounds in the donor area of flap in 3 patients were covered by free trunk medium-thick skin graft. The survival of flap, occurrence of vascular crisis and other complications, and healing of wounds in the donor area of flap were recorded. The appearance of flap, scar hyperplasia in the donor and recipient areas and the patients' satisfaction with the shape and function of the donor and recipient areas were followed up. In 1 year after surgery, the two-point discrimination distance of the flap was measured, and the recovery of hand function was evaluated by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results: The flaps of 17 patients survived without vascular crisis or other complications after surgery. The flap of 1 patient had poor blood circulation and partial necrosis, and the wound was healed 14 days after dressing change and grafting of split-thickness skin graft from head. Two patients had mild cyanosis at the margin of flap after surgery, which disappeared spontaneously 5 days later. Incisions at donor site, relay flaps, and skin grafts of all patients survived well. After surgery, the color and texture of flap were basically the same as that of the normal skin of hand, and linear scars were observed in the donor and recipient areas. The patients were satisfied with the recovery of appearance and function of donor and recipient areas. After 1 year of follow-up, the patients' hand sensory function recovered well, the two-point discrimination distance of flap was 4-6 mm, and the recovery of hand function was evaluated as excellent in 18 cases and good in 2 cases. Conclusions: The ultrathin anterolateral femoral flap in repairing the palmar combined with multiple finger wounds in one-stage split-finger can significantly reduce the number of surgeries and improve the function and beauty of the hand, so it is worthy of clinical promotion.
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Affiliation(s)
- H P Di
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - P P Xing
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - J J Zheng
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - C Ma
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - W X Huang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - L Liu
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - J D Xue
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - H N Guo
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - G Y Yang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - C D Xia
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - C Zhou
- Institute of Biomedical Engineering and Health Sciences, Changzhou University, Changzhou 213164, China
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11
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Ammar HM, Kim J, Lee KT. Usefulness of indocyanine green angiography in the intraoperative evaluation of recipient vessels for microsurgical lower extremity reconstruction in ischemic vasculopathy: Report of three cases. Microsurgery 2023; 43:611-616. [PMID: 37280042 DOI: 10.1002/micr.31071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
Choosing reliable recipient vessels is crucial for successful free flap reconstruction of lower extremity defects, especially in patients with ischemic vasculopathy. This report describes our experience with the intraoperative use of indocyanine green angiography (ICGA) for selecting recipient vessels in lower extremity free flap reconstruction cases. Three patients with lower extremity defects and ischemic vasculopathy underwent free flap reconstruction. Intraoperatively, the candidate vessels were evaluated using ICGA. In the first case, a 10 × 6 cm defect on the anterior side of the lower third of the leg caused by minor trauma and associated with peripheral arterial occlusive disease was reconstructed using a super-thin anterolateral thigh flap based on one perforator. In the second case, a 12 × 8 cm defect on the posterior side of the right lower leg caused by a dog bite and associated with severe atherosclerosis throughout all three major vessels in the lower leg was reconstructed using a muscle-sparing latissimus dorsi myocutaneous flap. In the third case, a 13.5 × 5.5 cm defect on the right lateral malleolar region, where the peroneus longus tendon was exposed due to Buerger's disease, was reconstructed using a one perforator-based super-thin anterolateral thigh flap. In all cases, ICGA was used to evaluate the functionality of the candidate recipient vessels. In two cases, the candidate vessels showed acceptable blood flow, and the operations proceeded as planned. In the third case, the planned vessels of posterior tibial vessels were not identified to have sufficient blood flow, and one of their branches showing enhancement in ICGA was selected and used as a recipient vessel. All flaps survived completely. No adverse events occurred during the follow-up period of postoperative 3 months. Our results suggest that ICGA may be a valuable diagnostic tool for evaluating the quality of candidate recipient vessels in cases where their functionality cannot be guaranteed with conventional imaging modalities.
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Affiliation(s)
- Hamad M Ammar
- Department of Plastic and Burn Surgery, Bahrain Defence Force Hospital, Royal Medical Services, Riffa, Bahrain
| | - Jina Kim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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12
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Ryoo HJ, Park SH, Park JA, Kim YH, Shim HS. Multiple digit resurfacing with a lateral thoracic free flap: Two-stage mitten hand and division procedures. Microsurgery 2023; 43:570-579. [PMID: 37415509 DOI: 10.1002/micr.31090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE The conventional abdominal and groin flaps for resurfacing the defect have several disadvantages, including the risk of flap failure due to accidental traction or detachment, immobilization of the arm before division, and aesthetic dissatisfaction because of the flap bulkiness. The aim of this study was to share our experiences with the free lateral thoracic flap and elucidate the optimal timing of division in complex hand reconstruction, which yielded favorable outcomes in terms of both functionality and aesthetics. METHODS This article is a retrospective review of multiple digit resurfacing using free tissue transfer from 2012 to 2022. Patients who underwent two-stage operation including mitten hand creation using superthin thoracodorsal artery perforator (TDAp) free flap and secondary division were included. A flap was elevated over the superficial fascia layer the midportion between the anterior border of the latissimus dorsi and pectoralis major muscles and once the pedicle was found, an outline that matched the defect was created. A process named "pushing with pressure and cutting" was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Two cases (18%) involved defects of the entire fingers reconstructed by TDAp flap with anterolateral thigh flap. Six cases (55%) had a super-thin TDAp flap only. In two cases (18%), non-vascularized iliac bone grafting was required for finger lengthening. One case (9%) was resurfaced with a TDAp chimeric flap including a skin paddle with the serratus anterior muscle. The primary outcome was defined as the survival or failure of the flap, while the secondary outcomes associated complications such as infection and partial flap necrosis. A statistical analysis was not performed due to the size of the case series. RESULTS All 13 flaps survived completely without any complications. Flap dimension ranged from 12 cm × 7 cm to 30 cm × 15 cm. Mitten hand duration prior to division was 41.9 days on average which was essential for the optimal result. During the division procedures, there were nine cases of debulking (82%), six cases of split-thickness skin graft (STSG) (55%), and three cases of Z-plasty performed on the first web space (27%). The mean follow-up period was 20.2 months. Mean Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire score was 10.76. CONCLUSIONS We resurfaced severe soft tissue defects of multiple fingers with thin to super-thin free flaps, mainly TDAp flaps. Surgeons can restore original hand shape using a two-stage reconstructive strategy of mitten hand creation and proper division timing to create a 3-dimensional hand structure, even in severely injured hands with multiple soft tissue defects of the digits.
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Affiliation(s)
- Hyun Jung Ryoo
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang Hyun Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Ji Ah Park
- Design Lab of Technology Commercialization Center, Industry-University Cooperation Foundation of Hanyang University, Seoul, South Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Hyung-Sup Shim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Xue JD, Di HP, Liang Y, Xing PP, Guo HN, Zhao XK, Wang LM, Xia CD. [Curative effects of foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:724-730. [PMID: 37805782 DOI: 10.3760/cma.j.cn501225-20230323-00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To explore the curative effects of foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers. Methods: A retrospective observational study was conducted. From July 2017 to February 2022, 20 patients with full-thickness electric burn wounds deep to tendon or even bone in fingers who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 19 males and 1 female, aged 18 to 64 years. Among the 20 wounds, 15 wounds were located on the palm side, including 8 on the thumb, 5 on the index finger, and 2 on the middle finger; 5 wounds were located on the back, including 1 on the index finger and 4 on the middle finger. After debridement, the wound area ranged from 4.5 cm×2.0 cm to 7.0 cm×3.0 cm. According to the principle of tissue structure similarity, 10 wounds were repaired with plantar medial flaps, 5 wounds were repaired with hallux peroneal flaps, and 5 wounds were repaired with dorsalis pedis artery flaps, with flap area of 5.0 cm×2.5 cm-8.0 cm×3.5 cm. The flaps were transplanted freely and arteries and veins and/or nerves were anastomosed at the same time. The wound in the donor site was repaired with thigh medium-thick skin graft. The survival of flaps and skin grafts were observed after surgery. The appearance of flap, temperature and color of the distal end in the affected finger were observed during follow-up. At the last follow-up, the joint function and flap sensory recovery of the affected finger were evaluated with the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association; the two-point discrimination distance of skin in the area of flaps with nerve anastomosis was measured; the satisfaction of patients with the curative effect was investigated by using the curative effect satisfaction rating scale, and the very satisfied rate was calculated; the repair effect of flap was evaluated by the comprehensive evaluation scale, and the excellent and good rate was calculated. Results: All the flaps and skin grafts survived after surgery. During the follow-up of 10-18 months after surgery, the appearance of flap was natural and not bloated; the temperature and color of the distal end in the affected finger were basically the same as that of normal finger skin. At the last follow-up, the function recovery of the affected finger joints was as follows: 11 affected fingers were within the normal range of motion, 6 affected fingers had their total active range of motion recovered to 85% of the healthy side, and 3 affected fingers had their total active range of motion recovered to 75% of the healthy side; the flap sensory recovery was as follows: the sense of 15 flaps with nerve anastomosis all recovered to grade S3+, and the two-point discrimination distance of skin in the flap area was 7.0-9.0 mm; the sense of 1 flap without nerve anastomosis recovered to grade S2 and the sense of 4 flaps recovered to grade S1. The satisfaction with curative effect of 20 patients was very satisfied in 16 cases and moderately satisfied in 4 cases, with the very satisfied rate of 80%; the repair result of 20 flaps was excellent in 16 cases, good in 2 cases, and fair in 2 cases, with excellent and good rate of 90%. Conclusions: Due to the similar tissue structure of donor site and recipient site, foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers can achieve good appearance and function, with better functional and sensory recovery of the affected finger in the case of nerve anastomosis. Patients have high degree of satisfaction with the curative effects, which is worthy of promotion.
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Affiliation(s)
- J D Xue
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - H P Di
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - Y Liang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - P P Xing
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - H N Guo
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - X K Zhao
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - L M Wang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
| | - C D Xia
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China
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Gorji S, Varnava C, Aitzetmüller M, Klietz ML, Hirsch T, Wiebringhaus P. [Stacked PAP flap for unilateral breast reconstruction: a case report]. HANDCHIR MIKROCHIR P 2023; 55:262-267. [PMID: 37348538 DOI: 10.1055/a-2084-0893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND In recent years, the PAP (profunda artery perforator) flap has gained popularity in reconstructive breast surgery. However, the tissue available for flap harvest is usually limited. Therefore, grafting two PAP flaps to form a stacked PAP flap for unilateral reconstruction of large breasts is a safe and reliable option. Patient We present the case of a 59-year-old patient arriving at our unit with prior bilateral nipple-sparing mastectomy and implant-based reconstruction after diagnosis of BRCA-2 mutation and breast cancer. Autologous reconstruction with a DIEP flap was the initial treatment suggested to our patient. Preoperative CT scans showed subpar perforators not suitable for anastomosis, ultimately resulting in unilateral DIEP flap reconstruction on the left side. After an uneventful postoperative period, the patient requested autologous conversion of the right side due to persistent symptomatic capsular contracture. To achieve symmetry with the contralateral breast, we decided to perform a stacked PAP flap for unilateral breast reconstruction. RESULTS The combined flaps provided enough tissue to achieve a satisfactory aesthetic result and symmetry and weighed 600 g in total, while the single DIEP flap on the left side weighed 716 g. There were no complications during the surgical procedure. Postoperative recovery was uneventful, and the patient was discharged after seven days. There were no signs of adipose tissue necrosis at the most recent check-up. On the left donor side, there was a small wound healing defect, which healed well non-surgically. The patient was satisfied with the results. CONCLUSION The PAP flap has become an established alternative to standard breast reconstruction procedures. The stacked PAP flap can provide a safe and efficient method for unilateral reconstruction of large breasts. Perfusion and drainage through the inferiorly anastomosed flap showed sufficient outflow and did not lead to increased adipose tissue necrosis. In our case, the total surgery time was not substantially longer than in single PAP flap surgery. Furthermore, the possibility of unilateral placement of two flaps may avoid follow-up operations such as multiple lipotransfers to equalise both breasts.
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Affiliation(s)
- Shaghayegh Gorji
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Charalampos Varnava
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Matthias Aitzetmüller
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Marie-Luise Klietz
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Tobias Hirsch
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Philipp Wiebringhaus
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany
- Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
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15
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Shetty D, Kumar N, Desai AK, Anehosur V. Single perforator-based anterolateral thigh flap, the workhorse flap, in oral cancer reconstruction: A tertiary care institution experience. J Cancer Res Ther 2023; 19:1255-1260. [PMID: 37787292 DOI: 10.4103/jcrt.jcrt_1761_21] [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: 10/04/2023]
Abstract
Background Ablative procedures of the oral cavity require composite removal of tissues, which results in compromise of both functional activities and esthetic mutilation and proves to be a reconstructive challenge. This paper focuses on the reliability and versatility of a single perforator-based anterolateral thigh (ALT) flap in oral cancer reconstruction. Materials and Methods All patients who underwent reconstruction with a single perforator-based ALT for oral cancer defects at our center were included in the study. Results Forty-seven patients who underwent reconstruction with a single perforator-based ALT flap were included in our study. The average flap size in our series was 111 cm2, with the largest measuring 375 cm2. They was a complete loss of flap in two patients; both of them underwent salvage procedure and were reconstructed with pectoralis major myocutaneous flap. One had a partial loss that underwent re-exploration. Conclusion We conclude that a single perforator-based ALT is a very safe, reliable, and versatile flap for head and neck reconstruction. The microvascular anastomosis may be expensive and technically a limitation; however, it has found a permanent place in our head and neck reconstructive toolkit and is the workhorse flap for head and neck reconstruction.
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Affiliation(s)
- Deepthi Shetty
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Niranjan Kumar
- Department of Plastic and Reconstructive Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Anil Kumar Desai
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Venkatesh Anehosur
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
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Yang XK, Zhang DL, He T, Zhang Y, Xu ZG, Wei JT, Li J, Liu MD. [Clinical experience of free superficial temporal fascia flap/anterolateral femoral fascial flap combined with skin grafting in repairing deep tissue defects of special parts of extremities]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:507-511. [PMID: 37805764 DOI: 10.3760/cma.j.cn501225-20220915-00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
The deep tissue defects of extremities are prone to cause the exposure of tendons, blood vessels, nerves, and bones, which are commonly repaired with free flaps in clinical practice. However, for special parts such as fingers, toes, posterior ankles, anterior tibias, and dorsum of feet, the appearances are usually bulky after being repaired with free flaps and need lipectomy operations, which bring great physiological, psychological, and economic burden to patients. As the fascia flap is soft and thin with reliable blood supply and strong anti-infection ability, the free fascia flap combined with skin grafting offers some advantages in repairing the above-mentioned wounds. However, its clinical application is severely limited due to the complexity of surgical operation and the difficulty in observing blood supply after operation. In recent years, our team has carried out a lot of work and accumulated rich experience in repairing deep tissue defects of special parts of extremities with free superficial temporal fascia flap/anterolateral femoral fascial flap combined with skin grafting. From the clinical perspective, this paper mainly introduces the anatomy and harvesting method of free superficial temporal fascia flap/anterolateral femoral fascial flap, as well as the advantages, difficulties, and precautions of clinical application, for reference of peers.
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Affiliation(s)
- X K Yang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - D L Zhang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - T He
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - Y Zhang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - Z G Xu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - J T Wei
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - J Li
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - M D Liu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
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Sun X, Yin ZQ, Zheng JX, Dou Y, Zhang Q, Fu Q, Zhang WL, Yi L. [A comparative study of the curative effects between butterfly-shaped flap and propeller flap based on the dorsal branch of digital artery in repairing the wound in volar aspect of finger]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:552-557. [PMID: 37805771 DOI: 10.3760/cma.j.cn501225-20220714-00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To compare the curative effects of butterfly-shaped flap based on the dorsal branch of digital artery (hereinafter referred to as butterfly-shaped flap) and propeller flap based on the dorsal branch of digital artery (hereinafter referred to as propeller flap) in repairing the wound in volar aspect of finger. Methods: A retrospective cohort study was conducted. From August 2018 to April 2022, 16 patients with finger palmar wounds admitted to Ruijin Hospital of Shanghai Jiao Tong University School of Medicine and 7 patients with finger palmar wounds admitted to General Hospital of PLA Central Theater Command met the inclusion criteria, including 14 males and 9 females, aged 25 to 64 years. After debridement or resection of skin benign tumor, the wounds ranged from 0.5 cm×0.5 cm to 1.5 cm×1.5 cm. According to the different rotation axes of flap pedicle during wound repair, the patients were divided into butterfly-shaped flap group (8 cases) and propeller flap group (15 cases), and their wounds were repaired by butterfly-shaped flap (with area of 0.5 cm×0.5 cm-1.5 cm×1.3 cm) or propeller flap (with area of 0.7 cm×0.5 cm-1.5 cm×1.5 cm) , respectively. In propeller flap group, wounds in the donor sites were repaired by full-thickness skin grafts taken from the palms of wrists or the groin. The surgical time, postoperative complications, flap survival, and wound healing time of patients in the two groups were recorded. Data were statistically analyzed with independent sample t test, Mann Whitney U test, or Fisher's exact probability test. Results: The surgical time and postoperative wound healing time of patients in butterfly-shaped flap group ((43±9) min and (13.1±0.8) d, respectively) were both significantly shorter than those in propeller flap group ((87±16) min and (16.7±4.6) d, respectively, with t values of -7.03 and -2.86, respectively, P<0.05). The postoperative flap survival and complications of patients between the two groups were both similar (P>0.05). Conclusions: For repairing the wound in volar aspect of finger, the butterfly-shaped flap has more advantages in comparison with the traditional propeller flap. The butterfly-shaped flap has a short surgical time and fast postoperative recovery, which is worthy of clinical promotion.
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Affiliation(s)
- X Sun
- Department of Burn and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Z Q Yin
- Department of Burn and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - J X Zheng
- Department of Burn and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Y Dou
- Department of Burn and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Q Zhang
- Department of Burn and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Q Fu
- Department of Orthopedics, General Hospital of PLA Central Theater Command, Wuhan 430072, China
| | - W L Zhang
- Department of Hand Surgery, the People's Hospital of Tianjin, Tianjin 300121, China
| | - L Yi
- Department of Burn and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Li L, Zhou ZH, Ju W, Deng W, Chen LC, Li CS, Xia YH, Ju JH. [Clinical effects of free anterolateral thigh perforator flap pedicled with descending genicular artery in repairing wounds after lower leg limb-sparing surgery]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:450-455. [PMID: 37805754 DOI: 10.3760/cma.j.cn501225-20220725-00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To explore the clinical effects of free anterolateral thigh perforator flap pedicled with descending genicular artery in repairing wounds after lower leg limb-sparing surgery. Methods: A retrospective observational study was conducted. From January 2019 to June 2021, 12 patients with wounds after lower leg limb-sparing surgery who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital, including 6 males and 6 females, aged 17 to 74 years, with original wound area ranging from 17 cm×9 cm to 40 cm×15 cm. Five patients had infection in wounds. The wounds were all repaired by free anterolateral thigh perforator flap from contralateral thigh, with area of 18 cm×10 cm to 37 cm×9 cm. The artery of flap was anastomosed with the descending genicular artery, and the wounds in donor areas were sutured directly. Seven patients were transplanted with split-thickness skin grafts from the contralateral thigh to cover the remaining wounds that can not be covered by flap and the wounds in donor areas were covered with gauze. During the operation, the types of perforating branch carried by flap and the types of arteries and veins in recipient areas were recorded. The survival and occurrence of vascular crisis of flap, the survival of skin graft, the wound healing in donor and recipient areas, and the length of hospital stay after flap transplant surgery were recorded. During follow-up, the color and texture of flap, reinfection in lower leg, and fracture healing were recorded. At the last follow-up, the limb salvage function of patients was evaluated according to the functional evaluation criteria of Chen Zhongwei's amputated limb replantation. Results: The types of perforating branches carried by flaps were as follows: 6 cases of only carrying the descending branch of the lateral circumflex femoral artery, 3 cases of only carrying the oblique branch of the lateral circumflex femoral artery, and 3 cases of carrying the descending branch of the lateral circumflex femoral artery and oblique branch of the lateral circumflex femoral artery after internal pressurization anastomosis. The types of arteries in the recipient area of flap were as follows: one case of main trunk of the descending genicular artery, 8 cases of the saphenous branch of the descending genicular artery, and 3 cases of the articular branch of the descending genicular artery. The types of veins in the recipient area of flap were as follows: 8 cases of one accompanying vein of the descending genicular artery and one branch of the great saphenous vein, and 4 cases of two branches of the great saphenous vein. All the flaps survived without vascular crisis, and all the skin grafts also survived. The wounds in the donor and recipient areas were all healed. The length of hospital stay of patient after flap transplant surgery ranged from 13 to 79 days. During the follow-up of 6 to 23 months, the color and texture of flap were both good, with no infection in lower leg wound. Internal or external fixation were removed after fracture healing in 5 patients, and bone graft internal fixation was performed in 7 patients whose fractures were not healed after surgery and all the incisions healed without infection. At the last follow-up, the limb salvage effect of patients was evaluated as followings: excellent in 7 patients, good in 4 patients, and fair in one patient. Conclusions: Free anterolateral thigh flap pedicled with descending genicular artery can effectively repair the wounds after lower leg limb-sparing surgery and control infection with short length of hospital stay, while not increasing the risk of secondary injury of distal limb vessels. Thus, it can obtain satisfactory limb salvage effect which is worthy of clinical promotion.
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Affiliation(s)
- L Li
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - Z H Zhou
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - W Ju
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - W Deng
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - L C Chen
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - C S Li
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - Y H Xia
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
| | - J H Ju
- Department of Orthopaedics Trauma, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China
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Liang PF, Xu XS, Zhang PH, Bi CL, Zhang H, Huang MT, He ZY, Zeng JZ, Huang Y, Li J, Cui X, Zhou ST, Zhang MH, Huang XY. [Repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:221-227. [PMID: 37805717 DOI: 10.3760/cma.j.cn501225-20221130-00520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To explore the repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness. Methods: A retrospective observational study was conducted. From January 2020 to May 2022, 5 patients admitted to the Department of Burns and Plastic Surgery of Xiangya Hospital of Central South University and 4 patients admitted to the Department of Burns and Plastic Surgery of Chenzhou First People's Hospital with complex facial defect wounds involving paranasal sinuses met the inclusion criteria, including 6 males and 3 females, aged 35-69 years, including 4 patients with titanium mesh exposure combined with paranasal sinuses injury and 5 patients with tumor involving paranasal sinuses. After an adequate assessment of the damage by a multiple discipline team, titanium mesh removal, paranasal sinus debridement, and paranasal sinus mucosa removal were performed in patients with exposed titanium mesh, and radical tumor resection was performed in patients with tumors, with postoperative skin and soft tissue defects areas of 5.0 cm×2.5 cm to 18.0 cm×7.0 cm, anterior paranasal sinus wall defects/absence areas of 3 cm×2 cm to 6 cm×4 cm, and sinus cavity depths of 1 to 4 cm. Depending on the perforator course of the descending branch of the lateral circumflex femoral artery, the anterolateral femoral chimeric flap or anterolateral femoral myocutaneous flap (with flap area of 9 cm×4 cm to 19 cm×8 cm, muscle size of 5 cm×3 cm×3 cm to 11 cm×6 cm×3 cm) was transplanted to repair the defect, and the donor site wound was sutured directly. The type of tissue flap transplanted, the blood vessel of the recipient area, and the vascular anastomosis way during the operation, the recovery of the donor and recipient areas and the occurrence of complications after operation were observed. The appearance and blood supply of the recipient area and the recurrence of ulcers and tumors were followed up. Results: The anterolateral femoral myocutaneous flap transplantation was performed in 6 patients, and the anterolateral femoral chimeric flap transplantation was performed in 3 patients. The blood vessels in recipient areas were facial arteries and veins in 3 cases and superficial temporal arteries and veins in 6 cases. The superficial temporal arteries and veins were bridged with blood vessels in tissue flaps by flow-through way in 2 patients, and end-to-end anastomosis of blood vessels in donor and recipient areas was performed in 7 patients. After operation, all the tissue flaps survived, and the facial defect wounds were well repaired without cerebrospinal fluid leakage or paranasal sinus secretion leakage, no intracranial infection occurred, and the wounds in donor areas were healed well. Follow-up of 6-35 months after operation showed that all the patients had good blood supply in the recipient area, and the shape was acceptable; 4 patients with exposed titanium mesh had no recurrence of ulceration, and 5 patients with tumor had no local tumor recurrence or metastasis. Conclusions: Based on an adequate assessment of the extent of paranasal sinuses involved in the facial wound and the nature of the defect, good clinical effects can be achieved by using the anterolateral femoral muscle flap or the anterolateral femoral chimeric flap transplantation to repair complex facial defect wounds with open paranasal sinuses.
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Affiliation(s)
- P F Liang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - X S Xu
- Department of Burns and Plastic Surgery, Chenzhou First People's Hospital, Chenzhou 423099, China
| | - P H Zhang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - C L Bi
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - H Zhang
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - M T Huang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Z Y He
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - J Z Zeng
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Y Huang
- Department of Burns and Plastic Surgery, Chenzhou First People's Hospital, Chenzhou 423099, China
| | - J Li
- Department of Burns and Plastic Surgery, Chenzhou First People's Hospital, Chenzhou 423099, China
| | - X Cui
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - S T Zhou
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - M H Zhang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - X Y Huang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
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He S, Liu J, Li W, Zhang G, Zheng J, Huang B. [Application of augmented reality technique in repairing soft tissue defects of lower limbs with posterior tibial artery perforator flap]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:185-188. [PMID: 36796814 DOI: 10.7507/1002-1892.202211109] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Objective To investigate the accuracy and reliability of augmented reality (AR) technique in locating the perforating vessels of the posterior tibial artery during the repair of soft tissue defects of the lower limbs with the posterior tibial artery perforator flap. Methods Between June 2019 and June 2022, the posterior tibial artery perforator flap was used to repair the skin and soft tissue defects around the ankle in 10 cases. There were 7 males and 3 females with an average age of 53.7 years (mean, 33-69 years). The injury was caused by traffic accident in 5 cases, bruising by heavy weight in 4 cases, and machine injury in 1 case. The size of wound ranged from 5 cm×3 cm to 14 cm×7 cm. The interval between injury and operation was 7-24 days (mean, 12.8 days). The CT angiography of lower limbs before operation was performed and the data was used to reconstruct the three-dimensional images of perforating vessels and bones with Mimics software. The above images were projected and superimposed on the surface of the affected limb using AR technology, and the skin flap was designed and resected with precise positioning. The size of the flap ranged from 6 cm×4 cm to 15 cm×8 cm. The donor site was sutured directly or repaired with skin graft. Results The 1-4 perforator branches of posterior tibial artery (mean, 3.4 perforator branches) in 10 patients were located by AR technique before operation. The location of perforator vessels during operation was basically consistent with that of AR before operation. The distance between the two locations ranged from 0 to 16 mm, with an average of 12.2 mm. The flap was successfully harvested and repaired according to the preoperative design. Nine flaps survived without vascular crisis. The local infection of skin graft occurred in 2 cases and the necrosis of the distal edge of the flap in 1 case, which healed after dressing change. The other skin grafts survived, and the incisions healed by first intention. All patients were followed up 6-12 months, with an average of 10.3 months. The flap was soft without obvious scar hyperplasia and contracture. At last follow-up, according to the American Orthopedic Foot and Ankle Association (AOFAS) score, the ankle function was excellent in 8 cases, good in 1 case, and poor in 1 case. Conclusion AR technique can be used to determine the location of perforator vessels in the preoperative planning of the posterior tibial artery perforator flap, which can reduce the risk of flap necrosis, and the operation is simple.
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Affiliation(s)
- Shaobo He
- Department of Hand and Foot Microscopy and Burn Plastic Surgery, 3201 Hospital Affiliated to Xi'an Jiaotong University, Hanzhong Shaanxi, 723000, P. R. China
| | - Jichao Liu
- Department of Hand and Foot Microscopy and Burn Plastic Surgery, 3201 Hospital Affiliated to Xi'an Jiaotong University, Hanzhong Shaanxi, 723000, P. R. China
| | - Wujian Li
- Department of Hand and Foot Microscopy and Burn Plastic Surgery, 3201 Hospital Affiliated to Xi'an Jiaotong University, Hanzhong Shaanxi, 723000, P. R. China
| | - Gensheng Zhang
- Department of Hand and Foot Microscopy and Burn Plastic Surgery, 3201 Hospital Affiliated to Xi'an Jiaotong University, Hanzhong Shaanxi, 723000, P. R. China
| | - Jinzhe Zheng
- Department of Hand and Foot Microscopy and Burn Plastic Surgery, 3201 Hospital Affiliated to Xi'an Jiaotong University, Hanzhong Shaanxi, 723000, P. R. China
| | - Bin Huang
- Department of Hand and Foot Microscopy and Burn Plastic Surgery, 3201 Hospital Affiliated to Xi'an Jiaotong University, Hanzhong Shaanxi, 723000, P. R. China
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崔 文, 卓 凤, 王 续, 李 建, 胡 恺, 陈 默, 杨 东, 郭 蕴. [Analysis of the effect of free posterior lateral peroneal artery perforator flap of lower leg in repairing oropharyngeal cancer]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:52-58;62. [PMID: 36597369 PMCID: PMC10128345 DOI: 10.13201/j.issn.2096-7993.2023.01.010] [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] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Indexed: 01/05/2023]
Abstract
Objective:To analyze the clinical effect of free posterior lateral peroneal artery perforator flap of lower leg in repairing postoperative defect of oropharyngeal carcinoma. Methods:Thirty-six patients with oropharyngeal carcinoma admitted to the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College from June 2016 to June 2019 were analyzed and followed up, eighteen patients were treated with free posterior lateral peroneal artery perforator flap of the lower leg to repair the postoperative defects(experimental group), and eighteen patients were treated with free forearm flap(control group). The survival rate of the transplanted flap, the wound stageⅠhealing rate and average hospitalization time were compared between the two groups. Kaplan-Meier method was used to calculate the 1-year and 3-year survival rates of patients after operation, and log-rank test was used to compare the difference between the survival curves of the two groups; The recovery of swallowing and palatopharyngeal closure function of patients in the two groups at 3, 6, 12 and 18 months after operation was calculated and statistically analyzed through the water swallow test and the air blowing method. Results:There was one case of skin flap necrosis in both the experimental group and the control group, and the survival rate was 94.4%. The wound stageⅠhealing rate in the surgical area was 94.4% in both groups. The wound healing rates of the donor area in the experimental group and the control group were 100.0% and 94.4% respectively. The average hospitalization time of the experimental group and the control group was 16.9 days and 17.2 days, respectively, with no significant difference (P>0.05). The overall survival rates of all patients at 1-year and 3-year were 91.2% and 66.5% respectively; The 1-year and 3-year survival rates of the experimental group and the control group were 94.1%, 69.3% and 88.2%, 63.7%, respectively, and there was no significant difference between the two groups (P>0.05). The 1-year and 3-year survival rates of P16+ and P16 - patients were 100.0%, 80.0% and 85.7%, 64.3%, respectively, and there was no significant difference between the two groups (P>0.05). There was no significant difference in the evaluation of swallowing and velopharyngeal closure function between the two groups at 3 and 6 months after operation (P>0.05), but there was a significant difference at 12 and 18 months after operation (P<0.05). Conclusion:The anatomic position of the perforating vessels of the free posterior lateral peroneal artery perforator flap of the lower leg is constant, and it can be prepared into single leaf, multi leaf, chimeric and other flaps according to the tissue defect space. And the concealed supply area can be directly drawn to suture. At the same time, the skin flap has strong plasticity. Therefore, the skin flap can be used as a common skin flap to repair the defects after the operation of oropharyngeal carcinoma.
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Affiliation(s)
- 文静 崔
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠,233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - 凤 卓
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠,233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - 续纪 王
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠,233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - 建成 李
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠,233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - 恺 胡
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠,233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - 默 陈
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠,233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - 东昆 杨
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠,233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - 蕴 郭
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠,233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
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Zhang YJ, Ju JH, Zhao Q, Wang BY, Cheng HY, Wang GY, Hou RX. [Clinical effects of proximal ulnar artery perforator flap combined with iliac bone graft in the reconstruction of subtotal thumb or finger defects]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2022; 38:959-963. [PMID: 36299208 DOI: 10.3760/cma.j.cn501120-20210707-00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To explore the clinical effects of proximal ulnar artery perforator flap combined with iliac bone graft in the reconstruction of subtotal thumb or finger defects. Methods: A retrospective observational study was conducted. From August 2016 to August 2019, 7 patients with thumb or finger defects caused by mechanical damage who met the inclusion criteria were admitted to Ruihua Affiliated Hospital of Soochow University, including 6 males and 1 female, aged 46 to 58 years. Their length of fingers was repaired with iliac bone, with length of 2.0 to 3.0 cm. After the bone graft, the skin defect area of the affected finger ranged from 2.8 cm×2.2 cm to 6.0 cm×3.2 cm. Then the free proximal ulnar artery perforator flap with area of 3.0 cm×2.4 cm to 6.5 cm×3.5 cm was used to cover the wounds. The wounds in donor sites of iliac crest and flap were directly sutured. The survival of flap in one week post surgery and the donor site wound healing in 2 weeks post surgery were observed, respectively. During the follow-up, the appearance and sensory function of the affected finger, bone healing, and scar hypertrophy of wound in the donor site were observed and evaluated. At the last follow-up, the functional recovery of the affected finger was evaluated with trial standard for the evaluation of functions of the upper limbs of the Hand Surgery Society of Chinese Medical Association. Results: In one week post surgery, all the flaps survived. In 2 weeks post surgery, the iliac bone and the wounds in forearm donor site healed. During the follow-up of 5 to 13 months, the flap was good in appearance, without obvious pigmentation; the sensory recovery reached level S2 in 5 patients and S0 in 2 patients; all the grafted iliac bones were bony union without obvious resorption; the wounds in donor site healed well, with only mild scar formation. At the last follow-up, the shape of the reconstructed finger was close to the healthy finger, and the functional evaluation results were excellent in 3 cases and good in 4 cases. Conclusions: The use of proximal ulnar artery perforator flap combined with iliac bone graft to reconstruct subtotal thumb or finger can partially restore part of the appearance and function, with less damage to the donor site. It is a good choice for patients who have low expectations of appearance and function for the reconstructed finger.
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Affiliation(s)
- Y J Zhang
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
| | - J H Ju
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
| | - Q Zhao
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
| | - B Y Wang
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
| | - H Y Cheng
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
| | - G Y Wang
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
| | - R X Hou
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
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杨 曦, 徐 永, 石 岩, 刘 武, 方 翔, 何 晓. [Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36:329-334. [PMID: 35293175 PMCID: PMC8923937 DOI: 10.7507/1002-1892.202110041] [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] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/23/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the effectiveness of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. METHODS The clinical data of 28 children with foot and ankle defect treated with perforator propeller flap of lower limb between January 2018 and January 2021 were retrospectively analyzed. There were 18 boys and 10 girls with an average age of 7.3 years (range, 6-14 years). There were 8 cases of traffic accident injury and 20 cases of chronic infection wound. The disease duration was 2-4 months, with an average of 2.8 months. After thorough debridement, the residual wound size ranged from 5 cm×4 cm to 9 cm×5 cm. Repairing was performed after 7-28 days of the infection in control. According to the location, size, and shape of the wound, the perforating vessels were located by ultrasonic Doppler, and the perforator propeller flap (area ranged from 6 cm×5 cm to 11 cm×6 cm) was designed and harvested to repair the wound. Flap transfer combined with free split-thickness skin graft covered the wound in 2 cases. The donor site was sutured directly (22 cases) or repaired with skin graft (6 cases). RESULTS Twenty-six flaps survived, of which 20 cases were in primary healing, and 6 cases had epidermal necrosis at the end of small paddle, which healed after dressing change. Necrosis occurred in 2 cases due to venous crisis which healed after anterolateral femoral flap free transplantation. Primary wound healing was achieved in donor site. All 28 children were followed up 6-24 months (mean, 10.5 months). The texture, shape, and motor function of the lower limb was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Association (AOFAS) score was 89.8±8.0, which was significantly different from the preoperative score (79.6±10.4) ( t=-11.205, P<0.001); 20 cases were excellent, 6 cases were good, and 2 cases were poor, and the excellent and good rate was 92.8%. CONCLUSION The perforator propeller flap of lower limb in children has its own characteristics. It is a reliable method to repair the foot and ankle defect in children.
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Affiliation(s)
- 曦 杨
- 中国人民解放军联勤保障部队第九二〇医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China
| | - 永清 徐
- 中国人民解放军联勤保障部队第九二〇医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China
| | - 岩 石
- 中国人民解放军联勤保障部队第九二〇医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China
| | - 武华 刘
- 中国人民解放军联勤保障部队第九二〇医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China
| | - 翔 方
- 中国人民解放军联勤保障部队第九二〇医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China
| | - 晓清 何
- 中国人民解放军联勤保障部队第九二〇医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China
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Shahzad F, Kiwanuka E, Marano A, Boyle J, Matros E. Reconstruction of Through-and-Through Mandibular Defects with the Fibula Osteocutaneous and Lower Lateral Leg Perforator Free Flaps. Plast Reconstr Surg 2022; 149:157e-158e. [PMID: 34846353 PMCID: PMC8934534 DOI: 10.1097/prs.0000000000008620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | | | | | | | - Evan Matros
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
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Kagaya Y, Arikawa M, Sekiyama T, Mitsuwa H, Takanashi R, Taga M, Akazawa S, Miyamoto S. The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series. PLoS One 2021; 16:e0256962. [PMID: 34473793 PMCID: PMC8412279 DOI: 10.1371/journal.pone.0256962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies have reported on the abundant cutaneous perforating blood vessels around the latissimus dorsi (LD) lateral border, such as a thoracodorsal artery perforator (TDAP) of septocutaneous type (TDAP-sc) and muscle-perforating type (TDAP-mp), or the lateral thoracic artery perforator (LTAP). These perforators have been clinically utilized for flap elevation; however, there have been few studies that accurately examined all the cutaneous perforators (TDAP-sc, TDAP-mp, LTAP) around the LD lateral border. Here, we propose a new “whole perforator system” (WPS) concept in the lateral thoracic region and a methodology that enables elevating large flaps with reliable perfusion in a muscle-preserving manner. Methods We first performed an anatomical study that verified the number and perforating points of all perforators around the LD lateral border using the results of dynamic contrast-enhanced magnetic resonance imaging of patients with breast cancer. Following the anatomical evaluation, we performed large muscle-preserving flap transfer that contained all of the perforators around the LD lateral border in an actual clinical setting. Results A total of 175 latissimus dorsi from 98 patients were included. The mean number of perforators (TDAP-sc + TDAP-mp + LTAP) per side was 4.51±1.44 (2–9); TDAP-sc was present in 57.1% (100/175) of cases, and TDAP-mp in 76.6% (134/175); the TDAP total prevalence rate (TDAP-sc + TDAP-mp) was 96.0% (168/175). The LTAP existence rate was 94.3% (165/175). Distance from the axillary artery to the TDAP-sc was 148.7±56.3 mm, which was significantly proximal to the TDAP-mp (183.8±54.2 mm) and LTAP (172.2±81.3 mm). Conclusion The lateral thoracic region has an abundant cutaneous perforator system derived from the descending branch of the thoracodorsal and lateral thoracic arteries. Clinical application of the lateral thoracic WPS flap is promising, with a large survival area even with muscle-preserving procedures and requiring a relatively simple procedure.
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Affiliation(s)
- Yu Kagaya
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
- * E-mail:
| | - Masaki Arikawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Takuya Sekiyama
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Hideyuki Mitsuwa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Ryo Takanashi
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Marie Taga
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Satoshi Akazawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Shimpei Miyamoto
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
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Jarvis NR, Torres RA, Avila FR, Forte AJ, Rebecca AM, Teven CM. Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review. Cancer Rep (Hoboken) 2021; 4:e1370. [PMID: 33826249 PMCID: PMC8388172 DOI: 10.1002/cnr2.1370] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/20/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Vascularized omental lymphatic transplant (VOLT) is an increasingly popular treatment of extremity lymphedema given its promising donor site. While the success of VOLT in the treatment of lymphedema has been reported previously, several questions remain. AIM To further elucidate appropriate use of VOLT in the treatment of lymphedema, specifically addressing patient selection, harvest technique, and operative methods. METHODS AND RESULTS A systematic review of VOLT for upper extremity lymphedema was performed. Of 115 yield studies, seven were included for analysis based on inclusion and exclusion criteria. Included studies demonstrated significant reductions in extremity circumference/volume (average volume reduction, 22.7%-39.5%) as well as subjective improvements using patient-reported outcomes. Though studies are heterogenous and limited, when analyzed in aggregate, suggest the efficacy of VOLT in lymphedema treatment. CONCLUSION This is the largest systematic review of VOLT to date. VOLT continues to show promise as a safe and efficacious surgical intervention for lymphedema in the upper extremity. Further studies are warranted to more definitively identify patients for whom this technique is appropriate as well as ideal harvest and inset technique.
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Affiliation(s)
| | | | | | | | - Alanna M. Rebecca
- Division of Plastic and Reconstructive Surgery, Department of SurgeryMayo ClinicPhoenixArizonaUSA
| | - Chad M. Teven
- Division of Plastic and Reconstructive Surgery, Department of SurgeryMayo ClinicPhoenixArizonaUSA
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Skochdopole AJ, Mentz JA, Gravina P, Winocour SJ, Reece EM. Maximizing Volume from the Medial Thigh: Introducing the PUG Flap. Plast Reconstr Surg 2021; 148:329e-331e. [PMID: 34233342 DOI: 10.1097/prs.0000000000008161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anna J Skochdopole
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Aizman L, Perz AM, Lukowiak TM, Sobanko JF, Miller CJ, Etzkorn JR. Reverse Dorsal Metacarpal Artery Flaps to Repair Distal Hand and Dorsal Finger Defects After Mohs Micrographic Surgery. Dermatol Surg 2021; 47:1130-1132. [PMID: 33941730 DOI: 10.1097/dss.0000000000002970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Shimbo K, Okuhara Y, Yokota K. Perforator switching flap: A breakthrough option for anatomical variation and perforator injury of anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2020; 74:1355-1401. [PMID: 33388269 DOI: 10.1016/j.bjps.2020.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/19/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Keisuke Shimbo
- Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
| | - Yukako Okuhara
- Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
| | - Kazunori Yokota
- Department of Plastic and Reconstructive Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Giroux PA, Dast S, Assaf N, Lari A, Sinna R. Internal pudendal perforator artery flap harvesting without pre-operative imaging: Reliability and approach. J Plast Reconstr Aesthet Surg 2020; 74:1355-1401. [PMID: 33454227 DOI: 10.1016/j.bjps.2020.12.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/31/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
Since its initial description in 1996 by Yii and Niranjan, the internal pudendal perforator flap (also known as the Singapore flap, the gluteal fold flap, and the lotus petal flap) has become a workhorse in perineal soft tissue reconstruction. In 2001, Hashimoto described the presence of three to five perforators in the perineal anogenital triangle. The ischial tuberosity has thus become a useful anatomic landmark for the safe boundary of medial dissection during flap elevation, in order to avoid damaging the perforator vessels. The objective of the present study was to evaluate the perforators' positions within the anogenital triangle by using color Doppler ultrasound. In a study of 15 subjects in the lithotomy position, we identified a total of 24 perforator vessels with a diameter greater than 5 mm. We noted the vessels' positions using orthonormal measurements, according to the distance from the midline and the distance on a straight line between the two ischial tuberosities (i.e. consistent bony anatomic landmarks that are independent of the patient's height and body mass index). The mean distance between the ischial tuberosity and the internal pudendal perforator was 27.3 mm. Based on our present results, we consider that routine ultrasound identification and dissection of the perforators is not always required before pudendal flap harvesting. This decreases the operating time and simplifies the flap harvesting procedure.
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Affiliation(s)
- Pierre-Antoine Giroux
- Department of plastic reconstructive and aesthetic surgery, university hospital of Picardie France.
| | - Swanie Dast
- Department of plastic reconstructive and aesthetic surgery, university hospital of Picardie France
| | - Nizar Assaf
- Department of plastic reconstructive and aesthetic surgery, university hospital of Picardie France
| | - Aqeel Lari
- Department of Plastic and Reconstructive Surgery, Croix-Rousse University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Raphael Sinna
- Department of plastic reconstructive and aesthetic surgery, university hospital of Picardie France
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Affiliation(s)
- Geoffrey G Hallock
- Division of Plastic Surgery, St. Luke's Hospital, Sacred Heart Division, 1230 South Cedar Crest Boulevard, Suite 306, Allentown, Pa. 18103,
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Sananpanich K, Boonyalapa A, Kraisarin J, Pattamapaspong N. Osteocutaneous proximal fibular flap: an anatomical and computed tomographic angiographic study of skin and bone perforators. Surg Radiol Anat 2020; 43:1099-1106. [PMID: 33047195 DOI: 10.1007/s00276-020-02591-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Vascularized proximal fibular epiphyseal transfer is a reconstruction method for joints and growing bones. The authors investigated the vascular supply of the proximal fibula, including skin perforators, for suitability in creating an osteocutaneous flap. METHODS Twenty fresh cadaveric knees were studied using computed tomographic angiography combined with anatomical dissection. Three-dimensional angiography was used to develop an overview, and multiplanar two-dimension angiography was used for detailed data collection. Anatomical dissection verified by angiography was used to locate skin perforators of the proximal part of the anterior tibial artery. RESULTS Proximal fibular bone perforators from the anterior tibial artery were found to arise either from the anterior tibial recurrent artery, the posterior tibial recurrent artery or the circumflex fibular artery in every specimen (100%), whereas perforators from the inferolateral genicular artery met those criteria in 12 of 18 specimens (66.7%). In the proximal half of 20 anterior tibial arteries, 129 skin perforators with a diameter larger than 0.5 mm were found. There were 54 potential septocutaneous skin perforators between the extensor digitorum longus and the peroneus longus muscles (EDL/PL), and 18 between the extensor digitorum longus and the tibialis anterior muscles (TA/EDL). Skin perforators from the inferolateral genicular artery emerging from the posterolateral corner of the knee had a diameter of < 0.5 mm. CONCLUSION Based on this cadaveric study, the reverse flow anterior tibial artery pedicle and the EDL/PL or TA/EDL skin perforators can be considered as options for osteocutaneous proximal fibular transfers.
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Affiliation(s)
- Kanit Sananpanich
- Department of Orthopedics, Chiang Mai University, Chiang Mai, Thailand
| | - Artit Boonyalapa
- Department of Orthopedics, Chiang Mai University, Chiang Mai, Thailand
| | | | - Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Abstract
BACKGROUND The forearm is a common donor site, providing thin, pliable workhorse flaps for head and neck reconstruction. There are no prospective studies comparing the donor-site morbidity of the radial forearm flap to the ulnar artery perforator flap. METHODS All patients undergoing forearm free flaps were included for analysis and followed for a minimum of 1 year. Grip strength, sensation to light touch, temperature sensation, and wound healing were assessed. RESULTS A total of 98 patients were enrolled (radial forearm flap, n = 50; ulnar artery perforator flap, n = 48). There were three osteocutaneous radial forearm flaps performed. The donor site was closed primarily in one radial forearm flap patient and four ulnar artery perforator flap patients. The majority of donor sites were resurfaced with full-thickness skin grafts (radial forearm flap, n = 40; ulnar artery perforator flap, n = 44), and the remaining were closed with split-thickness skin grafts. Average grip strength compared to baseline measured at 1, 3, 6, and 12 months after surgery demonstrated no significant differences. All patients returned to baseline sensation to light touch with no long-term sensory deficits at 1 year. No patients suffered significant changes in temperature sensation or cold intolerance. Seven patients suffered partial skin graft loss (radial forearm flap, n = 5; ulnar artery perforator flap, n = 2); all of them healed secondarily with local wound care. There were no flap losses in the study. CONCLUSIONS The radial forearm and ulnar artery perforator flaps are equivalent in terms of success and donor-site morbidity. Selection of flap should be based on need for pedicle length, flap bulk, concerns with radial or ulnar dominance, and surgeon comfort. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Edward I Chang
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Jun Liu
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
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Chang EI, Ibrahim A, Liu J, Robe C, Suami H, Hanasono MM, Nguyen AT. Optimizing Quality of Life for Patients with Breast Cancer-Related Lymphedema: A Prospective Study Combining DIEP Flap Breast Reconstruction and Lymphedema Surgery. Plast Reconstr Surg 2020; 145:676e-685e. [PMID: 32221193 DOI: 10.1097/prs.0000000000006634] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Patients with breast cancer-related lymphedema can be treated with a simultaneous deep inferior epigastric perforator (DIEP) flap, vascularized inguinal lymph node transfer, and lymphovenous anastomosis for aesthetic breast reconstruction and lymphedema in one operation. METHODS The authors performed a comparison of prospectively followed patients who underwent free flap breast reconstruction with vascularized inguinal lymph node transfer and anastomosis to a retrospective cohort of patients who underwent free flap breast reconstruction with vascularized inguinal lymph node transfer alone. RESULTS Thirty-three patients underwent DIEP flap reconstruction with vascularized inguinal lymph node transfer and lymphovenous anastomosis, and 21 received a free flap with lymph node transfer alone. There were no significant differences in demographics, adjuvant chemotherapy, or radiation therapy. The average number of nodes removed was also equivalent (21.2 versus 21.4 nodes). Two anastomoses per patient, on average, were performed (range, one to four) in the combined cohort, and all patients (100 percent) reported a subjective improvement in symptoms, compared with 81.0 percent of patients undergoing only lymph node transfer (p = 0.019). Perometer measurements demonstrated a significant reduction between the groups at early time points [3 months, 40.7 percent versus 20.0 percent (p = 0.037); 6 months, 57.0 percent versus 44.5 percent (p = 0.043)]; however, the difference was not statistically significant at 12 months (60.4 percent versus 57.8 percent; p = 0.43). CONCLUSION This is the first prospective study demonstrating the safety and efficacy of a combined DIEP flap with vascularized inguinal lymph node transfer and lymphovenous anastomosis, which may be superior to lymph node transfer alone. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Edward I Chang
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Amir Ibrahim
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Jun Liu
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Charee Robe
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Hiroo Suami
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Matthew M Hanasono
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Alexander T Nguyen
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
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Abstract
BACKGROUND With advances in technology and technique, the goal of microvascular breast reconstruction has transitioned from flap success to minimizing complications and maximizing aesthetic outcome and efficiency. In an effort to evaluate efficiency, the authors implemented a rigorous process analysis in their practice to evaluate deep inferior epigastric perforator (DIEP) flap breast reconstruction. METHODS A prospective implementation of process analysis was instituted on 147 DIEP flaps. The eight critical maneuvers for a DIEP flap are (1) skin to perforator identification, (2) perforator decision making, (3) perforator dissection, (4) pedicle dissection, (5) flap harvest, (6) preparation for microsurgery, (7) venous anastomosis, and (8) arterial anastomosis. Surgeons with variable experiences (faculty, faculty with senior resident/fellow, and supervised chief resident) used these eight steps to perform DIEP flap reconstruction. The outcomes and time of each maneuver were tracked. RESULTS The total flap harvest time among the three groups was 54.8 minutes for faculty surgeons, 98.3 minutes for senior resident/fellow working with faculty, and 178.8 minutes for supervised chief resident (p < 0.001). The largest difference was seen in perforator dissection. Increasing the number of perforators resulted in longer flap harvest times. Perforator location did not have an impact on times, but harvesting multiple rows took longer for less experienced surgeons. Body mass index and flap weight did not have an impact on time. CONCLUSIONS The authors share their experience using process analysis for DIEP flap reconstruction. They defined eight critical maneuvers to maximize efficiency and safety. By communicating efficient processes and integrating them into the workflow of a given operation, surgeons can continue to improve throughout the arc of their careers.
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Affiliation(s)
- Nicholas T Haddock
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center
| | - Sumeet S Teotia
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center
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赵 万, 徐 永, 何 晓, 罗 浩, 许 育. [Clinical application of digital technology in repairing of heel wound with peroneal artery perforator propeller flap]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:367-372. [PMID: 32174085 PMCID: PMC8171647 DOI: 10.7507/1002-1892.201908079] [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] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/24/2019] [Indexed: 09/26/2022]
Abstract
OBJECTIVE To study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap. METHODS Between March 2016 and March 2019, the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps. There were 21 males and 10 females, with an average age of 36 years (range, 12-53 years). Seventeen patients were admitted to hospital in emergency after trauma, the time from injury to admission was 6.0-12.5 hours, with an average of 8.5 hours; 14 patients were chronic infectious wounds and ulcer. The wound area ranged from 5 cm×4 cm to 12 cm×8 cm. Before flap repair, CT angiography (CTA) data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model, accurate location of perforator, accurate design of perforator flap, and simulated operation according to the defect range and location were obtained. RESULTS The origin and course of peroneal artery perforator, the position of perforator, the diameter of perforator, and the maximum length of the naked perforator were determined based on the three-dimensional model. There was no significant difference in locating point of perforator, diameter of perforator, maximum length of naked perforator between the pre- and intra-operative measurements ( P>0.05). The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip (5-10 cm) in 31 cases. The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%, and the length of vascular pedicle was (3.44±0.65) cm. The flap removal and transposition in 31 patients were successfully completed. The average operation time was 45 minutes (range, 30-65 minutes). After operation, vein crisis and partial necrosis occurred in 4 cases and 3 cases, respectively, which were survived after symptomatic treatment. All the grafts survived and the incisions healed by first intention. All the patients were followed up 3-18 months, with an average of 12 months. At last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%. CONCLUSION The digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.
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Affiliation(s)
- 万秋 赵
- 中国人民解放军联勤保障部队第 920 医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - 永清 徐
- 中国人民解放军联勤保障部队第 920 医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - 晓清 何
- 中国人民解放军联勤保障部队第 920 医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - 浩天 罗
- 中国人民解放军联勤保障部队第 920 医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - 育健 许
- 中国人民解放军联勤保障部队第 920 医院骨科(昆明 650032)Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
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Pafitanis G, Pawa A, Mohanna PN, Din AH. The Butterly iQ: An ultra-simplified color Doppler ultrasound for bedside pre-operative perforator mapping in DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:983-1007. [PMID: 32005639 DOI: 10.1016/j.bjps.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/05/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Georgios Pafitanis
- Department of Plastic Surgery, St Thomas Hospital, Guy's and St. Thomas' NHS Trust, London, UK; Group for Academic Plastic Surgery, The Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Amit Pawa
- Department of Anaesthesia, St Thomas Hospital, Guy's and St. Thomas' NHS Trust, London, UK
| | - Pari-Naz Mohanna
- Department of Plastic Surgery, St Thomas Hospital, Guy's and St. Thomas' NHS Trust, London, UK
| | - Asmat H Din
- Department of Plastic Surgery, St Thomas Hospital, Guy's and St. Thomas' NHS Trust, London, UK
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Yoon CS, Kim HB, Kim YK, Kim H, Kim KN. Relaxed skin tension line-oriented keystone-designed perforator island flaps considering the facial aesthetic unit concept for the coverage of small to moderate facial defects. Medicine (Baltimore) 2019; 98:e14167. [PMID: 30653161 PMCID: PMC6370060 DOI: 10.1097/md.0000000000014167] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A variety of reconstructive options including skin grafts, loco-regional flaps, and free flaps exist for the coverage of facial defects. Each technique has advantages and disadvantages. In this study, we present our experience with relaxed skin tension line (RSTL)-oriented, keystone-designed perforator island flap (KDPIF) reconstructions, in consideration of the facial aesthetic unit concept for coverage of small to moderate facial defects.Between May 2016 and February 2018, 17 patients (11 men and 6 women), with an average age of 63.53 years (range: 37-83 years) underwent KDPIF reconstructions to cover facial defects. We performed the KDPIF reconstructions in consideration of the RSTLs and facial aesthetic unit concept. We retrospectively reviewed the defect causes, locations, and sizes, and flap sizes, types, and survivals, as well as the complications. Cosmetic outcomes were evaluated using the Harris 4-stage scale from 3 independent plastic surgeons' point of view, and postoperative satisfactory surveys from all patients.All defects were successfully covered with KDPIF. The defect sizes varied from 1.5 × 1.5 cm to 3 × 3.5 cm. The flap sizes varied from 1.5 × 3 cm to 3 × 5.5 cm. All flaps fully survived and there were no postoperative complications. The average subjective patient satisfaction score was 8.29 (range: 7-10) and the objective cosmetic outcomes were favorable (fair, good, or excellent).Considering its simplicity and safety, the KDPIF is a good reconstruction option with few complications and high reproducibility. The RSTL-oriented KDPIF reconstruction is a good reconstructive option for covering small to moderate facial defects with superior aesthetic outcomes.
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Affiliation(s)
- Chi Sun Yoon
- Department of Plastic and Reconstructive Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Hyo Bong Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center
| | - Young Keun Kim
- Kim Young Keun's Plastic and Aesthetic Surgery Clinics, Daejeon, Korea
| | - Hoon Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center
| | - Kyu Nam Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center
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Sorooshian P, King I, Dunkin C. Keystone island flaps for reconstruction following lower leg skin cancer resection: A comparison with split-thickness skin grafts. J Plast Reconstr Aesthet Surg 2018; 72:513-527. [PMID: 30579906 DOI: 10.1016/j.bjps.2018.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/01/2018] [Accepted: 12/09/2018] [Indexed: 11/15/2022]
Affiliation(s)
- P Sorooshian
- Department of Plastic and Reconstructive Surgery, St George's University Hospital, London SW17 0QT, UK.
| | - Icc King
- Department of Plastic and Reconstructive Surgery, St George's University Hospital, London SW17 0QT, UK
| | - Csj Dunkin
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesborough TS4 3BW, UK
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Barone M, Cogliandro A, Tsangaris E, Salzillo R, Morelli Coppola M, Ciarrocchi S, Brunetti B, Tenna S, Tambone V, Persichetti P. Treatment of Severe Gynecomastia After Massive Weight Loss: Analysis of Long-Term Outcomes Measured with the Italian Version of the BODY-Q. Aesthetic Plast Surg 2018; 42:1506-1518. [PMID: 30259165 DOI: 10.1007/s00266-018-1232-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 06/11/2018] [Accepted: 09/09/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The objectives of this study are: (1) comparison of long-term outcomes after correction of severe gynecomastia using different techniques; (2) apply the Italian version of the BODY-Q; (3) present the role of intercostal perforator flap (ICAP) after massive weight loss for correction of severe gynecomastia. MATERIALS AND METHODS Between January 2008 and March 2016, we performed surgical correction of bilateral severe gynecomastia in 80 men (160 breasts) following massive weight loss. Patients answered the Italian version of BODY-Q postoperative module. All patients had experienced substantial weight loss (> 30 kg), presented with bilateral severe tissue ptosis of the breast, follow-up of almost 2 years and had a good understanding of the Italian language, and signed consents were included in the study. The sample was studied about age, BMI, comorbidity, bariatric surgical procedure, follow-up, type of post-bariatric surgical procedure, complications and secondary procedures. RESULTS We performed 487 severe gynecomastia corrections from 2008 to 2016; 80 patients adhered to the inclusion criteria and formed our study group. This cross-sectional study compared three cohorts: 52 access using a circumareolar scar, 18 with an inframammary fold scar, 10 with an inframammary fold scar using intercostal perforator flaps. There were 16 secondary procedures in group one, 2 in group two and 1 in group three. We compared the secondary procedures of group 1 with the other groups, and we obtained a significant difference with a P = 0.04. The mean patient age was 36.5 years, and the average body mass index was 27.5 kg/m2 at the time of surgical correction of gynecomastia. From the BODY-Q analysis, the group of patients undergoing adenomammectomy with inframammary fold scar using intercostal perforator flaps has achieved significantly better results regarding the satisfaction with chest, psychosocial function, satisfaction with outcome and better body image. CONCLUSIONS This is the first study that used the BODY-Q to analyze the correction of severe gynecomastia following massive weight loss with long-term results. The use of this patient-reported outcome measure underlined that the intercostal artery perforator flap, used in the correction of severe gynecomastia following massive weight loss, is a safe and effective technique with good outcomes and high patient satisfaction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- M Barone
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
- Research Group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy.
| | - A Cogliandro
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
- Research Group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
| | - E Tsangaris
- Department of Surgery, Patient Reported Outcomes, Value and Experience (PROVE) Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - R Salzillo
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - M Morelli Coppola
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - S Ciarrocchi
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - B Brunetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - S Tenna
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - V Tambone
- Research Group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
- Institute of Philosophy of Scientific and Technological Activity, Campus Bio-Medico University of Rome, Rome, Italy
| | - P Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
- Research Group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
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Manyacka Ma Nyemb P, Fontaine C, Martinot-Duquennoy V, Demondion X, Ndoye JM. Trapezius perforator flaps: anatomical basis using 58 dissections. Surg Radiol Anat 2018; 40:903-910. [PMID: 29978328 DOI: 10.1007/s00276-018-2044-y] [Citation(s) in RCA: 6] [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: 10/08/2017] [Accepted: 05/18/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The trapezius muscle is a good option for soft tissue defects in the cervical and thoracic regions. However, pedicled flaps raised from perforators in the trapezius are rare. Through a series of cadaver dissections, the authors aim to map the perforating arteries in the trapezius muscle. MATERIALS AND METHODS Dissection of 58 anatomical regions in 32 cadavers was carried out. The perforating arteries of the trapezius were inventoried based on their location, dimensions and frequency using the scapular spine and spinous process line as landmarks. RESULTS In 78% of cases, the main perforators of the trapezius were located along two vertical lines parallel to the spinous process line, 5-6 cm on either side of it, between the scapular spine laterally, the tip of the scapula caudally and the superior margin of the trapezius cranially. On each side of the spinous process line, we found an average of 16 perforators (range 5-27) with an average diameter of 0.6 mm (range 0.1-2.6 mm). CONCLUSION Our study shows that surgeons can use fixed landmarks when developing trapezius perforator flaps.
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Affiliation(s)
- Philippe Manyacka Ma Nyemb
- Department of Anatomy and Organogenesis, UFR 2S, Gaston Berger University, Route de Ngallèlle, 234, Saint-Louis, Senegal.
- Department of General Surgery, Regional Hospital, 401 Sud, Saint-Louis, Senegal.
| | - Christian Fontaine
- Department of Anatomy and Organogenesis, Henri Warembourg Faculty of Medicine, Université de Lille 2, Place de Verdun, 59045, Lille, France
| | - Véronique Martinot-Duquennoy
- Department of Plastic, Esthetic and Reconstructive Surgery, Roger Salengro Hospital, Lille University Hospital, rue du Professeur Emile Laine, 59037, Lille, France
| | - Xavier Demondion
- Department of Anatomy and Organogenesis, Henri Warembourg Faculty of Medicine, Université de Lille 2, Place de Verdun, 59045, Lille, France
- Department of Musculoskelettal Imaging, Roger Salengro Hospital, Lille University Hospital, rue du Professeur Emile Laine, 59037, Lille, France
| | - Jean-Marc Ndoye
- Department of Anatomy and Organogenesis, Cheikh Anta Diop University, Fann, 5005, Dakar, Senegal
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He J, Pan D, Wu P, Tang J. Recurrent skin ulcer cross-repair and sensory reconstruction in a WRN gene mutational patient. An Bras Dermatol 2018; 93:443-446. [PMID: 29924215 PMCID: PMC6001081 DOI: 10.1590/abd1806-4841.20187517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/05/2017] [Indexed: 01/31/2023] Open
Abstract
A 37-year-old man complained of a refractory posterior malleolar ulceration on his left ankle. He was diagnosed with Werner syndrome according to the progeroid clinical features and genetic testing. To approach the ulceration, a free flow-through right anterolateral thigh perforator flap with anterolateral thigh cutaneous nerve was harvested. One year later, he was readmitted due to a new ulceration on his right ankle. We harvested the left anterolateral thigh perforator flap with anterolateral thigh cutaneous nerve to reconstruct the defect. After one more year of follow-up, there was no recurrence of ulcers, and the sensation of the flap recovered partially after 6 months. We conclude that free flow-through anterolateral thigh perforator flap is a feasible choice for the repair of foot ulcers in Werner syndrome.
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Affiliation(s)
- Jiqiang He
- Department of Hand and Microsurgery, Xiangya Hospital of
Central South University, Xiangya Road, Changsha, China
| | - Ding Pan
- Department of Hand and Microsurgery, Xiangya Hospital of
Central South University, Xiangya Road, Changsha, China
| | - Panfeng Wu
- Department of Hand and Microsurgery, Xiangya Hospital of
Central South University, Xiangya Road, Changsha, China
| | - Juyu Tang
- Department of Hand and Microsurgery, Xiangya Hospital of
Central South University, Xiangya Road, Changsha, China
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Guo E, Xie Q, Zhu Z, Jin P, Jin P, Wang L. Laparoscopy-assisted Chimeric Peritoneal-deep Inferior Epigastric Perforator Flap for Reconstruction of Hand and Foot. Wounds 2018; 30:36-40. [PMID: 29481328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED Management of hand and foot defects with exposed tendons is a big challenge for plastic surgeons. Thin vascularized tissue offers an ideal surface for tendon excursion. OBJECTIVE This study examines the reconstructive benefits of a laparoscopy-assisted chimeric peritoneal-deep inferior epigastric artery perforator (DIEP) flap in the treatment of hand and foot injury defects. MATERIALS AND METHODS A retrospective review was performed on 8 patients (6 men, 2 women) that received hand or foot reconstruction with laparoscopy-assisted chimeric peritoneal-DIEP flap. Soft tissue defects of the hand or foot ranged from 16 cm x 10 cm to 22 cm x 14 cm. The peritoneum supplied by the peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover exposed extensor tendons, while the DIEP flap consisted of the cutaneous component part of this chimeric flap. RESULTS The flaps survived in 7 of 8 patients. Partial necrosis of the chimeric flap was observed in 1 patient due to venous thrombosis. A split-thickness skin graft then was performed to achieve wound closure on that patient. Motor and sensory functions of these 8 patients improved gradually within the first-year follow-up. CONCLUSIONS The laparoscopy-assisted chimeric peritoneal-DIEP flap is useful for reconstructing defects of the hand and foot with exposed tendons.
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Affiliation(s)
- Enqi Guo
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qingping Xie
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ziguan Zhu
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Peihong Jin
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Peihong Jin
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Liang Wang
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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Erdmann-Sager J, Wilkins EG, Pusic AL, Qi J, Hamill JB, Kim HM, Guldbrandsen GE, Chun YS. Complications and Patient-Reported Outcomes after Abdominally Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. Plast Reconstr Surg 2018; 141:271-281. [PMID: 29019862 PMCID: PMC5785552 DOI: 10.1097/prs.0000000000004016] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Abdominal flap reconstruction is the most popular form of autologous breast reconstruction. The current study compared complications and patient-reported outcomes after pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) flaps. METHODS Patients undergoing abdominally based breast reconstruction at 11 centers were prospectively evaluated for abdominal donor-site and breast complications. Patient-reported outcomes were measured by the BREAST-Q and Patient-Reported Outcomes Measurement Information System surveys. Mixed-effects regression models were used to assess the effects of procedure type on outcomes. RESULTS Seven hundred twenty patients had 1-year follow-up and 587 had 2-year follow-up. Two years after reconstruction, SIEA compared with DIEP flaps were associated with a higher rate of donor-site complications (OR, 2.7; p = 0.001); however, SIEA flaps were associated with higher BREAST-Q abdominal physical well-being scores compared with DIEP flaps at 1 year (mean difference, 4.72, on a scale from 0 to 100; p = 0.053). This difference was not significant at 2 years. Abdominal physical well-being scores at 2 years postoperatively were lower in the pedicled TRAM flap group by 7.2 points (p = 0.006) compared with DIEP flaps and by 7.8 points (p = 0.03) compared with SIEA flaps, and in the free TRAM flap group, scores were lower by 4.9 points (p = 0.04) compared with DIEP flaps. Bilateral reconstruction had significantly lower abdominal physical well-being scores compared with unilateral reconstruction. CONCLUSIONS Although all abdominally based flaps are viable breast reconstruction options, DIEP and SIEA flaps are associated with higher abdominal physical well-being than pedicled and free TRAM flaps. Although SIEA flaps offer the advantage of not violating the fascia, higher rates of donor-site complications may diminish patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
| | - Edwin G. Wilkins
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | | | - Ji Qi
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Jennifer B. Hamill
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Hyungjin Myra Kim
- Department of Biostatistics, University of Michigan Medical School, Ann Arbor, MI
| | | | - Yoon S. Chun
- Division of Plastic Surgery, Brigham and Women’s Hospital, Boston, MA
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Liang JL, Liu XY, Qiu T, Fu ZQ, Wang HY, Kong X, Tao K. Microdissected thin anterolateral thigh perforator flaps with multiple perforators: A series of case reports. Medicine (Baltimore) 2018; 97:e9454. [PMID: 29369171 PMCID: PMC5794355 DOI: 10.1097/md.0000000000009454] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The study aimed to explore the effect of microdissected thin anterolateral thigh (MTALT) perforator flap with multiple perforators on patients with complex defects on the hand, elbow, heel, or knee. METHODS From March 2012 to February 2013, 5 patients with complex defects on the hand, elbow, heel, or knee were included. During the flap preparation, 2 to 3 perforators penetrating the fascia of the anterolateral femoral area were initially detected, and the deep fascia was incised. The superficial fascia layer of the flap and the deep adipose were then dissected, and removed after verifying the distribution of the blood vessels using an operating microscope. The whole flap was then elevated, and transposed to the recipient areas for microsurgical reparation. RESULTS Two cases of post-burn scar contracture and 3 cases of traumatic tissue defects were successfully reconstructed with these multiple-perforator MTALT flaps. No complication was reported, and secondary operative procedure was not needed in any patient in the follow-up. CONCLUSION MTALT perforator flap with multiple perforators is safe and reliable for patients with complex defects on the hand, elbow, heel, or knee.
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Song D, Li Z, Zhou X, Zhang Y, Peng X, Zhou B, Lyu C, Yang L, Peng W, Wang X. [The clinical application of free anteromedial thigh perforator flap in the reconstruction of tongue and mouth floor defect after tongue carcinoma]. Zhonghua Zheng Xing Wai Ke Za Zhi 2017; 33:106-111. [PMID: 30070808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the application of free anteromedial thigh (AMT) perforator flap in the reconstruction of tongue defect after radical resection of tongue carcinoma. METHODS From September 2010 to January 2015,57 cases with tongue carcinoma underwent radical resection, leaving tongue and mouth floor defects which were reconstructed by AMT perforator flaps at the same stage. These 57 eases included tongue carcinoma at lingual margin (n =36),at ventral tongue (n =15) and at mouth floor (n=6). . RESULTS The size of AMT perforator flap ranged from 5.5 cm ×4.0 cm to 7.5 cm × 5.5 cm, the thickness of flap ranged from 1.0-1.7 cm. The length of pedicle from descending branch of lateral circumferential femoral artery is (8.2 ± 0.6) cm, found in 28 cases. The length of pedicle from profunda femoral artery is (8.5 ±0.4) cm, found in 17 cases. The length of pedicle from femoral artery is (8.1 ± 0.7) cm, found in 12 cases. All 57 perforator flaps survived uneventfully, the defects at donor site were closed directly in all cases. All patients were followed up for 12-24 months with satisfactory esthetic and functional results in reconstructed tongue. No local recurrence happened. Only linear scar left in the donor sites, the function of thighs were not affected CONCLUSIONS The free AMT perforator flap is an ideal choice for reconstruction of the tongue and mouth floor defect after radical resection of tongue carcinoma.
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Jeong WS, Han W, Eom JS. Comparison of Aesthetic Outcomes Between Vertical and Horizontal Flap Insets in Breast Reconstruction with the TRAM or DIEP Flaps. Aesthetic Plast Surg 2017; 41:19-25. [PMID: 28032178 DOI: 10.1007/s00266-016-0757-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 10/17/2016] [Accepted: 11/30/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tissue transfer, such as use of the transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) free flaps, is considered a standard method. However, outcomes may vary among inset methods. Here we compared the aesthetic outcomes of breast reconstructions using vertical and horizontal flap inset methods. METHODS We, respectively, reviewed 274 patients who underwent unilateral post-mastectomy breast reconstruction using TRAM or DIEP free flaps between April 2006 and December 2013. Photographs (frontal and bilateral oblique views) obtained 6 months post-operatively were evaluated. Symmetry scores and regional volume discrepancy scores were compared between the vertical and horizontal inset groups. Symmetry scores were adjusted for 11 potential confounding factors on multivariate regression analysis. RESULTS The vertical inset method was associated with higher total symmetry scores, projection, and ptotic naturalness scores. On multivariate regression analysis, the inset method was an independent predictor of outcomes. Regional volume discrepancy score analysis showed a greater tendency for more symmetrical volumes in the upper, medial, and lateral poles with the vertical inset. CONCLUSION The flap inset method is one of the key determinants of aesthetic breast reconstruction outcomes. The vertical inset method was associated with superior aesthetic outcomes and enabled balanced distribution of flap volume to the four poles of the breast. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Woo Shik Jeong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Wooyeon Han
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Qassemyar Q, Aguilar P, Temam S, Kolb F, Gorphe P. [The thin ALT perforator flap for oropharyngeal robotic-assisted reconstruction]. ANN CHIR PLAST ESTH 2017; 62:1-7. [PMID: 28041765 DOI: 10.1016/j.anplas.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/18/2022]
Abstract
Since a few years, the transoral robotic surgery reduced the morbidity of oropharyngeal tumors excision. Large posterior tumors can now be removed without any scar visible on the face. In this context and to respect the thinness required for reconstructions at the junction of the upper aerodigestive tract, the free radial forearm flap still remains the solution of choice. However, if the transoral robotic surgery respects the anatomy and the aesthetics of patients at the visible and social area that represents the face, the forearm flap provides visible scars on the other region of social interaction that represents the upper limb. The aim of our work was to prove the feasibility and the benefits in terms of reducing sequelae when using a thin anterolateral perforator flap harvested above the plane of the superficial fascia. We present this new original method in detail and the advantages it offers to patients after surgery.
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Affiliation(s)
- Q Qassemyar
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
| | - P Aguilar
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - S Temam
- Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - F Kolb
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - P Gorphe
- Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
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Hernandez Rosa J, Sherif RD, Torina PJ, Harmaty MA. Use of both antegrade and retrograde internal mammary vessels in the bipedicled deep inferior epigastric perforator flap for unilateral breast reconstruction. J Plast Reconstr Aesthet Surg 2016; 70:47-53. [PMID: 28029602 DOI: 10.1016/j.bjps.2016.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 05/27/2016] [Revised: 09/04/2016] [Accepted: 09/09/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Autologous abdominal tissue transfer is a well-established method of breast reconstruction. The deep inferior epigastric perforator (DIEP) flap has the additional benefit of minimal donor site morbidity as it spares the muscle and fascia. Conventional DIEP flaps may not provide adequate volume in cases where the patient is thin, has midline abdominal scars, and/or has a large volume of tissue to replace. One solution is to use a bipedicled DIEP flap, incorporating all the available abdominal tissue. Bipedicled DIEP flaps have been described in a number of different configurations. The literature appears to favor intra-flap anastomosis, with a minimal exposition of two recipient vessels. It has been demonstrated that both the antegrade internal mammary artery (aIMA) and retrograde internal mammary artery (rIMA) are adequate recipient vessels. Here, the authors present a single-center experience with bipedicled DIEP flaps to both the aIMA and rIMA, showing their feasibility and safety. METHODS A retrospective review of patients who underwent unilateral breast reconstruction using bipedicled DIEP flaps was performed to assess outcomes. RESULTS A total of 20 patients who underwent unilateral breast reconstruction using a bipedicled DIEP flap were selected for this study. All of them were previously diagnosed with cancer. There were zero flap failure and zero instance of abdominal hernia or issue with abdominal wall functionality following the surgeries. CONCLUSIONS The series of surgeries described in this study resulted in successful breast reconstruction in 20 women using a bipedicled DIEP flap. The results show that this approach allows for reconstruction in places where a conventional DIEP does not provide adequate volume, achieved safely, and does not increase morbidity. The bipedicled DIEP flap is a viable option for large-volume autologous breast reconstruction, providing ample tissue for successful reconstruction while also allowing for shorter recovery and limited donor site morbidity.
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Affiliation(s)
- Jonatan Hernandez Rosa
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, USA
| | - Rami D Sherif
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, USA.
| | - Philip J Torina
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, USA
| | - Marco A Harmaty
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, USA
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Zheng J, Xi S, Ding M, Li H, Xu W, Tang M, Chen S. Effects of Venous Superdrainage and Arterial Supercharging on Dorsal Perforator Flap in a Rat Model. PLoS One 2016; 11:e0160942. [PMID: 27513520 PMCID: PMC4981354 DOI: 10.1371/journal.pone.0160942] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022] Open
Abstract
Objective To comparatively assess the effects of venous superdrainage and arterial supercharging on dorsal perforator flap survival. Materials and Methods Sixty male Sprague-Dawley rats (450–550g) were randomly divided into three groups (n = 20), including control group (Control) and experimental groups A (venous superdrainage, Exp. A) and B (arterial supercharging, Exp. B). At postoperative day 7, survival areas of the flaps were evaluated and all animals underwent angiography. Laser Doppler was used to evaluate flap perfusion from 0h to 7days after surgery. Histology with hematoxylin and eosin staining was used to count microvessels. Tissue of “Choke vessels”was excised for quantification of hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) by western blot assay at 6h and 7days after surgery. Results In the Exp. A group, almost all flaps survived (98.2±1.6%); in the Exp. B and control group, survival areas accounted for 78.8±8.5% and 60.3±7.8%, respectively (P <0.001). In addition, Exp. A animals showed improved anastomosis of choke vessels 2 compared with the Exp. B and Control groups. Furthermore, flap blood flow and partial pressure of oxygen in the Exp. A group were significantly higher compared with values obtained for the Exp. B and Control groups, from 6 hours to 7 days after surgery. More microvessels were found in the Exp. A group (11.65±1.33) than in Exp. B (9.25±0.34) and control (7.25±0.91) animals on POD 7. The relative expression level of HIF-1α and VEGF were significant at 6h and 7days after surgery. Conclusions Venous superdrainage in rat dorsal perforator flap is more effective than arterial supercharging in promoting flap survival, and could effectively alter hemodynamics in the microcirculation and stimulate blood vessel formation.
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Affiliation(s)
- Jun Zheng
- Department of human anatomy, Wenzhou Medical University, Wenzhou, China
| | - Shanshan Xi
- Department of human anatomy, Wenzhou Medical University, Wenzhou, China
| | - Maochao Ding
- Department of human anatomy, Wenzhou Medical University, Wenzhou, China
| | - Hong Li
- Department of human anatomy, Wenzhou Medical University, Wenzhou, China
| | - Wei Xu
- Department of human anatomy, Wenzhou Medical University, Wenzhou, China
| | - Maolin Tang
- Department of human anatomy, Wenzhou Medical University, Wenzhou, China
| | - Shixin Chen
- Department of human anatomy, Wenzhou Medical University, Wenzhou, China
- * E-mail:
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