Cases Of Free Flaps Research Articles

Étude anatomique et applications cliniques des caractéristiques de la palette cutanée du lambeau libre de grand dentelé

Subject Several authors used musculocutaneous free flaps of serratus anterior. However, the localization and dimensions of its skin paddle are not clearly defined in the literature. Thus, we realized an anatomical study trying to prove the reality of this skin paddle and its localisation, before considering clinical applications. Patient and methods Twenty-six dissections on 13 fresh anatomical subjects were realized. The protocol consisted in catheterising the thoracic branch of the thoracodorsal artery to inject a mixture of iodized product and methylene blue. The results were obtained by direct measurement of the blue cutaneous area and by radiographic evaluation of the radiopaque area, compared to reproducible anatomical reference marks. Results Twenty-five dissections were interpretable with superposable results. The skin paddle was always located compared to the 5th, 6th and 7th ribs between the anterior axillary line and the mamelonnary line. The area of the skin paddle was 11,75 cm of length (10–14), 10,75 cm of width (9–12) and 125 cm 2 from surface (110–140). Then, we realized between January and December 2003 several clinical applications of this anatomical study. We report 12 cases of free flaps of serratus anterior with skin paddle for the monitoring of the flap (4 musculocutaneous, 5 osteomusculocutaneous, 3 of fascia with skin paddle). Conclusion This study comes to the support from the anatomical observations from Salmon, the peroperational observations of several authors and our own clinical experiment. It certifies the autonomy of cutaneous vascularization by branches resulting from the surface fascia of the muscle. It specifies the localization and dimensions of the skin paddle of the serratus anterior flap in its muscular, osteomuscular or fascial form, which still increases its versatility of use.

Troubles de croissance des lambeaux fibulaires prélevés chez l’enfant

Mandibular reconstruction with fibula free flap is a challenge in pediatric patients because of the size of the bone and absence of growth without epiphyseal transplantation. We report 2 cases of free fibula flap in children for mandibular reconstruction. The 2 patients presented with growth insufficiency of the bone graft after few years of evolution. Growth insufficiency was treated with different surgical procedures which were discussed We review the consequences on growth after fibula free flap and the specific indications to achieve epiphyseal fibular growth in children.

Advancement of the endoscopic assisted microsurgery: a clinical experience

Although the operating microscope was a must to perform microsurgery, we have tried to find new type equipmenlt which may be less invasive, cheaper in price, smaller in size, more portable, sterilizable, already present in many of the surgical departments, and also valid for performing microsurgery. It was the surgical endoscope by which we started to investigate the possibility to experience the skill of microsurgery. Of great importance is that the acceptance of this new technique will financially allow microsurgery to be performed in hospitals unable to afford the expensive microscopes but already having the investment in less costly and more readily available endoscopic equipment. In this project, we have tried to perform vascular microsurgical anastomoses in many of the free-flap cases. The microsurgical anastomoses were possible, easy, within a reasonable time, with good visualization. In the same terms, it is a new indication of the use of endoscopy and its interesting mode of operating, and also a new method for the microsurgical performance providing the needed clear vision without the problems of looking through the ocular pieces of a loupe or a microscope.

The use of free groin flaps in children.

The free groin flap is a well-established method of skin coverage. Although its use in children has been reported, there have been no published series specifically in such cases. The authors report 33 consecutive cases of free groin flaps in children in their unit over a period of 9 years (1992 to 2001). Tissue transfer was performed to provide soft-tissue coverage during reconstruction of congenital defects and tumor resection and following trauma. Twenty-six cases (79 percent) involved the upper limb, six cases (18 percent) involved the lower limb, and one case involved the head. The complication rate compares favorably with similar series published for adults, with only two complete failures (6 percent), three (9 percent) minor donor-site complications (superficial wound infection, hypertrophic scarring, and dog-ears), and nine flaps requiring debulking. The reexploration rate was 24 percent, with seven of the eight flaps undergoing reexploration surviving. The groin flap is a reliable flap that can be used safely in children, with minimal morbidity.

Perte du pédicule nourricier d’un lambeau libre : étude clinique sur 8 cas

The authors report on 8 cases of free flaps with vascular pedicle disruption that were encountered between postoperative days 8 to 18. In one case, the inflow disappeared 18 months after the transfer without any trouble. This resulted in 2 partial and one complete flap losses. The 4 other flaps survived completely. This complete survival is related to the angiogenesis process coming from the surrounding tissues. The most obvious causal factor responsible for the 2 partial losses was the coverage of large, non viable areas, such as a prosthetic material and bone deprived of periosteum. The only causal factor that could be assessed in the case of total necrosis was the presence of an immunosuppressive treatment. Variables participating in the installation of an adequate angiogenic response are then discussed in accordance to this experience and to the literature. Limited contact with viable tissue, ischemia–reperfusion or drugs limiting the angiogenesis seems to promote failure when the pedicle is quickly disrupted. Hypoxia seems to be the most important cellular mechanism promoting the angiogenesis in this context.

下肢の広範囲皮膚欠損に対する治療経験

Since May 1981, we have performed 25 cases cf Peroneal vascular island flap, 9 cases of free peroneal flap, 8 cases of free scapular flap, 9 cases of free groin flap and 5 cases of free latissimus dorsi flap. Our first selection for treating wide skin defects of the leg and foot is the peroneal vascular island flap which covers the exposed bone, vessels and nerves. In regard to free flaps, our first choice is to use a scapular flap.The advantages of this flap are that the subcutaneous fat is thin, the branch of the circumflex scapular artery can be easily located, the vascular pedicle is long and vessel diameter is 1.2 to 2.0mm. In cases with wide skin defects from the knee to ankle joint we use a latissimus dorsi flap.

四肢皮膚軟部組織欠損に対する肩甲皮弁の使用経験

Nine cases of free scapular flap to extremities were investigated postoperatively for an average of three years.Patients comprised seven male and two female with an average age of 28 years range: four to 63 years.The flap size ranged from 5×8cm to 7×20cm and all donor defects were able to be closed primarily.All the flaps survived postoperatively. The merits of this flap are as follows:(1) Relatively bigger flap can be obtained.(2) Its vascular bundle is suitable for anastomosis. (diameter and length)(3) There is no functional defect postoperatively.In contrast, their disadrantages are as follows:(1) It requires defatting after transfer to the hand.(2) Cosmetic problem at the donor site.(3) There is no sensory gain.This flap is not as popular in orthopaedic surgery, but appears to be versatile.

遊離腹直筋皮弁を用いて下顎再建を行った口腔癌の１例

A case of one-stage free rectus abdominis myocutaneous flap was reported. The patient was a 68 year old male with a very small primary cancer lesion in the right molar region of the mandible.However, the X-ray films at first visit (30-9-1988) showed abnormal figure.He was clinically diagnosed as mandibular cancer (T3N0M0). He had taken radiotherapy of Linac 2, 000 rads from June 13th to June 24th before operation.In as much as cervical lymph node metastasis was absent, we decided to operate on the mandibular cancer lesion.We used a free rectus abdominis myocutaneous flap to replace the loss of the mandible and the mouth floor.The mouth floor and the mandible were resected continuously at the 8-3 portion (and the mouth floor) and an upper neck dissection was performed.An A-O plate and a free abdominis myocutaneous flap was put in place in the mouth to close the defect.The flap was revascularized by anastomosing the inferior epigastric artery and vein to the facial vessels. The flap being well revascularized, no functionary morbidities occurred after its replacement. A denture was constructed after 6 months. The prognosis for this case is satisfactory. The main characteristics of this flap are as follows:(1) The flap is very easily and quickly elevated with the patient in a supine position.(2) In many cases flap elevation and oral cancer surgery can be performed simultaneously, thereby reducing operating time.(3) There are very few anatomical variations in the deep inferior epigastric vessels.

Lower leg reconstruction using a sural fasciocutaneous flap.

The fasciocutaneous flap in the lower leg has been widely used since Pontén's 1981 report. The cutaneous artery running along the sural nerve--known as the superficial sural artery--has an important role in the blood supply of the fasciocutaneous flap in the lower leg as stated by Haertsch. The superficial sural artery has great variation with regard to its location and the origin of the vessel. The cutaneous artery is intimately connected to the sural nerve or the lateral sural nerve. It may run along the sural nerve or along the lateral sural nerve. We examined this vessel in 10 cadaver dissections and applied it in 17 clinical cases of pedicled, island, and free flaps. The island sural fasciocutaneous flap is particularly versatile for the reconstruction of the soft tissue defect around the knee joint. The operative procedure involving the island fasciocutaneous flap and the characteristics of this sural fasciocutaneous flap are described.

The role of microvascular free soft tissue transfer in reconstructive surgery.

Free vascularized transfers have recently provided new perspectives on soft tissue replacement. Their main advantage over conventional pedicle flaps is the shortened hospital stay and overall treatment, particularly in traumatic injuries of the lower leg. Our review of 15 consecutive cases of free flaps show a high rate of early complications (33% surgical revision) and a low rate of failure (1 partial loss). The indications for a free flap versus pedicle flap are discussed, as well as the choice of a skin flap or muscle flap or musculocutaneous flap, with regard to their results and their consequences at the donor site.

ろっ骨付遊離筋皮弁を用いた下がく即時再建手術の１例

A case of one-stage serratus anterior osteomyoctaneous free flap was reported. The patient was a 42-year-old male. He had 45×35 mm primary cancer lesion in the middle of the mandible. However the X-ray films at first visit (9-2-1981) showed no abnormal figure. He was clinically diagnosed as mandible cancer (T3 NO MO), He had taken radiotherapy of Linac 4, 000 rads and Au-grain mold 6, 600 rads from September 17th to November 30th. After 5 months, radio-osteonecrosis of mandible was observed in the region of 6+6. He had complained of severe pain, especially contact pain, of the mandible for 10 months. Metastasis of cancer did not occur in the cervical lymph nodes. Then we deceided to operate on the mandibular radio-osteonecrosis. We used a free osteomyocutaneous flap from the chest to replace a loss of the mandible and the mouth floor. The mandible was resected continuously at the 7+7 portion, and the mouth floor was resected partially. For closure of the defect, the serratus anterior flap with the 6th rib was turned into the mouth. The flap was then revascularized by anastomosing the nutrient thoracodorsal vessels to the facial vessels. Then the flap was well revascularized and its color and texture became significantly better after 6 months. As absorption of the transferred bone was minimal, we made a denture. The prognosis is now satisfactory.

Evaluation of Free Tissue Transfer in The Reconstruction of Soft Tissue Defect in The Leg

Background: There are many possible reconstructive options for reconstruction of defects in the lower limb. These include:skin grafts, local flaps, distant flaps and free flaps.Patients and Methods: We present four cases with soft tissue defects in the legs who were admitted to the Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo Hospital, Jakarta, between February 2009 and February 2010. Result: In all four cases, the free anterolateral thigh (ALT) flaps have been performed for reconstruction of soft tissue defect in the upper third of the leg (3 patients) and lower third of the leg (1 patient). The cause of soft tissue defect was trauma in 3 patients and malignancy in 1 patient. All of the donor sites have similar size with the defect tissue with 15 to 20 cm in length and 10 to 15 cmin width. End-to-end microvascular anastomosis was performed in 2 cases while end-to-side anastomosis was done in the other 2 cases. Arterial thrombosis and infection were complications found in early post-operative period. Arterial thrombosis caused failure in 1 case of free ALT flap which were reconstructed further with free radial forearm flap. Summary: Free ALT flap is relatively easy to harvest once the technique of perforator flap dissection has been learnt. It has a reliable blood supply despite some anatomic variability, it is pliable and can be thinned to a significant degree without compromising blood supply, and can provide a long pedicle with large-diameter vessels.