Cases Of Partial Necrosis Research Articles

Earlobe‐based advancement flap for helical rim defect: A review of 30 cases

AbstractBackgroundVarious techniques have been proposed for helical rim reconstruction, including local flaps, grafts, and prosthetics. The earlobe‐based advancement flap (ELBAF) by Zilinsky, introduced in 2014, has emerged as a simple and effective method for helical rim ear defect reconstruction.ObjectivesThis study aims to evaluate the efficacy and complications of ELBAF in the reconstruction of helical rim defects.MethodsA retrospective single‐centre study was conducted on 30 consecutive cases with helical defects undergoing ELBAF procedures for cancer reconstruction between January 2014 and June 2023. Patient demographics, indications, surgical details, complications, and postoperative outcomes were assessed.ResultsThe study included 30 patients (mean age 79.4 years) with helical defects, mainly due to basal cell carcinoma (n = 13) and squamous cell carcinoma (n = 14). The helical rim defects were distributed in the upper (n = 12), middle (n = 9), and lower (n = 9) thirds. Triangular excisions through the ear lobe were performed in more than 60% of cases. The average defect length was 2.3 cm, and the average surgery time was 25 min. Complications included one case of partial necrosis and three cases of partial dehiscence, with successful corrections in two cases.ConclusionsOur experience with ELBAF in 30 cases demonstrates its reliability for helical rim reconstruction, with a high success rate. The technique, known for its simplicity, provides satisfactory aesthetic outcomes, supporting its consideration as a viable option for helical rim defects.

Subdermal dissection technique for pure skin SCIA and ALT perforator flaps in burns and trauma defects: Clinical experience.

The pure skin perforator (PSP) flap is gaining popularity for its remarkable thinness. The subdermal dissection technique was recently introduced, allowing for a quicker elevation of a PSP flap. In this report, we present our two-year experience utilizing subdermal dissection for harvesting PSP flaps. All patients who had undergone PSP flap reconstruction at our hospital from February 2021 to February 2023 were included. Demographic data, intraoperative variables, flap characteristics, and postoperative outcomes were collected. Surgical planning involved locating the perforator using ultrasound and harvesting the flap using the subdermal dissection technique. A total of 26 PSP flap reconstructions were conducted on 24 patients aged between 15 and 86 years. The flaps were based on perforators issuing from the superficial circumflex iliac artery in 24 cases, and from the descending branch of the lateral circumflex femoral artery in 2 cases. Flap sizes ranged from 3 × 1.5 cm to 19 × 6 cm, with a mean thickness of 3.48 mm. The average time for flap harvest was 131.92 min. Postoperatively, we observed four cases of partial necrosis, 1 total flap loss, and 2 instances of vascular thrombosis at the anastomosis site. The flaps exhibited good pliability without contracture, and no debulking procedures were required during the follow-up period (minimum 6 months, range 6-24; mean 9.4615). The subdermal dissection technique is a safe and efficient approach for elevating PSP flaps. Our initial experience with this technique has been encouraging, and it currently serves as our preferred reconstructive option for defects requiring thin reconstruction.

Various Free Flap Reconstruction Techniques after Hand and Foot Melanonychia Ablation: A Case Series.

(1) Purpose: The management of melanonychia is highly controversial. With growing melanonychia, in case of doubt, the entire lesion should be examined. It may appear similar to nail melanoma or may turn into melanoma. Here, we present surgical cases of nail bed total removal and free flap reconstruction. (2) Methods: Between 1 January 2020 and 31 December 2022, eleven patients were operated on for growing melanonychia, involving the hand and foot. After complete resection of the nail root and plate, immediate reconstruction was performed using a fasciocutaneous free flap. The authors describe the procedures in detail with a few illustrations and clinical photographs depicting the techniques. (3) Results: All patients underwent complete nail unit removal around the anatomic boundaries of the nail. Histology showed a nevus and no malignancy in all cases. We used three onychocutaneous flaps, three hypothenar flaps and five venous flaps. All flaps survived, with one case of partial necrosis which spontaneously healed with secondary intention. In the follow-up periods, there was no recurrence or nail regrowth. (4) Conclusions: These free flap techniques are very useful for total nail bed defect reconstruction after melanonychia lesion total ablation.

Improving Long-Term Projection in Nipple Reconstruction Using a New Human-Derived Acellular Dermal Matrix

Background: Loss of projection is a very common complaint after nipple reconstruction. In this paper, we present our experience with the use of a novel human cadaver-donor-derived acellular dermal matrix, named MODA (Matrice Omologa Dermica Acellulata) from the Regional Skin Bank to improve and stabilize nipple projection after oncoplastic breast surgery. Methods: We did a retrospective analysis of patients undergoing nipple reconstruction with local flap and MODA graft after breast reconstruction between February 2019 and May 2021. The analysis was done following the Declaration of Helsinki and was approved by the ethics committee; written consent was sought from all the participants. The main evaluation criterion was nipple projection measurement, performed immediately after surgery, 6 and 12 months postoperatively. The secondary endpoints were complications and patients’ satisfaction. Results: In this study, 50 patients underwent nipple reconstruction, with 57 reconstructed nipples. All cases except six followed delayed breast reconstruction. The patients were divided into 3 groups, according to the breast reconstructive technique. There were three cases of delayed wound healing and two cases of partial necrosis, but all of the cases healed by secondary intention. Five percent of the patients (3/57 reconstructions) presented more than 60% of nipple projection loss and required another procedure. The other reconstructed nipples maintained an average of over 60% projection after 12 months. Conclusion: The described technique presents a high success rate associated with low complications. Indeed, it provides the advantages of nipple reconstruction with ADM with low costs, appears safe after radiotherapy, and has similar results when used after different reconstructive techniques.

Pedicle Selection and Design in Reduction Mammaplasty: The Role of Preoperative Fluorescence Imaging.

Breast reduction has a wide selection of pedicles but often relies on the surgeon's preference and experience. Necrosis of the nipple-areola complex (NAC) is a catastrophic complication of breast reduction surgery. To solve the above problem objectively, we applied fluorescence imaging technology to the pedicle selection and design of breast reduction surgery for the first time, so that the dominant vessels of the NAC were included in the designed pedicle. We retrospectively enrolled 120 patients with breast reduction (a total of 239 breasts). We compared 60 patients who underwent breast reduction without fluorescence imaging for pedicle selection (Group A) with 60 patients who underwent pedicle selection with fluorescence imaging (Group B). The NAC blood supply was monitored after the operation. In this study, 60 Group A cases (119 breasts) and 60 Group B cases (120 breasts) were analyzed. There were no statistically significant differences in patient demographic data or intraoperative resection weights. There were 7 cases of NAC necrosis in Group A (1 case of complete necrosis and 6 cases of partial necrosis), while no NAC necrosis occurred in Group B. There was a significant difference in the rate of NAC necrosis between the 2 groups. Preoperative fluorescence imaging can guide the selection and design of breast reduction, significantly reducing postoperative NAC blood supply obstacles and necrosis.

Combined application of gluteus maximus muscle flaps and random pattern skin flaps in repairing sacrococcygeal sinus tracts: a prospective study and technical note.

Sacrococcygeal sinus ulcers are caused by pressure sores, trauma, or surgery. Several surgical techniques have been developed for its treatment; however, studies are ongoing to develop the ideal method. The present study aims to introduce an innovative application of gluteus maximus muscle flaps (GMMFs) packing combined with local random pattern skin flaps (RPSFs) in repairing sacrococcygeal sinus tracts (SSTs). This was a prospective analysis study conducted on the patients (n = 26) with SSTs underwent an innovative repairing surgery in Qilu Hospital of Shandong University, China between December 2015 and December 2020. The repairing surgery was GMMFs combined with RPSFs. The demographic information and the clinical parameters including operative time, postoperative healing time, and recurrence rate were used to evaluate the efficacy of the operation. Except one case of partial necrosis at the edge of the flap due to severe fibrosis, which was cured after dressing change, all the other cases showed effective healing after the operation. The combined application of GMMFs and RPSFs for the treatment of sacrococcygeal sinus tracts gains the advantages of short operative time, quick postoperative recovery, and low postoperative recurrence rate.

Hand Reconstruction Using Anterolateral Thigh Free Flap by Terminal Perforator-to-Digital Artery Anastomosis: Retrospective Analysis.

This study aimed to analyze cases of anterolateral thigh (ALT) free flap used for hand reconstruction with terminal perforator-to-digital artery anastomosis. Patients who underwent ALT free flap placement with terminal perforator-to-digital artery anastomosis for hand reconstruction between January 2011 and August 2021 were included. The number, length, and diameter of the perforators and veins, flap size, and operative time were investigated through a retrospective review of charts and photographs. The occurrences of arterial thrombosis, venous thrombosis, arterial spasm, and flap necrosis were analyzed. In total, 50 patients were included in this study. The mean diameter and length of the perforators were 0.68 mm and 3.25 cm, respectively, and the mean number of veins anastomosed was 1.88, with a mean diameter of 0.54 mm. Complications included four cases of arterial thrombosis, one case of venous thrombosis, seven cases of partial necrosis, and one case of total flap failure. Regression analysis showed that a longer perforator was associated with arterial thrombosis whereas larger flap size and number of anastomosed veins were associated with partial necrosis ( p < 0.05). The terminal perforator-to-digital artery anastomosis offers advantages in using compact free flaps with short pedicle lengths to cover small hand defects.

The combination of anterolateral thigh perforator flap and other flaps for repairing the extreme circumferential defects on the limb

To investigate the effectiveness of the combination of the anterolateral thigh perforator (ALTP) flap and other flaps for repairing the extreme circumferential defects on the limb. Between October 2016 and June 2019, 9 patients with the extreme circumferential defects on the limb were admitted, which resulted by degloving injury, including 8 males and 1 female with a median age of 42 years (range, 32-65 years). The etiology involved twist injury in 5 cases, traffic accident in 2 cases, and high voltage electric injury in 2 cases. The location of the defects was left forearm in 2 cases, right forearm in 3, left foot in 3, and right foot in 1. The injected wound bed followed by the exposure of bone, joint, tendon, and blood vessel. The dimension of defects was 25 cm×20 cm to 40 cm×28 cm. The period between the injury and admission was 1-12 hours (mean, 5 hours). All contaminated wounds were taken thorough and radical debridement and covered by the vacuum sealing drainage device during the emergency operation. The ALTP flap and the other one flap were tailored according to the dimension of the wound when the wound surface became granulating, including the thoracodorsal artery perforator (TAP) flap in 3 cases, superficial inferior epigastric artery perforator flap in 3 cases, superficial circumflex iliac artery perforator flap in 3 cases. And the donor site was primary closure. After operation, all the flaps survived except 1 case of partial necrosis at the edge of TAP flap and healed after secondary skin grafting, and the wounds in the donor and recipient areas healed by first intention. All patients were followed up 14-24 months (mean, 16 months). The shape of the flap was satisfactory and the texture was soft. There was no abnormal hair growth and obvious pigmentation during the follow-up. Only linear scar was left in the donor area, there was no complication such as abdominal wall hernia, and the activity of hip and knee was not affected. The functional reconstruction of upper limb and ankle was satisfactory, and the disabilities of the arm, shoulder, and hand (DASH) score was excellent in 4 cases and good in 1 case; the American Orthopaedic Foot and Ankle Association (AOFAS) score was excellent in 3 cases and good in 1 case. ALTP flap combined with different flaps can reconstruct the circumferential extreme defects after limb damage in one-stage, which can achieve limb salvage to the greatest extent.

Facial Artery Musculomucosal Flap in Alveolar Cleft Surgery.

Introduction:Large anterior palatal fistula and special alveolar clefts, such as edentulous atrophic premaxilla and absent premaxilla (premaxillectomy or agenesis), as well as wide unilateral alveolar cleft, are complicated cases in alveolar cleft bone grafting surgery. A superiorly-based buccinator myomucosal flap is suitable in this regard.Materials and Methods:The cleft patients whose large anterior palatal fistula and superiorly based buccinator myomucosal flap had been used for palatal or alveolar reconstruction were recruited in the study. The reconstruction method of the nasal floor, follow-up time, and hospital length of stay were recorded.Results:A total of 10 patients had been treated by this method. The majority of them were male (6/10), the age range of the patients was 14-25 years. All flaps survived and a case of partial necrosis occurred. Conclusion:As evidenced by the obtained results, a superiorly-based facial artery musculomucosal flap is suitable when the palatal fistula is continuous with the alveolar cleft. Transmaxillary transfer is the other option in patients with closed maxillary arch.

Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge

BackgroundSoft tissue defects in the distal third of the leg and malleolus are difficult to cover and often require free tissue transfer, even for small-sized defects. Propeller flaps were designed as an alternative to free tissue transfer, but are reportedly associated with high complication rates. The aim of our study was to assess our institutional experience with the propeller flap technique and to predict its outcome in lower-limb reconstruction.MethodsAll patients who had undergone propeller flap reconstruction of a distal leg defect between 2013 and 2018 were included. Demographic, clinical, and follow-up data were analyzed.ResultsComplications occurred in 17 of 82 propeller flaps (20.7%), comprising 11 cases of partial necrosis and six of total necrosis. There were no significant differences in age, sex, body mass index smoking, diabetes mellitus, and soft tissue defect sites between the groups of patients with versus without flap necrosis (p > 0.05). In univariate analysis, there were also no significant differences between these two groups in the length and width of the fascial pedicle, and the ratio of the flap length to the flap width (p > 0.05). Interestingly, there were significant differences between the two groups in the distance between the flap perforator, the shortest distance from the perforator to the defect location, and the rotation angle of the flap (p < 0.05). In multivariable logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (95% CIs), the shortest distance from the perforator to the defect location was a significant risk factor for flap complications (p = 0.000; OR = 0.806). Receiver operating characteristic curve analysis showed that when the shortest distance from the flap to the wound was less than 3.5 cm, the necrosis rate of the flap was markedly increased (AUC = 76.1); this suggests that the effective safe flap–wound distance was 3.5 cm.ConclusionsPropeller flaps are a reliable option for reconstruction in carefully selected patients with traumatic defects of the lower limb and malleolus. We found that the effective safe distance was 3.5 cm from the flap to the wound.

Free flap surgery in osteoradionecrosis of the head and neck

: Osteoradionecrosis (ORN) following radiation therapy is a much-feared complication of the treatment of head and neck cancer. Free flap reconstruction in the ORN patient has specific challenges for the surgeon. From 2014 to 2020 the Head and Neck Microvascular unit of the Oral and Maxillofacial Surgery Division at Jackson Health/University of Miami treated 149 ORN patients with free flap reconstruction. The fibula free flap (n=65) and anterior lateral thigh free flap (6n=1) were the workhorse flaps in our series comprising 44% and 41% of the total flap surgeries. A total of 13 cases (8.7%) involved performing 2 flaps in the same operation. Thirty cases had recorded complications with one flap loss (0.7%) and one case of partial necrosis (0.7%) of the flap. The most common complications encountered were flap congestion with 8 cases (5%), 5 cases of flap dehiscence,4 cases of neck hematoma (2.6%) and 3 cases of infection of the flap reconstruction site (3%). The average length of stay was 8.2 days. In this paper we present our approach to reconstruction in these patients and the lessons we have learned. Though this surgery is complex and has greater risks than free flap surgery in the “virgin” neck, our experience demonstrates that good outcomes can be achieved consistently with a structured approach.

Subdermal Dissection for Elevation of Pure Skin Perforator Flaps and Superthin Flaps: The Dermis as a Landmark for the Most Superficial Dissection Plane.

Pure skin perforator and superthin flaps have been reported and are becoming popular, as they allow one-stage thin skin reconstruction even from a thick donor site. However, currently reported elevation procedures use proximal-to-distal dissection requiring free-style perforator selection and primary thinning procedures. With distal-to-proximal dissection using the dermis as a landmark for dissection plane, it is expected that elevation of pure skin perforator or superthin flaps can be simplified. Patients who underwent pure skin perforator or superthin flap transfers with the subdermal dissection technique were included. Flaps were designed based on location of pure skin perforators visualized on color Doppler ultrasound, and elevated just below the dermis under an operating microscope. Medical charts were reviewed to obtain clinical and intraoperative findings. Characteristics of the patients, flaps, and postoperative courses were evaluated. Thirty-six flaps were transferred in 34 patients, all of which were elevated as true perforator flaps (superficial circumflex iliac artery perforator flap in 29 cases, other perforator flaps in seven cases). Mean ± SD flap thickness was 2.24 ± 0.77 mm (range, 1.0 to 4.0 mm). Skin flap size ranged from 3.5 × 2 cm to 27 × 8 cm. Time for flap elevation was 27.4 ± 11.6 minutes. All flaps survived without flap atrophy/contracture 6 months after surgery, except for two cases of partial necrosis. The subdermal elevation technique allows straightforward and direct elevation of a pure skin perforator or superthin flap within 30 minutes on average without the necessity of primary thinning. Therapeutic, IV.

Tips and Tricks for Successful Breast Reconstruction Following Radiotherapy Using the Implant-Enhanced Latissimus Dorsi Flap.

Introduction: Adjuvant radiotherapy poses the most serious challenges for surgeons who must choose both the time and the optimal reconstructive method for radiotherapy patients. One of the postmastectomy reconstructive techniques, in patients subjected to radiotherapy, is the method that combines the own tissue with the alloplastic material, the latissimus dorsi flap and the breast implant. This method is highly versatile and can be safely applied to radiotherapy patients. Materials and Methods: Between April 2014 and April 2020, we performed 219 breast reconstructions of which 156 cases were reconstructed with latissimus dorsi flap and implant. The main elements studied were: patient selection for the above mentioned technical procedure, indication of operative moment and type of intervention, preoperative measurements and sketching, minimal scar of the donor area, decision to perform simultaneous symmetrization, simultaneous prophylactic mastectomy with immediate reconstruction, cosmetic appearance, stability and evolution of results over time. The follow-up period was 1 year for all patients, while in the case of some patients up to 5 years. Results: This technique could be applied in all cases with radiotherapy, regardless of the size of the contralateral breast, the technique allowing the shaping of breasts of different volumes. The cosmetic appearance has improved over time, the breast having characteristics similar to the healthy one - shape, natural ptosis, consistency, well-defined inframammary groove. Simultaneous symmetrization by breast reduction, mastopexy with or without implant or breast augmentation led to superior results and a high degree of patient satisfaction. The average duration of recovery was 4 weeks, with rapid social and professional reintegration of patients. The small number of complications - 1 total flap necrosis, 3 cases of partial necrosis, 5 seromas, with a small number of reinterventions - 4, make this method one of the safest in the difficult context of the radiotherapy treatment of prepectoral area. Conclusions: Careful planning of breast reconstruction with the help of the latissimus dorsi flap in combination with the breast implant, the meticulous technique determines stable results over time, with superior cosmetic appearance of the breasts reconstructed with the aid of this method, while minimizing the risk of complications. Thus, the quality of life of patients is much improved, and the social and professional reintegration is relatively fast.

Outcomes of DIEP Flap and Fluorescent Angiography: A Randomized Controlled Clinical Trial.

Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap can be associated with complications such as fat necrosis. The authors' objective was to assess the safety and efficacy of fluorescent angiography with indocyanine green to reduce fat necrosis. The authors designed a parallel, randomized, controlled clinical trial for unilateral breast reconstruction. The poorly vascularized tissues of the DIEP flap were removed based on a clinical evaluation in group 1 and based on angiographic criteria in group 2. The authors recorded the flap dimensions, perfusion in terms of fluorescence intensity, complications, reoperations, and BREAST-Q questionnaire scores for both groups. The study included a total of 51 patients. The flaps showed no size differences after the tissue was excised. The flaps of group 2 presented higher perfusion rates (p = 0.001). The incidence of fat necrosis was 59.3 percent in group 1 and 8.3 percent in group 2 (p = 0.001). Four cases of partial necrosis were recorded in group 1 (18.2 percent) compared with none in group 2 (0 percent) (p = 0.131). Four patients underwent reoperation in group 1 (14.8 percent) compared with none in group 2 (0 percent) (p = 0.113). The patients in group 2 reported higher scores in all domains of the BREAST-Q. Fluorescent angiography with indocyanine green significantly reduced the incidence of fat necrosis without diminishing the flaps' dimensions. The perfusion rates were significantly higher and the patients reported significantly greater satisfaction and quality of life. Fluorescent angiography with indocyanine green may be considered a safe and effective tool to enhance the outcomes of breast reconstruction with the DIEP flap. Therapeutic, I.

Transoral robotic surgery (TORS) for head and neck squamous cell carcinoma: healing by secondary intention, local flap or free flap

The goal of any oncological therapy should be to achieve long-term disease-free survival while minimising acute and late toxicities. One of the goals of transoral robotic surgery (TORS) resection is to obtain negative margins around the primary tumour with minimal functional morbidity. The aim of this study was to assess the functional morbidity of TORS and evaluate the post-operative pain and functional outcomes 6 months after TORS for head and neck squamous cell carcinoma (SCC) in reconstructed and non-reconstructed patients. We retrospectively reviewed 64 patients with head and neck SCCs resected by TORS from 2008 to December 2017 in our institution. The tumour localisation, pathologic T classification, defect size, reconstructive method, wound healing time, complications, post-operative pain and functional outcomes at 6 months were statistically evaluated (Table 1). Fifty-four resections healed by secondary intention, and 4 patients were reconstructed with a local flap and 6 with a free flap. No flap loss was encountered, while two cases of flap dehiscence that needed surgical revision and one case of partial necrosis were recorded. Eight patients had post-operative oral bleeding from the primary tumour resection field with an average bleeding time of 6.2 days. All bleeding occurred in patients with secondary healing of the defect after tumour excision, while no oral bleeding was recorded in patients with flap reconstructions. The pain scores in the first 3 post-operative days were 8 ± 1.2 for the secondary healing wounds and 6.2 ± 1.5 for the flap reconstructions. From day 4 to day 10, the mean VAS score was 5.7 ± 1.2 for the secondary healing wounds and 5.5 ± 1.2 for the flap reconstructions. The average wound healing time was 21.3 days in the secondary healing wound patients and 14.5 days in the reconstructed patients. At the 6-month follow-up, 63 out of the 64 patients recovered oral feeding and comprehensive locution, and only one patient experienced severe post-operative dysphagia and needed a permanent tracheostomy tube and percutaneous endoscopic gastrostomy (PEG) feeding. In this retrospective study, the functional morbidity and complications of TORS for head and neck squamous cell carcinoma resection were favourable in reconstructed and non-reconstructed patients. Level of Evidence: Level III, therapeutic study.

Transplantation of lobulated free latissimus dorsi flap for repairing irregular soft tissue defect of shank

Objective To investigate the feasibility and clinical effects of lobulated free latissimus dorsi flap in repairing severe shank trauma with irregular soft tissue defect. Methods Eight patients with soft tissue defect of shank due to trauma were treated from February, 2013 to November, 2018, which were 5 males and 3 females. All wounds were irregular. The size of soft tissue defect ranged from 11.0 cm×15.0 cm to 15.0 cm×23.0 cm, with different degrees exposure of deep tissue such as bone and tendon. Five cases out of 8 were infected wound, 3 cases of which had internal fixation bracket exposed. Five infected wounds were firstly treated with negative pressure after debridement, then repaired with flap transplantation until the infection were completely controlled. Other wounds were repaired directly after debridement. The free lobulated latissimus dorsi flap was designed and applied to repair the irregular soft tissue defect of shank. The lobulated latissimus dorsi flap with the outer branch of the thoracodorsal artery ranged from 14.0 cm×7.0 cm to 24.0 cm×8.5 cm. The lobulated latissimus dorsi flap with the inner branch of the thoracodorsal artery ranged from 10.0 cm×5.0 cm to 15.0 cm×7.0 cm. When cutting the flap, the branch vessels should be protected to insure the continuity of the thoracodorsal artery. After spliced the 2 lobulated flaps, the thoracodorsal arteriovenous was anastomosed with the recipient region arteriovenous. All the donor sites were sutured directly. All patients were followed-up by outpatient and telephone regularly. Results Seven flaps survived well. Only 1 case of partial necrosis appeared at the distal edge of the lobulated flap and healed after wound care. All patients were followed-up from 3 to 30 months, averaged of 14 months. The texture of flap was flexible and the appearance was well. Only a linear scar was left in the donor site. The shoulder joint retained good mobility. Conclusion The lobulated latissimus dorsi flap has rich blood supply, concealed donor area and high survival rate after transplantation, which can flexibly repair the irregular soft tissue defect of the shank, and effectively prettify the appearance of the recipient area. This strategy has little effect on the appearance and function of the donor area, and worthy of promoting in clinic. Key words: Lobulated, latissimus dorsi flap; Transplantation; Shank; Microsurgical technique

Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi breast reconstruction: A review of patient satisfaction.

BackgroundNipple-areolar complex (NAC) reconstruction following curative mastectomy is traditionally performed as a second-stage procedure several months after initial breast reconstruction. The recent literature has documented the increasing popularity of immediate nipple reconstruction carried out simultaneously during autologous reconstruction. The aim of this study was to evaluate the surgical outcomes and patient satisfaction with immediate breast and nipple reconstruction performed in a single stage after skin-sparing mastectomy.MethodsAll patients who underwent a skin-sparing mastectomy with immediate latissimus dorsi flap breast and NAC reconstruction as a single-stage procedure from 2007 to 2015 were included. Patient demographics, oncologic details, and surgical outcomes were recorded. The BREAST-Q questionnaire was administered to patients to assess the impact and effectiveness of this reconstructive strategy.ResultsDuring the study period, 34 breast and NAC reconstructions in 29 patients were performed at Cork University Hospital. The majority of our patient cohort were non-smokers (93.1%) and did not receive adjuvant radiotherapy. Postoperative complications were infrequent, with no cases of partial necrosis or complete loss of the nipple. The response rate to the BREAST-Q was 62% (n=18). Patients reported high levels of satisfaction with the reconstructed breast (62±4), nipple reconstruction (61±4.8), overall outcome (74.3±5), and psychosocialwell-being (77.7±3.2).ConclusionsSkin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi reconstruction was demonstrated to be a safe and aesthetically reliable procedure in our cohort, yielding high levels of psychological and physical well-being. A single-stage procedure promotes psychosocial well-being involving issues that are intrinsically linked with breast cancer surgery.

The Use of Pedicled Perforator Flaps in Chest Reconstruction: A Systematic Review of Outcomes and Reliability.

In recent years, pedicled perforator flaps have revolutionized plastic surgery by reducing donor site morbidity and ensuring larger and deeper reconstructions with local pedicled cutaneous flaps. The aim of the study was to make a systematic review of perforator pedicled propeller flaps (PPPFs) in chest reconstruction. Pubmed and Cochrane databases were searched from 1989 to October 2016 for articles describing the use of PPPFs in chest reconstruction. The preferred reporting items for systematic reviews and meta analyses statement was used in the selection process. The review was registered on international prospective register of systematic reviews. Furthermore, operative technique, indications and complications were searched. Twenty-four articles were selected (174 patients and 182 flaps). Oncological surgery was the first etiology (34.5%), followed by infections (11.5%), chest keloid scars (6.23%), malformations (4.6%), burns (3.4%), chronic ulcers (2.3%), Verneuil disease (1.8%), and acute wounds (1.8%). The arc of rotation was between 90° and 120° in 24.2%. The mean surface of flaps was 127.45 ± 123.11 cm. Dissection was subfascial in 78.5% of the cases. Complications were found in 9.9% of patients and included mainly wound dehiscence (4.4%) and hematoma/seroma (2.2%). One case of total necrosis (0.5%) and 2 cases of partial necrosis (1.1%) were found. The possibility of numerous pedicles makes it possible for PPPFs to offset most areas of wall chest defects. Furthermore, this surgical technique is reliable and reproducible, with lower donor site morbidity than that in the case of muscular flaps, which are classically used in this location.

Vaginal omentum prolapse due to uterine anterior wall necrosis after prophylactic compression suture for postpartum hemorrhage: case report and review of the literature

Abstract Introduction Postpartum or peripartum hemorrhage (PPH) is a major cause of maternal death in Western industrialized countries. Fertility preserving second stage interventions following uterotonic drugs include embolization or ligation of relevant arteries, uterine tamponade or compression sutures. Little is known about the complications due to uterine compression sutures. We describe a case report in association with uterine compression sutures and provide a systematic review on necrosis due to compression sutures (CSU). Data sources A PubMed database search was done up to October 1, 2016 without any restrictions of publication date or journal, using the following key words: “compression suture” and “postpartum hemorrhage” or “peripartum hemorrhage”. Reported cases were considered eligible when reason for postpartum hemorrhage (PPH), type of compression suture, suture material and type of complication were described. Results Among 199 publications a total of 11 reported on uterus necrosis after CSU applied for PPH. B-Lynch and modifications were applied in seven cases, Cho compression sutures in three cases and in one case B-Lynch and Cho techniques were combined. In six cases no additional measures were applied, in two cases vessel ligation, in one case embolization and in one case intrauterine balloon application were applied. In one case of partial necrosis it is not reported if additional measures were applied. Discussion and conclusion Uterine compression sutures are a useful method for fertility preserving management of postpartum hemorrhage. The risk of serious complications demands the careful consideration of its use. More research is necessary to improve the technique.

Intérêt du lambeau fasciocutané médial de la cuisse dans la gangrène de Fournier

IntroductionThe authors propose a focus on the management of perineoscrotal defects caused by Fournier's gangrene, and emphasize the importance of the medial thigh fasciocutaneous flap. Patients and methodsThis a retrospective study of 12 cases of Fournier's gangrene managed initially by intensivists and urologists then addressed to plastic surgeons for skin coverage. The latter was achieved through a medial thigh fasciocutaneous flap, unilateral in some cases, bilateral in others. ResultsAll patients were male, 63 years on average, and the defect was perineoscrotal, associated in three cases with penile skin defect. The medial thigh fasciocutaneous flap was bilateral in 8 cases. We deplore two cases of partial necrosis. Long-term cosmetic results were satisfactory. Conclusioncoverage of perineoscrotal defect in Fournier's gangrene was dominated for a long time by burying the testicles and skin grafting. Certainly these two techniques are simple, but they are not always achievable. Compared to other flaps, musculocutaneous in this case, the medial thigh fasciocutaneous flap remains simple, useful, and is associated with lower morbidity. It must occupy a prominent place in the cover of such defects, especially in the elderly, in whom the desire for procreation is no longer a priority.