Cases Of Partial Necrosis Research Articles

The posterior thigh flap revisited: clinical use in oncology patients

The posterior thigh flap is a reliable flap owing to the dependability of the inferior gluteal artery. Its utility for the reconstruction of sacral, perineal, ischial, pelvic, trochanteric and vulvar defects is well established. We herein describe the use of the flap for a variety of indications, and discuss the results with respect to postoperative complications in oncology patients. We reviewed nine oncology patients who were treated with pedicled posterior thigh flaps. We assessed the use of this treatment by recording the site of the defect, the type of flap used, and the presence or absence of previous surgical procedures, radiation therapy and postoperative complications. Defects after resection of soft tissue sarcomas were the most common condition (n = 4), followed by skin cancers (n = 2), gastrointestinal cancers (n = 2) and radiation osteomyelitis (n = 1). Six patients (66 %) developed complications; three (33 %) were major and three (33 %) were minor. There was one case of total necrosis of the flap and two cases of partial necrosis. In oncology patients, the posterior thigh flap is an excellent choice for the reconstruction of sacral, ischial, pelvic or buttock defects, since it does not cause any donor site morbidity.

Pectoralis Major Musculocutaneous Flap in Oropharyngeal Reconstruction: Revisited

Free tissue transfer is now favored for head and neck reconstruction following cancer resection. Its success rate is rising with the obvious advances in microsurgery. The pectoralis major musculocutaneous flap, a former workhorse in head and neck reconstruction, has been overlooked and criticized because of its seemingly high rate of complications and cosmetic inferiority, but it is still being used by many surgeons and plays an important role in head and neck reconstruction. The authors reviewed 34 pectoralis major musculocutaneous flap cases and 18 free flap cases (12 radial forearm flaps, six rectus abdominis flaps) involving oropharyngeal reconstruction. Flap necrosis, fistula formation, and operative times were compared. The pectoralis major musculocutaneous flap was elevated in true island type with maximal skeletonization of the pectoral branch of the thoracoacromial vessels. In pectoralis major musculocutaneous cases, all defects were reconstructed successfully, with only two cases of partial necrosis that were managed conservatively. Among the free flaps, two resulted in total flap loss and were subsequently replaced with pectoralis major musculocutaneous flaps. Fistula formation did not occur in any case in either group. Mean operative time for pectoralis major musculocutaneous flap preparation was 76 +/- 7 minutes; that for free flap preparation was 145 +/- 11 minutes. Technical refinements and meticulous procedures minimized necrosis of the pectoralis major musculocutaneous flap and guaranteed the success of the reconstruction. The free flap is an excellent method for oropharyngeal reconstruction, but the refined pectoralis major musculocutaneous flap can also produce acceptable results with minimal complications. In some instances, the pectoralis major musculocutaneous flap is not only an alternative to the free flap but a better choice that presents less risk to the patient.

Thyroid alar cartilage graft in paediatric laryngotracheal reconstruction

To evaluate the potential indications of thyroid alar cartilage (TAC) graft in the paediatric laryngotracheal reconstruction (LTR) population based on observations obtained in a case series of 27 consecutive infants referred to our tertiary care center. Thyroid alar cartilage grafting was performed for limited Myer grade II and grade III subglottic stenosis requiring a single-stage laryngoplasty and for laryngeal enlargement after translaryngotracheal resection of endolaryngeal tumors. The evolution of the grafted area was evaluated prospectively during endoscopic follow-up. Twenty-five patients (92.5%) were successfully extubated after a mean of 5.1 days. No perioperative or postoperative complications were observed. The mean duration of graft harvesting was 7.7 min. Follow-up of the grafted area revealed one case of partial necrosis without prolapse into the lumen. The mean duration of graft epithelialization was 18.1 days (range: 12-30 days). Development of granulation tissue was observed in eight patients (32%) with a mean duration of granulation tissue persistence of 61.5 days (range: 7-155 days). Endoscopic follow-up did not demonstrate any pharyngolaryngeal asymmetry or feeding difficulties. This study demonstrated that the use of thyroid alar cartilage grafting is feasible for pediatric laryngotracheal reconstruction. The indications of thyroid alar cartilage graft should be reserved for moderated subglottic stenosis. The use of TAC reduced the operative time and cosmetic sequelae significantly. The healing of the grafted area was similar to those obtained with other types of graft. The TAC removal did not induce laryngeal deformation but longer follow-up is necessary to confirm this.

Closure of Complicated Palatal Fistula with Facial Artery Musculomucosal Flap

Palatal fistulas occur most commonly as a complication of cleft palate surgery. Treatment of these fistulas, especially when they are wide and scarred, is a challenge for both patients and plastic surgeons, with a high rate of recurrence. The authors have operated on 22 cases of wide, scarred, recurrent palatal fistula with the use of the facial artery musculomucosal flap, first introduced by Pribaz et al. in 1992. The patients were operated on from March of 2001 to December of 2002 and ranged in age from 2 to 21 years. This flap is axial, centered over the facial artery, and can be raised inferiorly based or superiorly based. All of these patients with cleft palate had been operated on before. In one case, because of a very wide fistula, a bilateral facial artery musculomucosal flap was used. There were two cases of partial necrosis and one case of complete failure, probably caused by twisting of the whole pedicle. The nasal lining was made using turndown flaps of the fistula margin. Because of hanging the base of the flap (inferiorly based) and producing bite block during mastication, the pedicle had to be divided and the flap inset secondarily 1 month later. The facial artery musculomucosal flap is an alternative for closing the scarred, wide, recurrent fistula, and is associated with a high rate of success. The flap should be included among the techniques of any plastic surgeon who performs palatal surgery.

Traumatic Hip Dislocation in Childhood

Traumatic dislocation of the hip in childhood is uncommon and can be a consequence of minor trauma. The authors report a series of 35 dislocations in skeletally immature patients. Most were isolated posterior dislocations without acetabular lesions. In 75% of cases, reduction of the dislocation was easy. Nine children required surgery to remove interposed joint capsule and/or osteochondral fragments to achieve anatomic reduction. Outcomes were generally good, except in one patient in whom a displaced fracture of the femoral physis was followed by total head avascular necrosis. One case of partial necrosis had a satisfactory outcome. Epiphyseal necrosis, though uncommon, appeared to be inconsistent to prevent and hard to predict. Bone scan seems to be more effective than MRI for the detection of necrosis.

Two designs of platysma myocutaneous flap for reconstruction of oral and facial defects following cancer surgery

This study evaluates the effects of two different designs of platysma myocutaneous flap, vertical and transverse, used in the reconstruction of defects following the excision of oral and facial tumors. Modified radical neck dissection or selected neck dissection was also performed. Out of the 48 patients, vertical and transverse platysma myocutaneous flaps were used for 41 and 7, respectively. The postoperative outcome for the vertical flaps was 37 cases surviving, two cases of complete necrosis, and two cases of partial necrosis. With the transverse flaps, six survived and there was one case of complete necrosis. The success rate was 90.2% and 85.7% for the vertical and the transverse flap, respectively. The form and function of recipient sites were well recovered. In conclusion, the platysma myocutaneous flap has clinical value in selected patients needing reconstruction of small and medium-sized intraoral or facial defects. It is recommended that the vertical design be used for reconstruction of buccal mucosa defects, and the transverse design for mouth-floor and facial defects.

Immediate breast reconstruction using a laparoscopically harvested omental flap.

Use of an omental flap to reconstruct the breast after cancer surgery was first reported by Kiricuta in 1963. Since then, the omentum has been widely used in cancer surgery to cover extensive thoracic defects associated with radionecrosis. In contrast, for breast reconstruction or augmentation mammaplasty, rectus abdominis and latissimus dorsi flaps have been used far more often than omental flaps. This article describes a new technique for immediate breast reconstruction using laparoscopically harvested omentum and reports the results obtained in 10 patients. Nine patients underwent immediate breast reconstruction after subcutaneous mastectomy. In the other patient, omentum was used in combination with skin grafting to cover a postmastectomy defect. Follow-up exceeded 16 months in the first patients. The results suggest that breast reconstruction using a laparoscopically harvested omental flap may be extremely dependable in terms of vascular supply (there was one case of partial necrosis, which healed with local management alone). The postoperative course of all patients was uneventful, and the use of laparoscopy reduced the hospital stay to less than 7 days. Donor-site scars were minimal. There was no residual loss of function, and there were no cases of incisional ventral hernia. Cosmetic results were satisfactory, with a soft breast that was both natural in appearance and stable in volume. However, in two patients the amount of omentum was found to be inadequate during the procedure; consequently, an implant was inserted under the omental flap. Breast reconstruction using a laparoscopically harvested omental flap is a new technique that allows autogenous reconstruction without disfigurement of the do-nor site and that results in a soft, natural-looking breast.