Complicated Soft Tissue Defects Research Articles

Various soft tissue defect reconstructions using anterolateral thigh and vascularized fascia lata composite free flap.

The anterolateral thigh flap (ALT) is versatile for soft-tissue reconstruction of various body defects because of its thick and vascularized fascia component. We present our clinical experience with the functional one-stage reconstruction of complicated soft-tissue defects using ALTs with vascularized fascia lata (FL). Between April 2018 and February 2022, we transferred ALTs with FL components for various soft-tissue defects in 15 patients. The FL component was used for reconstruction of hand & forearm tendon, medial and lateral patellar synovial membrane, plantar aponeurosis, abdominal wall, dura and Achilles tendon. Functional outcomes were evaluated in each patient. Partial flap necrosis occurred in 2 patients and were treated successfully with minimal surgical debridement and dressing. The vascularized fascia could replace a tendon and fascial component and all the patients achieved satisfactory results without major postoperative complications. Anterolateral thigh flaps with vascularized FL provide reliable fascial and tendon components for single-stage reconstruction of complex soft tissue defects.

Reconstruction of the soft tissue defects of limbs using the free thoracodorsal artery perforator flaps

Objective To investigate the clinical effects of reparing the complicated soft tissue defects of limbs with free thoracodorsal artery perforator(TDAP) flaps. Methods From April, 2009 to March, 2014, 19 limbs (including 8 upper limbs and 11 lower limbs) soft tissue defects with bone and tendon exposure were repaired with free TDAP flaps in the secondary stage. There were 12 thoracodorsal artery perforator flaps, 5 polyfoliate perforator flaps, 1 chimeric muscle flap, and 1 chimeric muscle polyfoliate flap. The sizes of the flaps ranged from 5.0 cm×6.0 cm-20.0 cm×11.0 cm. Seventeen wounds of the dornor site were closed directly, and the other 2 were closed with skin grafts. Results Sixteen flaps survived successfully. Two flaps had venous congestion and survived at last after taking the stitches out. One flap had partial necrosis and repaired by skin graft finally. The clinical results were satisfactory after 12-18 months following-up, and the scars of the dornor sites of all but 3 patients were not obvious. All the shoulder function were normal. Conclusion The TDAP flap has dependable blood supply, good texture, less dornor site morbility. The polyfoliate TDAP flap can be used for repairing irregular defect. The chimeric latissimus TDAP flap can be used for the function reconstruction. The free TDAP flap is suited for repairing soft tissue defects of the limbs. Key words: Thoracodorsal artery perforator flap; Polyfoliate flap; Limbs; Soft tissue defect; Transplantation

Using the special type of free tissue flap based on radial artery superficial palmar branch from palmar wrist repairing complex soft tissue defects of the digitals

Objective To investigate the clinical outcomes of repairing complex soft tissue defects of the fingers with transplantation of the special type of free tissue flap based on radial artery superficial palmar branch from palmar wrist. Methods Thirteen cases with complex soft tissue defects of fingers were repaired with free tissue flap based on radial artery superficial palmar branch from palmar wrist between March, 2012 to January, 2015. Skin and soft tissue defect 1.5 cm × 3.0 cm to 2.5 cm × 6.0 cm, accompanied by bilateral segmental artery defect and injured finger blood circulation disorder in 4 cases; with unilateral finger artery and nerve defect in 2 cases; with extensor tendon defect in 4 cases; with of the artery, nerves or tendons. The size of the skin flap was 2.0 cm × 3.0 cm-3.5 cm × 6.5 cm, and the donor site was primary closed, finger flexor tendon defect, finger artery defect in 3 cases, respectively to radial palmar superficial branch of the transverse crease of the wrist portion of the flow-through flap, carrying the median nerve of the palmar cutaneous branch of the chimeric flap, carrying palm longus chimeric flap, carrying palm longus chimeric flow-through flap to repair the wound, and defect and reconstruction. Results All the flaps survived completely, the wounds and the donor sites were healed by first intention. All the patients were followed up from 6 to 15 months (average 9.5 months). The color and appearance of the flaps were satisfactory with tender texture. The scar of donor district was not conspicuous. The twopoint discrimination of the flap was 5.5-9.5 mm (mean, 7.2 mm). According to the Chinese Medical Association Society of hand surgery of thumb and finger reconstruction function evaluation standard trial evaluation, were excellent in 11 cases, good in 1 case, medium in 1 case. Conclusion Using the special type of free tissue flap based on radial artery superficial palmar branch from palmar wrist can repair of finger skin defect, and reconstruction of the defect of digital artery, nerve or tendon tissue in one stage. It is a method for repairing complicated soft tissue defects of finger, with the advantages of shortening the course of disease and satisfied recovering of the appearance and function of the finger. Key words: Superficial palmar branch of the radial artery; Perforate flap; Digitals; Soft tissue defect; Repair

Reconstruction of facial soft tissue defects with free flaps by microsurgery

To investigate the method and indications for reconstruction of facial complicated soft tissue defects with free flaps by microsurgery. 37 patients (16 males and 21 females, aged from 1 to 54 years) with different size of facial soft tissue defects were reconstructed with free flaps, including 10 latissimus dorsi myocutaneous flaps, 3 thoracodorsal artery perforator flaps, 9 scapular flaps, forearm flaps and 9 postauricular flaps. The defects size ranged from 1 cm x 2 cm to 25 cm x 12 cm. Venous obstruction happened in 3 postauricular flaps, resulting partial necrosis in 2 flaps. All the other flaps survived completely. The cosmetic and functional results were both satisfactory. The facial complicated soft tissue defects can be treated successfully with free flaps by microsurgery. The wounds can be healed primarily with short recovery time and reliable cosmetic and functional result.

Using flap or musculocutaneous flap by anatomosis repairs soft tissue defects of serious traumatic shank

Objective To summary and discuss the curative effect and experience of repairing serious and complicated soft tissue defects of traumatic shank by flap or musculocutaneous flap by anatomosis.Methods From October 2009 to December 2011, the wounds of 59 patients suffering from serious and complicated soft tissue defects of traumatic shank were covered by VSD after repeated debridement,when the conditions of the whole bodies were stable and the local acute infection was controlled in the main. Fifty-six patients were repaired by a single flap or musculocutaneous flap attributing to the fresh granulation, three patients were repaired by compound tissue flaps because a single flap was insufficient. Five patients who had no available blood vessels at recipient site were repaired by flaps with bridge cross vascular anatomosis. The compound flaps were no more than 2 pieces, the maximum area of flap was 32 cm × 13 cm, the minimum was 15 cm × 8 cm. Results The flaps of all of 59 cases survived, fifty-seven cases were healed in one stage, two in two stage, one case had complication of infection at donate site due to the hematocele, and was cured by debridement and skin graft. Serious and complicated soft tissue defects of shanks were repaired by reconstruction,damaged limbs were salvaged,the functions of the legs were reserved. Conclusion It is the most effective and irreplaceable way that using flaps and musculocutaneous flaps,by anatomosis with the microsurgery technique, repairs the serious and complicated soft tissue defects of shank, which can shorten course and salvage the damaged limbs. Key words: Leg; Surgical flap; Musculocutaneous flap; Trauma; Microsurgery

Abductor hallucis muscle flap with circular external fixation for Charcot foot osteomyelitis: a case report

Complicated soft tissue defects of the diabetic foot often call for alternative methods to traditional primary closure. Despite the popularity of microvascular free flaps, local muscle flaps can offer reliable reconstruction for these challenging wounds with shorter surgical times and reduced complication rates. In this article, the authors describe the successful use of the abductor hallucis muscle flap and external fixation for soft tissue reconstruction of a chronic Charcot foot wound and osteomyelitis in a diabetic patient.

Extended vertical trapezius myocutaneous flap in head and neck reconstruction as a salvage procedure.

In surgical treatment of head and neck cancer, when local tumor recurrence or failure of the previous reconstruction method occurs, reoperation for reconstruction of complicated soft-tissue defects can become a challenge for the plastic surgeon. This article describes the authors' experience with the extended vertical trapezius myocutaneous flap for head and neck complicated soft-tissue defects in nine patients ranging in age from 17 to 72 years. The causes of the defects were squamous cell carcinoma of the external ear (n = 2), lip (n = 2), larynx (n = 1), and oral cavity floor (n = 1); congenital hemifacial atrophy-temporomandibular joint ankylosis (n = 1); synovial sarcoma at the mandibular ramus (n = 1); and malignant fibrous histiocytoma at the posterior cranial fossa (n = 1). Eight of the nine patients had previously been operated on using other flap procedures, including free flaps and/or distant pedicled flaps (pectoralis major and deltopectoral flaps). One patient had been operated on using a graft procedure. After failure of the previous flap procedures in four patients and tumor recurrence in five patients, the extended vertical trapezius myocutaneous pedicled flap was used as a salvage procedure. The mean flap size was 7 x 34 cm. The flap was based solely on the transverse cervical artery. Superior muscle fibers of the trapezius were preserved and the caudal end of the flap was extended from 10 to 13 cm beyond the caudal end of the trapezius muscle. Three weeks postoperatively, the pedicle was separated. No flap failure occurred. The donor sites were closed primarily. There were no disabilities with regard to shoulder motion. Tumor recurrence was observed in two patients. In conclusion, for complicated soft-tissue defects of the head and neck, the extended vertical trapezius flap can be preferred as a salvage procedure because it is a simple, reliable, large flap that is located far enough from the damaged area.

Adipofascial Turn-Over Flap for the Reconstruction of Complicated Soft Tissue Defects of Distal Forearm and Hand

Adipofascial Turn-Over Flap for the Reconstruction of Complicated Soft Tissue Defects of Distal Forearm and Hand

The Cutaneous Scapular Free Flap in Head and Neck Reconstruction

Successful surgical reconstruction of complicated soft-tissue defects of the head and neck region has been greatly enhanced by free-revascularized tissue transfers. The scapular free flap has become a favored reconstructive option in our department and has been reported previously for one-stage mandibular reconstruction. This flap can also be transferred as a cutaneous free flap. We present our clinical experience with the fasciocutaneous scapular free flap and review the anatomy, surgical technique, and utility of this versatile flap.