Coverage Of Soft Tissue Defects Research Articles

ROLL OF LOCAL FLAP TECHNIQUE IN THE MANAGEMENT OF COMPOUND INJURIES OF LEG

Objective: The objective of this study was to study the feasibility of local flaps in management of soft-tissue defects with exposed fracture bone fragments in lower extremity (particularly the leg) due to trauma. Methods: The present study included 20 cases of traumatized lower extremity having a soft-tissue defect and an exposed bone with or without associated fractures. Study was conducted from January 1989 to August 1990. Local flaps provide a reliable single stage procedure for coverage of lower extremity soft-tissue defects. Distant flap provides good coverage but these procedures are long drown out and tedious. Only those cases were selected in which wound was found to be preferably, in the upper 1/3rd, middle 1/3rd and the upper most part of the lower third of the leg due to easy accessibility and placement of the flaps to these area. (As flaps can easily be transposed to these areas). All flaps, that is, Fasciocutaneous, Musculocutaneous, or local Muscle flaps were under taken as a delayed procedure after careful evaluation of traumatized limb, that is, repeated dressing, debridement and control of infection. Results: In this study, stable wound coverage was achieved in all patients. Most of the patients were in the age group of 18 to 42 (55%), of these 90% were male. The longest duration of follow-up was 14 months and shortest was 3 months. Excellent result were obtained in Muscle and Musculocutaneous flaps while good result was obtained in 10% cases of Fasciocutaneous flap. Conclusion: Stable coverage can be achieved by flap techniques using Fasciocutaneous Muscle of Musculocutaneous flaps. Coverage of exposed cartical bones, tendon and major vessels and adequate control of infection can be achieved by Muscle and Musculocutaneous flap in post traumatized limb. Fasciocutaneous flap (Ponten super flap) is very useful in repair of soft-tissue defect asit is a much simpler, easy to design and construct large flaps are safe due to good circulations, requires less time without any functional loss. Post-operative management is simple for both patient and staff.

Keystone flap: Suitable option for coverage of soft tissue defect over Tendo Achilles following open repair

Introduction: Wound complications are not uncommon following operative Tendo Achilles repair. Patients presented in Plastic surgery department with soft tissue defect on Tendo achilles region with exposed Tendon. The paucity of tissue and poor blood circulation are main challenges for the reconstructive surgeon. The study aimed to evaluate the Keystone flap for soft tissue coverage of defects following Tendo achilles repair. Methods: This prospective study was conducted on January 2021 to December 2022 in Plastic surgery department of Rajshahi Medical College Hospital and all 12 cases were done by single surgeon. All patients had history of repair for ruptured Tendo Achilles and were presented with defect over Tendo achilles near or at its insertion, where the defect length was larger than width. Keystone flap type IIA was done for each defect. Results: Mean age of the study patients was 43.42 ±9.79 years. The highest dimension of wound was 36.80 (8 X 4.6) cm2 and flap was 66 (10 X 6.6) cm2. The range of advancement of flap was 3- 4.6 cm (mean: 3.43 ±0.54 cm) in transverse axis of leg. Mean duration of operative time was 53.58± 10.06 minutes. Follow up period was 3 months to measure outcome the flap. Conclusion: The keystone flap has high survivability rate with low complications rate providing with good functional outcome of joint. So, keystone flap is a suitable option for coverage of soft tissue defects following operative Tendo Achilles repair. J Bangladesh Coll Phys Surg 2024; 42: 155-160

Microvascular free flap coverage of complex soft tissue defects after revision total knee arthroplasty: a cross-sectional observation study.

Soft tissue defects after total knee arthroplasties (TKA) represent a major orthopedic challenge with amputation as a feared outcome. Microvascular free flap coverage (FFC) can increase limb salvage rates, but complications related to the procedure are yet to be explored further. We aimed to review a single-center experience with FFC for soft tissue defects related to revision total knee arthroplasty. Through a retrospective chart review from 2006 to 2021, we identified all patients who had FFC of a knee with an existing TKA. Typically, patients underwent 2-stage revision arthroplasty. To identify areas of intervention, we divided the entire regimen into 2 phases divided by the free flap surgery (pre- and post-free flap). We identified 18 patients with a median age at free flap surgery of 69 years (range 39-85), who were followed for a median of 5.1 years (range 2 months to 10.6 years). The median duration from primary TKA to their final operation was 17.5 months (range 19 days to 7 years). Patients underwent a mean of 7.6 surgical procedures on their knee with 3.6 orthopedic revisions prior to the FFC and 0.6 after. Soft tissue coverage was achieved in all patients and no patients underwent amputation. One-third of patients experienced early complications at recipient site after free flap surgery. There were no donor site complications. Microvascular FFC of complex soft tissue defects after revision total knee arthroplasty proved achievable in all patients with successful limb salvage in all patients.

Pedicled Groin Flap for Coverage of Soft Tissue Defect of Hand

Background: Distant pedicle flaps like groin flaps are still considered workhorse flaps for the coverage of soft tissue defects of the hand. In the era of free flaps pedicle flaps are still considered as primary flaps by many surgeons. Pedicle flaps are easy to raise, require less experience and microsurgical facility. Methods: In this retrospective descriptive study, patients in whom groin flap was done for reconstruction of hand soft tissue defects were included from April 2017 to April 2022. Results: Thirty-three flaps were included in this study with an average patients’ age of 34.6 years. There were 24 males and 9 females. All flaps survived and served the purpose of covering wounds. Complications like finger and shoulder stiffness were seen in 18 (54.5%), partial necrosis was seen in 4 (12.1%), marginal necrosis in 2 (6%), and infection was seen in 5 (15.2%) patients. Donor sites were healthy after insetting of the flap and did not show any sign of morbidities like infection or bad scarring. Conclusion:Groin flaps are versatile flaps. Where microvascular free flaps are not possible due to severity of injury or due to unavailability of the facility for microvascular free flap groin flap is an excellent option. With less complication, those flaps can be executed easily.

Reconstruction of soft tissue defects of hand: A systematic approach.

A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries.

Interdisciplinary aspects of abdominal and plastic surgery- what does the (abdominal) surgeon need to know?

The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons. - Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or"tensor-fascia-lata"(TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber).-Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps.-Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight.-Abdominoperineal rectum extirpation (APE): Holm's procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty.-Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension.-Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty.-Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time-plastic surgery expertise has to be included into interdisciplinary tumor concepts.-Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose.-Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer).-Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e.,surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve.-Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed byplastic surgery coveragecan prevent chronification, threatening mediastinitis, persisting infectious risk, long-term suffering or limited quality of life. The presented selection of single topics can only be an excerpt of all the options for surgical cooperation in daily clinical and surgical practice. An interdisciplinary approach of abdominal and plastic surgery is characterized bya highly developed cooperationin common surgical interventions including various techniques and tactics highlighting the specifics of the two fields.

Transverse Eponychial Flap For Nail Lengthening And Fingertip Reconstruction

Introduction: Fingertip injuries are frequented with loss of pulp and nail complex. Most reconstructive procedures provide either the soft tissue defect coverage or lengthen the nail. Methods: Patients included were more than 10 years of age with fingertip injury of Allen type III and IV with intact eponychium. Transverse Eponychial Flap was used to lengthen the nail lost as well as provide defect coverage. Paired t test, chi square test and Pearson correlation and Mann Whitney test were used for statistical analysis. Results: Seventeen digits were analyzed. The average lengthening of the nail achieved was 142.4%. The average nail length during follow up was 59.1% of contralateral, with average final nail lengthening achieved was 31%. Reconstruction with Transverse Eponychial flap alone was performed in 58.8% of digits. Four patients (23.52%) had complete near normal nail. Sixteen digits had satisfactory and higher results. With Transverse Eponychial Flap alone it was possible to completely cover 10 fingertips (58.8%), requiring local flaps or skin graft for the remaining cases. Obliquely orientated injuries (76.47%) were more likely to undergo the procedure. Conclusion: The flap significantly lengthens the nail, and provides satisfactory results. We recommend the use of this flap in defects with Allen type III and IV fingertip injuries.

Soleus Muscle Flap for Coverage of Soft Tissue Defect of Leg

Background: Open tibia fracture with soft tissue loss at the fracture site is and always a challenging problem for orthopedic surgeons to deal with. Soleus flap is an important option for such defects out of many other options. Methods: Retrospective descriptive study in which twenty-one patients with open tibia fracture with soft tissue defect at fracture site requiring flap coverage were included in the study. In all 21 patients, the soleus muscle flap was done. Results: Out of 21 patients, in 16 patients medial hemisoleus flap was done and in five composite soleus muscle flap was done. The average age of the patients was 37.8 years, and the right leg was more involved. In all patients, bone coverage was achieved. Three patients required debridement and mobilization of flap due to infective necrosis at the margin. The mean follow-up was 12 months. Conclusion: Soleus muscle flap is a good and versatile flap for the coverage of soft tissue defects of the leg exposing bone or fracture.

Reconstruction with an Anterolateral Thigh Free Flap Following a Skin Graft from the Same Donor Site for Tissue Use Efficacy: Two Case Reports

The coverage of extensive soft tissue defects requires several considerations, such as limited donor sites, reconstruction methods, and the outcome of functional recovery. In the cases described herein, when a significant soft tissue defect was present on an extremity, we opted for staged reconstruction. We first performed a split-thickness skin graft (STSG) to reduce the soft tissue defect, using the anterolateral thigh (ALT) as the donor site. In the second stage, the remaining soft tissue defect was reconstructed with an ALT free flap, utilizing the same lateral thigh area that had previously served as the STSG donor site. After the free flap procedure, we encountered several challenges in monitoring the ALT flap; however, all flaps ultimately survived. To the best of our knowledge, this is the first report of using an ALT free flap following STSG from the same donor site, demonstrating efficient tissue utilization. We believe this approach is beneficial for reconstructing extensive soft tissue defects, as it maximizes tissue use efficiency and reduces donor site morbidity when donor options are limited.

Efficacité de la fixation interne précoce associée à un lambeau libre pour le traitement des fractures ouvertes de l’avant-bras Gustilo IIIB

IntroductionGustilo IIIB open forearm fractures are severe injuries often associated with extensive bone and soft tissue injuries. The treatment of Gustilo IIIB open forearm fractures remains a challenging problem, with a high morbidity rate such as infection, nonunion, even amputation. External fixation is preferred for open lower limb fractures. However, there are significant differences between open bone injuries of the upper and lower extremity in terms of treatment plans. Use of internal fixation methods for open fractures is a controversial issue, as it requires early coverage of skin and soft tissue defects after radical debridement and irrigation. The optimal approach for open forearm fractures remains to be determined. The present study evaluated whether early internal fixation combined with free flap placement is effective for the treatment of Gustilo IIIB open forearm fracture. HypothesisEarly internal fixation combined with the free flap technique in the treatment of Gustilo IIIB open forearm fracture provides good consolidation results. Material and methodsFrom January 2015 to January 2020, 20 patients with Gustilo IIIB open forearm fracture treated with early internal fixation combined with free skin flap placement were retrospectively analyzed. There were 9 males and 11 females, with an average age of 40years. In all cases, the injuries were classified as Gustilo type IIIB. The area of the wounds ranged from 9×3cm to 27×10cm. Fist-stage plate fixation was adopted in 16 cases. Four patients presenting with major contamination received first-stage fixation with Kirschner wires and external fixation, and the second-stage surgery of surgical treatment included flap placement and internal fixation within 10days. The rates of limb salvage and complications were recorded. The Anderson scoring system was utilized to assess limb function. ResultsLimb salvage was successful in all 20 cases. The average length of hospital was 19 days (range, 7–28days). Four patients developed superficial infections. After debridement, the wounds were covered with skin grafts. No deep infections or osteomyelitis occurred. Three patients developed nonunion, and bone grafts achieved bone healing later. The donor skin flaps healed well, with partial pigmentation. No complete necrosis of the flaps occurred. Only the distal part of flaps became necrotic in two cases, which were then successfully treated by debridement and skin grafting. The average follow-up duration was 14.7months (range, 8–24months). According to the Anderson scoring system, 7 cases were graded as excellent, 6 cases as good, 5 cases as fair, and 2 cases as poor. ConclusionFor Gustilo IIIB type injuries, early and thorough debridement along with early internal fixation and skin flap coverage of the wound can achieve satisfactory clinical results, shorten the treatment cycle, and maximize limb function recovery. Level of evidenceIV; retrospective study without control group.

Individualized design of thoracodorsal artery perforator chimeric flap for customized reconstruction of complex three-dimensional defects in the extremities

BackgroundIt was always challenging to accurately and effectively reconstruct the complicated defects with three-dimensional tissue deficits in the extremities. Muscle-chimeric perforator flap is an excellent choice for repairing those complicated wound. However, problems like donor-site morbidity and time-consuming intramuscular dissection still exist. This purpose of this study was to present a novel design of the thoracodorsal artery perforator (TDAP) chimeric flap for the customized reconstruction of complex three-dimensional tissue defects in the extremities.MethodsFrom January 2012 to June 2020, 17 patients with complex three-dimensional deficits in the extremities were retrospectively analyzed. All patients in this series underwent extremity reconstruction using latissimus dorsi (LD)-chimeric TDAP flap. Three different types of LD-chimeric TDAP flaps were performed.ResultsA total of seventeen TDAP chimeric flaps were successfully harvested for the reconstruction of those complex three-dimensional defects in extremities. Among them, Design Type A flaps were used in 6 cases, Design Type B flaps were performed in 7 cases, and Design Type C flaps were used in the remaining 4 cases. The sizes of the skin paddles ranged from 6 cm × 3 cm to 24 cm × 11 cm. Meanwhile, the sizes of the muscle segments ranged from 3 cm × 4 cm to 33 cm × 4 cm. All the flaps survived. Nevertheless, one case required re-exploration owing to venous congestion. Moreover, the primary closure of the donor site was successfully achieved in all patients, and the mean follow-up time was 15.8 months. Most of the cases displayed satisfactory contour.ConclusionThe LD-chimeric TDAP flap is available for the reconstruction of complicated defects with three-dimensional tissue deficits in the extremities. It provided a flexible design for customized coverage of complex soft tissue defects with limited donor site morbidity.

Versatility of antero-lateral thigh free flap in reconstruction of defects in different parts of body - our experience

Extensive soft tissue defects pose a great deal of challenge to the reconstructive surgeon. The aim of this study is to analyze the outcome of free anterolateral thigh (ALT) flaps for soft tissue reconstruction of defects following tumor excision, trauma and post burn. A retrospective review of 19 patients undergoing ALT Flaps for various reasons from Dec 2018 to Jan 2021 was performed to determine perioperative factors, demographic profile, complications and outcomes. The mean age of the study population was 47.2 years. The male to female ratio was 2.16:1 (68.5 % male, 31.5% females). The etiology of soft tissue defect was post-tumor resection-47.36%, truam-36.8%, post burn reconstruction-10.5%. The defect sites were most commonly leg-31.5%, upper extremity-26.3%, buccal mucosa-15.7%, scalp-10.5%, tongue-10.5%, breast-5.2%. Flaps were harvested from right thigh in 52% of cases and left thigh in 58% of the cases. Donor site was closed primarily in 11 cases (57.8%), SSG coverage was done for 8 cases (42.8%). The minimum hospital stay post op was 12 days, maximum being 45 days. Postoperative complications were seen in 36.8% of the cases. Partial flap necrosis occurred in 3 cases (15.7%), complete necrosis in 1 case (5.2%), donor site morbidity was seen in 3 cases (15.7%). In the post-operative period hematoma and infection occurred in 3 cases. ALT Flap in experienced hands provide reliable coverage of large soft tissue defects with excellent aesthetic and functional outcomes with minimal donor site morbidity.

Assessment of Flap Viability and Post-operative Hand Function After Resurfacing of Acute Soft Tissue Injury onthe Palm of Hand byGroin Flap and Reverse Pedicled RadialForearm Flap

Background: Many flaps have been described and used for coverage of various soft tissue defects of hand, which can be regional or distant. Objective: In this study main goal is to evaluate the assessment of flap viability and post-operative hand function by Total Active Motion (TAM) and Hand grip strength. Method: This was a comparative observational study, conducted at department of Orthopaedic Surgery and Burn and Plastic surgery in Sylhet MAG Osmani Medical College Hospital (SOMCH) from January 2018 to October, 2019. A total of 16 patients with acute hand injury or pathology in the palm which may create surgical wound, admitted in the study place during the study period were the study population. Where those who had Acute wound in palm with exposed tendon, nerve and bones or degloving hand injury were included in the study. Patient were divided into two group namely Group-A and Group-B. Patient chosen for groin flap were allocated in group-A and for reverse pedicled radial forearm flap were in group-B. Results: During the study, complete flap survival was 100% in both group A and B. At all the follow-ups hand grip strength was more in group B and the difference was statistically significant (p&lt;0.05, obtained by unpaired t-test). At final follow-up (12 weeks) hand grip strength was 22.38 (SD±5.26) kg in Group A and 30.13 (SD±10.15) kg in Group B.There is no(0.0%) excellent result of index and middle finger in group A patient compared to 3 (37.5%) and 6 (75.0%) patients respectively in group B. Ingroup A3 patient had excellent outcome in ring fingercompared to 7 (87.5%) patients in group B. Majority (87.5%) patient‘s little finger was excellent in group A and 8(100.0%) in group B.The difference of index finger and middle finger were statistically significant between groups (p&lt;0.05 obtained by Fisher Exact test). Conclusion: From this study we can say that, both the handgrip strength and TAM score was better in patients who underwent radial forearm flap and the difference was statistically significant (p&lt;0.05). It is concluded that reverse pedicled radial forearm flap has better outcome regarding flap viability and post-operative hand function than groin flap.

First Dorsal Metacarpal Artery Flap : A Reliable Option for Reconstruction of Extensive Pulp Defects of the Thumb

Background: Thumb pulp defects are commonly due to avulsion injuries. The choice of reconstructive procedure for thumb depends on the amount and type of tissue lost. The First Dorsal Metacarpal Artery (FDMA) flap is a versatile method with minimum donor site morbidity which provides protective sensation, adequate length, stability and good mobility. Method: This study was done over a period of 2 years and involved 15 consecutive cases of thumb pulp defects treated at our institution. The patient included 13 men and 2 women ranging in age from 16 to 60 years. The defects were ranged from 2cm x 1.5cm to 5cm x 3cm. Results: All flaps survived completely except one had marginal flap necrosis healed without the need for a secondary procedure. Donor site was covered with full thickness skin graft that healed spontaneously. Conclusion: First dorsal metacarpal artery flap offers a sensate, pliable and versatile coverage for soft tissue defects of the thumb. It provides good functional Results with minimum donor site morbidity. J Bangladesh Coll Phys Surg 2023; 41: 53-57

Evaluation of various options for resurfacing of soft-tissue defects of dorsum of hand and their outcome assessment

Background: Soft tissue defect of dorsum of hand is a difficult problem to deal with in reconstructive surgery. Various factors have to be considered for planning of the reconstruction. Aims and Objectives: To assess the overall incidence of soft tissue defect on dorsum of hand, evaluation of different options for coverage of soft tissue defect on dorsum of hand, assessment of outcome and complications (both primary and donor sites) of reconstructive procedures and coverage of defect with like for like tissue. Materials and Methods: We present our experience of resurfacing soft-tissue defects of dorsum of hand in 27 patients by split thickness skin grafting, local flaps, distant pedicled flaps, and free flaps. Results: Among total 27 patients, in whom resurfacing was done, distant pedicled flaps such as groin/abdominal flap were performed in 13 patients, regional flaps like posterior interosseous artery flap were done in seven patients, free flap like anterolateral thigh flap was the method in three patients, and skin grafting was used in two patients. Complications such as partial or complete flap necrosis were noted in one patient each of free and regional flap and none in distant pedicled flap. The operating time was relatively less in distant pedicled flaps. Conclusion: Skin grafting had limited use when underlying vital structures were exposed. Distant pedicled flaps such groin and abdominal flaps were very useful for resurfacing the defect especially in emergency situations. Regional and free flaps had limited indications.

Usefulness of Reverse Radial Forearm Flaps in Covering Soft Tissue Defects of Hand and Wrist

Aim: To emphasize on the importance of reverse radial forearm flap (RRF flap) in the coverage of soft tissue defects of hand and wrist. Study design: This is a descriptive experimental study. Study place and duration: Study was comprised on the period of six months from January 2022 to June 2022. It was conducted in the plastic surgery department of Allama Iqbal Memorial Teaching Hospital Sialkot Methodology: Patients with the soft tissue defects of hand and wrist due to road traffic accidents, industrial or mechanical trauma and firearm injury were admitted to the plastic surgery ward. After achieving healthy wound with wound debridement, soft tissue coverage was done using reverse radial fasciocutaneous forearm flap. Patients with amputation of thumb and those with partial or complete bone loss were excluded from the study. Ages of the patients were 17-50 years with mean age of 31.42±5.3 years. Donor site of the flap was covered with split thickness skin graft and follow-up of the patients was done for at least three months. Results: 20 cases were included in this study including 16(80%) male and 04(20%) female cases. 15(75%) cases had soft tissue defect on the dorsum of hand, 04(20%) cases had palmar defect and in 01(5%) case there was amputation at transmetacarpal level and flap coverage of the stump was done. Partial loss of the flap happened in one 01(5%) case and it was treated with debridement and skin coverage. In one case superficial epidermolysis was found and managed conservatively. Practical implication Conclusion: Reverse radial forearm fasciocutaneous flap is an excellent option for the coverage of soft tissue defects of hand and wrist due to its greater arc of rotation which makes it easy to apply to the recipient site. Key words: Hand trauma, Soft tissue defects of hand, Reverse Radial Forearm Flap, Flap Coverage of Hand

Reconstruction of chronic radiation-induced ulcers in the chest wall using free and pedicle flaps.

Resection of radiation-induced ulcers often causes full-thickness defects of the chest wall. We retrospectively reviewed and evaluated 17 patients to explore a method of chest wall reconstruction. A total of 17 breast cancer patients with radiation-induced ulcers were included. Various type of prostheses and flaps were used, results of clinic were evaluated. Sixteen patients had full-thickness defects and one patient had only a soft tissue defect and underwent reconstruction with a pedicle latissimus dorsi (LD) myocutaneous flap. Among all 16 full-thickness defect cases, 15 patients underwent bony thoracic reconstruction using polymesh/3D-printed titanium plates or methyl methacrylate. For soft tissue reconstruction, 13 patients reconstruction using a free deep inferior epigastric perforator (DIEP) flap in combination with a contralateral transverse rectus abdominis myocutaneous (TRAM) flap, and 2 underwent pure free DIEP flap reconstruction. Among all the patients 15 healed with no complications, and 2 patients had delayed healing on the edges of the flaps. Distant pedicle or free flap can used for soft tissue defect coverage, for those severe patients with full-thickness defects and used prostheses, free deep inferior epigastric perforator flap in combination with a contralateral transverse rectus abdominis myocutaneous flap (TRAM + DIEP) would be an applicable choice.

Reconstruction of Multiple Digital Defects by Temporary Syndactylization Using a Lateral Arm Free Flap.

Background Soft tissue defects of the multiple finger present challenges to reconstruction surgeons. Here, we introduce the use of a lateral arm free flap and syndactylization for the coverage of multiple finger soft tissue defects. Methods This retrospective study was conducted based on reviews of the medical records of 13 patients with multiple soft tissue defects of fingers ( n = 33) that underwent temporary syndactylization with a microvascular lateral arm flap for temporary syndactylization from January 2010 to December 2020. Surgical and functional outcomes, times of flap division, complications, and demographic data were analyzed. Results Middle fingers were most frequently affected, followed by ring and index fingers. Mean patient age was 43.58 years. The 13 patients had suffered 10 traumas, 2 thermal burns, and 1 scar contracture. Release of temporary syndactyly was performed 3 to 9 weeks after syndactylization. All flaps survived, but partial necrosis occurred in one patient, who required a local transposition flap after syndactylization release. The mean follow-up was 15.8 months. Conclusion Coverage of multiple finger defects by temporary syndactylization using a free lateral arm flap with subsequent division offers an alternative treatment option.

The turbocharged wide anterolateral thigh perforator flap to reconstruct massive soft tissue defects in traumatized lower extremities: A case series.

Extensive traumatic soft tissue defects in the lower extremities typically require complete coverage of exposed bone because inadequate coverage, such as partial flap loss, may result in bony infection and ultimately lead to limb salvage failure. To achieve complete coverage of these defects, we used the wide anterolateral thigh perforator flap in which the turbocharging procedure augments the blood flow. Herein, we describe our turbocharging technique and discuss its effectiveness. From January 2014 to December 2020, the turbocharged wide ALTP free flaps were used to treat 13 patients with massive traumatic soft tissue defects in the lower extremities, ranging in size from 22 × 10 cm2 (220 cm2) to 21 × 17 cm2 (357 cm2) (mean, 270 cm2). All ALTP flaps were supplied by perforators from both the transverse branch of the lateral circumflex artery (TB-LCFA) and descending branch of the lateral circumflex artery (DB-LCFA) simultaneously. The turbocharging procedure by connecting the TB-LCFA to a side branch of the DB-LCFA was carried out in all these flaps. A retrospective review of medical records for each patient was performed. The size of the transferred ALTP flap ranged from 23 × 12 cm2 (276 cm2) to 23 × 19 (437 cm2) (mean, 331 cm2). The total number of perforators included in the flaps was three on average. All ALTP flaps survived completely without partial necrosis. The postoperative course was uneventful except for two cases with minor complications, including hematoma and partial necrosis of the recipient's skin. Free transfer of the turbocharged wide ALTP flap can be a reliable and effective reconstructive method to obtain complete coverage of extensive traumatic soft tissue defects in the lower extremities and achieve successful limb salvage.

Tratamiento multidisciplinario de condrosarcoma gigante de fémur proximal mediante hemipelvectomía externa y reconstrucción con colgajo pediculado tipo Fillet flap

El condrosarcoma forma parte de los tumores primarios malignos más frecuentes. Las localizaciones pélvicas y de raíz de muslo requerirán abordajes amplios con la consecuente dificultad de cobertura de partes blandas. La hemipelvectomía externa es habitualmente el procedimiento de elección para estas localizaciones. Implica la resección de la extremidad inferior en bloque asociada a la hemipelvis ipsilateral, dando como resultado un gran defecto de cobertura. En algunas circunstancias, la extensa resección de partes blandas hace imposible la utilización de colgajos rotacionales locales.&#x0D; La reconstrucción con colgajo tipo “Fillet flaps” ofrece a estos defectos de partes blandas la opción de lograr una adecuada cobertura. El objetivo del trabajo es mostrar la resolución de un caso poco convencional de condrosarcoma de fémur proximal y su reconstrucción de partes blandas con un método nunca antes utilizado en nuestro medio.