Flap For Reconstruction Of Defects Research Articles

Use of reverse sural artery flap for reconstruction of defects of distal leg, ankle and foot

Use of reverse sural artery flap for reconstruction of defects of distal leg, ankle and foot

Complications and Peri-operative Characteristics of Flaps for Reconstruction of Defects after Ablation of Squamous Cell Carcinoma of the Floor of the Mouth.

To determine the appropriate method to use to repair defects after ablation of squamous cell carcinoma (SCC) of the floor of the mouth (FOM). A retrospective review of 119 patients who underwent surgical resections of SCC of the FOM and flap reconstructions was conducted. A Student t test was used to examine the statistical differences in operative time, length of hospital stay and complications among groups with different reconstructions. Advanced-stage patients were repaired with more free flaps than local pedicled flaps that provided more reconstructions for small-to-medium defects. The most common recipient complication was wound dehiscence, and patients in the anterolateral thigh flap group developed a greater number of overall recipient site complications compared with those in other groups. Patients undergoing local flap reconstructions had shorter operative times compared with those with free flap reconstructions. In contrast to a radial forearm free flap as a more appropriate reconstruction for defects involving the tongue, an anterolateral thigh flap was better suited for defects with dead spaces. A fibular flap was appropriate for massive complex defects involving the mandible, FOM and tongue. A pectoralis major musculocutaneous flap provided the last line of reconstruction for patients with relapsed SCC or high-risk factors for microsurgical reconstructions.

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.

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

Introduction Extensive soft tissue defects pose a great deal of challenge to the reconstructive surgeon.The aim of this study is to analyse the outcome of free anterolateral thigh(ALT) flaps for soft tissue reconstruction of defects following tumor excision,trauma and post burn. Methods : 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. Results : The mean age 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 operating time was 205 minutes and maximum was 435 minutes, with an average time of …………..The minimum hospital stay post op was 12 days , maximum being 45 days.

Application of trifoliate flap design of radial forearm flap in reconstruction of defects after mouth floor cancer resection

Objective: To evaluate the effect of trifoliate flap design of radial forearm flap in reconstruction of defects after mouth floor cancer resection. Methods: From June 2016 to December 2019, 12 patients with defect after resection of mouth floor cancer were treated with trifoliate flap design of radial forearm flap. All of these patients were T2 stage, included 9 well-differentiated squamous cell carcinoma (SCC) and 3 moderate differentiated SCC. The defect size ranged from 8.0 cm×6.0 cm to 5.0 cm×4.5 cm after resection of tumor and neck dissection. All defects were repaired with trifoliate flap design of radial forearm flap. The flap size ranged from 8.0 cm×2.0 cm to 4.0 cm×1.5 cm, the donor site was sutured directly on Z plasty. Results: All flaps completely survived well. Both the wound and the donor site were stage Ⅰ healing. With the average follow-up of 38.6 months, the swallowing and speech function were satisfactory. Conclusions: Trifoliate flap design of radial forearm flap can effectively repair the postoperative defect of mouth floor cancer, and the donor site can be directly sutured on Z plasty. This technique can avoid forearm scar caused by skin grafting and the formation of the second donor site.

Pedicled Anterolateral Thigh Flap As A Workhourse Flap for Reconstruction of Inguino-Scrotal Defects

Background: Reconstructions around inguinoscrotal region has been a challenging task owing to complex anatomy. There are variety of flap options available for reconstruction of Inguinoscrotal region. Our study was done to evaluate the use of pedicled anterolateral thigh flap for reconstruction of defects around inguinoscrotal regions. Methodology: In this study a total of 18 patients with various types of defects around inguinoscrotal region were evaluated. The etiology of defects included trauma (𝑛=6), infection (𝑛=8), malignancy (𝑛=2) and burn (𝑛=2). Patients were evaluated in terms of viability of the flap, number of perforators included, pedicled length and flap dimensions and donor site morbidity. Results: All flaps were survived well except 1 flap develop venous congestion in immediate post operative period due to tension over vascular pedicle which was managed by increasing pedicle length. 2 patients had developed partial loss of the skin graft at the donor site which got healed secondarily in due course. All patients were followed up for an average period of 6 months, ranging from 1 to 12 months. Donor site morbidity was minimal. Conclusion: Pedicled ALT flap is a versatile, reliable flap, with wide arc of rotation which makes it as an ideal flap for the coverage of defects around inguinoscrotal region.

Utility of parascapular flaps for regional reconstruction of upper back defects: a case series

The latissimus dorsi (LD) flap has classically been described for posterior upper quadrant trunk defects. Perforator flaps have gained popularity among reconstructive surgeons as the predictable anatomy and muscle-sparing nature of parascapular flaps make this an attractive reconstructive option. We describe the versatility of the parascapular flap for reconstruction of defects in the axilla, deltoid, scapula and paraspinal region performed in six patients over a two-year period. The history of the parascapular flap, technique, patient outcomes and technical pearls are also discussed. We recommend this flap be considered a workhorse flap for defects in the posterior upper quadrant.

Retrospective analysis of free temporoparietal fascial flap for defect reconstruction of the hand and the distal upper extremity

IntroductionSoft tissue reconstruction of the hand and distal upper extremity is challenging to preserve the function of the hand as good as possible. Therefore, a thin flap has been shown to be useful. In this retrospective study, we aimed to show the use of the free temporoparietal fascial flap in soft tissue reconstruction of the hand and distal upper extremity.MethodsWe analysed the outcome of free temporoparietal fascial flaps that were used between the years 2007and 2016 at our institution. Major and minor complications, defect location and donor site morbidity were the main fields of interest.Results14 patients received a free temporoparietal fascial flap for soft tissue reconstruction of the distal upper extremity. Minor complications were noted in three patients and major complications in two patients. Total flap necrosis occurred in one patient.ConclusionThe free temporoparietal fascial flap is a useful tool in reconstructive surgery of the hand and the distal upper extremity with a low donor site morbidity and moderate rates of major and minor complications.

Masseter Flap for Reconstruction of Defects After Excision of Buccal Mucosa Cancers with Intact Mandible.

Among the reconstructive options available for buccal mucosa defects with an intact mandible, free flap with microvascular anastomosis is the best option. However, in the developing world, with poor resources, limited in- frastructure, and high patient load, this cannot be offered to all patients. We report on the success of the masseter flap for reconstruction of such defects in carefully selected patients. Despite some known limitations, this flap is easy to learn and carries acceptable complications. The results of this flap may not be comparable to those of microvas- cular reconstructions, but they are better than those from other options such as skin graft, nasolabial flap, submental flap, etc. in terms of surgical time required, no donor site morbidity, and minimal aesthetic deformity.

Lateral genicular artery flap for reconstruction of defects around the knee: a series of 5 cases

The lateral genicular artery flap is a fasciocutaneous flap used for knee reconstruction with low donor site morbidity. It is raised from the lower lateral thigh and is based upon the cutaneous termination of superior lateral genicular artery. This flap showed constant anatomy and is reliable for coverage of defects at superior and lateral portions of the knee and the proximal part of the lower leg. The study period was from January 2016 to June 2017 where we operated on 5 patients, 3 for post-traumatic and 2 were post burn contracture excision. The flap was used as a pedicled fasciocutanous and was based on the superior lateral genicular artery. Five cases underwent lateral genicular artery flap of which 4 were males and 1 was a female. Mean defect size was 12 cm×10 cm. All the donor sites were closed with a split skin graft. One patient had distal necrosis which was managed conservatively. The lateral genicular artery flap is a thin, versatile, reliable and easy to harvest flap for reconstructing defects around the knee, with good cosmetic and functional outcome.

Free flap reconstruction of sarcoma defects in the setting of radiation: a ten-year experience

Neoadjuvant treatment and surgical resection for sarcoma patients can often leave devastating wounds necessitating soft-tissue coverage in the form of free flaps. There is still debate as to the optimal flap for reconstruction of defects in irradiated fields. We aim to describe our experiences with free fasciocutaneous and free muscle flaps for sarcoma reconstruction in the setting of radiation therapy. A retrospective chart review was conducted encompassing all patients requiring soft-tissue reconstruction secondary to sarcoma resection from January 2010 to June 2019. Patient characteristics, flap viability and post-operative healing outcomes were all recorded and examined. In total, 49 patients who underwent 51 free-flaps were identified. Of these, 30 flaps were fasciocutaneous, while 21 were muscle-based. Most patients received pre-operative radiotherapy (76.5%), although these rates were not different between groups of flap type, and had no significant association with post-operative outcomes. Complication rates (31.3%) and re-operative rates (21.6%) were also comparable between flap types. Diabetes mellitus was significantly associated with delayed wound healing (p < .016), while the presence of peripheral vascular disease had a significant association with post-operative infection (p < .006). This study shows that free fasciocutaneous and free muscle-based flaps are both viable options for soft-tissue reconstruction demanded by sarcoma resection, even in the setting of radiation. Peripheral vascular disease and diabetes mellitus may confer increased wound complications.

Abstract B36: Avoidance of “prophylactic” tracheostomy in free-flap reconstruction surgery of the head and neck: Implications for postoperative outcomes and patient quality of life

Abstract Introduction: Elective “prophylactic” tracheostomy has routinely been performed intraoperatively at the time of resection and reconstruction of defects of the head and neck for airway protection in anticipation of potential airway complications. We hypothesized that selected patients do not require “prophylactic” or intraoperative tracheostomy placement at the time of resection and free flap reconstruction. Methods: Retrospective review over a 3-year period (2015-2018) of free flap reconstruction cases for defects resulting from the resection of head and neck pathology at Rush University Medical Center. Incidence and timing of tracheostomy placement, sites of resection and reconstruction, postoperative complications, length of stay (LOS), demographics, and procedure details were assessed. Results: 88 patients (59 male, 29 female, average age 63.06 years) undergoing free flap reconstruction for defects resulting from the resection of head and neck pathology were included. 59 patients did not receive “prophylactic” tracheostomy and 29 received “prophylactic” tracheostomy at the time of surgery. Of the 29 “prophylactic” tracheostomies, 16 underwent decannulation prior to discharge. Compared to those patients who did not receive “prophylactic” tracheostomies, patients who received “prophylactic” tracheostomies had longer average ICU LOS (6.41 ± 1.54 days vs. 3.34 ± 0.14 days, p&amp;lt;0.006) and longer average total hospital LOS (15.10 ± 1.79 days vs. 10.68 ± 0.95 days, p&amp;lt;0.018). Those patients who received “prophylactic” tracheostomies had a higher incidence of airway-related postoperative complications compared to those patients who did not receive “prophylactic” tracheostomies (27.6% vs. 6.8%, respectively, p&amp;lt;0.011). There was no statistically significant difference in incidence of general postoperative complications between those who received “prophylactic” tracheostomies and those who did not receive “prophylactic” tracheostomies (48.3% vs. 44.1%, respectively, p&amp;lt;0.442). Among those patients who did not receive “prophylactic” tracheostomies, only 2 patients went on to require tracheostomies prior to discharge. Conclusions: Patients who received “prophylactic” tracheostomies had increased ICU LOS, hospital LOS, and rate of airway-related postoperative complications, suggesting that select patients do not require “prophylactic” tracheostomy placement at the time of resection and free flap reconstruction. Citation Format: Hannah N. Kuhar, Ashley Heilingoetter, Samer Al-Khudari, Peter C. Revenaugh, Pete S. Batra, Kerstin Stenson. Avoidance of “prophylactic” tracheostomy in free-flap reconstruction surgery of the head and neck: Implications for postoperative outcomes and patient quality of life [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B36.

Using Freestyle Skin Flap in Closure of Defects in Upper Limb

Background: Defects in upper limb may result from primary open trauma, postoperative wound infection, raw area after burns or post burn scar excision, tumor excision, radiation injury. Some defects require skin flap for proper coverage and restoration of function. One of the methods recently used for reconstruction of defects in upper limb is local freestyle skin flap. This flap is based on a perforator which provides blood supply for flap and acts as pivot point when the flap is rotated. Objectives: To evaluate using freestyle flap for reconstruction of defects in upper limb and assess the post-operative results for restoring function and cosmoses. Patients and Methods: This is a prospective study carried out in Plastic & Reconstructive Surgery Department & Emergency Unit, Zagazig University Hospitals in the period from January to July 2018 including 12 patients with soft tissue loss in upper limb managed by freestyle skin flap. Results: 50% of the cases had soft tissue defect after contracture scar release, while 25% were due to traumatic cause and the remaining 25% were post malignancy resection. flap dimensions ranged from 6 - 96 cm². we had no complications in 58.3% of our cases, while minor complications like flap congestion and distal partial necrosis occurred in 33.4% which were resolved within 1 week. Unfortunately, we experienced 1 flap loss (8.3%) which managed later by debridement of necrotic tissue and skin grafting the remaining soft tissue. Conclusion: Freestyle skin flaps are a reliable option for coverage of small to moderate sized defects

Impact of sarcopenia on postoperative surgical site infections in patients undergoing flap reconstruction for oral cancer

Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength. The aim of the study was to investigate the impact of skeletal muscle mass on surgical site infection (SSI) in flap reconstruction for defects after oral cancer resection. The subjects were a non-randomized, retrospective cohort of 106 patients who underwent this procedure after preoperative abdominal-lumbar computed tomography (CT). Cross-sectional areas (cm2) of skeletal muscles in the L3 region were measured by manual outlining on CT images. These areas were then normalized for height (cm2/m2) and defined as the skeletal muscle index (SMI). Recipient site SSI occurred in 28 patients (26.4%). Lower body mass index, haemoglobin and SMI were significantly related to recipient site SSI in univariate analysis (P<0. 05). In a multiple logistic regression model, lower SMI was a significant risk factor for recipient site SSI (odds ratio = 3.95 per 10 cm2/m2 decrease, P=0. 005). This result suggests that increasing skeletal muscle mass by exercise or nutrition before surgery may prevent recipient site SSI after resection of oral cancer and subsequent reconstruction.

Peroneus brevis muscle flap for reconstruction of defects around the ankle: Clinical evaluation

Peroneus brevis muscle flap for reconstruction of defects around the ankle: Clinical evaluation

Usefulness of supraclavicular flap inreconstruction following resection oforalcancer.

ObjectiveTo evaluate the usefulness of supraclavicular artery flap in reconstruction of defects following resection of buccal mucosa cancer.MethodsTwenty-five patients who presented to R.L Jalappa Hospital and Research centre and diagnosed as squamous cell carcinoma of buccal mucosa staged T2 and above were included in our study. All patients underwent wide excision of tumour and neck dissection. Six patients underwent hemi-mandibulectomy while 4 patients underwent marginal mandibulectomy depending on extent of the tumour along with neck dissection. The defect following surgery was reconstructed using the supraclavicular artery flap and were followed up for minimum 6 months during which they were assessed for the functional and aesthetic outcome using a scoring system. The details of the scoring system comprised of 7 attributes. Each attribute was given a score of 10 if the patients experienced that attribute, while a score of 0 was given if the patient did not experience that particular attribute.ResultsSeven (28%) patients had complete necrosis of the flap. One patient had a local recurrence 2 months following surgery and was lost to follow up. The remaining 17 patients were followed up for a minimum of 6 months and a scoring system was adopted to evaluate the functional and aesthetic outcome of the supraclavicular flap. We observed that 14 patients had an excellent outcome score (58%), 3 patients had a good outcome score (13%), while 7 patients (28%) had flap necrosis.ConclusionsWe find the supraclavicular flap to be safe, technically simple, sensate, thin, pliable and reliable regional fasciocutaneous flap in reconstructing intra oral defects. Preserving the external jugular vein and sacrificing supraclavicular nerves give good outcome.

Assessment of functional outcome after parotidectomy reconstruction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Total or superficial parotidectomy, when a reconstructive technique is not used, usually leads to Frey’s syndrome, preauricular and retromandibular depression. These together with the scar from a classic or modified Blair incision limit the final aesthetic outcome. The superiorly based sternocleidomastoid muscle (SCM) flap or superficial musculo-aponeurotic system (SMAS) flap can be used for reconstruction of the defect to achieve better facial contour restoration. The aim and objective of the study was to evaluate the functional and cosmetic outcome of patients after reconstruction in parotid surgeries.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was done in the department of Otorhinolaryngology &amp;amp; Head-Neck Surgery. Total number of patients with parotid tumours were 24 in each group namely- Group A: Patients undergoing parotid surgery without reconstruction. Group B: Patients undergoing parotid surgery with reconstruction using superiorly based sternocleidomastoid muscle flap. All patients were followed and analyzed on 6 weeks, 6 months and 1 year postoperatively on the basis of patient’s satisfaction, cosmesis, subjective Frey’s syndrome, retromandibular and pre-auricular depression using visual analogue scale. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In Group A, subjective Frey’s syndrome was present in 8.3% patients from 6 month to 1 year. In contrast, in Group B, it remain absent in all patients at all periods. In Group A, preauricular depression was present in 79.2% patients in immediate postop and 95.8% patients from 6 week to 1 year. In contrast, in Group B, it was present in only 4.2% patients at all periods. In Group A, retromandibular depression was present in 70.8% patients while in Group B, it was absent in all patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The superiorly based SCM flap for reconstruction of defect following superficial or total parotidectomy improves the final outcome in terms of the facial deformity (pre-auricular, retro-auricular depression) and lowers the incidence of Frey’s syndrome.&lt;/p&gt;

Reconstruction of the Heel, Middle Foot Sole, and Plantar Forefoot with the Medial Plantar Artery Perforator Flap: Clinical Experience with 28 Cases.

Defects in the weight-bearing region of the foot sole can represent a substantial restriction in quality of life and pose a challenge for reconstructive plastic surgery. The purpose of this article is to report the authors' experience with the use of the medial plantar artery perforator flap for reconstruction of defects of the foot sole in three different regions: heel, middle foot sole, and plantar forefoot. From January of 2003 to May of 2016, 28 patients (13 male and 15 female patients) with an average age of 54 years (range, 12 to 84 years) underwent reconstruction with 28 medial plantar artery perforator flaps. Twenty-six flaps were harvested as pedicle perforator flaps and two as free perforator flaps. All flaps were raised from the ipsilateral instep area. The defect locations included the heel (20 cases), middle foot sole (four cases), and forefoot (four cases). The causes of reconstruction were tumors in 18 patients, decubitus in eight patients, and trauma in two patients. The flap sizes varied from 2.5 × 2.5 cm to 5.5 × 9.5 cm. All of the flaps survived completely after surgery, apart from one. The donor sites were all covered with a split-thickness skin graft. Follow-up observations were conducted for 4 to 12 months, and all patients had good functional recovery with satisfactory cosmetic results. The medial plantar artery perforator flap can be considered an optimal method of foot sole reconstruction not only for covering the weight-bearing area of the heel but also for the middle and forefoot plantar region. Therapeutic, IV.

Platysma myocutaneous flaps in reconstruction of defects caused by hypopharyngeal cancer resection

Objective:To study the method and feasibility in reconstruction of platysma myocutaneous flap of defects caused by hypopharyngeal cancer resection. Method:Twelve cases underwent reconstruction with the platysma myocutaneous flap of hypopharyngeal soft defect were investigated. All cases received 2 times preoperative induction chemotherapy followed by hypopharyngeal cancer resection with laryngeal function preservation and the neck lymph node dissection. Platysma myocutaneous flap was used to repair the hypopharyngeal soft tissue defect. Result:All the flaps survived. Three weeks after surgery, all patients can eat without pharyngeal fistula and dysphagia, but pharyngeal foreign body sensation. Three cases of cough after surgery, improved after training. After postoperative radiotherapy, flap survived without secondary necrosis. Laryngeal function of all cases was retained, and only one case with cannula maintained. Conclusion:Preoperative induction program can effectively reduce the lesion. The placenta myocutaneous flap has rich blood supply, strong anti-infectivity. It is an effective method to repair the hypopharyngeal tissue defect with the placenta myocutaneous flap.

The application of microvascular anastomotic coupler in vascular anastomosis of free tissue flap for reconstruction of defect after head and neck cancer resection

Objective: To investigate the application and operation skills in vein anastomosis by microvascular anastomotic coupler (MAC) in reconstruction of defects after head and neck cancer resection. Methods: From August 2015 to July 2016, in Department of Head and Neck Surgery, Sichuan Cancer Hosipital, 17 cases underwent the reconstruction of defects after head and neck cancer resection with free tissue flaps, including forearm flaps in 11 casess, anterolateral flaps in 4 casess and fibula flaps in 2 casess. Totally 17 MAC were used, including 14 MAC for end-to-end anastomosis and 3 MAC for end-to-side anastomosis. SPSS 22.0 software was used to analyze the data. Results: Venous anastomoses in 17 free tissue flaps were successfully completed, with no anastomotic errhysis. All flaps survived well. The time required for vascular anastomoses with MAC varied 2-9 min, with average time of (4.2±2.3) min, which was significantly shorter than that with manually anastomosis (17.4 ± 2.7) min (t=15.1, P<0.01). The followed-up time ranged from 6 to 18 months. The flaps in recipient area healed well. The shape and function of recipient area were satisfying. Conclusions: Microvascular anastomotic coupler can be used for vessel anastomosis in free tissue flap for reconstruction of defect after head and neck cancer resection, which requires for less operation time and shows good results.