Microneurovascular Flaps Research Articles

Free Gracilis Muscle Flap for Sarcoma Reconstruction: 19 Years of Clinical Experience.

Background Sarcoma treatment necessitates high-dose chemoradiation therapy and wide surgical margins that create wounds that are difficult to reconstruct. Many techniques have been developed to cover these defects, originating with muscle flaps such as the rectus abdominis and latissimus dorsi. The gracilis flap, which is best known in contemporary practice as a microneurovascular flap for functional reconstructions, is not usually considered a robust option for reconstruction after sarcoma extirpation. Methods We reviewed records of 22 patients (9 women) at our institution who underwent reconstructive surgery after sarcoma extirpation using gracilis flaps for soft-tissue coverage from 1998 to 2017. Neurotized gracilis flaps were excluded. The mean patient age was 51 years (range, 18–85 years), and mean length of follow-up was 53 months (range, 9–156 months). Patients had 7 tumor types, with fibrosarcomas and undifferentiated tumors being most common. There were 23 defects (mean size, 118 cm2 (range, 54–200 cm2)). Defects were located most commonly in the foot and leg (n=9 each), upper extremity (n=4), and head and neck (n=1). The primary outcome was the flap success rate. Secondary outcomes were rates of major complications (unplanned reoperations, infections requiring intravenous antibiotics, and amputations); minor complications (superficial infections, partial skin-graft loss, partial flap necrosis, fluid collections treated in the office, and cosmetic reoperations); and sarcoma recurrence. Results Twenty-one flaps (91%) survived. Six patients (27%) experienced a major complication, and 12 patients (54%) experienced a minor complication. There were 2 amputations, for a limb salvage rate of 91%. Conclusions This series shows that the gracilis is well suited to covering large, compromised wounds across diverse anatomic features, which are the hallmark of sarcoma resections. The high rate of limb salvage and minimal donor-site morbidity further support the use of this flap as a first-line option for sarcoma reconstruction.

Magnetic resonance imaging of microneurovascular free muscle flaps in facial reanimation

The purpose of this study was to describe the survival and volume of microneurovascular muscle flaps at different times after two-stage facial reanimation procedure by using magnetic resonance imaging (MRI) and to compare the functional outcome with MRI findings. Fifteen patients with a mean age of 36 years (range 7–63 years) operated on between 1988 and 1999 were available for this study. The muscles used for functional reconstruction were the latissimus dorsi (eight patients), gracilis (six patients) and serratus anterior (one patient). Hospital charts were reviewed and the clinical outcome of facial reanimation was graded on a scale from 1 to 6 according to House. The mean postoperative follow-up time was 7 years (range 3–14 years). Clinical grading and 1.5 T unit MRI of patients were performed concomitantly. The MR images were evaluated semi-quantitatively so that the muscle structure of the free flaps was graded on a scale from 1 to 4. The free flap area of each slice was defined and the volume of the free flap was calculated. Data were analysed statistically. The long-term functional outcome of the facial reanimation was regarded as good in 10 patients, which means they had only mild or moderate dysfunction of facial movements. In MR images, six free flaps displayed normal muscle structure, another six had a fatty appearance and two displayed severe muscle atrophy; in one patient the muscle tissue could not be identified. The volume of the free flap clearly declined in the course of the follow-up. A correlation was found between good functional outcome and normal muscle structure of the free flap in MRI, p=0.020. The longer the follow-up time after muscle transplantation the poorer the functional result. A similar correlation was found between abnormal muscle structure in MRI and a long follow-up time. Magnetic resonance imaging can be used to assess the muscle structure of free microneurovascular flaps. Normal findings in MRI seem to correlate with a good clinical outcome in facial reanimation. A good functional result correlates with a shorter follow-up time and normal muscle structure in MRI.

Complications in circulation hamper the reinnervation of rat groin flaps

The reinnervation of rat groin island flaps and microneurovascular flaps was investigated. The nerve trunk leading to the flap was transsected in all rats and the nerve ends were either resutured or ligated. Sensory and adrenergic reinnervation of the flaps was studied semiquantitatively after 20 weeks using specific antisera for calcitonin gene-related peptide (CGRP) as a marker for sensory nerves, neuropeptide Y (NPY) for adrenergic nerves and Protein Gene Product 9.5 (PGP 9.5) as a general neuronal marker. The reinnervation of island groin flaps was compared to that in corresponding microneurovascular flaps. The nerve suture clearly increased both sensory and adrenergic reinnervation. In island flaps the reinnervation was good throughout the flap, whereas in microsurgical flaps the reinnervation pattern was more sparse and patchier. Evidently the cause for this was circulatory disorders and the reperfusion injury which takes place after the ischemic period in microsurgical flaps.

259. Der Unterarmlappen

Our experience with the forearm flap based on the radial artery, one or two forearm veins and nerves is demonstrated in typical clinical applications (originator: Prof. Song, Beijing). This micro-neurovascular flap has been used as free flap including the osteocutaneous modality to resurface tissue defects in the neck, the upper and lower extremities. As a neuro-vascular island flap, it can cover defects of the ipsilateral hand.

Neurovascular free flaps from the foot for innervation of the hand

Microneurovascular flaps from the first web space of the foot offer a solution to upgrade sensibility of the denervated hand. Based on the dorsalis pedis artery, it allows simple dissection and a large vessel for easy and safe anastomosis. Seven cases are presented in which combinations of the first web anatomy for a variety of denervation injuries were used. The technique is ideally suited in those cases where no areas of island flap tissue are available for transfer.