Pedicled Abdominal Flap Research Articles

Pedicled Abdominal Flaps for Hand Reconstruction in Adults: Physiotherapy of the Attached Hand.

Background:Hand reconstruction using pedicled abdominal flaps has several disadvantages, including delayed hand therapy leading to stiffness.Methods:This is a retrospective study of 70 cases of pedicled abdominal flaps used for hand reconstruction in adults in whom physiotherapy of the attached hand was implemented. The review aims to investigate the rate of flap dehiscence, infection, hematoma, and flap edge necrosis in our cases, and to establish that physiotherapy of the attached hand is not associated with an increased risk of complications. The review also aims to establish the effectiveness of physiotherapy of the attached hand in reducing the risk of stiffness by documenting the range of motion of the uninjured digits immediately after flap division and at final follow-up.Results:There were no cases of flap dehiscence, infection, or hematoma. Six cases had minor partial flap edge necrosis that was treated conservatively and allowed to heal by secondary intention. In 62 patients, the range of motion of the uninjured digits was 90%–100% of the normal range of motion at day 1 post-flap division, and all of these patients recovered a full range of motion (in the uninjured digits) within 2 weeks of follow-up. Eight patients were reluctant to do the exercises as instructed because of low pain threshold; 4 of these 8 patients had residual stiffness at the final follow-up.Conclusion:The implementation of active exercises of the attached hand is feasible in selected cases and it helps minimize the risk of stiffness of the hand.

Use of a combined SIEA and SCIP based double pedicled abdominal flap for breast reconstruction.

Recently, the deep inferior epigastric perforator (DIEP) flap has become the gold standard for breast reconstruction, but it has some drawbacks such as abdominal bulging and hernia. To overcome these disadvantages, the superficial inferior epigastric artery perforator (SIEA) flap is used as an alternative option, but it has another problem, namely limited vascular territory and risk of vascular thrombosis. To solve these problems, we introduced our new technique, a combined SIEA and superficial circumflex iliac artery perforator (SCIP) based double pedicled abdominal flap. In this report, we present our experience of using this technique. The SIEA and SCIP based double pedicled abdominal flap was used in five patients who wanted to have unilateral breast reconstruction after a mastectomy due to breast cancer. The average age was 48.2 (range 38-56) years, and the average BMI was 24.4 (range 19.2-31.4). The SIEA and SCIP based double pedicled abdominal flap was designed as a modified DIEP flap, and all flaps were placed in the vertical setting. The flap pedicles had two different vascular supplies, SIEA and SCIA, and the drainage systems, SIEV and SCIV, anastomosed to the internal mammary artery and vein in all cases. The harvested SIEA and SCIP based double pedicled abdominal flaps were a median volume of 925 g (range 452-1570 g) and average size of 491 cm2 (range 440-611 cm2 ). The average reconstructive time was 7:41 (range 6:31-9:17). In four out of the five cases, the SIEA and SCIA joined together to make a common pedicle artery trunk, and its average size was 1.08 mm. Four out of the five cases had a wide vascular territory crossing the abdominal midline as shown by ICG angiography. One case showed ICG fluorescence for the hemi-side of the abdominal flap. Postoperative course was uneventful, and there were no major perioperative complications, which need extra surgical procedures. Follow-up period averaged 273 days (range 194-312 days). The SIEA and SCIP based double pedicled abdominal flap showed viable flap territory across the midline in all cases. The SIEA and SCIP based double pedicled abdominal flap might be another ideal option for breast reconstruction, when appropriate SIEA and SCIA pedicles are identified, and an adequate ICG fluorescence is obtained for the size of flap needed.

The use of pedicled abdominal flap to salvage a necrotic forearm - a case study

The use of pedicled abdominal flap to salvage a necrotic forearm - a case study

Contralateral pelvic upper limb external fixation: External fixation to stabilize of pedicled abdominal flap for crush injury of upper limbs

Contralateral pelvic upper limb external fixation: External fixation to stabilize of pedicled abdominal flap for crush injury of upper limbs

Clinical characteristics and repair effect of 136 patients with electric burns of upper limb

Objective: To analyze clinical characteristics and wound repair methods and effects of patients with upper limb electric burns. Methods: Medical records of 136 patients with upper limb electric burn who met the inclusion criteria and hospitalized in our unit from January 2015 to March 2019 were retrospectively analyzed. Proportion in patients with electric burns in the same period, gender, age, admission time, categories, injury causes, injury voltage, burn area and depth of upper limb, simultaneous injury of both upper limbs, and early wound treatment measure of patients with upper limb electric burn were recorded. The main repair methods of each affected limb were classified and recorded. The overall efficacy of the patients was recorded, including postoperative wound complications and healing condition. The patients repaired with distal pedicled flaps and those with free flaps were followed up for 3 to 6 months. The survival rate of flaps were recorded, the function of affected limbs after operation was evaluated, and the satisfaction degree of patients was investigated by Curative Effect Score Table. The amputation rate, age, and burn area of upper limbs of patients caused by high-voltage and low-voltage electricity were compared. Data were processed with Wilcoxon rank sum test, chi-square test, or Fisher's exact probability test. Results: (1) The number of upper limb electric burn patients accounted for 88.3% of 154 patients with electric burns hospitalized in the same period, including 117 males and 19 females, aged 1 year and 2 months to 72 years [(34±18) years], admitted 1 h to 48 d after injury, including 51 electricians, 32 rural migrant workers, 31 students and preschool children, and 22 patients belonging to other categories. Patients of the first two categories were mainly injured by work accidents, and those of the latter two categories mainly suffered from touching power source or power leakage. Among all the patients, 75 cases were injured by high-voltage electric burn, and 61 cases were injured by low-voltage electric burn, with burn area of upper limb from 0.2% to 16.0% [2% (1%, 5%)] total body surface area (TBSA) and area of wounds deep to bone from 0.2% to 15.0% [2% (1%, 5%)] TBSA. Two upper limbs in 54 cases were simultaneously injured, accounting for 39.7%. Early fasciotomy was performed for 73 limbs. (2) Thirteen affected limbs were treated with dressing change, 2 affected limbs were sutured directly after debridement, 56 affected limbs were repaired by skin grafting, 12 affected limbs were repaired by local flap, 45 affected limbs were repaired by distal pedicled flap, 22 affected limbs were repaired by free flap, and 40 affected limbs were amputated (accounting for 21.1%). (3) One case died of pulmonary infection, sepsis, and multiple organ failure after operation, and the rest patients were all cured. One case with avulsion of abdominal flap was repaired by skin grafting after dressing change. The anterolateral thigh flap in one case necrotized after transplantation, which was replaced by pedicled abdominal flap. Seven cases had small erosion on the pedicle or margin after transplantation of abdominal flap and were healed by dressing change. Six cases had local bruising at the distal end after transplantation of abdominal flap and were healed after conservative treatment such as hyperbaric oxygen. The other flaps survived well. (4) The survival rate of distal pedicled flap grafting was 97.8% (44/45), which was close to that of free flap grafting (95.5%, 21/22, P>0.05). The function recovery of affected limb after free flap grafting was better than that of distal pedicled flap grafting (Z=-3.054, P<0.01), but their satisfaction degree of patients was similar (Z=-0.474, P>0.05). (5) Patients with high-voltage electric burn had higher amputation rate, older age, and larger upper limb burn area than those with low-voltage electric burn (χ(2)=4.743, Z=-2.801, -6.469, P<0.05 or P<0.01). Conclusions: Upper extremity electric burn often occurs in children, electricians, and rural migrant workers with high rate of amputation. Teachers and parents should strengthen safety education for children and manage power source of life well. Workers should improve safety awareness and operate standardly. Fasciotomy for relaxation should be performed for electric burn wound as soon as possible, and flap grafting can effectively repair wound after early debridement. The function recovery of affected upper limb repaired with free flap grafting is better.

Application of self-made vacuum sealing drainage device in postoperative fixation and drainage of abdominal pedicled flaps in 8 patients with deep burns of upper limbs

From January 2013 to December 2017, 8 patients with deep burns of upper limbs were admitted to our hospital, including 6 males and 2 females, aged 23-48 years. The wound area of full-thickness burns to burns with tendon and bone injury was 4.5 cm×2.0 cm-20.0 cm×10.5 cm. After debridement, thin abdominal flaps with subdermal vascular network in the size of 5.0 cm×2.5 cm-22.0 cm×12.0 cm were applied to cover the wounds, and the donor sites were sutured directly by relaxation. The disposable suction tubes with holes cut on side walls were used as drainage tubes. The part of drainage tubes with holes were wrapped with nano-silver antimicrobial dressings and then placed at the lowest position of pedicle and donor site of abdominal flap and the space between the injured limb and the abdominal wall. The loose nano-silver antibacterial dressing was used to fill the webs of fingers and the gap between the injured limb and the abdominal wall. The transparent film dressing was used to close the surgical area and then connected with a low negative voltage electric suction device to continuously suck at a negative pressure of -15 to -10 kPa. The self-made vacuum sealing drainage device was replaced at intervals of 4 to 5 days until pedicle breakage was performed 2 to 3 weeks after operation. The pedicled abdominal flaps of 8 patients had no torsion or avulsion, no pedicle blood supply disorder, and no infection or skin erosion in the operation area, and all the flaps survived after pedicle breakage.

The role of pedicled abdominal flaps in hand and forearm composite tissue injuries: Results of technical refinements for safe harvest

We evaluated the outcome of new technical refinements in abdominal flap coverage of major defects in upper limb for its reliability and safety. 68 patients were assessed for indications, additional procedures, complications and DASH questionnaire evaluation at the end of a year. The mean size of flap was 56 cm2 (range 6-250 cm2). Median DASH score was 11.5 (range: 0-63). Hand stiffness was observed in 39% of patients. However, this was absent in whom prophylactic pinning of metacarpophalangeal joints were done in James position. Abdominal flaps give satisfactory results in hand injuries. Competent hand therapy program is essential to get best results.

Novel Injury Site Targeted Fusion Protein Comprising Annexin V and Kunitz Inhibitor Domains Ameliorates Ischemia-Reperfusion Injury and Promotes Survival of Ischemic Rat Abdominal Skin Flaps

The effects of ANV-6L15 on survival of rat abdominal fasciocutaneous flaps subjected to 10 hours of critical ischemia were assessed on day 5. Near-IR imaging was applied to evaluate the distribution of ANV-6L15 and flap perfusion. The rat cremaster muscle island flap was used to evaluate the effect of ANV-6L15 on IRI-induced leukocyte-endothelial interactions via intravital microscopy. 2,3,5 triphenyl-tetrazolium chloride assay was used to determine the ratio between live-versus-dead tissue. ANV-6L15 significantly increased the ratio of viable tissue (68.5 ± 9.79% vs 84.8 ± 5.14%, P < 0.05), and promoted survival of rat pedicled abdominal flaps (59.3 ± 6.86 vs. 47.0 ± 8.67, P < 0.05). Intravital microscopy demonstrated a significant decrease in the number of adhesive leukocytes (1.8 ± 1.64 vs. 10.0 ± 6.32, P < 0.05), and the percentage change of functional capillaries (16.4 ± 15.1 vs. 47.3 ± 18.3, P < 0.05) in ANV-6L15-treatment group. ANV-6L15 promoted survival of ischemic rat cremaster muscle and abdominal fasciocutaneous flaps and ameliorated leukocyte-related IRI. Future evaluation of potential clinical application of ANV-6L15 is warranted as a flap treatment adjunct.

Application of anti skin grafting and two pedicled abdominal flap to repair the whole hand degloving injury

Objective To explore the application of anti skin grafting and two pedicled abdominal flap to repair the whole hand degloving injury.Methods From June,2007 to December,2013,20 cases of hand degloving injury of skin and skin graft,waste application and combined application of VSD vacuum suction and two fingers abdominal pedicled skin flap repair,postoperative fingers activity,strength,degree of sensory recovery and function of four standards,respectively.After doing comprehensive evaluation.Evaluation standard:excellent for 13-16,good for 9-12 minutes,could be 5-8,difference of 4 points.Results Excellent functional recovery in 19 cases,accounting for 95％.In 1 patient the pain was not combined with exercise induced proximal interphalangeal joint part stiffness function can,accounted for 5％.Metacarpophalangeal joint activity of about 80 °-90 °,proximal interphalangeal joint activity of about 85 °-90 °.The 6 cases of sensory recovery grade S5,14 cases of abdominal two-way two subdermal vascular network flap for repair of sensory recovery S3.The patients were followed up for 2-6 years,results of 19 cases of activity were 4 points,1 case of active degree was 3,16 cases of power:4 points,3 points in 3 cases,1 case of 2 points.Feel:18 cases was 3,2 cases of 2 points.Function:18 cases was 4,2 cases of 3 points.Conclusion The operation method of small trauma,no multiple finger operation,avoids the contracture of the first web space and joint stiffness,for basic level hospital. Key words: Hand; Degloving injury ; Vacuum sealing pressure drainage technique ; Skin graft ; Microsurgical operation

Paraumbilical Perforator-Based Pedicled Abdominal Flap for Extensive Soft-Tissue Deficiencies of the Forearm and Hand

A new paraumbilical-based pedicled abdominal flap was used in 11 patients with extensive soft-tissue defects of the forearm and hand. With a relatively narrow pedicle, large flaps up to 5- x 14-cm can be raised. Another advantage of this flap is the comfortable position of the hand and forearm for the patient. The main disadvantage is the conspicuous abdominal scars like the other pedicled abdominal flaps.

Contraction of experimental skin flaps.

Contraction of experimental skin flaps in loose-skinned animals is a well-known but underestimated phenomenon that in fact may vary in different circumstances and complicate the calculations of survived and necrosed areas. A standard abdominal island skin flap design in the rat was used in this study to investigate the difference between the contraction rates of necrotic and survived tissues, and to determine its significance in the experimental models. The abdominal island skin flap was based on the inferior epigastric neurovascular bundles, and it extended from the pubis to the xiphoid and between the both midaxillary lines. The study was conducted in two steps. In the first step, contraction rates of completely necrosed (both pedicles severed) and completely survived (vascular pedicles were intact on both sides either with or without a nerve supply) flaps were assessed in 45 animals. After 1 week, area loss was highly significant in both necrosed and survived flaps (p < 0.001). The rate of contraction was significantly higher in necrosed tissues than in survived tissues (p < 0.001), and it was also significantly higher in the neurovascular flaps than in the denervated flaps (p < 0.05). The contraction of all flaps occurred in the vertical dimension, whereas the horizontal dimension stayed almost the same. In the second step of the study, a unilateral, pedicled abdominal flap was used, which had a constant necrotic zone on the nonpedicled half, either with or without a nerve supply in 30 animals. After 1 week the pedicled halves of all flaps were significantly larger than the nonpedicled halves (p < 0.001). Although the total area loss was higher in the neurovascular flaps than the denervated flaps, the difference was not significant statistically (p > 0.05). There was no statistically significant difference between the areas of necrosis seen in both groups when it was expressed as a proportion of the total flap area (p > 0.05). However, this insignificant difference became significant when the amount of necrosis was expressed as a proportion of only the nonpedicled flap half, favoring the denervated flaps (p < 0.005). It appears in this study that ultimate proportions of surviving and necrosed tissues may be inconsistent owing to the variable contraction rates of these tissues, and misleading conclusions may appear during the assessment of given treatment modalities.