Reconstruction Of Extensive Defects Research Articles

Re: "Extensive Defect Reconstruction With Pre-Expanded Anterolateral Thigh Flap".

Re: "Extensive Defect Reconstruction With Pre-Expanded Anterolateral Thigh Flap".

Free Tissue Transfer in Head and Neck Reconstruction: A Multidisciplinary 15-Year Experience.

Free tissue transfer is considered the gold standard in reconstruction of extensive defects in head and neck surgery. The aim of this 15-year retrospective study is to analyze the outcomes of free tissue transfers in the head and neck area in a tertiary referral university hospital. A retrospective, single-center study of all patients undergoing free tissue transfers for head and neck reconstruction between 2006 and 2020 was performed. Patient demographics, comorbidities, flap characteristics, outcomes and complications were assessed. A total of 353 free flaps were performed. The most common defect etiology was synchronous oncologic resection (74.2%). The majority of patients had at least one comorbidity (70.3%), with smoking recorded in 46.2% of the cases and alcohol consumption in 31.7%. The anterolateral thigh flap was the most commonly used flap (37.7%), followed by the osteoseptocutaneous fibula flap (26.9%). Our overall flap success rate was 97.7%, while the overall complication rate was 45.9%. Free tissue transfer in head and neck reconstruction is reliable. However, complication rates remain high due to the complexity of such cases and frequent presence of comorbidities. Nonetheless, when effectively managed within a multidisciplinary team, complications rarely jeopardize the overall reconstruction outcome.

Extensive Defect Reconstruction With Pre-expanded Anterolateral Thigh Flap: Tissue Expansion of the "Outskirts".

Previously reported pre-expansion techniques of the anterolateral thigh flap are mainly perforator-based. The expansion will interfere with the flap harvest if the requisite perforator is found unsuitable as a pedicle. Expansion of the peripheral territories of the flap donor site can minimize the interference from the expansion. Forty-eight peripheral pre-expansions of the anterolateral thigh flap were retrospectively reviewed in 38 patients from 2012 to 2021. The reconstructive outcomes, including flap success, increase in flap size, donor-site closure, and complications, were assessed. In addition, subgroup analysis was performed based on the expanded territories. Rate of successful flap elevation of 100% and flap survival rate of 97.9% were achieved. One patient had total flap necrosis, which was salvaged with skin grafting. Peripheral expansion attained a mean 55.5% ± 19.6% increase in flap width. Primary donor-site closure was accomplished in 95.8% of flaps and fascial restoration in 97.9% of the donor sites. Three patients developed major expansion-related complications, which required surgical intervention. One patient had wound dehiscence in the donor site, which healed by secondary intention. Compared with other subgroups, the lateral-and-medial-side expansion provided a larger flap for reconstruction (P = 0.001). If time is not of the essence, peripheral pre-expansion permits direct donor-site closure with size augment of the anterolateral thigh flap. In addition, it preserves the reliability and versatility of the anterolateral thigh flap.

Platelet and leukocyte rich fibrin (L-PRF) applied in necrotizing Fasciitis treatment: case report

The reconstruction of extensive defects on the face caused by infections is a challenge for the oral and maxillofacial surgeon. Platelet and leukocyte-rich fibrin (L-PRF) is an excellent option for rehabilitative treatment, as it contains molecular and cellular elements that induce repair, being a therapeutic biomaterial with high potential for soft tissue regeneration. This article presents the clinical case of the patient C.T.A.S., female, 21 years old, who reported multiple tooth extractions, with an evolution of 30 days of volume increase and intense algesia in the left bucal space. Diagnosing necrotizing fasciitis, the patient underwent IV antibiotic therapy and surgery to drain and debride the lesion. Postoperatively, therapy with platelet- and leukocyte-rich fibrin was initiated for tissue regeneration in the area affected by fasciitis. As an adjuvant to L-PRF membranes, low-level laser therapy and hyperbaric oxygenation sessions were performed. When using L-PRF to resolve this case, a satisfactory result was observed regarding the aesthetic-functional repair. In addition to having the advantage of being cost-effective, and having a simple protocol to be performed, L-PRF proved to be effective in promoting tissue regeneration.

Surgical treatment of children with extensive bone defects (Literature review)

BACKGROUND: Reconstruction of extensive defects to bone tissue is one of the important problems of orthopedics and traumatology. Especially in acuteis, the problem is associated with the restoration of bone tissue in conditions of its deficiency in pediatric patients.
 AIM: The aim of the study is to analyze modern methods of surgical treatment in children with extensive bone tissue injuries based on the published literature.
 MATERIALS AND METHODS: Our report presents a review of the literature of methods of surgical treatment of extensive bone defects. The literature search was carried out in several databases such as PubMed, ScienceDirect, E-library, GoogleScholar for the period from 2005 to 2020, using the keywords given below. As a result of the search, 105 foreign and 37 domestic sources were found. After exclusion, 56 articles were analyzed, all presented works were published in the last 15 years.
 RESULTS: The gold standard for replacing bone defects is still the use of autografts, including the use of technologies on a vascular pedicle. Various types of xenografts and allografts of bone tissue are increasingly being replaced by various kinds of synthetic implants.
 CONCLUSIONS: To date, there is no single generally accepted standard for the surgical treatment of extensive bone defects. The option of surgical treatment of extensive bone tissue defects using tissue-engineered bone implants with axial blood supply seems to be extremely interesting and promising.

Nasal reconstruction of extensive defect using axial paramedian forehead flap after staged excision for relapsed basal cell carcinoma

Nasal reconstruction of extensive defect using axial paramedian forehead flap after staged excision for relapsed basal cell carcinoma

Reconstruction of Extensive Defects with Combined Transverse-Vertical Rectus Abdominis (Cruciate) Myocutaneous Flaps

Reconstruction of Extensive Defects with Combined Transverse-Vertical Rectus Abdominis (Cruciate) Myocutaneous Flaps

Cultured epithelial autografts for the coverage of large wounds: minimizing skin graft donor sites in the sick patient

Systemically unwell patients with extensive wounds present a reconstructive challenge. Conventional skin grafting results in surgical morbidity and donor wounds that may not heal. We propose that cultured skin, in the form of cultured epithelial autografts, be used for wound coverage in these patients. We present two patients with chronic large wounds over the abdomen and the leg. Keratinocytes obtained from a skin biopsy were cultured on a fibrin mat and the cultured epithelial autograft (CEA)–fibrin construct was delivered onto the wound bed 3 weeks later. Initial graft take was 85 and 75 % respectively, and epithelization was complete by 3 weeks. Stable, good quality coverage was maintained at 1.5 years follow-up. We conclude that in a selected group of patients, CEA is a useful modality for the reconstruction of extensive defects with minimum donor site morbidity. The fibrin mat is an optimal system that supports the growth of keratinocytes and allows easy delivery to the wound bed.

Transoral robotic surgery: Role in the management of upper aerodigestive tract tumors

The toxicity associated with concomitant chemoradiation for the management of laryngeal and pharyngeal carcinoma has been well documented. Minimally invasive surgical techniques offer the potential to extirpate the malignancy as a single-modality therapy and provide essential information that may direct subsequent treatment. In selected patients, radiation doses may be reduced and systemic chemotherapy may be withheld after tumor extirpation. Transoral laser microsurgery has proven effective, although inability to manipulate and suture tissue by this modality limits ablation and reconstruction of extensive defects. Transoral robotic surgery is a relatively new technique that provides several unique advantages, which include a 3-dimensional magnified view, ability to see and work around curves or angles, and the availability of 2 or 3 robotic arms that can be used to reconstruct extensive defects using either local, regional, or free flaps. Preliminary data suggest that transoral robotic surgery may provide a technique for ablation and reconstruction of pharyngeal defects that may be superior to other transoral techniques. It may also provide a means for personalizing therapy for oropharyngeal and supraglottic carcinoma.

Dorsal forearm adipofascial turnover flap among the elderly

We have assessed the results of soft tissue cover on the back of the hand using an adipofascial turnover flap. From 2004 until 2007, 14 patients (mean age: 62 years) underwent reconstruction of extensive defects in the dorsum of the hand, using a forearm adipofascial turnover flap based on the perforators of the anterior interosseous artery covered with a split skin graft. The pivot point of the flap is typically 4-6 cm proximal to the level of the radial styloid process. In 93% of patients, the reconstruction healed without any problem. The adipofascial turnover flap is a useful and reliable method of reconstruction of the dorsum of the hand even in elderly patients.

Use of Titanium Mesh for Reconstruction of Extensive Defects in Fronto-orbito-ethmoidal Fracture

Traumatic injuries treatment of the fronto-naso-orbito-ethmoidal region has been one of the most challenging treatments within maxillofacial surgery, particularly of extensive orbital defects, very common in this type of pathologic condition. A 48-year-old man involved in a car collision presented an extensive bilateral fracture of the orbit medial wall, nasal bones, the nasal septum, and the frontal anterior table. The clinical and tomographic findings concluded the diagnosis of a maxilla and fronto-naso-orbito-ethmoidal fracture. Among the variety of biomaterials, the titanium mesh was elected because of the extension and magnitude of the bone defect, obtaining this way esthetic and functional results with better prognosis.

Reconstruction of complicated defect after ablation of superficial cranial malignant tumor with latissimus dorsi musculocutaneous flap

Objective To deal with complicated defect 'after ablation of scalp malignant tumor, especially in patients with cranium or dura defect. Method Seventeen consecutive scalp reconstructions with free latissimus dorsi musculocutaneous flap after large tumors ablation were reviewed. Results The scalp defects varied from 15 cm × 15 cm to 20 cm ×25 cm. The cranium defect varied from 5 cm ×5 em to 14 cm× 14 cm. There were seven patients with dura defect. The dura defects varied from 5 cm ×5 cm to 10 cm ×9 cm. The areas of latissimus dorsi musculocutaneous flap varied from 19 cm × 20 cm to 30 cm× 25cm. All flaps survived intact. The defects healed primarily expect one infection under the flap. There were nine patients undergone adjacent radiotherapy. No cranioplasty was needed. Follow up time was from six months to twenty-five months (mean 17 months). There were four local recurrences and one metastasis on lung. Twelve patients survived without tumor. Conchusions The latissimus dorsi musculocutaneous flap is an optimal choice for reconstruction of extensive defect after tumor ablation. Key words: Head and neck neoplasms; Reconstruction surgical procedures; Surgical flaps

Combination of periocular myocutaneous flaps for one-stage reconstruction of extensive defects of the eyelid

We present the reconstructive challenge after excision of a large periocular tumour in a patient who needed early visual rehabilitation. The periocular full thickness deficit of his only sighted eye was reconstructed with a combination of periocular myocutaneous flaps and a free buccal mucosal graft. Adequate functional and cosmetic results with early visual rehabilitation were achieved in a single procedure.

Limb salvage using distraction osteogenesis. A classification of the technique.

We report the results of distraction osteogenesis (callotasis) for the reconstruction of extensive defects after the excision of skeletal tumours in the limbs. Bone transport was performed in ten patients (five osteosarcomas and five giant-cell tumours), shortening-distraction in three (two osteosarcomas and one Ewing's sarcoma), and distraction osteogenesis combined with an intramedullary nail to reduce the time of external fixation in six (three osteosarcomas, two chondrosarcomas, and one malignant fibrous histiocytoma). The mean length of the defects after excision of the lesion was 8.4 cm. The mean external fixation index was 39.5 days/cm for the group treated by bone transport, 34.1 days/cm for the shortening-distraction group, and 24.0 days/cm for the group treated by distraction and an intramedullary nail. Functional evaluation gave excellent results in 12 patients, good in five and fair in two. There were ten complications in 19 patients, all of which were successfully treated. We also classified reconstruction using distraction osteogenesis into five types based on the location of the defects after resection of the tumour: type 1, diaphyseal; type 2, metaphyseal; type 3, epiphyseal; type 4, subarticular reconstruction; and type 5, arthrodesis. Our results suggest that reconstruction using distraction osteogenesis provides bone which will develop sufficient biomechanical strength and durability. It is beneficial in patients with an expectation of long-term survival and in growing children.

Staged Replacement of the Canine Trachea with Ringed Polyethylene Terephthalate Grafts

The reconstruction of extensive defects of the trachea ist best accomplished by the use of the patient's own tissue. Unfortunately, this is not always feasible and several prosthetic devices for replacement of the trachea have been described. In an experimental study staged tracheal replacements were performed in five dogs using a ringed polyethylene terephthalate (PET) tubular prosthesis previously cultured in the major omentum of the subjects. A set of stainless-steel arches embodied in silicone compound was designed to prevent collapse of the prosthesis. One of the subjects died on the 10th post-operative day of an unidentified cause and the remaining four eventually developed signs of respiratory distress. The cause of the respiratory insufficiency was anastomotic stenosis in every case. Infection, erosion, collapse or displacement were not observed. The rings designed to avoid collapse of the prosthesis represent a suitable alternative for use as external reinforcement in the tracheal situation. The PET grafts implanted as tracheal prosthesis according to the guidelines of this protocol consistently developed anastomotic stenosis and failed to support a functional respiratory epithelium. A further conclusion is that the use of absorbable sutures encourages anastomotic dehiscence and thus must be avoided.

Reconstruction of burned lower extremities by free flaps

Three latissimus dorsi muscle flaps with skin grafts, one latissimus dorsi myocutaneous flap, and one scapular flap were used in reconstruction of deep burns of the heels and calf caused by various agents. The follow-up period was 11 to 46 months. Of the five patients treated, two sustained electrical injuries, two had contact burns and one suffered a degloving injury with a contact burn resulting from a car accident. The latissimus dorsi muscle flaps with skin grafts gave excellent results in reconstruction of the calf and ankle areas due to their large caliber vessels and versatility. The latissimus dorsi myocutaneous flap was indicated in a case with extensive soft tissue loss on the sole of the foot with stiffness of the ankle joint in plantar flexion. A non-sensory scapular flap was satisfactory for reconstruction of the medial half of the heel since the remaining lateral half of the heel provided adequate sensation for weight-bearing and protection. Early reconstruction of the burned lower part of the leg with free flaps shortens hospitalization and prevents further extension of the injury. Reconstruction of a burned distal lower extremity provides a challenge for the reconstructive surgeon due to limited availability of local tissue; there is durable soft tissue in the weight-bearing area and a relatively poor blood supply compared to other areas of the body. The basic requirement in the treatment of a full thickness burn is early debridement and immediate coverage of the defect with a skin graft or a well vascularized flap. Even though multiple local flaps, such as axial [7, 17], muscle [1], musculocutaneous [5], fasciocutaneous [11], and island flaps [4], have been described. These flaps are useful in relatively small wounds with undamaged sourrounding tissues. Electrical injuries are manifested in a variety of clinical and pathologic ways with early, as well as delayed, tissue damage complicating reconstruction. With the advent and refinement of microvascular techniques, it has become possible to reconstruct extensive defects of the distal lower extremity with either free muscle flaps with skin grafts [8], myocutaneous free flaps [10], or axial free flaps [18]. This paper relates our experience in reconstruction of extensive defects of the lower extremities caused by various burning agents.

The pectoralis major muscle in head and neck reconstruction.

From June 1980 to June 1985 51 pectoralis major muscle flaps have been used for one-stage reconstruction of extensive defects in the head and neck following cancer surgery. The pectoralis major muscle was used as a myocutaneous flap on 28 occasions, as a muscle covered with split thickness skin on 17 occasions, and as a muscle-only flap six times. The muscle, in its various forms, was used for reconstruction of the pharyngooesophageal segment, the tongue, floor of the mouth and oropharynx, to replace the skin of the face and neck, and to provide a well vascularized recipient bed for a split-rib graft, used to replace a defect of the anterior arch of the mandible. Many of the problems associated with the use of a pectoralis major myocutaneous flap can be avoided by the judicious use of a muscle flap on its own or covered by a split thickness skin graft.

Free Microvascular Muscle Flaps with Skin Graft Reconstruction of Extensive Defects of the Foot: A Clinical and Gait Analysis Study

Free Microvascular Muscle Flaps with Skin Graft Reconstruction of Extensive Defects of the Foot: A Clinical and Gait Analysis Study

Latissimus dorsi myocutaneous flap in cervicofacial cancer surgery

The authors present their experience with the latissimus dorsi myocutaneous flap in cervicofacial oncologic reconstructions. They conclude that it is a very reliable flap allowing a one stage reconstruction of extensive defects. Nevertheless they prefer to use it as a pedicle flap rather than a free flap because of the independence of the recipient site vascularisation and a shorter operative time.

Microsurgical composite tissue transplantation. A new method of immediate reconstruction of extensive defects

Microsurgical composite tissue transplantation. A new method of immediate reconstruction of extensive defects