Reliable Soft Tissue Coverage Research Articles

Soft-Tissue Coverage of an Open Tibial Wound in the Junction of the Middle and Distal Thirds of the Leg With the Medial Hemisoleus Muscle Flap

A relatively simple but reliable option for soft-tissue coverage of a less extensive tibial wound in the junction of the middle and distal thirds of the leg has never been determined. In this series, the author reports his clinical experience utilizing the medial hemisoleus muscle flap as a local reconstructive option for management of this unique clinical problem. Over the past 2 years, 14 patients underwent a soft-tissue reconstruction of an open tibial wound (4 x 3 to 10 x 5 cm) in the junction of the middle and distal thirds of the leg with the proximally based medial hemisoleus muscle flap. Only the medial half of the soleus muscle was elevated, with attention to preserving critical perforators from the posterior tibial vessels to the flap while allowing adequate arc of flap rotation to cover the exposed fracture site and hardware. All patients were followed for up to 2 years. Only 1 patient developed insignificant distal flap necrosis and was treated with debridement and flap readvancement. All patients had primary healing of their wounds, reliable soft-tissue coverage, evidenced fracture healing, and good cosmetic outcome during follow-up. Therefore, the medial hemisoleus muscle flap described by the author can be a reliable local option for soft-tissue coverage of a less extensive tibial wound in the junction of the middle and distal thirds of the leg with good outcome and minimal morbidity.

Defektdeckung an der Hand mit der A. interossea posterior-Lappenplastik

Significant trauma, severe bacterial infections and tumour resections of the hand are often complicated by primary or secondary soft-tissue defects. The Posterior Interosseous Artery Flap (PIA), described by Zancolli and Angrigiani in 1985 offers one possibility for soft-tissue coverage. In this abstract, we present the results of 35 patients who were treated with distally based PIA flap reconstructions during the years 1998 to 2003. 24 patients were available for one-year follow-up and beyond. Long-term follow-up demonstrates excellent colour and texture match with reliable soft-tissue coverage. Two of the 33 flaps were lost because of ischemic necrosis. The incidence of distal local ischemia was predictable when the flaps were extended to the level of the PIP joint or beyond. The PIA flap affords a very durable and aesthetic option for soft-tissue coverage of the dorsum of the hand. The flap donor site can usually be closed primarily with little to no morbidity. In comparison to other local and distally based flaps such as the radial forearm flap, major blood vessels are spared. In summary, the PIA flap should be considered as a reliable and judicious alternative to free microvascular transfer procedures for soft-tissue defects of the hand proximal to the level of the PIP joint.

Reconstruction of an extensive tibial soft-tissue defect with multiple local muscle flaps for limb salvage when free-tissue transfer was not an option

The use of microvascular free-tissue transfer for stable soft-tissue coverage has all but replaced the use of local muscle flaps to provide for reliable soft-tissue coverage of an extensive tibial wound. However, free-tissue transfer may not be an option of choice for patients with an extensive tibial defect for various reasons. We present two cases of extensive tibial soft-tissue defect that were managed successfully by multiple local muscle flaps with skin grafts. Both patients had complete healing of their wounds with only minimal complications. These cases demonstrate that an extensive tibial soft-tissue defect can be reconstructed with innovative use of multiple local muscle flaps. This approach is a good alternative to free-tissue transfer for limb salvage, and should be offered to patients with an extensive tibial wound when free-tissue transfer is not an option.

Closure of infected sternal wounds with a unilateral rectus abdominis muscle flap in addition to bilateral pectoralis major myocutaneous advancement flaps

We have recently added to our regimen a unilateral rectus abdominis muscle flap to cover the lower sternum and adjacent soft tissues, in addition to bilateral pectoralis major myocutaneous advancement flaps for closure of infected sternal wounds. Twenty patients underwent this procedure for closure of infected sternal wounds after initial debridement at our institutions. There were no intraoperative deaths in this series, but three patients died of other medical conditions. Two patients developed hematomas and one developed recurrent sternal wound infection after surgery; two had superficial wound infections and five had minor wound problems (i.e., skin edge necrosis). All surviving patients (17/20, 85%) had healed sternal wounds with normal chest contour and there were no instances of flap necrosis, sternal wound dehiscence, or abdominal wall hernia during the follow-up (18–60 months). Based upon our experience, we recommend a unilateral rectus abdominis muscle flap in addition to bilateral pectoralis major myocutaneous advancement flaps for selected patients with infected sternal wounds. This approach provides reliable soft tissue coverage with acceptable morbidity and mortality in this high-risk patient population.

Progress in limb and digital replantation: Part B

Progress in micro- or macroreplantation has resulted in higher survival rates of formerly amputated parts. Progress has been made as a result of intensive laboratory training and considerable experience due to the popular application of microsurgical techniques. More amputated digits or limbs may survive because the time of ischemia can be exceeded in using cold storage or perfusion. Homo- or heterodigital vessel transposition, expanded indications for vein graft interposition, as well as heterotopic transplantation allow for extremity preservation even in crush injuries, and in disastrous multiple amputations combined with contusion or avulsion. Nowadays, microvascular digital replantation with vessel anastomosis distal to the distal interphalangeal joint in adults is technically feasible. Finger amputations in children are a prime indication for replantation. Maintenance of extremity length is possible in applying external fixation. Emergency free flaps or compound tissue transfer under the "Urgence differée" condition may provide reliable soft tissue coverage. Secondary reconstruction with regard to bone defects, tendon repair, and eventual nerve grafting have to be aspired, finally leading to an improvement of functional results in daily and leisure activities as well as in early professional readaptation.