Resurfacing Of Defects Research Articles

Syndactyly release with the use of the Pelnac™ artificial dermal substitute without skin grafting

We present our results of one-stage resurfacing following syndactyly release with the Pelnac™ artificial dermal substitute. From 2016 to 2020, raw areas after digit release were restored with an artificial dermal substitute in 145 webs from 62 patients (average age, 33.1 months) including 65 simple incomplete web spaces, 29 simple complete web spaces, 20 complex complete web spaces, and 31 complex complicated web spaces. Fourteen patients were syndromic. The average follow-up period was 33.4 months (range, 7-55 months). Postoperative outcomes assessed as according to the Vancouver scar scale (0-14) averaged 1.8 (range, 0-11) and web creep score (0-5) averaged 0.7 (range, 0-4). Patient- and family-provided visual analog scale scores averaged 1.1 (range, 0-10) for appearance. In conclusion, the Pelnac™ artificial dermal substitute is a minimally invasive, simple, and effective option for one-stage resurfacing of defects in syndactyly release.

Cervicofacial Defect Reconstruction Using the Pre-Expanded Medial Arm Flap Without Immobilization of the Upper Extremity.

The medial arm flap has multiple advantages when used for cervicofacial defect reconstruction but remains underused. The main drawback of the medial arm flap is that the patient must maintain the passive immobilized posture before the pedicle division. This clinical study aims to introduce a reconstructive method for cervicofacial defects using the medial arm flap without the immobilization of the upper extremity. This retrospective study was performed with data from 14 patients requiring pre-expanded medial arm flaps to reconstruct cervicofacial defects. Indocyanine green (ICG) angiography was used to detect perforators and evaluate the flap perfusion; all the flaps underwent pre-transfer tissue expansion. A total of 15 full-length medial arm flaps were used. All the perforators identified by ICG angiography were directly visualized during flap elevation. In four cases, poor perfusion areas in the flaps were noted by intraoperative ICG angiography. Combined with the clinical observation, parts with poor perfusion were resected. The average flap size was 203.9 ± 75.2 cm2 and ranged 20 to 28 cm in length after tissue expansion. The medial arm donor sites were closed directly or using another flap. All flaps survived completely. The patients were followed-up for 1 to 22 months. All patients and their family members were satisfied with the outcomes. Cervicofacial defect reconstruction using a medial arm flap with the aid of tissue expansion and ICG angiography can provide sufficient tissue for defect resurfacing and also eliminate the necessity of the immobilization of the upper extremity during surgery.

Keystone Perforator Island Flap for Postmastectomy Defect Resurfacing in Late-stage Breast Cancer Patients.

Background:Late-stage breast cancer usually presents with locally advanced disease, with or without metastasis. The primary tumor is typically large with skin infiltration which affects quality of life. Surgical resection will result in an extensive defect which potentially deteriorates patients’ quality of life if not properly managed. Keystone perforator island flap (KPIF) is a local advancement flap based on multiple perforators which can be a reliable reconstructive method to close an extensive defect.Methods:This is a case series of 11 patients with symptomatic late-stage breast cancers indicated for neoadjuvant chemotherapy and subsequent mastectomy at Dharmais Cancer Hospital. The postmastectomy defect was closed with KPIF and clinical evaluation included flap success rate, percentage of flap necrotic area, and quality of life. There are modifications of the KPIF consisting of the more rounded shape and additional flap movement of the flap’s distal lateral ends to the center resembling an “omega” conformation.Results:Mean percentage of flap necrosis area was 9.7% and none of the patients needed additional surgery. The patients’ quality of life evaluated using Patient-reported Aesthetic European Organization for Research and Treatment of Cancer (EORTC) Quality of Life, Questionnaire-Core 30-questions (QLQ-C30) and Quality of Life, Questionnaire-Breast Cancer-23-questions (QLQ-BR23) was fair, with sufficiently good scores for global health status and functional scale, and minimal symptomatology burden. The lowest score was for fatigue and financial difficulties parameters from QLQ-C30 and sexual functioning and future perspective from QLQ-BR23.Conclusion:This is a preliminary study to show that a KPIF could be considered as a method for defect-resurfacing reconstruction after mastectomy.

The Dorsal Metatarsal Artery Perforator Flap

Few options exist for the resurfacing of web-space and small soft tissue defects of the dorsum of the distal foot. The study examines the anatomy of the second to fourth dorsal metatarsal arteries in 16 fresh frozen cadavers to determine if the anatomy correlates to that in the hand, permitting the design of local flaps based on perforators of these vessels. A clinical case is also presented, illustrating the efficacy of such a perforator-based flap.Sixteen Asian cadaveric lower limbs were used for this study. The specimens were prepared with latex dye injection. Dissection under loupe magnification was carried out to determine the position and caliber of the cutaneous perforators from the dorsal metatarsal arteries, and the spread of the latex dye in the skin from these cutaneous perforators. One clinical case illustration of this perforator-based flap for distal foot defect resurfacing is presented.In our cadaveric study, each second to fourth dorsal metatarsal artery had between 2 and 5 cutaneous perforators with calibers of 0.5 to 0.7 mm in diameter. The most distal cutaneous perforator was present consistently, always arising between the heads of the respective metatarsals.In conclusion, the vascular anatomy of the second to fourth dorsal metatarsal arteries is similar to that in the hand, thus allowing for the design of reliable perforator-based flaps for distal foot resurfacing.

Convenient coverage of soft-tissue defects around the knee by the pedicled vastus medialis perforator flap

Various reconstructive methods have been reported for coverage of soft-tissue defects around the knee; however, there is still no report about the pedicled vastus medialis perforator flap; hence, this article aims to elaborate on this approach for resurfacing of defects around the knee. From January 2010 to December 2010, six patients with defect size ranging from 5.0 × 3.3 to 10.5 × 7.0 cm received soft-tissue coverage with the pedicled vastus medialis perforator flap. Among them, five cases were male, and the other female. The age of patients ranged from 20 to 52 years, with an average of 34.5 years. The injury of one patient was caused by being crushed by a heavy metal object, and the rest sustained injuries in traffic accidents. The defect in one case was located at the inferomedial aspect of the thigh, and the rest around the knee. Five flaps survived completely, while one case suffered marginal necrosis due to infection. The donor sites healed without complication. Postoperative follow-ups of the patients ranged from 1 to 18 months. Through the article, we demonstrate the feasibility of using the pedicled vastus medialis perforator flap for reconstruction of knee injuries, which makes the knowledge of the vastus medialis-related flap series more complete and also enriches the methods of repairing defects around the knee.

Technique of Osteochondral Autograft Transplantation Mosaicplasty for Capitellar Osteochondritis Dissecans

Osteochondritis dissecans (OCD) is a localized condition affecting an articular surface that involves separation of a segment of cartilage and subchondral bone. It is found primarily in the knee, ankle, and elbow joints. Various theories about its etiology have been proposed, but the exact etiology of OCD still remains obscure. Osteochondritis dissecans of the elbow is characterized by pain, swelling, and limitation of motion, usually in adolescence through early adulthood. An uncommon clinical entity, it occurs as a result of overuse injuries, especially throwing activities. The treatment of OCD has evolved from the removal of loose bodies to the resurfacing of defects with an osteochondral autogenous graft (mosaicplasty). Mosaicplasty is a relatively new and viable option for the treatment of advanced OCD of the capitellum. In this article, we describe the technique of mosaicplasty for OCD of the capitellum.

The Use of Artificial Dermis in the Reconstruction of Oncologic Surgical Defects

Integra dermal substitute has been used in burn reconstruction with great success. Its use in general reconstruction is currently being reported. The authors set out to evaluate the utility of Integra in the reconstruction and resurfacing of defects created by tumor excision. Since 2003, 17 patients with soft-tissue tumors involving the head and neck, lower extremity, and anterior chest wall underwent tumor resection and reconstruction with Integra dermal substitute. These patients were followed and clinical outcomes were assessed. Seventeen patients with a mean age of 54 +/- 21 years underwent tumor resection and reconstruction with Integra dermal substitute. Twelve patients (71 percent) were male and five (29 percent) were female. Twelve cases (71 percent) involved recurrent tumor resection. The 17 cases involved 10 different tumor types at six different anatomical locations. The mean defect size was 172 +/- 260 cm (range, 20 to 1080 cm). The second stage of the reconstruction occurred on postoperative day 23 +/- 6. The mean follow-up was 12.3 +/- 7.2 months (range, 3 to 26 months). Clinically, 16 patients had 100 percent take of skin grafts and one patient had approximately 97 percent take of his graft. All patients experienced excellent defect contouring and cosmesis. Artificial bilaminate acellular dermis is an excellent option for reconstructing defects created by tumor resection and can be used in a wide variety of locations. It is especially useful in large defects that usually require flaps for coverage. Patients experience minimal donor-site morbidity and have outstanding cosmetic and functional results.

One day exposure to FGF-2 was sufficient for the regenerative repair of full-thickness defects of articular cartilage in rabbits

Administration of fibroblast growth factor (FGF)-2 for 2 weeks induces a successful cartilaginous repair response in 5-mm full-thickness articular cartilage defects in rabbits. The purpose of this study was to investigate the effects of a short time exposure to FGF-2 on the repair of the defects. Five-mm-diameter cylindrical defects, which do not repair spontaneously, were created in the femoral trochlea of the rabbit knees. The defects were administered sterile saline or FGF-2 (150pg/h) via an osmotic pump for the initial 1 day, 3 days, or 2 weeks, and we assessed the FGF-2 action on the proliferation and migration of mesenchymal cells in the reparative tissue. Using a total of 126 rabbits, we performed three sets of experiments. We also studied the effect of FGF-2 on migration of marrow-derived mesenchymal cells in vitro. FGF-2 treatment for 1 day or 3 days induced the sequential chondrogenic repair responses that led to successful cartilaginous resurfacing of defects within 8 weeks as well as the 2-week treatment did. We confirmed by a radioisotope study that FGF-2 injected was rapidly eliminated from the defects (a residual ratio of 50% within 30min). The effect of FGF-2 on cultured marrow-derived cells suggested that FGF-2 facilitated the mobilization and migration of replicating mesenchymal cells from bone marrow. Only 1 day exposure to FGF-2 is sufficient for induction of the chondrogenic repair response in 5-mm-diameter full-thickness defects of articular cartilage in rabbits. FGF-2 stimulated the recruitment of mesenchymal cells into the defects, which was a limiting step for the induction of cartilage.

Current Concept Review - Osteochondritis Dissecans*

SCHENCK, ROBERT C. JR. M.D.†; GOODNIGHT, JON MARC M.D.†, SAN ANTONIO, TEXAS Author Information

The extended role of the delto-pectoral flap

Summary 1.An extended role for Bakamjian's delto-pectoral flap is described in surgery of the head and neck and surgery of the hand. 2.The role in head and neck surgery has included the primary resurfacing of defects of post-triangle mastoid, ear, parotid, full thickness of cheek, angle of mouth and chin. 3.The role in hand surgery has concerned primary resurfacing of the hand—dorsum and palm.

Immediate replacement of tissue losses from hand or wrist by means of bipedicled cross arm flaps

A simple method for the resurfacing of defects of the hand or wrist is described. This method is simple and efficient, and gives uniformly good results. Its chief advantage is the rapid resurfacing of these defects, thereby improving the function of the hand and wrist. The amount of scar tissue formed and the length of time of immobilization are markedly reduced. This method is of distinct advantage in the primary or immediate treatment of injuries to the hand and wrist.