Treatment Of Soft Tissue Defects Research Articles

Management of Residual Gingival Defect in Esthetic Zone after Excision Fibroepithelial Hyperplasia Using Platelet-Rich Fibrin Membrane: A 12-Month Follow-Up Case Report

Abstract The nonneoplastic entity that occurs on gingiva which is of fibrous connective tissue origin is fibrous epithelial hyperplasia which is also considered to be histologic variant of fibroma that causes esthetic and functional problems. It is thought to occur in response to chronic recurring tissue injury which stimulates an exuberant or extreme tissue response. Surgical excision is treatment of choice with recurrence being rarely reported. The soft-tissue defect after excision can be treated using various periodontal plastic surgical treatment modalities available. This case report discusses excision of fibroepithelial hyperplasia, followed by treatment of soft-tissue defect using platelet-rich fibrin membrane with 12-month follow-up.

Treatment of Soft Tissue Defects after Minimally Invasive Plate Osteosynthesis in Fractures of the Distal Tibia: Clinical Results after Reverse Sural Artery Flap.

Introduction: Distal tibial fractures make up approximately 3% to 10% of all tibial fractures or about 1% of lower extremity fractures. MIPO is an appropriate procedure and method to achieve stable metal plate fixation and osseointegration by minimizing soft tissue damage and vascular integrity at the fracture site. MIPO to the medial tibia during distal tibial fractures induces skin irritation due to the thickness of the metal plate, which causes discomfort and pain on the medial side of the distal leg, and if severe, complications such as infection and skin defect may occur. The reverse sural flap is a well-researched approach for covering defects in the lower third of the leg, ankle, and foot. Materials and Methods: Among 151 patients with distal tibia fractures who underwent minimally invasive metal plate fixation, soft tissue was injured due to postoperative complications. We treated 13 cases with necrosis and exposed metal plates by retrograde nasogastric artery flap surgery. For these patients, we collected obligatory patient records, radiological data, and wound photographs of the treatment results and complications of reconstructive surgery. Results: In all the cases, flap survival was confirmed at the final outpatient follow-up. The exposed area of the metal plate was well coated, and there was no plate failure due to complete necrosis. Three out of four women complained of aesthetic dissatisfaction because the volume of the tunnel through which the skin mirror passed and the skin plate itself were thick. In two cases, defatting was performed to reduce the thickness of the plate while removing the metal plate. Conclusions: Metal plate exposure after distal tibial fractures have been treated with minimally invasive metal plate fusion and can be successfully treated with retrograde nasogastric artery flaps, and several surgical techniques are used during flap surgery.

Combining decellularized adipose tissue with decellularized adventitia extravascular matrix or small intestinal submucosa matrix for the construction of vascularized tissue-engineered adipose

Adipose tissue is an endocrine organ. It serves many important functions, such as energy storage, hormones secretion, and providing insulation, cushioning and aesthetics to the body etc. Adipose tissue engineering offers a promising treatment for soft tissue defects. Early adipose tissue production and long-term survival are closely associated with angiogenesis. Decellularized matrix has a natural ECM (extracellular matrix) component, good biocompatibility, and low immunogenicity. Therefore, in this study, the injectable composite hydrogels were developed to construct vascularized tissue-engineered adipose by using the pro-angiogenic effects of aortic adventitia extravascular matrix (Adv) or small intestinal submucosa (SIS), and the pro-adipogenic effects of decellularized adipose tissue (DAT). The composite hydrogels were cross-linked by genipin. The adipogenic and angiogenic abilities of composite hydrogels were investigated in vitro, and in a rat dorsal subcutaneous implant model. The results showed that DAT and SIS or Adv 1:1 composite hydrogel promoted the migration and tube formation of endothelial cells. Furthermore, DAT and SIS or Adv 1:1 composite hydrogel enhanced adipogenic differentiation of adipose-derived mesenchymal stem cells (ASCs) through activation of PPARγ and C/EBPα. The in vivo studies further demonstrated that DAT with SIS or Adv in a 1:1 ratio also significantly promoted adipogenesis and angiogenesis. In addition, DAT with SIS or Adv in a 1:1 ratio hydrogel recruited macrophage population with enhanced M2-type macrophage polarization, suggesting a positive effect of inflammatory response on angiogenesis. In conclusion, these data suggest that the composite hydrogels of DAT with SIS or Adv in 1:1 ratio have apparent pro-adiogenic and angiogenic abilities, thus providing a promising cell-free tissue engineering biomaterial with broad clinical applications. Statement of significanceDecellularized adipose tissue (DAT) has emerged as an important biomaterial in adipose tissue regeneration. Early adipose tissue production and long-term survival is tightly related to the angiogenesis. The revascularization of the DAT is a key issue that needs to be solved in adipose regeneration. In this study, the injectable composite hydrogels were developed by using DAT with Adv (aortic adventitia extravascular matrix) or SIS (small intestinal submucosa) in different ratio. We demonstrated that the combination of DAT with SIS or Adv in 1:1 ratio effectively improved the proliferation of adipose stem cells and endothelial cells, and promoted greater adipose regeneration and tissue vascularization as compared to the DAT scaffold. This study provides the potential biomaterial for clinical soft tissue regeneration.

Can anterolateral thigh flap be a rescuer in lower extremity injuries?

The lower extremity contains a variety of functional structures therefore re-establishing soft tissue coverage in large-scale injuries is a challenging procedure. Microsurgery has made progress in reducing donor morbidity and achieving a functional and aesthetic appearance in recent years. This study aimed to apply anterolateral thigh (ALT) flap to tissue defects in the lower extremity and to discuss the results. Twenty-three patients who were admitted to our hospital with lower extremity trauma and underwent ALT flap surgery due to soft tissue defect between November 2020 and March 2022 were included in the study. Patients' demographic data, the applied surgical procedure, the development of postoperative complications, and postoperative functional results were evaluated. Twenty-three patients were included in this research. The mean age of the patients was 36.56±14.67 (10-61). Of these patients, 3 were female (13%), and 20 were male (87%). The most common etiology was traffic accident (n=8, 34%), followed by gunshot injuries (n=5, 21%), electrical burn (n=4, 17%), open fractures (n=2, 7%), infection (n=2, 7%), diabetic foot (n=1, 4%), skin tumor (n=1, 4%). Flaps were raised from the contralateral extremity in twelve patients (52%) and on the ipsilateral extremity in eleven patients (48%). The average time from first trauma to free flap surgery was 10.7±5 days (4-22). The average postoperative hospitalization was 13.6 days (9-23 days). The average follow-up time of patients was 8 months (3-13 months). The donor site is closed with primary saturation in 19 patients (82%) and closed with split-thickness skin grafting in 4 patients (18%). Our overall success rate was 96%. We had only one total flap failure out of twenty-three patients (4%). ALT-free flap is an excellent choice for reconstructing lower extremity complex defects. For experienced surgeons, the ALT flap can be used successfully in the treatment of soft tissue defects of variable size in the lower extremity.

Comparison of lateral arm flap and posterior interosseous artery flap for soft tissue reconstruction of the elbow.

The study aimed to evaluate and compare the two different flap techniques used for the reconstruction of soft tissue defects in the elbow region: the lateral arm flap (LAA) and posterior interosseous artery (PIA) flap. The retrospective study included 12 patients who underwent surgical treatment for soft tissue defects between 2012-2018 at the clinic. The study evaluated demographic data, flap size, operating time, donor site, flap complications, number of perfora-tors, and functional and cosmetic outcomes. Results showed that patients who underwent PIA flap had significantly smaller defect size than those who underwent LAA flap (p<0.001). However, there were no significant differences between the two groups (p>0.05). Patients who received PIA flaps had significantly lower QuickDASH scores, indicating better functional results (p<0.05). The operating time was significantly shorter in the PIA group than in the LAA flap group (p<0.05). Additionally, the range of motion (ROM) of the elbow joint was significantly higher among the patients who received the PIA flap (p<0.05). The study concludes that both flap techniques are easy to apply depending on the surgeon's experience, have low complication risk, and provide similar functional and cosmetic results in similar defect sizes.

Single-stage acellular dermal matrix reconstruction of defects in the nose and ears with exposed cartilage: a prospective case series

BackgroundThe treatment of soft tissue defects with exposed cartilage after tumor excision is challenging. Local flap reconstruction causes occasional scarring, especially in non-Caucasian populations. Scar treatment requires secondary procedures for aesthetic modifications. Two-step reconstruction with an acellular dermal matrix addresses this issue and yields highly acceptable aesthetic resultsWe aimed to investigate the efficacy of an artificial dermal matrix cover using one-step reconstruction for defects with cartilage exposure.MethodsFrom July 2018 to September 2020, seven patients were enrolled and underwent a single-stage operation using acellular dermal matrices. Patients were followed up for at least 6 months and the size of the wound, days to heal, patient satisfaction, and scar scale scores were recorded.ResultsPatients were followed up for an average of 25.7 months. The average time to heal was 23.4 days postoperatively. No hyperpigmentation, tumor recurrence, or retraction was noted. High acceptance and satisfaction with the outcome were observed in all patients.ConclusionsSingle-stage reconstruction yielded high acceptance of aesthetic results similar to that in two-stage reconstruction. Less time and cost make this an effective and efficient treatment for soft tissue defects compared with traditional techniques.

3D Bioprinted Patient-Specific Extracellular Matrix Scaffolds for Soft Tissue Defects.

Soft tissue injuries such as volumetric muscle loss (VML) are often too large to heal normally on their own, resulting in scar formation and functional deficits. Decellularized extracellular matrix (dECM) scaffolds placed into these wounds have shown the ability to modulate the immune response and drive constructive healing. This provides a potential solution for functional tissue regeneration, however, these acellular dECM scaffolds are challenging to fabricate into complex geometries. 3D bioprinting is uniquely positioned to address this, being able to create patient-specific scaffolds based on clinical 3D imaging data. Here, a process to use freeform reversible embedding of suspended hydrogels (FRESH) 3D bioprinting and computed tomography (CT) imaging to build large volume, patient-specific dECM patches (≈12×8×2cm) for implantation into canine VML wound models is developed. Quantitative analysis shows that these dECM patches are dimensionally accurate and conformally adapt to the surface of complex wounds. Finally, this approach is extendedto a human VML injury to demonstrate the fabrication of clinically relevant dECM scaffolds with precise control over fiber alignment and micro-architecture. Together these advancements represent a step towards an improved, clinically translatable, patient-specific treatment for soft tissue defects from trauma, tumor resection, and other surgical procedures.

Pituitary Adenylate Cyclase-activating Polypeptide (PACAP) -derived Peptide MPAPO Stimulates Adipogenic Differentiation by Regulating the Early Stage of Adipogenesis and ERK Signaling Pathway.

Regenerative medicine and tissue engineering have delivered new healing possibilities to the treatment of soft tissue defects, but the selection of seed cells is critical for treatment. Adipose-derived stem cells have perpetually been a preferred candidate for seed cells due to their wealthy sources, simple access, high plasticity, and powerful value-added capabilities. How to improve the efficiency of adipogenic differentiation is the key to the treatment. Pituitary adenylate cyclase-activating peptide, as a biologically active peptide secreted by the pituitary, is widely involved in regulating the body's sugar metabolism and lipid metabolism. However, the effects of MPAPO in ADSCs adipogenic differentiation remain unknown. Our results reveal that MPAPO treatment improves the adipogenic differentiation efficiency of ADSCs, including promoting the accumulation of lipid droplets and triglycerides, and the expression of adipocyte protein biomarkers PPARγ and C/EBPa. Additionally, the mechanism studies showed that the effective window of MPAPO-induced adipogenesis was the first 3 days during ADSCs differentiation. MPAPO selectively binds to the PAC1 receptor and promotes adipogenic differentiation of ADSCs by activating the ERK signaling pathway and elevating cell proliferation during postconfluent mitosis stage. Altogether, we demonstrate that MPAPO plays a crucial role in ADSCs adipogenesis, providing experimental basis and data for exploring therapeutic options in tissue defect repair.

Fasciocutaneous flaps in the lower limb soft tissue reconstruction – A surgical case series

Traumatic injuries, metabolic, vascular and malignant diseases are among the main causes of soft tissue defects in the lower limb. The limited tissue resources and the peculiarities of the blood supply make reconstructive treatment a challenge. Various modalities of fasciocutaneous flaps have been gaining popularity in the treatment of soft tissue defects in the lower extremity. A retrospective analysis including a group of 19 patients with soft tissue defects in the lower limb, treated in the period June 2019–July 2021 in the Department of Burns and Plastic Surgery, UMHATEM “N. I. Pirogov” was conducted. Twenty fasciocutaneous flaps were performed (6 - Keystone flaps, 6 - Reverse flow Sural flaps, 4 - Perforator Propeller flaps, 2- V–Y perforator flap, 2 - Axial Rotation flap). Demographic and clinical data is analyzed. Functional (LEFS) and aesthetic evaluation (POSAS 2.0) of the achieved results is obtained. Patients were of both sexes, aged between 23 and 78 years. All of the flaps survived. Minor complications occurred in 3 cases. Significant functional improvement and satisfactory aesthetic results were reported. Free tissue transfer, considered as the “gold standard” in the reconstruction of complex defects involving the lower limb, has its drawbacks. Fasciocutaneous flaps are a good alternative option to free flaps. They are characterized by good functional results and rare complications. Utilization of the fasciocutaneous flap strategy is a reliable method for ensuring the integrity and the function of the lower limb. • Fasciocutaneous flaps can be used reliably in lower limb soft tissue reconstruction. • Respect to the perforasomes is crucial. • Greatest mobility has the sural flap. • Perforator propeller flaps are capable of transferring largest amount of tissue. • Significant functional improvement and satisfactory aesthetic results are reported.

Dual-Perforator Flap With Wide Pedicle Versus Sural Neurocutaneous Flap With Peroneal Artery Perforator in the Treatment of Soft Tissue Defects of Foot and Ankle

How to deal with large soft tissue defects around the foot and ankle is still controversial. The aim of this study was: (1) to display a new pedicled flap, also named the dual-perforator flap with wide pedicle (DPFWP), and (2) to compare it with the sural neurovascular flap with peroneal artery perforator (SNFPAP) in foot and ankle reconstruction. According to different surgical methods, 82 patients were divided into 2 groups: the DPFWP group (42 cases) and the SNFPAP group (40 cases). All cases underwent a flap surgery after radical debridement. The 2 groups were homogeneous in terms of age, sex, body mass index (BMI), etiology, location, and follow-up duration. Operation indexes were compared, including flap length, flap width, operation time and blood loss. Complications, cosmetic appearance, and functional outcome were analyzed, and statistical analysis was performed. The DPFWP group had larger flap length (24.5 ± 4.6 cm vs 16.3 ± 3.8 cm), and flap width (10.5 ± 2.7 cm vs 7.8 ± 1.7 cm) than the SNFPAP group. In postoperative follow-up, DPFWP group showed a lower complication rate and better cosmetic, functional outcomes than SNFPAP group. In conclusion, this study showed that a DPFWP flap brought better results than a SNFPAP flap in terms of complications, cosmetic appearance, and functional outcomes for patients undergoing reconstruction of foot and ankle defects.

The Role of Mesenchymal Stromal Cells in Tissue Repair and Fibrosis.

Significance: The present review covers an overview of the current understanding of biology of mesenchymal stromal cells (MSCs) and suggests an important role of their differential potential for clinical approaches associated with tissue repair and fibrosis. Recent Advances: Genetic lineage tracing technology has enabled the delineation of cellular hierarchies and examination of MSC cellular origins and myofibroblast sources. This technique has led to the characterization of perivascular MSC populations and suggests that pericytes might provide a local source of tissue-specific MSCs, which can differentiate into tissue-specific cells for tissue repair and fibrosis. Autologous adipose tissue MSCs led to the advance in tissue engineering for regeneration of damaged tissues. Critical Issues: Recent investigation has revealed that perivascular MSCs might be the origin of myofibroblasts during fibrosis development, and perivascular MSCs might be the major source of myofibroblasts in fibrogenic disease. Adipose tissue MSCs combined with cytokines and biomaterials are available in the treatment of soft tissue defect and skin wound healing. Future Directions: Further investigation of the roles of perivascular MSCs may enable new approaches in the treatment of fibrogenic disease; moreover, perivascular MSCs might have potential as an antifibrotic target for fibrogenic disease. Autologous adipose tissue MSCs combined with cytokines and biomaterials will be an alternative method for the treatment of soft tissue defect and skin wound healing.

Efficacy and safety of external tissue expansion technique in the treatment of soft tissue defects: a systematic review and meta-analysis of outcomes and complication rates.

Currently, various external tissue expansion devices are becoming widely used. Considering the scarcity of relevant application standards, this systematic review was performed to explore the effectiveness and safety of external tissue expansion techniques for the reconstruction of soft tissue defects. A systematic review and meta-analysis on the efficacy and safety of external tissue expansion technique was conducted. A comprehensive search was performed in the following electronic databases: PubMed/Medline, Embase, Cochrane Library (Wiley Online Library), and Web of Science. Studies reporting patients with soft tissue defects under the treatment of external tissue expansion technique were included. A total of 66 studies with 22 different types of external tissue expansion devices met the inclusion criteria. We performed a descriptive analysis of different kinds of devices. A single-arm meta-analysis was performed to evaluate the efficacy and safety of the external tissue expansion technique for different aetiologies. The pooled mean wound healing time among patients with defects after fasciotomy was 10.548days [95% confidence interval (CI) = 5.796-15.299]. The pooled median wound healing times of patients with defects after excisional surgery, trauma, chronic ulcers and abdominal defects were 11.218days (95% CI = 6.183-16.253), 11.561days (95% CI = 7.062-16.060), 15.956days (95% CI = 11.916-19.996) and 12.853 days (95% CI=9.444-16.227), respectively. The pooled wound healing rates of patients with defects after fasciotomy, excisional surgery, trauma, chronic ulcers and abdominal defects were 93.8% (95% CI=87.1-98.2%), 97.2% (95%CI=92.2-99.7%), 97.0% (95%CI=91.2-99.8%), 99.5% (95%CI=97.6-100%), and 96.8% (95%CI=79.2-100%), respectively. We performed a subgroup analysis in patients with diabetic ulcers and open abdominal wounds. The pooled median wound healing time of patients with diabetic ulcers was 11.730days (95% CI = 10.334-13.125). The pooled median wound healing time of patients with open abdomen defects was 48.810days (95% CI = 35.557-62.063) and the pooled successful healing rate was 68.8% (95% CI = 45.9-88.1%). A total of 1686 patients were included, 265 (15.7%) of whom experienced complications. The most common complication was dehiscence (n = 53, 3.14%). Our systematic review is the first to demonstrate the efficacy and safety of external tissue expansion in the management of soft tissue defects. However, we must interpret the meta-analysis results with caution considering the limitations of this review. Large-scale randomized controlled trials and long-term follow-up studies are still needed to confirm the effectiveness and evaluate the quality of healing.

Emerging Potential of Exosomes on Adipogenic Differentiation of Mesenchymal Stem Cells.

The mesenchymal stem cells have multidirectional differentiation potential and can differentiate into adipocytes, osteoblasts, cartilage tissue, muscle cells and so on. The adipogenic differentiation of mesenchymal stem cells is of great significance for the construction of tissue-engineered fat and the treatment of soft tissue defects. Exosomes are nanoscale vesicles secreted by cells and widely exist in body fluids. They are mainly involved in cell communication processes and transferring cargo contents to recipient cells. In addition, exosomes can also promote tissue and organ regeneration. Recent studies have shown that various exosomes can influence the adipogenic differentiation of stem cells. In this review, the effects of exosomes on stem cell differentiation, especially on adipogenic differentiation, will be discussed, and the mechanisms and conclusions will be drawn. The main purpose of studying the role of these exosomes is to understand more comprehensively the influencing factors existing in the process of stem cell differentiation into adipocytes and provide a new idea in adipose tissue engineering research.

Lipofilling in Breast Oncological Surgery: A Safe Opportunity or Risk for Cancer Recurrence?

Lipofilling (LF) is a largely employed technique in reconstructive and esthetic breast surgery. Over the years, it has demonstrated to be extremely useful for treatment of soft tissue defects after demolitive or conservative breast cancer surgery and different procedures have been developed to improve the survival of transplanted fat graft. The regenerative potential of LF is attributed to the multipotent stem cells found in large quantity in adipose tissue. However, a growing body of pre-clinical evidence shows that adipocytes and adipose-derived stromal cells may have pro-tumorigenic potential. Despite no clear indication from clinical studies has demonstrated an increased risk of cancer recurrence upon LF, these observations challenge the oncologic safety of the procedure. This review aims to provide an updated overview of both the clinical and the pre-clinical indications to the suitability and safety of LF in breast oncological surgery. Cellular and molecular players in the crosstalk between adipose tissue and cancer are described, and heterogeneous contradictory results are discussed, highlighting that important issues still remain to be solved to get a clear understanding of LF safety in breast cancer patients.

Modified Medial Gastrocnemius Myocutaneous Flap Technique for Knee Joint Coverage after Total Knee Arthroplasty

While there are many reasons the medial gastrocnemius flap is often the favored treatment for soft tissue defects around the knee area, this flap has some disadvantages. Reduced volume at the distal part of the flap and a short reach complicate provision of sufficient coverage for soft tissue defects superior to the patella and the lateral knee. In order to overcome these shortcomings, we modified the typical surgical technique by combining a medial gastrocnemius muscle flap and a medial sural artery perforator flap. This approach was applied to four patients who had developed deep infections and skin and soft tissue defects around the knee joint after total knee arthroplasty. The surgeries were successful. Dead space was well-filled and wounds healed without complications in all patients. This modified medial gastrocnemius myocutaneous flap provides a new option for treating challenging skin and soft tissue defects caused by deep infection after total knee arthroplasty.

Systematic Review: Adipose-Derived Mesenchymal Stem Cells, Platelet-Rich Plasma and Biomaterials as New Regenerative Strategies in Chronic Skin Wounds and Soft Tissue Defects.

The number of clinical trials evaluating adipose-derived mesenchymal stem cells (AD-MSCs), platelet-rich plasma (PRP), and biomaterials efficacy in regenerative plastic surgery has exponentially increased during the last ten years. AD-MSCs are easily accessible from various fat depots and show intrinsic plasticity in giving rise to cell types involved in wound healing and angiogenesis. AD-MSCs have been used in the treatment of soft tissue defects and chronic wounds, employed in conjunction with a fat grafting technique or with dermal substitute scaffolds and platelet-rich plasma. In this systematic review, an overview of the current knowledge on this topic has been provided, based on existing studies and the authors’ experience. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Scopus database, and Cochrane databases has been performed to identify papers on AD-MSCs, PRP, and biomaterials used in soft tissue defects and chronic wounds. Of the 2136 articles initially identified, 422 articles focusing on regenerative strategies in wound healing were selected and, consequently, only 278 articles apparently related to AD-MSC, PRP, and biomaterials were initially assessed for eligibility. Of these, 85 articles were excluded as pre-clinical, experimental, and in vitro studies. For the above-mentioned reasons, 193 articles were selected; of this amount, 121 letters, expert opinions, commentary, and editorials were removed. The remaining 72 articles, strictly regarding the use of AD-MSCs, PRP, and biomaterials in chronic skin wounds and soft tissue defects, were analyzed. The studies included had to match predetermined criteria according to the patients, intervention, comparator, outcomes, and study design (PICOS) approach. The information analyzed highlights the safety and efficacy of AD-MSCs, PRP, and biomaterials on soft tissue defects and chronic wounds, without major side effects.

Distally Based Peroneal Artery Perforator-Plus Fasciocutaneous Flap to Reconstruct Soft Tissue Defect Combined With Chronic Osteomyelitis in the Lateral Malleolus.

Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used to reconstruct soft tissue defects of the lower extremity. Treatment for soft tissue defect combined with chronic osteomyelitis in the lateral malleolus has rarely been reported. The aim of this study was to elaborate the superiority of the DPAPF flap and provide referential experience for using the DPAPF flap in this situation. Between June 2010 and December 2017, soft tissue defects in the setting of chronic osteomyelitis in the lateral malleolus were reconstructed with DPAPF flaps in 17 patients. After thorough debridement, the defect was repaired with the DPAPF flap, and patients subsequently followed an antibiotic regimen for 6 weeks. Follow-up periods for all patients were at least 24 months. The reconstruction outcomes and the satisfaction of the 17 patients were evaluated. Of the 17 flaps, 16 survived uneventfully, except one occurrence of partial necrosis. No infection occurred in the follow-up period. In the study, 17 patients except one were satisfied with flap appearance. All the patients were satisfied with the reconstruction outcomes. In a one-stage procedure, the use of DPAPF flaps is ideal for reconstructing soft tissue defects in the setting of chronic osteomyelitis in the lateral malleolus.

Pedicled bridge transplantation for soft tissue defects at the contrallateral leg with medial leg skin flap and medial hemi-soleus muscle flap

Objective To evaluate the pedicled bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap for the treatment of soft tissue defects at the contrallateral leg. Methods Between January of 2012 and January of 2016, 8 patients with soft tissue defects at the leg were treated at Department of Orthopedic Surgery, Hand and Foot Surgery Hospital of Lanzhou. They were 5 men and 3 women, aged from 19 to 50 years (mean, 35 years). All of them were treated by bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap pedicled with posterior tibial artery. The size of the defects ranged from 10 cm×9 cm to 13 cm×8 cm. The immediate coverage of the muscle flaps and vessel pedicle was repaired by a meshed split-thickness skin graft. The donor site was closed directly. The therapeutic efficacy was assessed at the final follow-up according to the criteria by Iowa for tibial fractures. Results All the skin flaps and muscle flaps survived without any vascular crisis. One case developed necrosis of small skin graft at the distal muscle flap which spontaneously healed after dressing change for 2 weeks. Their follow-up ranged from 2.5 to 4.5 years (mean, 3.8 years). A good contour was confirmed at the recipient area. By the Iowa criteria at the final follow-up, 3 cases were excellent, 4 good and one fair. Conclusion Pedicled bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap is a good treatment for soft tissue defects at the contrallateral leg which has only one major blood vessel, reducing damage to the donor site. Key words: Leg injuries; Soft tissue injuries; Surgical Flaps; Muscle flap

Vestibuloplasty following denture hyperplasia resection with diode laser

Denture hyperplasia is a common clinical finding in patients wearing dentures. In this case report, a patient who was treated for denture hyperplasia presented with a post operative complication which led to inadequate vestibular depth. Inadequate vestibule is a common challenge dental surgeons encounter while considering fixed or removable prosthesis and implants. Objective is to achieve acceptable retention and aesthetics for the prosthesis by increasing the vestibular depth and also to manage the complication encountered during the resection procedure. Several techniques have been employed to increase the vestibular depth and the width of attached gingiva in the literature. In this case the denture hypereplasia was resected using diode laser which resulted in bone necrosis and opening of the wound post surgically. This was managed with curettage and PRF application. Following this the patient presented with inadequate vestibular depth. Vestibuloplasty was performed with Diode laser to deepen the vestibular depth and augment keratinized tissue to facilitate prosthetic rehabilitation. Three months following vestibuloplasy, patient presented with adequate vestibule. At six months follow up there was sufficient keratinized tissue to facilitate prosthetic rehabilitation. This case presents a unique way of managing a complication encountered after denture hyperplasia resection followed by vestibuloplasty with diode laser. The results obtained were clinically acceptable. PRF provides excellent results when used for the management of surgical complications like wound exposure. Laser technique is optimal for the treatment of soft tissue defects and is proven to be ideal for vestibuloplasty.

Brachioradialis muscle flap for posterior elbow defects: a simple and effective solution for the upper limb surgeon

Trauma, infection, and posterior surgical approach are the most frequent causes of soft tissue defects of posterior elbow. The brachioradialis (BR) muscle flap is a rotational muscular pedicled flap, and the dominant vascular pedicle arises from the radial recurrent artery in the proximal portion of the muscle. The aim of the study was to present the BR muscle flap as a simple, safe, and effective solution for the treatment of soft tissue defects of the posterior elbow. Five patients (3 males; mean age, 61.4 years; range, 40-73 years) with soft tissue defects of the posterior elbow underwent surgical treatment with the BR muscle flap. The causes of the defects weretotal elbow arthroplasty and postsurgical infection (n = 2), 1 patient with elbow arthrodesis due to neuropathic arthropathy, and postsurgical infection after open reduction and internal fixation of olecranon fractures (n = 2). All patients had a BR muscle flap and skin grafting. Orthopedic hardware was removed in 3 cases. Atthe mean follow-up of 45 months (range, 26-61 months), all patients had viable and functional soft tissue coverage. All patients were free of infection, whereas 1 patient had a posterior elbow discomfort in daily activities. None of the patients reported wrist problems. The BR muscle flap is a reliable solution, easy to harvestwithout requiring microsurgical expertise for small-size posterior elbow defects. It is a 1-stage procedure with no morbidity to the harvest site that provides stable and adequate coverage even in cases with postoperative infection.