Treatment Of Soft Tissue Defects Research Articles

Anconeus muscle flap for the treatment of soft tissue defects over the olecranon after total elbow arthroplasty

Anconeus muscle flap for the treatment of soft tissue defects over the olecranon after total elbow arthroplasty

Reconstruction of soft tissue defects of the lower limb using the free serratus anterior flap

To present the application and clinical results of soft tissue reconstruction of the lower limb with the free serratus anterior muscle flap. Twenty Chinese adult cadavers were studied to determine detailed anatomical information about the serratus anterior muscle flap. From 1997 to 2007, 82 patients with soft tissue defects of the lower limbs were treated with free serratus anterior muscle flaps and skin grafts. There were 24 females and 58 males, aged from 22 to 63 years (mean 34). The patients were followed up for an average of 30 months (range, 8 months-5 years). All flaps survived except for one, in which necrosis occurred. Six patients developed partial necroses of the muscle flap or skin graft. Five of them healed with debridement or wound care, and one healed with a repeat skin graft. There was no notable donor site morbidity. Dysfunction of the shoulder was not found in any of the patients. The serratus anterior muscle flap is a good option for the treatment of soft tissue defects of the lower limb. This muscle flap has many advantages owing to its anatomical features.

Treatment for soft tissue defect combined with infection in the knee and upper leg used reverse anterolateral thigh flap or musculocutaneous flap.

Objective To investigate the clinical effect of reverse anterolateral thigh flap with lateral superior genicular artery or musculocutaneous flap for treating soft tissue defect combined with infection in the knee and upper leg. Methods From March 2007 to March 2008, 11 patients with soft tissue defect combined with infection in the knee and upper leg were treated in our hospital. There were 8 males, 3 fe-males, with the mean age of 33.4 years (range, 23-65 years), left thigh for 7 patients and right thigh for 4 patients. The course of disease was ranged for 6 hours to 8 months. One patient was caused by a open injury leading to skin and soft tissue defect in the anteroinferior knee combined with the fracture of tibial plateau, and was treated with debridement, internal fixation and transferring flap; ten patients were caused by the chronics infection with skin and soft tissue defect, and were treated with transferring anterolateral thigh flap later after treating with anti-infection, debridement and drainage. The injury area ranged from 6.3 cm×3.0 cm to 12 cm×7 cm. Results All patients were followed up for 3 to 6 months, with the average 4.7 months. All the flaps kept alive after operation. Three cases were debrided again in the followed 1-2 weeks because of the unhealing borderline of the flaps. Nine cases were sutured without need for skin graft, 2 cases had partial skin graft. No infection and necrosis were found in all flaps and the flaps were all alive after 3 months fol-low-up. The knee joints of all patients had a good motion. Conclusion The soft tissue defect combined with infection in the knee and upper leg can be treated with reverse anterolateral thigh flap, after controlling in-fection successfully. The flaps were thin and easy to alive, the musculocutaneous flaps can obturate the space and anti-infection. This method can reduce the operative trauma especially without need for the skin graft and get a good effect. Key words: Surgical flaps; Soft tissue injuries; Infection

Collagen matrices from sponge to nano: new perspectives for tissue engineering of skeletal muscle

BackgroundTissue engineering of vascularised skeletal muscle is a promising method for the treatment of soft tissue defects in reconstructive surgery. In this study we explored the characteristics of novel collagen and fibrin matrices for skeletal muscle tissue engineering. We analyzed the characteristics of newly developed hybrid collagen-I-fibrin-gels and collagen nanofibers as well as collagen sponges and OPLA®-scaffolds. Collagen-fibrin gels were also tested with genipin as stabilizing substitute for aprotinin.ResultsWhereas rapid lysis and contraction of pure collagen I- or fibrin-matrices have been great problems in the past, the latter could be overcome by combining both materials. Significant proliferation of cultivated myoblasts was detected in collagen-I-fibrin matrices and collagen nanofibers. Seeding cells on parallel orientated nanofibers resulted in strongly aligned myoblasts. In contrast, common collagen sponges and OPLA®-scaffolds showed less cell proliferation and in collagen sponges an increased apoptosis rate was evident. The application of genipin caused deleterious effects on primary myoblasts.ConclusionCollagen I-fibrin mixtures as well as collagen nanofibers yield good proliferation rates and myogenic differentiation of primary rat myoblasts in vitro In addition, parallel orientated nanofibers enable the generation of aligned cell layers and therefore represent the most promising step towards successful engineering of skeletal muscle tissue.

Sural Artery Flap for the Treatment of Osteomyelitis of the Lower Leg

Purpose: We report our experiences with a sural artery flap for the treatment of soft tissue defects in the lower leg with osteomyelitis. Materials and Methods: From 1998 to December 2004, 35 patients underwent sural artery flap surgery for soft tissue coverage in the lower leg. Among them, 13 cases also had osteomyelitis. The defects were located at the proximal 1/3 of the lower leg in 2 cases, middle 1/3 in 2 cases, and around the ankle in 9 cases. A distally based sural artery flap was performed in 11 cases, and 2 cases were treated with a proximally based sural artery flap. Results: The size of the defects ranged from 3×3 cm to 15×10 cm. Two cases showed marginal superficial necrosis that required debridement and secondary closure. After an average follow-up period of 33 months, the osteomyelitis was cured in all cases without recurrence. Conclusion: A sural arteriolized flap is useful for the treatment of osteomyelitis in the lower leg accompanied by a soft tissue defect.

Distally Based Fasciocutaneous Sural Flap for Foot Reconstruction: A Retrospective Review of 10 Years Experience

The treatment of soft tissue defects of the foot is a problem mainly connected to the thickness of the coverage tissues, to the poor circulation, and to the frequent involvement of muscle, tendon, and bone. The authors present their experience with the sural flap, also in some particular cases. The authors treated 33 patients for small- and medium-size defects of the foot, caused by work, home, and road accidents, and by venous or diabetic ulcers. In all cases, the flap was cut in its fasciocutaneous variant; an extension of the sole portion of fascia was added in 5 patients. The flap was transferred under a subcutaneous tunnel in 10 cases, with an open incision in 20 cases, and in 3 cases the pedicle was kept external for 4 weeks, then resected. One patient showed a complete necrosis of the flap and another showed a superficial necrosis preserving the deep fascia; in the remaining 31 cases, the flap incorporated without any major complication. The flap provided proper coverage of the defects from both an aesthetic and functional point of view as evidenced clinically and through a baropedographic test. The advantages of this flap include: dissection is fast and easy, it is not necessary to sacrifice important arterial pedicle or muscular units as it can be used in traumatized limbs without further damage to main arteries, and a wide rotation arc is possible. Disadvantages include the sacrifice of the sural nerve and the covering of the donor region with skin grafts.

Therapeutic effects of different flaps in treatment of soft tissue defects at anterior tibia

胫前外伤所致软组织缺损、伤口感染致内固定物暴露、慢性骨髓炎等愈合困难,处理棘手[1].文献报道可采用不同皮瓣进行修复,疗效不一[1-4].我院自1998年10月～2006年12月共收治胫前组织缺损47例,分别采用小腿内侧皮瓣、腓肠肌内侧头肌皮瓣和腓肠神经营养血管皮瓣进行修复,45例患者经0.5～3年的随访,疗效良好.本文对三种方法的适应证选择、预后及术中相关处理进行了探讨,总结分析如下。

Treatment for soft tissue defect of upper extremities by use of free skin graft or artificial dermis

Treatment for soft tissue defect of upper extremities by use of free skin graft or artificial dermis

The Use of Negative-Pressure Therapy and Skin Grafting in the Treatment of Soft-Tissue Defects Over the Achilles Tendon

Management of soft-tissue defects over the Achilles tendon presents specific challenges to the plastic surgeon. Primary closure or local flaps are often not feasible repair options for such wounds, and many of these patients may be poor candidates for free-tissue transfer secondary to their comorbidity. In this case series, the use of negative-pressure therapy in the preoperative period to prepare the wound bed for placement of a split-thickness skin graft and in the immediate postoperative period as a dressing for the graft was successfully used in 3 patients with soft-tissue defects over the Achilles tendon with exposed tendon. All 3 patients had stable wounds at 48 to 80 months postoperatively. Negative-pressure therapy and skin grafting was found to be a reliable method of repair that provided stable coverage for such wounds.

Management of soft tissue defects of the ankle and foot

Background: Treatment of soft tissue defect of ankle and foot has always been a challenging problem. Methods: Thirty patients with soft tissue defects of the ankle and foot who underwent various reconstructive procedures in two tertiary care teaching hospitals were studied. Results: Most of the defects (33%) were located in and around the ankle. Trauma was the major cause (56.6%). Defects were reconstructed with a variety of local, regional, distant and microvascular free flaps. Distally based superficial sural artery flap was used in majority of the cases (40%). Free tissue transfer using radial artery forearm flap was done in three (10%) complex wounds where other flaps were not found to be suitable. Superficial soft tissue defects on the dorsum of foot were resurfaced with split thickness skin grafts in 3 (10%) cases. Out of 27 flaps used, 26 survived completely. One inferiorly based fasciocutaneous flap developed partial necrosis. There was graft loss in one patient which required regrafting with the stored autograft. Conclusion: Distally based superficial sural artery flap remains the choice for reconstruction of soft tissue defects of ankle and foot because of its reliable blood supply and easy elevation.

Treatment of soft tissue defects on hand and forearm with vacuum assisted closure

Bei Verletzungen der Hand kommt es häufig im Zuge von Quetschungen und Kontusionen des Hautweichteilmantels zu primärem, aber auch sekundärem Verlust größerer Hautareale. Üblicherweise werden diese Verletzungen durch chirurgisches Débridement, Anlage eines sterilen Verbandes und die Ruhigstellung der Extremität behandelt. Im Zuge dieser Behandlung sind häufige Verbandswechsel erforderlich, welche die Gefahr der sekundären Infektion und dadurch bedingtem zusätzlichen Gewebeverlust beinhalten. Die langwierige Wundbehandlung führt darüber hinaus zu persistierenden Schwellungszuständen und folgenden Bewegungseinschränkungen. Die Vakuum assistierte Wundbehandlung hat sich bei der Behandlung chronischer Wunden bestens bewährt und wurde nun auch bei schweren Verletzungen an der Hand eingesetzt.

Treatment of soft tissue defects with exposed bone in the head and face region with alginates and hydrocolloid dressings

Purpose: In cases of soft tissue defects with exposed bone surfaces in the head and face region, there is the option of treating the defect with free split-thickness skin grafts following appropriate wound granulation. Secondary granulation on free bone surfaces is often a lengthy process, as granulation primarily occurs from the edges of the wound. Hydrocolloid dressings are gaining increasing attention in this context. The question arises as to whether the positive properties of hydrocolloid dressings can bring about rapid and positive conditioning of the base of the wound in soft tissue defects with exposed bone in the head and face region, with a view to subsequent split-thickness skin graft transplantation. Materials and Methods: In the period from 1997 to 2000, a total of 25 patients with soft tissue defects with exposed bone surfaces in the head and face region were treated with hydrocolloid dressings in the framework of a prospective clinical study. Results: The average time taken for complete granulation of the bone surface was 39.44 days (minimum, 10 days; maximum, 72 days). As a rule, this necessitated 12.8 changes of dressing (minimum, 3; maximum, 26). The granulation tissue was of good quality, generously vascularized, and occasionally exuberant at the edges of the wound Conclusion: On the whole, the combination of hydrocolloid dressing and alginate compress was found to have significant advantages as regards conditioning the exposed bone surface. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1126-1130, 2002

The Sural Artery Pedicled Flap for the Coverage of Soft Tissue Defects of the Leg, Ankle and Foot

Purpose : To represent our clinical experiences on the use of distally or proximally based sural artery pedicled flap for the treat-ment of soft tissue defects of the leg, ankle or foot. We expanded the indication for soft tissue coverage using sural artery flap by adding a proximally based sural artery flap to the distally based flap presented previously. Materials and Methods : Since 1994, 55 patients with soft tissue defects of the leg, ankle and foot were covered by using sural artery pedicled flaps, proximally based flaps in 7 patients and distally based in 48 patients. The size of the flaps varied from 5 cm wide and 6 cm long to 10 cm wide and 15 cm long. Results : All of the flaps except one survived. Marginal necrosis of the flap ocurred in 3 cases. Another three cases showed venous congestion during the early postoperative period. Sensibility loss was observed on the dorsolateral aspect of the foot. An unsightly scar was left at the donor site. Conclusion : The sural artery pedicled flap has a wide variety of indications, and can be used as a good alternative method for soft tissue coverage of small and medium sized soft tissue defects of the leg, ankle or foot. However, donor site morbidities should be considered before surgery.

Therapeutic options in treatment of heel defects. Presentation of an algorithm for therapeutic strategy

The treatment of soft tissue defects of the foot and ankle region remains a challenge, because special anatomical and physiological properties have to be considered. The data of 52 patients, who were treated between 1994 and 1998, were analyzed. 48% were posttraumatic defects and were located in the weight bearing zone in 37%. Fifty-nine procedures were used, including skin transplantation in 16 patients, local flaps in 3 cases, regional flaps in 14 cases, and microvascular procedures in 17 cases. Amputation was required in 4 patients. The overall success rate was 92%. Complications occurred in 18 patients. Using these data and evaluation of the actual literature lead to the development of an algorithm for the treatment of defects in this area. The modern armamentarium of plastic surgery offers the possible different treatment modalities.

Vacuum sealing: indication, technique, and results

Vacuum sealing is a new therapeutic concept to achieve secure and rapid wound healing in traumatic soft tissue damage (incl.open and closed fractures), in acute and, as an intermediate measure, in chronic infections. The tissue defect is filled in with open-porous polyvinylalcohol-foam and the entire wound surface is covered with a semipermeable transparent Polyurethane drape. Using Redon-drainage tubes and vacuum bottles, a vacuum of 80 kPa is established in the entire wound. This results in a complete evacuation of fluids and a high pressure in the interface between the foam and the wound surface without compression of deeper wound layers. The therapeutic benefit lies in the rapid formation of sound granulation tissue. Between January 1992 and August 1993, 181 patients had undergone a vacuum sealing procedure. 121 patients were followed up, underlining the benefit of vacuum sealing for the treatment of soft tissue defects.

Muscle Transposition in the Treatment of Soft Tissue Defect of the Leg

Muscle Transposition in the Treatment of Soft Tissue Defect of the Leg

The Proximally Pedicled Arteria Radialis Forearm Flap in the Treatment of Soft Tissue Defects of the Dorsal Elbow

Soft tissue defects of the dorsal side of the elbow require a stable soft tissue reconstruction. Therefore, for the treatment of limited, uninfected defects, local or distant skin flaps should be used. For large and infected defects, the use of the proximally pedicled arteria radialis forearm flap is indicated. We used the flap in 14 patients as an alternative to conventional methods. This neurovascular, septocutaneous flap proved safe and versatile, guaranteeing stable soft tissue reconstruction of the dorsal aspect of the elbow. The flap has an orthograde flow and is nourished by the radial artery. With its long, neurovascular pedicle, it can be transposed in a proximal ulnar or radial direction. Four years after operation, all elbow joints showed a complete range of motion. No further soft tissue instabilities were seen.

Lateral sural cutaneous artery island flap in the treatment of soft tissue defects at the knee

This paper describes a flap for covering defects around the knee. Dissections of 20 legs showed that in the majority the lateral sural cutaneous artery branched from the popliteal artery and descended along the posterolateral aspect of the leg together with two venae comitantes and the lateral sural cutaneous nerve. An island flap was designed, pedicled on these vessels and nerve, and was used in 17 patients with defects around the knee, including acute trauma (three cases), soft tissue tumours (three cases), unstable scar or ulcer (seven cases), and chronic osteomyelitis or infected open fractures with tissue loss (four cases). All the flaps survived entirely and possessed normal sensation. Furthermore, it was not necessary to sacrifice the main vessels of the lower leg.

Serratus anterior muscle transplantation for treatment of soft tissue defects in the hand

The inferior three slips of the serratus anterior muscle have been used as a free tissue transfer in 18 patients for the reconstruction of dorsal and palmar defects in the hand. Mean follow-up was 2.8 years. There were 1218 flaps for palmar coverage and 618 for dorsal coverage. All flaps survived. On the basis of this experience we conclude that this flap has three attributes making it suitable for palmar and dorsal metacarpal resurfacing: (1) low donor site morbidity, (2) the three separate slips are easily divisible for contouring, and (3) durability and adhesion provide a stable resurfacing for grasp.

Treatment of Soft Tissue Defect on Dorsum of hand by Using the Reverse Radial Forearm Flap: Report of 5 Cases

Treatment of Soft Tissue Defect on Dorsum of hand by Using the Reverse Radial Forearm Flap: Report of 5 Cases