Use Of Musculocutaneous Flap Research Articles

Delayed Breast Reconstruction on Patients With Upper Extremity Lymphedema: A Systematic Review of the Literature and Pooled Analysis.

Breast cancer-related lymphedema (BCRL) is a debilitating condition with morbidity, hindered quality of life, and increased health-related costs. Experimental studies support the use of musculocutaneous flaps for managing animal models with lymphedema. Although vascularized lymph node transfer (VLNT) and lymphovenous anastomosis are used to surgically treat patients with lymphedema, it is not known whether musculocutaneous or adipocutaneous flaps (eg, delayed autologous breast reconstruction) are effective for treating refractory upper extremity BCRL. We conducted a systematic review and pooled analysis to assess the impact of delayed breast reconstruction on developed BCRL. Following PRISMA guidelines, we systematically searched PubMed, Scopus, EMBASE, and Google Scholar databases for relevant studies published through November 11, 2016. We screened 934 unique articles. Of these, we conducted full-text and reference screening on 37 articles. We then performed a pooled and sensitivity analysis using random effects. Eight studies met our inclusion criteria. One study was a case report; 7 studies were case series with sample sizes ranging from 3 to 38 patients. According to our pooled analysis 58% of patients reported improvement after breast reconstruction with or without VLNT. Sensitivity analysis revealed that 84% (95% confidence interval, 0.74-0.95) of patients who underwent breast reconstruction and VLNT reported improvement, whereas only 22% (95% confidence interval, 0.12-0.32) of those who had breast reconstruction alone reported improvement. Our review summarizes the current evidence regarding the effect of delayed breast reconstruction on established lymphedema. The VLNT component of the autologous breast reconstruction procedures may be the largest contributing factor leading to lymphedema improvement.

Lambeau fasciocutané sous fessier fiabilisé par une perforante de l’artère fémorale profonde en reconstruction d’escarre ischiatique

The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers. A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily. A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory. Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size.

Morbidity of immediate breast reconstruction (IBR) after mastectomy by a subpectorally placed silicone prosthesis:the adverse effect of radiotherapy

Aims This study evaluates the incidence of local complications after immediate breast reconstruction (IBR) following mastectomy with a subpectorally placed silicone prosthesis, with emphasis on the effect of radiation treatment on IBR. Methods The medical records of 100 women, who underwent a mastectomy followed by IBR with a subpectorally placed silicone prosthesis at the University Hospital Rotterdam/Daniel den Hoed Cancer Center, between March 1990 and March 1995, were reviewed. Thirteen prostheses were implanted prior to radiation treatment, and 15 prostheses were implanted after irradiation of the chest wall. Results Early complications were seen in 15% of the IBR and were more often in irradiated women. At long-term follow-up, the most common complication was capsular contracture (21%). This occurred significantly more around prostheses placed in a previously irradiated area (P<0.0005), or which were irradiated after IBR (P=0.001). Loss of prosthesis was seen in 11 cases, and was significantly (P<0.005) more in irradiated women (n=5; 18%) compared to women who were not irradiated (n=6; 7%).Conclusions Complications after IBR with a silicone prosthesis were more common in women who were treated with radiotherapy prior to or after IBR following mastectomy than in women who were not irradiated. In particular, capsular contracture around a prosthesis placed in a previously irradiated area was significantly increased. The use of musculocutaneous flaps, such as the transverse rectus abdominis muscle or latissimus dorsi flap, is preferable for reconstruction of previously irradiated breasts. There is no indication to remove the prosthesis before radiation therapy of the chest wall.

Intrathoracic Transposition of the Musculocutaneous Flap in Treating Empyema

Intrathoracic transposition of the musculocutaneous (MC) flaps of the latissimus dorsi and rectus abdominis was performed after open-drainage thoracotomy in 6 patients with empyema. The MC flaps were designed in such a way that the muscle-bearing skin paddle was extended well beyond the distal muscle borders. The MC flaps thus provided substantially larger pieces compared to muscle flaps. With the exception of one patient with persistent bronchopleural fistula whose empyema recurred due to the reopening of the fistula, the thoracic closure was successful in all patients. Postoperative magnetic resonance imaging revealed a well-preserved volume of subcutaneous tissue in the flaps, while the muscle portions of the flaps had atrophied. In conclusion, compared to muscle flaps, MC flaps have the advantages that (1) larger empyema cavities can be obliterated, and (2) the deformity of the thoracic wall can be minimized because of the small range of resected rib segments and well-preserved volume of subcutaneous tissue in the flap long after the transposition. The use of MC flaps is thus indicated for the empyema cavity remaining when a cavity is cleaned up of granulatous tissue with eradication of bronchopleural fistula.

Musculocutaneous Flaps in Head and Neck Surgery

Educational objectives: To identify the musculocutaneous flaps most commonly used in head and neck reconstructive surgery and to discuss the clinical considerations and indications for use of musculocutaneous flaps in head and neck reconstructive surgery.

仙骨部じょくそうの外科的治療

Recently, various techniques have been used to cover sacral pressure sores. These include skin grafts, local flaps, musculocutaneous flaps and fasciocutaneous flaps.We investigated how to decide which technique should best be used for managing sacral pressure sores of individual patients.The points are (1) confidence, (2) damage to patient, (3) surgical technique, (4) infection, (5) sore size, and (6) recurrence of sore.Our first option has been the use of local flaps where possible. However, when local flaps cannot be applied, we recommend the use of musculocutaneous flaps.

Early, Aggressive Management of Postoperative Oropharyngocutaneous Fistulas

Oropharyngocutaneous fistulas remain a serious and potentially lethal complication. Advantages from surgical repair and the use of musculocutaneous flaps have been demonstrated. Timing of the procedure, however, has not been adequately addressed or emphasized. This report presents our experience with early, aggressive management of postoperative orocutaneous fistulas. Patients were reoperated at an average of 12 days after the initial surgery and underwent exploration, debridement of all devitalized tissues, and closure by reelevation of previously used flaps or with additional flaps. All wounds healed without further problem. We conclude that as long as the patient's general condition permits, early, aggressive management of fistulas should be the procedure of choice to reduce hospital stay and costly wound care and to avoid maceration and partial or complete necrosis of flaps and the potential rupture of the carotid artery. Timely radiotherapy can then be delivered, and quality of life can be significantly improved.

Early, Aggressive Management of Postoperative Oropharyngocutaneous Fistulas

Oropharyngocutaneous fistulas remain a serious and potentially lethal complication. Advantages from surgical repair and the use of musculocutaneous flaps have been demonstrated. Timing of the procedure, however, has not been adequately addressed or emphasized. This report presents our experience with early, aggressive management of postoperative orocutaneous fistulas. Patients were reoperated at an average of 12 days after the initial surgery and underwent exploration, debridement of all devitalized tissues, and closure by reelevation of previously used flaps or with additional flaps. All wounds healed without further problem. We conclude that as long as the patient's general condition permits, early, aggressive management of fistulas should be the procedure of choice to reduce hospital stay and costly wound care and to avoid maceration and partial or complete necrosis of flaps and the potential rupture of the carotid artery. Timely radiotherapy can then be delivered, and quality of life can be significantly improved.

筋皮弁を用いたじょくそうの治療について（骨盤周囲のじょくそうを中心に）

Despite emphasis on prevention, pressure sores continue to occur and prevent these patients from functioning in society. It is important to evaluate the extent of the lesion correctly and to make treatment programs. We have managed sacral, trochanteric and ischial pressure sores by the use of musculocutaneous flap. A total of 12 musculocutaneous transpositions have been done for the last 4 years. This experience will be reviewed.

Our experience with the use of musculocutaneous flaps in trochanteric decubitus ulcers

Our experience with the use of musculocutaneous flaps in trochanteric decubitus ulcers

The total gluteus maximus rotation and other gluteus maximus musculocutaneous flaps in the treatment of pressure ulcers

The use of musculocutaneous flaps in the treatment of pressure ulcers has been widely accepted. This study presents the results of the use of various types of gluteus maximus musculocutaneous flaps such as island flaps, advancement flaps and new total gluteus maximus rotation flaps with or without an inferior gluteal fasciocutaneous extension, in the treatment of pressure ulcers.

Our experience in the use of musculocutaneous flaps for the repair of ischial pressure sores. (French)

Our experience in the use of musculocutaneous flaps for the repair of ischial pressure sores. (French)

Skin flap research: a candid view.

To better understand skin flap research, three pivotal papers of the last decade are reviewed. The validity of Milton's questioning the accepted length to width ratio is confirmed, whereas the shunt theory of skin flap failure is rejected, and the value of isoxsuprine treatment for preventing flap failure is debated. Current trends in three other areas of skin flap research are highlighted--skin flap metabolism, skin flap monitoring, and the use of musculocutaneous flaps for contaminated wounds.

Use of gracilis musculocutaneous flap in urologic cancer surgery

The recently increased use of musculocutaneous flaps has revolutionized plastic surgery. The gracilis musculocutaneous flap, complete with its own blood and nerve supply, can be rotated on its vascular pedicle to close safely defects in the lower pelvis. This flap can be especially useful for patients with urogenital cancer when surgery, irradiation, or chemotherapy creates a wound too large for primary closure.

One-Stage Cervical Esophageal and Pharyngeal Reconstruction for a Fourth Primary Cancer

This case is presented to describe how an ellipse of skin taken with a pectoralis major musculocutaneous flap can be sewn in a spiral fashion to make a water-tight tube to replace the cervical esophagus. While this case may represent a technical triumph of the use of musculocutaneous flaps, we cannot help but feel it is a hollow victory because of the patient's addiction to cigarettes and alcohol. While constant attention and hard work have kept her alive for 16 years, with four primary cancers of the oral cavity, pharynx, and proximal esophagus, continued use of alcohol and cigarettes (Fig. 7) may well defeat our technical advances.