Variety Of Soft Tissue Defects Research Articles

The Effect of Previous Transradial Catheterization on Radial Forearm Free Flaps

Radial forearm free flaps (RFFF) are a versatile option for the reconstruction of a wide variety of soft tissue defects and are particularly common in head and neck surgery. Benefits of RFFF include a relatively short operating time, a long pedicle, and a thinner, more pliable flap. However, in addition to its role in reconstructive surgery, the radial artery may be utilized for a number of other procedures including coronary angiography and percutaneous coronary interventions. Concern has previously been raised that prior catheterization may deleteriously affect the function of the radial artery and in the field of cardiothoracic surgery, individuals are increasingly advising against its use as a graft for coronary artery bypass graft surgery in such circumstances. Despite this, little is known about the effect on RFFF. In this review article, we concisely consider the available evidence of the effect of previous transradial catheterization on the radial artery and discuss the implications for reconstructive surgery. We then summarize the key considerations regarding their use in current practice.

Infectious Complications Associated with the Use of Integra: A Systematic Review of the Literature.

Background:Dermal regeneration templates such as Integra are effective reconstructive biomaterials used in a variety of soft-tissue defects. Fully understanding the complications associated with their use is paramount to improve outcomes and maximize patient safety. In this study, our purpose is to perform a comprehensive literature review to assess the previously reported infectious complications linked to Integra-based wound closure.Methods:We conducted a systematic review of the literature to identify previous articles indexed in PubMed and Ovid for Integra and its synonymous terms. We used these search terms: [Integra OR (dermal regenerative matrix) OR (dermal regeneration matrix) OR (dermal regenerative template) OR (dermal regeneration template) OR (dermal substitute) OR (skin substitute) OR (artificial skin)] AND infection.Results:Of the 3508 articles for initial review, 69 reported rates of infection, of which 26 reported ≥1 infection within their cohort. Of these 26 articles, the patients (n = 602) underwent Integra-based reconstruction in 1254 sites and had reported infections in 212 of the sites (16.9%). Among these, we encountered a single report of a fatal case of toxic shock syndrome (TSS) related to the use of Integra in secondary burn reconstruction.Conclusions:While Integra offers many benefits, surgeons must be aware that infectious complications are not uncommon. As a result, a careful risk–benefit analysis of its use in reconstruction must be performed, and open discussion with the patient preoperatively regarding infection rate is of utmost importance.

The Essential Local Muscle Flaps for Lower Extremity Reconstruction.

Lower extremity reconstruction is often a challenging prospect with major implications on a patient's quality of life. For complex defects of the lower extremity, special consideration must be given to ensure suitable and durable coverage. In the following article, we present the essential local muscle flaps for lower extremity reconstruction and discuss guiding principles for the reconstructive surgeon to consider. A thorough literature review was performed using PubMed to identify commonly used local muscle flaps for lower extremity reconstruction. Common considerations for each identified flap were noted. The essential local muscle flaps for lower extremity reconstruction were identified and classified based on anatomical region of the defect to be reconstructed. General considerations and postoperative management were discussed to aid in operative decision making. While many factors must be taken into account when performing lower extremity reconstruction, there are numerous reliable local muscle flaps which can be used to successfully provide durable coverage for a variety of soft tissue defects of the lower extremity.

Amélioration de la technique de prélèvement des lambeaux périscapulaires grâce au système de positionnement de membre Spider®

Subscapular vascular system based flaps provide excellent solutions for the coverage of a large variety of soft tissue defects. Dorsal decubitus position allows two teams of surgeons to work simultaneously and to harvest the flap in both an effective and safer way. Previously described for orthopaedic surgery, the Spider® limb positioning system offers a precious addition to the technique, giving a simple mean to keep the arm in the desired position while harvesting the flap. The need for an assistant to hold the upper limb is no longer required, enabling him to help in a more effective and time sparing way during surgery.

Treatment of complications from polyacrylamide hydrogel breast augmentation.

Polyacrylamide hydrogel (PAHG) is a medical soft tissue filling agent utilized for the treatment of a variety of soft tissue defects. However, postoperative complications occur that have to be alleviated. The aim of the present study was to examine the treatments of postoperative complications of mammoplasty augmentation with PAHG. Open suction techniques and partial mastectomies via periareolar incisions were performed in 28 patients who had been injected with PAHG for breast augmentation. The PAHG was removed precluding breast complications resulting from the hydrogel injections. The symptoms disappeared completely, and the results were satisfactory following removal of the PAHG. In conclusion, the periareolar approach is valuable and removes PAHG to the greatest extent.

Surgical Anatomy of the Medial Sural Artery Perforator Flap

The medial sural (medial gastrocnemius) perforator flap is a thin flap with a long pedicle. It has tremendous potential for applications in a variety of soft-tissue defects. We aimed to further clarify the vascular anatomy of the medial sural region and establish a safe approach for elevation of this flap. Ten fresh cadaveric lower limbs were injected and used in this study. We identified the locations and courses of the medial sural artery perforators and correlated them to anatomic landmarks. The medial sural artery divides into two branches, a medial and lateral branch. Correspondingly, musculocutaneous perforators supplying the overlying skin were oriented in two parallel vertical rows, along the course of the lateral or medial branch of the medial sural artery. Two to six perforators were located 6 cm to 22.5 cm from the popliteal crease. Perforators from the lateral row, nearer the posterior midline, were generally larger. In most cases, a large perforator with a superficial, straight intramuscular course could be identified a mean of 10 cm distal to the popliteal crease and an average of 2 cm from the posterior midline. Based on the above findings, we successfully used this flap in five clinical cases. Perforators of the medial sural artery were arranged in a medial and a lateral row. Use of perforators from the lateral row, nearer the posterior midline, is preferable as these are usually larger in size. A consistent major perforator could always be identified in all specimens. With increased safety and confidence in flap harvesting, the medial sural artery perforator flap may find wider clinical applications. TherapeuticLevel of Evidence: IV.

Versatile use of rectus abdominis muscle and musculocutaneous flaps for soft-tissue reconstruction: our clinical experiences in 25 cases

The rectus abdominis muscle and musculocutaneous flaps have contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous and muscular tissue. In this article, outcomes of soft-tissue defects after reconstruction with the rectus abdominis muscle and musculocutaneous flaps were retrospectively analyzed. From August 2003 to June 2009, 25 flaps were transferred to reconstruct a wide variety of soft-tissue defects in the breast, chest wall, groin, perineal, and head and neck regions, as well as the upper and lower extremities. The rectus abdominis muscle and musculocutaneous flaps were used as part of 11 different approaches in 25 cases. There were 13 male and 12 female patients; the mean patient age was 44.2 years. The mean follow-up period was 8 months (range, 4–15 months). The overall success rate was 100%, and all flaps healed uneventfully. All reconstructive procedures were completed without any major complications. Rectus sheets were repaired primarily, and no mesh application was used. Minor complications related to transferred flaps were wound infection and dehiscence in one case, wound dehiscence in two cases, and flap lymphedema in one case. Minor complications related to the donor site were seroma in one case and wound infection and dehiscence in another case. This study presents our experience with the rectus abdominis muscle and musculocutaneous flaps in a series of 25 cases. The indications for the use of this particular flap with other flaps are discussed.

Anatomo-radiological study of the internal pudendal perforator vessels : clinical relevance in reconstructive surgery of the perineal region

Introduction . The mobilization of muscular and fasciocutaneous flaps represents a mandatory reconstructive surgery in a variety of soft tissue defects of the the pelvi-perineal area. Often oncological surgery, trauma or severe soft tissue infections such as Fournier’s gangrene, produce functional and morphological deformities of this region. An appropriate soft tissue reconstruction may limit the development of scar contractures and stenosys. The possibility to better localize the main vascular perforators may help the surgeon in a safe flap mobilization. Methods . To objectively document the topografical location of external and internal pudendal arteries and respectively perforators branches, an anatomo-radiological study on 24 CT angiographies of 12 lower limbs (multidetector CT 16 slides), and analysis of multiplannar images and 3D reconstructions (Terarecon™) were performed. The origin, number, course and location of perforators of the internal pudendal artery in vivo were recorded. Results . Superficial landmarks (anus, external urethral meatus and ischiatic tuberosity) may describe a safe cutaneous perineal region in which is possible to localize all internal pudendal perforator arteries. In this area the mean number of perforators was 2,6 (range: 0-4). In one case (4%) the perforators vessels originated from the inferior gluteal artery. The mean diameter of perforators was 2,3 mm (0,47SD; range 1,4-3,4). The most proximal perforator of the internal pudendal artery presented a mean caliber of 2,6 mm (range 2-3,4). Discussion . This study confirms the presence of a rich vascular network between the internal and external pudendal artery. Moreover a reliable caliber and constant location of the perforators of the internal pudendal artery are documented. These observations are also confirmed intraoperatively during the mobilization of perforators flaps for the reconstruction of perineal area. The knowledge of the rich vascular plexus allows to plan a variety of fascio-cutaneous perforator flaps that may guarantee better reconstruction results then the past.

Synthesis and properties of a novel anisotropic self-inflating hydrogel tissue expander

The advent of self-inflating hydrogel tissue expanders heralded a significant advance in the reconstructive techniques available for the surgical restoration of a wide variety of soft tissue defects. However, their use in specific applications such as cleft palate surgery is limited on account of their isotropic expansion. An anisotropic self-inflating hydrogel tissue expander has been developed which markedly increases the potential indications for which this restorative tool may be employed. These include complex pediatric soft tissue reconstructions of the palate, nose, ear and digits. Anisotropic expansion in a hydrogel polymer network composed of methyl methacrylate and vinylpyrrolidone has been achieved by annealing the xerogel under a compressive load for a specified time period. By controlling the anisotropic processing conditions and composition we have been able to accurately tailor the ultimate expansion ratio up to 1500%. The expansion rate of the xerogel has also been significantly reduced by encapsulating the polymer within a semi-permeable silicone membrane. The structure and properties of the novel anisotropic hydrogel were characterized by attenuated total reflectance infrared spectroscopy, differential scanning calorimetry, thermogravimetric analysis and small-angle neutron scattering.

Clinical Application of the Anterolateral Thigh Flap for Soft Tissue Reconstruction

The purpose of this article is to describe the author's experience using the anterolateral thigh (ALT) flap for the reconstruction of a variety of soft tissue defects. The flap utility and donor site morbidity were evaluated in 126 cases from March 1985 to August 2007. The ALT flaps were harvested as either free fasciocutaneous, free adipofascial, fasciocutaneous island, or reversed fasciocutaneous island flaps to repair facial, neck, breast, trunk, and extremity defects. In 40 cases (32%), the skin vessels were found to be septocutaneous perforators, and in 86 cases (68%), they were found as musculocutaneous perforators. Of the 126 flaps, 121 survived completely, providing a success rate of 96.0%. There were four cases undergoing multidetector-row computed tomographic angiography (CTA) for preoperative perforator mapping, and all perforators were confirmed intraoperatively. In conclusion, the ALT flap is a versatile and reliable flap that could well be a priority option for soft tissue reconstruction. CTA can provide more valuable and accurate anatomic information about the pedicle and perforators, making it safer and faster to harvest a targeted ALT perforator flap with less donor site morbidity.

Versatility of the free anterolateral thigh flap: clinical experience in a series of 20 patients

The main nutrient vessel of the anterolateral thigh flap is the perforator originating from the descending branch of the lateral circumflex femoral artery (LCFA). It supplies a large area of skin on the anterolateral aspect of the thigh. We present the experience of 20 consecutive anterolateral thigh flaps used for a variety of soft tissue defects. Fourteen flaps were used for lower leg reconstruction, four in the head and neck, and the remaining two in the hand. The largest flap was 30×15 cm. All flaps survived except two which had partial skin necrosis, but the underlying adipose tissue survived and was grafted. Reexploration was needed for one patient in whom a thrombus blocking the vein was removed, and the flap survived completely. The anterolateral thigh flap has the advantage of a long vascular pedicle, large-caliber vessels, availability of a large skin flap area, and suitability as a flow-through flap.

Donor leg morbidity after pedicled rectus femoris muscle flap transfer for abdominal wall and pelvic reconstruction.

The pedicled rectus femoris muscle and myocutaneous flap has found application for a variety of soft tissue defects of the groin, pelvis, and lower abdomen. Although a number of authors have discussed the usefulness of this muscle flap, few have documented the morbidity from loss of this muscle in the leg. We have studied 7 patients who underwent unilateral rectus femoris muscle transfer, comparing strength of the donor knee to the normal knee. All patients were studied using a computerized dynamometer for strength of knee flexion and contraction. We found that loss of the rectus femoris in patients not undergoing a postoperative program of therapy led to an average decrease in strength about the knee of 24% to 28%, depending on the motion measured. A single patient who underwent an intensive postoperative therapy program had return of normal strength in his donor leg. Despite this common loss of strength, patient complaints were few and the results of reconstruction appeared to outweigh this loss of strength.