Donor site morbidity in buccinator-based myomucosal flaps: A retrospective study

Introduction: Reconstruction of sacral and ischial pressure injury offers great challenges due to its high complication and recurrence rate. Providing durable tissue coverage with minimal donor site morbidity is paramount while ensuring fast operative time for the patients who often possess multiple comorbidities. This study aims to present cases of sacral and ischial pressure injury reconstruction using a keystone flap. Method: A retrospective study was performed by reviewing data from fifteen patients with a sacral and ischial pressure injury who underwent reconstruction using various types of keystone flaps in our center between 2019 and 2020. Results: The patients’ age ranged from 10 to 83 years old (average, 40.5 years old). The average wound dimensions were 9.4 ± 3.1 cm x 6.5 ± 2.7 cm and the mean area of the defects was 52.3 ± 35.7 cm2, with the largest defect was 15 x 12 cm (141.3 cm2). Mean operative time was 140 ± 24.5 minutes with nine wounds were reconstructed using type IV keystone flap (60%) and six patients using type IIA (40%). Postoperative complications occurred in three patients (20%). Other patients resulted in uneventful complete healing. Conclusion: The keystone flap is reliable, simple, has a fast technique, and minimal donor site morbidity to cover the defects of sacral and ischial pressure injury. Performing thorough debridement, choosing the right type of keystone flap, elevating the flap adequately to allow mobilization, preserving perforator “hotspots”, and suturing of the flap without tension are keys to achieve satisfactory results.

Download Full-text

A Retrospective Study of an Updated and Traditional Surgical Approach of the Distally Based Sural Flap

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1716744 ◽

2020 ◽

Author(s):

Heng Xu ◽

Xuexin Cao ◽

Sally Kiu-Huen ◽

Zhu Zhu ◽

Jun Chen ◽

...

Keyword(s):

Retrospective Study ◽

Traditional Approach ◽

Donor Site ◽

Donor Site Morbidity ◽

Lateral Malleolus ◽

Sural Flap ◽

Pivot Point ◽

Propeller Flap ◽

Distally Based ◽

Distally Based Sural Flap

Abstract Background The distally based sural flap (DBSF) is one of the armamentarium in the lower limb reconstruction. However, the flap has not gained popularity due to concerns about its reliability and donor site morbidity. Based on the anatomy characterization, we combined and developed five modifications to improve the vascular supply and reduce donor site morbidity. Patients and Methods The authors performed a comparison of retrospective study that included patients who underwent either traditional distally based sural flap (tDBSF) or modified distally based sural flap (mDBSF) surgery approach for ankle, heel, and dorsal foot coverage between January 2007 and May, 2019. The five modifications developed to improve the reliability of the flap include: 1. shift the pivot point more proximally 7.0 cm above the lateral malleolus, 2. preserve the lesser saphenous vein and include branches that communicates with the flap, 3. harvest thinner fascial pedicle, 4. change the skin incision to “S” shape, 5. closure of the donor site with a propeller flap. Results Thirty-one patients underwent mDBSF, and 23 received tDBSF. There were no significant differences in the size of the DBSF. Mean pedicle width was significantly narrower in mDBSF (1.63 ± 0.52 cm vs. 3.81 ± 0.70 in tDBSF). The pivot point was also found to be higher in mDBSF (8.01 ± 0.63 cm vs. 5.46 ± 0.56 cm) above the lateral malleolus. In mDBSF, the size of the propeller flap required for donor site closure was 53.45 ± 19.06 cm2 (range 33–80 cm2). The rate of partial necrosis between mDBSF and tDBSF was significantly different (9.68 vs. 34.78%). While the other complications had no difference. Conclusion The modifications applied to the harvesting of the DBSF have achieved higher survival rate, lower dehiscence rate, and shorter hospital stay time in comparison with traditional approach in our retrospective study.

Download Full-text

Retrospective analysis of free temporoparietal fascial flap for defect reconstruction of the hand and the distal upper extremity

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03635-9 ◽

2020 ◽

Author(s):

Wibke Müller-Seubert ◽

Raymund E. Horch ◽

Vanessa Franziska Schmidt ◽

Ingo Ludolph ◽

Marweh Schmitz ◽

...

Keyword(s):

Retrospective Study ◽

Soft Tissue ◽

Upper Extremity ◽

Reconstructive Surgery ◽

Donor Site ◽

Donor Site Morbidity ◽

Soft Tissue Reconstruction ◽

Flap Necrosis ◽

Fascial Flap ◽

Tissue Reconstruction

Abstract Introduction Soft tissue reconstruction of the hand and distal upper extremity is challenging to preserve the function of the hand as good as possible. Therefore, a thin flap has been shown to be useful. In this retrospective study, we aimed to show the use of the free temporoparietal fascial flap in soft tissue reconstruction of the hand and distal upper extremity. Methods We analysed the outcome of free temporoparietal fascial flaps that were used between the years 2007and 2016 at our institution. Major and minor complications, defect location and donor site morbidity were the main fields of interest. Results 14 patients received a free temporoparietal fascial flap for soft tissue reconstruction of the distal upper extremity. Minor complications were noted in three patients and major complications in two patients. Total flap necrosis occurred in one patient. Conclusion The free temporoparietal fascial flap is a useful tool in reconstructive surgery of the hand and the distal upper extremity with a low donor site morbidity and moderate rates of major and minor complications.

Download Full-text

DONOR SITE MORBIDITY AFTER HARVESTING OF BONE FROM ANTERIOR ILIAC CREST FOR MAXILLOFACIAL RECONSTRUCTION

Egyptian Dental Journal ◽

10.21608/edj.2017.74734 ◽

2017 ◽

Vol 63 (1) ◽

pp. 263-269

Author(s):

Ahmed Naguib ◽

Khalid Saad ◽

Rafic Bedir

Keyword(s):

Iliac Crest ◽

Donor Site ◽

Donor Site Morbidity ◽

Maxillofacial Reconstruction

Download Full-text

Investigation Into the Optimal Number of Intercostal Nerve Transfers for Musculocutaneous Nerve Reinnervation: A Systematic Review

Hand ◽

10.1177/1558944717744280 ◽

2017 ◽

Vol 13 (6) ◽

pp. 621-626 ◽

Cited By ~ 2

Author(s):

Hyuma A. Leland ◽

Beina Azadgoli ◽

Daniel J. Gould ◽

Mitchel Seruya

Keyword(s):

Systematic Review ◽

Brachial Plexus ◽

Donor Site ◽

Elbow Flexion ◽

Donor Site Morbidity ◽

Intercostal Nerve ◽

Optimal Number ◽

Musculocutaneous Nerve ◽

Nerve Transfers ◽

Meta Analyses

Background: The purpose of this study was to systematically review outcomes following intercostal nerve (ICN) transfer for restoration of elbow flexion, with a focus on identifying the optimal number of nerve transfers. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies describing ICN transfers to the musculocutaneous nerve (MCN) for traumatic brachial plexus injuries in patients 16 years or older. Demographics were recorded, including age, time to operation, and level of brachial plexus injury. Muscle strength was scored based upon the British Medical Research Council scale. Results: Twelve studies met inclusion criteria for a total of 196 patients. Either 2 (n = 113), 3 (n = 69), or 4 (n = 11) ICNs were transferred to the MCN in each patient. The groups were similar with regard to patient demographics. Elbow flexion ≥M3 was achieved in 71.3% (95% confidence interval [CI], 61.1%-79.7%) of patients with 2 ICNs, 67.7% (95% CI, 55.3%-78.0%) of patients with 3 ICNs, and 77.0% (95% CI, 44.9%-93.2%) of patients with 4 ICNs ( P = .79). Elbow flexion ≥M4 was achieved in 51.1% (95% CI, 37.4%-64.6%) of patients with 2 ICNs, 42.1% (95% CI, 29.5%-55.9%) of patients with 3 ICNs, and 48.4% (95% CI, 19.2%-78.8%) of patients with 4 ICNs ( P = .66). Conclusions: Previous reports have described 2.5 times increased morbidity with each additional ICN harvest. Based on the equivalent strength of elbow flexion irrespective of the number of nerves transferred, 2 ICNs are recommended to the MCN to avoid further donor-site morbidity.

Download Full-text

Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04197-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Marie Protais ◽

Maxime Laurent-Perrot ◽

Mickaël Artuso ◽

M. Christian Moody ◽

Alain Sautet ◽

...

Keyword(s):

Rotator Cuff ◽

Donor Site ◽

Anatomical Study ◽

Donor Site Morbidity ◽

Rotator Cuff Tears ◽

Subacromial Space ◽

Greater Tuberosity ◽

Working Zone ◽

Superior Capsular Reconstruction

Abstract Background Irreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. Methods This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. Results The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. Conclusion This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.

Download Full-text

Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

Craniomaxillofacial Trauma & Reconstruction Open ◽

10.1177/24727512211020574 ◽

2021 ◽

Vol 6 ◽

pp. 247275122110205

Author(s):

Sebastian Rios ◽

María Isabel Falguera-Uceda ◽

Alicia Dean ◽

Susana Heredero

Keyword(s):

Survival Rate ◽

Preoperative Planning ◽

Donor Site ◽

Free Flaps ◽

Donor Site Morbidity ◽

Anterolateral Thigh Flap ◽

Cochrane Library ◽

Review Of The Literature ◽

Comprehensive Review ◽

Search Terms

Study Design: Suprafascial free flaps have become common place in reconstructive surgery units. Nomenclature related to these flaps has not been uniform throughout the scientific literature, especially in regard to planes of dissection. This study is designed as a comprehensive review of the literature. Objectives: Our study highlights which flaps are used most frequently, their main indications, their survival rate, and how they have evolved in the last few decades as innovations have been introduced. Methods: A review of the literature was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and Cochrane Library were searched using the appropriate search terms. Data collected from each study included flap type, dissection plane, preoperative planning, area of reconstruction, as well as complications, donor-site morbidity and survival rate. Results: Seven hundred and fifty-five studies were found based on the search criteria. After full-text screening for inclusion and exclusion criteria 34 studies were included. A total of 1332 patients were comprised in these studies. The most common types of flaps used were superficial circumflex iliac perforator flap (SCIP), anterolateral thigh flap (ALT), and radial forearm flap. The most common areas of reconstruction were head & neck and limbs. There was no significant difference in survival rates between flaps that were raised in different planes of dissection. Conclusions: Based on the author’s review of the literature, suprafascial flaps are reliable, they have low donor site morbidity, and there is a wide selection available for harvest. The use of new technologies for preoperative planning, such as CT-Angiography and UHF ultrasound, have contributed to have more predictable results. We propose a standardized classification for these flaps, in order to create a uniform nomenclature for future reference.

Download Full-text

Gracilis Flap Reconstruction After Proctocolectomy for Malignancy and Inflammatory Bowel Disease

The American Surgeon ◽

10.1177/00031348211011146 ◽

2021 ◽

pp. 000313482110111

Author(s):

Olivia M. DeLozier ◽

Zachary E. Stiles ◽

David Shibata ◽

Jeremiah L. Deneve ◽

Justin Monroe ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Donor Site ◽

Donor Site Morbidity ◽

Neoadjuvant Chemoradiation ◽

Wound Complications ◽

Flap Reconstruction ◽

Major Complications ◽

Inflammatory Bowel ◽

Perineal Wounds

Background Gracilis flap reconstruction (GFR) following abdominoperineal resection (APR) or proctocolectomy (PC) can reduce pelvic wound complications but has not been adequately assessed in the setting of immunosuppression, fistulous disease, and neoadjuvant chemoradiation. Methods Patients undergoing APR/PC with GFR were retrospectively analyzed with regard to perioperative characteristics, and morbidity was assessed. Results Patients underwent GFR for rectal cancer ( n = 28), anal cancer ( n = 3), inflammatory bowel disease ( n = 13), or benign fistulizing disease ( n = 1). 22.2% were chronically immunosuppressed, and 66.7% underwent preoperative chemoradiation. Twenty (44.4%) patients had minor wound complications, all treated nonoperatively. Nine patients had major complications with 4 patients requiring reoperation. The 4 threatened flaps were unilateral, and all were salvaged. Donor site morbidity was minimal. Patients with major complications were older (56 vs. 71 years, P = .030), and less likely to have pelvic drains ( P = .018). Conclusion In high-risk perineal wounds, GFR offers durable reconstruction with acceptably low morbidity.

Download Full-text

Autogenous bone augmentation from the zygomatic alveolar crest: a volumetric retrospective analysis in the maxilla

International Journal of Implant Dentistry ◽

10.1186/s40729-020-00258-y ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Irina Kuster ◽

Livia Osterwalder ◽

Silvio Valdec ◽

Bernd Stadlinger ◽

Maximilian E. H. Wagner ◽

...

Keyword(s):

Gold Standard ◽

Donor Site ◽

Bone Defects ◽

Donor Site Morbidity ◽

Bone Volume ◽

Autogenous Bone ◽

Bone Augmentation ◽

Maximum Volume ◽

Alveolar Crest ◽

Good Access

Abstract Background Autogenous bone augmentation is the gold standard for the treatment of extended bone defects prior to implantation. Bone augmentation from the zygomatic crest is a valuable option with several advantages, but the current literature for this treatment is scant. The aim of this study was to evaluate the increase in bone volume after locoregional bone augmentation using autogenous bone from the zygomatic alveolar crest as well as the complications and success rate. Results Analysis of the augmented bone volume in seven patients showed a maximum volume gain of 0.97 cm3. An average of 0.54 cm3 of autogenous bone (SD 0.24 cm3; median: 0.54 cm3) was augmented. Implantation following bone augmentation was possible in all cases. Complications occurred in three patients. Conclusion The zygomatic alveolar crest is a valuable donor site for autogenous alveolar onlay grafting in a locoregional area such as the maxillary front. Low donor site morbidity, good access, and its suitable convexity make it a beneficial choice for autogenous bone augmentation.

Download Full-text