Reconstruction of upper limb soft-tissue defects after sarcoma resection with free flaps: A systematic review

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.

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Results of Microvascular Free Flap for Reconstruction of Soft Tissue Defects: Our Early Experience

Bangladesh Journal of Plastic Surgery ◽

10.3329/bdjps.v3i2.18242 ◽

2014 ◽

Vol 3 (2) ◽

pp. 33-37

Author(s):

Debashis Biswas ◽

Md Abul Kalam ◽

Tanveer Ahmed ◽

Md Rabiul Karim Khan

Keyword(s):

Soft Tissue ◽

Free Flap ◽

Free Flaps ◽

Soft Tissue Defect ◽

Soft Tissue Defects ◽

Tissue Defect ◽

Radial Forearm ◽

After Cancer ◽

Microvascular Free Flap ◽

Tissue Defects

Extensive soft tissue defects following trauma, burn or after cancer surgery need coverage by flaps. Sometimes surrounding tissues are not healthy enough or quantity is not favorable to provide adequate pedicle flaps. Microvascular free flap can provide healthy tissue of adequate amount from distant area for those difficult situations.15 microvascular free flaps were performed from October 2011 to February 2013. Radial forearm free flap was done in 8 and Latissimusdorsi (LD) flap in 7 cases. 10 flaps done in foot, ankle & lower leg region (radial forearm-5, LD-5) and 5 flaps were done in face and scalp region (radial forearm-4, LD-1).12 flaps healed uneventfully with good coverage of the defect. Average ischemia time was 135 min (range 100-240 min) and average anastomosis time was 75 min (average 60-100 min). 2 flaps failed. There was necrosis of the tip of 2 LD and cumbersome swelling of the flap was found in 2 cases of LD flaps.Large soft tissue defect of body where local or regional flaps are not feasible; can be easily covered with free flaps. Its capacity to cover huge soft tissue defect has neutralizes its technical demand. Though complications are still high in our hands; can be reduced performing more number of cases. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18242 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 33-37

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Revisited Anterolateral Thigh Free Flaps For Reconstructive Microsurgery : One Year Evaluation

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v1i2.44 ◽

1970 ◽

Vol 1 (2) ◽

Author(s):

Parintosa Atmodiwirjo ◽

Siti Handayani ◽

Shelly Madona Djaprie

Keyword(s):

Soft Tissue ◽

Free Flaps ◽

Soft Tissue Defect ◽

Anterolateral Thigh Flap ◽

Soft Tissue Defects ◽

Anterolateral Thigh ◽

Wide Range ◽

Reconstructive Microsurgery ◽

One Year ◽

Tissue Defects

Extensive soft tissue defects present a dif!cult problem to the plastic surgeon as they are usually associated with exposed important structures such as vessels, nerves, tendons, joint cavity or bone. Reconstruction of soft tissue defects have a wide range of therapeutic options. We reconstructed soft tissue defect in many areas using free anterolateral thigh flap (ALTF). From Februari 2009 - 2010, 9 cases of soft tissue defects in the face, neck, leg and foot of various etiologic factors were admitted to the plastic and reconstructive surgery unit, Cipto Mangunkusumo general hospital. Trauma is the commonest cause of soft tissue defects of the lower extremity, followed by tumours. The cruris was the commonest site (4 cases, 44,4%). Flap success rate was 66,67 %. Failure was reported 1 cases in this study due to vein compromise. In our hospital, we are quite familiar with Anterolateral thigh flap (ALTF) even though the case is limited. Anterolateral thigh flap (ALTF) is used for reconstruction of various simple and complex soft tissue defects, for big and small defects with cavity (orbita).

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Retrospective Analysis in Lower Limb Reconstruction: Propeller Perforator Flaps versus Free Flaps

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1606268 ◽

2017 ◽

Vol 33 (S 01) ◽

pp. S34-S39 ◽

Cited By ~ 3

Author(s):

Marta Cajozzo ◽

Alessandro Innocenti ◽

Massimiliano Tripoli ◽

Giovanni Zabbia ◽

Salvatore D'Arpa ◽

...

Keyword(s):

Soft Tissue ◽

Retrospective Analysis ◽

Revision Surgery ◽

Lower Limb ◽

Lower Extremities ◽

Free Flaps ◽

Soft Tissue Defects ◽

Perforator Flaps ◽

Hospitalization Period ◽

Tissue Defects

Background Technical advancements and increasing experience in the management of soft tissue defects in lower extremities have led to the evolution of decisional reconstructive algorithms. Both propeller perforator flaps (PPFs) and free flaps (FFs) proved to be useful methods of reconstruction for lower extremities defects, offering alternative reconstructive tools. We present a case series of PPFs and FFs for reconstruction of lower limbs defects, analyzing and comparing treatment and outcomes. Methods Through a retrospective analysis, we report our experience in performing PPFs or FFs for reconstruction of soft tissue defects of the lower extremities, in patients admitted between 2010 and 2015 at the Department of Plastic and Reconstructive Surgery, University of Palermo. In these patients, we evaluated location and causes of defects, types of flaps used, recipient vessels, complications, time to healing, and aesthetic outcome. Results A primary healing rate was obtained in 13 patients for PPF and 16 cases for FF. Revision surgery for partial skin necrosis was required in eight cases (PPF: four and FF: four). Recovery time and hospitalization period were eventually shorter in patients with FFs, due to lower rate of complications and revision surgery. Conclusion In the past years, our indications for reconstruction with PPFs in the lower limb have become more restricted, while we favor reconstruction with FFs. Recommendations are provided to orient surgical treatment in small, medium, and large lower limb defects.

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Soft tissue defects and bone loss in tibial fractures–treatment with free flaps and bone transport

Acta Orthopaedica Scandinavica ◽

10.3109/17453679708999039 ◽

1997 ◽

Vol 68 (6) ◽

pp. 615-622 ◽

Cited By ~ 2

Author(s):

Astor Reigstad

Keyword(s):

Soft Tissue ◽

Bone Loss ◽

Free Flaps ◽

Bone Transport ◽

Tibial Fractures ◽

Soft Tissue Defects ◽

Tissue Defects

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Reconstruction of Complex Soft-Tissue Defects in Buttock Using The Proximally Based Anterolateral Thigh Flap: An Alternative Algorithm

10.21203/rs.3.rs-789636/v1 ◽

2021 ◽

Author(s):

Danying Wang ◽

Mengqing Zang ◽

Shan Zhu ◽

Bo Chen ◽

Shanshan Li ◽

...

Keyword(s):

Soft Tissue ◽

Free Flaps ◽

Melanocytic Nevus ◽

Anterolateral Thigh Flap ◽

Soft Tissue Defects ◽

Defect Reconstruction ◽

Reconstruction Methods ◽

Circumflex Femoral Artery ◽

Anterolateral Thigh ◽

Tissue Defects

Abstract Background Local and free flaps are most widely used in buttock reconstruction. However, local flaps and free flaps may not be appropriate for all complex soft tissue defects in buttock. In this study, we propose an alternative approach for buttock reconstruction and provide preliminary assessment in clinical efficacy of using a proximally based anterolateral thigh flap for buttock reconstruction. Methods In this study, we retrospectively analyzed the data of the patients with medium- to large-sized defects of buttock. All patients underwent buttock defect reconstruction using a proximally based anterolateral thigh flap between August 2012 and December 2020. Results Eight pedicled anterolateral thigh flaps were used to reconstruct buttock defects after tumor ablation in six patients, scar revision in one patient, melanocytic nevus resection in one patient. Flap size ranged from 25 × 8 cm to 30 × 12 cm, with pedicle length ranging from 12 to 20 cm. Flaps were elevated based on the distal musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery and completely survived without any perfusion-related complications. We achieved satisfactory results from both the functional and aesthetic point-of-view at the 6-month follow-up in all cases. Conclusions The proximally based anterolateral thigh flap can be a valuable reconstructive option with sufficient tissue and a long vascular pedicle for buttock defect reconstruction.

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A simple method for immobilising the upper limb following groin or abdominal flaps for soft tissue defects in the hand

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1697227 ◽

2004 ◽

Vol 37 (02) ◽

pp. 129-130 ◽

Cited By ~ 2

Author(s):

Jagannath B. Kamath ◽

Chitta Ranjan Sahu ◽

Thangam Verghese Joshua

Keyword(s):

Soft Tissue ◽

Upper Limb ◽

Hand Injuries ◽

Soft Tissue Defects ◽

Easy Method ◽

Simple Method ◽

The Common ◽

Tissue Defects ◽

Abdominal Flaps

ABSTRACTAbdominal and groin flaps are the main workhorse for soft tissue defects in hand injuries. A simple and easy method is being described for immobilising the upper limb following abdominal and groin flaps for soft tissue defects of the hand using commonly available clavicular braces. This is devoid of all the problems of immobilisation using the common methods such as adhesive plasters and pin fixators and has its own advantages.

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