Auricular reconstruction in microtia for soft tissue coverage: Flap pocket method versus expansion method

Background: Reverse-flow posterior interosseous artery (rPIA) flap is an excellent tool for restoration of defects in the hand and upper extremity, sparing the main arteries to the hand. Its reliability has been well established. Materials and Methods: Fifty-one cases of rPIA flap involving 49 patients were retrospectively reviewed. The inclusion criteria were age, sex, etiology, size and location of the defect, flap size, number of perforators included, pedicle length, flap inset, donor site coverage, complications, and ancillary procedures. Results: This study included 44 men and 5 women, ranging in age between 10 and 73 years. The subjects had soft tissue defects of the hand and upper extremity mainly due to traumatic injuries, including scar contractures of the first web space in 18 cases, thumb amputations in 6 cases, and congenital defects in 1 case. Among the 51 rPIA flap elevations, 3 cases involved flap failure due to the absence of proper pedicle. A fasciocutaneous pattern was observed in 45 cases and a myocutaneous pattern in 3 cases. In 5 cases of unplantable thumb amputations, the rPIA flap was performed for arterial inflow to the secondary toe-to-thumb transfer. Venous congestion of varying degrees was noted in 7 cases involving partial necrosis in 2 cases. During the mean 17 months of follow-up, patients were generally satisfied with the final outcomes. Conclusion: The rPIA flap can be used not only for soft tissue coverage of the hand and upper extremity but also as a recipient arterial pedicle for a secondary toe-to thumb transfer.

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FREE FLAPS FOR SOFT TISSUE COVERAGE IN THE HAND AND FINGERS

Hand Clinics ◽

10.1016/s0749-0712(21)00476-5 ◽

1999 ◽

Vol 15 (4) ◽

pp. 541-554 ◽

Cited By ~ 2

Author(s):

Hung-Chi Chen ◽

Mark T. Buchman ◽

Fu-Chan Wei

Keyword(s):

Soft Tissue ◽

Free Flaps ◽

Soft Tissue Coverage

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Workhorse Flaps for Soft Tissue Coverage in the Hand

Operative Techniques in Orthopaedics ◽

10.1053/j.oto.2012.04.003 ◽

2012 ◽

Vol 22 (3) ◽

pp. 119-130

Author(s):

Paul Tran ◽

Crystal Kavanagh ◽

Steven L. Moran

Keyword(s):

Soft Tissue ◽

Soft Tissue Coverage

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592 Surgical Management of Open Tibia Fractures at A Major Trauma Centre: A Review of Cases Over A One-Year Period

British Journal of Surgery ◽

10.1093/bjs/znab134.153 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Khajuria

Keyword(s):

Soft Tissue ◽

Surgical Management ◽

Open Fracture ◽

Major Trauma ◽

Trauma Centre ◽

Soft Tissue Coverage ◽

Internal Stabilization ◽

Major Trauma Centre ◽

Tibia Fractures ◽

One Year

Abstract Introduction The BOAST/BAPRAS updated the open fracture guidelines in December 2017 to replace BOAST 4 Open fracture guidelines; the changes gave clearer recommendations for timing of surgery and recommendations for reducing infection rates. Method Our work retrospectively evaluates the surgical management of open tibia fractures at a Major Trauma Centre (MTC), over a one-year period in light of key standards (13,14 and 15 of the standards for open fractures). Results The vast majority of cases (93%) had definitive internal stabilization only when immediate soft tissue coverage was achievable. 90% of cases were not managed as ‘clean cases’ following the initial debridement. 50% of cases underwent definitive closure within 72 hours. The reasons for definitive closure beyond 72hours were: patients medically unwell (20%), multiple wound debridement’s (33%) and no medical or surgical reason was clearly stated (47%). Conclusions The implementation of a ‘clean surgery’ protocol following surgical debridement is essential in diminishing risk of recontamination and infection. Hence, this must be the gold standard and should be clearly documented in operation notes. The extent of availability of a joint Orthoplastic theatre list provides a key limiting step in definitive bony fixation and soft tissue coverage of open tibia fractures.

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Soft tissue coverage of mandibular reconstruction plates

Head & Neck ◽

10.1002/hed.2880160203 ◽

1994 ◽

Vol 16 (2) ◽

pp. 112-115 ◽

Cited By ~ 55

Author(s):

Peter G. Cordeiro ◽

David A. Hidalgo

Keyword(s):

Soft Tissue ◽

Mandibular Reconstruction ◽

Soft Tissue Coverage

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Principles of Wound Management and Soft Tissue Repair II

10.2310/vasc.2384 ◽

2018 ◽

Author(s):

Jonathan S. Friedstat ◽

Michelle R Coriddi ◽

Eric G Halvorson ◽

Joseph J Disa

Keyword(s):

Soft Tissue ◽

Tissue Repair ◽

Free Tissue Transfer ◽

Free Flaps ◽

Wound Management ◽

Soft Tissue Coverage ◽

Soft Tissue Repair ◽

Healing Wound ◽

Contour Defects ◽

Tissue Flaps

Wound management and soft-tissue repair can vary depending on the location. The head and neck, chest and back, arm and forearm, hand, abdomen, gluteal area and perineum, thigh, knee, lower leg, and foot all have different local options and preferred free flaps to use for reconstruction. Secondary reconstruction requires a detailed analysis of all aspects of the wound including any scars, soft tissue and/or skin deficits, functional defects, contour defects, complex or composite defects, and/or unstable previous wound coverage. Careful monitoring of both the patient and reconstruction is necessary in the postoperative period to ensure long-term success. This review contains 2 figures and 17 references. Key Words: free tissue transfer, pedicle flaps, soft-tissue coverage, wound closure, wound healing, wound management, wound reconstruction, tissue flaps

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Central perforated VRAM flap and neurostimulated levator augmentation for functional and aesthetical reconstruction after abdominoperineal excision in cancer

Technology and Health Care ◽

10.3233/thc-213021 ◽

2021 ◽

pp. 1-11

Author(s):

Silvia Bernuth ◽

Michael Jakubietz ◽

Christoph Isbert ◽

Joachim Reibetanz ◽

Rainer Meffert ◽

...

Keyword(s):

Quality Of Life ◽

Soft Tissue ◽

Interdisciplinary Collaboration ◽

Life Quality ◽

Objective Evaluation ◽

Abdominoperineal Excision ◽

Soft Tissue Coverage ◽

Soft Tissue Reconstruction ◽

Sphincter Function

BACKGROUND: Preservation of quality of life regarding fecal continence after abdominoperineal excision (APE) in cancer is challenging. Simultaneous soft tissue coverage and restoration of continence mechanism can be provided through an interdisciplinary collaboration of colorectal and plastic reconstructive surgery. OBJECTIVE: Evaluation of surgical procedure and outcome combining soft tissue reconstruction using a central perforated vertical rectus abdominis myocutaneous flap (VRAM), implementing a perineostoma and restoring anorectal angle augmenting the levator ani by neurostimulated graciloplasty. METHODS: 14 Patients underwent APE due to cancer. In all patients coverage was achieved by pedicled VRAM and simultaneous pull-through descendostomy (perineostoma). 10 of those patients received a levator augmentation additionally. Postoperative complications, functional measures of continence as well as quality of life were obtained. RESULTS: Perineal minor complication rate was 43% without need of surgical intervention. All but one VRAM survived. Continence measures and disease specific life quality showed a good preservation of continence in most patients. CONCLUSION: The results present a complex therapy option accomplished by a collaboration of two highly specialized partners (visceral and plastic surgery) after total loss of the sphincter function and consecutive fecal insufficiency after APE.

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The Use of Engineered Bilayered Skin (MyDermTM) in the Management of Massive Skin Defect in Grade III Gustilo-Anderson Open Fracture

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734617724974 ◽

2017 ◽

Vol 16 (3) ◽

pp. 212-216

Author(s):

Nor Hazla Mohamed Haflah ◽

Min Hwei Ng ◽

Mohd Heikal Mohd Yunus ◽

Amaramalar Selvee Naicker ◽

Ohnmar Htwe ◽

...

Keyword(s):

Soft Tissue ◽

Open Fracture ◽

Wound Closure ◽

Posterior Tibial Artery ◽

Soft Tissue Coverage ◽

Skin Defect ◽

Vascular Repair ◽

Posterior Compartment ◽

Large Defect ◽

Large Skin

Open fracture Gustilo-Anderson grade IIIC is associated with higher risk of infection and problems with soft tissue coverage. Various methods have been used for soft tissue coverage in open fractures with large skin defect. We report a case of a patient who had grade IIIC open fracture of the tibia with posterior tibial artery injury. The patient underwent external fixation and reduction. Because of potential compartment syndrome after vascular repair, fasciotomy of the posterior compartment was performed. This wound, however, became infected and because of further debridement, gave rise to a large skin defect. A tissue engineered skin construct, MyDermTM was employed to cover this large defect. Complete wound closure was achieved 35 days postimplantation. The patient then underwent plating of the tibia for nonunion with no adverse effect to the grafted site. The tibia eventually healed 5 months postplating, and the cosmetic appearance of the newly formed skin was satisfactory.

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