Post-traumatic posterior heel soft tissue defect reconstruction

ABSTRACTWe present a simple algorithm for management of post-traumatic posterior heel defect. We covered these with various flaps depending upon the defect size, its exact location, associated injuries, extent of zone of trauma, and complexity of the defect. The aim was to select the most suitable method for soft tissue coverage for posterior heel reconstruction.

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COVERAGE CONSIDERATIONS AND OUTCOME ANALYSIS OF RECONSTRUCTION OF POST TRAUMATIC SOFT TISSUE DEFECTS AROUND THE ELBOW

10.36106/ijsr/8502139 ◽

2020 ◽

pp. 70-72

Author(s):

Vishwamitra B Dayal ◽

M. Senthil Kumaran ◽

S Raja Sabapathy

Keyword(s):

Soft Tissue ◽

Soft Tissue Defect ◽

Defect Size ◽

Outcome Analysis ◽

Soft Tissue Reconstruction ◽

Soft Tissue Defects ◽

Comparison Results ◽

Average Defect ◽

A Prospective Study ◽

Tissue Defects

Introduction: Major crush injury of elbow joint following trauma with extensive injury to skin & soft tissue, bone, tendon, nerves and vessels remains a challenge to the reconstructive surgeon. Purpose of this study is to nd out whether the size of the defect, type of ap used and the location of the soft tissue defect inuence the outcome of soft tissue reconstruction. Material and methods: A prospective study was performed in all patients with soft tissue defects around the elbow in need of ap cover at Ganga Medical Centre Coimbatore, Tamilnadu India from April 2014 to December 2015.Patients demographics, defect size, location, type of ap used, complications and long – term outcomes analysed. Patients Mayo elbow performance score and Likert scale score were recorded for analysis of functional and aesthetic outcome respectively. The Kruskal wallis test was used for statistical comparison. Results: Forty three aps were performed primarily for coverage in forty patients. Three patients required two primary aps for reconstruction. The aps used in our study included 14 local fasciocutaneous aps (32.5%); 20 pedicled aps both locoregional and distant (46.5%) and 9 2 2 Anterolateral thigh free aps (20.9%) The average defect size was 151 cm . For local fasciocutaneous ap the average defect size was 44.7cm , 2 2 2 2 2 (range, 4-120 cm ), distant pedicled ap was181 cm (range 24- 600 cm ) and for the ALT free ap was 252.2 cm (range 80-450 cm ). Conclusion: The defect size is the main determinant of the type of ap used and their outcomes.

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Post-traumatic posterior heel soft tissue defect reconstruction

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.19783 ◽

2005 ◽

Vol 38 (2) ◽

pp. 138

Author(s):

UH Vyas ◽

MP Suri ◽

AG Patel ◽

HJ Vora ◽

SC Raibagkar ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Defect ◽

Tissue Defect ◽

Defect Reconstruction ◽

Post Traumatic

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Mega Fibula Free Flap for Reconstruction of an Extensive Mandibulofacial Defect

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420946782 ◽

2020 ◽

pp. 000348942094678

Author(s):

Chen Lin ◽

Akina Tamaki ◽

Enver Ozer

Keyword(s):

Soft Tissue ◽

Free Flap ◽

Single Mode ◽

Soft Tissue Defect ◽

Peroneal Artery ◽

Soft Tissue Coverage ◽

Large Defect ◽

Skin Paddle ◽

Lower Lip ◽

Fibula Free Flap

Objective: Extensive mandibulofacial defects can be challenging to reconstruct. We present the case of a complex mandibulofacial defect reconstructed with a mega, chimeric fibula free flap. Methods: Ablation of the oral cavity tumor resulted in a large defect involving mandible, floor of mouth, and tongue. Skin of the chin and neck as well as the lower lip were also resected. A fibula free flap was harvested with the skin paddle involving most of the lateral compartment. Results: The fibula free flap was split into proximal (80 cm2) and distal (120 cm2) skin paddle islands, which were supplied by separate perforators off the peroneal artery. The intraoral soft tissue defect was reconstructed with the proximal skin paddle while the skin was recreated with the distal skin paddle. A Karapandzic flap was used to reconstruct the lower lip. Conclusions: The traditional fibula free flap skin paddle often does not provide sufficient soft tissue coverage for large mandibulofacial defects. Some surgeons opt to harvest a second free flap. We describe our technique for using the mega fibula free flap – one of the largest reported in the literature – as a single mode of reconstruction.

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The Pedicled Latissimus Dorsi Flap Provides Effective Coverage for Large and Complex Soft Tissue Injuries Around the Elbow

Hand ◽

10.1177/1558944717725381 ◽

2017 ◽

Vol 13 (5) ◽

pp. 586-592 ◽

Cited By ~ 2

Author(s):

Jacques H. Hacquebord ◽

Douglas P. Hanel ◽

Jeffrey B. Friedrich

Keyword(s):

Soft Tissue ◽

Latissimus Dorsi ◽

Soft Tissue Injuries ◽

Soft Tissue Defect ◽

Latissimus Dorsi Flap ◽

Soft Tissue Coverage ◽

Effective Coverage ◽

Latissimus Flap ◽

Proximal Forearm

Background: The pedicled latissimus flap has been shown to provide effective coverage of wounds around the elbow with an average size of 100 to 147 cm2 but with complication rates of 20% to 57%. We believe the pedicled latissimus dorsi flap is an effective and safe technique that provides reliable and durable coverage of considerably larger soft tissue defects around the elbow and proximal forearm. Methods: A retrospective review was performed including all patients from Harborview Medical Center between 1998 and 2012 who underwent coverage with pedicled latissimus dorsi flap for defects around the elbow. Demographic information, injury mechanism, soft tissue defect size, complications (minor vs major), and time to surgery were collected. The size of the soft tissue defect, complications, and successful soft tissue coverage were the primary outcome measures. Results: A total of 18 patients were identified with variable mechanisms of injury. Average defect size around the elbow was 422 cm2. Three patients had partial necrosis of the distal most aspect of the flap, which was treated conservatively. One patient required a secondary fasciocutaneous flap, and another required conversion to a free latissimus flap secondary to venous congestion. Two were lost to follow-up after discharge from the hospital. In all, 88% (14 of 16) of the patients had documented (>3-month follow-up) successful soft tissue coverage with single-stage pedicled latissimus dorsi flap. Conclusions: The pedicled latissimus dorsi flap is a reliable option for large and complex soft tissue injuries around the elbow significantly larger than previous reports. However, coverage of the proximal forearm remains challenging.

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Combined Bone Transportation and Lengthening Techniques for the Treatment of Septic Nonunion of the Forearm Followed by Tendon Transfer

Case Reports in Orthopedics ◽

10.1155/2017/9672126 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Konstantinos Ditsios ◽

Eirini Iosifidou ◽

Lazaros Kostretzis ◽

Panagiotis Konstantinou ◽

Iosafat Pinto ◽

...

Keyword(s):

Soft Tissue ◽

Forearm Fracture ◽

Soft Tissue Defect ◽

Functional Restoration ◽

Bony Union ◽

Soft Tissue Coverage ◽

Bone Lengthening ◽

Muscle Loss ◽

Infected Nonunion ◽

Bone Transportation

Infected nonunion of a forearm fracture complicated by a considerable skin-muscle defect poses a great challenge to orthopaedic surgeons. The treatment strategy comprises eradication of the infection, ensuring bony union and soft tissue coverage along with functional restoration. We report a case of a 23-year-old man with an open Gustilo-Anderson IIIb fracture complicated by infected nonunion after internal fixation. After thorough surgical debridement, a considerable soft tissue defect, extensor muscle loss, and posterior interosseous nerve laceration had to be addressed. He was finally treated with bone transportation and bone lengthening followed by tendon transfers.

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Increasing the Width of Keratinized Mucosa in Maxillary Implant Areas Using a Split Palatal Bridge Flap: Surgical Technique and 1-Year Follow-Up

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-14-00025 ◽

2015 ◽

Vol 41 (5) ◽

pp. e195-e201 ◽

Cited By ~ 2

Author(s):

Eberhard Frisch ◽

Petra Ratka-Krüger ◽

Dirk Ziebolz

Keyword(s):

Wound Healing ◽

Soft Tissue ◽

Wound Closure ◽

Soft Tissue Defect ◽

Soft Tissue Coverage ◽

Probing Depth ◽

Secondary Wound Healing ◽

Keratinized Mucosa ◽

Tissue Defects

Sufficient soft-tissue coverage of maxillary implant sites may be difficult to achieve, especially after bone augmentation. The use of vestibular flaps moves keratinized mucosa (KM) toward the palate and may be disadvantageous for future peri-implant tissue stability. This study describes a new split palatal bridge flap (SPBF) that achieves tension-free wound closure and increases the KM width in maxillary implant areas. We began SPBF surgery with a horizontal incision in the palatal soft tissue to create a split-thickness flap. The second incision was performed perpendicular to the first, using a bridge design, at a distance of 10 to 15 mm. The superior layer can be moved crestally and sutured to cover the soft-tissue defect. The defect width was measured using a periodontal probe. The inferior layer was left exposed, and secondary wound healing created new KM in this region. This SPBF technique was performed on 37 patients. Of these, 16 patients were included in the assessment of clinical peri-implant outcomes. All of the SPBF procedures successfully resulted in a palatal regeneration of KM through secondary wound healing (mean regeneration width, 4.51 ± 1.17 mm; range, 3–6 mm). The 1-year follow-up of 16 patients revealed a mean pocket probing depth of 3.22 ± 0.6 mm with zero cases of peri-implantitis. The vestibular KM width at the involved implants was 2.82 ± 1.07 mm (range, 1.5–6 mm). Surgery for SPBF may be a promising technique for covering soft-tissue defects and increasing KM width in maxillary implant surgery.

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What Is the Treatment “Algorithm” for Infection After Achilles Tendon Repair/Reconstruction?

Foot & Ankle International ◽

10.1177/1071100719861646 ◽

2019 ◽

Vol 40 (1_suppl) ◽

pp. 71S-73S

Author(s):

Brian Winters ◽

Ferdinando Da Rin de Lorenzo ◽

David Beck

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Clinical Symptoms ◽

Treatment Algorithm ◽

Tendon Repair ◽

Soft Tissue Defect ◽

Soft Tissue Coverage ◽

Antibiotic Administration ◽

Level Of Evidence ◽

Tendon Reconstruction

Recommendation: The initial treatment of an infected Achilles tendon reconstruction should include thorough debridement of all infected tissues with the removal of retained sutures or foreign material. Cultures should be taken at the time of debridement, and antibiotic administration should be dictated by the result of culture and continued until inflammatory markers and clinical symptoms normalize. If significant soft tissue defect in the overlying area remains, the choice of tendon reconstruction and/or transfer with soft tissue coverage should be left up to the discretion of the treating surgeon based on preference and expertise. Revision reconstruction should be delayed until the infection is cleared. Level of Evidence: Moderate. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

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Vein-Supercharged Peroneal Artery Perforator Propeller Flap for Achilles Soft Tissue Coverage

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v2i2.157 ◽

1970 ◽

Vol 2 (2) ◽

Author(s):

Parintosa Atmodiwirjo ◽

Laureen Supit

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Tissue Expansion ◽

Soft Tissue Defect ◽

Peroneal Artery ◽

Soft Tissue Coverage ◽

Aesthetic Result ◽

Propeller Flap ◽

Split Thickness Skin Grafting ◽

Artery Perforator

Background: Wounds on the distal third of the lower extremity are reconstructively challenging, as there is lack of spare local tissue to design local flaps from. The perceived alternative is to perform free flaps to cover for these defects. Drawbacks include the need for specific training to perform microsurgery, longer time required, and the probable bulkiness when donor is obtained from certain areas. The perforator propeller flap is a local island fasciocutaneous flap, designed with 2 blades of skin island of unequal length extending from each side of the perforator. As the flap is rotated, the longer blade will cover the defect. Patient and Method: A case of soft tissue defect on the achilles is reported, with successful defect closure by utilizing a peronal artery perforator based fasciocutaneous propeller flap with 180 degree rotation and vein supercharge to facilitate backflow. Secondary defect required split-thickness skin grafting. Result: After surgery, muscles of the lower limb started to swell and get compromised. We removed some stitches to allow soft tissue expansion underneath the flap. after the release, flap perfusion improved. Stitches were left open for 3 days, then closure of flap edges by placing gradual traction sutures which were tightened daily. By the 7th day, flap edges was re-approximated and the skin grafts took well. Summary: The ability of the propeller flap to rotate makes this flap highly useful and versatile for the reconstruction of distal lower limb defects. Flap dimension can be enhanced when distal part of the flap is supercharged to neighboring recipient vessels. Another advantage is the close vicinity of donor, giving better aesthetic result.6

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Laparoscopic Greater Omentum Harvesting with Split-Thickness Skin Grafting for Sternal Wound Dehiscence

The American Surgeon ◽

10.1177/000313480607200913 ◽

2006 ◽

Vol 72 (9) ◽

pp. 829-832

Author(s):

Barnard A. Barragan ◽

Ari O. Halldorsson ◽

Mitchell S. Wachtel ◽

Eldo E. Frezza

Keyword(s):

Soft Tissue ◽

Wound Dehiscence ◽

Skin Grafting ◽

Soft Tissue Defect ◽

Omental Flap ◽

Greater Omentum ◽

Soft Tissue Coverage ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Sternal Wound Dehiscence

Sternal wound dehiscence is a serious complication occasionally requiring soft tissue coverage. The greater omentum typically has been used as a last resort because of the underlying morbidity from a laparotomy. We present a case in which a laparoscopically created omental flap with subsequent split-thickness skin grafting was used to correct a large soft tissue defect that occurred after sternal wound dehiscence developed. A nonambulatory 49-year-old man who underwent coronary artery bypass grafting developed sternal wound dehiscence. Because a large soft tissue defect developed after multiple debridements, soft tissue coverage was required. A laparoscopically harvested omental flap spared this man's upper extremity musculature and provided a soft tissue bed for split-thickness skin grafting. This case helps to establish the role of laparoscopically harvested omentum. If the results suggested by this case are confirmed in a large series, omental flaps should be considered as options of first choice in the management of sternal wound dehiscence.

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