scholarly journals The pedicled thoraco-umbilical flap: A versatile technique for upper limb coverage

2009 ◽  
Vol 42 (02) ◽  
pp. 169-175 ◽  
Author(s):  
Sharad Mishra ◽  
Ramesh Kumar Sharma
Keyword(s):  
Upper Limb ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Flap Necrosis ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Versatile Technique ◽  
Soft Tissue Loss ◽  
Flap Cover

ABSTRACTInjuries to upper limb has been on the increase and is invariably associated with significant soft tissue loss requiring a flap cover. Local tissue may not be available for cover in a majority of situations, necessitating import of tissue from a distant source. We have utilized the thoraco-umbilical flap taken from the trunk for this purpose. This flap is based on the perforators of the deep inferior epigastric artery that are maximally centred on the periumbilical region. This flap was used in 83 patients. The patients were observed for at least 3 weeks and any flap or donor site complications were recorded. The patients were again followed up at 3 months interval and the donor site scar was assessed. The flaps survived in 81 patients; there was marginal flap necrosis in five patients and partial flap necrosis in two patients. None of these patients required any additional procedure for coverage. The flap is technically easy to plan, almost effortless to drape around upper limb defects, with no significant donor site morbidity and also the post operative immobilization was fairly comfortable. The thoraco-umbilical flap thus is a very useful technique for coverage of the upper limb and is recommended as a first line flap for this purpose.

A STUDY ON DIFFERENT SURGICAL OPTIONS OF LOWER THIRD LEG DEFECTS AND ITS OUTCOME

2021 ◽  
pp. 32-34
Author(s):  
Ajay Kumar Pathak ◽  
Md Ghulam Jeelani Naiyer ◽  
Pragati Awasthi
Keyword(s):  
Reconstructive Surgery ◽  
Soft Tissues ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Conventional Teaching ◽  
Surgical Options ◽  
Soft Tissue Loss ◽  
Flap Cover ◽  
Upper Third

Background: The bones of the lower third are vulnerable to injury. Due to the paucity of soft tissues around them, the fractures that occur are often open. Most muscles become tendons at that level and in the case of soft tissue loss, skin graft may not sufce and flap cover becomes mandatory. Conventional teaching recommends gastrocnemius muscle and myocutaneous aps and fasciocutaneous aps for the upper third leg defects, soleus aps for the middle third defects and free aps for the lower third defects. Aim: Different surgical options in management of lower third leg defects. Material And Method: The study was conducted from JANUARY 2018 to December 2019, in the Department of Plastic & Reconstructive Surgery Institute of Post Graduate Medical Education and Research (IPGME&R) and SSKM Hospital, KOLKATA. Result: 70 patients admitted to the Department of Plastic & Reconstructive Surgery and referred patients from Department of General Surgery & Orthopaedic Surgery, IPGME&R and SSKM Hospital, KOLKATA. Association of FLAP LOSS with Pedicled ap was statistically signicant (p=0.0259). We found that association of DONOR SITE MORBIDITYwith Pedicled ap was not statistically signicant (p=0.7679). Conclusion: We consider that perforator propeller aps are ideal in reconstructing small-medium defects of the middle and distal third of the leg, being safe, easy to perform, providing similar tissue in texture and thickness of damaged tissues, with low donor-site morbidity.

scholarly journals First dorsal metacarpal artery islanded flap: A useful flap for reconstruction of thumb pulp defects

2009 ◽  
Vol 42 (01) ◽  
pp. 032-035
Author(s):  
Chetan Satish ◽  
Sunit Nema
Keyword(s):  
Soft Tissue ◽  
Local Anesthesia ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Flap Necrosis ◽  
Secondary Procedure ◽  
Dorsal Metacarpal Artery ◽  
Soft Tissue Loss ◽  
First Dorsal Metacarpal Artery

ABSTRACTThumb pulp defects are commonly due to avulsion injuries. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. A very good option for coverage of these defects is the islanded first dorsal metacarpal artery flap. Our study was done over a period of 2 years and involved 9 consecutive cases of thumb pulp defects treated at our institution. The patients included 8 males and 1 female, ranging in age from 16 to 51 years old. The flap size ranged from 2 × 1.5 cm to 5 × 3 cm. We had only one complication in the form of partial flap necrosis, which fortunately healed following debridement without the need for a secondary procedure. All our cases were done under local anesthesia with tourniquet control. All the patients had good fine touch and average two-point discrimination of 6 mm, which was satisfactory. Our good results further reinforce the islanded first dorsal metacarpal artery flap as one the best flaps for sensate reconstruction of thumb pulp defects. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation.

Time and Speed of Vascular Pedicle Dissection in Deep Inferior Epigastric Artery Perforator Flap Elevation

2017 ◽  
Vol 33 (08) ◽  
pp. 557-562
Author(s):  
Ji Yim ◽  
Yeon Lee ◽  
Young Kim ◽  
Eun Kim ◽  
Taik Lee ◽  
...  
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Vascular Pedicle ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Time Required ◽  
Artery Perforator

Background Breast reconstruction using deep inferior epigastric artery perforator (DIEP) free flap is widely used because of the advantages of minimizing donor-site morbidity, but it requires technical competency in vascular dissection. This study evaluated the influence of patient factors and vascular status on the time and speed of dissection of the vascular pedicle. Methods DIEP free flap procedures were performed in 49 patients assigned to immediate or delayed reconstruction groups. Factors that significantly influenced the time required and the speed of dissection were evaluated. Results The average total dissection time was 55.9 minutes (34.5 minutes for the intramuscular dissection and 21.4 minutes for the submuscular dissection). The dissection speed for the total vascular pedicle was 2.65 cm/10 minutes (1.71 cm/10 minutes for the intramuscular dissection and 4.30 cm/10 minutes for the submuscular dissection). The presence of a Pfannenstiel scar, length of the vascular pedicle in the intramuscular area, and the number of microclips used significantly correlated with the total dissection time. Conclusion The length of the intramuscular pedicle, number of microclips used, and presence of a Pfannenstiel scar significantly correlated with the total dissection time of the vascular pedicle. An assessment prior to the surgery can reduce the time of operation and make it easier to elevate the flap.

scholarly journals Our early experience in immediate total breast reconstruction with deep inferior epigastric artery perforator flap

2019 ◽  
Vol 6 (12) ◽  
pp. 4444
Author(s):  
Thyagaraj . ◽  
Ashrith Iyanahally ◽  
B. G. Tilak ◽  
M. E. Sham ◽  
Ganesh .
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Breast Cancer Diagnosis ◽  
Donor Site Morbidity ◽  
Diep Flap ◽  
Inferior Epigastric Artery ◽  
Aesthetic Result ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Artery Perforator

Background: As the breast cancer diagnosis has increased over recent years, patient have become more informative regarding treatment and reconstructive options, hence the expectation of the results will be very high. Reconstruction of breast with best result and less donor site morbidity is the target.Methods: A total of 20 cases were studied between January 2018 to January 2019 at our hospital to assess the outcome of deep inferior epigastric artery perforator (DIEP) flap for immediate breast reconstruction.Results: A total of twenty DIEP flaps were performed. Mean time required for flap harvest was 125 minutes, and time taken for flap inset was 110 minutes. There was no flap loss in any of the twenty cases. Two patients had fat necrosis. All patients were satisfied with aesthetic outcome.Conclusions: DIEP flap has good aesthetic result with less donor site morbidity.

scholarly journals Island Posterior Thigh Flap Revisited in Covering Extensive Sacral Wounds: Our Experience with Two Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
F. Nangole Wanjala ◽  
Ajujo Martin
Keyword(s):  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Island Flap ◽  
Tissue Loss ◽  
Gluteal Muscle ◽  
Posterior Thigh ◽  
Soft Tissue Loss

Deep sacral wounds are best covered by flaps. Posterior thigh flaps have routinely been used to cover such wounds. The flap can however be modified as an island flap. Two patients with extensive sacral wounds were managed with island posterior thigh flaps. Both patients were admitted secondary to road traffic accident with subsequent soft tissue loss of the sacral area. The sacral defects in both patients were approximately 17 cm by 23 cm in dimensions. Unilateral island posterior thigh flap was raised and used to cover the wounds. Postoperatively both patients did well; the donor site and recipient sites healed without any complications. Island posterior thigh flap is thus an option in covering extensive defects of the sacral area. The flap is reliable and easy to raise and has minimal donor site morbidity. By raising it as an island flap the dog ear defect is avoided and the flap is able to be tunneled under the gluteal muscle. This maneuver enables the flap to be advanced further allowing it to cover more distal and extensive defects.

scholarly journals Contralateral lumbo-umbilical flap: A versatile technique for volar finger coverage

2017 ◽  
Vol 50 (02) ◽  
pp. 201-206
Author(s):  
Akram Hussain Bijli ◽  
Sheikh Adil Bashir ◽  
Altaf Rasool ◽  
Mir Yasir ◽  
Adil Hafeez Wani ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Patient Comfort ◽  
Soft Tissue Reconstruction ◽  
Recipient Site ◽  
Epigastric Artery ◽  
Volar Aspect ◽  
Deep Inferior Epigastric Artery ◽  
Tissue Reconstruction ◽  
Versatile Technique

ABSTRACT Background: While contemplating any difficult soft tissue reconstruction, patient comfort and compliance is of paramount importance. Reconstruction of the volar aspect of fingers and hand by the ipsilateral pedicled flaps (groin flap, abdominal flaps) is demanding as the flap inset is difficult for the surgeon and very uncomfortable for the patient. This often leads to flap complications. For the comfort of the patient, better compliance and ease of complete inset, we planned to manage soft tissue defects of the volar aspect of fingers and hand by a new contralateral pedicled lumbo-umbilical flap. This flap is based on the paraumbilical perforators of deep inferior epigastric artery. Materials and Methods: The contralateral pedicled lumbo-umbilical flap was used in eight patients with high-tension electrical burn injuries involving the volar aspect of fingers and hand. The patients were closely observed for first 6 weeks for any flap or donor site complications and then followed monthly to assess donor and recipient site characteristics for 6 months to 2 years. Results and Conclusion: Large flaps up to 8 cm × 16 cm were raised. All but one flaps survived completely. All patients were mobilised within 48 h and five were discharged in less than a week after initial inset. The flap is reliable, easy to harvest and easy to inset on the volar aspect of fingers. The arm is positioned in a very comfortable position. The main disadvantage, however, is a conspicuous abdominal scar.

Preliminary Experience with Perforator Flaps in Reconstruction of Soft-Tissue Defects of the Foot and Ankle

2005 ◽  
Vol 26 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Frederick J. Duffy ◽  
James W. Brodsky ◽  
Christian T. Royer
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Foot And Ankle ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Microsurgical Reconstruction ◽  
Tissue Defects

Background: Microsurgical reconstruction has improved limb salvage in patients who because of many etiologies have soft-tissue loss from the lower extremities. Free-tissue transfer to the foot and ankle often interferes with postoperative function and footwear because of the bulk of a muscle flap. The foot and ankle often are best treated using thin flaps that will not contract and fibrose, particularly if secondary procedures are required. We hypothesized that perforator flaps, which are thin free-tissue transfers consisting of skin and subcutaneous tissue, both diminish donor site morbidity and are ideally suited for soft-tissue reconstruction of the foot and ankle. Methods: Ten patients had free- tissue transfers to the foot and ankle using perforator flaps during a 2-year period. Four had acute posttraumatic wounds, three had soft tissue defects with exposed hardware or bone graft after reconstructive surgery, and three had large soft-tissue defects after foot infection secondary to diabetes. Nine had reconstruction with anterolateral thigh perforator flaps and one had reconstruction with a deep inferior epigastric artery (DIEP) perforator flap. Results: All flaps survived. There were no deep infections. Three flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. There were no donor site complications and no interference of muscle function at the donor sites. Custom shoewear was not required to accommodate the flaps. Conclusion: This series highlights the success and utility of perforator flaps in microsurgical reconstruction of the foot and ankle. The greatest advantage of perforator flaps is the diminished donor site morbidity, which was achieved while maintaining high microsurgical success rates. These skin and fat flaps remained pliable and contracted less than muscle flaps, allowing for smooth tendon gliding and easy flap elevation for secondary orthopaedic procedures.

Perforator Free Flap Coverage of Chronic Lower Extremity Ulcers in Patients With Autoimmune Diseases Under Immunosuppression

2020 ◽  
pp. 153473462091961
Author(s):  
Sang Wha Kim
Keyword(s):  
Lower Extremity ◽  
Autoimmune Diseases ◽  
Free Flap ◽  
Donor Site ◽  
Wound Dehiscence ◽  
High Rate ◽  
Flap Transfer ◽  
Epigastric Artery ◽  
Free Flap Transfer ◽  
Deep Inferior Epigastric Artery

Objectives. Lower extremity ulcers are quite common in patients with autoimmune diseases. Due to chronic use of immunosuppressants, these wounds may develop into deeper wounds resulting in exposure of bone or tendon, which in turn may require free tissue transfers for coverage. The author reviewed perforator free flap transfers performed in this group of patients and analyzed the results. Methods. A retrospective review was performed on all patients who underwent perforator free flap transfer for coverage of lower extremity ulcers without trauma, over a 10-year period. Patient demographics, administered immunosuppressants, and flap and donor site complications were analyzed. Results. Twenty-two perforator free flap transfers were performed in patients with autoimmune diseases, including 18 thoracodorsal perforator flaps, 2 anterolateral thigh flaps, and 2 deep inferior epigastric artery flaps. There was no total flap loss, but there was a high rate of partial flap necrosis (40.9%) and wound dehiscence (40.9%). Intake of corticosteroids was significantly associated with postoperative complications ( P < .05). Conclusion. As partial loss of flap and wound dehiscence is much more common in this group of patients, treatment may take longer, and a fully informed consent should be obtained preoperatively. Surgeons should not avoid performing perforator free flap transfers in patients with autoimmune diseases under immunosuppression; instead, much more preparation and caution are required.

A Homodigital Reverse Pedicle Island Flap in Soft Tissue Reconstruction of the Finger and the Thumb

1994 ◽  
Vol 19 (2) ◽  
pp. 135-141 ◽  
Author(s):  
N. S. NIRANJAN ◽  
J. R. ARMSTRONG
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Single Stage ◽  
Island Flap ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction

A single stage homodigital reverse pedicle island flap is described for the repair of volar or dorsal tissue loss on the finger or thumb. Donor site morbidity is minimal, and the length of the digit is preserved. Satisfactory function results in 25 patients are presented.

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