scholarly journals Management of Wounds with Exposed Bones or Tendons in Children by Vacuum-Assisted Closure Therapy: A Prospective Study

2020 ◽  
Vol 53 (01) ◽  
pp. 097-104
Author(s):  
Altaf Rasool ◽  
Sheikh Adil Bashir ◽  
Prince Ajaz Ahmad ◽  
Akram Hussain Bijli ◽  
Umer Farooq Baba ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Road Traffic ◽  
Pediatric Population ◽  
Split Thickness Skin Graft ◽  
Soft Tissue Defects ◽  
Vacuum Assisted Closure ◽  
Vac Therapy ◽  
The Mean ◽  
Complex Wounds ◽  
Tissue Defects

Abstract Background The management of complex soft tissue defects with exposed bones/tendons is always a challenging task for the surgeon and the problem becomes more pronounced when it comes to the management of these wounds in children. Though flap procedures are considered the standard for managing the complex soft tissue defects with exposed bones/tendons yet small blood vessels for anastomosis, long operative period, increased chances of perioperative thrombosis, and difficult perioperative management in children add to the difficulty in performing flap procedures in children. The vacuum-assisted closure (VAC) therapy has emerged as a novel modality for the management of the difficult wounds with added advantages, especially in children. Objective To evaluate the efficacy of VAC in the management of wounds with exposed bones/tendons in children. Patients and Method Forty-six children of complex wounds with exposed bones/tendons were included in the study from July 2016 to June 2018. Results Out of 46 patients, 31 were male; the patients had a mean age of 8.4 years. Road traffic accident was the most common mode of injury (54%), with most of the wounds located over extremities. The mean duration of VAC therapy was 12 days. More than 90% coverage of the exposed structure was seen in 89% of patients. The wounds were definitively managed by split-thickness skin graft in 89% of patients and flap cover in 6.5% of patients. The mean cost of the VAC therapy at our government run hospital was 187 Indian rupees per day. No significant major complications were seen during the treatment. Conclusion VAC therapy is an efficient, safe, and cost-effective modality of treatment for the management of complex wounds in the pediatric population.

scholarly journals Skin stretch suturing with Nice knots in the treatment of small- or medium-sized wounds

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jianmin Xu ◽  
Rui Chang ◽  
Wei Zhang ◽  
Chengcheng Zhang ◽  
Dezhi Zhu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hair Growth ◽  
Wound Closure ◽  
Skin Wound ◽  
Soft Tissue Defects ◽  
Cutaneous Sensation ◽  
The Mean ◽  
Skin Stretch ◽  
Mean Time ◽  
Tissue Defects

Abstract Background To investigate the clinical efficacy and outcomes of skin stretch suturing with self-locking sliding Nice knots in the treatment of small- or medium-sized wounds. Methods From June 2015 to May 2018, 26 patients with small- or medium-sized wounds were included in the present study. Skin stretch suturing with self-locking slide Nice knots was performed to gradually close the soft-tissue defects in these patients. The time of wound closure and healing was recorded. The color and blood supply of the skin, cutaneous sensation, the stretch of skin, and the hair growth situation of the skin wound were observed and recorded. Results There were 17 males and 9 females with an average age of 30.65 years (range, 15–48 years). The areas of the soft-tissue defects were between 3.2 × 7.1 cm and 8.0 × 15.2 cm. All patients underwent stretch suturing with self-locking slide Nice knots to close the soft-tissue defects. All wounds were successfully closed and healed. The mean time of wound closure was 10.69 days (range, 5–20 days), and the mean time of wound healing was 16.85 days (range, 10–24 days). The cutaneous sensation of skin wound recovered normally, and the color of the skin wounds was the same as that of normal skin at the last follow-up. The hair growth situation of the skin wounds also returned to normal. Conclusions This study revealed that Nice knots yielded an accepted clinical result as a new method to close small- or medium-sized wounds that was simple and less minimally invasive, resulted in progressive tension, did not return to previous results, and partially replace flaps or free skin grafts.

scholarly journals MANAGEMENT OF ACQUIRED SOFT TISSUE DEFECTS OF GROIN AND GENITALIA

2020 ◽  
pp. 1-4
Author(s):  
Ratnakar Sharma ◽  
Mir Adnan Samad ◽  
Kumar Sourav Dogra ◽  
Shaarang Gupta
Keyword(s):  
Soft Tissue ◽  
Road Traffic ◽  
Past History ◽  
Skin Grafting ◽  
Soft Tissue Defects ◽  
Detailed History ◽  
Flap Coverage ◽  
Split Thickness Skin Grafting ◽  
History Of ◽  
Tissue Defects

Background: The defects of the groin and the genitalia are complex and pose a challenge to the reconstructive surgeon. These defects may arise out of a variety of insults which include – extirpative oncologic surgeries, necrotizing fasciitis, post burn defects, post traumatic defects including road traffic accidents and animal bites etc. Objectives: To study the epidemiology of the acquired soft tissue defects of the groin and genitalia. To evaluate the role of various reconstructive modalities for the acquired soft tissue defects of groin and genitalia. Materials & Methods: This study was conducted in the Department of Surgery, Govt. Medical College Jammu, J&K, India and included 25 patients admitted with acquired soft-tissue defects of groin and genitalia over a period extending from November 2018 to October 2019 (Prospective study). Personal and demographic data of the patient was noted. A detailed history regarding the cause of the defect along with history of trauma, discharge and bleed from the site was taken. Any past history of surgery and irradiation of the region was noted. The patients having soft tissue defects of the groin and genitalia secondary to the release of post burn contracture were subjected to the detailed history as regards cause of burn, treatment taken and time taken for burn wounds to heal. Examination included general physical examination along with the local wound condition which included site, size, discharge, slough, granulation tissue and any exposed vital structures such as vessels/ nerves. A hemogram, assessment of blood sugar, renal function (blood urea nitrogen and serum creatinine), coagulation profile, blood grouping, viral markers, chest x-ray and ECG were done as a part of routine pre-operative investigations. Wound swab was sent for culture. Biopsy was taken wherever required. Analysis of report of any previously taken biopsy was done. Split thickness skin grafting was the modality of coverage utilized in 56% cases followed by flap coverage in 32% cases. 12% of the defects were closed primarily. Results: Majority of the patients had durable coverage of the defects of groin/genitalia and the coverage modality was acceptable to the patient as regards aesthesis and functional outcome. No major complication was encountered in any of the patients. Conclusion: The reconstruction of the soft tissue defects of groin and genitalia need a meticulous examination and planning of reconstructive modality which may include skin grafting or a flap coverage.

scholarly journals Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study

2020 ◽  
Author(s):  
Emrah Aydogan ◽  
Stefan Langer ◽  
Christoph Josten ◽  
Johannes Maria Karl Fakler ◽  
Ralf Henkelmann
Keyword(s):  
Quality Of Life ◽  
Soft Tissue ◽  
Lower Leg ◽  
Outcome Data ◽  
Soft Tissue Defects ◽  
Tissue Reconstruction ◽  
Closed Fractures ◽  
The Mean ◽  
Tissue Defects

Abstract Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage.Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores.Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after one year.Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

scholarly journals The Holevich modification of the first dorsal metacarpal artery flap in coverage of thumb skin losses

2019 ◽  
Vol 5 (6) ◽  
pp. 1144
Author(s):  
Prakash Panagatla ◽  
Sindhuri Kondapavuluri ◽  
Parvathi Ravula
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Soft Tissue Defects ◽  
Average Hospital ◽  
Sensory Recovery ◽  
Dorsal Metacarpal Artery ◽  
The Mean ◽  
And Function ◽  
Tissue Defects ◽  
First Dorsal Metacarpal Artery

<p class="abstract"><strong>Background:</strong> Reconstruction of complex soft tissue defects of the thumb is a challenging problem. 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. The aim of this study is to report our experience on the safety and functional outcome of the innervated first dorsal metacarpal artery flap (FDMA) for soft tissue defects of thumb.</p><p class="abstract"><strong>Methods:</strong> During 18 month period, nine patients with a mean age of 29 years, male:female ratio of 8:1 underwent coverage of soft tissue defects of the thumb, of various volar and dorsal defects, using an innervated first dorsal metacarpal artery flap. Indications were postburn deformities and acute trauma. None of the patients had any neurorraphy. Outcome of the Holevich modification of FDMA flap was assessed with regards to survival and function, reachability for different locations of the thumb, recovery of sensation in terms of two-point discrimination (2PD), donor morbidity with regards to deformity and range of motion were analysed.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean size of the defect was 6.7 cm<sup>2</sup>. Average hospital stay was 5 days. Average time of sensory recovery was 6 months. The mean 2PD was 4 mm (range 2-6 mm). All patients had a normal active range of motion in the donor finger. One of nine patients had distal flap marginal necrosis of 3-4 mm; it healed with debridement and regular dressings over 12 days.</p><p class="abstract"><strong>Conclusions:</strong> The Holevich modification ensures the safety of the innervated FDMA flap in thumb defect coverage with good recovery of sensation.</p>

scholarly journals Functional and aesthetic outcomes of first dorsal metacarpal artery flap for thumb reconstruction: a prospective study

2020 ◽  
Vol 7 (7) ◽  
pp. 2268
Author(s):  
Sujana Ravada ◽  
Surya Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj ◽  
Narayanamurthy Sundaramurthy ◽  
Anand Prasath Jayachandiran
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Sensory Function ◽  
Soft Tissue Defects ◽  
Aesthetic Outcome ◽  
Dorsal Metacarpal Artery ◽  
The Mean ◽  
The Aesthetic ◽  
Tissue Defects ◽  
First Dorsal Metacarpal Artery

Background: Reconstruction of soft tissue defects of the thumb, with exposure of tendon, joint or bone, has been a challenging problem. Surgical options include local, regional or free flaps. Here, we have evaluated the functional and aesthetic outcomes of first dorsal metacarpal artery (FDMA) island flap in reconstruction of various soft tissue defects of the thumb.Methods: Between January 2018 and January 2019, twenty patients with post-traumatic and post-infective thumb defects underwent FDMA flaps. Sensory function was evaluated with static 2 point discrimination and mobility of the thumb was tested by the Kapandji score. The aesthetic outcome was also assessed.Results: The mean defect size was 39.9×19.95 mm. Eighteen flaps survived completely and one had distal flap necrosis and one had superficial epidermal peeling which was treated conservatively. The mean static two-point discrimination was 9.3 mm. Cortical reorientation was complete in 45%. The average Kapandji score was 7.9. The aesthetic outcome was excellent in ten, good in eight and poor in two subjects. After a mean follow up period of 11.85 months, most patients regained all functions of the thumb and index finger and were pleased with the cosmetic appearance of the flap and donor site.Conclusions: FDMA flap offers a good quality skin cover for small to moderate sized thumb defects. It is a reliable and versatile flap which is sensate and pliable. It gives excellent functional and aesthetic outcomes with minimal or no donor site morbidity.

scholarly journals MANAGEMENT OF ACQUIRED SOFT TISSUE DEFECTS OF FACE

2020 ◽  
pp. 1-3
Author(s):  
Mehvash Khan ◽  
Shaarang Gupta ◽  
Aayushi Aayushi ◽  
Ratnakar Sharma
Keyword(s):  
Soft Tissue ◽  
Road Traffic ◽  
Normal Function ◽  
Soft Tissue Defects ◽  
Recipient Site ◽  
Reconstructive Procedures ◽  
Contour Matching ◽  
Human Bites ◽  
The Face ◽  
Tissue Defects

Background: Since time immemorial, soft-tissue defects of face due to injuries have been documented in literature and even depicted in sculptures, reflecting the image of society. Facial injuries themselves are rarely life-threatening, but are indicators of the energy of injury. Soft-tissue defects of the face can arise out of various causes which may include simple or complex contused lacerations with loss of tissue, avulsions, bites and burns. Common etiologies are road traffic accidents, foreign bodies, defects secondary to tumor excision, homicidal trauma, thermal, chemical and electrical burn, suicidal injuries, human bites, animal bites, gunshot injuries and blast injuries. The management of acquired soft tissue defects of face requires precise planning and coverage by a modality which is functionally and aesthetically pleasant. Objectives: To study the epidemiology of acquired soft tissue defects of face. To restore the aesthetics of the face by resorting to appropriate modality of reconstruction. Materials & Methods: This study was conducted in the Department of Surgery, Govt. Medical College Jammu, J&K, India and included 40 patients having been diagnosed with acquired soft-tissue defects of the face admitted in surgery ward from November 2018 to October 2019 (Prospective study). All the defects were evaluated for size, depth, and status of the base of the defect (presence of gross contamination or infection, integrity, and viability of the wound edges) along with evaluation and documentation of cranial nerve function, particularly the facial and trigeminal nerves. The management depended upon the defect site, size, status and type. 52.5 % patients underwent flap coverage whereas 22.5% underwent skin grafting for coverage of defects. 25% of the patients underwent primary closure of the facial defects. Results: Majority of the patients had restoration of anatomy and normal function after reconstructive procedures with colour and contour matching of that of the recipient site. No major complication was encountered in any of the patients. Conclusion: Acquired soft tissue defects of the face can be reconstructed by a variety of modalities which should not only be functionally adequate but also aesthetically appealing. Flaps are a versatile modality of reconstruction with the choice of flap being governed by the site and size of the defect.

Use of twin dorsal middle phalangeal finger flaps for thumb or index finger reconstruction

2012 ◽  
Vol 38 (4) ◽  
pp. 387-393 ◽  
Author(s):  
W. Qi ◽  
K. J. Chen
Keyword(s):  
Soft Tissue ◽  
Index Finger ◽  
Middle Finger ◽  
Digital Artery ◽  
Soft Tissue Defects ◽  
The Mean ◽  
Degloving Injuries ◽  
Finger Reconstruction ◽  
Tissue Defects

Amputation or degloving injuries of the thumb or index finger are highly disabling. We describe the use of twin dorsal middle finger flaps harvested from the dorsal aspects of the middle and ring fingers, and based on one palmar proper digital artery, its venae comitantes, and the dorsal branches of the palmar digital nerves of the middle and ring fingers, respectively. These flaps offer advantages when large soft tissue defects of the thumb or index finger are present. In this study, twin dorsal middle finger flaps were used in nine patients (six thumbs, three index fingers). All flaps completely survived. At the mean follow-up of 20 months, the appearance of the reconstructed thumbs or index fingers was acceptable, the length was maintained, and the mean static 2-point discrimination values were 10 mm in the palmar flap and 13 mm in the dorsal flap of the reconstructed digit. All patients were satisfied with the appearance and mobility of the donor fingers. All but one donor finger showed normal finger pulp sensibility, with a static 2-point discrimination between 3 and 6 mm.

Keystone-Designed Perforator Island Flaps for the Coverage of Traumatic Pretibial Defects in Patients With Comorbidities

2017 ◽  
Vol 16 (4) ◽  
pp. 302-309 ◽  
Author(s):  
Chi Sun Yoon ◽  
Sang Il Kim ◽  
Hoon Kim ◽  
Kyu Nam Kim
Keyword(s):  
Soft Tissue ◽  
Postoperative Complications ◽  
Medical Records ◽  
Operative Time ◽  
Free Flaps ◽  
Defect Size ◽  
Soft Tissue Defects ◽  
Algorithmic Approach ◽  
The Mean ◽  
Tissue Defects

Reconstruction of pretibial skin and soft-tissue defects remains a challenge because this area has less underlying tissues and limited tissue mobility. Here, we present a retrospective review of our experience with pretibial reconstruction using the keystone-designed perforator island flap (KDPIF) in patients with comorbidities. All defects resulted from nononcological causes. We describe the expanding versatility of KDPIF reconstruction for pretibial defects and suggest a simple algorithmic approach. The medical records of 9 patients who underwent reconstruction with a KDPIF to cover a pretibial defect between May 2016 and June 2017 were reviewed. Clinical and operative data were collected. All 9 KDPIFs fully survived. The defect size varied from 3 × 2 cm2 to 8 × 6 cm2. The flap size varied from 5 × 3 to 20 × 10 cm2. The mean operative time was 90.4 minutes (range = 37-127 minutes). No postoperative complications occurred. The cosmetic results were favorable, and all patients were satisfied with the final outcomes. Thus, the KDPIF is a good reconstruction modality with few complications and provides an alternative to free flaps for pretibial defect reconstruction in patients with comorbidities.

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