Long Term Follow-up of Composite Flaps for Single-stage Reconstruction of Concomitant Tendon and Soft Tissue Defects

Background: Complex soft tissue defects of thumb and first web space are a reconstructive challenge. Low voltage electric burns of the hand commonly result in localised and deep soft tissue destruction. The first dorsal metacarpal artery flap (FDMA) is an attractive local flap option to reconstruct these. This study illustrates our experience with the same.Methods: Between March 2014 and February 2017, 16 patients with complex soft tissue defects of thumb and first web space resulting from low voltage electric burns underwent reconstruction with the FDMA flap and subsequent structured hand therapy. In the follow up visits objective assessment of hand function included tests of mobility using Kapandji Score, sensory evaluation with static 2 point discrimination and cortical reorientation. The Subjective Satisfaction Score was used to ascertain the patient’s overall perception of aesthetic and functional outcome.Results: Majority (43.75%) of the patients had defects involving the thumb IP joint. No case of complete flap failure was noted. In a mean follow-up of 11.5 months the reconstructed thumb showed return of good protective sensation as well as mobility. Though cortical reorientation was complete in only 18.75 %, it did not substantially impede hand functioning. All patients were satisfied with the functional and aesthetic result.Conclusions: In cases of low voltage electric burn injuries the FDMA flap is a reliable reconstructive option for small to moderate sized complex defects of thumb and first web space. It has minimal donor site morbidity and can be accomplished in a relatively simple single stage procedure.

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Long-Term Follow-up of Patients with Clubfeet Treated with Extensive Soft-Tissue Release

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200611000-00034 ◽

2006 ◽

Vol 88 (11) ◽

pp. 2536 ◽

Cited By ~ 1

Author(s):

Ravi Goyal ◽

Subjeet Gujral ◽

Robin W. Paton

Keyword(s):

Soft Tissue ◽

Soft Tissue Release ◽

Long Term Follow Up

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Ad hoc posterior tibial vessels perforator propeller flaps for the reconstruction of lower third leg soft- tissue defects

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_67_17 ◽

2017 ◽

Vol 50 (03) ◽

pp. 281-287

Author(s):

Thalaivirithan Margabandu Balakrishnan ◽

Jayagosh Ramkumar ◽

Janardhanan Jaganmohan

Keyword(s):

Retrospective Study ◽

Soft Tissue ◽

Ad Hoc ◽

Soft Tissue Defects ◽

Secondary Procedure ◽

Posterior Tibial ◽

Minimal Scarring ◽

Tissue Defects

ABSTRACT Introduction: Lower third leg soft tissue defects with anatomical and pathological constraints are posing formidable challenges to reconstructive surgeon. Aim: This retrospective study was conducted to assess the effectiveness of ad hoc posterior tibial vessels perforator-propeller flaps for the reconstruction of small and medium sized soft tissue defects in the lower third leg. Patients and Methods: 22 patients (16 were males and 6 were females) were involved in this study between period of January 2012 and December 2016. We followed the protocol of initial non delineating exploratory incision made to find out single best perforator in all patients. All the defects in leg reconstructed with adhoc posterior tibial vessel propeller flaps. Results: All 22 flaps survived well. All in an average of 13 months follow up period, had pain free walking, with minimal scarring and acceptable aesthesis at the reconstruction sites with no need for any secondary procedure. Conclusion: With inability of preoperatively dopplering the perforators in the lower third leg region, the exploratory posterior nondelineating incision was used in all cases to secure the single best perforator for the propeller flaps. Thus adhoc posterior tibial vessel propeller flaps are dependable, easily adoptable for the reconstruction of soft tissue defects of the lower third leg region.

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Stability of Soft Tissue Profile After Mandibular Setback in Sagittal Split Osteotomies: A Longitudinal and Long-Term Follow-Up Study

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2007.11.036 ◽

2008 ◽

Vol 66 (8) ◽

pp. 1610-1616 ◽

Cited By ~ 16

Author(s):

Christof Urs Joss ◽

Isabella Maria Vassalli ◽

Urs Walter Thüer

Keyword(s):

Soft Tissue ◽

Follow Up Study ◽

Mandibular Setback ◽

Soft Tissue Profile ◽

Long Term Follow Up

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Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_19_17 ◽

2018 ◽

Vol 51 (02) ◽

pp. 216-221 ◽

Cited By ~ 4

Author(s):

Deepak Nanda ◽

Shamendra Anand Sahu ◽

Durga Karki ◽

Sanjay Kumar ◽

Amrita Mandal

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Donor Site ◽

Soft Tissue Defect ◽

Soft Tissue Defects ◽

Adipofascial Flap ◽

Tibial Artery ◽

Split Skin ◽

Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

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Bone Transport for Treatment of Traumatic Composite Tibial Bone and Soft Tissue Defects: Any Specific Needs besides the Ilizarov Technique?

BioMed Research International ◽

10.1155/2020/2716547 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13 ◽

Cited By ~ 1

Author(s):

Runguang Li ◽

Guozheng Zhu ◽

Chaojie Chen ◽

Yirong Chen ◽

Gaohong Ren

Keyword(s):

Soft Tissue ◽

Deep Infection ◽

Bone Transport ◽

Fixation Time ◽

Ilizarov Technique ◽

Soft Tissue Defects ◽

Flap Surgery ◽

Tibial Bone ◽

Tissue Defects

Objective. To evaluate the surgical efficacy of bone transport (Ilizarov technique) plus “shortening-lengthening,” “flap surgery,” and “open bone transport” as individualized treatments for traumatic composite tibial bone and soft tissue defects. Methods. We retrospectively analyzed sixty-eight cases (mean age: 35.69 years, (range, 16–65)) treated from July 2014 to June 2017, including 29 middle, 18 distal, and 21 proximal tibial bone defects (4–18 cm, mean: 7.97 cm) with soft tissue defects (2.5 cm × 4.0 cm to 30.0 cm × 35.0 cm after debridement). We adopted the bone transport external fixator to fix the fracture after debriding the defect parts. In the meantime, we adopted the “shortening-lengthening technique,” “flap surgery,” and “open bone transport” as individualized treatment based on the location, range, and severity of the composite tibial bone and soft tissue defects. Postoperative follow-up was carried out. Surgical efficacy was assessed based on (1) wound healing; (2) bone defect healing rate; (3) external fixation time and index; (4) incidence/recurrence of deep infection; (5) postoperative complications; and (6) Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Results. The mean duration from injury to reconstruction was 22 days (4–80 d), and the mean postoperative follow-up period was 30.8 months (18–54 m). After the repair and reconstruction, 2 open bone transport patients required infected bone removal first before continuing the bone transport treatment. No deep infection (osteomyelitis) occurred or recurred in the remaining patients, and no secondary debridement was required. Some patients had complications after surgery. All the postoperative complications, including flap venous crisis, nail channel reaction, bone nonunion, mechanical axis deviation, and refracture, were improved or alleviated. External fixation time was 12.5 ± 3.41 months, and the index was 1.63 ± 0.44. According to the ASAMI score, 76.47% of the outcomes were good/excellent. Conclusion. The Ilizarov technique yields satisfactory efficacy for composite tibial bone and soft tissue defects when combined with “shortening-lengthening technique,” “flap surgery,” and “open bone transport” with appropriate individualized treatment strategies.

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Modified IVAN Technique: Long-term Follow-up of 20 Cases Over 2 to 11 Years

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00102 ◽

2020 ◽

pp. 0000-0000

Author(s):

Snjezana Pohl ◽

Gregori M. Kurtzman

Keyword(s):

Soft Tissue ◽

Soft Tissue Augmentation ◽

Extraction Socket ◽

Immediate Placement ◽

Long Term Follow Up ◽

A Site ◽

Natural Tooth ◽

Implant Reconstruction

Failure of a natural tooth may not permit placement of an implant at the time of extraction due to insufficiency in available bone to house the implant. Reconstruction of the extraction socket frequently involves both hard and soft tissue augmentation to provide a site that can house the implant and ridge contours that mimic the adjacent natural anatomy. The modified IVAN technique achieves those goals and may be used in both delayed and immediate placement situations. The technique will be discussed as well as long-term follow-up on 20 cases treated by the author.

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Effectiveness of Calcium Hydroxylapatite Paste in Vocal Rehabilitation

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940911800802 ◽

2009 ◽

Vol 118 (8) ◽

pp. 546-551 ◽

Cited By ~ 17

Author(s):

M. Boyd Gillespie ◽

Thomas S. Dozier ◽

Terry A. Day ◽

Bonnie Martin-Harris ◽

Shaun A. Nguyen

Keyword(s):

Soft Tissue ◽

Vocal Fold ◽

Case Series ◽

Soft Tissue Defects ◽

Retrospective Case ◽

Vocal Rehabilitation ◽

Calcium Hydroxylapatite ◽

The Voice ◽

Tissue Defects

Objectives We determined the effectiveness of calcium hydroxylapatite (CaHA) paste in vocal rehabilitation. Methods We examined a retrospective case series of 39 adult patients who underwent CaHA paste injection for vocal fold rehabilitation over a 5-year period. The outcomes included the change in the Voice Handicap Index (VHI) score; procedure-related complications; and the need for follow-up voice procedures. Results The VHI scores demonstrated overall improvement, with a decrease from the preoperative mean of 61.2 ± 24.0 to a postoperative mean of 35.9 ± 26.3 (p = 0.0001) after a mean follow-up time of 17.8 ± 13.6 months. The procedure was more likely to succeed in patients with paralysis and/or paresis than in patients with glottic soft tissue defects. After injection, the VHI scores worsened in 3 of 7 patients (43%) in the soft tissue defect group, compared to only 2 of 28 (7%) in the paralysis and/or paresis group (p = 0.04). Four of 7 patients with soft tissue defects (57%) required secondary vocal procedures to improve the voice, compared to only 2 of 32 (6%) in the paralysis and/or paresis group (p = 0.006). Conclusions Injection of CaHA paste results in significantly improved vocal scores in the majority of patients. Use of the paste was less satisfactory in patients with soft tissue defects because of poor retention of the paste in the scarred vocal fold remnant.

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