scholarly journals Free Gracilis Muscle Flap for Sarcoma Reconstruction: 19 Years of Clinical Experience

Sarcoma ◽  
2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Rachel Pedreira ◽  
Nicholas A. Calotta ◽  
E. Gene Deune
Keyword(s):  
Limb Salvage ◽  
Donor Site ◽  
Graft Loss ◽  
Muscle Flap ◽  
Major Complication ◽  
Donor Site Morbidity ◽  
High Rate ◽  
High Dose ◽  
Soft Tissue Coverage ◽  
Muscle Flaps

Background. Sarcoma treatment necessitates high-dose chemoradiation therapy and wide surgical margins that create wounds that are difficult to reconstruct. Many techniques have been developed to cover these defects, originating with muscle flaps such as the rectus abdominis and latissimus dorsi. The gracilis flap, which is best known in contemporary practice as a microneurovascular flap for functional reconstructions, is not usually considered a robust option for reconstruction after sarcoma extirpation.Methods. We reviewed records of 22 patients (9 women) at our institution who underwent reconstructive surgery after sarcoma extirpation using gracilis flaps for soft-tissue coverage from 1998 to 2017. Neurotized gracilis flaps were excluded. The mean patient age was 51 years (range, 18–85 years), and mean length of follow-up was 53 months (range, 9–156 months). Patients had 7 tumor types, with fibrosarcomas and undifferentiated tumors being most common. There were 23 defects (mean size, 118 cm2(range, 54–200 cm2)). Defects were located most commonly in the foot and leg (n=9each), upper extremity (n=4), and head and neck (n=1). The primary outcome was the flap success rate. Secondary outcomes were rates of major complications (unplanned reoperations, infections requiring intravenous antibiotics, and amputations); minor complications (superficial infections, partial skin-graft loss, partial flap necrosis, fluid collections treated in the office, and cosmetic reoperations); and sarcoma recurrence.Results. Twenty-one flaps (91%) survived. Six patients (27%) experienced a major complication, and 12 patients (54%) experienced a minor complication. There were 2 amputations, for a limb salvage rate of 91%.Conclusions. This series shows that the gracilis is well suited to covering large, compromised wounds across diverse anatomic features, which are the hallmark of sarcoma resections. The high rate of limb salvage and minimal donor-site morbidity further support the use of this flap as a first-line option for sarcoma reconstruction.

Tracheoplasty Using Titanium Reconstructive Plates with Strap-Muscle Flap

1994 ◽  
Vol 111 (3P1) ◽  
pp. 205-210 ◽  
Author(s):  
Roy A. Casiano ◽  
Michael Patete ◽  
Todd Lindquist
Keyword(s):  
Donor Site ◽  
Muscle Flap ◽  
Donor Site Morbidity ◽  
Tracheal Wall ◽  
Tracheal Lumen ◽  
Muscle Flaps ◽  
Strap Muscle ◽  
Respiratory Problems ◽  
Medial Migration ◽  
Simple Alternative

The reasons for unsuccessful decannulation after a laryngotracheoplasty may be multifactorial depending on the techniques used. Excessive granulation tissue may develop, necessitating further adjunctive procedures. Cartilaginous grafts may get infected, resorb, or collapse into the tracheal lumen. Bulky regional skin-muscle flaps may dehisce under tension or collapse into the tracheal lumen. Medial migration of the split ends of the anterior cartilaginous tracheal rings ensues with subsequent restenosis. Donor-site morbidity may compound these problems as well. During a 2.5-year period, we have performed laryngotracheoplasty on nine patients with 60% to 100% tracheal stenosis using titanium reconstruction plates. The split anterior tracheal wall is fixed by the plates in its expanded position. A neurovascularized strap-muscle flap is used to reconstruct the anterior tracheal wall. The flap becomes epithelialized with squamous epithelium within 3 weeks. Successful decannulation was possible in seven of the nine (78%) patients with no further respiratory problems. Of these, six required no further procedures. This technique offers a viable simple alternative to other methods of laryngotracheoplasty without the need for donor cartilage grafts or thick bulky Skin-muscle flaps.

Donor-Site Morbidity of Free Muscle and Perforator Flaps: Comparison of the Gracilis Muscle Flap and the Anterolateral Thigh Flap

2017 ◽  
Vol 33 (07) ◽  
pp. 526-532 ◽  
Author(s):  
M. Rassner ◽  
J. Kiefer ◽  
H. Bannasch ◽  
G. Stark ◽  
S. Eisenhardt ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Donor Site ◽  
Muscle Flap ◽  
Donor Site Morbidity ◽  
Gracilis Muscle ◽  
Perforator Flaps ◽  
Muscle Flaps ◽  
Gracilis Muscle Flap ◽  
Anterolateral Thigh ◽  
Alt Flap

Background Both the gracilis muscle flap and the anterolateral thigh (ALT) flap have been described as successful reconstructive options for defect coverage after trauma or tumor resection. In general, free perforator flaps are considered to generate less donor-site morbidity than muscle flaps. Here, we put this hypothesis to the test. Methods In this study, 193 patients who had undergone free flap reconstruction with either free gracilis muscle flaps (n = 131) or ALT flaps (n = 62) were included. Subjective patient satisfaction with the aesthetic and functional outcome of the donor sites was assessed using a self-report questionnaire as well as the Lower Extremity Functional Scale (LEFS). Results Comparing the donor-site morbidity of free ALT and gracilis flaps, the LEFS revealed no significant differences in functional impairment (p = 0.6447) of the lower extremity. The donor-site scar was significantly longer after ALT flap harvest (mean: 21.16 cm) than after gracilis muscle flap harvest (mean: 14.17 cm; p < 0.0001). Furthermore, donor-site numbness was significantly greater in the ALT group than in the gracilis group (p = 0.0068). Conclusion No significant differences in functional impairment of the lower extremity were reported after gracilis muscle and ALT flap harvest. Regarding scar length and level of numbness of the donor site, the gracilis muscle flap was shown to be superior to the ALT flap.

scholarly journals Microsurgical Reconstruction of the Lower Extremity

2019 ◽  
Vol 33 (01) ◽  
pp. 054-058 ◽  
Author(s):  
Luke Grome ◽  
William Pederson
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Donor Site ◽  
Foot Drop ◽  
Long Term Results ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Muscle Flaps ◽  
Microsurgical Reconstruction

AbstractReconstruction of bony and soft tissue defects of the lower extremity has been revolutionized by the advent of microsurgical tissue transfer. There are numerous options for reconstruction. Possibilities include transfer of soft tissue, composite (bone and soft tissue) tissue, and functional muscle. Many lower extremity reconstructions require staged procedures. Planning is of paramount importance especially in regard to vascular access when multiple free flaps are required. Soft tissue reconstruction of the lower extremity may be accomplished with muscle flaps such as the rectus femoris and latissimus dorsi covered with a skin graft. Fasciocutaneous flaps such as the anterolateral thigh flap may be more appropriate in a staged reconstruction which requires later elevation of the flap. Loss of a significant portion of bone, such as the tibia, can be difficult to manage. Any gap greater than 6 cm is considered a reasonable indication for vascularized bone transfer. The contralateral free fibula is the donor site of choice. Functional reconstruction of the anterior compartment of the leg may be performed with a gracilis muscle transfer, effectively eliminating foot drop and providing soft tissue coverage. Muscle tensioning is critical for effective excursion and dorsiflexion of the foot. Long-term results of microsurgical reconstruction of the lower extremity show good results and reasonable rates of limb salvage.

The Role of Free Flaps in the Treatment of Persistent Scalp Osteomyelitis

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-64-ONS-67 ◽  
Author(s):  
Willy D. Boeckx ◽  
René R.W.J. van der Hulst ◽  
Lloyd V. Nanhekhan ◽  
Francesca De Lorenzi
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Muscle Flap ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Surgical Debridement ◽  
Neurosurgical Procedures ◽  
Latissimus Dorsi Muscle Flap ◽  
Flap Transfer ◽  
Free Flap Transfer

Abstract OBJECTIVE: To evaluate the efficacy of the combination of an extensive surgical debridement and simultaneous free flap repair in case of troublesome cranial osteomyelitis. METHODS: Five patients with persistent, frontal bone osteomyelitis were treated with surgical debridement of the infected bone and reconstruction with a free flap. In all patients, osteomyelitis occurred after neurosurgical procedures and lasted from 1 to 7 years. A latissimus dorsi muscle flap with a split skin graft has been performed. RESULTS: No flap failure occurred and donor site morbidity was negligible. No signs of osteomyelitis or soft tissue infection were observed during the mean follow-up period of 3.2 years. Furthermore, the contour of the cranium could be preserved without a need for bone grafts or implants. CONCLUSION: In our experience, the combination of an extensive surgical debridement and a free flap transfer is demonstrated to be an effective treatment for “chronic” osteomyelitis of the cranium.

Donor-Site Morbidity of the Pedicled Rectus Femoris Muscle Flap

2005 ◽  
Vol 115 (3) ◽  
pp. 786-792 ◽  
Author(s):  
Adrien Daigeler ◽  
Tomislav Dodic ◽  
Friedemann Awiszus ◽  
Wolfgang Schneider ◽  
Hisham Fansa
Keyword(s):  
Donor Site ◽  
Muscle Flap ◽  
Rectus Femoris ◽  
Donor Site Morbidity ◽  
Rectus Femoris Muscle ◽  
Femoris Muscle

scholarly journals Protection of femoral vessels and vascular grafts after inguinal lymphadenectomy or femoral bypass by using prophylactic routine sartorius muscle flap shield coverage

2017 ◽  
Vol 4 (7) ◽  
pp. 2157 ◽  
Author(s):  
Ahmed Fawzy ◽  
Ahmed Gaber ◽  
Hesham Abugruidah ◽  
Ahmed El Kased
Keyword(s):  
Donor Site ◽  
Bypass Graft ◽  
Vascular Grafts ◽  
Muscle Flap ◽  
Sartorius Muscle ◽  
Vascular Protection ◽  
Muscle Flaps ◽  
Inguinal Lymphadenectomy ◽  
Superficial Skin ◽  
Femoral Vessels

Background: Groin vascular infections are potentially catastrophic situations as limb loss or even death may occur in a high percentage of patients. A growing evidence support the benefit of muscle flap covering for these non-healing or infected wounds with stressing on their increased efficacy when used prophylactically. Sartorius muscle flap is granted here by its anatomical characteristics.Methods: Fifty Sartorius muscle flaps were done for 39 patients. Flaps were done routinely on prophylactic basis for protection of native femoral vessels or vascular grafts either for oncological or vascular causes in conjunction with inguinal lymphadenectomy or femoral bypass graft. Great care was taken to preserve the first segmental branch to the muscle and avoided its injury.Results: Prophylactic Sartorius muscle flap was done for oncological causes in 46% while for vascular causes in 54% of total flap number. The operative time ranged from 14-20 minutes for every flap with mean 16 minutes with negligible blood loss and no any donor site morbidity. The complication rate was 26%, including mild skin infection 12%, seroma 6%, partial superficial skin necrosis 6%, and hematoma 2%.Conclusions: Sartorius muscle flap has versatile benefits. Its role has been proved as a shield protecting and covering the femoral vessels or vascular grafts and resulted in decreased rate of overall complications. We recommend prophylactic Sartorius muscle flap coverage on routine basis considering it the workhorse of efforts done to vascular protection.

scholarly journals Hinged multiperforator-based extended dorsalis pedis adipofascial flap for dorsal foot defects

2020 ◽  
Vol 47 (4) ◽  
pp. 340-346
Author(s):  
Magdy A. Abd Al Moktader
Keyword(s):  
Skin Graft ◽  
Donor Site ◽  
Graft Loss ◽  
Plantar Fascia ◽  
Donor Site Morbidity ◽  
Adipofascial Flap ◽  
Dorsalis Pedis Artery ◽  
Flap Viability ◽  
Cutaneous Flap ◽  
The Right

Background Adipofascial flaps covered with a skin graft address the challenges involved in reconstructing dorsal foot defects. The purpose of this study was to describe a large adipofascial flap based on the perforators of the dorsalis pedis artery for large foot defects.Methods Twelve patients aged 5–18 years with large soft tissue defects of the dorsal foot due to trauma were treated with an extended dorsalis pedis adipofascial flap from May 2016 to December 2018. The flap was elevated from the non-injured half of the dorsum of the foot. Its length was increased by fascial extension from the medial or lateral foot fascia to the plantar fascia to cover the defect. All perforators of the dorsalis pedis artery were preserved to increase flap viability. The dorsalis pedis artery and its branches were kept intact.Results The right foot was affected in 10 patients, and the left foot in two patients. All flaps survived, providing an adequate contour and durable coverage with a thin flap. Follow-up lasted up to 2 years, and patients were satisfied with the results. They were able to wear shoes. Donor-site morbidity was negligible. Two cases each of partial skin graft loss and superficial necrosis at the tip of the donor cutaneous flap occurred and were healed by a dressing.Conclusions The hinged multiperforator-based extended dorsalis pedis adipofascial flap described herein is a suitable method for reconstructing dorsal foot defects, as it provides optimal functional and aesthetic outcomes with minimal donor site morbidity.

scholarly journals SUPRACLAVICULAR ARTERY FLAP: A SAFE, VERSATILE AND A RELIABLE FLAP A NEW WORKHORSE IN HEAD AND NECK RECONSTRUCTION OUR CLINICAL EXPERIENCE

2021 ◽  
Vol 9 (01) ◽  
pp. 544-550
Author(s):  
Mir Mushtaq ◽  
◽  
Bashir Ahmad Bhat ◽  
Taj Din Wani ◽  
Shabir Iqbal ◽  
...  
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Graft Loss ◽  
Surgical Techniques ◽  
Free Tissue Transfer ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Head And Neck Reconstruction ◽  
Wide Range

Background: Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Material and Methods: This study was carried out in the Plastic Surgery Department of GMC Srinagar between November 2015 and October 2019. It involved 50 patients (40 females and 10 males), in whom supraclavicular artery flap was done to reconstruct head and neck. Follow-up period ranged from 2-27 months (average 12.3). Results: The study involved 50 patients. Mean age was 26.5 years (range 57-12 years). Thirty five patients had post-burn neck contractures, five patients had portwine stain face, three had marjolin ulcer, four patients had post traumatic and three had post bear maul defect. We harvested unilateral flaps in all of patients. In thirty five patients the flap was pedicled, three had adipofascial pedicle and twelve were islanded. The size of the reconstructed defect ranged from 23x10 to 14x6, and the size of the flap varied from 16x7cm to 25x11. Mean length was 21.7 cm. We used a partial thickness skin graft for donor site closure in 41 cases and closed primarily in 9 cases. Flap was used to resurface neck in 35 patients, face resurfacing in 10 patients, as intraoral lining in 3 patients. The following complications occurred: hematoma in 3 cases, partial distal necrosis in 2 cases, and donor site graft loss in 3 cases. Follow-up period ranged from 2-27 months Conclusion: The supraclavicular artery island flap is a thin, malleable fasciocutaneous flap that is easily and rapidly harvested, with a reliable pedicle and minimal donor site morbidity. It constitutes an alternative to local flaps, while providing equivalent functional results, and must be an integral part of the head and neck reconstructive surgeons therapeutic armamentarium.

Outcomes of Dog Bite Avulsion Injury Reconstruction With Urinary Bladder Matrix

2020 ◽  
Vol 163 (6) ◽  
pp. 1166-1168
Author(s):  
Adrian A. Ong ◽  
Ryan Nagy ◽  
Michelle R. Fincham ◽  
Mark L. Nagy
Keyword(s):  
Urinary Bladder ◽  
Head And Neck ◽  
Pediatric Patients ◽  
Donor Site ◽  
Graft Loss ◽  
Wound Dehiscence ◽  
Donor Site Morbidity ◽  
Dog Bite ◽  
Urinary Bladder Matrix ◽  
Reconstructive Option

Dog bite avulsion injuries of the head and neck are difficult to manage in pediatric patients. This study assesses the outcomes of using porcine urinary bladder extracellular matrix (UBM) for reconstruction of these complete avulsion injuries. Five male pediatric patients underwent reconstruction using UBM. Two (40%) patients underwent reconstruction of the nose; the other 3 patients underwent reconstruction of the forehead, forehead/glabella, and auricle. The average size of the avulsion defect was 7.0 ± 2.4 cm2. No patient developed wound dehiscence, graft loss, or wound infection. Four (80%) patients received pulsed dye laser treatment to improve wound cosmesis. Use of UBM is a safe and effective reconstructive option after dog bite avulsion injuries of the head and neck. Given the advantages of convenient availability and avoidance of donor site morbidity, UBM can be considered for reconstruction of posttraumatic avulsion injuries or Mohs defects.

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