Pedicle Flap Designs for Soft Tissue Conditioning in the Therapy of Peri-implantitis

Background: Coverage of soft tissue defects around distal third of the leg, particularly ankle and foot is a common situation faced by a plastic and reconstructive surgeon. Options available for such defects are limited due to scarcity of additional soft tissue that can be used without exposing tendons or bone. Associated conditions such as major vascular compromise, comorbidities and lack of facilities or expertise make free tissue transfer less preferred. Distally based sural artery flap has been a frequently used flap in such conditions, easy to perform and has reproducible results. We extended the reach of the flap and reproduced the results.Methods: We performed extended reverse sural artery pedicled flaps in 19 patients who presented to us between 2015 to 2017 with soft tissue defects around ankle and foot. Patients included 15 post RTA, 2 diabetic foot, 1 post resection defect and 1 post burn contracture release defect. Size of the defect ranged between 8x6cm to 14x10cm. Average follow up period was ranging from 8 months to 2.5 years.Results: All the flaps healed well without any obvious complications except one patient in whom marginal necrosis (2 cm margin of distal most flap) was observed and was secondarily treated with skin grafting.Conclusions: We observed that extended reverse sural pedicle flap is a rapid, reliable option for coverage of soft tissue defects around ankle and heel, sparing major vessel compromise and lengthy surgical procedure during free tissue transfer. This flap should be the first option for the patients with trauma and defects over weight bearing foot in whom peroneal axis vessels are preserved.

Download Full-text

Use of the Composite Pedicled Pectoralis Minor Flap after Resection of Soft Tissue Sarcoma in Reconstruction of the Glenohumeral Joint

Case Reports in Orthopedics ◽

10.1155/2014/937342 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Michiel A. J. van de Sande ◽

Tom Cosker ◽

Stephen M. McDonnell ◽

C. L. M. H. Gibbons ◽

Henk Giele

Keyword(s):

Soft Tissue ◽

Glenohumeral Joint ◽

External Rotation ◽

Pectoralis Major Muscle ◽

Shoulder Function ◽

Soft Tissue Defect ◽

Glenohumeral Instability ◽

Pedicle Flap ◽

Lesser Tuberosity ◽

Pectoralis Minor

The surgical repair of an extensive anterior glenohumeral soft tissue defect is complicated by glenohumeral instability and subsequent significant functional deficit. This surgical note offers a relatively simple reconstruction of the anterior capsule and subscapularis muscle using a pectoralis minor pedicle flap. This reconstruction is supplemented with functional reconstruction of the anterior glenohumeral joint. A conventional deltopectoral approach is utilized and pectoralis minor is freed from its coracoid insertion, released, and mobilized without compromising the pedicle entering from the dorsum and inferior one-third of the muscle. The mobilized pectoralis minor vascular pedicle has sufficient length for the pectoralis minor to be transferred to provide coverage of the anterior shoulder joint even in full external rotation, providing anterior stability. To further improve glenohumeral stability and shoulder function, the pectoralis major muscle can be split with the clavicular part reinserted lateral to the bicipital groove onto the lesser tuberosity replacing subscapularis function while stabilising the glenohumeral joint.

Download Full-text

Reverse sural artery fasciocutaneous flap in soft tissue reconstruction in lower extremity

Journal of Chitwan Medical College ◽

10.3126/jcmc.v10i3.32055 ◽

2020 ◽

Vol 10 (3) ◽

pp. 84-87

Author(s):

Suresh Pandey ◽

Suraj Bidary

Keyword(s):

Soft Tissue ◽

Demographic Data ◽

Soft Tissue Defect ◽

Soft Tissue Reconstruction ◽

Superficial Infection ◽

Pedicle Flap ◽

Satisfactory Outcome ◽

Flap Procedure ◽

Tissue Reconstruction ◽

Sural Artery

Background: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue reconstruction around the ankle and distal leg. Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0. Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics. Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.

Download Full-text

Management of an upper central incisor having periapical pathology with unusual presentation

Update Dental College Journal ◽

10.3329/updcj.v3i2.17998 ◽

2014 ◽

Vol 3 (2) ◽

pp. 39-42

Author(s):

Mohammad Aminul Islam ◽

Tasnim Wakia ◽

Shamima Afroz ◽

Md Ali Asgor Moral

Keyword(s):

Soft Tissue ◽

Mineral Trioxide Aggregate ◽

Unusual Presentation ◽

Tissue Loss ◽

Central Incisor ◽

Pedicle Flap ◽

Retrograde Filling ◽

Flap Design ◽

Soft Tissue Loss ◽

Apical Area

The aim of this report is to discuss a case about a traumatized upper left central incisor presented with chronic periapical pathology with unusual presentation. In this case, the apical area of the tooth was exposed for a long period and the apex was open due to loss of affected tooth materials and its surrounding bone and soft tissue loss. The apical area was corrected with apical curettage and retrograde filling with Mineral Trioxide Aggregate (MTA) as well as soft tissue managed with pedicle flap design. The discolouration and mild shortening of the crown due to intrusive effect was managed by lamination of cosmetic restorative material. After 12 months follow up, the offending tooth was accepted both functionally and aesthetically. DOI: http://dx.doi.org/10.3329/updcj.v3i2.17998 Update Dent. Coll. j: 2013; 3 (2): 39-42

Download Full-text

Latissimus dorsi pedicle flap for coverage of soft tissue defects about the elbow

Journal of Shoulder and Elbow Surgery ◽

10.1016/s1058-2746(99)90104-0 ◽

1999 ◽

Vol 8 (6) ◽

pp. 634-643 ◽

Cited By ~ 24

Author(s):

Milan Stevanovic ◽

Frances Sharpe ◽

Virginia D Thommen ◽

John M Itamura ◽

Stephen B Schnall

Keyword(s):

Soft Tissue ◽

Latissimus Dorsi ◽

Soft Tissue Defects ◽

Pedicle Flap ◽

Tissue Defects

Download Full-text

Reconstruction of Heel Soft Tissue Defects Using Medial Plantar Artery Island Pedicle Flap: Clinical Experience and Outcomes Analysis

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2016.11.022 ◽

2017 ◽

Vol 56 (2) ◽

pp. 226-229 ◽

Cited By ~ 7

Author(s):

Jia-xiang Gu ◽

An-shi Huan ◽

Nai-chen Zhang ◽

Hong-jun Liu ◽

Shi-cong Xia ◽

...

Keyword(s):

Soft Tissue ◽

Clinical Experience ◽

Soft Tissue Defects ◽

Outcomes Analysis ◽

Pedicle Flap ◽

Plantar Artery ◽

Tissue Defects ◽

Medial Plantar Artery

Download Full-text

Vascular Perfusion of a Flexor Carpi Ulnaris Muscle Turnover Pedicle Flap for Posterior Elbow Soft Tissue Reconstruction: A Cadaveric Study

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2010.10.035 ◽

2011 ◽

Vol 36 (2) ◽

pp. 246-251 ◽

Cited By ~ 15

Author(s):

Diane E.S. Payne ◽

Adam M. Kaufman ◽

Robert W. Wysocki ◽

Marc J. Richard ◽

David S. Ruch ◽

...

Keyword(s):

Soft Tissue ◽

Cadaveric Study ◽

Soft Tissue Reconstruction ◽

Vascular Perfusion ◽

Pedicle Flap ◽

Flexor Carpi Ulnaris ◽

Tissue Reconstruction

Download Full-text

Pedicled Lingual Flap to Provide Keratinized Tissue Regeneration Over Dental Implants: A Description of the Technique and a Case Report

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-12-00218 ◽

2015 ◽

Vol 41 (2) ◽

pp. 196-199 ◽

Cited By ~ 3

Author(s):

Alan S. Herford ◽

Rahul Tandon ◽

Luca Pivetti ◽

Marco Cicciù

Keyword(s):

Case Report ◽

Soft Tissue ◽

Case Reports ◽

Tissue Loss ◽

Pedicle Flap ◽

Collagen Matrices ◽

Keratinized Tissue ◽

Patient Reported ◽

Implant Dentistry ◽

Soft Tissue Loss

The aim of this study is to report the efficacy of a lingual pedicle flap for soft tissue pre-prosthetic surgery in implant rehabilitation. While it has been demonstrated that keratinized gingiva is an important factor for implant success, there remains a dearth of case reports concerning the use of a lingual pedicle flap to achieve this desired outcome in such a large reconstructive effort. For this case report, the patient underwent an anterior mandibular resection of an ameloblastoma and subsequent reconstruction, resulting in soft tissue loss. To satisfy the patient's desires, both functionally and esthetically, a bilateral rotated pedicled lingual flap was performed to augment keratinized tissue on the anterior mandibular ridge. An additional vestibuloplasty with two collagen matrices was also performed, and an acrylic splint was then applied to achieve better stabilization. The primary outcome was to evaluate the efficacy of this technique, which, until now, was used only for exposed root coverage. The site demonstrated excellent healing over time, even resulting in an excess of healthy and pink soft tissue, which later had to be corrected with a small gingivectomy. Although the patient reported slight discomfort for a few days after surgery, she was nonetheless pleased both with her ability to function and her appearance. The results of this study show that the bilateral rotated pedicled lingual flap is a viable technique for the correction of soft tissue defects in implant dentistry, providing a good amount of keratinized gingiva.

Download Full-text