The Use of Engineered Bilayered Skin (MyDermTM) in the Management of Massive Skin Defect in Grade III Gustilo-Anderson Open Fracture

2017 ◽  
Vol 16 (3) ◽  
pp. 212-216
Author(s):  
Nor Hazla Mohamed Haflah ◽  
Min Hwei Ng ◽  
Mohd Heikal Mohd Yunus ◽  
Amaramalar Selvee Naicker ◽  
Ohnmar Htwe ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Wound Closure ◽  
Posterior Tibial Artery ◽  
Soft Tissue Coverage ◽  
Skin Defect ◽  
Vascular Repair ◽  
Posterior Compartment ◽  
Large Defect ◽  
Large Skin

Open fracture Gustilo-Anderson grade IIIC is associated with higher risk of infection and problems with soft tissue coverage. Various methods have been used for soft tissue coverage in open fractures with large skin defect. We report a case of a patient who had grade IIIC open fracture of the tibia with posterior tibial artery injury. The patient underwent external fixation and reduction. Because of potential compartment syndrome after vascular repair, fasciotomy of the posterior compartment was performed. This wound, however, became infected and because of further debridement, gave rise to a large skin defect. A tissue engineered skin construct, MyDermTM was employed to cover this large defect. Complete wound closure was achieved 35 days postimplantation. The patient then underwent plating of the tibia for nonunion with no adverse effect to the grafted site. The tibia eventually healed 5 months postplating, and the cosmetic appearance of the newly formed skin was satisfactory.

scholarly journals Variants of Extended Latissimus Dorsi Musculocutaneous Flap for Large Wounds in Extremities

2020 ◽  
Author(s):  
Jiqiang He ◽  
Liming Qing ◽  
Panfeng Wu ◽  
Zhengbing Zhou ◽  
Fang Yu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Latissimus Dorsi ◽  
Donor Site ◽  
Free Flaps ◽  
Lower Limbs ◽  
Soft Tissue Coverage ◽  
Skin Defect ◽  
Reliable Methods ◽  
Large Skin

Abstract Background: Extended latissimus dorsi musculocutaneous (LDMC) flap increasing the size of the flap and most used for breast reconstruction. This report will share our experience in designing different extended LDMC flap for large wounds in extremities.Patients and methods: From January 2004 to December 2018, extended LDMC flaps were performed on 72 consecutive patients aged 2 to 68 years (37 men and 35 women). All the wounds were extensive, either in upper or lower limbs, the skin defect ranged from 18 ×10 cm2 to 37 × 21 cm2. Single wing and double wings extended LDMC flaps were designed and harvested based on the wounds.Results: Seventy-two patients included this series, 5 pedicle and 67 free flaps were successfully harvested. The mean flap harvest time was 56.2 min. The donor sites were closed primarily in all patients. The venous compromise was noticed on the first postoperative day in 4 cases. Two flaps were salvaged after emergency re-exploration, another two patient’s flaps were total necrosis. One of the patients was received lower extremity amputation, another patient was repaired by extended LDMC flap on the other side. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Five patients lost follow-up, the follow-up period ranged from 10 to 56 months (mean, 15.7 months). Patients didn’t occur significant donor site morbidities that influenced their daily activities during follow-up.Conclusion: The single wing and double wings extended latissimus dorsi musculocutaneous flaps are simple and reliable methods for large skin and soft-tissue defects in extremities.

scholarly journals 592 Surgical Management of Open Tibia Fractures at A Major Trauma Centre: A Review of Cases Over A One-Year Period

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Khajuria
Keyword(s):  
Soft Tissue ◽  
Surgical Management ◽  
Open Fracture ◽  
Major Trauma ◽  
Trauma Centre ◽  
Soft Tissue Coverage ◽  
Internal Stabilization ◽  
Major Trauma Centre ◽  
Tibia Fractures ◽  
One Year

Abstract Introduction The BOAST/BAPRAS updated the open fracture guidelines in December 2017 to replace BOAST 4 Open fracture guidelines; the changes gave clearer recommendations for timing of surgery and recommendations for reducing infection rates. Method Our work retrospectively evaluates the surgical management of open tibia fractures at a Major Trauma Centre (MTC), over a one-year period in light of key standards (13,14 and 15 of the standards for open fractures). Results The vast majority of cases (93%) had definitive internal stabilization only when immediate soft tissue coverage was achievable. 90% of cases were not managed as ‘clean cases’ following the initial debridement. 50% of cases underwent definitive closure within 72 hours. The reasons for definitive closure beyond 72hours were: patients medically unwell (20%), multiple wound debridement’s (33%) and no medical or surgical reason was clearly stated (47%). Conclusions The implementation of a ‘clean surgery’ protocol following surgical debridement is essential in diminishing risk of recontamination and infection. Hence, this must be the gold standard and should be clearly documented in operation notes. The extent of availability of a joint Orthoplastic theatre list provides a key limiting step in definitive bony fixation and soft tissue coverage of open tibia fractures.

Mega Fibula Free Flap for Reconstruction of an Extensive Mandibulofacial Defect

2020 ◽  
pp. 000348942094678
Author(s):  
Chen Lin ◽  
Akina Tamaki ◽  
Enver Ozer
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Single Mode ◽  
Soft Tissue Defect ◽  
Peroneal Artery ◽  
Soft Tissue Coverage ◽  
Large Defect ◽  
Skin Paddle ◽  
Lower Lip ◽  
Fibula Free Flap

Objective: Extensive mandibulofacial defects can be challenging to reconstruct. We present the case of a complex mandibulofacial defect reconstructed with a mega, chimeric fibula free flap. Methods: Ablation of the oral cavity tumor resulted in a large defect involving mandible, floor of mouth, and tongue. Skin of the chin and neck as well as the lower lip were also resected. A fibula free flap was harvested with the skin paddle involving most of the lateral compartment. Results: The fibula free flap was split into proximal (80 cm2) and distal (120 cm2) skin paddle islands, which were supplied by separate perforators off the peroneal artery. The intraoral soft tissue defect was reconstructed with the proximal skin paddle while the skin was recreated with the distal skin paddle. A Karapandzic flap was used to reconstruct the lower lip. Conclusions: The traditional fibula free flap skin paddle often does not provide sufficient soft tissue coverage for large mandibulofacial defects. Some surgeons opt to harvest a second free flap. We describe our technique for using the mega fibula free flap – one of the largest reported in the literature – as a single mode of reconstruction.

scholarly journals An analysis of post traumatic leg and foot defects

2019 ◽  
Vol 6 (6) ◽  
pp. 2041
Author(s):  
Gopalan G. ◽  
Dhanaraju S.
Keyword(s):  
Soft Tissue ◽  
Skin Graft ◽  
Traffic Accidents ◽  
Lower Limbs ◽  
Split Thickness Skin Graft ◽  
Soft Tissue Coverage ◽  
Durable Good ◽  
Skin Defect ◽  
Early Recovery ◽  
Thickness Skin

Background: Management of lower extremity trauma with bone and soft tissue injury is a challenging task with the aim of giving early recovery and durable good quality skin cover according to the skin defect and analyze various reconstructive options at various levels of injury. Our aim of the study is to analyze various reconstructive options for traumatic skin loss involving lower limbs especially knee and below knee, and analyze the incidence of age, sex and etiology of traumatic defects.Methods: Prospective study in our plastic surgery department in the period of 24 months, with all the cases of traumatic defects of leg and foot where included. All age and sex patients were included.Results: Most common cause for traumatic leg and foot defects are road traffic accidents followed by accidental fall and others, most commonly in males amounting 73%, children 10% and  females 17%, among the skin and soft tissue  defects upper and lower 1/3 leg defects are predominant. Among the soft tissue coverage split thickness skin graft dominating about 60% of cases, flaps 30% of cases, among the flaps 70% are fasciocutaneous flaps predominantly inferiorly based  and 30% are muscle and musculocutaneous flaps, among the muscle predominantly soleus muscle flap was used to cover the defect.Conclusions:Road traffic accidents dominating the cause for leg and foot defects , males are more commonly affected  and upper one third leg defects are predominant for soft tissue coverage split thickness skin graft are commonest procedures followed that cutaneous and muscle flaps. 

Abductor Hallucis Muscle Flap and Staged Medial Column Arthrodesis for the Chronic Ulcerated Charcot Foot With Concomitant Osteomyelitis

2010 ◽  
Vol 3 (5) ◽  
pp. 269-273 ◽  
Author(s):  
Claire M. Capobianco ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Wound Closure ◽  
Wound Care ◽  
Weight Bearing ◽  
Deformity Correction ◽  
Muscle Flap ◽  
Surgical Reconstruction ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Abductor Hallucis

Midfoot ulceration is a common sequela of the diabetic Charcot rocker-bottom deformity. Because redundant soft tissue from a non— weight-bearing area is often scarce in this area of the foot, soft-tissue coverage may be challenging. Wound closure may be difficult to achieve with local wound care and off-loading techniques if the predisposing deformity that caused the ulceration is not addressed. In the same setting, surgical reconstruction is often feared when open wounds are present, given the potential for infection. Approaching these wounds with a rational stepwise and staged approach is prudent to eradicate the underlying infection and also to achieve durable wound closure and long-term deformity correction. The authors present the use of a local muscle flap and circular external fixation for closure of a recalcitrant Charcot plantar-medial midfoot ulceration and also discuss different adjunctive modalities to facilitate soft-tissue reconstruction in the diabetic foot.

Increasing the Width of Keratinized Mucosa in Maxillary Implant Areas Using a Split Palatal Bridge Flap: Surgical Technique and 1-Year Follow-Up

2015 ◽  
Vol 41 (5) ◽  
pp. e195-e201 ◽  
Author(s):  
Eberhard Frisch ◽  
Petra Ratka-Krüger ◽  
Dirk Ziebolz
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Wound Closure ◽  
Soft Tissue Defect ◽  
Soft Tissue Coverage ◽  
Probing Depth ◽  
Secondary Wound Healing ◽  
Keratinized Mucosa ◽  
Tissue Defects

Sufficient soft-tissue coverage of maxillary implant sites may be difficult to achieve, especially after bone augmentation. The use of vestibular flaps moves keratinized mucosa (KM) toward the palate and may be disadvantageous for future peri-implant tissue stability. This study describes a new split palatal bridge flap (SPBF) that achieves tension-free wound closure and increases the KM width in maxillary implant areas. We began SPBF surgery with a horizontal incision in the palatal soft tissue to create a split-thickness flap. The second incision was performed perpendicular to the first, using a bridge design, at a distance of 10 to 15 mm. The superior layer can be moved crestally and sutured to cover the soft-tissue defect. The defect width was measured using a periodontal probe. The inferior layer was left exposed, and secondary wound healing created new KM in this region. This SPBF technique was performed on 37 patients. Of these, 16 patients were included in the assessment of clinical peri-implant outcomes. All of the SPBF procedures successfully resulted in a palatal regeneration of KM through secondary wound healing (mean regeneration width, 4.51 ± 1.17 mm; range, 3–6 mm). The 1-year follow-up of 16 patients revealed a mean pocket probing depth of 3.22 ± 0.6 mm with zero cases of peri-implantitis. The vestibular KM width at the involved implants was 2.82 ± 1.07 mm (range, 1.5–6 mm). Surgery for SPBF may be a promising technique for covering soft-tissue defects and increasing KM width in maxillary implant surgery.

Principles of Wound Management and Soft Tissue Repair I

2018 ◽  
Author(s):  
Jonathan S. Friedstat ◽  
Michelle R Coriddi ◽  
Eric G Halvorson ◽  
Joseph J Disa
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Wound Closure ◽  
Free Tissue Transfer ◽  
Skin Grafting ◽  
Free Flaps ◽  
Wound Management ◽  
Soft Tissue Coverage ◽  
Contamination Assessment ◽  
Secondary Intention

Principles of initial wound management include adequate debridement, bacterial contamination assessment, nutritional optimization, and moist wound healing versus the use of negative-pressure wound therapy. The main goals of coverage procedures are to achieve a healed wound and avoid infection. Aside from allowing to heal by secondary intention, options for wound closure include primary closure, skin grafting, local flaps, and free flaps. Each wound should be evaluated on an individual basis to determine which method of coverage is most appropriate. This review contains 13 figures, 2 tables, and 22 references. Key Words: free tissue transfer, pedicle flaps, soft-tissue coverage, wound closure, wound healing, wound management, wound reconstruction, tissue flaps

scholarly journals Perioperative management of open fractures in the lower limb

2021 ◽  
pp. 175045892110121
Author(s):  
Bryan Loh ◽  
Jiang An Lim ◽  
Matthew Seah ◽  
Wasim Khan
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Open Fracture ◽  
Wound Care ◽  
Operative Management ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Non Union ◽  
Patient Presentation ◽  
British Orthopaedic Association

An open fracture is a fracture which communicates with the external environment through a wound in the skin. Severe open fractures are managed by both orthopaedic and plastic surgeons to address injuries in both the bone and soft tissue. This review outlines the management of open fractures in the lower limb from the initial patient presentation to operative management (including debridement, skeletal fixation, definitive soft tissue coverage) according to the standards jointly published by the British Orthopaedic Association (BOA) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Additionally, the decision-making between limb salvage or amputation will be explored. Finally, this review will discuss the patient’s postoperative care including wound care and management of potential complications that may arise such as infection, flap failure and fracture non-union.

scholarly journals The impact of a dedicated orthoplastic operating list on time to soft tissue coverage of open lower limb fractures

2015 ◽  
Vol 97 (6) ◽  
pp. 456-459 ◽  
Author(s):  
MA Fernandez ◽  
K Wallis ◽  
M Venus ◽  
J Skillman ◽  
J Young ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Soft Tissue Coverage ◽  
National Guidelines ◽  
Management Standards ◽  
Lower Limb Fractures ◽  
Time Period ◽  
Operating List ◽  
Limb Fractures ◽  
The Impact

An observational study was conducted of 105 patients presenting with an open fracture of the tibia or ankle to determine the impact of a dedicated orthoplastic operating list on our management of these injuries over the time period January 2012 to July 2014. There were 51 patients before and 54 after the introduction of the orthoplastic list. Significant improvements were noted in our ability to deliver a service in line with national guidelines across all Gustilo–Anderson grades of injury. Among patients with the most severe grades of injury (Gustilo types IIIB and IIIC), there was a trend towards an improved time to first skeletal stabilisation (29.5 vs 14.2 hours, p=0.068), an improvement in time to soft tissue coverage (173.6 vs 88.1 hours, p=0.009) and a trend towards a reduced length of inpatient stay (32.6 vs 23.2 days, p=0.138). Where the 72-hour target had been breached, there was a significant improvement in the proportion of patients covered within 7 days of injury (48.2% vs 83.3%, p=0.017). Our compliance with national management standards increased significantly to reflect these improvements in care. These results support the implementation of dedicated orthoplastic operating sessions to meet the growing burden of patients presenting with open fractures at specialist centres.

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