Management of Postfasciotomy Wounds and Skin Defects Following Complex Vascular Trauma to the Extremities Using the External Tissue Extender System

Management of large postfasciotomy wounds and/or skin and soft tissue defects after major vascular trauma to the extremities can be challenging. The External Tissue Extender (Blomqvist; ETE), a skin-stretching device, which consists of silicone tapes and plastic stoppers, approximates wound margins and facilitates delayed primary closure. We describe our experience with the use of ETE in 5 patients (4 males) with a total of 8 wounds (7 postfasciotomy, 1 soft tissue defect) over the past 12 years. The mean patient age was 32 (range 17-61) years. The wounds involved the lower limb in 3 patients and the upper limb in 2, whereas the injured arteries were the popliteal in 3, the axillary in 1, and the brachial in 1. The mean wound length was 24 cm (range 9-37 cm), and the mean number of ETE silicone tapes used per wound was 13 (range 5-19). The median duration of ETE therapy was 7 days (range 4-7). ETE therapy resulted in sufficient wound approximation to allow complete closure with conventional suturing in 7 out of the 8 wounds. Of these, one developed infection that required drainage, debridement, and resuturing. All wounds achieved satisfactory healing status and all limbs had been salvaged. In conclusion, the ETE is a useful, easy-to-use, and simple adjunct that may facilitate delayed primary closure of large postfasciotomy wounds or extensive skin and soft tissue defects following complex vascular trauma to the extremities.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02007-8 ◽

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.

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COVERAGE CONSIDERATIONS AND OUTCOME ANALYSIS OF RECONSTRUCTION OF POST TRAUMATIC SOFT TISSUE DEFECTS AROUND THE ELBOW

10.36106/ijsr/8502139 ◽

2020 ◽

pp. 70-72

Author(s):

Vishwamitra B Dayal ◽

M. Senthil Kumaran ◽

S Raja Sabapathy

Keyword(s):

Soft Tissue ◽

Soft Tissue Defect ◽

Defect Size ◽

Outcome Analysis ◽

Soft Tissue Reconstruction ◽

Soft Tissue Defects ◽

Comparison Results ◽

Average Defect ◽

A Prospective Study ◽

Tissue Defects

Introduction: Major crush injury of elbow joint following trauma with extensive injury to skin & soft tissue, bone, tendon, nerves and vessels remains a challenge to the reconstructive surgeon. Purpose of this study is to nd out whether the size of the defect, type of ap used and the location of the soft tissue defect inuence the outcome of soft tissue reconstruction. Material and methods: A prospective study was performed in all patients with soft tissue defects around the elbow in need of ap cover at Ganga Medical Centre Coimbatore, Tamilnadu India from April 2014 to December 2015.Patients demographics, defect size, location, type of ap used, complications and long – term outcomes analysed. Patients Mayo elbow performance score and Likert scale score were recorded for analysis of functional and aesthetic outcome respectively. The Kruskal wallis test was used for statistical comparison. Results: Forty three aps were performed primarily for coverage in forty patients. Three patients required two primary aps for reconstruction. The aps used in our study included 14 local fasciocutaneous aps (32.5%); 20 pedicled aps both locoregional and distant (46.5%) and 9 2 2 Anterolateral thigh free aps (20.9%) The average defect size was 151 cm . For local fasciocutaneous ap the average defect size was 44.7cm , 2 2 2 2 2 (range, 4-120 cm ), distant pedicled ap was181 cm (range 24- 600 cm ) and for the ALT free ap was 252.2 cm (range 80-450 cm ). Conclusion: The defect size is the main determinant of the type of ap used and their outcomes.

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Results of Microvascular Free Flap for Reconstruction of Soft Tissue Defects: Our Early Experience

Bangladesh Journal of Plastic Surgery ◽

10.3329/bdjps.v3i2.18242 ◽

2014 ◽

Vol 3 (2) ◽

pp. 33-37

Author(s):

Debashis Biswas ◽

Md Abul Kalam ◽

Tanveer Ahmed ◽

Md Rabiul Karim Khan

Keyword(s):

Soft Tissue ◽

Free Flap ◽

Free Flaps ◽

Soft Tissue Defect ◽

Soft Tissue Defects ◽

Tissue Defect ◽

Radial Forearm ◽

After Cancer ◽

Microvascular Free Flap ◽

Tissue Defects

Extensive soft tissue defects following trauma, burn or after cancer surgery need coverage by flaps. Sometimes surrounding tissues are not healthy enough or quantity is not favorable to provide adequate pedicle flaps. Microvascular free flap can provide healthy tissue of adequate amount from distant area for those difficult situations.15 microvascular free flaps were performed from October 2011 to February 2013. Radial forearm free flap was done in 8 and Latissimusdorsi (LD) flap in 7 cases. 10 flaps done in foot, ankle & lower leg region (radial forearm-5, LD-5) and 5 flaps were done in face and scalp region (radial forearm-4, LD-1).12 flaps healed uneventfully with good coverage of the defect. Average ischemia time was 135 min (range 100-240 min) and average anastomosis time was 75 min (average 60-100 min). 2 flaps failed. There was necrosis of the tip of 2 LD and cumbersome swelling of the flap was found in 2 cases of LD flaps.Large soft tissue defect of body where local or regional flaps are not feasible; can be easily covered with free flaps. Its capacity to cover huge soft tissue defect has neutralizes its technical demand. Though complications are still high in our hands; can be reduced performing more number of cases. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18242 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 33-37

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Revisited Anterolateral Thigh Free Flaps For Reconstructive Microsurgery : One Year Evaluation

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v1i2.44 ◽

1970 ◽

Vol 1 (2) ◽

Author(s):

Parintosa Atmodiwirjo ◽

Siti Handayani ◽

Shelly Madona Djaprie

Keyword(s):

Soft Tissue ◽

Free Flaps ◽

Soft Tissue Defect ◽

Anterolateral Thigh Flap ◽

Soft Tissue Defects ◽

Anterolateral Thigh ◽

Wide Range ◽

Reconstructive Microsurgery ◽

One Year ◽

Tissue Defects

Extensive soft tissue defects present a dif!cult problem to the plastic surgeon as they are usually associated with exposed important structures such as vessels, nerves, tendons, joint cavity or bone. Reconstruction of soft tissue defects have a wide range of therapeutic options. We reconstructed soft tissue defect in many areas using free anterolateral thigh flap (ALTF). From Februari 2009 - 2010, 9 cases of soft tissue defects in the face, neck, leg and foot of various etiologic factors were admitted to the plastic and reconstructive surgery unit, Cipto Mangunkusumo general hospital. Trauma is the commonest cause of soft tissue defects of the lower extremity, followed by tumours. The cruris was the commonest site (4 cases, 44,4%). Flap success rate was 66,67 %. Failure was reported 1 cases in this study due to vein compromise. In our hospital, we are quite familiar with Anterolateral thigh flap (ALTF) even though the case is limited. Anterolateral thigh flap (ALTF) is used for reconstruction of various simple and complex soft tissue defects, for big and small defects with cavity (orbita).

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Study on Chitosan-Based Nanocomposite Hydrogel in Soft Tissue Defect of Hand

Nanoscience and Nanotechnology Letters ◽

10.1166/nnl.2020.3217 ◽

2020 ◽

Vol 12 (9) ◽

pp. 1120-1126

Author(s):

Jian Zhang ◽

Zhaoyu Gao ◽

Yao Zhang ◽

Jinghai Tian

Keyword(s):

Soft Tissue ◽

Blood Compatibility ◽

Rabbit Model ◽

Soft Tissue Defect ◽

Common Disease ◽

Nanocomposite Hydrogel ◽

Soft Tissue Defects ◽

Clinical Role ◽

Tissue Defects

Hand soft tissue defects are a common disease in surgical emergency, which seriously affects the limb function of patients and significantly reduces their quality of life. To effectively repair hand soft tissue defects, a difficult problem posed to surgeons, we report here the use of a chitosan-based nanocomposite hydrogel (CS-GEL-PDRN). In vitro experiments showed that the nanocomposite hydrogel could promote the proliferation of human embryonic fibroblasts M-22 and human vascular endothelial cells EC-304. In addition, the hydrogel had excellent blood compatibility. In the rabbit model of soft tissue defects, CS-GEL-PDRN effectively coordinated cytokine responses, accelerated wound healing and promoted tissue repair. Based on this, CS-GEL-PDRN is expected to play a clinical role in the repair of hand and other soft tissue defects in the future.

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Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

Journal of International Medical Research ◽

10.1177/0300060516687229 ◽

2017 ◽

Vol 45 (3) ◽

pp. 1074-1089 ◽

Cited By ~ 10

Author(s):

Lifeng Shen ◽

Yiyang Liu ◽

Chun Zhang ◽

Qiaofeng Guo ◽

Wenhua Huang ◽

...

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Lower Leg ◽

Soft Tissue Defect ◽

Venous Congestion ◽

Peroneal Artery ◽

Soft Tissue Defects ◽

Propeller Flap ◽

Perforator Vessel ◽

Tissue Defects

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs.

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Ten technical considerations revisited in tissue expansion

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa273 ◽

2020 ◽

Vol 2020 (8) ◽

Author(s):

Luke Geoghegan ◽

Dariush Nikkhah

Keyword(s):

Soft Tissue ◽

Skin Flap ◽

Tissue Expansion ◽

Soft Tissue Defect ◽

Illustrative Case ◽

Soft Tissue Defects ◽

Case Presentation ◽

Versatile Tool ◽

Technical Factors ◽

Tissue Defects

Abstract Tissue expansion is a versatile tool in resurfacing soft tissue defects of the breast, extremity, head and neck that involves the placement of a temporary implant adjacent to a soft tissue defect. Incremental expansion exploits the viscoelastic properties of skin to generate a skin flap that can be used to resurface defects and provide cover over permanent protheses. Infection, implant extrusion and skin necrosis are recognized complications of tissue expansion. This article presents a revised framework of 10 technical factors to reduce the risk of complications and optimize outcomes with tissue expansion using an illustrative case presentation.

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

10.21203/rs.3.rs-26620/v4 ◽

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.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194820 ◽

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

Background: 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.Methods: 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.Results: The mean size of the defect was 6.7 cm2. 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.Conclusions: The Holevich modification ensures the safety of the innervated FDMA flap in thumb defect coverage with good recovery of sensation.

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