scholarly journals A case report of a reverse sural flap for posterior ankle soft-tissue defect following an injury in a patient from Tanzania

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110606
Author(s):  
Joseph R Msemwa ◽  
Clement N Mweya
Keyword(s):  
Learning Experience ◽  
Donor Site ◽  
Tendon Repair ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Working Environment ◽  
Sural Flap ◽  
Recipient Vessel ◽  
Medical Treatment Facility ◽  
Restoration Technique

In the treatment and management of severe wounds, microsurgical repair remains the gold standard. However, it is difficult to transfer free tissue from a Tanzanian perspective due to donor site morbidity, longer operational times, bulky forms, recipient vessel stress, sophisticated surgical expertise, and high costs of the equipment. Meanwhile, the reverse sural flap has been considered as the ultimate tissue restoration technique. This study reviews a case of a 35-year-old man who was admitted at Mbeya Zonal Referral Hospital in the Department of Orthopaedics, Trauma, and Neurosurgery in Mbeya, Tanzania. The patient had a 9-day injury to the rear of his right ankle due to a cut he suffered after tripping over a toilet seat in the washroom. After the diagnosis, the plan involved surgical debridement, tendon repair, and reverse sural flap rotation. Despite the difficult working environment requiring advanced learning experience, our patient fully recovered after 3 weeks. Proving that reverse sural flap is one of the few available possibilities in the protection of vital structures such as bone or tendons, in the distal areas of the leg, ankle, and foot especially when the medical treatment facility lacks a strong microsurgery team and equipment.

scholarly journals Radical Surgical Excision and Use of Axillary Flap for Intractable Axillary Hidradenitis Suppurativa

2021 ◽  
Vol 24 (2) ◽  
pp. 51-56
Author(s):  
Munny Momotaz ◽  
Abul Kalam ◽  
Md Sazzad Khondoker ◽  
Sharmin Akter Sumi
Keyword(s):  
Medical Treatment ◽  
Hidradenitis Suppurativa ◽  
Donor Site ◽  
Surgical Excision ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Radical Excision ◽  
Maximum Dimension ◽  
College Hospital ◽  
Excellent Outcome

Background: Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and reconstruction with axillary flap as a treatment option for such cases. Objectives: The purpose of the study was to see the outcome after radical surgical excision and coverage with axillary flap for intractable Hidradenitis suppurativa. Methods: This prospective observational study was carried out from July, 2014 to June,2016. Patients admitted at the Plastic Surgery Department of Dhaka Medical College Hospital with intractable Hydradenitis suppurativa were included the study population. Result:Among 20 cases, 12 cases were female and 8 cases were male. Maximum dimension of the soft tissue defect was 15x6.5 cm2 = (97.5 cm2). Maximum dimension of the flap was 17x7 cm2 = (119 cm2).Flap survived completely with minimum donor site morbidity. Result of reconstruction of 90% of the patients exhibited excellent outcome. In 10% patient’s outcome was considered good. Conclusion:With a suitable flap coverage option, the management paradigm of intractable Hydradenitis Suppurativa should shift from prolonged medical treatment to allowdecisive radical excision, which will improve the quality of life for patients. Axilary flap is the flap of choice to cover the defect. Journal of Surgical Sciences (2020) Vol. 24 (2) : 51-56

scholarly journals Versatility of Latissimus Dorsi Free Flap-a Prospective Study

2021 ◽  
Vol 28 (2) ◽  
pp. 142-152
Author(s):  
Abu Faisal Md Ariful Islam ◽  
Mohammad Rabiul Karim Khan ◽  
Sharmin Akter Sumi ◽  
Mohammad Hedayet Ali Khan ◽  
Md Abul Kalam
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Latissimus Dorsi ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Latissimus Dorsi Flap ◽  
Tissue Defect ◽  
Medical College ◽  
The Mean

Introduction: Free flaps offer a great variable of available tissues to cover larger, multifocal or multistructural defects. The choice among different free flap is dependent upon their recipient site requirement. Reconstruction with latissimus dorsi flap is now versatile tool in coverage. It can resurface large wound with reliable vascularity, consistent anatomy ,long pedicle length, opportunity for tailoring of flap. It has less donor site morbidity and has very little post-operative complications. Objective: To evaluate the versatility of free Latissimus dorsi flap for soft tissue reconstruction. Materials and methods: A prospective, observational study design was used in Department of Plastic Surgery of Dhaka Medical College and Hospital. Here 20 patients with soft tissue defect of variable sizes over lower limb, head neck and trunk underwent coverage with microvascular surgery. The study was carried out from July 2017 to June 2018. Result: Regarding the age distribution, the mean age was 35.65with an SD of + 10.81. The lowest age was 20years and the highest age was 56 years, Male female ratio was 3:2.The major cause (65.0%) of soft tissue defect of the samples was RTA. The flap was used to reconstruct the soft tissue defect over lower leg in 13 (65%)cases, on scalp 05 (25%) cases and over anterior trunk in two cases. The mean flap dimension was 229.25cm2 and its range was between 120 – 384 cm2. The standard myocutaneous flap was harvested in 80% cases, chimeric (10%) and partial Latissimus muscle flap in two cases. The donor site in all the 20 (100%) cases was closed primarily. The outcome of reconstruction was excellent in 16(80%), good in 02 (10%) cases and poor in 02 (10%) cases. There was no significant complication during the three months postoperative period. Conclusion: The Latissimus dorsi flap is a versatile option for resurfacing the soft tissue defect in different areas of the body with variable flap components and with minimal donor site morbidity. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 142-152

scholarly journals Double free-flap for a bimalleolar defect of lower leg and ankle

2016 ◽  
Vol 49 (01) ◽  
pp. 95-98
Author(s):  
Naren Shetty ◽  
Narendra S. Mashalkar ◽  
Sunder Raj Ellur ◽  
Karishma Kagodu
Keyword(s):  
Donor Site ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Lower Leg ◽  
Donor Site Morbidity ◽  
The Other ◽  
Limb Ischaemia ◽  
Distal Limb ◽  
Limb Defects ◽  
Recipient Vessel

ABSTRACTDouble free-flaps are necessary when tissue cover cannot be sufficed with a single flap. The other factors to be considered when using two free flaps for resurfacing of distal limb defects are the availability of more than one recipient vessel, the risk of distal limb ischaemia and the donor site morbidity of double flap harvest. If these factors are adequately addressed, double free-flaps can be safely executed for resurfacing distal limb defects with minimal morbidity. We report the simultaneous harvest and transfer of the anterolateral and anteromedial thigh flaps inset and vascularised as double free-flaps to resurface a large bimalleolar defect in a 14-year-old boy with no additional morbidity as compared to that of a single free tissue transfer.

scholarly journals Oromandibular Reconstruction: The History, Operative Options and Strategies, and Our Experience

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Pao-Yuan Lin ◽  
Kevin C. Lin ◽  
Seng-Feng Jeng
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Segmental Defect ◽  
Neck Infection ◽  
Aesthetic Result ◽  
Recipient Vessel ◽  
Surgical Treatment Planning ◽  
Osteocutaneous Flap ◽  
Oromandibular Reconstruction

Oromandibular reconstruction resulting from resection of benign tumor, malignant cancer, osteomyelitic or osteoradionecrotic mandible remains a challenge for plastic surgeons today. At present, fibula osteocutaneous flap is the perhaps most commonly used technique for oromandibular reconstruction because of its potential for contouring, immediate dental implant placement, and favorable donor site morbidity. In this study, we review the history of oromandibular reconstruction, summarize the characteristics of different osteocutaneous flaps, offer surgical options of different osteocutaneous flaps, and provide reconstructive strategies for different locations of mandibular defects. Furthermore, we give a detailed description of various modifications in oromandibular reconstruction: (1) the myoosseous flap for lateral segmental defect repair may reduce donor site complication; (2) to improve the function of oral commissure in patients with obscure recipient vessels, we modify the fibula osteocutaneous flap with anterolateral thigh flap and combine the tensor fascia lata using one set of recipient vessel for composite oromandibular reconstruction; (3) to decrease the likelihood of neck infection and improve aesthetic result, we add the segmental soleus muscle to the fibula osteocutaneous flap to obliterate and augment submandibular dead space. Lastly, dental rehabilitation considerations associated with mandibular reconstruction have been given to help assist in surgical treatment planning.

Microsurgical Scalp Reconstruction: An Overview of the Contemporary Approach

2021 ◽  
Author(s):  
Ping Song ◽  
Lee L. Q. Pu
Keyword(s):  
Preoperative Evaluation ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Primary Role ◽  
Recipient Site ◽  
Recipient Vessel ◽  
Scalp Reconstruction ◽  
Core Concepts ◽  
Contemporary Approach

Abstract Background Microsurgical scalp reconstruction has evolved immensely in the last half-century. The core concepts of microsurgical scalp reconstruction have always been to transfer soft tissue of a sufficient quality to within the defect while minimizing donor site morbidity. Refinements in scalp reconstruction consist of both improvement in reducing donor site morbidity and enhancing recipient site contour and balance. Furthermore, technical advancements and the vast experience within our field have allowed for preoperative evaluation of recipient vessels that are more favorable in proximity to the scalp. Methods In this review, we aim to describe the contemporary approach to microsurgical scalp reconstruction. This is to include the indications of choosing free flaps as well as how to select the ideal flap based on patient-oriented factors. The need for cranioplasty, recipient vessel selection, operative technique, and reoperations is also reviewed. In addition, our considerations and the nuances within each category are also described. Summary Scalp reconstructions involve the fundamental tenants of plastic surgery and demand application of these principles to each case on an individual basis and a successful reconstruction must consider all aspects, with backup options at the ready. Two workhorse free flaps, the anterolateral thigh perforator and latissimus dorsi muscles flaps, serve a primary role in the contemporary approach to microsurgical scalp reconstruction. Conclusion We hope this review can lay the foundation for which future plastic surgeons may continue to build and advance the approach to complex microsurgical scalp reconstruction.

A Retrospective Study of an Updated and Traditional Surgical Approach of the Distally Based Sural Flap

2020 ◽  
Author(s):  
Heng Xu ◽  
Xuexin Cao ◽  
Sally Kiu-Huen ◽  
Zhu Zhu ◽  
Jun Chen ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Traditional Approach ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Lateral Malleolus ◽  
Sural Flap ◽  
Pivot Point ◽  
Propeller Flap ◽  
Distally Based ◽  
Distally Based Sural Flap

Abstract Background The distally based sural flap (DBSF) is one of the armamentarium in the lower limb reconstruction. However, the flap has not gained popularity due to concerns about its reliability and donor site morbidity. Based on the anatomy characterization, we combined and developed five modifications to improve the vascular supply and reduce donor site morbidity. Patients and Methods The authors performed a comparison of retrospective study that included patients who underwent either traditional distally based sural flap (tDBSF) or modified distally based sural flap (mDBSF) surgery approach for ankle, heel, and dorsal foot coverage between January 2007 and May, 2019. The five modifications developed to improve the reliability of the flap include: 1. shift the pivot point more proximally 7.0 cm above the lateral malleolus, 2. preserve the lesser saphenous vein and include branches that communicates with the flap, 3. harvest thinner fascial pedicle, 4. change the skin incision to “S” shape, 5. closure of the donor site with a propeller flap. Results Thirty-one patients underwent mDBSF, and 23 received tDBSF. There were no significant differences in the size of the DBSF. Mean pedicle width was significantly narrower in mDBSF (1.63 ± 0.52 cm vs. 3.81 ± 0.70 in tDBSF). The pivot point was also found to be higher in mDBSF (8.01 ± 0.63 cm vs. 5.46 ± 0.56 cm) above the lateral malleolus. In mDBSF, the size of the propeller flap required for donor site closure was 53.45 ± 19.06 cm2 (range 33–80 cm2). The rate of partial necrosis between mDBSF and tDBSF was significantly different (9.68 vs. 34.78%). While the other complications had no difference. Conclusion The modifications applied to the harvesting of the DBSF have achieved higher survival rate, lower dehiscence rate, and shorter hospital stay time in comparison with traditional approach in our retrospective study.

scholarly journals Use of the Spare-Part Strategy to Reconstruct the External Auditory Canal After Subtotal Auriculectomy for Basal Cell Carcinoma

2021 ◽  
Author(s):  
Marco Pignatti ◽  
Gioia Sorbi ◽  
Valentina Pinto ◽  
Giovanni Sorrenti ◽  
Riccardo Cipriani
Keyword(s):  
External Auditory Canal ◽  
Skin Flap ◽  
Donor Site ◽  
Spare Part ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Spare Parts ◽  
Thin Skin ◽  
Adequate Coverage ◽  
Bone Exposure

AbstractAfter removal of an infiltrative BCC of the auditory meatus, a soft tissue defect of the temporal-mastoid area with bone exposure, needed reconstruction. Several options have been taken into account and a simple yet effective solution has been found following the spare-parts principle. The ear lobe, preserved during cancer removal, was split and used as a thin skin flap. Adequate coverage of the bone exposure and resurfacing of the external auditory canal was obtained with minimal donor site morbidity and a short surgery in a fragile patient with several comorbidities. The spare-parts strategy can provide successful solution to difficult reconstructive cases regardless of the anatomical area.

scholarly journals REVERSE FLOW SURAL FLAP;

2019 ◽  
Vol 26 (01) ◽  
Author(s):  
Hyder Ali ◽  
Faraz Adil ◽  
Farah Idress
Keyword(s):  
Soft Tissue ◽  
Reverse Flow ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Soft Tissue Coverage ◽  
Sural Flap ◽  
Venous Ulcers ◽  
Flap Failure ◽  
Dorsum Of Foot ◽  
Sural Artery

Background:Soft tissues injuries at foot especially at heel expose the tendons, bones and especially joints, which leads to risk of infections and necrosis. These often result from trauma (spoke wheel), tumors, systemic diseases and their wounds such as venous ulcers and diabetic foot wounds. Surgical planning of these defects remains a challenge due to shortage of local scar free tissue and reliable blood supply. The current study is conducted to observe the purposeful benefits of reverse sural artery flap to cover wounds at dorsum of foot, ankle & heel.Study Design:Descriptive, experimental study.Setting: Department of Plastic & Reconstructive Surgery, Dr. Ruth KM Pfau Civil Hospital Karachi.Period:January 2015 to January 2018.Material & Methods:All patients who presented with wounds at heel, dorsum of foot, and exposed calcaneus or Achilles tendon were included. A peroneal based perforator identified by hand held Doppler, a superficial vein, and the sural nerve were included in the pedicle. Patients were followed during the first 6 postoperative months. Postoperative outcomes like flap congestion, tip necrosis and flap failure were noted. Results:Total of 36reverse low sural flaps were done for the soft tissue coverage of the 24 heel defects, 8 ankle defects and4 dorsum of the foot defects. Twenty eight patients were male and eight were females and age ranged from 6 to 36 years (mean 21). Partial flap failure was seen in 3 cases and complete flap failure in 2 cases. There were no serious donor site complications and all patients were satisfied with the functional and aesthetic outcome postoperatively.Conclusion:Reverse sural artery flap is very suitable in providing soft tissue coverage of the wounds of heel and dorsum of foot. Harvesting sural flap is dependable and safe as it does not ends in any major postoperative donor site morbidity.

scholarly journals Customized Reconstruction of Complex Soft Tissue Defect Around the Knee with Individual Design of Free Perforator Flap

2020 ◽  
Author(s):  
Jinfei Fu ◽  
Liming Qing ◽  
Panfeng Wu ◽  
Zhengbing Zhou ◽  
Fang Yu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Soft Tissue Reconstruction ◽  
Knee Region ◽  
Tissue Defect ◽  
Individual Design ◽  
Free Perforator Flap

Abstract Background Reconstruction of complex soft tissue defect around the knee, particularly in involving with large soft tissue defect or disruption of extensor mechanism, always is a challenging problem. The purpose of this study was to introduce our clinical experience on using individual design of free perforator flap for complex soft-tissue reconstruction around the knee. Methods Between June 2010 and March 2017, 16 patients underwent the reconstruction of complex soft tissue defect in the knee region with free perforator flap, Various flap designs was performed basing on the location of wound, the require pedicle length, the tissue components that are deficient, the volume of such components and the risk of donor site morbidity.Results Complex soft tissue defect of the knee was reconstructed with anteriorlateral thigh perforator (ALTP) flap in 5 cases, modified ALTP flap in 2 cases, chimeric ALTP flap in 4 cases, dual skin paddles ALTP flap in 2 cases and chimeric thoracodorsal artery perforator (TDAP) flap in 2 cases. Multiple perforator flaps and vascularized fascia lata in combination were performed in one case. All flaps survived postoperative. None vascular congestion was observed. Only one case suffered partial necrosis. Primary closure of donor site was performed for all patients. The mean follow-up time was 16.5 months. Most cases showed satisfactory flap contour and acceptable function outcome. Conclusions Free perforator flap is a reliable option for repairing complex soft tissue defect in the knee region, especially when local and pedicled flaps are unavailable. Various flap designs allow for more individualized treatment approaches.

scholarly journals Use of Perforator Propeller Flaps for Coverage of Soft issue Defects Around The Distal Leg and Ankle

2021 ◽  
Vol 39 (2) ◽  
pp. 87-93
Author(s):  
Avijit Sarker ◽  
Kazi Nishat Ara Begum ◽  
Sajedur Reza Faruquee ◽  
Md Ayub Ali ◽  
Maruf Alam Chowdhury ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Peroneal Artery ◽  
Medial Malleolus ◽  
Soft Tissue Defects ◽  
Flap Loss ◽  
Orthopedic Rehabilitation ◽  
Tissue Defects

Introduction: Perforator propeller flap is a suitable option to cover soft tissue defects in the distal leg and ankle which preserves the main vascular arteries of the lower extremity and muscle function. The aim of this study is to evaluate the use of perforator propeller flaps for coverage of soft tissue defects around the distal leg and ankle. Methods: This prospective study was donebetween December 2018 to November 2019in the Department of Burn & Plastic Surgery of National Institute of Traumatology and Orthopedic Rehabilitation ( NITOR), Dhaka. Total 32 patients with small to medium sized soft tissue defect over distal leg and ankle underwent reconstruction with perforator propeller flaps. Sixteen patients had defect over tendo achilles area, 6 had defect over lateral malleolus,7 over medial malleolus and medial aspect of distal third leg and only 3 had defect in front of ankle. Average Flap length and width were 12.72 (+4.19) & 5.63 (+1.78) cm respectively. Flap rotation was measured 180 degrees in 84.37% of the cases. The propeller flaps were based on a single perforator and it was observed from the posterior tibial artery in 62.5% and peroneal artery in 37.5% of the cases. Results: 81.25% of the flaps completely survived. Total flap loss was observed in one case (3%) while partial flap loss occurred in 6.2% cases. Marginal flap necrosis and epidermolysis were observed in 6.2% and 3% cases respectively. Conclusions: Propeller flapshavereliable vascular pedicle as well as greater freedom in design and arc of rotation that extend the possibility ofreconstructing difficult wounds with local tissues and minimal donor-site morbidity. J Bangladesh Coll Phys Surg 2021; 39(2): 87-93

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