scholarly journals Extremity soft tissue coverage in the combat zone: use of pedicled flap transfers by the deployed orthopedic surgeon

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Laurent MATHIEU ◽  
Soryapong PLANG ◽  
Nicolas de l’ESCALOPIER ◽  
James Charles MURISON ◽  
Christophe GAILLARD ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Pedicled Flap ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Fasciocutaneous Flaps ◽  
Muscle Flaps ◽  
Reconstructive Procedures ◽  
Orthopedic Surgeon ◽  
Orthopedic Surgeons ◽  
The Mean

Abstract Background In theaters of operation, military orthopedic surgeons have to deal with complex open extremity injuries and perform soft-tissue reconstruction on local patients who cannot be evacuated. Our objective was to evaluate the outcomes and discuss practical issues regarding the use of pedicled flap transfers performed in the combat zone on local national patients. Methods A retrospective study was conducted on data from patients treated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali between 2010 and 2017. All pedicled flap transfers performed on extremity soft-tissue defects were included, and two groups were analyzed: combat-related injuries (CRIs) and non-combat related injuries (NCRIs). Results Forty-one patients with a mean age of 25.6 years were included. In total, 46 open injuries required flap coverage: 19 CRIs and 27 NCRIs. Twenty of these injuries were infected. The mean number of prior debridements was significantly higher in the CRIs group. Overall, 63 pedicled flap transfers were carried out: 15 muscle flaps, 35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Complications included one flap failure, one partial flap necrosis and six deep infections. At the mean follow-up time of 71 days, limb salvage had been successful in 38 of the 41 cases. There were no significant differences between CRIs and NCRIs in terms of endpoint assessment. Conclusions Satisfying results can be achieved by simple pedicled flaps performed by orthopedic surgeons deployed in forward surgical units. Most complications were related to failure of bone infection treatment. The teaching of such basic reconstructive procedures should be part of the training for any military orthopedic surgeon. Trial registration Retrospectively registered on January 2019 (n°2019–090 1-001).

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.

scholarly journals RECONSTRUCTION OF UPPER LIMB SOFT TISSUE INJURIES, EXCEPT FOR FINGERTIPS LESIONS

2021 ◽  
Vol 29 (2) ◽  
pp. 81-86
Author(s):  
CARLOS ALBERTO EGUEZ JELSKI ◽  
GUSTAVO BALADORE SZENDLER ◽  
CRISTINA SCHMITT CAVALHEIRO ◽  
LUIZ ANGELO VIEIRA ◽  
EDIE BENEDITO CAETANO
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Free Flaps ◽  
Fasciocutaneous Flaps ◽  
Muscle Flaps ◽  
Reconstructive Procedures ◽  
Advantages And Disadvantages ◽  
Tissue Injuries

ABSTRACT Objective: The main purpose of this work was to evaluate the advantages and disadvantages of reconstructive procedures applied in upper limb soft tissue injuries according to their location. Methods: The study involved 94 male and 22 female patients (116 total) operated between April 2001 and November 2017 due to traumatic injuries in a upper limb. Individuals were evaluated considering their age, sex, etiology, reconstruction area , applied methodology and complications. The finger injuries were excluded. Results: The performed reconstruction procedures include 29 skin grafts; six advancement flaps; seven rotation flaps; 33 pedicled fasciocutaneous flaps, 9 free fasciocutaneous flaps; 5 pedicled muscle flaps; 12 free muscle flaps, three pedicled musculocutaneous flaps; one free musculocutaneous flap; 11 neurovascular free flaps. Conclusion: Reconstructive procedures in the upper limbs are diverse, varying from skin grafting to free flaps. The indication of the best option depends on the type of injurie and the surgeon. The final goal is to reach the best functional result combined with the lowest possible morbidity. Level of Evidence IV, Case series.

scholarly journals Correction to: Extremity soft tissue coverage in the combat zone: use of pedicled flap transfers by the deployed orthopedic surgeon

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Laurent Mathieu ◽  
Soryapong Plang ◽  
Nicolas de l’Escalopier ◽  
James Charles Murison ◽  
Christophe Gaillard ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Pedicled Flap ◽  
Soft Tissue Coverage ◽  
Orthopedic Surgeon

An amendment to this paper has been published and can be accessed via the original article.

Central perforated VRAM flap and neurostimulated levator augmentation for functional and aesthetical reconstruction after abdominoperineal excision in cancer

2021 ◽  
pp. 1-11
Author(s):  
Silvia Bernuth ◽  
Michael Jakubietz ◽  
Christoph Isbert ◽  
Joachim Reibetanz ◽  
Rainer Meffert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Soft Tissue ◽  
Interdisciplinary Collaboration ◽  
Life Quality ◽  
Objective Evaluation ◽  
Abdominoperineal Excision ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Sphincter Function

BACKGROUND: Preservation of quality of life regarding fecal continence after abdominoperineal excision (APE) in cancer is challenging. Simultaneous soft tissue coverage and restoration of continence mechanism can be provided through an interdisciplinary collaboration of colorectal and plastic reconstructive surgery. OBJECTIVE: Evaluation of surgical procedure and outcome combining soft tissue reconstruction using a central perforated vertical rectus abdominis myocutaneous flap (VRAM), implementing a perineostoma and restoring anorectal angle augmenting the levator ani by neurostimulated graciloplasty. METHODS: 14 Patients underwent APE due to cancer. In all patients coverage was achieved by pedicled VRAM and simultaneous pull-through descendostomy (perineostoma). 10 of those patients received a levator augmentation additionally. Postoperative complications, functional measures of continence as well as quality of life were obtained. RESULTS: Perineal minor complication rate was 43% without need of surgical intervention. All but one VRAM survived. Continence measures and disease specific life quality showed a good preservation of continence in most patients. CONCLUSION: The results present a complex therapy option accomplished by a collaboration of two highly specialized partners (visceral and plastic surgery) after total loss of the sphincter function and consecutive fecal insufficiency after APE.

Soft Tissue Reconstruction Pyramid in the Diabetic Foot

2010 ◽  
Vol 3 (5) ◽  
pp. 241-248 ◽  
Author(s):  
Claire M. Capobianco ◽  
John J. Stapleton ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Weight Bearing ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Best Interest ◽  
Foot Complications ◽  
Uncontrolled Diabetes ◽  
Wound Healing Response ◽  
Tissue Reconstruction

Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non—weight bearing, all of which have been shown to adversely affect the patient’s quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient’s best interest and is crucial for resolution of the chronic nonhealing wound. The options for soft tissue coverage and the logical progression of application of these techniques in the diabetic foot will be described.

Forearm-Based Turnover Muscle Flaps for Elbow Soft-Tissue Reconstruction

2018 ◽  
Vol 142 (1) ◽  
pp. 152-157 ◽  
Author(s):  
Yash J. Avashia ◽  
Ronnie L. Shammas ◽  
Luke P. Poveromo ◽  
Travis J. Dekker ◽  
Jacob W. Brubacher ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Reconstruction ◽  
Muscle Flaps ◽  
Tissue Reconstruction

Modified anterograde pedicle advancement flap in fingertip injury

2014 ◽  
Vol 40 (9) ◽  
pp. 944-951 ◽  
Author(s):  
S. H. Lee ◽  
J. H. Jang ◽  
J. I. Kim ◽  
S. J. Cheon
Keyword(s):  
Soft Tissue ◽  
Advancement Flap ◽  
Mean Value ◽  
Soft Tissue Reconstruction ◽  
Discrimination Test ◽  
Fingertip Injury ◽  
Level Ii ◽  
Bone Shortening ◽  
Tissue Reconstruction ◽  
The Mean

Soft tissue reconstruction is needed to maintain the maximum length of the fingers in fingertip injury. The purpose of this study was to present an anterograde pedicle advancement flap technique, for the treatment of fingertip injuries, which involved a modification to the anterograde advancement flap by the dissection of the digital nerve and artery with a pedicle to advance the flap. This technique was used in 12 fingers in patients who had undergone soft tissue reconstruction of fingertip injuries between January 2012 and October 2013. The sizes of the flaps ranged from 8 × 7 mm to 14 × 10 mm. The mean length of advancement was 9.7 mm (range 7–13). The mean value of the static two-point discrimination test of the healed flaps was 5.1 mm (range 4–6) and the flaps survived in all the 12 cases. The modified anterograde pedicle advancement flap provides a reliable coverage of sensate soft tissue without bone shortening in fingertip injuries. Level II

scholarly journals Soft tissue reconstruction of foot and ankle defects with reverse sural fasciocutaneous flaps

2018 ◽  
Vol 53 (3) ◽  
pp. 319-322 ◽  
Author(s):  
Kaya Turan ◽  
Mesut Tahta ◽  
Tuğrul Bulut ◽  
Ulaş Akgün ◽  
Muhittin Sener
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Reconstruction ◽  
Foot And Ankle ◽  
Fasciocutaneous Flaps ◽  
Tissue Reconstruction

scholarly journals Radical treatment of severe open fractures of extremities by orthoplastic surgery: a 10-year retrospective study

2020 ◽  
Author(s):  
Zhao Yang ◽  
Chao Xu ◽  
Yong-Gang Zhu ◽  
Jun Li ◽  
Zi-Xiang Wu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Aesthetic Surgery ◽  
Open Fractures ◽  
Soft Tissue Reconstruction ◽  
Central Unit ◽  
Chinese Characteristics ◽  
Tissue Reconstruction ◽  
The Mean

Abstract Orthoplastic treatment based on the collaboration of orthopedic and plastic surgeons in an “orthoplastic” central unit has been recommended by the British Association of Plastic Reconstructive and Aesthetic Surgery. However, this approach is not used worldwide especially in most developing countries. Based on the aggressive orthoplastic management, orthoplastic experience with Chinese characteristics has been carried out in last 10 years. The clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and April 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed. The mean (±SD) age of the patients was 38±16 years. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks. The overall rate of infection exhibited a lower tendency in this study. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.

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