scholarly journals Keystone Flap for Reconstruction of Sacral and Ischial Pressure Injury

2021 ◽  
Vol 8 (1) ◽  
pp. 30-37
Author(s):  
Narottama Tunjung ◽  
Nandita Melati Putri
Keyword(s):  
Retrospective Study ◽  
Operative Time ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Complete Healing ◽  
Type Iv ◽  
Pressure Injury ◽  
The Mean ◽  
The Right ◽  
Thorough Debridement

Introduction: Reconstruction of sacral and ischial pressure injury offers great challenges due to its high complication and recurrence rate. Providing durable tissue coverage with minimal donor site morbidity is paramount while ensuring fast operative time for the patients who often possess multiple comorbidities. This study aims to present cases of sacral and ischial pressure injury reconstruction using a keystone flap. Method: A retrospective study was performed by reviewing data from fifteen patients with a sacral and ischial pressure injury who underwent reconstruction using various types of keystone flaps in our center between 2019 and 2020. Results: The patients’ age ranged from 10 to 83 years old (average, 40.5 years old). The average wound dimensions were 9.4 ± 3.1 cm x 6.5 ± 2.7 cm and the mean area of the defects was 52.3 ± 35.7 cm2, with the largest defect was 15 x 12 cm (141.3 cm2). Mean operative time was 140 ± 24.5 minutes with nine wounds were reconstructed using type IV keystone flap (60%) and six patients using type IIA (40%). Postoperative complications occurred in three patients (20%). Other patients resulted in uneventful complete healing. Conclusion: The keystone flap is reliable, simple, has a fast technique, and minimal donor site morbidity to cover the defects of sacral and ischial pressure injury. Performing thorough debridement, choosing the right type of keystone flap, elevating the flap adequately to allow mobilization, preserving perforator “hotspots”, and suturing of the flap without tension are keys to achieve satisfactory results.

scholarly journals Minimum 2-Year Outcomes of All-Arthroscopic Capsular Autograft Labral Reconstruction

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0024
Author(s):  
Michael Kucharik ◽  
Paul Abraham ◽  
Mark Nazal ◽  
Nathan Varady ◽  
Wendy Meek ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Labral Tear ◽  
Labral Repair ◽  
Inclusion Criteria ◽  
The Mean ◽  
Tönnis Grade

Objectives: Acetabular labral tears distort the architecture of the hip and result in accelerated osteoarthritis and increases in femoroacetabular stress. Uncomplicated tears with preserved, native fibers can be fixed to acetabular bone using labral repair techniques, which have shown improved outcomes when compared to the previous gold standard, labral debridement and resection. If the tear is complex or the labrum is hypoplastic, labral reconstruction techniques can be utilized to add grafted tissue to existing, structurally intact tissue or completely replace a deficient labrum. The ultimate goal is to reconstruct the labrum to restore the labral seal and hip biomechanics. Clinical outcomes using autografts and allografts from multiple sources for segmental and whole labral reconstruction have been reported as successful. However, reconstruction using autografts has been associated with substantial donor-site morbidity. More recently, all-arthroscopic capsular autograft labral reconstruction has been proposed as a way to repair complex or irreparable tears without the downside of donor-site morbidity. Since all-arthroscopic capsular autograft labral reconstruction is a novel technique, there is limited data in the literature on patient outcomes. The purpose of this study is to report outcomes in patients who have undergone this procedure at a minimum 2-year follow-up. Methods: This is a retrospective case series of prospectively collected data on patients who underwent arthroscopic acetabular labral repair by a senior surgeon between December 2013 and May 2017. Patients who failed at least 3 months of conservative therapy and had a symptomatic labral tear on magnetic resonance angiography (MRA) were designated for hip arthroscopy. The inclusion criteria for this study were adult patients age 18 or older who underwent arthroscopic labral repair with capsular autograft labral reconstruction and completion of a minimum 2-year follow-up. Intraoperatively, these patients were found to have a labrum with hypoplastic tissue (width < 5 mm), complex tearing, or frank degeneration of native tissue. Patients with lateral center edge angle (LCEA) ≤ 20° were excluded from analysis. Using the patients’ clinical visit notes with detailed history and physical exam findings, demographic and descriptive data were collected, including age, sex, laterality, body mass index (BMI), and Tönnis grade to evaluate osteoarthritis. Patients completed patient-reported outcome measures and postoperatively at 3 months, 6 months, 12 months, and annually thereafter. Results: A total of 72 hips (69 patients) met inclusion criteria. No patients were excluded. The cohort consisted of 37 (51.4%) male and 35 (48.6%) female patients. The minimum follow-up was 24 months, with an average follow-up of 30.3 ± 13.2 months (range, 24-60). The mean patient age was 44.0 ± 10.4 years (range 21-64), with mean body mass index of 26.3 ± 4.3. The cohort consisted of 6 (8.3%) Tönnis grade 0, 48 (66.7%) Tönnis grade 1, and 18 (25.0%) Tönnis grade 2. Two (2.8%) progressed to total hip arthroplasty. Intraoperatively, 5 (6.9%) patients were classified as Outerbridge I, 14 (19.4%) Outerbridge II, 45 (62.5%) Outerbridge III, and 8 (11.1%) Outerbridge IV. Seventy-two (100.0%) patients had a confirmed labral tear, 34 (47.2%) isolated pincer lesion, 4 (5.6%) isolated CAM lesion, and 27 (37.5%) had both a pincer and CAM lesion. The mean of differences between preoperative and 24-month postoperative follow-up PROMs was 22.5 for mHHS, 17.4 for HOS-ADL, 32.7 for HOS-Sport, 22.9 for NAHS, 33.9 for iHOT-33. (Figure 1) The mean of differences between preoperative and final post-operative follow-up PROMs was 22.1 for mHHS, 17.6 for HOS-ADL, 33.2 for HOS-Sport, 23.3 for NAHS, and 34.2 for iHOT-33. (Table 1) Patient age and presence of femoroacetabular impingement were independently predictive of higher postoperative PROM improvements at final follow-up, whereas Tönnis grade was not. (Table 2) The proportion of patients to achieve the minimally clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) thresholds were also calculated. (Table 3) Conclusions: In this study of 72 hips undergoing arthroscopic labral repair with capsular autograft labral reconstruction, we found excellent outcomes that exceeded the MCID thresholds in the majority of patients at an average 30.3 months follow-up. When compared to capsular reconstruction from autografts and allografts, this technique offers the potential advantages of minimized donor-site morbidity and fewer complications, respectively. [Table: see text][Table: see text][Table: see text]

scholarly journals Modification of Combined Vibrated Power Assisted Liposuction with Periareolar Gland Excision in management of Gynecomastia

2018 ◽  
Vol 14 (1) ◽  
pp. 18-23
Author(s):  
Kurdo Akram Qradaghi
Keyword(s):  
Patient Satisfaction ◽  
Retrospective Study ◽  
Operative Time ◽  
Surgical Techniques ◽  
Satisfaction Rate ◽  
Areola Complex ◽  
Different Types ◽  
Aesthetic Results ◽  
The Mean ◽  
Patient Satisfaction Rate

Background: The recognized procedures that have been used to treat gynecomastia are said to have relatively a long operative time, less patient satisfaction rate, they are merely used, in mild to moderate gynecomastia, leaves a mild bulging over the nipple areola complex, resulting in aesthetically unsatisfactory results. The more the grade of gynecomastia, the more complicated the used surgical techniques. This study evaluates the success rate of these simplest surgical technique in higher grades of gynecomastia. Objectives: to present the experiences with use of Modification of Combined Vibrated Power Assisted Liposuction with Periareolar Gland Excision in management of in different type Gynecomastia Type of the study: This is a retrospective study Methods: The study  includes the use of a modification of combine vibrated power-assisted liposuction with periareolar gland excision applied for managing different types of gynecomastia. In 23 consecutive patients (46 breasts) treated between February of 2011 and March of 2016. Results: 23 patients (46 breasts) were successfully treated using this technique. Volume aspirated in both breast was 792 ml (range, 450 to 1600 ml). Using the periareolar excision technique, the mean operative time was 55 minutes (range, 45 to 90 minute). Complications were minimal (1.5 % per breasts), and no revisions were required. Conclusions: The modified Combined vibrated power assisted liposuction and the periareolartechnique have demonstrated to be a less time consuming versatileapproach, for the treatment of gynecomastia and consistently produces a smoothcontoured male breast, it is promising method to achieve good aesthetic results in gynecomastia surgerywhile resulting in an inconspicuous scar.

Gender Disparity between Donor Sites of the Trochlea Used for Autologous Osteoarticular Transfer: An MRI Analysis

2019 ◽  
Vol 33 (04) ◽  
pp. 357-364
Author(s):  
Kelly M. Rogers ◽  
Daniel C. Berman ◽  
Justin W. Griffin ◽  
Kevin F. Bonner
Keyword(s):  
Standard Deviation ◽  
Trochlear Dysplasia ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Gender Disparity ◽  
Measurement Tool ◽  
Level Of Evidence ◽  
Osteochondral Autograft Transfer ◽  
Males And Females ◽  
The Mean

AbstractThe purpose of this study was to assess potential gender differences in size of the lateral and medial trochlea of the male and female knee as well as the variation within gender of potential osteochondral autograft transfer (OAT) donor site area. Two hundred and twelve skeletally mature patients, 106 males and 106 females, who underwent a 3T magnetic resonance imaging of the knee for a variety of indications were utilized for analysis. Exclusion criteria included degenerative arthritis, trochlear dysplasia, and poor image quality. Medial and lateral femoral trochlear cartilage width was obtained using a linear radiologic measurement tool. Widths were measured from a reproducible anatomic location representing the maximal trochlear dimension in a region where donor plugs are commonly harvested. Trochlear width was also plotted as a function of patient height. Statistical analysis was performed using a two-sample t-test. The mean and standard deviation of the lateral trochlear cartilage width (mm) for males and females were 23.38 +/− 2.14 and 20.44 +/− 2.16, respectively (p < 0.00001). The mean and standard deviation of the medial trochlear cartilage width (mm) for males and females were 14.16 +/− 2.17 and 11.78 +/− 2.03, respectively (p < 0.00001). The overall range in trochlear width for both the lateral and medial sides was 22.22 and 19.73 mm for males and females, respectively. A graft measuring 10 mm could represent as little as 34% of the lateral trochlea in males versus as much as 65% in females. Our results indicate that donor OAT plug diameter relative to available trochlear cartilage width will vary significantly both between genders and individual patients. Trochlear width variability and its potential implications on donor site morbidity may be an important consideration when contemplating osteochondral plug harvest for OAT or other indications. The level of evidence is IV.

scholarly journals The Revolving Door Flap: Revisiting an Elegant but Forgotten Flap for Ear Defect Reconstruction

2020 ◽  
Vol 53 (01) ◽  
pp. 064-070
Author(s):  
Anupam Golash ◽  
Sudipta Bera ◽  
Aditya V. Kanoi ◽  
Abhijit Golash
Keyword(s):  
Learning Curve ◽  
Operative Time ◽  
Donor Site ◽  
Case Series ◽  
Senior Author ◽  
Revolving Door ◽  
Harvest Technique ◽  
Flap Design ◽  
Mean Dimension ◽  
The Mean

Abstract Background The revolving door flap, although well described in the literature, is not widely used in general plastic surgery practice. The flap has been used for anterior auricular and conchal defects and is considered elegant for its unique flap design and peculiarity of flap harvest. However, due to its use for a very specific purpose and unique flap harvest technique that may be difficult to grasp, the flap is not very popular in reconstructive practice. Objectives This study aims to evaluate the understanding and learning curve of the revolving door flap, assess surgical outcome, and reemphasize its utility and elegance in reconstruction of ear defects. Methodology This is a case series of nine surgeries performed between January 2014 and 2018. Three cases were performed by the senior author and six cases by two junior authors. Patients were observed for complications and aesthetic outcomes. Results The mean dimension of the flaps was 27.22 mm × 22.78 mm. The mean operative time was 56.56 minutes (standard deviation 22.50, standard error of the mean 7.5). Flap congestion was noted in three cases postoperatively which resolved completely by the second week. Major “pinning” of the ear was noted in four cases. Conclusion Though infrequently performed, the revolving door flap has an easy learning curve once the proper harvest technique and flap movement has been grasped. The flap harvest is convenient, safe, and yields predictable results. Not only is total or partial flap loss extremely rare, the flap is sensate, color match is good, auricular contour is maintained, and the donor site can be closed primarily and remains well hidden.

Type IIIB and IV hypoplastic thumb reconstruction with non-vascularized fourth metatarsal

2020 ◽  
Vol 45 (7) ◽  
pp. 722-728 ◽  
Author(s):  
Bo Liu ◽  
Shanlin Chen ◽  
Esther Ching San Chow ◽  
Pengcheng Li ◽  
Kun Liu ◽  
...  
Keyword(s):  
Hand Function ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Pinch Strength ◽  
Reconstruction Method ◽  
Level Of Evidence ◽  
Type Iv ◽  
Type Iiib ◽  
Rotational Flap ◽  
Staged Reconstruction

We treated 16 patients with 17 hypoplastic thumbs (eight Type IIIB and nine Type IV) using a non-vascularized fourth metatarsal transfer with a rotational flap and multi-staged reconstruction. The average age at the first operation was 24 months. The average follow-up time was 46 months. All patients achieved reasonable hand function and were able to use the reconstructed thumb to grip small and large objects. The operated thumb achieved an average Kapandji score of 6.7 and average pinch strength of 0.9 kg. There were two cases of graft nonunion. All parents are satisfied with the function and appearance of the reconstructed thumb and donor foot. We conclude that non-vascularized fourth metatarsal transfer is a feasible reconstruction method for patients with Types IIIB and IV hypoplastic thumbs. The reconstruction allows for the preservation of a 5-digit hand with reasonable function and appearance and minimal donor site morbidity, although long-term growth of the metatarsals still need to be monitored. Level of evidence: IV

scholarly journals Endoscopic esophagogastric anastomosis with luminal apposition Axios stent (LAS) approach: a new concept for hybrid “Lewis Santy”

2017 ◽  
Vol 05 (06) ◽  
pp. E455-E462
Author(s):  
Adrian Culetto ◽  
Jean-Michel Gonzalez ◽  
Geoffroy Vanbiervliet ◽  
Pablo Miranda Garcia ◽  
Juan Tellechea ◽  
...  
Keyword(s):  
Operative Time ◽  
Hybrid Approach ◽  
Esophagogastric Anastomosis ◽  
Pathological Examination ◽  
Gastrojejunal Anastomosis ◽  
Endoscopic Suture ◽  
The Mean ◽  
The Right ◽  
Good Patency ◽  
Endoscopic Assessment

Abstract Background and study aims Esophagogastric anastomosis (EGA) has a high risk of leakage. Based upon our experience in endoscopic gastrojejunal anastomosis using LAS, the aim of this study was to verify the technical feasibility and the safety of performing an EGA using a hybrid approach (endoscopic and surgical). Materials and methods A pilot prospective study was performed on 8 survival pigs. The procedure was carried out in 2 stages: (i) surgical step consisting of an esogastrectomy by laparotomy with separated suture of the esophagus and stomach; (ii) endoscopic esophagogastric anastomosis using the LAS. The first 2 pigs allowed for the setting of the 2 steps procedure, and 6 were included in the study for assessing the efficacy and safety of the procedure with a 3-week survival course. The primary endpoint was morbidity and mortality. Results All procedures were successfull. The mean operative time was 98 minutes, with a mean endoscopic time of 46 minutes. Three early deaths occurred within the first weeks, unrelated to the LAS anastomosis. At 3 weeks, endoscopic assessment followed by necropsy demonstrated the right position and the endoscopic removability of the stent with good patency of the esophagogastric anastomosis, without leakage of the endoscopic suture. Pathological examination confirmed the patency of the anastomosis with fusion of mucosal and muscle layers. Conclusion Endoscopic esophagogastric anastomosis with LAS is feasible and reproducible, without anastomotic leakage. It could be a new alternative to perform safe anastomoses, as part of a hybrid approach (surgical and endoscopic).

Application of Proximal Lateral Leg Perforator Flaps for Head and Neck Reconstructions

2014 ◽  
Vol 151 (5) ◽  
pp. 791-796 ◽  
Author(s):  
Honda Hsu ◽  
Peir-Rong Chen ◽  
Sou-Hsin Chien ◽  
Jiunn-Tat Lee
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Tertiary Care ◽  
Case Series ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Recipient Site ◽  
The Mean

Objective Analyze the reliability, complications, and donor site morbidity of the proximal lateral leg flap when applied to head and neck reconstruction. Study Design Case series and chart review. Setting Tertiary care teaching hospital. Subjects and Methods Nineteen patients who underwent reconstruction of various head and neck defects with this flap were analyzed. The patient demographics, flap characteristics, method of donor site closure, scars of the donor area, complication rates, as well as functional results at the recipient site were assessed. Results The flap size ranged from 4 × 4 cm to 11 × 8 cm. Vascular pedicle length ranged from 5 to 9 cm. The mean distance of the perforator from the fibula head was 9.2 cm. The mean thickness of this flap was 5.5 mm. All the donor wounds were closed primarily. The flap survival rate was 100%. Conclusion This flap has the advantages of thinness, short harvesting time, minimal donor site morbidity, and primary closure at the donor site when the flap width is less than 6 cm. This flap may be useful for reconstruction in selected patients with small and thin heads and neck defects.

Autologous osteochondral graft for traumatic defects of finger joints

2011 ◽  
Vol 37 (3) ◽  
pp. 251-257 ◽  
Author(s):  
W. C. Wu ◽  
M. W. M. Fok ◽  
K. Y. Fung ◽  
K. H. Tam
Keyword(s):  
Donor Site ◽  
Joint Space ◽  
Donor Site Morbidity ◽  
Finger Joint ◽  
Osteochondral Graft ◽  
Range Of Movement ◽  
No Donor ◽  
The Mean ◽  
Open Injuries

Finger joint defects in 16 adults were treated with an autologous osteochondral graft from the base of the second metacarpal, the radial styloid, the base of the third metacarpal or the trapezoid and these patients were followed up from between 12 and 62 months. There was no donor site morbidity. One patient had resorption of the graft and developed pain. The joint was subsequently fused. The mean range of movement was 55.8% of the opposite normal joint. At follow up, 15 patients had no discomfort or mild discomfort. Three had mild narrowing of the joint space and two had slight joint subluxation. Only two patients with concomitant severe injury to the same limb had difficulty performing daily activities. Ten were open injuries and these had poorer outcomes. A hemicondylar defect of a finger joint can be treated using an osteochondral graft obtained from the same hand.

scholarly journals Laparoscopic Harvesting of Omental Flaps for Breast Reconstruction—A Review of the Literature and Outcome Analysis

2017 ◽  
Vol 26 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Hani Shash ◽  
Becher Al-halabi ◽  
Salah Aldekhayel ◽  
Tassos Dionisopoulos
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Patient Characteristics ◽  
Donor Site Morbidity ◽  
Outcome Analysis ◽  
Complication Rates ◽  
Search Terms ◽  
The Mean ◽  
Pedicle Flaps

Background: Evidence on the use of omental flaps for breast reconstruction in patients with breast cancer is lacking, and no published reviews report an outcome-based assessment of such flap. This review explores available data and evidence for change in complication rates following the shift toward laparoscopic harvesting. Methods: We searched the databases Excerpta Medica database, MEDLINE, and PubMed from inception until December 2015 using search terms “omental flaps“ and “breast reconstruction.” Data extracted were patient characteristics, technique used, and outcome measures reported and were then analyzed based on the technique of harvesting. Results: Twenty-two articles reporting 651 patients who underwent mastectomies and breast-conserving surgeries were included in this review. Most flaps, 537 (82.5%), were harvested by laparoscopy, and 626 (96.2%) of the flaps were pedicle flaps. The mean age was 47.7 years (standard deviation: 4.29), and mean follow-up was 38.1 months. There were 88 reported complications among 562 patients in 16 reports. The rate of any complication was calculated to be 15.0%, with a higher rate (29.1%) occurring with the open technique in comparison to laparoscopy (12.6%). The commonest complications were postoperative infection and breast firmness each reported in 2.22%. Most authors reported advantages of malleability and excellent aesthetic outcomes and disadvantages in terms of inability to estimate the volume of the flap and variability in size. Conclusion: Omentum use is safe and has advantages in breast reconstruction where other options are limited including a natural feeling and minimal donor site morbidity if harvested laparoscopically.

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