scholarly journals Role of large transverse fasciocutaneous cross leg flap (whole leg flap) in lower extremity salvage

2017 ◽  
Vol 5 (5) ◽  
pp. 1760
Author(s):  
Manish Zade ◽  
Dhananjay Nakade ◽  
Jitendra Mehta ◽  
Pawan Shahane ◽  
Shitiz Gupta ◽  
...  
Keyword(s):  
Donor Site ◽  
Graft Loss ◽  
Joint Stiffness ◽  
Skin Grafting ◽  
Donor Site Morbidity ◽  
Average Hospital ◽  
Female Ratio ◽  
Donor Area ◽  
Microvascular Flap ◽  
Ankle And Foot

Background: Extensive soft tissue defects of leg, ankle and foot are challenge to reconstructive surgeons due to lack of local tissue. Microvascular flap coverage has become a standard line of treatment as large amount of tissue transfer is required. Large transverse fasciocutaneous cross leg flap remains an alternative for reconstruction of such extensive defects. We present our experience with this flap in 14 patients.Methods: A total of 14 patients were operated for large transverse fasciocutaneous cross leg flap cover for defects over leg (9), ankle and foot (3) and sole (2). Age group ranged from 4 years to 50 years with 4 patients below 12 years of age. Male to female ratio was 5:2. Flaps were divided at 3weeks and final inset was done.Results: 11 patients had complete flap survival. Two patients had marginal necrosis and one patient had superficial necrosis of proximal flap margin after flap division. One patient with partial skin graft loss at donor area required secondary skin grafting at the time of flap division. Average hospital stay was 34.5 days (range 10 - 50 days). The donor limb had no joint stiffness related to immobilisation and cosmetic outcome of flap and donor area was satisfactory.Conclusions: large transverse fasciocutaneous cross leg flap is safe, technically easy and is associated with minimal donor site morbidity. It offers the possibility of limb salvage in difficult situations.

Evaluation of Fingertip Injuries and Modalities of Flap Coverage in the Emergency Settings: A Retrospective Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Salah Nasser Mohamed ◽  
AbdelRahman AbdeIAal ◽  
Mina Agaiby Estawrow ◽  
Andrew Adel Wassef Attia
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Joint Stiffness ◽  
Skin Grafting ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
University Hospitals ◽  
Maximum Function ◽  
Reconstruction Methods

Abstract Background Fingertip comprises the nail complex and glabrous pulp, which is richly vascularized and innervated, built around the distal phalanx. The fingertip is commonly affected because it is the most distal part of the hand so it's easily to be injured during athletic participation, occupational activities or in accidents. Various fingertip reconstruction methods are reported as healing by secondary intention, shortening and primary closure, skin grafts and flaps. Flaps are considered when there's a big soft tissue loss or an exposed bone. Complications of fingertip reconstructions are common such as flexion deformity and neuroma. Objective In this study, we assessed and compared the outcomes of different modalities of soft tissue covemge using different flap techniques in cases of fingertip injuries as regalding the incidence of neuroma, necrosis, donor site morbidity, joint stiffness and sensory impairment, together with the patient satisfaction. Patients and Methods We analyzed a retrospective cohort study of 90 patients with 96 fingertip injuries who underwent coverage by various flap techniques at Ain Shams University Hospitals in the period between July 2017 and July 2019. Results The V-Y Advancement flap and the Cross-finger flap were the commonest flaps done in 26 cases (27.1%) and 25 cases (26.0%) respectively. There's a highly statistically significance in the incidence of necrosis in abdominal flap (100%) followed by Moberg flap (46.2%). In addition, there is a statistically significance in the incidence of neuroma in Moberg flap (53.8%). Most of patients who underwent coverage by flap technique were very satisfied by the results (60.4%). Conclusion Many techniques have been described for reconstruction of fingertip trauma including revision amputation, skin grafting, local flaps, distant flaps and free flaps. The treatment choice depends on many factors such as patient preference, culture, resources available and surgeon skills. The goals of reconstruction in fingertip amputations are to cover the defect with a satisfactory cosmetic appearance, establish maximum function and preservation of sensation.

scholarly journals Minimising the donor area morbidity of radial forearm phalloplasty using prefabricated thigh flap: A new technique

2017 ◽  
Vol 50 (01) ◽  
pp. 091-095 ◽  
Author(s):  
Aditya Aggarwal ◽  
Hardeep Singh ◽  
Sanjay Mahendru ◽  
Vimalendu Brajesh ◽  
Sukhdeep Singh ◽  
...  
Keyword(s):  
Donor Site ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Skin Grafting ◽  
Free Flaps ◽  
Standing Position ◽  
Donor Site Morbidity ◽  
New Technique ◽  
Donor Area ◽  
Radial Forearm

ABSTRACTPhalloplasty is indicated in various conditions of penile loss or absence. There are numerous techniques for phalloplasty including the pedicle and free flaps with the ultimate goal of micturition in standing position, attaining adequate size, aesthesis and sensations for sexual intercourse. Radial forearm phalloplasty is the gold standard flap to achieve above results but gives a very bad scar on the forearm. We present a technique of using prefabricated thigh flap to reduce the morbidity of donor area. The descending branch of lateral circumflex femoral pedicle was placed in a subcutaneous plane over tissue expander. After attaining an adequate size of flap with tissue expansion, it was delayed 3 weeks before phalloplasty. Prefabricated flap was thin and of large size replicating the radial forearm flap used for phalloplasty. Whole forearm defect was covered with the thigh flap, and the thigh could be closed primarily. This new technique of using prefabricated thigh flap has significantly reduced the donor site morbidity both aesthetically and functionally without the use of skin grafting in the whole procedure.

Full Thickness Skin Graft for Nail Unit Reconstruction

2005 ◽  
Vol 30 (2) ◽  
pp. 194-198 ◽  
Author(s):  
A. LAZAR ◽  
P. ABIMELEC ◽  
C. DUMONTIER
Keyword(s):  
Skin Graft ◽  
Simple Procedure ◽  
Donor Site ◽  
Skin Grafting ◽  
Malignant Tumour ◽  
Donor Site Morbidity ◽  
Full Thickness ◽  
Full Thickness Skin Graft ◽  
Full Thickness Skin ◽  
Thickness Skin

A retrospective study of 13 patients assessed the use of a full thickness skin graft for nail unit reconstruction after total nail unit removal for nail bed malignancies. No failures of the graft were observed and no patient had recurrence of the malignant tumour at 4 year follow-up. Full thickness skin grafting is a simple procedure which provides a good cosmetic outcome and does not produce significant donor site morbidity.

Article Commentary: Optimizing Aesthetic Results in Skin Grafting

2012 ◽  
Vol 78 (2) ◽  
pp. 151-154 ◽  
Author(s):  
Ron Hazani ◽  
Ryan Whitney ◽  
Bradon J. Wilhelmi
Keyword(s):  
Donor Site ◽  
Skin Grafting ◽  
Donor Site Morbidity ◽  
Secondary Intention ◽  
Donor Skin ◽  
Aesthetic Results ◽  
The Aesthetic ◽  
Sheet Graft ◽  
Surrounding Skin ◽  
Tissue Defects

The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.

Fractional Skin Harvesting: Device Operational Principles and Deployment Evaluation

2014 ◽  
Vol 8 (4) ◽  
Author(s):  
Walfre Franco ◽  
Joel N. Jimenez-Lozano ◽  
Joshua Tam ◽  
Martin Purschke ◽  
Ying Wang ◽  
...  
Keyword(s):  
Donor Site ◽  
Fluid Flows ◽  
Skin Grafting ◽  
Donor Site Morbidity ◽  
Skin Wound ◽  
Skin Tissue ◽  
Hypodermic Needle ◽  
Cutting Geometry ◽  
Tissue Core ◽  
Thickness Skin

As an alternative method to conventional split-thickness skin grafts (STSGs), we recently proposed fractional skin grafting (FSG), which consists in harvesting hundreds of microscopic skin tissue columns (MSTCs) to place them directly into the skin wound (Tam et al., 2013, “Fractional Skin Harvesting: Autologous Skin Graft Without Donor Site Morbidity,” Plast. Reconstructive Surgery–Global Open, 1(6)). This paper (i) introduces the concept and operational principles of a simple but robust fractional skin harvesting (FSH) device and (ii) presents the quantitative evaluation of the deployment of the FSH device with respect to different harvesting-needle sizes. The device utilizes a hypodermic needle with a specific cutting-geometry to core skin tissue mechanically. The tissue core is removed from the donor site into a collecting basket by air and fluid flows. The air flow transports the tissue core, while the fluid flow serves the purpose of lubrication for tissue transport and wetting for tissue preservation. The design and functionality of the device were validated in an animal study conducted to establish preclinical feasibility, safety and efficacy of the proposed FSH device and FSG method. The FSH device, operating at 55.16 kPa (8 psi) gauge pressure and 208 ml/min saline flow rate, cored 800 μm diameter × 2.5 mm length skin columns using a 1.05/0.81 mm outer/inner diameter needle. The MSTC harvesting rate was established by the user at 1 column/sec. For this columns size, about 50 MSTCs are required to cover a 1.5 cm × 1.5 cm wound. In comparison to STSGs, the proposed FSG method results in superior healing outcomes on the donor and wound sites. Most important, the donor site heals without morbidity by remodeling tissue, as opposed to scarring. The FSH device has the capability of extracting full-thickness skin columns while preserving its viability and eliminating the donor site morbidity associated with skin grafting.

scholarly journals Hinged multiperforator-based extended dorsalis pedis adipofascial flap for dorsal foot defects

2020 ◽  
Vol 47 (4) ◽  
pp. 340-346
Author(s):  
Magdy A. Abd Al Moktader
Keyword(s):  
Skin Graft ◽  
Donor Site ◽  
Graft Loss ◽  
Plantar Fascia ◽  
Donor Site Morbidity ◽  
Adipofascial Flap ◽  
Dorsalis Pedis Artery ◽  
Flap Viability ◽  
Cutaneous Flap ◽  
The Right

Background Adipofascial flaps covered with a skin graft address the challenges involved in reconstructing dorsal foot defects. The purpose of this study was to describe a large adipofascial flap based on the perforators of the dorsalis pedis artery for large foot defects.Methods Twelve patients aged 5–18 years with large soft tissue defects of the dorsal foot due to trauma were treated with an extended dorsalis pedis adipofascial flap from May 2016 to December 2018. The flap was elevated from the non-injured half of the dorsum of the foot. Its length was increased by fascial extension from the medial or lateral foot fascia to the plantar fascia to cover the defect. All perforators of the dorsalis pedis artery were preserved to increase flap viability. The dorsalis pedis artery and its branches were kept intact.Results The right foot was affected in 10 patients, and the left foot in two patients. All flaps survived, providing an adequate contour and durable coverage with a thin flap. Follow-up lasted up to 2 years, and patients were satisfied with the results. They were able to wear shoes. Donor-site morbidity was negligible. Two cases each of partial skin graft loss and superficial necrosis at the tip of the donor cutaneous flap occurred and were healed by a dressing.Conclusions The hinged multiperforator-based extended dorsalis pedis adipofascial flap described herein is a suitable method for reconstructing dorsal foot defects, as it provides optimal functional and aesthetic outcomes with minimal donor site morbidity.

scholarly journals SUPRACLAVICULAR ARTERY FLAP: A SAFE, VERSATILE AND A RELIABLE FLAP A NEW WORKHORSE IN HEAD AND NECK RECONSTRUCTION OUR CLINICAL EXPERIENCE

2021 ◽  
Vol 9 (01) ◽  
pp. 544-550
Author(s):  
Mir Mushtaq ◽  
◽  
Bashir Ahmad Bhat ◽  
Taj Din Wani ◽  
Shabir Iqbal ◽  
...  
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Graft Loss ◽  
Surgical Techniques ◽  
Free Tissue Transfer ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Head And Neck Reconstruction ◽  
Wide Range

Background: Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Material and Methods: This study was carried out in the Plastic Surgery Department of GMC Srinagar between November 2015 and October 2019. It involved 50 patients (40 females and 10 males), in whom supraclavicular artery flap was done to reconstruct head and neck. Follow-up period ranged from 2-27 months (average 12.3). Results: The study involved 50 patients. Mean age was 26.5 years (range 57-12 years). Thirty five patients had post-burn neck contractures, five patients had portwine stain face, three had marjolin ulcer, four patients had post traumatic and three had post bear maul defect. We harvested unilateral flaps in all of patients. In thirty five patients the flap was pedicled, three had adipofascial pedicle and twelve were islanded. The size of the reconstructed defect ranged from 23x10 to 14x6, and the size of the flap varied from 16x7cm to 25x11. Mean length was 21.7 cm. We used a partial thickness skin graft for donor site closure in 41 cases and closed primarily in 9 cases. Flap was used to resurface neck in 35 patients, face resurfacing in 10 patients, as intraoral lining in 3 patients. The following complications occurred: hematoma in 3 cases, partial distal necrosis in 2 cases, and donor site graft loss in 3 cases. Follow-up period ranged from 2-27 months Conclusion: The supraclavicular artery island flap is a thin, malleable fasciocutaneous flap that is easily and rapidly harvested, with a reliable pedicle and minimal donor site morbidity. It constitutes an alternative to local flaps, while providing equivalent functional results, and must be an integral part of the head and neck reconstructive surgeons therapeutic armamentarium.

Outcomes of Dog Bite Avulsion Injury Reconstruction With Urinary Bladder Matrix

2020 ◽  
Vol 163 (6) ◽  
pp. 1166-1168
Author(s):  
Adrian A. Ong ◽  
Ryan Nagy ◽  
Michelle R. Fincham ◽  
Mark L. Nagy
Keyword(s):  
Urinary Bladder ◽  
Head And Neck ◽  
Pediatric Patients ◽  
Donor Site ◽  
Graft Loss ◽  
Wound Dehiscence ◽  
Donor Site Morbidity ◽  
Dog Bite ◽  
Urinary Bladder Matrix ◽  
Reconstructive Option

Dog bite avulsion injuries of the head and neck are difficult to manage in pediatric patients. This study assesses the outcomes of using porcine urinary bladder extracellular matrix (UBM) for reconstruction of these complete avulsion injuries. Five male pediatric patients underwent reconstruction using UBM. Two (40%) patients underwent reconstruction of the nose; the other 3 patients underwent reconstruction of the forehead, forehead/glabella, and auricle. The average size of the avulsion defect was 7.0 ± 2.4 cm2. No patient developed wound dehiscence, graft loss, or wound infection. Four (80%) patients received pulsed dye laser treatment to improve wound cosmesis. Use of UBM is a safe and effective reconstructive option after dog bite avulsion injuries of the head and neck. Given the advantages of convenient availability and avoidance of donor site morbidity, UBM can be considered for reconstruction of posttraumatic avulsion injuries or Mohs defects.

Impact of Topical Heparin on Healing of Skin Graft Donor Site in Burn Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Mohamed Salah El-Din El-Badawi ◽  
Sherine Mohamed Aboul-Fotouh ◽  
Ahmed Mohamed Abdelsalam ◽  
Mai Raafat Abdelazim Hammad
Keyword(s):  
Platelet Count ◽  
Conventional Treatment ◽  
Donor Site ◽  
Reference Value ◽  
Skin Grafting ◽  
Healing Time ◽  
Burn Patients ◽  
Donor Area ◽  
Graft Donor ◽  
Topical Heparin

Abstract Background The ability of topical heparin application to improve the healing outcome of burn wounds has been demonstrated by several studies. However, its impact on healing of skin graft donor site was not studied. Aim The present study was done to compare the healing outcome (healing time, pain, itching, scarring and complications) of topical heparin treatment with topical conventional treatment in the donor areas after skin grafting in burn patients. Methods This prospective, interventional, controlled, single-blinded clinical study was done on 40 patients with 2nd or 3rd degree burns of any etiology and <30% of body surface area requiring skin grafting, aged 18-65 years, of both sexes. Each patient was subjected to harvesting of two grafts. Patients served as their own controls. One donor area was treated with topical heparin and the other was treated with the topical conventional treatment. Immediately after graft harvesting, all donor areas were treated conventionally. Starting from the 2nd day, each donor area was treated once daily according to its group allocation. The topical heparin donor area was treated with heparin diluted in saline in a concentration of 250 IU/ml in a dose of 4200 IU/1% total body surface area (TBSA). The area was covered with gauze soaked with the solution for 5 days. The conventional treatment (control) donor area was covered by gauze soaked with an equivalent amount of normal saline on top of Vaseline gauze. Heparin was to be discontinued if the platelet count before each session was < 100,000 /mm3 and/or APTT exceeded double the reference value. Pain was assessed twice daily for 5 days. The patients’ donor areas were followed-up postoperatively for 8 weeks for healing time in days, itching over the wound and scarring using Vancouver Scar Scale. Complications in the form of wound site bleeding or infection were recorded. An analgesic was given twice daily for 5 days then as needed. Results There were no statistically significant differences between the two donor areas regarding the site and size. The healing time was significantly shorter in the heparin donor areas (P < 0.00001) with less scarring reported as significantly lower scores of the Vancouver scar scale compared with the control donor areas for each component and the total score (P < 0.05). Pain, itching and infection rate were insignificantly less in the heparin area. Bleeding was not observed in any of the areas in all cases and the daily values of platelet count and APTT in the five treatment days did not differ significantly compared with the preoperative values. None of the patients showed a platelet count < 100,000 /mm3 or APTT exceeding double the reference value. Conclusion Topical heparin treatment, compared with topical conventional treatment, of the donor areas after skin grafting in burn patients resulted in better clinical outcome manifested as significantly shorter wound healing time and significantly less scarring with no treatment-related complications.

scholarly journals The Versatility of Perforator-Based Propeller Flap for Reconstruction of Distal Leg and Ankle Defects

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Durga Karki ◽  
R. P. Narayan
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Wound Dehiscence ◽  
Skin Grafting ◽  
Donor Site Morbidity ◽  
Peroneal Artery ◽  
Medium Size ◽  
Soft Tissue Coverage ◽  
Propeller Flap ◽  
Flap Design

Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. Material and Methods. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm × 3.5 cm to 7 cm × 5 cm. Results. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result.

Sign in / Sign up

Export Citation Format

Share Document