scholarly journals Soft tissue coverage techniques for management of open fractures of tibia (type IIIB)

2020 ◽  
Vol 6 (4) ◽  
pp. 773
Author(s):  
Mahaveer Meena ◽  
Vikas Chavan ◽  
Sanjay Kumar Ghilley ◽  
Nilesh Kumar Jangir
Keyword(s):  
Soft Tissue ◽  
Soleus Muscle ◽  
Road Traffic ◽  
Muscle Flap ◽  
High Energy ◽  
Open Fractures ◽  
Split Thickness Skin Graft ◽  
Soft Tissue Coverage ◽  
Muscle Flaps ◽  
Type Iiib

<p class="abstract"><strong>Background:</strong> Open fractures are surgical emergencies; incidence of open fractures is increasing with more high-energy road traffic accidents. The tibia is exposed to frequent injury because of its location. The need for aggressive debridement, adequate fracture fixation, and early flap coverage in reducing the morbidity cannot be over emphasized.</p><p class="abstract"><strong>Methods:</strong> Treatment of open fracture by immediate debridement and anatomical fracture reduction using external fixator device. Gastrocnemius muscle flap done in upper 1/3 open fractures (type IIIB) with larger defects along with split thickness skin graft (STSG). In middle and lower 1/3 open fractures (type IIIB), fasciocutaneous and soleus muscle flaps done with relatively smaller soft tissue defects and exposed bone with STSG.<strong></strong></p><p class="abstract"><strong>Results:</strong> The study included 15 patients with open tibia fracture Gustillo Anderson type IIIB classified after the initial debridement. Excellent flap takes up was seen in all cases. 11 cases (73.3%) achieved union at the end of 6 months follow-up while 4 cases (26.7%) showed delayed union which required additional procedures like BMI or bone graft.</p><p class="abstract"><strong>Conclusions:</strong> Soft tissue coverage techniques like fascicutaneous flap, gastrocnemius and soleus muscle flap had a definitive role in the management of open fractures of tibia (type IIIB).</p>

scholarly journals Reconstructive strategies for lower one-third leg soft tissue defects

2018 ◽  
Vol 5 (12) ◽  
pp. 4016
Author(s):  
Mahesh S. G. ◽  
Ashwath Narayan Ramji ◽  
Balaji R. ◽  
Mali Chetan S. M.
Keyword(s):  
Soft Tissue ◽  
Road Traffic ◽  
Muscle Flap ◽  
Free Flaps ◽  
Fracture Site ◽  
Soft Tissue Defects ◽  
Muscle Flaps ◽  
Aesthetic Appearance ◽  
Flap Cover ◽  
Tissue Defects

Background: Despite recent technical advances, reconstruction of lower third of leg wounds with soft tissue defects remains a challenge to the Plastic Surgeon. This is due to the inherent anatomical and structural configuration, including the limited vascularity of the skin of the lower third of the leg. Maintaining maximal function without compromising the aesthetic appearance of the leg is the goal of reconstruction.Methods: This was a retrospective study conducted in the Department of Plastic Surgery, KIMS Hospital, Bangalore, from January 2016 to January 2018. Patients with soft tissue defects involving lower third of leg requiring flap cover were included in the study. Orthopedic intervention was done as required. All patients underwent loco-regional or free flap cover as clinically indicated. Outcomes were studied.Results: Total of 20 patients were included in the study. Most common presentation was due to road traffic accidents (RTA). Right leg was involved in 12 cases and left in 8 cases. Fracture was present in 7 cases, exposed bone without fracture in 11 cases, exposed tendons alone in 1 case and exposed implants in 1 case. 3 Patients required orthopaedic intervention along with the flap procedure, and 4 had already undergone orthopaedic stabilisation. Most commonly performed procedure was muscle flap (45%), followed by perforator-based fascio-cutaneous flap (25%). No major complications were observed in the post-operative period.Conclusions: Lower third of leg reconstruction is a challenge, but a wide variety of options ranging from loco-regional to free flaps can be employed, depending on the situation. In present study, various types of flap cover were adopted to cover the lower-third of leg defects, depending on the nature of the wound. Present study delineated that muscle flaps - particularly the reverse hemi-soleus flap, are an ideal flap for lower third of leg defects with fracture site exposed and wound infected. Local muscle flaps have the advantage of being single-staged, faster to perform and technically easier, compared to free flaps, which have long been considered the gold standard.

Sartorius Muscle Flaps for Vascular Groin Wound Complications

2015 ◽  
Vol 81 (11) ◽  
pp. 1163-1169 ◽  
Author(s):  
Michael B. Brewer ◽  
Christian J. Ochoa ◽  
Karen Woo ◽  
Sarah M. Wartman ◽  
Vahagn Nikolian ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Muscle Flap ◽  
Skin Grafting ◽  
Wound Complication ◽  
Wound Complications ◽  
Sartorius Muscle ◽  
Soft Tissue Coverage ◽  
Vascular Surgeon ◽  
Muscle Flaps ◽  
Rotational Flap

Sartorius myoplasty (SM) has been used as an adjunct for soft tissue coverage in vascular groin wound complications. However, the reliability of SM as a primary muscle flap has been questioned. The purpose of this study is to determine the reliability of SM performed by vascular surgeons in the management of vascular groin wound complications. A retrospective review was performed on all patients who underwent SM from 1997 to 2012. The three indications for SM were prophylactic, infection, and noninfectious wound complication. Failure of SM was defined as operative reintervention for bleeding, persistent wound drainage, or infection. A total of 99 patients underwent 103 SM procedures. The patients were 43 per cent male and 57 per cent female; the mean age was 69 years. The indication for SM was infectious in 62 cases (60%), prophylactic in 21 cases (20%), and noninfectious in the remaining 20 cases. Failure of SM occurred in 11 cases (11%). Of these, salvage bypass and/or salvage muscle flap was required in eight cases (73%). When salvage bypass was required, extra-anatomic obturator bypass was performed in 80 per cent of cases. Salvage wound coverage included rectus abdominus flap (60%), rotational flap (20%), and skin grafting (20%). Seventy-three per cent of failures came from the infectious wound group. The most common reason for SM failure was hemorrhage (45%). In 82 per cent of the cases, the sartorius muscle was still viable at reoperation and was used for continued muscle coverage. SM performed by the vascular surgeon provides reliable soft tissue coverage for vascular groin wound complications and should be used as the primary muscle flap in the majority of patients. In cases of SM failure, the vascular surgeon should consider other more extensive muscle flap options.

Reverse Distally Based Abductor Hallucis Muscle Flap for Soft Tissue Coverage of the First Metatarsophalangeal Joint Wounds

2017 ◽  
Vol 16 (3) ◽  
pp. 208-211 ◽  
Author(s):  
Edgardo R. Rodriguez-Collazo ◽  
Ryan J. Pereira ◽  
Grace C. Craig
Keyword(s):  
Soft Tissue ◽  
Structural Integrity ◽  
Wound Care ◽  
Muscle Flap ◽  
Metatarsophalangeal Joint ◽  
Soft Tissue Coverage ◽  
Abductor Hallucis ◽  
First Metatarsophalangeal Joint ◽  
Secondary Intention ◽  
Abductor Hallucis Muscle

Loss of soft tissue coverage distally around the foot poses threats of amputation of the exposed boney structures. An amputation of a portion of the foot leads to loss of the biomechanical structural integrity of the foot. This promulgates an imbalance with its inherent risks of developing new ulcers. This in turn potentiates the limb loss cycle. The reverse abductor hallucis muscle flap is ideally suited for small to moderate-sized defects in the vicinity of the first metatarsophalangeal joint based on its arc of rotation. In this article, we present cases of 5 patients who failed local wound care and healing by secondary intention for at least 6 months duration. The patients were treated successfully using reverse abductor hallucis muscle flap.

The Effects of Timing of Soft Tissue Coverage on Outcomes After Reconstruction of Type IIIB Open Tibia Fractures

Orthopedics ◽  
2019 ◽  
Vol 42 (5) ◽  
pp. 260-266 ◽  
Author(s):  
Devin J. Clegg ◽  
Paula F. Rosenbaum ◽  
Brian J. Harley
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Coverage ◽  
Type Iiib ◽  
Tibia Fractures

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.

Giant Eccrine Adenocarcinoma of the Scalp with Intracranial Invasion:Resection and Reconstruction Using a Vacuum-assisted Closure Device:Technical Case Report

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-E371-ONS-E371 ◽  
Author(s):  
Daniel J. Donovan ◽  
Donald A. Person
Keyword(s):  
Wound Closure ◽  
Tumor Resection ◽  
Muscle Flap ◽  
Cerebrospinal Fluid Leakage ◽  
Split Thickness Skin Graft ◽  
Closure Device ◽  
Soft Tissue Coverage ◽  
Neurosurgical Procedures ◽  
Secondary Intention ◽  
Scalp Defects

Abstract Objective and Importance: Carcinoma of the adnexal structures of the skin is a rare malignancy, and is even more unusual in the scalp. We report an unusual case of scalp adnexal carcinoma of eccrine origin that went untreated for years, resulting in a giant tumor with extension through the cranium. The tumor resection and reconstruction of the cranium and scalp defects posed unique challenges. Clinical Presentation: A 54-year-old woman experienced a large recurrence of her scalp adnexal carcinoma after an incomplete wide local excision, which invaded through the cranium. Intervention: The entire vertex of the scalp and cranium were removed en bloc. After cranioplasty, a free vascularized muscle flap was used for soft tissue coverage, but failed owing to poor vascular inflow. A large area of dura was left open, using a vacuum-assisted wound closure device to generate granulation tissue by secondary intention. Another split thickness skin graft was used to provide a cosmetically acceptable outcome. Conclusion: Scalp adnexal tumors of eccrine origin rarely metastasize and can be resected for cure with complete removal. Reconstruction options for large scalp and cranial tumors may be limited, and allowing the dura to granulate by secondary intention has been very rarely described. The novel use of a vacuum-assisted wound closure device was a very useful adjunct in this situation, and may be beneficial in the reconstruction of other patients with large scalp and cranial defects after neurosurgical procedures. It should be used with caution, since it may risk injury to a major venous sinus, especially when used in the midline, or cerebrospinal fluid leakage.

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