scholarly journals Variants of Extended Latissimus Dorsi Musculocutaneous Flap for Large Wounds in Extremities

2020 ◽  
Author(s):  
Jiqiang He ◽  
Liming Qing ◽  
Panfeng Wu ◽  
Zhengbing Zhou ◽  
Fang Yu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Latissimus Dorsi ◽  
Donor Site ◽  
Free Flaps ◽  
Lower Limbs ◽  
Soft Tissue Coverage ◽  
Skin Defect ◽  
Reliable Methods ◽  
Large Skin

Abstract Background: Extended latissimus dorsi musculocutaneous (LDMC) flap increasing the size of the flap and most used for breast reconstruction. This report will share our experience in designing different extended LDMC flap for large wounds in extremities.Patients and methods: From January 2004 to December 2018, extended LDMC flaps were performed on 72 consecutive patients aged 2 to 68 years (37 men and 35 women). All the wounds were extensive, either in upper or lower limbs, the skin defect ranged from 18 ×10 cm2 to 37 × 21 cm2. Single wing and double wings extended LDMC flaps were designed and harvested based on the wounds.Results: Seventy-two patients included this series, 5 pedicle and 67 free flaps were successfully harvested. The mean flap harvest time was 56.2 min. The donor sites were closed primarily in all patients. The venous compromise was noticed on the first postoperative day in 4 cases. Two flaps were salvaged after emergency re-exploration, another two patient’s flaps were total necrosis. One of the patients was received lower extremity amputation, another patient was repaired by extended LDMC flap on the other side. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Five patients lost follow-up, the follow-up period ranged from 10 to 56 months (mean, 15.7 months). Patients didn’t occur significant donor site morbidities that influenced their daily activities during follow-up.Conclusion: The single wing and double wings extended latissimus dorsi musculocutaneous flaps are simple and reliable methods for large skin and soft-tissue defects in extremities.

The Use of Engineered Bilayered Skin (MyDermTM) in the Management of Massive Skin Defect in Grade III Gustilo-Anderson Open Fracture

2017 ◽  
Vol 16 (3) ◽  
pp. 212-216
Author(s):  
Nor Hazla Mohamed Haflah ◽  
Min Hwei Ng ◽  
Mohd Heikal Mohd Yunus ◽  
Amaramalar Selvee Naicker ◽  
Ohnmar Htwe ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Wound Closure ◽  
Posterior Tibial Artery ◽  
Soft Tissue Coverage ◽  
Skin Defect ◽  
Vascular Repair ◽  
Posterior Compartment ◽  
Large Defect ◽  
Large Skin

Open fracture Gustilo-Anderson grade IIIC is associated with higher risk of infection and problems with soft tissue coverage. Various methods have been used for soft tissue coverage in open fractures with large skin defect. We report a case of a patient who had grade IIIC open fracture of the tibia with posterior tibial artery injury. The patient underwent external fixation and reduction. Because of potential compartment syndrome after vascular repair, fasciotomy of the posterior compartment was performed. This wound, however, became infected and because of further debridement, gave rise to a large skin defect. A tissue engineered skin construct, MyDermTM was employed to cover this large defect. Complete wound closure was achieved 35 days postimplantation. The patient then underwent plating of the tibia for nonunion with no adverse effect to the grafted site. The tibia eventually healed 5 months postplating, and the cosmetic appearance of the newly formed skin was satisfactory.

scholarly journals The Pedicled Latissimus Dorsi Flap Provides Effective Coverage for Large and Complex Soft Tissue Injuries Around the Elbow

Hand ◽  
2017 ◽  
Vol 13 (5) ◽  
pp. 586-592 ◽  
Author(s):  
Jacques H. Hacquebord ◽  
Douglas P. Hanel ◽  
Jeffrey B. Friedrich
Keyword(s):  
Soft Tissue ◽  
Latissimus Dorsi ◽  
Soft Tissue Injuries ◽  
Soft Tissue Defect ◽  
Latissimus Dorsi Flap ◽  
Soft Tissue Coverage ◽  
Effective Coverage ◽  
Latissimus Flap ◽  
Proximal Forearm

Background: The pedicled latissimus flap has been shown to provide effective coverage of wounds around the elbow with an average size of 100 to 147 cm2 but with complication rates of 20% to 57%. We believe the pedicled latissimus dorsi flap is an effective and safe technique that provides reliable and durable coverage of considerably larger soft tissue defects around the elbow and proximal forearm. Methods: A retrospective review was performed including all patients from Harborview Medical Center between 1998 and 2012 who underwent coverage with pedicled latissimus dorsi flap for defects around the elbow. Demographic information, injury mechanism, soft tissue defect size, complications (minor vs major), and time to surgery were collected. The size of the soft tissue defect, complications, and successful soft tissue coverage were the primary outcome measures. Results: A total of 18 patients were identified with variable mechanisms of injury. Average defect size around the elbow was 422 cm2. Three patients had partial necrosis of the distal most aspect of the flap, which was treated conservatively. One patient required a secondary fasciocutaneous flap, and another required conversion to a free latissimus flap secondary to venous congestion. Two were lost to follow-up after discharge from the hospital. In all, 88% (14 of 16) of the patients had documented (>3-month follow-up) successful soft tissue coverage with single-stage pedicled latissimus dorsi flap. Conclusions: The pedicled latissimus dorsi flap is a reliable option for large and complex soft tissue injuries around the elbow significantly larger than previous reports. However, coverage of the proximal forearm remains challenging.

scholarly journals An analysis of post traumatic leg and foot defects

2019 ◽  
Vol 6 (6) ◽  
pp. 2041
Author(s):  
Gopalan G. ◽  
Dhanaraju S.
Keyword(s):  
Soft Tissue ◽  
Skin Graft ◽  
Traffic Accidents ◽  
Lower Limbs ◽  
Split Thickness Skin Graft ◽  
Soft Tissue Coverage ◽  
Durable Good ◽  
Skin Defect ◽  
Early Recovery ◽  
Thickness Skin

Background: Management of lower extremity trauma with bone and soft tissue injury is a challenging task with the aim of giving early recovery and durable good quality skin cover according to the skin defect and analyze various reconstructive options at various levels of injury. Our aim of the study is to analyze various reconstructive options for traumatic skin loss involving lower limbs especially knee and below knee, and analyze the incidence of age, sex and etiology of traumatic defects.Methods: Prospective study in our plastic surgery department in the period of 24 months, with all the cases of traumatic defects of leg and foot where included. All age and sex patients were included.Results: Most common cause for traumatic leg and foot defects are road traffic accidents followed by accidental fall and others, most commonly in males amounting 73%, children 10% and  females 17%, among the skin and soft tissue  defects upper and lower 1/3 leg defects are predominant. Among the soft tissue coverage split thickness skin graft dominating about 60% of cases, flaps 30% of cases, among the flaps 70% are fasciocutaneous flaps predominantly inferiorly based  and 30% are muscle and musculocutaneous flaps, among the muscle predominantly soleus muscle flap was used to cover the defect.Conclusions:Road traffic accidents dominating the cause for leg and foot defects , males are more commonly affected  and upper one third leg defects are predominant for soft tissue coverage split thickness skin graft are commonest procedures followed that cutaneous and muscle flaps. 

Soft Tissue Reconstruction

2020 ◽  
pp. 63-74
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction ◽  
Wound Excision

Soft tissue coverage of open fractures with well-vascularised tissues should be performed within 72 hours of injury or at the same time as internal fixation. It may be in the form of local or free flaps, and may comprise muscle, fasciocutaneous tissues, or both. Flap selection depends on multiple factors, including the size and location of the defect following wound excision, availability of flaps, and donor site morbidity. Local flaps are usually used to cover defects with a limited zone of injury. Anastomoses for free flaps should be performed outside the zone of injury. Experimental data suggest that coverage with muscle leads to improved healing of fractures. However, there is currently little clinical evidence to support the use of one form of soft tissue cover over another for open fractures of the lower limb. The plastic surgeon must always consider the donor site morbidity of the flap(s) chosen.

Outcomes of VAC temporization following the excision of microinvasive sarcomas pending negative formal pathologic margins.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23559-e23559
Author(s):  
Mitchell Stephen Fourman ◽  
Duncan C. Ramsey ◽  
Erik T. Newman ◽  
Joseph H. Schwab ◽  
Yen-Lin Chen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
False Negative ◽  
Free Flaps ◽  
Soft Tissue Coverage ◽  
Tumor Bed ◽  
Local Recurrences ◽  
Additional Surgery ◽  
Comorbidity Index

e23559 Background: Microinvasive sarcomas can yield a high number of false negative intraoperative pathology margin analyses. Additional oncologic resection after soft tissue coverage is technically challenging and oncologically inaccurate. As a result the rate of local recurrence for these histologies can be 25% or higher. In select patients we have temporized the sarcoma tumor bed with a wound VAC pending final pathologic margins. If positive, the patient can return to the OR for a tumor bed excision. If negative, soft tissue coverage can proceed. Here we evaluate our outcomes using this approach. Methods: We retrospectively studied patients with primary sarcomas managed with a VAC temporizing approach from from 1/1/2003 to 12/1/2019 with a minimum of 2 years of oncologic follow-up. Patients with unplanned ("oopsie") excisions were also included. Our primary outcome was local recurrence. Data is presented as percentages or mean ± standard deviation where appropriate. Results: Sixty-three patients were included (Table). Mean age was 62.3 ± 22.3 (median 67.3) years, 23 (36.5%) were female, and mean age-adjusted charlson comorbidity index was 5.3 ± 1.9. Twenty-four (38.1%) had undergone “oopsie” excisions. R0 margins were achieved in 59 (93.7%) patients, while the other 4 were known R1 resections due to patient tolerance or anatomy. Five local recurrences (7.9%) were diagnosed 3.2 ± 1.5 years after surgery, of which 3 had known positive margins. Free flaps were needed in 17 (27.0%) patients. Metastatic disease was diagnosed in 8 (12.7%) patients, who all died of disease. Mean follow-up was 4.4 ± 2.9 years. Conclusions: VAC temporization results few local recurrences in patients with formally confirmed negative margins. This technique is particularly useful in the treatment of microinvasive disease or in the management of vulnerable hosts who may not be able to tolerate additional surgery in the future.[Table: see text]

Versatility of the Posterior Interosseous Artery Flap: Emphasis on Powering Up the Toe Transfer

Hand ◽  
2021 ◽  
pp. 155894472110289
Author(s):  
GiJun Lee ◽  
BumSik Kim ◽  
Neunghan Jeon ◽  
JungSoo Yoon ◽  
Ki Yong Hong ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Upper Extremity ◽  
Reverse Flow ◽  
Donor Site ◽  
Congenital Defects ◽  
Soft Tissue Coverage ◽  
Posterior Interosseous Artery ◽  
Arterial Inflow ◽  
Pedicle Length ◽  
Interosseous Artery

Background: Reverse-flow posterior interosseous artery (rPIA) flap is an excellent tool for restoration of defects in the hand and upper extremity, sparing the main arteries to the hand. Its reliability has been well established. Materials and Methods: Fifty-one cases of rPIA flap involving 49 patients were retrospectively reviewed. The inclusion criteria were age, sex, etiology, size and location of the defect, flap size, number of perforators included, pedicle length, flap inset, donor site coverage, complications, and ancillary procedures. Results: This study included 44 men and 5 women, ranging in age between 10 and 73 years. The subjects had soft tissue defects of the hand and upper extremity mainly due to traumatic injuries, including scar contractures of the first web space in 18 cases, thumb amputations in 6 cases, and congenital defects in 1 case. Among the 51 rPIA flap elevations, 3 cases involved flap failure due to the absence of proper pedicle. A fasciocutaneous pattern was observed in 45 cases and a myocutaneous pattern in 3 cases. In 5 cases of unplantable thumb amputations, the rPIA flap was performed for arterial inflow to the secondary toe-to-thumb transfer. Venous congestion of varying degrees was noted in 7 cases involving partial necrosis in 2 cases. During the mean 17 months of follow-up, patients were generally satisfied with the final outcomes. Conclusion: The rPIA flap can be used not only for soft tissue coverage of the hand and upper extremity but also as a recipient arterial pedicle for a secondary toe-to thumb transfer.

FREE FLAPS FOR SOFT TISSUE COVERAGE IN THE HAND AND FINGERS

Hand Clinics ◽  
1999 ◽  
Vol 15 (4) ◽  
pp. 541-554 ◽  
Author(s):  
Hung-Chi Chen ◽  
Mark T. Buchman ◽  
Fu-Chan Wei
Keyword(s):  
Soft Tissue ◽  
Free Flaps ◽  
Soft Tissue Coverage

Principles of Wound Management and Soft Tissue Repair II

2018 ◽  
Author(s):  
Jonathan S. Friedstat ◽  
Michelle R Coriddi ◽  
Eric G Halvorson ◽  
Joseph J Disa
Keyword(s):  
Soft Tissue ◽  
Tissue Repair ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Wound Management ◽  
Soft Tissue Coverage ◽  
Soft Tissue Repair ◽  
Healing Wound ◽  
Contour Defects ◽  
Tissue Flaps

Wound management and soft-tissue repair can vary depending on the location. The head and neck, chest and back, arm and forearm, hand, abdomen, gluteal area and perineum, thigh, knee, lower leg, and foot all have different local options and preferred free flaps to use for reconstruction. Secondary reconstruction requires a detailed analysis of all aspects of the wound including any scars, soft tissue and/or skin deficits, functional defects, contour defects, complex or composite defects, and/or unstable previous wound coverage. Careful monitoring of both the patient and reconstruction is necessary in the postoperative period to ensure long-term success.   This review contains 2 figures and 17 references. Key Words: free tissue transfer, pedicle flaps, soft-tissue coverage, wound closure, wound healing, wound management, wound reconstruction, tissue flaps

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