scholarly journals Customized Reconstruction of Complex Soft Tissue Defect Around the Knee with Individual Design of Free Perforator Flap

2020 ◽  
Author(s):  
Jinfei Fu ◽  
Liming Qing ◽  
Panfeng Wu ◽  
Zhengbing Zhou ◽  
Fang Yu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Soft Tissue Reconstruction ◽  
Knee Region ◽  
Tissue Defect ◽  
Individual Design ◽  
Free Perforator Flap

Abstract Background Reconstruction of complex soft tissue defect around the knee, particularly in involving with large soft tissue defect or disruption of extensor mechanism, always is a challenging problem. The purpose of this study was to introduce our clinical experience on using individual design of free perforator flap for complex soft-tissue reconstruction around the knee. Methods Between June 2010 and March 2017, 16 patients underwent the reconstruction of complex soft tissue defect in the knee region with free perforator flap, Various flap designs was performed basing on the location of wound, the require pedicle length, the tissue components that are deficient, the volume of such components and the risk of donor site morbidity.Results Complex soft tissue defect of the knee was reconstructed with anteriorlateral thigh perforator (ALTP) flap in 5 cases, modified ALTP flap in 2 cases, chimeric ALTP flap in 4 cases, dual skin paddles ALTP flap in 2 cases and chimeric thoracodorsal artery perforator (TDAP) flap in 2 cases. Multiple perforator flaps and vascularized fascia lata in combination were performed in one case. All flaps survived postoperative. None vascular congestion was observed. Only one case suffered partial necrosis. Primary closure of donor site was performed for all patients. The mean follow-up time was 16.5 months. Most cases showed satisfactory flap contour and acceptable function outcome. Conclusions Free perforator flap is a reliable option for repairing complex soft tissue defect in the knee region, especially when local and pedicled flaps are unavailable. Various flap designs allow for more individualized treatment approaches.

Commentary on Reconstruction of Soft Tissue Defect in the Knee Region With Individual Design of Perforator Flap

2018 ◽  
Vol 81 (6) ◽  
pp. 743
Author(s):  
Cécile Philandrianos ◽  
Alice Mayoly ◽  
Dominique Casanova ◽  
Baptiste Bertrand ◽  
Charlotte Jaloux
Keyword(s):  
Soft Tissue ◽  
Perforator Flap ◽  
Soft Tissue Defect ◽  
Knee Region ◽  
Tissue Defect ◽  
Individual Design

scholarly journals Versatility of Latissimus Dorsi Free Flap-a Prospective Study

2021 ◽  
Vol 28 (2) ◽  
pp. 142-152
Author(s):  
Abu Faisal Md Ariful Islam ◽  
Mohammad Rabiul Karim Khan ◽  
Sharmin Akter Sumi ◽  
Mohammad Hedayet Ali Khan ◽  
Md Abul Kalam
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Latissimus Dorsi ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Latissimus Dorsi Flap ◽  
Tissue Defect ◽  
Medical College ◽  
The Mean

Introduction: Free flaps offer a great variable of available tissues to cover larger, multifocal or multistructural defects. The choice among different free flap is dependent upon their recipient site requirement. Reconstruction with latissimus dorsi flap is now versatile tool in coverage. It can resurface large wound with reliable vascularity, consistent anatomy ,long pedicle length, opportunity for tailoring of flap. It has less donor site morbidity and has very little post-operative complications. Objective: To evaluate the versatility of free Latissimus dorsi flap for soft tissue reconstruction. Materials and methods: A prospective, observational study design was used in Department of Plastic Surgery of Dhaka Medical College and Hospital. Here 20 patients with soft tissue defect of variable sizes over lower limb, head neck and trunk underwent coverage with microvascular surgery. The study was carried out from July 2017 to June 2018. Result: Regarding the age distribution, the mean age was 35.65with an SD of + 10.81. The lowest age was 20years and the highest age was 56 years, Male female ratio was 3:2.The major cause (65.0%) of soft tissue defect of the samples was RTA. The flap was used to reconstruct the soft tissue defect over lower leg in 13 (65%)cases, on scalp 05 (25%) cases and over anterior trunk in two cases. The mean flap dimension was 229.25cm2 and its range was between 120 – 384 cm2. The standard myocutaneous flap was harvested in 80% cases, chimeric (10%) and partial Latissimus muscle flap in two cases. The donor site in all the 20 (100%) cases was closed primarily. The outcome of reconstruction was excellent in 16(80%), good in 02 (10%) cases and poor in 02 (10%) cases. There was no significant complication during the three months postoperative period. Conclusion: The Latissimus dorsi flap is a versatile option for resurfacing the soft tissue defect in different areas of the body with variable flap components and with minimal donor site morbidity. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 142-152

Nanofiber-hydrogel composite–mediated angiogenesis for soft tissue reconstruction

2019 ◽  
Vol 11 (490) ◽  
pp. eaau6210 ◽  
Author(s):  
Xiaowei Li ◽  
Brian Cho ◽  
Russell Martin ◽  
Michelle Seu ◽  
Chi Zhang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Rabbit Model ◽  
Soft Tissue Defect ◽  
Fat Grafting ◽  
Foreign Body Response ◽  
Soft Tissue Reconstruction ◽  
Hydrogel Composite ◽  
Tissue Flaps ◽  
Tissue Restoration

Soft tissue losses from tumor removal, trauma, aging, and congenital malformation affect millions of people each year. Existing options for soft tissue restoration have several drawbacks: Surgical options such as the use of autologous tissue flaps lead to donor site defects, prosthetic implants are prone to foreign body response leading to fibrosis, and fat grafting and dermal fillers are limited to small-volume defects and only provide transient volume restoration. In addition, large-volume fat grafting and other tissue-engineering attempts are hampered by poor vascular ingrowth. Currently, there are no off-the-shelf materials that can fill the volume lost in soft tissue defects while promoting early angiogenesis. Here, we report a nanofiber-hydrogel composite that addresses these issues. By incorporating interfacial bonding between electrospun poly(ε-caprolactone) fibers and a hyaluronic acid hydrogel network, we generated a composite that mimics the microarchitecture and mechanical properties of soft tissue extracellular matrix. Upon subcutaneous injection in a rat model, this composite permitted infiltration of host macrophages and conditioned them into the pro-regenerative phenotype. By secreting pro-angiogenic cytokines and growth factors, these polarized macrophages enabled gradual remodeling and replacement of the composite with vascularized soft tissue. Such host cell infiltration and angiogenesis were also observed in a rabbit model for repairing a soft tissue defect filled with the composite. This injectable nanofiber-hydrogel composite augments native tissue regenerative responses, thus enabling durable soft tissue restoration outcomes.

Pedicled superior epigastric perforator flap for reconstruction of a soft tissue defect at the ventral thoracic wall

2007 ◽  
Vol 30 (3) ◽  
pp. 141-146 ◽  
Author(s):  
S. Deiler ◽  
R. Zulkowski ◽  
O. Muensterer ◽  
J. Widmann ◽  
K. G. Kanz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Perforator Flap ◽  
Soft Tissue Defect ◽  
Thoracic Wall ◽  
Tissue Defect

scholarly journals Double-Pedicled Free Deep Inferior Epigastric Perforator Flap for the Coverage of Thigh Soft-Tissue Defect

2017 ◽  
Vol 5 (8) ◽  
pp. e1372 ◽  
Author(s):  
Olimpiu Bota ◽  
Nick Spindler ◽  
Jeannine Sauber ◽  
Emrah Aydogan ◽  
Stefan Langer
Keyword(s):  
Soft Tissue ◽  
Perforator Flap ◽  
Soft Tissue Defect ◽  
Tissue Defect ◽  
Deep Inferior Epigastric Perforator

An Extraordinary Reconstruction of a Postoperative Defect after Metatarsophalangeal Joint Arthrodesis of the Big Toe Using the “Chinese Forearm Flap”

2021 ◽  
Author(s):  
Andrej Ring
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
Posterior Tibial Artery ◽  
Hallux Rigidus ◽  
Soft Tissue Defect ◽  
Medial Malleolus ◽  
Soft Tissue Reconstruction ◽  
Tissue Defect ◽  
Posterior Tibial ◽  
Tibial Artery

Abstract Background We present an unusual technique for reconstruction of a postoperative tissue defect following hallux rigidus surgery. Methods A complicated course after left big toe arthrodesis resulted in a soft tissue defect with bone exposure of the first ray. Amputation of the big toe was categorically rejected by the patient. There was advanced arteriosclerosis with single-vessel supply to the foot via the posterior tibial artery. Outcome To preserve the big toe, the defect was covered by a fasciocutaneous radial free flap with a 15 cm long vascular pedicle which was microanastomosed to the posterior tibial artery and its accompanying vein at the level of the medial malleolus. Conclusion In certain extreme situations, the free “Chinese” radial flap can be quite effective in covering forefoot defects and allowing satisfactory and aesthetically pleasing soft tissue reconstruction.

scholarly journals Skull Base Reconstruction in the Pediatric Patient

2018 ◽  
Vol 79 (01) ◽  
pp. 081-090 ◽  
Author(s):  
Irit Duek ◽  
Alon Pener-Tessler ◽  
Ravit Yanko-Arzi ◽  
Arik Zaretski ◽  
Avraham Abergel ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Children And Adolescents ◽  
Skull Base ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Soft Tissue Reconstruction ◽  
Cumulative Impact ◽  
Skull Base Reconstruction ◽  
Unique Challenge ◽  
First Choice

Introduction Pediatric skull base and craniofacial reconstruction presents a unique challenge since the potential benefits of therapy must be balanced against the cumulative impact of multimodality treatment on craniofacial growth, donor-site morbidity, and the potential for serious psychosocial issues. Objectives To suggest an algorithm for skull base reconstruction in children and adolescents after tumor resection. Materials and Methods Comprehensive literature review and summary of our experience. Results We advocate soft-tissue reconstruction as the primary technique, reserving bony flaps for definitive procedures in survivors who have reached skeletal maturity. Free soft-tissue transfer in microvascular technique is the mainstay for reconstruction of large, three-dimensional defects, involving more than one anatomic region of the skull base, as well as defects involving an irradiated field. However, to reduce total operative time, intraoperative blood loss, postoperative hospital stay, and donor-site morbidity, locoregional flaps are better be considered the flap of first choice for skull base reconstruction in children and adolescents, as long as the flap is large enough to cover the defect. Our “workhorse” for dural reconstruction is the double-layer fascia lata. Advances in endoscopic surgery, image guidance, alloplastic grafts, and biomaterials have increased the armamentarium for reconstruction of small and mid-sized defects. Conclusions Skull base reconstruction using locoregional flaps or free flaps may be safely performed in pediatrics. Although the general principles of skull base reconstruction are applicable to nearly all patients, the unique demands of skull base surgery in pediatrics merit special attention. Multidisciplinary care in experienced centers is of utmost importance.

Preliminary Experience with Perforator Flaps in Reconstruction of Soft-Tissue Defects of the Foot and Ankle

2005 ◽  
Vol 26 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Frederick J. Duffy ◽  
James W. Brodsky ◽  
Christian T. Royer
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Foot And Ankle ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Microsurgical Reconstruction ◽  
Tissue Defects

Background: Microsurgical reconstruction has improved limb salvage in patients who because of many etiologies have soft-tissue loss from the lower extremities. Free-tissue transfer to the foot and ankle often interferes with postoperative function and footwear because of the bulk of a muscle flap. The foot and ankle often are best treated using thin flaps that will not contract and fibrose, particularly if secondary procedures are required. We hypothesized that perforator flaps, which are thin free-tissue transfers consisting of skin and subcutaneous tissue, both diminish donor site morbidity and are ideally suited for soft-tissue reconstruction of the foot and ankle. Methods: Ten patients had free- tissue transfers to the foot and ankle using perforator flaps during a 2-year period. Four had acute posttraumatic wounds, three had soft tissue defects with exposed hardware or bone graft after reconstructive surgery, and three had large soft-tissue defects after foot infection secondary to diabetes. Nine had reconstruction with anterolateral thigh perforator flaps and one had reconstruction with a deep inferior epigastric artery (DIEP) perforator flap. Results: All flaps survived. There were no deep infections. Three flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. There were no donor site complications and no interference of muscle function at the donor sites. Custom shoewear was not required to accommodate the flaps. Conclusion: This series highlights the success and utility of perforator flaps in microsurgical reconstruction of the foot and ankle. The greatest advantage of perforator flaps is the diminished donor site morbidity, which was achieved while maintaining high microsurgical success rates. These skin and fat flaps remained pliable and contracted less than muscle flaps, allowing for smooth tendon gliding and easy flap elevation for secondary orthopaedic procedures.

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