scholarly journals Buried Superior Gluteal Artery Perforator Flap for Dead Space Coverage in the Sacral Area

2020 ◽  
Vol 16 (1) ◽  
pp. 53-55
Author(s):  
Seung Heon Hong ◽  
Kyeong-Tae Lee
Keyword(s):  
Dead Space ◽  
Rectal Wall ◽  
Healing Process ◽  
Epithelioid Sarcoma ◽  
Advancement Flap ◽  
Wound Complications ◽  
Superior Gluteal Artery ◽  
Skin Paddle ◽  
Artery Perforator ◽  
Sgap Flap

Partial sacrectomy is a common treatment for sacral sarcomas, which often results in a large defect and exposed rectal wall. The defect could be covered using a gluteus maximus (GM) advancement flap. However, seroma and wound dehiscence are often observed after GM advancement flap coverage, delaying the wound healing process. We present a case of buried superior gluteal artery perforator (SGAP) flap following GM muscle splitting. An 11-year-old male patient with epithelioid sarcoma in the sacrum underwent partial sacrectomy. The sacral defect size was 9×6 cm, and the GM muscle was intact. We designed a 7×4-cm elliptically-shaped SGAP flap skin paddle, after which perforator dissection was performed underneath the GM muscle. To minimize dead space, the GM muscle was split and the flap was de-epithelized and advanced to the posterior rectal wall. There were no wound complications during admission and the patient was discharged on postoperative day 16. No atrophy of the flap was found on postoperative magnetic resonance imaging, either. This case demonstrates that using a buried SGAP flap for covering dead space could be a good surgical method to cover wide sacral defects.

scholarly journals Long-term follow-up of superior gluteal artery perforator flap closure of large myelomeningoceles

2017 ◽  
Vol 19 (3) ◽  
pp. 333-338 ◽  
Author(s):  
Brett A. Whittemore ◽  
Dale M. Swift ◽  
Bradley E. Weprin ◽  
Frederick J. Duffy
Keyword(s):  
Perforator Flap ◽  
Surrounding Tissue ◽  
Tissue Quality ◽  
Superior Gluteal Artery ◽  
Flap Technique ◽  
Long Term Follow Up ◽  
Artery Perforator ◽  
Sgap Flap

OBJECTIVE Large myelomeningocele defects and poor surrounding tissue quality make some defects particularly difficult to close primarily. This paper describes the superior gluteal artery perforator (SGAP) flap technique for defect closure and long-term clinical outcomes. METHODS The technique for closing a myelomeningocele with an SGAP flap is described. A retrospective chart review was performed on a cohort of 11 patients who underwent closure in this manner. RESULTS Between 1999 and 2015, 271 myelomeningoceles were closed, 11 of which were SGAP flap closures. The mean defect size was 5.5 × 7.2 cm. All patients underwent ventriculoperitoneal shunting. There were no cases of CSF infection. Five patients had minor wound issues (small dehiscence or eschar formation) that healed satisfactorily. Two patients had soft-tissue wound infections and required multiple revisions; one patient had multiple severe developmental abnormalities, and the other patient's flap had healed with a thick underlying fat pad 4 months postoperatively. No patients had significant surgical site pain on long-term follow-up. CONCLUSIONS The SGAP flap technique achieves tension-free closure with vascularized, fat-bearing full-thickness skin. It is useful for closure of large, complex defects, is not associated with chronic pain, and carries a morbidity risk that is comparable to other complex myelomeningocele closure techniques.

scholarly journals Perianal Circumferential Reconstruction with Tailored Superior Gluteal Artery Perforator Flap

2020 ◽  
Vol 25 (4) ◽  
pp. 304-308
Author(s):  
Jeehyun Moon ◽  
Kyeong Tae Lee
Keyword(s):  
Perforator Flap ◽  
Good Option ◽  
Wide Excision ◽  
General Surgeon ◽  
Anal Function ◽  
Superior Gluteal Artery ◽  
Wound Contamination ◽  
Artery Perforator ◽  
Sgap Flap

Reconstruction following wide excision of perianal lesion is challenging as it requires resistance to high risks of wound contamination and preservation of anal function. Here, we present a case of a unilateral superior gluteal artery perforator (SGAP) flap with an opening in the flap. A 77-year old woman was referred due to an extramammary Pagets disease encircling the anus. Wide excision was performed by the general surgeon team, which generated a circumferential perianal defect. A unilateral SGAP flap was elevated. Primary defatting was done and an opening was made at the proper location of the anus. The anal mucosa was pulled out through the hole and sutured to the flap. She was discharged without any complications. At the follow-up visit, preservation of postoperative anal functions, as well as satisfactory contour, were observed. A well-tailored unilateral SGAP flap may be a good option for reconstruction of a perianal defect encircling the anus.

Pilonidal sinus disease: Karydakis flap procedure in our patients

2020 ◽  
Vol 99 (8) ◽  
Keyword(s):  
Wound Healing ◽  
Pilonidal Sinus ◽  
Healing Process ◽  
Pilonidal Sinus Disease ◽  
Wound Complications ◽  
Limberg Flap ◽  
New Disease ◽  
Sinus Disease ◽  
Flap Procedure

Introduction: Despite the available guidelines, opinions of many surgeons are quite ambiguous when it comes to the therapy of pilonidal sinus disease. The treatment can be a frustrating problem both for the surgeon and the patient because it is associated with wound complications and high recurrence rate. The objective of this study was to analyze the results of patients with pilonidal sinus disease undergoing the Karydakis flap procedure. Methods: A total of 27 patients treated for primary and recurrent pilonidal disease using the Karydakis flap procedure at our department between October 23, 2018 and November 22, 2019 were analyzed prospectively. We evaluated postoperative wound healing, complications and recurrence of the disease in a short-term follow-up period. Disease recurrence was defined as prolonged healing or as a new disease requiring repeated surgery. Results: In December 2019 all 27 patients came for a follow-up visit. The result was a fully lateralized wound without any signs of a new disease in all patients. In May 2020 a follow-up visit by phone was performed. The median follow-up was 12 months. The healing process was free of any serious complications in 25 patients. Seroma formation cases were managed by puncture in the outpatient setting. Conclusion: According to the available evidence and guidelines, off-midline procedures – the Karydakis flap, Bascom cleft lift, and Limberg flap procedures – are associated with lower recurrence rates and better wound healing. An important goal is to achieve complete wound lateralization and to change the configuration of the gluteal cleft by reshaping it, which results in a nicely flattened gluteal crease.

Plasma-Derived Exosomes Boost the Healing of Irradiated Wound by Regulating Cell Proliferation and Ferroptosis

2021 ◽  
Vol 17 (1) ◽  
pp. 100-114
Author(s):  
Feihong Gan ◽  
Raokaijuan Wang ◽  
Ping Lyu ◽  
Yanxi Li ◽  
Ruijie Fu ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Fluorescence Probe ◽  
Malignant Tumors ◽  
Colorimetric Assay ◽  
Quantitative Polymerase Chain Reaction ◽  
Healing Process ◽  
Wound Complications ◽  
Sequencing Analysis ◽  
Collagen Formation ◽  
Post Radiation

Ionizing radiation (IR) therapy for malignant tumors can damage adjacent tissues, leading to severe wound complications. Plasma-derived exosome treatment has recently emerged as a safe and impactful cell-free therapy. Herein, we aimed to determine whether plasma-derived exosomes could improve the healing of post-radiation wound. Rat plasma-derived exosomes (RP-Exos) were locally injected on cutaneous wounds created on the backs of irradiated rats and boosted the healing process as well as the deposition and remodeling of the extracellular matrix with collagen formation. Subsequently, the effects of RP-Exos were further evaluated on irradiated fibroblasts in vitro. The results suggested that exosomes promoted fibroblast proliferation, migration, cell cycle progression, and cell survival. Moreover, transcriptome sequencing analysis and quantitative polymerase chain reaction validation were performed to identify potential mechanisms. RPExos enhanced the expression of cell proliferation and radioresistance-related genes, and yet downregulated ferroptosis pathway in irradiated fibroblasts. Inhibition of ferroptosis by RP-Exos was further confirmed through colorimetric assay, fluorescence probe and flow cytometry in ferroptosis-induced fibroblasts. Our results suggest that RP-Exos regulate cell proliferation and ferroptosis in irradiated fibroblasts, thereby boosting the healing of irradiated wound. These findings support plasma-derived exosomes as a potential therapeutic method for post-radiation wound complications.

scholarly journals Features of NATO’s soldiers limbs combat trauma treatment during armed conflicts on the territory of Iraq and Afghanistan (literature review)

2021 ◽  
Vol 8 (3) ◽  
pp. 8-12
Author(s):  
V. V. Beschastnov
Keyword(s):  
Negative Pressure Wound Therapy ◽  
Healing Process ◽  
Infectious Complications ◽  
Combat Trauma ◽  
Armed Conflicts ◽  
Trauma Treatment ◽  
Wound Complications ◽  
Wound Healing Process ◽  
Wound Therapy ◽  
Antibiotic Resistant

The article describes armed conflicts on the territory of Iraq and Afghanistan. Improvement of individual and collective protection equipment has reduced the number of cases of soft tissue wounds in the extremities. The main cause of mortality and wound complications is antibiotic-resistant microflora. Purulent complications lead to chronic treatment of the wound healing process and a long period of specialized treatment and rehabilitation, which entails difficulties in the socialization of wounded servicemen, as well as significant financial costs from the state. When providing medical care to wounded military personnel, it is negative pressure wound therapy. Phage therapy is a promising method for treating infectious complications.

scholarly journals Management of Sacral Pressure Sore by Clinically Isolated Superior Gluteal Artery Perforator-based Fasciocutaneus Flap in Patients with Spinal Cord Injury

2016 ◽  
Vol 27 (1) ◽  
pp. 14-18
Author(s):  
S P Das ◽  
Mamtamanjari Sahu ◽  
Pramod Kumar Parida
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Constant Pressure ◽  
Spinal Injury ◽  
Wound Dehiscence ◽  
Pressure Sore ◽  
Superior Gluteal Artery ◽  
Doppler Probe ◽  
Cord Injury ◽  
Artery Perforator

Abstract Prolong confinement to bed in spinal injury patients imparts constant pressure on bony prominences resulting impairment of blood flow to local tissue. Constant pressure of 2 hours or more produces irreversible changes leading to tissue necrosis and development of pressure sore. Sacrum encounters highest pressure in supine position and is the commonest site of pressure sore in spinal cord injury patients followed by trochanter and heel. Objective of the study Observation on management of sacral pressure sore by superior gluteal arterial perforatorbased flap using anatomical land marks in the absence of facility of Doppler probe for isolation of superior gluteal arterial perforators. Materials and methods Thirteen patients of spinal cord injury presented with sacral pressure sore were managed surgically using superior gluteal artery perforator-based flap coverage. The location of the artery was identifi ed using anatomical land marks. In 10 patients the flap was heeled uneventfully, one had signifi cant complication with wound dehiscence. Conclusions Management of sacral pressure sore by superior gluteal arterial perforator-based flap using anatomical land marks is a simple and reliable procedure. The learning curve is not that stiff. Sophisticated instruments are not required for this procedure.

Short-Scar Latissimus Dorsi (SSLD) With a Lateral Approach: A Game Changer in Breast Reconstruction?

2021 ◽  
Author(s):  
Simon Perez ◽  
Emmanuel Delay ◽  
Raphaël Sinna ◽  
Traian Savu ◽  
Richard Vaucher ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Skin Necrosis ◽  
Lateral Approach ◽  
Advancement Flap ◽  
Autologous Reconstruction ◽  
Skin Paddle ◽  
Cutaneous Tissue ◽  
Delayed Breast Reconstruction ◽  
Short Scar

Abstract Background In delayed breast reconstruction, the thoraco-mammary cutaneous tissue often shows residual damage from radiotherapy. The fragility of this tissue is associated with a risk of skin necroses of about 8% when dissection is performed by reopening of the mastectomy scar. Objectives The objective of our study was to adapt the technique of short-scar latissimus dorsi flap surgery with an abdominal advancement flap using a lateral approach only avoiding re-incision of the mastectomy scar. Methods In this retrospective study, we performed 150 reconstructions in 146 patients to assess the safety and effectiveness of the SSLD technique with lateral approach. The primary outcome was the occurrence of postoperative skin necrosis of the thoraco-mammary area. Results Of the 150 delayed breast reconstruction procedures performed, none showed skin necrosis of the thoraco-mammary area, and a positive effect on skin trophicity of this area was observed. The resulting patient and surgical team satisfaction were very favorable. Conclusions In our practice, this technique changed our paradigm because of good skin safety and effectiveness. It allows reconstruction without a patch-effect in patients with very poor skin quality in whom the thoraco-mammary skin would have been replaced in the past by a skin paddle. Reconstruction would have even be contraindicated. It could also be an alternative to many other more complex and longer techniques of autologous reconstruction.

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