Soft tissue defects and bone loss in tibial fractures–treatment with free flaps and bone transport

Extensive soft tissue defects following trauma, burn or after cancer surgery need coverage by flaps. Sometimes surrounding tissues are not healthy enough or quantity is not favorable to provide adequate pedicle flaps. Microvascular free flap can provide healthy tissue of adequate amount from distant area for those difficult situations.15 microvascular free flaps were performed from October 2011 to February 2013. Radial forearm free flap was done in 8 and Latissimusdorsi (LD) flap in 7 cases. 10 flaps done in foot, ankle & lower leg region (radial forearm-5, LD-5) and 5 flaps were done in face and scalp region (radial forearm-4, LD-1).12 flaps healed uneventfully with good coverage of the defect. Average ischemia time was 135 min (range 100-240 min) and average anastomosis time was 75 min (average 60-100 min). 2 flaps failed. There was necrosis of the tip of 2 LD and cumbersome swelling of the flap was found in 2 cases of LD flaps.Large soft tissue defect of body where local or regional flaps are not feasible; can be easily covered with free flaps. Its capacity to cover huge soft tissue defect has neutralizes its technical demand. Though complications are still high in our hands; can be reduced performing more number of cases. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18242 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 33-37

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Revisited Anterolateral Thigh Free Flaps For Reconstructive Microsurgery : One Year Evaluation

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v1i2.44 ◽

1970 ◽

Vol 1 (2) ◽

Author(s):

Parintosa Atmodiwirjo ◽

Siti Handayani ◽

Shelly Madona Djaprie

Keyword(s):

Soft Tissue ◽

Free Flaps ◽

Soft Tissue Defect ◽

Anterolateral Thigh Flap ◽

Soft Tissue Defects ◽

Anterolateral Thigh ◽

Wide Range ◽

Reconstructive Microsurgery ◽

One Year ◽

Tissue Defects

Extensive soft tissue defects present a dif!cult problem to the plastic surgeon as they are usually associated with exposed important structures such as vessels, nerves, tendons, joint cavity or bone. Reconstruction of soft tissue defects have a wide range of therapeutic options. We reconstructed soft tissue defect in many areas using free anterolateral thigh flap (ALTF). From Februari 2009 - 2010, 9 cases of soft tissue defects in the face, neck, leg and foot of various etiologic factors were admitted to the plastic and reconstructive surgery unit, Cipto Mangunkusumo general hospital. Trauma is the commonest cause of soft tissue defects of the lower extremity, followed by tumours. The cruris was the commonest site (4 cases, 44,4%). Flap success rate was 66,67 %. Failure was reported 1 cases in this study due to vein compromise. In our hospital, we are quite familiar with Anterolateral thigh flap (ALTF) even though the case is limited. Anterolateral thigh flap (ALTF) is used for reconstruction of various simple and complex soft tissue defects, for big and small defects with cavity (orbita).

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Reconstruction of upper limb soft-tissue defects after sarcoma resection with free flaps: A systematic review

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.10.065 ◽

2020 ◽

Author(s):

Elena Lucattelli ◽

Irene Laura Lusetti ◽

Federico Cipriani ◽

Alessandro Innocenti ◽

Giorgio De Santis ◽

...

Keyword(s):

Systematic Review ◽

Soft Tissue ◽

Upper Limb ◽

Free Flaps ◽

Soft Tissue Defects ◽

Tissue Defects

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Retrospective Analysis in Lower Limb Reconstruction: Propeller Perforator Flaps versus Free Flaps

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1606268 ◽

2017 ◽

Vol 33 (S 01) ◽

pp. S34-S39 ◽

Cited By ~ 3

Author(s):

Marta Cajozzo ◽

Alessandro Innocenti ◽

Massimiliano Tripoli ◽

Giovanni Zabbia ◽

Salvatore D'Arpa ◽

...

Keyword(s):

Soft Tissue ◽

Retrospective Analysis ◽

Revision Surgery ◽

Lower Limb ◽

Lower Extremities ◽

Free Flaps ◽

Soft Tissue Defects ◽

Perforator Flaps ◽

Hospitalization Period ◽

Tissue Defects

Background Technical advancements and increasing experience in the management of soft tissue defects in lower extremities have led to the evolution of decisional reconstructive algorithms. Both propeller perforator flaps (PPFs) and free flaps (FFs) proved to be useful methods of reconstruction for lower extremities defects, offering alternative reconstructive tools. We present a case series of PPFs and FFs for reconstruction of lower limbs defects, analyzing and comparing treatment and outcomes. Methods Through a retrospective analysis, we report our experience in performing PPFs or FFs for reconstruction of soft tissue defects of the lower extremities, in patients admitted between 2010 and 2015 at the Department of Plastic and Reconstructive Surgery, University of Palermo. In these patients, we evaluated location and causes of defects, types of flaps used, recipient vessels, complications, time to healing, and aesthetic outcome. Results A primary healing rate was obtained in 13 patients for PPF and 16 cases for FF. Revision surgery for partial skin necrosis was required in eight cases (PPF: four and FF: four). Recovery time and hospitalization period were eventually shorter in patients with FFs, due to lower rate of complications and revision surgery. Conclusion In the past years, our indications for reconstruction with PPFs in the lower limb have become more restricted, while we favor reconstruction with FFs. Recommendations are provided to orient surgical treatment in small, medium, and large lower limb defects.

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Bone Transport for Treatment of Traumatic Composite Tibial Bone and Soft Tissue Defects: Any Specific Needs besides the Ilizarov Technique?

BioMed Research International ◽

10.1155/2020/2716547 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13 ◽

Cited By ~ 1

Author(s):

Runguang Li ◽

Guozheng Zhu ◽

Chaojie Chen ◽

Yirong Chen ◽

Gaohong Ren

Keyword(s):

Soft Tissue ◽

Deep Infection ◽

Bone Transport ◽

Fixation Time ◽

Ilizarov Technique ◽

Soft Tissue Defects ◽

Flap Surgery ◽

Tibial Bone ◽

Tissue Defects

Objective. To evaluate the surgical efficacy of bone transport (Ilizarov technique) plus “shortening-lengthening,” “flap surgery,” and “open bone transport” as individualized treatments for traumatic composite tibial bone and soft tissue defects. Methods. We retrospectively analyzed sixty-eight cases (mean age: 35.69 years, (range, 16–65)) treated from July 2014 to June 2017, including 29 middle, 18 distal, and 21 proximal tibial bone defects (4–18 cm, mean: 7.97 cm) with soft tissue defects (2.5 cm × 4.0 cm to 30.0 cm × 35.0 cm after debridement). We adopted the bone transport external fixator to fix the fracture after debriding the defect parts. In the meantime, we adopted the “shortening-lengthening technique,” “flap surgery,” and “open bone transport” as individualized treatment based on the location, range, and severity of the composite tibial bone and soft tissue defects. Postoperative follow-up was carried out. Surgical efficacy was assessed based on (1) wound healing; (2) bone defect healing rate; (3) external fixation time and index; (4) incidence/recurrence of deep infection; (5) postoperative complications; and (6) Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Results. The mean duration from injury to reconstruction was 22 days (4–80 d), and the mean postoperative follow-up period was 30.8 months (18–54 m). After the repair and reconstruction, 2 open bone transport patients required infected bone removal first before continuing the bone transport treatment. No deep infection (osteomyelitis) occurred or recurred in the remaining patients, and no secondary debridement was required. Some patients had complications after surgery. All the postoperative complications, including flap venous crisis, nail channel reaction, bone nonunion, mechanical axis deviation, and refracture, were improved or alleviated. External fixation time was 12.5 ± 3.41 months, and the index was 1.63 ± 0.44. According to the ASAMI score, 76.47% of the outcomes were good/excellent. Conclusion. The Ilizarov technique yields satisfactory efficacy for composite tibial bone and soft tissue defects when combined with “shortening-lengthening technique,” “flap surgery,” and “open bone transport” with appropriate individualized treatment strategies.

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Reconstruction of Complex Soft-Tissue Defects in Buttock Using The Proximally Based Anterolateral Thigh Flap: An Alternative Algorithm

10.21203/rs.3.rs-789636/v1 ◽

2021 ◽

Author(s):

Danying Wang ◽

Mengqing Zang ◽

Shan Zhu ◽

Bo Chen ◽

Shanshan Li ◽

...

Keyword(s):

Soft Tissue ◽

Free Flaps ◽

Melanocytic Nevus ◽

Anterolateral Thigh Flap ◽

Soft Tissue Defects ◽

Defect Reconstruction ◽

Reconstruction Methods ◽

Circumflex Femoral Artery ◽

Anterolateral Thigh ◽

Tissue Defects

Abstract Background Local and free flaps are most widely used in buttock reconstruction. However, local flaps and free flaps may not be appropriate for all complex soft tissue defects in buttock. In this study, we propose an alternative approach for buttock reconstruction and provide preliminary assessment in clinical efficacy of using a proximally based anterolateral thigh flap for buttock reconstruction. Methods In this study, we retrospectively analyzed the data of the patients with medium- to large-sized defects of buttock. All patients underwent buttock defect reconstruction using a proximally based anterolateral thigh flap between August 2012 and December 2020. Results Eight pedicled anterolateral thigh flaps were used to reconstruct buttock defects after tumor ablation in six patients, scar revision in one patient, melanocytic nevus resection in one patient. Flap size ranged from 25 × 8 cm to 30 × 12 cm, with pedicle length ranging from 12 to 20 cm. Flaps were elevated based on the distal musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery and completely survived without any perfusion-related complications. We achieved satisfactory results from both the functional and aesthetic point-of-view at the 6-month follow-up in all cases. Conclusions The proximally based anterolateral thigh flap can be a valuable reconstructive option with sufficient tissue and a long vascular pedicle for buttock defect reconstruction.

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