scholarly journals Using the keystone design perforator island flap in large myelomeningocele closure

2019 ◽  
Vol 47 (4) ◽  
pp. E19
Author(s):  
Cleiton Formentin ◽  
Erion Junior de Andrade ◽  
Leo Gordiano Matias ◽  
Andrei F. Joaquim ◽  
Helder Tedeschi ◽  
...  
Keyword(s):  
Skin Flap ◽  
Wound Dehiscence ◽  
Longitudinal Axis ◽  
Island Flap ◽  
Skin Defect ◽  
Skin Defects ◽  
Csf Leakage ◽  
Aesthetic Results ◽  
Defect Repair ◽  
Large Skin

OBJECTIVEMany repair techniques have been proposed to treat large myelomeningocele (MMC), and although effective in many cases, some of these techniques can be complex and time consuming, with complications such as cerebrospinal fluid (CSF) leakage, flap loss, tip necrosis, and wound dehiscence. The purpose of this study was to analyze cases of large skin defects and the methods applied and to report the outcomes of the keystone design perforator island flap (KDPIF) technique for large MMC closure.METHODSThe authors performed a retrospective review of all neonatal patients who had undergone KDPIF for MMC closure in the period from 2013 to 2018. All patients had a diagnosis of lumbosacral MMC based on obstetric ultrasound. The neurosurgeons and plastic surgeons had selected the cases after concluding that primary closure would be unlikely. The design of the flap is based on the randomly located vascular perforators, creating two identical opposing flaps to fashion a double keystone flap. During wound closure, V-Y advancement of each end of the double flap in the longitudinal axis creates redundancy in the central portion of the flap and reduces the horizontal tension. After discharge, both the neurosurgery and plastic surgery teams followed up all patients, tracking the results with photography.RESULTSNo skin flap dehiscence or necrosis, infection, or CSF leakage was detected, proving the reliability of the flap. One of the patients required further surgery for the large skin defects after insufficient intrauterine closure of the MMC and successfully underwent KDPIF treatment. Another patient (14.3%) had severe neonatal sepsis, which ultimately led to death. A ventriculoperitoneal shunt was required after the skin defect repair in 5 (83.3%) of the 6 surviving patients. Exceptional aesthetic results were achieved for all patients during the follow-up.CONCLUSIONSThe KDPIF technique is based on well-known vascular perforators of the intercostal, lumbar, and gluteal regions. Wound tension is widely distributed by the flap and, as a consequence, relevant tissue bulk, reliable vascularity, and important geometrical versatility are provided. In addition, most of the muscles and fascia are preserved, which is another advantage in terms of minimizing secondary morbidity to local tissue rearrangement. The use of KDPIF closure was successfully shown to be a viable alternative for more complex MMCs that present with large skin defects.

scholarly journals Comparison of Shoulder Management Strategies after Stage I of Fingertip Skin Defect Repair with a Random-Pattern Abdominal Skin Flap

2015 ◽  
Vol 21 ◽  
pp. 3042-3047 ◽  
Author(s):  
Feng Zhao ◽  
Wei He ◽  
Guoping Zhang ◽  
Shaojun Liu ◽  
Kunlun Yu ◽  
...  
Keyword(s):  
Skin Flap ◽  
Management Strategies ◽  
Stage I ◽  
Random Pattern ◽  
Skin Defect ◽  
Abdominal Skin ◽  
Defect Repair

Evaluation of Wound Healing Following Wide Surgical Resection and Subdermal Skin Flap Reconstruction for Management of Soft Tissue Tumours in 20 Dogs 

2021 ◽  
Author(s):  
Jasleen Kaur ◽  
N. Umeshwori Devi ◽  
Jitender Mohindroo ◽  
Devendra Pathak ◽  
Kuldip Gupta
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Surgical Resection ◽  
Skin Flap ◽  
Reconstruction Technique ◽  
Skin Defect ◽  
Thoracic Region ◽  
Soft Tissue Tumours ◽  
Skin Reconstruction ◽  
Large Skin

Background: Tumours in dogs are increasing day by day and the mainstay of treatment is surgery. Wide surgical resection of soft tissue tumour in dogs is mandatory to prevent recurrence but it leads to the formation of a large skin defect requiring skin reconstruction. Among the various skin reconstruction techniques, subdermal skin flap is a simple reconstruction technique which can be performed by harvesting full-thickness skin from the surrounding skin without using special instruments. The current study was aimed to evaluate the healing and recurrence of tumours in dogs after wide surgical resection of tumour and subdermal skin flap reconstruction.Methods: 20 dogs with soft tissue tumours presented to MSVH, GADVASU, Ludhiana, Punjab, during the period 2019-2020 were treated by wide surgical resection and subdermal skin flap technique. Routine clinico-physical, Hematobiochemical, Radiographic examinations, Fine Needle Aspiration Cytology, Histopathology and Culture Sensitivity Test were performed. Different types of flap were created according to the location of tumour and availability of the loose skin and wound healing was evaluated and complications recorded. Result: Healing of subdermal flap was seen in 15 dogs (75%) while necrosis of subdermal flap was recorded in 5 dogs (25 %) of the cases of which 4 of them had mobility of flap base and were located in ventral abdomen (n=4) and limb (n=1). Overall tumour recurrence was recorded in 3 dogs (15%) which were located in limbs of which 2 dogs had lung metastasis and the tumours were malignant. It can be concluded that single pedicle advancement flaps for thoracic region; bipedicle advancement flap for thoracic and abdominal regions; rotational flaps for lateral thoracic region and transposition flap for proximal limb region are feasible skin reconstruction techniques for the repair of large skin defects in dogs.

scholarly journals Triggering Drug Release and Thermal-Disrupting Interface Induced Mitigation of Composite Photothermal Hydrogel Treating Infectious Wounds

2021 ◽  
Vol 9 ◽  
Author(s):  
Long Hua ◽  
Hu Qian ◽  
Ting Lei ◽  
Wenbin Liu ◽  
Xi He ◽  
...  
Keyword(s):  
Drug Release ◽  
Tannic Acid ◽  
Antibacterial Properties ◽  
Skin Defect ◽  
Antibacterial Ability ◽  
Skin Defects ◽  
Swelling Rate ◽  
Defect Repair ◽  
Good Biocompatibility

Introduction: With the development of photothermal technology, the appearance of composite photothermal hydrogels has increased the selectivity of treating infectious skin defects. However, how to design composite photothermal hydrogel with better antibacterial performance, reduce the resistance rate of bacteria, and the damage rate of normal tissue still needs further study.Methods: The Prussian blue and tannic acid were loaded on polyacrylamide hydrogels. Characterization of DLS, Zeta potential, UV absorption spectrum, hydrogel swelling rate, scanning electronic microscopic, drug release profile, photothermal properties, in vitro cytocompatibility, and antibacterial properties. Experiments were measured by skin defect repair, antibacterial detection, and histological staining experiments.Results: The polyacrylamide hydrogel with photothermal effect and controllable release of tannic acid was successfully prepared. The hydrogel has strong light transmittance and adhesion, and the swelling rate can reach 600%, which improves the self-cleaning ability. SEM results showed the porous structure of hydrogels, promoting cell growth. Through photothermal switches, the composite hydrogel represented adjustable and controllable drug release ability. Combined with the synergistic antibacterial effect of tannic acid, this further enhanced the antibacterial ability and reduced the probability of antibiotic resistance. The in vitro and in vivo experiments showed the hydrogel had good biocompatibility and excellent antibacterial properties, which could promote the repair of infectious skin defects in SD rats.Conclusion: We fabricated a hydrogel with a triggering drug release rate, alleviating heat damage, transparent morphology, mechanical stability, strong adhesion, good biocompatibility, and synergistic antibacterial ability, which presents new treatment options for infectious skin defect repair.

Clinical outcome of V-Y flap with latissimus dorsi and gluteal advancement for treatment of large thoracolumbar myelomeningocele defects: a comparative study

2019 ◽  
Vol 24 (1) ◽  
pp. 75-84
Author(s):  
Mohammad Sadegh Masoudi ◽  
Mohammad Ali Hoghoughi ◽  
Fariborz Ghaffarpasand ◽  
Shekoofeh Yaghmaei ◽  
Maryam Azadegan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Comparative Study ◽  
Surgical Site Infection ◽  
Latissimus Dorsi ◽  
Primary Closure ◽  
Wound Dehiscence ◽  
Site Infection ◽  
Gluteal Muscle ◽  
Operative Duration ◽  
Csf Leakage

OBJECTIVESurgical repair and closure of myelomeningocele (MMC) defects are important and vital, as the mortality rate is as high as 65%–70% in untreated patients. Closure of large MMC defects is challenging for pediatric neurosurgeons and plastic surgeons. The aim of the current study is to report the operative characteristics and outcome of a series of Iranian patients with large MMC defects utilizing the V-Y flap and with latissimus dorsi or gluteal muscle advancement.METHODSThis comparative study was conducted during a 4-year period from September 2013 to October 2017 in the pediatric neurosurgery department of Shiraz Namazi Hospital, Southern Iran. The authors included 24 patients with large MMC defects who underwent surgery utilizing the bilateral V-Y flap and latissimus dorsi and gluteal muscle advancement. They also retrospectively included 19 patients with similar age, sex, and defect size who underwent surgery using the primary or delayed closure techniques at their center. At least 2 years of follow-up was conducted. The frequency of leakage, necrosis, dehiscence, systemic infection (sepsis, pneumonia), need for ventriculoperitoneal shunt insertion, and mortality was compared between the 2 groups.RESULTSThe bilateral V-Y flap with muscle advancement was associated with a significantly longer operative duration (p < 0.001) than the primary closure group. Those undergoing bilateral V-Y flaps with muscle advancement had significantly lower rates of surgical site infection (p = 0.038), wound dehiscence (p = 0.013), and postoperative CSF leakage (p = 0.030) than those undergoing primary repair. The bilateral V-Y flap with muscle advancement was also associated with a lower mortality rate (p = 0.038; OR 5.09 [95% CI 1.12–23.1]) than primary closure. In patients undergoing bilateral V-Y flap and muscle advancement, a longer operative duration was significantly associated with mortality (p = 0.008). In addition, surgical site infection (p = 0.032), wound dehiscence (p = 0.011), and postoperative leakage (p = 0.011) were predictors of mortality. Neonatal sepsis (p = 0.002) and postoperative NEC (p = 0.011) were among other predictors of mortality in this group.CONCLUSIONSThe bilateral V-Y flap with latissimus dorsi or gluteal advancement is a safe and effective surgical approach for covering large MMC defects and is associated with lower rates of surgical site infection, dehiscence, CSF leakage, and mortality. Further studies are required to elucidate the long-term outcomes.

The future of bioengineering personalised skin on demand for large skin defects

2021 ◽  
Vol 30 (11) ◽  
pp. 878-879
Author(s):  
Daniela Marino ◽  
Vincent Ronfard
Keyword(s):  
On Demand ◽  
Skin Defects ◽  
The Future ◽  
Large Skin

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.

The Second Dorsal Metacarpal Artery Neurovascular Island Flap

1989 ◽  
Vol 14 (4) ◽  
pp. 434-440
Author(s):  
M. J. EARLEY
Keyword(s):  
Donor Site ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Island Flap ◽  
Arterial Supply ◽  
Flap Necrosis ◽  
Local Skin ◽  
Skin Defects ◽  
Dorsal Metacarpal Artery

Eleven patients have had second dorsal metacarpal sensate island flaps used to cover local skin defects in the hand. The arterial supply is reliable but if the flap is extended beyond the proximal interphalangeal joint, distal flap necrosis or donor site difficulties may occur. Possible applications for this flap are demonstrated and some untried variations to increase its range are suggested. Its main use appears to be in the release of first web contractures and for resurfacing radio-palmar and thumb defects.

Using KISS Flaps in a Chest Wall Reconstruction After Mastectomy for Locally Advanced Breast Cancer: A New Technique

2019 ◽  
Vol 27 (1) ◽  
pp. 5-10
Author(s):  
Jia Song ◽  
Yong Han ◽  
Jian Liu ◽  
Kai Cheng ◽  
Qiang Gao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Primary Closure ◽  
Locally Advanced Breast Cancer ◽  
Skin Flap ◽  
Donor Site ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Advanced Breast ◽  
Skin Defect

This study described a technique for the reconstruction of large lateral thoracic defects after local advanced breast cancer resection that allows for complete cover of the defect and primary closure of the donor site. The authors performed reconstruction using the newly designed KISS flap in 2 women for coverage of their large skin defect (15 × 13 cm each) following mastectomies with extensive tissue resection. The KISS flap consisting of 2 skin islands (marked Flap A and Flap B; 15 × 6 cm each) was designed and transferred to the thoracic defect through the subcutaneous tunnel, and based on the same vessel. The flap covered properly without causing excessive tension and allowed primary closure of chest wound and donor defect. The security it brings is comparable with that of classical radical mastectomy, and its success rate is similar to that of single skin flap transplantation. Compared with the conventional pedicled latissimus-dorsi-musculocutaneous flap, we believe that the donor zone tension decreases, wherein the KISS flaps can reduce the incidence of incision dehiscence and nonhealing complications to some extent. The study reported good results from this technique and discussed the techniques that referenced previous reports.

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