scholarly journals Use of Muscle Flaps in Burn Reconstruction

2014 ◽  
Vol 4 (1) ◽  
pp. 29-31
Author(s):  
Sk Nishat Abdullah ◽  
Kishore Kumar Das ◽  
Md Zakir Hossain ◽  
Rayhana Awwal ◽  
Md Sazzad Khondoker ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Graft Loss ◽  
Joint Stiffness ◽  
Muscle Flap ◽  
Striated Muscles ◽  
College Hospital ◽  
Muscle Flaps ◽  
Paediatric Age ◽  
Massive Muscle ◽  
Electric Burns

Electric burns are deep burns that by once-only or continuing stimulation of the nerves and striated muscles causes massive muscle contractions which can cause ruptures, ligamentous tears, fractures, and joint dislocations.High resistance of bone to the passage of electric current results in periosteal necrosis. Deep burns particularly electric burns when exposes structures valuable for important functions like joints, demands reconstructive options consisting robust viability and huge vascularity. The study was conducted in Department of plastic surgery and burn, Dhaka Medical College Hospital,Dhaka from June, 2011 to January, 2012. 18 patients were included in this series. Among them in ten patients gastrochnemius flap was applied, Lattissimus dorsi muscle flap was applied in 4 cases, Trapezius flap was applied in 2 cases and each of the other two patients were treated with Tensor fascia lata and Transverse Rectus Abdominis myocutaneous flap. Fifteen patients were adult and three patients were from paediatric age group. 88% of flaps were primarily used to cover exposed structures (bones and joints) and others were used to correct deformities. Complications include partial graft loss (3), joint stiffness(3), wound infection(1) and flap loss(1). Though these flaps are very commonly used in trauma reconstruction, their use in reconstruction in burn patients are included in this series. DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18690 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 29-31

scholarly journals Soleus muscle flap for the coverage of pre-tibial defect of middle third of leg

2014 ◽  
Vol 4 (1) ◽  
pp. 10-15
Author(s):  
Tahmina Satter ◽  
Md Noazesh Khan ◽  
Rayhan Awwal
Keyword(s):  
Soft Tissue ◽  
Plastic Surgery ◽  
Soleus Muscle ◽  
Operative Procedure ◽  
Muscle Flap ◽  
Soft Tissue Defect ◽  
College Hospital ◽  
Transposition Flap ◽  
Satisfactory Outcome

Soft tissue defects of the lower limb are a challenge to the plastic surgeon but a soleus muscle flap often provides the solution. Early reconstruction by soft tissue to cover exposed bone significantly reduces the risk of infection, nonunion and subsequent amputation. A Prospective, observational study was carried out in the Department of Plastic Surgery & Burn Unit, Dhaka Medical College Hospital and Department of Plastic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, from September 2011 to March 2013. 30 cases were selected by purposive continuous sampling who had soft tissue defect in front of the middle third of the legs only. Proximally based soleus muscle transposition flap was done by standard operative procedure under spinal anaesthesia or general anaesthesia and under tourniquet control. After 2 months of operation, final follow-up was done. Regarding the outcome of flap surgery, 18 (60%) cases were found excellent. 7 (23.33%) cases were good, 3 (10%) were fair and 2 (6.66%) were poor. In the final follow up, according to the preset criteria for evaluation of wound coverage by soleus muscle flap, the satisfactory result (excellent and good) was 83.33%. Unsatisfactory (fair and poor) result was in 16.67% cases. Effective coverage of pretibial defect of middle third of leg by soleus muscle flap with satisfactory outcome was seen in this study. DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18685 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 10-15

scholarly journals Free Gracilis Muscle Flap for Sarcoma Reconstruction: 19 Years of Clinical Experience

Sarcoma ◽  
2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Rachel Pedreira ◽  
Nicholas A. Calotta ◽  
E. Gene Deune
Keyword(s):  
Limb Salvage ◽  
Donor Site ◽  
Graft Loss ◽  
Muscle Flap ◽  
Major Complication ◽  
Donor Site Morbidity ◽  
High Rate ◽  
High Dose ◽  
Soft Tissue Coverage ◽  
Muscle Flaps

Background. Sarcoma treatment necessitates high-dose chemoradiation therapy and wide surgical margins that create wounds that are difficult to reconstruct. Many techniques have been developed to cover these defects, originating with muscle flaps such as the rectus abdominis and latissimus dorsi. The gracilis flap, which is best known in contemporary practice as a microneurovascular flap for functional reconstructions, is not usually considered a robust option for reconstruction after sarcoma extirpation.Methods. We reviewed records of 22 patients (9 women) at our institution who underwent reconstructive surgery after sarcoma extirpation using gracilis flaps for soft-tissue coverage from 1998 to 2017. Neurotized gracilis flaps were excluded. The mean patient age was 51 years (range, 18–85 years), and mean length of follow-up was 53 months (range, 9–156 months). Patients had 7 tumor types, with fibrosarcomas and undifferentiated tumors being most common. There were 23 defects (mean size, 118 cm2(range, 54–200 cm2)). Defects were located most commonly in the foot and leg (n=9each), upper extremity (n=4), and head and neck (n=1). The primary outcome was the flap success rate. Secondary outcomes were rates of major complications (unplanned reoperations, infections requiring intravenous antibiotics, and amputations); minor complications (superficial infections, partial skin-graft loss, partial flap necrosis, fluid collections treated in the office, and cosmetic reoperations); and sarcoma recurrence.Results. Twenty-one flaps (91%) survived. Six patients (27%) experienced a major complication, and 12 patients (54%) experienced a minor complication. There were 2 amputations, for a limb salvage rate of 91%.Conclusions. This series shows that the gracilis is well suited to covering large, compromised wounds across diverse anatomic features, which are the hallmark of sarcoma resections. The high rate of limb salvage and minimal donor-site morbidity further support the use of this flap as a first-line option for sarcoma reconstruction.

scholarly journals Scalp Reconstruction Following High Voltage Electric Burn

2014 ◽  
Vol 3 (2) ◽  
pp. 49-52 ◽  
Author(s):  
Md Zakir Hossain ◽  
Bidhan Sarker ◽  
Lutfar Kader Lenin ◽  
Ayesha Hanna ◽  
Limon Kumar Dhar
Keyword(s):  
Plastic Surgery ◽  
High Voltage ◽  
Skin Grafting ◽  
College Hospital ◽  
Transposition Flap ◽  
Reconstructive Procedures ◽  
Rotation Flap ◽  
Medical College ◽  
Scalp Reconstruction ◽  
Scalp Defects

Background: Scalp reconstruction following high voltage electric burn can be challenging. A useful Reconstructive algorithm is lacking. The purpose of this study was to evaluate our experience and to identify an appropriate reconstructive strategy. Methodology: This was a prospective observational study, conducted in the Burn unit of Dhaka Medical College Hospital & Department of Burn & Plastic Surgery,Sir Salimullah Medical College & Mitford Hospital over a period of five years. Reconstructive procedures, independent factors and outcomes were evaluated. A total of 7 procedures were performed in 30 patients. Techniques for reconstruction included skin grafting, outer table drilling & skin grafting, Bipedicle flap, Single rotation flap, Double opposing rotation flap, Transposition flap, Tissue expansion & primary closure. Conclusion: Important tenets for successful management of scalp defects are durable coverage, adequate debridement, preservation of blood supply, and proper wound drainage. Local scalp flaps with skin grafts remain the mainstay of reconstruction in most instances. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18251 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 49-52

scholarly journals Distal major pedicle of sartorius muscle flap: Anatomical study and its clinical implications

2018 ◽  
Vol 51 (01) ◽  
pp. 040-045
Author(s):  
K. N. Manjunath ◽  
M. S. Venkatesh ◽  
Ashwini Shivaprasad
Keyword(s):  
Gastrocnemius Muscle ◽  
Muscle Flap ◽  
Sartorius Muscle ◽  
Lateral Aspect ◽  
Muscle Flaps ◽  
Suitable Alternative ◽  
Myocutaneous Flaps ◽  
Mean Diameter ◽  
The Mean ◽  
Clinical Cases

ABSTRACT Background: Reconstruction of the popliteal region has limited option in terms of muscle flaps or myocutaneous flaps. Gastrocnemius muscle or the myocutaneous flaps are the option for majority of cases. However, reach of Gastrocnemius is limited if the wound is on the distal one-third thigh or the lateral aspect of knee region. Similarly, if the wound injures the muscle, then coverage becomes all the more difficult. Although inferiorly based fasciocutaneous flaps can cover the wound in case of bony injuries, muscle flaps are beneficial as they help in fracture healing. However, in cases with direct gastrocnemius muscle injury or if the wound on the distal one-third thigh or the lateral aspect then the options of muscle flaps is limited. An inferiorly based sartorius muscle can be one suitable alternative to cover this region. Aims and Objective: The aim is to devise an inferiorly based sartorius muscle flap for coverage of lower thigh, popliteal and upper one-third leg region. Objectives: (1) To identify the location of distal major (largest diameter) pedicle in cadavers and its clinical application. (2) To determine the arc of rotation with distal major pedicle as pivot point. Methods: Ten Cadavers and 20 sartorius muscle dissected out. Prior silicone injection onto the femoral vessels was done to identify the location of the perforators for the sartorius muscle. The distance of perforators from anterior superior iliac spine (ASIS) measured and the diameter of each perforator by transverse cut measured using callipers. In clinical cases, the arc of rotation was measured by keeping the distal perforator intact as pedicle (detaching the muscle from the ASIS without detaching from the insertion and then rotating it). Results: Out of the 10 cadavers analysed, 6 were male and 4 were female. The mean location of the distal major pedicle was at 35.25 cm from ASIS and range was between 30.4 cm to 38.3 cm. There was no significant variation between right and left limbs in individual cadaver (range 0.2 cm–1.6 cm). The mean diameter of the arterial component of distal major pedicle was 1.54 mm. In three clinical cases where this flap was harvested the arc of rotation were 95°, 110°, 125°. In one of the cases where flap was used to cover the tibial plateau (arc of rotation 155°), distal end of the muscle necrosed. Conclusion: This cadaver study supported by various other studies show that it has sizeable distal pedicle based on which whole muscle can be harvested as flap. In our study, the usual location of this pedicle is at 35 cm from ASIS. The mean diameter of the widest pedicle in distal one-third was 1.54 mm which along with other small diameter pedicle can support the entire muscle. This flap reached up to the infrapatellar region without any vascular compromise.

Tracheoplasty Using Titanium Reconstructive Plates with Strap-Muscle Flap

1994 ◽  
Vol 111 (3P1) ◽  
pp. 205-210 ◽  
Author(s):  
Roy A. Casiano ◽  
Michael Patete ◽  
Todd Lindquist
Keyword(s):  
Donor Site ◽  
Muscle Flap ◽  
Donor Site Morbidity ◽  
Tracheal Wall ◽  
Tracheal Lumen ◽  
Muscle Flaps ◽  
Strap Muscle ◽  
Respiratory Problems ◽  
Medial Migration ◽  
Simple Alternative

The reasons for unsuccessful decannulation after a laryngotracheoplasty may be multifactorial depending on the techniques used. Excessive granulation tissue may develop, necessitating further adjunctive procedures. Cartilaginous grafts may get infected, resorb, or collapse into the tracheal lumen. Bulky regional skin-muscle flaps may dehisce under tension or collapse into the tracheal lumen. Medial migration of the split ends of the anterior cartilaginous tracheal rings ensues with subsequent restenosis. Donor-site morbidity may compound these problems as well. During a 2.5-year period, we have performed laryngotracheoplasty on nine patients with 60% to 100% tracheal stenosis using titanium reconstruction plates. The split anterior tracheal wall is fixed by the plates in its expanded position. A neurovascularized strap-muscle flap is used to reconstruct the anterior tracheal wall. The flap becomes epithelialized with squamous epithelium within 3 weeks. Successful decannulation was possible in seven of the nine (78%) patients with no further respiratory problems. Of these, six required no further procedures. This technique offers a viable simple alternative to other methods of laryngotracheoplasty without the need for donor cartilage grafts or thick bulky Skin-muscle flaps.

Salvage of infected vascular graft via ‘perivascular venous banding’ technique coupled with rectus abdominis myocutaneous muscle flap transposition

Vascular ◽  
2012 ◽  
Vol 21 (1) ◽  
pp. 17-22 ◽  
Author(s):  
F De Santis ◽  
C M Chaves Brait ◽  
G Caravelli ◽  
S Pompei ◽  
V Di Cintio
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Muscle Flap ◽  
Rectus Abdominis ◽  
Banding Technique ◽  
Vascular Graft Infection ◽  
Muscle Flaps ◽  
Crossover Bypass ◽  
Muscle Flap Transposition

This is the case of a severe Pseudomonas aeruginosa biological vascular graft infection, completely involving the perianastomotic tract of a femoro — femoral crossover bypass and resulting in repeated bleeding from the offended vessel wall. After the failure of a sartorious rotational muscle flap transposition into the infected groin wound, this ‘high-grade’ vascular graft infection was finally treated successfully by wrapping a great saphenous vein patch reinforcement circumferentially around the damaged biological vascular conduit and filling the infected wound with a rectus abdominis myocutaneous muscle flap transposition. The aim of this report is to illustrate this novel, to our knowledge, ‘perivascular venous banding’ technique and to evaluate the prospective of future testing of this surgical procedure. Starting from this singular case, we will also review the role of the rotational muscle flaps in the conservative management of major vascular graft infections.

scholarly journals Protection of femoral vessels and vascular grafts after inguinal lymphadenectomy or femoral bypass by using prophylactic routine sartorius muscle flap shield coverage

2017 ◽  
Vol 4 (7) ◽  
pp. 2157 ◽  
Author(s):  
Ahmed Fawzy ◽  
Ahmed Gaber ◽  
Hesham Abugruidah ◽  
Ahmed El Kased
Keyword(s):  
Donor Site ◽  
Bypass Graft ◽  
Vascular Grafts ◽  
Muscle Flap ◽  
Sartorius Muscle ◽  
Vascular Protection ◽  
Muscle Flaps ◽  
Inguinal Lymphadenectomy ◽  
Superficial Skin ◽  
Femoral Vessels

Background: Groin vascular infections are potentially catastrophic situations as limb loss or even death may occur in a high percentage of patients. A growing evidence support the benefit of muscle flap covering for these non-healing or infected wounds with stressing on their increased efficacy when used prophylactically. Sartorius muscle flap is granted here by its anatomical characteristics.Methods: Fifty Sartorius muscle flaps were done for 39 patients. Flaps were done routinely on prophylactic basis for protection of native femoral vessels or vascular grafts either for oncological or vascular causes in conjunction with inguinal lymphadenectomy or femoral bypass graft. Great care was taken to preserve the first segmental branch to the muscle and avoided its injury.Results: Prophylactic Sartorius muscle flap was done for oncological causes in 46% while for vascular causes in 54% of total flap number. The operative time ranged from 14-20 minutes for every flap with mean 16 minutes with negligible blood loss and no any donor site morbidity. The complication rate was 26%, including mild skin infection 12%, seroma 6%, partial superficial skin necrosis 6%, and hematoma 2%.Conclusions: Sartorius muscle flap has versatile benefits. Its role has been proved as a shield protecting and covering the femoral vessels or vascular grafts and resulted in decreased rate of overall complications. We recommend prophylactic Sartorius muscle flap coverage on routine basis considering it the workhorse of efforts done to vascular protection.

scholarly journals Simultaneous debridement, Ilizarov reconstruction and free muscle flaps in the management of complex tibial infection

2020 ◽  
Vol 6 (3) ◽  
pp. 63-72
Author(s):  
Max Mifsud ◽  
Jamie Y. Ferguson ◽  
David A. Stubbs ◽  
Alex J. Ramsden ◽  
Martin A. McNally
Keyword(s):  
Muscle Flap ◽  
Tissue Loss ◽  
Bony Union ◽  
Ilizarov Method ◽  
Muscle Flaps ◽  
Flap Transfer ◽  
Non Union ◽  
Free Muscle Flap ◽  
Initial Surgery

Abstract. Chronic bone infections often present with complex bone and soft tissue loss. Management is difficult and commonly delivered in multiple stages over many months. This study investigated the feasibility and clinical outcomes of reconstruction in one stage. Fifty-seven consecutive patients with chronic osteomyelitis (n=27) or infected non-union (n=30) were treated with simultaneous debridement, Ilizarov method and free muscle flap transfer. 41 patients (71.9 %) had systemic co-morbidities (Cierny-Mader group Bs hosts). Infection was confirmed with strict criteria. 48 patients (84.2 %) had segmental defects. The primary outcome was eradication of infection at final follow-up. Secondary outcomes included bone union, flap survival and complications or re-operation related to the reconstruction. Infection was eradicated in 55∕57 cases (96.5 %) at a mean follow-up of 36 months (range 12–146). No flap failures occurred during distraction but 6 required early anastomotic revision and 3 were not salvageable (flap failure rate 5.3 %). Bony union was achieved in 52∕57 (91.2 %) with the initial surgery alone. After treatment of the five un-united docking sites, all cases achieved bony union at final follow-up. Simultaneous reconstruction with Ilizarov method and free tissue transfer is safe but requires careful planning and logistic considerations. The outcomes from this study are equivalent or better than those reported after staged surgery.

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