A STUDY ON DIFFERENT SURGICAL OPTIONS OF LOWER THIRD LEG DEFECTS AND ITS OUTCOME

2021 ◽  
pp. 32-34
Author(s):  
Ajay Kumar Pathak ◽  
Md Ghulam Jeelani Naiyer ◽  
Pragati Awasthi
Keyword(s):  
Reconstructive Surgery ◽  
Soft Tissues ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Conventional Teaching ◽  
Surgical Options ◽  
Soft Tissue Loss ◽  
Flap Cover ◽  
Upper Third

Background: The bones of the lower third are vulnerable to injury. Due to the paucity of soft tissues around them, the fractures that occur are often open. Most muscles become tendons at that level and in the case of soft tissue loss, skin graft may not sufce and flap cover becomes mandatory. Conventional teaching recommends gastrocnemius muscle and myocutaneous aps and fasciocutaneous aps for the upper third leg defects, soleus aps for the middle third defects and free aps for the lower third defects. Aim: Different surgical options in management of lower third leg defects. Material And Method: The study was conducted from JANUARY 2018 to December 2019, in the Department of Plastic & Reconstructive Surgery Institute of Post Graduate Medical Education and Research (IPGME&R) and SSKM Hospital, KOLKATA. Result: 70 patients admitted to the Department of Plastic & Reconstructive Surgery and referred patients from Department of General Surgery & Orthopaedic Surgery, IPGME&R and SSKM Hospital, KOLKATA. Association of FLAP LOSS with Pedicled ap was statistically signicant (p=0.0259). We found that association of DONOR SITE MORBIDITYwith Pedicled ap was not statistically signicant (p=0.7679). Conclusion: We consider that perforator propeller aps are ideal in reconstructing small-medium defects of the middle and distal third of the leg, being safe, easy to perform, providing similar tissue in texture and thickness of damaged tissues, with low donor-site morbidity.

scholarly journals The pedicled thoraco-umbilical flap: A versatile technique for upper limb coverage

2009 ◽  
Vol 42 (02) ◽  
pp. 169-175 ◽  
Author(s):  
Sharad Mishra ◽  
Ramesh Kumar Sharma
Keyword(s):  
Upper Limb ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Flap Necrosis ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Versatile Technique ◽  
Soft Tissue Loss ◽  
Flap Cover

ABSTRACTInjuries to upper limb has been on the increase and is invariably associated with significant soft tissue loss requiring a flap cover. Local tissue may not be available for cover in a majority of situations, necessitating import of tissue from a distant source. We have utilized the thoraco-umbilical flap taken from the trunk for this purpose. This flap is based on the perforators of the deep inferior epigastric artery that are maximally centred on the periumbilical region. This flap was used in 83 patients. The patients were observed for at least 3 weeks and any flap or donor site complications were recorded. The patients were again followed up at 3 months interval and the donor site scar was assessed. The flaps survived in 81 patients; there was marginal flap necrosis in five patients and partial flap necrosis in two patients. None of these patients required any additional procedure for coverage. The flap is technically easy to plan, almost effortless to drape around upper limb defects, with no significant donor site morbidity and also the post operative immobilization was fairly comfortable. The thoraco-umbilical flap thus is a very useful technique for coverage of the upper limb and is recommended as a first line flap for this purpose.

scholarly journals Island Posterior Thigh Flap Revisited in Covering Extensive Sacral Wounds: Our Experience with Two Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
F. Nangole Wanjala ◽  
Ajujo Martin
Keyword(s):  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Island Flap ◽  
Tissue Loss ◽  
Gluteal Muscle ◽  
Posterior Thigh ◽  
Soft Tissue Loss

Deep sacral wounds are best covered by flaps. Posterior thigh flaps have routinely been used to cover such wounds. The flap can however be modified as an island flap. Two patients with extensive sacral wounds were managed with island posterior thigh flaps. Both patients were admitted secondary to road traffic accident with subsequent soft tissue loss of the sacral area. The sacral defects in both patients were approximately 17 cm by 23 cm in dimensions. Unilateral island posterior thigh flap was raised and used to cover the wounds. Postoperatively both patients did well; the donor site and recipient sites healed without any complications. Island posterior thigh flap is thus an option in covering extensive defects of the sacral area. The flap is reliable and easy to raise and has minimal donor site morbidity. By raising it as an island flap the dog ear defect is avoided and the flap is able to be tunneled under the gluteal muscle. This maneuver enables the flap to be advanced further allowing it to cover more distal and extensive defects.

scholarly journals First dorsal metacarpal artery islanded flap: A useful flap for reconstruction of thumb pulp defects

2009 ◽  
Vol 42 (01) ◽  
pp. 032-035
Author(s):  
Chetan Satish ◽  
Sunit Nema
Keyword(s):  
Soft Tissue ◽  
Local Anesthesia ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Flap Necrosis ◽  
Secondary Procedure ◽  
Dorsal Metacarpal Artery ◽  
Soft Tissue Loss ◽  
First Dorsal Metacarpal Artery

ABSTRACTThumb pulp defects are commonly due to avulsion injuries. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. A very good option for coverage of these defects is the islanded first dorsal metacarpal artery flap. Our study was done over a period of 2 years and involved 9 consecutive cases of thumb pulp defects treated at our institution. The patients included 8 males and 1 female, ranging in age from 16 to 51 years old. The flap size ranged from 2 × 1.5 cm to 5 × 3 cm. We had only one complication in the form of partial flap necrosis, which fortunately healed following debridement without the need for a secondary procedure. All our cases were done under local anesthesia with tourniquet control. All the patients had good fine touch and average two-point discrimination of 6 mm, which was satisfactory. Our good results further reinforce the islanded first dorsal metacarpal artery flap as one the best flaps for sensate reconstruction of thumb pulp defects. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation.

Surgical Technique and Outcomes of Reconstruction for Blauth Type III Thumb Hypoplasia

Hand ◽  
2021 ◽  
pp. 155894472110387
Author(s):  
Morad Chughtai ◽  
Kara McConaghy ◽  
Xem Bui ◽  
Grzegorz J. Kwiecien ◽  
William H. Seitz
Keyword(s):  
Hand Function ◽  
Functional Limitations ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Reconstruction Procedure ◽  
Type Iii ◽  
Cultural Preferences ◽  
Surgical Options ◽  
Hypoplastic Thumb ◽  
Postoperative Improvement

Background Historically, amputation and pollicization has been the recommended surgical treatment for Blauth type III hypoplastic thumbs. However, due to aesthetic objections or cultural preferences, some parents seek out alternative surgical options. The present study describes a nontraditional technique that preserves and augments the hypoplastic thumb. Methods Patient charts were retrospectively reviewed to identify patients with Blauth type III hypoplastic thumbs who underwent thumb reconstruction at our institution from 2008 to 2018. The reconstruction procedure involved toe phalanx transfer, staged tendon transfers, and lengthening as needed. Motion was assessed categorically as ability to flex, extend, or oppose the thumb. Functionality was assessed as ability to pinch and grasp with the surgical hand. Patient- or parent-reported improvement in thumb function was also recorded. Results Of the 13 patients, 100% could flex, extend, and oppose the thumb to some degree. Eleven patients (85%) had functional one-handed grasp, and 9 (69%) had a functional pinch. Eleven patients (85%) reported no functional limitations of the operative hand. Thirteen patients (100%) reported improvement in hand function after surgery as compared to pre-operatively. There were 2 minor complications (15%), both of which resolved after intervention. No patients experienced donor-site morbidity. Conclusions Reconstruction of Blauth III thumbs is a nontraditional technique that allows for digit retention by salvaging the hypoplastic thumb. In the present study, the majority of patients had functional thumbs and all reported postoperative improvement. Overall, our results suggest that reconstruction is a viable surgical option for Blauth III hypoplastic thumbs.

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.

A Homodigital Reverse Pedicle Island Flap in Soft Tissue Reconstruction of the Finger and the Thumb

1994 ◽  
Vol 19 (2) ◽  
pp. 135-141 ◽  
Author(s):  
N. S. NIRANJAN ◽  
J. R. ARMSTRONG
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Single Stage ◽  
Island Flap ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction

A single stage homodigital reverse pedicle island flap is described for the repair of volar or dorsal tissue loss on the finger or thumb. Donor site morbidity is minimal, and the length of the digit is preserved. Satisfactory function results in 25 patients are presented.

Evaluation of Fingertip Injuries and Modalities of Flap Coverage in the Emergency Settings: A Retrospective Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Salah Nasser Mohamed ◽  
AbdelRahman AbdeIAal ◽  
Mina Agaiby Estawrow ◽  
Andrew Adel Wassef Attia
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Joint Stiffness ◽  
Skin Grafting ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
University Hospitals ◽  
Maximum Function ◽  
Reconstruction Methods

Abstract Background Fingertip comprises the nail complex and glabrous pulp, which is richly vascularized and innervated, built around the distal phalanx. The fingertip is commonly affected because it is the most distal part of the hand so it's easily to be injured during athletic participation, occupational activities or in accidents. Various fingertip reconstruction methods are reported as healing by secondary intention, shortening and primary closure, skin grafts and flaps. Flaps are considered when there's a big soft tissue loss or an exposed bone. Complications of fingertip reconstructions are common such as flexion deformity and neuroma. Objective In this study, we assessed and compared the outcomes of different modalities of soft tissue covemge using different flap techniques in cases of fingertip injuries as regalding the incidence of neuroma, necrosis, donor site morbidity, joint stiffness and sensory impairment, together with the patient satisfaction. Patients and Methods We analyzed a retrospective cohort study of 90 patients with 96 fingertip injuries who underwent coverage by various flap techniques at Ain Shams University Hospitals in the period between July 2017 and July 2019. Results The V-Y Advancement flap and the Cross-finger flap were the commonest flaps done in 26 cases (27.1%) and 25 cases (26.0%) respectively. There's a highly statistically significance in the incidence of necrosis in abdominal flap (100%) followed by Moberg flap (46.2%). In addition, there is a statistically significance in the incidence of neuroma in Moberg flap (53.8%). Most of patients who underwent coverage by flap technique were very satisfied by the results (60.4%). Conclusion Many techniques have been described for reconstruction of fingertip trauma including revision amputation, skin grafting, local flaps, distant flaps and free flaps. The treatment choice depends on many factors such as patient preference, culture, resources available and surgeon skills. The goals of reconstruction in fingertip amputations are to cover the defect with a satisfactory cosmetic appearance, establish maximum function and preservation of sensation.

scholarly journals 807 A Review of The Applications of Autologous Fascia Lata Grafts in Reconstructive Surgery

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Baldwin ◽  
A Lahiri
Keyword(s):  
Reconstructive Surgery ◽  
Donor Site ◽  
Abdominal Wall Reconstruction ◽  
Neck Surgery ◽  
Donor Site Morbidity ◽  
Fascia Lata ◽  
Limited Data ◽  
Careful Planning ◽  
Autologous Grafts ◽  
Review Current

Abstract Background We sought to review current applications of fascia lata autografts and update the original collection of uses proposed almost a century ago, thereby revealing the full extent of uses available to the contemporary reconstructive surgeon. Method A comprehensive literature search of peer-reviewed articles listed within PubMed and Medline was performed. Results The properties of autologous fascia lata grafts are presented, a technique for its harvest and the numerous uses of this material in reconstructive surgery. Specifically, its applications in head and neck surgery, surgery of the limbs, abdominal wall reconstruction and penile reconstruction are reviewed. There is limited data on donor site morbidity, but complications appear to be uncommon. However, it was established that the reported risk of muscle herniation varies greatly in the available literature from 0-36% and appears to be related to the width of tissue harvested. Conclusions Autologous fascia lata grafts are a viable and versatile material in the armamentarium of a reconstructive surgeon, that, with careful planning, can be used with minimal donor site morbidity. This is especially true in lower resource settings where a surgeon may not have access to allogenic material and autologous grafts can provide an easily accessible, cheaper, and practical alternative.

scholarly journals Gastrocnemius Muscle Flap for Coverage Of Knee & Proximal Third of Tibial Defects

2013 ◽  
Vol 23 (2) ◽  
pp. 58-61
Author(s):  
Alak Kanti Biswas ◽  
Tafhim Ehsan Kabir ◽  
M Nazrul Islam Chowdhury ◽  
Md Abdul Hye ◽  
Quasarul Matin ◽  
...  
Keyword(s):  
Gastrocnemius Muscle ◽  
Operative Procedure ◽  
Age Groups ◽  
Muscle Flap ◽  
Functional Restoration ◽  
Tissue Loss ◽  
Soft Tissue Loss ◽  
Upper Third ◽  
Delayed Reconstruction ◽  
Results Of Surgery

Gastrocnemius is the muscle of choice for reconstruction of defects involving soft tissue loss over the upper third tibia as well as knee joint. We present a series of 12 patients who underwent gastrocnemius muscle flap(Medial head, proximally based) coverage for this type of defects. Patients age-18 years or above. There were 9 males and 3 females. In all cases, delayed reconstruction was performed ranging from 1 week to 3 months after the creation of defects. Maximum number of pts were within 18-35 years age groups (66.66%), 75% were victims of RTA, 75% had associated fractures. Results of surgery were graded as excellent(83.33%) to good(16.67%) depending upon the outcome and functional restoration of patients. There was no case of complete muscle flap failure. Minor complications were ( 1 pt. developed partial flap necrosis & 1 pt. developed infection) noted but none required a separate operative procedure. We have found this procedure to be reliable, technically easy, biologically sound and esthetically acceptable. JCMCTA 2012 ; 23 (2): 58-61

scholarly journals Experience with Mandibular Reconstruction Using Transport-Disc-Distraction Osteogenesis

2015 ◽  
Vol 8 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Lorena Pingarrón-Martín ◽  
T. González Otero ◽  
L.J.Arias Gallo
Keyword(s):  
Distraction Osteogenesis ◽  
Soft Tissues ◽  
Donor Site ◽  
Latency Period ◽  
Donor Site Morbidity ◽  
Mandibular Reconstruction ◽  
Distraction Device ◽  
Duration Of Hospitalization ◽  
Education And Awareness ◽  
Comminuted Fractures

The goal of transport-disc-distraction osteogenesis (TDDO) is to restore bone continuity by using in-situ bone. It may be useful following trauma, gunshot injuries, or tumor ablation, especially when there may be contraindications at the donor site or for prolonged surgery. To the best of the authors’ knowledge, this is the first time TDDO has been used for mandibular reconstruction reporting additional procedures, which include osseointegrated dental implants rehabilitation and orthognathic surgery. A retrospective study is performed analyzing all mandibular reconstruction cases that may be suitable for distraction from January 2006 to December 2011. A thorough description of the documented cases includes details about sex, gender, complications, duration of hospitalization, etiology, size, and location of the defect. Eight cases of mandibular reconstruction were included. Six cases correspond to mandibular ameloblastoma. The remaining two cases were mandibular gunshot comminuted fractures. Range of the defects was from 45 to 60 mm. Length of the transport disc was 15 to 20 mm. Protocolized technique consisted of 5 days of latency period, 19 to 45 days of activation term (average 30 days), and 8 to 12 weeks for consolidation. Mean distraction length achieved was 40.45 mm. We can conclude that TDDO is an alternative to conventional and more invasive procedures, when we face severe segmental mandibular defects reconstruction. It shows the potential to restore a better anatomical bone regeneration, also providing soft tissues and reducing donor-site morbidity. Patients’ education and awareness about the proper use of the transport-disc-distraction device is important to optimize functional outcomes.

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