COVERAGE CONSIDERATIONS AND OUTCOME ANALYSIS OF RECONSTRUCTION OF POST TRAUMATIC SOFT TISSUE DEFECTS AROUND THE ELBOW

2020 ◽  
pp. 70-72
Author(s):  
Vishwamitra B Dayal ◽  
M. Senthil Kumaran ◽  
S Raja Sabapathy
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Defect ◽  
Defect Size ◽  
Outcome Analysis ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Comparison Results ◽  
Average Defect ◽  
A Prospective Study ◽  
Tissue Defects

Introduction: Major crush injury of elbow joint following trauma with extensive injury to skin & soft tissue, bone, tendon, nerves and vessels remains a challenge to the reconstructive surgeon. Purpose of this study is to nd out whether the size of the defect, type of ap used and the location of the soft tissue defect inuence the outcome of soft tissue reconstruction. Material and methods: A prospective study was performed in all patients with soft tissue defects around the elbow in need of ap cover at Ganga Medical Centre Coimbatore, Tamilnadu India from April 2014 to December 2015.Patients demographics, defect size, location, type of ap used, complications and long – term outcomes analysed. Patients Mayo elbow performance score and Likert scale score were recorded for analysis of functional and aesthetic outcome respectively. The Kruskal wallis test was used for statistical comparison. Results: Forty three aps were performed primarily for coverage in forty patients. Three patients required two primary aps for reconstruction. The aps used in our study included 14 local fasciocutaneous aps (32.5%); 20 pedicled aps both locoregional and distant (46.5%) and 9 2 2 Anterolateral thigh free aps (20.9%) The average defect size was 151 cm . For local fasciocutaneous ap the average defect size was 44.7cm , 2 2 2 2 2 (range, 4-120 cm ), distant pedicled ap was181 cm (range 24- 600 cm ) and for the ALT free ap was 252.2 cm (range 80-450 cm ). Conclusion: The defect size is the main determinant of the type of ap used and their outcomes.

scholarly journals Results of Microvascular Free Flap for Reconstruction of Soft Tissue Defects: Our Early Experience

2014 ◽  
Vol 3 (2) ◽  
pp. 33-37
Author(s):  
Debashis Biswas ◽  
Md Abul Kalam ◽  
Tanveer Ahmed ◽  
Md Rabiul Karim Khan
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Free Flaps ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Tissue Defect ◽  
Radial Forearm ◽  
After Cancer ◽  
Microvascular Free Flap ◽  
Tissue Defects

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

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

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).

Study on Chitosan-Based Nanocomposite Hydrogel in Soft Tissue Defect of Hand

2020 ◽  
Vol 12 (9) ◽  
pp. 1120-1126
Author(s):  
Jian Zhang ◽  
Zhaoyu Gao ◽  
Yao Zhang ◽  
Jinghai Tian
Keyword(s):  
Soft Tissue ◽  
Blood Compatibility ◽  
Rabbit Model ◽  
Soft Tissue Defect ◽  
Common Disease ◽  
Nanocomposite Hydrogel ◽  
Soft Tissue Defects ◽  
Clinical Role ◽  
Tissue Defects

Hand soft tissue defects are a common disease in surgical emergency, which seriously affects the limb function of patients and significantly reduces their quality of life. To effectively repair hand soft tissue defects, a difficult problem posed to surgeons, we report here the use of a chitosan-based nanocomposite hydrogel (CS-GEL-PDRN). In vitro experiments showed that the nanocomposite hydrogel could promote the proliferation of human embryonic fibroblasts M-22 and human vascular endothelial cells EC-304. In addition, the hydrogel had excellent blood compatibility. In the rabbit model of soft tissue defects, CS-GEL-PDRN effectively coordinated cytokine responses, accelerated wound healing and promoted tissue repair. Based on this, CS-GEL-PDRN is expected to play a clinical role in the repair of hand and other soft tissue defects in the future.

scholarly journals Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

2017 ◽  
Vol 45 (3) ◽  
pp. 1074-1089 ◽  
Author(s):  
Lifeng Shen ◽  
Yiyang Liu ◽  
Chun Zhang ◽  
Qiaofeng Guo ◽  
Wenhua Huang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Lower Leg ◽  
Soft Tissue Defect ◽  
Venous Congestion ◽  
Peroneal Artery ◽  
Soft Tissue Defects ◽  
Propeller Flap ◽  
Perforator Vessel ◽  
Tissue Defects

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs.

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.

scholarly journals Ten technical considerations revisited in tissue expansion

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Luke Geoghegan ◽  
Dariush Nikkhah
Keyword(s):  
Soft Tissue ◽  
Skin Flap ◽  
Tissue Expansion ◽  
Soft Tissue Defect ◽  
Illustrative Case ◽  
Soft Tissue Defects ◽  
Case Presentation ◽  
Versatile Tool ◽  
Technical Factors ◽  
Tissue Defects

Abstract Tissue expansion is a versatile tool in resurfacing soft tissue defects of the breast, extremity, head and neck that involves the placement of a temporary implant adjacent to a soft tissue defect. Incremental expansion exploits the viscoelastic properties of skin to generate a skin flap that can be used to resurface defects and provide cover over permanent protheses. Infection, implant extrusion and skin necrosis are recognized complications of tissue expansion. This article presents a revised framework of 10 technical factors to reduce the risk of complications and optimize outcomes with tissue expansion using an illustrative case presentation.

scholarly journals Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

2018 ◽  
Vol 51 (02) ◽  
pp. 216-221 ◽  
Author(s):  
Deepak Nanda ◽  
Shamendra Anand Sahu ◽  
Durga Karki ◽  
Sanjay Kumar ◽  
Amrita Mandal
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Adipofascial Flap ◽  
Tibial Artery ◽  
Split Skin ◽  
Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

scholarly journals THE USE OF BILATERAL DEEP INFERIOR EPIGASTRIC PERFORATOR FLAP (DIEP) IN BUTTOCK DEFORMITY RECONSTRUCTION - CASE REPORT

2021 ◽  
Vol 506 (1-2) ◽  
Author(s):  
Vu Ngoc Lam ◽  
Nguyen Quang Duc ◽  
Le Diep Linh ◽  
Nguyen Phuong Tien
Keyword(s):  
Soft Tissue ◽  
Perforator Flap ◽  
Soft Tissue Defect ◽  
Skin Flaps ◽  
Soft Tissue Defects ◽  
Postoperative Results ◽  
Left Behind ◽  
Operative Care ◽  
Deep Inferior Epigastric Perforator ◽  
Tissue Defects

Buttock soft tissue defects can be encountered due to many causes and also have many treatment solutions. Usually, defects are common on one side of the buttocks and cutaneous skin flaps in place, local or regional used. The article analyzes a rather rare case with a soft tissue defect in the buttocks on both sides as a necrotic sequela after injecting fillers for cosmetic purposes. After treatment of necrotizing inflammation, the sequelae left behind is a concave scar and deformed buttock on both sides. The local fat flaps are not valuable in this case, while the free fat flap will face many risks of failure due to the use of 2 flaps on both sides, the post-operative care position is also very difficult, easy to cause tension, compress the vascular pedicles. This clinical case with the use of bilateral DIEP flaps, and the postoperative results in this case are analyzed and evaluated in the article.

scholarly journals Brachioradialis Flap With Vascularized Lateral Ulnar Collateral Ligament Reconstruction: A Case Report

Hand ◽  
2019 ◽  
Vol 15 (2) ◽  
pp. NP37-NP41
Author(s):  
Nicholas A. Trasolini ◽  
Jerry Chidester ◽  
Alidad Ghiassi ◽  
Milan Stevanovic
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Ulnar Collateral Ligament ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Collateral Ligament ◽  
Lateral Ulnar Collateral Ligament ◽  
Lateral Elbow ◽  
Rotational Flap ◽  
Tissue Defects

Background: Soft tissue defects about the elbow with concurrent ligamentous instability can be challenging to treat. Methods: We present a case report of a lateral elbow wound that resulted in lateral ulnar collateral ligament deficiency and posterolateral elbow instability. Results: We describe our technique of a modified brachioradialis rotational flap, in which the muscle is rotated to cover the soft tissue defect, while the vascularized brachioradialis tendon is used to simultaneously reconstruct the lateral ulnar collateral ligament. This procedure successfully restored posterolateral elbow stability at the time of wound coverage. Conclusion: Elbow soft tissue defects with associated ligamentous injuries can be treated using a modification of the brachioradialis rotational flap.

Defektdeckung: Stufenweise Modifikation der Lappenpräparation bringt Vorteile

2020 ◽  
Vol 8 (2) ◽  
pp. 58-59
Author(s):  
Marc André Quambusch ◽  
Michael Sand
Keyword(s):  
Soft Tissue ◽  
Wound Dehiscence ◽  
Skin Lesions ◽  
Tumor Ablation ◽  
Skin Tumor ◽  
Selection Strategy ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Average Size ◽  
Tissue Defects

Skin cancer and precancerous skin lesions cause significant soft-tissue defects following tumor ablation. Recently, keystone flaps have gained popularity due to their simplicity, versatility, and reliability. We evaluated the efficacy of modified keystone flaps for soft-tissue reconstruction following skin tumor ablation in 2 medical centers. We reviewed the medical records of patients who received modified keystone flaps following the removal of skin tumors from January 2017 to December 2017. The diagnosis, site, flap size, and complications were recorded. Forty-one modified keystone flaps were evaluated, and the wound dimensions ranged from 1 cm × 1 cm to 18 cm × 9.5 cm, with an average size of 9.8 cm × 6.4 cm. With our selection strategy, specific modified keystone flaps were designed for the soft-tissue defects. The flap dimensions ranged from 2.2 cm × 1 cm to 26 cm × 10 cm, with an average size of 14.3 cm × 7.5 cm. Two patients developed minor wound dehiscence (4.9%), and 1 patient developed partial flap loss (2.4%), but all of these patients healed after local wound care without the need for surgical intervention. Our selection strategy for modified keystone flaps is a feasible and reliable option for reconstruction following skin tumor excision.

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