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.

TRAUMATIC LESIONS OF THE BRACHIAL PLEXUS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 873-886 ◽  
Author(s):  
Kartik G. Krishnan ◽  
K. Daniel Martin ◽  
Gabriele Schackert
Keyword(s):  
Brachial Plexus ◽  
Muscle Flap ◽  
Multiple Root ◽  
Outcome Evaluation ◽  
Favorable Effect ◽  
Reconstructive Procedures ◽  
Traumatic Lesion ◽  
Flap Transfer ◽  
Nerve Transfers

Abstract OBJECTIVE To analyze retrospectively the outcomes of primary as well as secondary functional reconstructions in 49 patients with traumatic brachial plexus lesions from a single service. Guidelines for treatment might be extracted from this analysis. METHODS Among 152 cases of traumatic lesion of the brachial plexus presented to our clinic, 58 underwent primary brachial plexus reconstructive surgery. On exploration, all patients showed stretching and scarring of plexus elements; root avulsions were found in 28 patients (48%). Outcome evaluation was carried out in 49 of these patients with a follow-up period of 1 year or longer (mean follow-up, 27.9 mo; range, 12–72 mo). A total of 43 secondary reconstructive procedures to improve functionality of the involved arm were performed at a later stage in 25 of 58 patients. Outcomes of the secondary functional restorative procedures were evaluated (mean follow-up, 11.5 mo; range, 3–60 mo in 43 procedures). RESULTS Patients with neurolysis as a stand-alone procedure (11 patients) showed an outcome grade of 4 or 5. The average outcome of the 19 patients with C5, C6, and C7 grafting was Grade 3, the same as in patients with nerve transfers to the upper plexus elements (C5–C6 root avulsions, 13 patients). Patients with multiple root avulsions (five cases) showed an overall poor outcome (Grades 0–2). Secondary functional restorative surgery was performed in 43% of the patients and helped improve individual outcomes, providing a favorable effect on the general functionality of the arm. Among the restorative operations performed, the Steindler procedure, wrist extension restoration, claw hand correction, and free functional muscle flap transfer to the arm and forearm were the most rewarding. CONCLUSION A combination of primary brachial plexus reconstruction and carefully evaluated, selected, and planned function-restorative secondary procedures might offer favorable outcomes in patients with partial or total brachial plexus lesions.

Safety of neonatal sternal wound reconstruction after open heart surgery

2020 ◽  
Vol 13 (12) ◽  
pp. e237573
Author(s):  
Venus Barlas ◽  
Barkat Ali ◽  
Anil Shetty
Keyword(s):  
Wound Repair ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Muscle Flap ◽  
Standard Of Care ◽  
Open Heart ◽  
Muscle Flaps ◽  
Congenital Cardiac Anomalies ◽  
Long Term Follow Up

An open sternal wound is a dreaded complication after open heart surgery for neonatal congenital cardiac anomalies. Vascularised muscle flap reconstruction of sternal wound defects, to prevent life-threatening mediastinal infections, is the standard of care in adults and children. However, there is paucity of published literature regarding the safety of this technique in neonates. We describe a successful operative technique for complex reconstruction of an open heart sternal defect on a neonatal male patient. On 6 months postoperative follow-up, we identified an issue with sternal instability. Patient underwent a subsequent operation for reinforcement of the sternal wound repair with Vicryl mesh. The authors report safety of using three separate vascularised muscle flaps in a single neonatal operation. Long-term follow-up of the sternal wound reconstruction is warranted to determine need for secondary procedures.

scholarly journals Experience with free fibula transfer with screw fixation as a primary modality of treatment for congenital pseudarthosis of tibia in children - Series of 26 cases

2012 ◽  
Vol 45 (03) ◽  
pp. 468-477 ◽  
Author(s):  
Guru Dayal Singh Kalra ◽  
Amit Agarwal
Keyword(s):  
Weight Bearing ◽  
Treatment Options ◽  
Bony Union ◽  
Non Union ◽  
Fibula Graft ◽  
Congenital Pseudarthrosis ◽  
Free Fibula ◽  
Paediatric Orthopaedic ◽  
Primary Modality

ABSTRACTBackground: Congenital pseudarthrosis is one of the greatest challenges of paediatric orthopaedic practice. Treatment options and literature addressing this condition are numerous, reflecting the difficulty in management. We aimed to study the effectiveness of free fibula transfer as a primary modality of treatment in children with this condition in terms of achieving length, union, and normal axis of the involved leg. Materials and Methods: During the period of 2001 to 2010, 26 children with congenital pseudarthrosis of tibia between age group of 2-8 years were evaluated and were reconstructed using contra-lateral free fibula graft, and then patients were followed up for 5 years subsequently. Patients were examined and time of bony union, weight bearing ability and walking without support were noted. Any complication directly or indirectly related to surgery with any complication seen in the due course of follow up of 5 years was also taken care of. Results: In our experience with treatment of congenital pseudarthrosis over a span of 10 years with free fibula transfer, the results have been gratifying with no flap loss. All our patients had UNEVENTFUL post-op recovery. Only 2 patients out of 26 had non-union, for which cancellous bone grafting was done (7.6%). Most of the patients were ambulatory with support by 3-6 months and continued to walk without support after a span of 18-24 months. The incidence of stress fracture in our study over the follow-up period was 4 out of 26 pts (15.3%). None of them had any deformity in the donor leg. Conclusion: When compared to other surgical modalities of treatment of the problem in question, vascularised free fibula transfer has emerged as a real saviour with good patient compliance and less complication rate in our study. It achieves the desired target with no residual deformities and near normal to normal gait with no stigma of bone removal from other leg.

scholarly journals The Effect of Age on Outcome in Excision of Chronic Osteomyelitis with Free Muscle Flap Reconstruction

2019 ◽  
Vol 4 (4) ◽  
pp. 181-188 ◽  
Author(s):  
John Victor Kendall ◽  
Martin McNally ◽  
Christopher Taylor ◽  
Jamie Ferguson ◽  
Svetlana Galitzine ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Chronic Osteomyelitis ◽  
Muscle Flap ◽  
Length Of Hospital Stay ◽  
Free Tissue Transfer ◽  
Tissue Transfer ◽  
Free Muscle Flap ◽  
Group A

Abstract. Introduction: Curative surgical treatment of chronic osteomyelitis often requires free tissue transfer if there is significant soft tissue compromise. We investigated whether age influenced outcomes of curative osteomyelitis excision in those patients requiring free muscle flap soft tissue reconstruction.Methods: We assessed ninety-five consecutive patients treated with excision of chronic osteomyelitis, skeletal stabilisation/reconstruction and free muscle transfer between 2006 and 2012. We compared outcomes of those aged ≥60 years (n=23) with those <60 years old (n=72).Results: Groups were similar with regard to Cierny and Mader anatomic type and physiological host classification. Length of procedure and length of hospital stay were similar for both groups. There was a greater proportion of ASA grade III patients in the older cohort. Infection recurrence occurred in one of the older cohort (4.3%) and in seven patients in the younger cohort (9.9%) at a mean follow-up of 42 months (range 11-131 months), this was not statistically significant (p=0.27874). There were five free flap losses (6.9%) in the younger group and none in the older group. A greater proportion of patients from the younger cohort required further unplanned surgery (28%) compared to the older group (4.3%), which was statistically significant (p=0.01174). Seven patients (7.4%) had serious medical complications - five of whom were in the younger cohort, including one mortality.Conclusions: Both the young and old can enjoy satisfactory outcomes from surgical resection of chronic osteomyelitis with simultaneous orthoplastic reconstruction including free tissue transfer. Age alone should not be a barrier to potentially curative surgical treatment.

scholarly journals Limb-salvage by Femoro-distal Bypass and Free Muscle Flap Transfer

2004 ◽  
Vol 27 (6) ◽  
pp. 635-639 ◽  
Author(s):  
M. Czerny ◽  
W. Trubel ◽  
D. Zimpfer ◽  
M. Grimm ◽  
R. Koller ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Muscle Flap ◽  
Flap Transfer ◽  
Free Muscle Flap

scholarly journals Reconstruction of segmental defects of Achilles tendon: Is it a must in infected complex defects?

2013 ◽  
Vol 46 (01) ◽  
pp. 121-123 ◽  
Author(s):  
S. Raja Sabapathy ◽  
Hari Venkataramani ◽  
Latheesh Latheef ◽  
Praveen Bhardwaj
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Muscle Flap ◽  
Tendon Graft ◽  
Tendon Injury ◽  
Soft Tissue Defect ◽  
Tissue Loss ◽  
Muscle Flaps ◽  
Gracilis Muscle Flap ◽  
Soft Tissue Flap

ABSTRACTLoss of Achilles tendon combined with overlying soft tissue loss is a challenging problem. Multiple techniques like tendon graft with coverage by soft tissue flap or composite flaps have been used. All these options are technically demanding. Reports do exist whereby muscle flaps bridging the defect used as cover in course of time could transmit the tendon force across the defect. We are presenting a case where a free gracilis muscle flap used to cover the soft tissue defect at the Achilles tendon at 2 years follow up provided stable cover and produced active function of the Achilles tendon allowing the patient to stand tip toe. Mechanism of its action has been analysed by MRI and M-mode ultrasound. While in primary Achilles tendon injury reconstruction is still the recommended option, in complex situations mere filling of the gap with the flap without formal reconstruction of the tendon could give good functional outcome. This technique can be used in demanding situations.

Pronator Quadratus Free Muscle Flap for Treatment of Palmar Defects

1993 ◽  
Vol 18 (5) ◽  
pp. 576-578 ◽  
Author(s):  
G. DAUTEL ◽  
M. MERLE
Keyword(s):  
Soft Tissue ◽  
Muscle Flap ◽  
Soft Tissue Defects ◽  
Muscle Flaps ◽  
Recipient Site ◽  
Pronator Quadratus ◽  
Free Muscle Flap ◽  
Small Defect ◽  
Pronator Quadratus Muscle ◽  
Tissue Defects

Cutaneous flaps are not entirely satisfactory when used for soft tissue defects of the palm, because the skin cover is too mobile. Use of muscle flaps can therefore be advocated for this recipient site. A case is reported where the pronator quadratus muscle has been used as a free muscle flap for coverage of a small defect of the palm.

scholarly journals A Case Report of Proximal Migration of Fibular Head with Intact Peroneal Nerve in a Post-Operative Infected Tibia Gap Non-union Managed by Ilizarov Technique

2021 ◽  
Vol 11 (4) ◽  
Author(s):  
Spandan R Koshire ◽  
Rajesh R Koshire ◽  
Ajay M Wankhade
Keyword(s):  
Case Report ◽  
Rare Complication ◽  
Fracture Site ◽  
Bony Union ◽  
Ilizarov Technique ◽  
Fibular Head ◽  
Non Union ◽  
Wound Debridement ◽  
Proximal Migration

Introduction: We hereby present a rare case of proximal fibular head migration associated with Ilizarov technique for infected tibia gap non-union due to follow-up failure in post-operative management during the coronavirus disease (COVID) pandemic. Case Report: A 45-year-old male patient had undergone primary external fixation with wound debridement for a compound tibia shaft fracture Grade 3 A Gustilo class which later on with a healed external wound with a discharging sinus at the fracture site was confirmed to be infected non-union and subsequently managed by Ilizarov ring fixation over an antibiotic coated intramedullary nail and local gentamycin beads after a necrotic bone fragment of around 6 cm was excised. Post-operative protocol of compression and distraction was initiated and the patient educated regarding the same before discharge. As the world over was hit by the COVID pandemic and the lockdown limited all possible movements in our country, the patient could not follow up for monitoring the Ilizarov limb lengthening procedure. He presented to us after 4 months after the relaxation of lockdown with radiological union at the docking site but with a shortening of about 3 cm. Vigorous knee range physiotherapy failed to improve range beyond 90° which prompted us to check X-ray the knee joint and revealed the complication of proximal fibular head migration of 4 cm but with no neurodeficit and currently the patient is being managed with full weight mobilization with the help of crutch and shoe raise and an improved knee range till 100° of flexion with no pain tenderness or any other complaints. Conclusion: Having knowledge of this possible rare complication and the need for follow-up and monitoring with the importance of patient education makes practicing orthopedic surgeons equipped to handle and anticipate such undesirable complications. Keywords: Bony union, fibula migration, fibula resection, Ilizarov technique, infected non-union.

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