scholarly journals Soft-tissue coverage for wound complications following total elbow arthroplasty

2021 ◽  
Vol 24 (4) ◽  
pp. 245-252
Author(s):  
Arno A. Macken ◽  
Jonathan Lans ◽  
Satoshi Miyamura ◽  
Kyle R. Eberlin ◽  
Neal C. Chen
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Demographic Data ◽  
Total Elbow Arthroplasty ◽  
Wound Complications ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Local Tissue ◽  
Elbow Arthroplasty ◽  
Tissue Reconstruction

Background: In patients with total elbow arthroplasty (TEA), the soft-tissue around the elbow can be vulnerable to soft-tissue complications. This study aims to assess the outcomes after soft-tissue reconstruction following TEA. Methods: We retrospectively included nine adult patients who underwent soft-tissue reconstruction following TEA. Demographic data and disease characteristics were collected through medical chart reviews. Additionally, we contacted all four patients that were alive at the time of the study by phone to assess any current elbow complications. Local tissue rearrangement was used for soft-tissue reconstruction in six patients, and a pedicle flap was used in three patients. The median follow-up period was 1.3 years (range, 6 months–14.7 years).Results: Seven patients (78%) underwent reoperation. Four patients (44%) had a reoperation for soft-tissue complications, including dehiscence or nonhealing of infected wounds. Five patients (56%) had a reoperation for implant-related complications, including three infections and two peri-prosthetic fractures. At the final follow-ups, six patients (67%) achieved successful wound healing and two patients had continued wound healing issues, while two patients had an antibiotic spacer in situ and one patient underwent an above-the-elbow amputation. Conclusions: This study reports a complication rate of 78% for soft-tissue reconstructions after TEA. Successful soft-tissue healing was achieved in 67% of patients, but at the cost of multiple surgeries. Early definitive soft-tissue reconstruction could prove to be preferable to minor interventions such as irrigation, debridement, and local tissue advancement, or smaller soft-tissue reconstructions using local tissue rearrangement or a pedicled flap at a later stage.

scholarly journals Flexor Carpi Ulnaris Muscle Flap for Soft Tissue Reconstruction after Total Elbow Arthroplasty

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Syunro Okamoto ◽  
Kaoru Tada ◽  
Hachinota Ai ◽  
Hiroyuki Tsuchiya
Keyword(s):  
Soft Tissue ◽  
Muscle Flap ◽  
Clinical Results ◽  
Soft Tissue Defect ◽  
Total Elbow Arthroplasty ◽  
Wound Complications ◽  
Soft Tissue Reconstruction ◽  
Elbow Arthroplasty ◽  
Flexor Carpi Ulnaris ◽  
Tissue Reconstruction

The soft tissue at the tip of the olecranon is very thin, leading to the frequent occurrence of wound complications after total elbow arthroplasty. To cover a soft tissue defect of the elbow, the flexor carpi ulnaris muscle flap is thought to be appropriate for reconstruction of the elbow with regard to its size, location, and blood supply. We got positive clinical results, so we report our experiences of using a flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty.

Soft Tissue Reconstruction Pyramid in the Diabetic Foot

2010 ◽  
Vol 3 (5) ◽  
pp. 241-248 ◽  
Author(s):  
Claire M. Capobianco ◽  
John J. Stapleton ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Weight Bearing ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Best Interest ◽  
Foot Complications ◽  
Uncontrolled Diabetes ◽  
Wound Healing Response ◽  
Tissue Reconstruction

Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non—weight bearing, all of which have been shown to adversely affect the patient’s quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient’s best interest and is crucial for resolution of the chronic nonhealing wound. The options for soft tissue coverage and the logical progression of application of these techniques in the diabetic foot will be described.

scholarly journals Reverse sural artery fasciocutaneous flap in soft tissue reconstruction in lower extremity

2020 ◽  
Vol 10 (3) ◽  
pp. 84-87
Author(s):  
Suresh Pandey ◽  
Suraj Bidary
Keyword(s):  
Soft Tissue ◽  
Demographic Data ◽  
Soft Tissue Defect ◽  
Soft Tissue Reconstruction ◽  
Superficial Infection ◽  
Pedicle Flap ◽  
Satisfactory Outcome ◽  
Flap Procedure ◽  
Tissue Reconstruction ◽  
Sural Artery

Background: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue recon­struction around the ankle and distal leg. Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0. Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics. Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.

Chest Wall Reconstruction Following Tumor

2020 ◽  
Author(s):  
Farooq Shahzad ◽  
Evan Matros
Keyword(s):  
Soft Tissue ◽  
Chest Wall ◽  
Free Flaps ◽  
Chest Wall Reconstruction ◽  
Chest Wall Tumor ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Pedicled Flaps ◽  
Ablative Surgery ◽  
Tissue Reconstruction

Plastic surgeons are typically called upon to reconstruct the chest wall in four situations: oncologic resection, infections, trauma and osteoradionecrosis. In this chapter we will discuss post-oncologic reconstruction. Chest wall reconstruction following tumor resection is typically performed at the same setting as the ablative surgery; this results in quicker patient recovery and overall better outcomes. The reconstruction should be planned with the ablative surgeon so that an assessment can be made of the extent of resection and available donor sites for reconstruction. The major components of reconstruction are 1) skeletal support and 2) soft tissue coverage. Skeletal support is indicated if the defect is >5 cm, 4 or more ribs are removed or more than 2/3rd of the sternum is resected. Prosthetic mesh is most commonly used. Soft tissue reconstruction is performed with regional pedicled flaps in the vast majority of cases. Free flaps are used when regional flaps are not sufficient (large defects) or not available.  This review contains 11 figures, 3 tables, and 49 references. Keywords: chest wall, tumor, skeletal reconstruction, soft tissue reconstruction, mesh, acellular dermal matrix, titanium osteosynthesis systems, resorbable plates, pedicled flaps, free flaps

Soft Tissue Reconstruction

2020 ◽  
pp. 63-74
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction ◽  
Wound Excision

Soft tissue coverage of open fractures with well-vascularised tissues should be performed within 72 hours of injury or at the same time as internal fixation. It may be in the form of local or free flaps, and may comprise muscle, fasciocutaneous tissues, or both. Flap selection depends on multiple factors, including the size and location of the defect following wound excision, availability of flaps, and donor site morbidity. Local flaps are usually used to cover defects with a limited zone of injury. Anastomoses for free flaps should be performed outside the zone of injury. Experimental data suggest that coverage with muscle leads to improved healing of fractures. However, there is currently little clinical evidence to support the use of one form of soft tissue cover over another for open fractures of the lower limb. The plastic surgeon must always consider the donor site morbidity of the flap(s) chosen.

VAC temporization pending final margins after suprafascial myxofibrosarcoma excision to reduce the rate of local recurrence.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11573-11573
Author(s):  
Mitchell Stephen Fourman ◽  
Duncan C. Ramsey ◽  
Justin Kleiner ◽  
Anser Daud ◽  
Erik T. Newman ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Single Stage ◽  
Cancer Center ◽  
Wound Complications ◽  
P Value ◽  
Adjuvant Radiation ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Tumor Bed

11573 Background: The microinvasive nature of suprafascial myxofibrosarcoma complicates the accuracy of intraoperative margin assessment, and tumor bed resections after soft tissue reconstruction are unreliable. For the past 3 years we have temporized the excised tumor bed with a wound VAC, delaying soft tissue coverage until final negative margins were achieved. Here, we compare the oncologic/surgical outcomes of suprafascial myxofibrosarcomas managed with VAC temporization (VT) with single-stage excision/reconstruction (SS). Methods: We retrospectively studied suprafascial myxofibrosarcomas managed from 1/1/2000 to 1/1/2019 who received neoadjuvant or adjuvant radiation and had at least 2-years of oncologic follow-up at a tertiary referral cancer center. Our primary outcome was local recurrence. Comparisons were performed using Fisher’s Exact Test or Students t-test. A p-value < 0.05 was considered significant. Results: Fifty-three patients (18 VAC temporized, 35 single stage) were included. While VT patients were older (74.9 ± 10.2 vs. 63.9 ± 13.6, p = 0.003), treatment groups did not significantly differ with respect to comorbidity, tumor volume, stage and grade. VT patients had significantly fewer local recurrences (5.6% vs. 28.6% after SS, p = 0.048) and R1 resections that required an unplanned readmission for tumor bed re-excision (0% vs. 37.1% after SS, p = 0.002). VT required more total surgeries (2.8 ± 0.9 vs. 1.8 ± 0.9 for SS, p = 0.0002). Post-operative infectious and wound complications were equivalent (Table). Conclusions: Our VAC temporization strategy had a significantly lower LR than SS treatment. While high quality multi-institutional validation is required, VT may represent a paradigm shift in the management of myxofibrosarcoma.[Table: see text]

Patient and Surgical Factors Contributing to Perioperative Infection in Complex Lower Extremity Trauma

2016 ◽  
Vol 82 (10) ◽  
pp. 940-943 ◽  
Author(s):  
Karen E. Burtt ◽  
Alexis D. Rounds ◽  
Hyuma A. Leland ◽  
Ram K. Alluri ◽  
Ketan M. Patel ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Perioperative Outcomes ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Infection Rates ◽  
Lower Extremity Injuries ◽  
Tissue Reconstruction ◽  
Extremity Injuries

Infections in the traumatized lower extremity are a significant source of morbidity and expense. Outcomes after vascularized soft tissue reconstruction were analyzed to determine impact on infection rates. A retrospective review of a prospectively maintained database was performed, including 114 trauma patients requiring soft tissue reconstruction of lower extremity injuries at an urban Level I tertiary referral center from 2008 to 2015. Patient characteristics and perioperative outcomes were analyzed. After trauma, 39 (34.2%) patients developed wound infections, of which 74.4 per cent of infections occurred before soft tissue coverage. Isolated lower extremity injury yielded a 4-fold increase in the incidence of infection. Infection rates doubled in patients who smoked, sustained a fall, had a proximal third of the lower leg wound, or underwent external fixation. Comorbid diabetes, underlying fracture, and wound size were not predictive of infection. Overall, there was a 97.4 per cent rate of limb salvage after soft tissue reconstruction. In patients with infection before soft tissue reconstruction, a salvage rate of 96.6 per cent was achieved. Soft tissue reconstruction in the traumatized and infected lower extremity resulted in high limb salvage success rates, demonstrating vascularized tissue transfer in lower extremity injuries is effective in treating lower extremity infection.

scholarly journals Contemporary reconstruction after complex facial trauma

2020 ◽  
Vol 8 ◽  
Author(s):  
Matthew R Zeiderman ◽  
Lee L Q Pu
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Facial Trauma ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Reconstruction Process ◽  
Optimal Outcomes ◽  
Reconstructive Process ◽  
Tissue Reconstruction

Abstract Complex facial trauma requires complex repair and solutions. This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result. Historically, the use of pedicled flaps, and then free tissue transfer, were the primary techniques utilized. Advancements in soft-tissue reconstruction, such as perforator flaps and pre-expanded and prefabricated flaps, allow refinement of the soft-tissue reconstruction process to create the best initial soft-tissue coverage. The advent of contemporary technologies, such as virtual surgical planning, stereolithography and customized implants and plates, facilitates a tailored approach to the patient’s reconstructive needs for precise bony reconstruction. When surgical and technological techniques are combined in complementary multistage reconstructions, better reconstructive and aesthetic outcomes are achievable than ever before. In this review, the authors present a summary of the management of complex facial trauma based on the senior author’s broad experience. Initial management and contemporary reconstructive techniques and technology to provide optimal outcomes are reviewed. A case series of complex facial traumas and their reconstructive process is also presented to demonstrate how complementary staged procedures can yield an optimal result. We believe the reconstructive surgeon managing complex facial trauma should strive to incorporate contemporary technologies and techniques into their armamentarium to provide the best patient care.

scholarly journals Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Adrian Ooi ◽  
Jonathan Ng ◽  
Christopher Chui ◽  
Terence Goh ◽  
Bien Keem Tan
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Case Review ◽  
Tissue Transfer ◽  
Tissue Reconstruction ◽  
Elbow Reconstruction

Background. Injuries to the elbow have led to consequences varying from significant limitation in function to loss of the entire upper limb. Soft tissue reconstruction with durable and pliable coverage balanced with the ability to mobilize the joint early to optimize rehabilitation outcomes is paramount. Methods. Methods of flap reconstruction have evolved from local and pedicled flaps to perforator-based flaps and free tissue transfer. Here we performed a review of 20 patients who have undergone flap reconstruction of the elbow at our institution. Discussion. 20 consecutive patients were identified and included in this study. Flap types include local (n=5), regional pedicled (n=7), and free (n=8) flaps. The average size of defect was 138 cm2 (range 36–420 cm2). There were no flap failures in our series, and, at follow-up, the average range of movement of elbow flexion was 100°. Results. While the pedicled latissimus dorsi flap is the workhorse for elbow soft tissue coverage, advancements in microvascular knowledge and surgery have brought about great benefit, with the use of perforator flaps and free tissue transfer for wound coverage. Conclusion. We present here our case series on elbow reconstruction and an abbreviated algorithm on flap choice, highlighting our decision making process in the selection of safe flap choice for soft tissue elbow reconstruction.

Soleus Flap for Lower Leg Reconstruction

2019 ◽  
pp. 873-880
Author(s):  
Jeffrey D. Friedman ◽  
Eric S. Ruff
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Blood Supply ◽  
Soleus Muscle ◽  
Muscle Flap ◽  
Lower Leg ◽  
Soft Tissue Reconstruction ◽  
Posterior Tibial ◽  
Medial Head ◽  
Tissue Reconstruction

Open wounds in the middle third of the lower leg often require soft tissue reconstruction to allow for primary wound healing. The soleus muscle flap is uniquely suited for this purpose and is used primarily as a muscle flap without the accompanying overlying skin. This muscle has a blood supply that is segmental in nature, arising from multiple perforators from the posterior tibial vessels. Given that that this blood supply is primarily located in the proximal third of the leg, the soleus muscle flap is generally based proximally to allow for coverage of middle-third defects. While the muscle has a clear intermuscular septum which separates the medial head from the lateral segment, the use of a so-called hemi-soleus flap is less reliable and thus used on an infrequent basis. The soleus muscle flap can also be based distally in the leg for small distal-third defects; however, this flap can often be unreliable due to a paucity of sufficient perforators located in this area.

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