scholarly journals Resurfacing the donor sites of reverse sural artery flaps using thoracodorsal artery perforator flaps

2021 ◽  
Vol 48 (6) ◽  
pp. 691-698
Author(s):  
Se Won Oh ◽  
Seong Oh Park ◽  
Youn Hwan Kim
Keyword(s):  
Knee Joint ◽  
Lower Extremity ◽  
Skin Graft ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Split Thickness Skin Graft ◽  
Scar Contracture ◽  
Thoracodorsal Artery ◽  
Sural Artery ◽  
Artery Perforator

Background The reverse sural artery (RSA) flap is widely used for lower extremity reconstruction. However, patients sometimes suffer from donor site complications such as scar contracture and paresthesia, resulting in dissatisfaction with the aesthetic outcomes. This study investigated the characteristics of donor site morbidity associated with RSA flaps and described our experiences of dealing with complications by performing resurfacing surgery using thoracodorsal artery perforator (TDAP) flaps.Methods From April 2008 to August 2018, a total of 11 patients underwent contracture release and resurfacing surgery using TDAP flaps due to donor morbidity associated with RSA flaps. All affected donor sites were covered with a skin graft, the most common of which was a meshed split-thickness skin graft (six cases).Results Eight of the 11 patients (72.7%) suffered from pain and discomfort due to scar contracture, and seven (63.6%) complained of a depression scar. The donor sites were located 6.3±4.1 cm below the knee joint, and their average size was 140.1 cm². After resurfacing using TDAP flaps, significant improvements were found in the Lower Extremity Functional Scale (LEFS) scores and the active and passive ranges of motion (AROM and PROM) of the knee joint. The LEFS scores increased from 45.1 to 56.7 postoperatively (P=0.003), AROM increased from 108.2° to 118.6° (P=0.003), and PROM from 121.4° to 126.4° (P=0.021).Conclusions Planning of RSA flaps should take into account donor site morbidity. If complications occur at the donor site, resurfacing surgery using TDAP flaps achieves aesthetic and functional improvements.

scholarly journals Split-thickness skin graft donor-site morbidity: A systematic literature review

Burns ◽  
2021 ◽  
Author(s):  
Malachy Asuku ◽  
Tzy-Chyi Yu ◽  
Qi Yan ◽  
Elaine Böing ◽  
Helen Hahn ◽  
...  
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Skin Graft ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Split Thickness Skin Graft ◽  
Thickness Skin ◽  
Graft Donor

scholarly journals Axillary Reconstruction Using a Pedicled Thoracodorsal Artery Perforator Flap Including Latissimus Dorsi Muscle Strip

2020 ◽  
Vol 16 (1) ◽  
pp. 43-48
Author(s):  
Jin An Cha ◽  
Sung Ho Yoon
Keyword(s):  
Latissimus Dorsi ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Latissimus Dorsi Muscle ◽  
Muscle Strip ◽  
Dorsi Muscle ◽  
Thoracodorsal Artery ◽  
Tdap Flap ◽  
Artery Perforator

For axillary reconstruction, most reconstructive surgeons use the latissimus dorsi flap because of its usefulness and reliability. However, the latissimus dorsi musculocutaneous flap poses complications such as donor site morbidity and poor aesthetic results. Moreover, the thoracodorsal artery perforator (TDAP) flap, without muscle, presents difficulties for the delicate procedure of dissecting the perforators separately. Therefore, we propose the use of a pedicled TDAP flap including a latissimus dorsi muscle strip for axillary reconstruction, as it is believed to be easier and safer to perform.

scholarly journals A Meta-Analysis of the Outcomes of Split-Thickness Skin Graft on Diabetic Leg and Foot Ulcers

2019 ◽  
Vol 18 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Kaissar Yammine ◽  
Chahine Assi
Keyword(s):  
Skin Graft ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Foot Ulcers ◽  
Split Thickness Skin Graft ◽  
Quantitative Evidence ◽  
Thickness Skin ◽  
Weighted Values

Diabetic lower limb ulcers are a serious complication to diabetes that could lead to amputation and death. Split-thickness skin graft (STSG) has been proposed by some authors to treat noninfected diabetic wounds, mainly those found in the leg and on the dorsum of the foot. No quantitative evidence synthesis over this technique has been reported in the literature. The study is a meta-analysis on the effectiveness of STSG in treating diabetic leg and foot ulcers. Electronic databases were searched from inception. No limitation was imposed on study design. Eleven studies comprising 757 patients with 759 foot/leg ulcers were included. After a mean period of 2 years, 85.5% (95% confidence interval [CI] = 0.766-0.925) of ulcers were healed over a mean time of 5.35 ± 2.25 weeks, with a recurrence rate of 4.2% (95% CI = 0.009-0.096), an infection rate of 4.4% (95% CI = 0.013-0.092), and a regrafting rate of 12.1% (95% CI = 0.053-0.212). Infection was the only reported donor site morbidity with a frequency of 1.74% (95% CI = 0.001-0.048). These weighted values are found to be noticeably superior to those reported in the literature following standard conventional care. The results of the review make STSG the ideal method to treat noninfected recurrent or recalcitrant ulcers of the leg and dorsal foot. Furthermore, the authors argue that STSG should be used more frequently in the management of such wounds. The findings should encourage future prospective investigations.

scholarly journals GLABROUS & NON-GLABROUS SPLIT SKIN GRAFT IN THE RECONSTRUCTION OF FLEXION CONTRACTURE OF FINGERS – AN OBSERVATIONALAND COMPARATIVE STUDY.

2020 ◽  
pp. 1-3
Author(s):  
Abhishek Gaur ◽  
Nidhi Gaur
Keyword(s):  
Skin Graft ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Flexion Contracture ◽  
Split Thickness Skin Graft ◽  
Skin Grafts ◽  
Flexion Deformity ◽  
Split Skin Graft ◽  
Thickness Skin ◽  
Split Skin

Background: Flexion contractures of the fingers cause functional and aesthetic problems to a burn patient. Various methods of reconstruction have been described in the literature. These include release and split thickness grafting, release and full thickness grafting. Among those incision or excision of the contracture band and split skin grafting were the simplest and commonest techniques. In this study, we aim to compare functional & aesthetic outcomes of glabrous & non glabrous split skin graft in flexion contracture of fingers. Methods: A total of 60 fingers of patients of post burn finger contractures were undertaken for the study. Patients were evaluated preoperatively on duration of contracture, extent of involvement, type of scar, range of movements using goniometer and degree of fixed flexion deformity. Finger contractures were released and resurfacing done with glabrous & non-glabrous split thickness skin grafts. Postoperative evaluation was done by measuring range of movements of Proximal Interphalangeal (PIP) and Distal interphalangeal (DIP) joints, flexion deformity, donor site morbidity, number of visits to the hospital, colour match of graft to adjacent skin. Results: Functional outcome in terms of active range of motion combined at DIP joint, PIP joint & metacarpophalangeal joint were similar in both glabrous split thickness skin graft & non glabrous split thickness skin graft at the end of six months. As compared with non-glabrous split thickness skin grafts, glabrous split thickness grafts provided superior colour & texture match to surround tissue. There was no significant donor site morbidity in plantar in-step area & patients were able to walk from third to fourth post operative day. There was minimal hypertrophy of plantar donor site, owing to persistent pressure in standing posture. Conclusion: Patient’s satisfaction was greater in glabrous split skin graft.

Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

2020 ◽  
Author(s):  
Domenico Pagliara ◽  
Maria Lucia Mangialardi ◽  
Stefano Vitagliano ◽  
Valentina Pino ◽  
Marzia Salgarello
Keyword(s):  
Comparative Study ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Tactile Sensitivity ◽  
Aesthetic Outcome ◽  
Propeller Flap ◽  
Thickness Skin ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

scholarly journals Reconstruction of a secondary scalp defect using the crane principle and a split-thickness skin graft

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Lu ◽  
Ke-Chung Chang ◽  
Che-Ning Chang ◽  
Dun-Hao Chang
Keyword(s):  
Skin Graft ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Salvage Procedure ◽  
Primary Defect ◽  
Scalp Defects ◽  
Thickness Skin ◽  
Scalp Defect ◽  
Secondary Defect

Abstract Background Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The “crane principle” is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. Case report We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. Conclusions Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.

LONG-TERM DONOR-SITE MORBIDITY IN COMPOSITE ANTEROLATERAL THIGH FREE FLAP FOR COMPLEX DEFECT OF LOWER LEG AND FOOT RECONSTRUCTION

2020 ◽  
pp. 85-91
Author(s):  
Phuc Le Hong ◽  
Son Tran Thiet ◽  
Thuy Nguyen Xuan
Keyword(s):  
Soft Tissue ◽  
Skin Graft ◽  
Free Flap ◽  
Donor Site ◽  
Lower Extremities ◽  
Lower Leg ◽  
Donor Site Morbidity ◽  
Thigh Circumference ◽  
Anterolateral Thigh

Background: In recent years, the composite anterolateral thigh free flap with tensor fasciae latae or vastus lateralis has been a new-applied type of flap that can provide very good reconstruction materials in complex defects of lower leg and foot. The study purpose is to evaluate the systematically complications of donor site, related factors to results of the donor area, in order to apply the result to improve the treatment, which have not been much reported in literature. Materials and Methods: Systematic donor site morbilidy evaluation in a prospective, uncontrolled clinical descriptive study of 33 composite anterolateral thigh free flaps in various forms to reconstruct anatomical structures or to resconstruct deep defects combined with covering the surfaces for complex soft tissue defects in lower extremities for 32 patients due to different causes in lower leg and foot area from 2014-2019 at Hue University of Medicine and Pharmacy. Examining and evaluating aesthetic and functional result of donor-site 3 months and 6 months up to 2 year after surgery; evaluating the correlation between the width and the type of the flaps and donor site closure methods. Result: In 33 composite flaps used, flap width to thigh circumference less than 20% in 27 cases (81.8%), more than 20% in 6 cases (18.20% ); There were 28 cases in which the donor site was directly closed, 5 cases required skin graft; All direct closed cases had flap width/ thigh circumference index below 20%; On the contrary, in cases having this index greater than 20%, the donor site required skin graft with p < 0.01. There are 11/33 (33.33%) of cases reported complications in donor site ; lateral thigh paresthesia is the most complicated complication with 8/33 cases (24.24%), followed by bad scarring 3/33 cases (9.09%). Conclusion: Long term follow up donor site morbility after composite anterior thigh free flap present 11/33 cases (33.33%): mostly complications of the donor site are thigh paresthesia with 8/33 cases (24.24%), and bad scarring 3/33 cases (9,09%), which improve time by time. Keywords: Composite anterior thigh free flap, lower extremities soft tissue defect, donor site morbidity

Sign in / Sign up

Export Citation Format

Share Document