Extracorporeal Perfusion for Free Fillet Lower Leg Flap After External Hemipelvectomy for Recurrent Osteosarcoma: A New Surgical Technique

BackgroundExternal hemipelvectomy often results in exposure of noble structures such as pelvic organs, joint surfaces, iliac neurovascular bundle and bone. Consequently, reconstructive surgery is always challenging. The free fillet lower leg flap is an optimal solution since it allows the transfer of a large amount of tissue and the it determines the absence of donor site morbidities. The prolonged ischemic time represents the weak point of this flap.Methods We presented the case of a 38-year-old man with recurrent radio-induced osteosarcoma arisen on pelvic cavity and involving common iliac vessels, bladder, left ureter and left kidney. We decided to use extracorporeal circulation (ECMO) in order to reduce ischemic time of the flap, since iliac vessels were necessary ligated in the middle of oncologic resection. We perfused the popliteal-based filleted lower leg musculocutaneous free flap with homologue blood and saline solution, while the oncologic dissection was completed.ResultsThe free fillet flap remained vital in the immediate postoperative period and in the following months. The patient did not come back to a life-threatening condition at 1y follow-up. ConclusionWe believed that ECMO expand the reconstructive indications in those cases in which a complex and long-lasting oncologic resection would make impossible a free flap due to prolonged ischemic time.

Radial fillet flap following double ray amputation of the 2nd and 3rd fingers for invasive squamous cell carcinoma: a case report and review of the literature

Double ray amputation of the hand due to malignancy is extremely rare, with a paucity of published cases. We reviewed the literature and analysed our own experience in order to familiarise clinicians with this rare condition through a discussion of its diagnosis, management and prognosis. We present the case of a 54-year-old male with invasive squamous cell carcinoma (SCC) of the 2nd web space. He underwent a double ray amputation of the 2nd and 3rd fingers with a radial fillet flap and has begun range of motion exercises after six weeks. SCC of the hand requiring a double ray amputation is extremely rare. An MRI is required to accurately diagnose and manage this condition. The ray amputation technique is important for ensuring negative margins. A fillet flap should be used to close the defect as it provides a sensate web-space and improves motor function prognosis.

Восстановление тканей опорных поверхностей стоп усовершенствованным методом fillet flap

Представлен собственный опыт применения метода digital fillet flap, в том числе предложенного лоскута переднебокового отдела подошвы с включением латеральной краевой артерии (arteriae plantaris lateralis digiti quinti, или fibular plantar marginal artery) и вариабельных подошвенных плюсневых артерий IV межплюсневого промежутка в сочетании с пластикой мягкими тканями V пальца, для восстановления длительно незаживающих ран и язв переднего отдела стопы у 5 пациентов. Показано, что данный способ позволяет восстанавливать дефект переднего отдела стопы подошвенным опороспособным лоскутом, имеющим множественное осевое кровоснабжение и чувствительную иннервацию. Предложен метод адаптации лоскута к поверхности раны, основанный на выполнении 3–5 радиальных разрезов длиной 2–3 мм мягких тканей гемисферических краев пальцевого лоскута без повреждения пальцевых сосудов и нервов, что позволяет снизить кривизну лоскута, минимизировать подлоскутное пространство, тканевое натяжение и закрыть большую раневую площадь. Лоскуты fillet flap были успешно применены для восстановления тканей нейротрофических язв и незаживающих ран переднего отдела стопы.

Aesthetic outcomes following adipose flap versus fillet flap technique for radial polydactyly: a comparison study

We performed a comparative study looking at the aesthetic outcomes of using a digital artery vascularized adipose flap (DAAF) for treatment of Wassel type IV radial polydactyly versus a fillet flap technique. Clinical charts and pictures of patients between 2002 and 2017 were reviewed to evaluate the appearance of 16 reconstructed thumbs using a visual analogue scale. Our results showed that the DAAF technique resulted in better outcomes with regard to contour of the thumb than the fillet flap group, with significantly less conspicuous scarring in the DAAF group. We conclude that the DAAF can produce better aesthetic outcomes in the reconstruction of radial polydactyly than conventional fillet flaps. Level of evidence: III