Preference for Fasciocutaneous Flap Over Musculocutaneous Flap as a First-Line Option for Ischial Pressure Wound Reconstruction: A Review of 64 Cases

The ischial pressure wound usually comprises a large, extensive defect and involves the repair of more than a small opening. Most surgeons have used a musculocutaneous flap to fill the large dead space of an ischial pressure wound. However, sacrificing muscle tissue has a potential risk of postoperative bleeding. The transferred muscle ultimately loses function as a cushion to absorb pressure. Conservation of muscle structures may be beneficial for use in future recurrence, which is common with ischial pressure wound. We compared the difference in outcome between musculocutaneous and fasciocutaneous flaps and analyzed factors affecting complications with the flaps in ischial pressure wound reconstruction. This study reviewed the results of 64 flaps in 44 patients with ischial wounds. The wounds were reconstructed with 34 musculocutaneous flaps (53%) and 30 fasciocutaneous flaps (47%). Twenty-three cases (36%) had complete healing, and 41 (64%) had complications. There was no significant difference in outcomes between fasciocutaneous and musculocutaneous flap groups. Crude logistic regression analysis showed no significant risk factors for occurrence of major complications. When fasciocutaneous flaps were used, the neighboring perforators and muscle tissues could be conserved. With a perforator-based fasciocutaneous flap, a de-epithelized distal portion of the flap could be used to fill the dead space. Therefore, the fasciocutaneous flap may have priority over the musculocutaneous flap as a first-line option for ischial pressure wound reconstruction.

Chest wall resection and reconstruction for locally recurrent breast cancer: an experience of five cases over a five-Year period and literature review

Background: Expanded local resection is suitable for recurrent breast cancer patients who have isolated local lesion and have not metastasized. The extend of chest wall resection must be overall radical resection of the tumors diagnosed by pathology. However, surgery often leads to huge defects, even full-thickness defects, and these defects are difficult to repair. Here, we reported our experience in chest wall resection and reconstruction of patients with locally recurrent breast cancer, and also did a comprehensive literature review.Case Presentation: We report five cases with locally recurrent breast cancer, followed by chest wall reconstruction with a pedicled rectus abdominis musculocutaneous flap or a pedicled latissimus dorsi musculocutaneous flap and, if necessary, a piece of titanium mesh. Chest wall resection and reconstruction were successfully achieved in all 5 patients. No complication and recurrence were observed, except one patient died of late lymphatic metastasis. Other patients reported good quality of life.Conclusion: For locally recurrent breast cancer, complete tumor resection is essential and ensures no recurrence. Appropriate material and the blood-rich flap or myocutaneous flap should be used to reconstruct the chest wall defect as an effective treatment for surgical procedure.