scholarly journals Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas

Sarcoma ◽  
2008 ◽  
Vol 2008 ◽  
pp. 1-6 ◽  
Author(s):  
Haitham H. Khalil ◽  
Ahmed El-Ghoneimy ◽  
Yasser Farid ◽  
Walid Ebeid ◽  
Ahmed Afifi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Rectus Abdominis ◽  
Skin Paddle ◽  
Musculoskeletal Sarcoma ◽  
Lower Trunk ◽  
Vram Flap ◽  
Ischemic Events ◽  
Proximal Lower Limb

Introduction and aim. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The authors present modified vertical rectus abdominis musculocutaneous (VRAM) flap techniques to reconstruct extensive defects after debridment of these complicated wounds.Material and Methods. Over a period of 4 years (2002–2005), 5 men and 2 women were managed. Median age was 21 years (range 15–49). The patients were managed for complicated lower trunk, groin, and upper thigh wounds after resection of three pelvic chondrosarcomas as well as two pelvic and two proximal femur osteosarcomas. The modifications included a VRAM flap with lateral and tongue-like extension design of the skin paddle (5 cases) or a delayed extended VRAM flap (2 cases).Results. All flaps showed complete survival and healing with no ischemic events providing stable coverage. All patients were ambulant with good limb functions in terms of walking and gait after adequate rehabilitation, 2 needed support with crutches.Conclusion. The modified VRAM flaps offer reliable reconstructive tools for coverage of complex groin and thigh defects by providing larger well-vascularized soft tissue with acceptable donor site.

scholarly journals Personalized Reconstruction of Genital Defects in Complicated Wounds with Vertical Rectus Abdominis Myocutaneous Flaps including Urethral Neo-Orifice

2021 ◽  
Vol 11 (11) ◽  
pp. 1076
Author(s):  
Raymund E. Horch ◽  
Ingo Ludolph ◽  
Andreas Arkudas ◽  
Aijia Cai
Keyword(s):  
Soft Tissue ◽  
Rectus Abdominis ◽  
Skin Paddle ◽  
Wound Breakdown ◽  
Pelvic Malignancies ◽  
Urethral Orifice ◽  
Vram Flap ◽  
Surgical Options ◽  
Perineal Region ◽  
Vertical Rectus Abdominis Myocutaneous

Non-healing extensive wounds in the perineal region can lead to severe soft tissue infections and disastrous complications, which are not manageable with conservative measures. Specifically in recurrent or advanced pelvic malignancies, irradiation often leads to extensive scarring and wound breakdown, resulting in significant soft tissue defects during surgical tumor excision. Among several surgical options to reconstruct the perineum, the transpelvic vertical rectus abdominis myocutaneous (VRAM) flap has proven to be one of the most reliable methods. Specific modifications of this flap allow an individualized procedure depending on the patient’s needs. We modified this technique to include the urethral orifice into the skin paddle of VRAM flaps in three patients as a novel option to circumvent urinary diversion and maintain an acceptable quality of life.

scholarly journals Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

2018 ◽  
Vol 51 (02) ◽  
pp. 216-221 ◽  
Author(s):  
Deepak Nanda ◽  
Shamendra Anand Sahu ◽  
Durga Karki ◽  
Sanjay Kumar ◽  
Amrita Mandal
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Adipofascial Flap ◽  
Tibial Artery ◽  
Split Skin ◽  
Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

scholarly journals Facial contouring with parascapular free flap: A case series of 22 cases

2013 ◽  
Vol 46 (03) ◽  
pp. 561-567 ◽  
Author(s):  
Guru Dayal Singh Kalra ◽  
Ram Krishna Gupta
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Donor Site ◽  
Case Series ◽  
Facial Asymmetry ◽  
Free Flaps ◽  
Soft Tissue Augmentation ◽  
Facial Soft Tissue ◽  
Skin Paddle ◽  
Hemifacial Atrophy

ABSTRACT Background: The facial asymmetry correction in complex craniofacial malformations presents a challenging problem for reconstructive surgeons. Progressive hemifacial atrophy (HFA) and hemifacial microsomia (HFM) can manifest in different grades of severity. Most patients require only soft-tissue augmentation. Free flaps are the best option for correction of severe facial soft-tissue deficiency. Materials and Methods: Twenty-two patients of HFM and HFA were included in this study from January 2006 to March 2009 in the Department of Plastic and Reconstructive Surgery, SMS Medical College and Hospital. In all cases, atrophy correction was done using de-epithelialised parascapular free flap with the de-epithelialised surface was placed under the skin. A small skin paddle was taken for monitoring. Results: All cases were reconstructed with de-epithelialised parascapular free flap. There was no flap loss in this series. Hematoma was noted in five cases. Debulking and removal of skin paddle were done in all cases after 6 months. Atrophy recurrence was not observed in any of the cases on follow-up. Conclusion: Contouring of face in cases of HMF and HFA is satisfactorily done with the parascapular free flap. It gives better cosmetic results with minimal donor site morbidity. Facial vessels are better recipient vessels for anastomosis. Keeping de-epithelialised surface of flap under the skin helped in preventing sagging.

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.

scholarly journals Donor Site Morbidity of Patients Receiving Vertical Rectus Abdominis Myocutaneous Flap for Perineal, Vaginal or Inguinal Reconstruction

2020 ◽  
Vol 45 (1) ◽  
pp. 132-140
Author(s):  
Vera S. Schellerer ◽  
Lenka Bartholomé ◽  
Melanie C. Langheinrich ◽  
Robert Grützmann ◽  
Raymund E. Horch ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Myocutaneous Flap ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Rectus Abdominis ◽  
Flap Reconstruction ◽  
Direct Closure ◽  
Vram Flap ◽  
Vertical Rectus Abdominis Myocutaneous

Abstract Background Management of donor site closure after harvesting a vertical rectus abdominis myocutaneous (VRAM) flap is discussed heterogeneously in the literature. We aim to analyze the postoperative complications of the donor site depending on the closure technique. Methods During a 12-year period (2003–2015), 192 patients in our department received transpelvic VRAM flap reconstruction. Prospectively collected data were analyzed retrospectively. Results 182 patients received a VRAM flap reconstruction for malignant, 10 patients for benign disease. The median age of patients was 62 years. 117 patients (61%) received a reconstruction of donor site by Vypro® mesh, 46 patients (24%) by Vicryl® mesh, 23 patients (12%) by direct closure and 6 patients (3%) by combination of different meshes. 32 patients (17%) developed in total 34 postoperative complications at the donor site. 22 complications (11%) were treated conservatively, 12 (6%) surgically. 17 patients (9%) developed incisional hernia during follow-up, with highest incidence in the Vicryl® group (n = 8; 17%) and lowest in the Vypro® group (n = 7; 6%). Postoperative parastomal hernias were found in 30 patients (16%) including three patients with simultaneous hernia around an urostomy and a colostomy. The highest incidence of parastomal hernia was found in patients receiving primary closure of the donor site (n = 6; 26%), the lowest incidence in the Vypro® group (n = 16; 14%). Conclusion The use of Vypro® mesh for donor site closure appears to be associated with a low postoperative incidence of complications and can therefore be recommended as a preferred technique.

scholarly journals Reconstructive Treatment following Resection of High-Grade Soft-Tissue Sarcomas of the Lower Limb

2005 ◽  
Vol 13 (1) ◽  
pp. 58-63 ◽  
Author(s):  
AM Leow ◽  
AS Halim ◽  
Z Wan
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Soft Tissue Sarcomas ◽  
Free Tissue Transfer ◽  
Rectus Abdominis ◽  
Lower Limbs ◽  
High Grade ◽  
Rectus Abdominis Flap ◽  
Tissue Transfer ◽  
Fibula Flap

Purpose. To review the role of free tissue transfer in reconstructive surgery following resection of high-grade soft-tissue sarcomas of the lower limb. Methods. Medical records of all consecutive patients with high-grade soft-tissue sarcomas of the lower limbs between August 1997 and September 2003 were reviewed. Results. Of 8 patients (6 women and 2 men) aged between 19 and 65 years, 4 had malignant fibrous histiocytoma, one had malignant peripheral nerve sheath tumour, one had synovial sarcoma, one had recurrent liposarcoma, and one had epitheloid sarcoma. The tumour sizes ranged from 132 cm2 to 483 cm2. The soft-tissue defects following tumour extirpation ranged from 153 cm2 to 896 cm2. The flaps used were 3 free latissimus dorsi flaps, 2 free osteoseptocutaneous fibula flaps (one vascularised fibula flap and one ‘double barrel’ fibula flap), one free rectus abdominis flap, 2 free mini-transverse rectus abdominis flaps, and one pedicled rectus abdominis flap. Five patients did not have local recurrence and systemic metastases. Conclusion. Tissue transfer allows early adjuvant therapy facilitating the multimodal approach for the high-grade soft-tissue sarcomas of the lower extremity.

Soft tissue reconstruction of the thumb with the dorsoradial forearm flap

2013 ◽  
Vol 38 (4) ◽  
pp. 412-417 ◽  
Author(s):  
E. C. Demiri ◽  
D. D. Dionyssiou ◽  
L. C. Pavlidis ◽  
A. V. Papas ◽  
N. H. Kostogloudis ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Soft Tissue Reconstruction ◽  
Skin Paddle ◽  
Skin Island ◽  
Tissue Reconstruction ◽  
Cutaneous Flap ◽  
Post Traumatic ◽  
Large Skin ◽  
Tissue Defects

The dorsoradial flap is a recently described cutaneous flap, which is harvested from the distal forearm and indicated for covering dorsal soft tissue defects of the hand and thumb. Vascularization of the flap is assured by a cutaneous branch of the radial artery, which arises at the level of the first intermetacarpal space and supplies the skin of the distal quarter of the forearm dorsum. This area corresponds to the skin island of the dorsoradial flap. We report our clinical experience on seven patients where this flap was used for covering post-traumatic defects of the thumb. Dimensions of the defect varied from 18 to 28 cm2. The donor site was skin grafted. All flaps survived and provided satisfactory coverage of the defect. Based on a secondary vascular axis, the flap has a large skin paddle and a wide rotation arc that allows soft tissue reconstruction of the dorsal and radiopalmar areas of the thumb.

Muscle versus Fasciocutaneous Flap in Lower Limb Reconstruction: Is There a Best Option?

2017 ◽  
Vol 33 (S 01) ◽  
pp. S27-S33 ◽  
Author(s):  
Martina Corno ◽  
Salvatore D'Arpa ◽  
Pietro Di Summa ◽  
Igor Pellegatta ◽  
Luigi Valdatta ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Muscle Flaps ◽  
Limb Reconstruction ◽  
Lower Limb Reconstruction ◽  
Tissue Defects

AbstractSoft tissue defects of the lower extremity that expose underlying bones, joints, and tendons pose challenging problems and generally require free tissue transfer for a successful reconstruction. Historically, muscle flaps were the gold standard choice for lower limb reconstruction. To obviate the unpredictable appearance and high donor-site morbidity of muscle flaps, fasciocutaneous flaps were introduced. Recently, perforator flaps, such as the anterolateral thigh flap, gained a leading role in the reconstructive scenario. There is growing evidence in the literature supporting that fasciocutaneous and perforator flaps are comparable to muscle flaps in terms of flap survival, postoperative infection, osteomyelitis, bone union, and ambulation. With the advances of knowledge in perforator anatomy and their mapping, a new era of lower limb reconstruction has begun. Propeller flap could be raised on any suitable perforator vessel and, without the aid of microsurgical anastomosis, used to restore small- to middle-sized soft tissue defects. In this review, we intend to analyze pros and cons of muscle and fasciocutaneous free flaps and the applicability of the propeller flaps in lower limb reconstruction.

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