scholarly journals Biological Extremity Reconstruction after Sarcoma Resection: Past, Present, and Future

Sarcoma ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Lukas A. Holzer ◽  
Andreas Leithner
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Biological Reconstruction ◽  
Bone Allografts ◽  
Tissue Reconstruction ◽  
Extremity Reconstruction ◽  
Reconstructive Techniques ◽  
Tissue Defects ◽  
Reconstructive Methods

In sarcoma surgery besides a wide local resection, limb salvage became more and more important. Reconstruction of bone and soft tissue defects after sarcoma resection poses a major challenge for surgeons. Nowadays a broad range of reconstructive methods exist to deal with bony defects. Among these are prostheses, bone autografts, or bone allografts. Furthermore a variety of plastic reconstructive techniques exist that allow soft tissue reconstruction or coverage after sarcoma resection. Here we discuss the historical highlights, the present role, and possible future options for biological reconstruction.

scholarly journals Delayed Soft Tissue Reconstruction with a Horizontal Rectus Abdominis Musculocutaneous Flap following Hip Exarticulation

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Jes Christian Rødgaard ◽  
Troels Michael Tei
Keyword(s):  
Soft Tissue ◽  
Rectus Abdominis ◽  
Successful Outcome ◽  
Soft Tissue Reconstruction ◽  
Necrotic Tissue ◽  
Soft Tissue Defects ◽  
Future Planning ◽  
Tissue Reconstruction ◽  
The Right ◽  
Tissue Defects

Coverage of large soft tissue defects at the hip region constitutes a challenge for plastic surgeons. We report the case of a 43-year-old female with necrotizing fasciitis of the right thigh, necessitating hip exarticulation and substantial debridement of necrotic tissue. An ipsilateral horizontal rectus abdominis myocutaneous (HRAM) flap was used to cover the defect. The reconstruction was carried out after the attempt of local tissue rearrangement. In light of the successful outcome, we propose that this flap be considered in the future planning of soft tissue reconstruction at the hip region.

scholarly journals Complex Soft Tissue Defects in Operative Urology: Pedicled Perforator Flaps of the Anterior Lateral Thigh for Tissue Reconstruction of the Lower Trunk

2021 ◽  
pp. 1-6
Author(s):  
Rafael Jakubietz ◽  
Michael Jakubietz ◽  
Adrian Vater ◽  
Arkadius Kocot ◽  
Hubert Kübler ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Interdisciplinary Approach ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Lower Abdomen ◽  
Perforator Flaps ◽  
Urologic Surgery ◽  
Tissue Reconstruction ◽  
Alt Flap ◽  
Tissue Defects

<b><i>Background:</i></b> Complex soft tissue defects involving the lower abdomen, perineum, and groin (LAPG) represent reconstructive challenges following urologic surgery. Consequently, these often require an interdisciplinary approach involving plastic surgery. While pedicled flaps from the lower abdomen are a reliable option, previous placement of colostomies and urinary urostomies renders these flap types unavailable. Here, the pedicled anterolateral thigh perforator (ALT) flap represents a reliable pedicled alternative which can harvest from the thigh. <b><i>Materials and Methods:</i></b> A retrospective data analysis of pedicled perforator flaps harvested from the thigh to reconstruct soft tissue defects was conducted. Seven patients treated in the urology department with soft tissue defects following tumor resection, infection, and dehiscence were included. <b><i>Results:</i></b> In all patients, the ALT flap was utilized successfully to reconstruct soft tissue defects up to 450 cm<sup>2</sup> in size. All flaps survived. In 1 case, prolonged wound healing was observed. All defects were adequately addressed with no recurrence of dehiscence or fistula formation. <b><i>Conclusions:</i></b> Pedicled perforator flaps represent a valid option for the soft tissue reconstruction of the lower abdomen and perineum when a pedicled rectus abdominis flap is no longer available. This flap is, therefore, a good option in an interdisciplinary approach to soft tissue reconstruction, especially following urologic surgery, which is predominantly performed in the LAPG region.

scholarly journals Free Peroneal Artery Perforator-Based Flap for Soft Tissue Reconstruction of the Finger

2017 ◽  
Vol 02 (02) ◽  
pp. e136-e139
Author(s):  
Kenji Kawamura ◽  
Hiroshi Yajima ◽  
Shohei Omokawa ◽  
Takamasa Shimizu ◽  
Satoshi Hayashi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Peroneal Artery ◽  
Soft Tissue Reconstruction ◽  
Digital Artery ◽  
Soft Tissue Defects ◽  
Tissue Reconstruction ◽  
Perforator Vessels ◽  
Artery Perforator ◽  
Tissue Defects

Background The peroneal artery perforator-based flap has been widely used as a pedicled propeller flap for soft tissue reconstruction in the lower extremity; however, its application as a free flap has been rarely reported. We report on the utility of the free peroneal artery perforator-based flap for finger soft tissue reconstruction. Methods Twelve patients underwent reconstructions of soft tissue defects of the finger with free peroneal artery perforator-based flaps. The soft tissue defects were located either dorsally and/or laterally on the fingers. The size of the flaps ranged from 5 × 2 to 8 × 3 cm. The length of the vascular pedicles ranged from 4 to 5 cm. The artery and vein of the perforator vessels were anastomosed in the finger to the digital artery and subcutaneous vein, respectively. Results All twelve flaps survived completely, and the donor site in the lower leg was closed primarily in all cases. Secondary defatting was performed in six cases, while in the remaining cases, thinning of the flap was performed when the flap was transferred. Conclusion The advantages of the free peroneal artery perforator-based flap for finger soft tissue reconstruction include the following: the flap is flexible and can be thinned to match the texture of the finger; elevation of the flap is easy; the donor site can be closed primarily; there is no need to sacrifice any main arteries in the lower leg; and the diameter of the perforator vessels is suitable for anastomosis to the digital artery and subcutaneous vein in the finger.

Soft Tissue Reconstruction for Deep Defects over a Complicated Total Knee Arthroplasty: A Systematic Review

2019 ◽  
Vol 33 (07) ◽  
pp. 732-744 ◽  
Author(s):  
Demetrius M. Coombs ◽  
Jessica Churchill ◽  
Paul Cartwright ◽  
Morad Chughtai ◽  
Assem A. Sultan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Flap Coverage ◽  
Tissue Reconstruction ◽  
Total Knee ◽  
Tissue Defects

AbstractDeep soft tissue defects after complicated primary or revision total knee arthroplasty (TKA) can be devastating to the patient and technically challenging. The purpose of this review was to (1) discuss different methods used to provide coverage for deep defects of the knee following TKA, as well as to (2) report on their success rates. A comprehensive literature search was performed. Reports were only included if they (1) were case series, (2) were level III studies or above (including retrospective cohort studies and meta-analyses), (3) were in English, and (4) discussed the outcome of graft or flap coverage of soft tissue defects after total knee arthroplasty. A total of 28 case series and four retrospective comparative studies were retrieved. In 16 studies, 195 out of 241 patients who received gastrocnemius flaps (81%) experienced successful outcomes. In seven studies including 84 patients that underwent fasciocutaneous flap coverage, over 90% of patients experienced successful outcomes. In the four studies examining 144 patients with delayed versus prophylactic soft tissue reconstruction, up to 81% of patients experienced a successful outcome. Various factors must be taken into consideration when assessing full-thickness defects over a TKA and collaboration between plastic and orthopaedic surgeons is required to select the optimal approach.

Soft-Tissue Defects and Exposed Hardware: A Review of Indications for Soft-Tissue Reconstruction and Hardware Preservation

2009 ◽  
Vol 123 (4) ◽  
pp. 1256-1263 ◽  
Author(s):  
Anthony Viol ◽  
Sarah P. Pradka ◽  
Steffen P. Baumeister ◽  
Danru Wang ◽  
Kurtis E. Moyer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Tissue Reconstruction ◽  
Tissue Defects

scholarly journals Clinical Study of the Lateral Supramalleolar Flap in the Soft Tissue Reconstruction around the Ankle Region

2020 ◽  
Vol 53 (01) ◽  
pp. 083-089 ◽  
Author(s):  
G. I. Nambi ◽  
T. K. Arudra Varanambigai
Keyword(s):  
Clinical Study ◽  
Soft Tissue ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Split Skin Graft ◽  
Tissue Reconstruction ◽  
Split Skin ◽  
Tissue Defects ◽  
Ankle And Foot

Abstract Objective The purpose of this study is to present the efficiency of the lateral supramalleolar flap which is a very useful and yet underutilized in the soft tissue reconstruction of the regions extending from the distal leg, ankle, and foot. Methods Over a period of 3 years, 20 flaps were used in the reconstruction of soft tissue defects in the region extending from the distal leg, ankle, and foot. The location of the defects, the etiology, possible alternative flaps, outcome, and the complications were studied and presented. Results The follow-up period of the cases was from 1 month to 18 months after surgery. Seventeen flaps survived and three were lost. All the three lost flaps were those used over the tendocalcaneal region. The lost flaps were later replaced with split skin graft after the wound was debrided and was later covered with granulation tissue. Conclusion The lateral supramalleolar flap is a very useful flap in the regional soft tissue reconstruction around the ankle except in the tendocalcaneal region.

scholarly journals Abdominal, perineal, and genital soft tissue reconstruction with pedicled anterolateral thigh perforator flaps

2021 ◽  
Author(s):  
Stephan Alois Steiner ◽  
Riccardo Schweizer ◽  
Holger Klein ◽  
Matthias Waldner ◽  
Pietro Giovanoli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Anterolateral Thigh ◽  
Tissue Reconstruction ◽  
Alt Flap ◽  
Tissue Defects

Abstract Background Pedicled perforator flaps have become a contemporary alternative to muscle flaps for soft tissue reconstruction as they have reduced donor site morbidity, avoid the need for microsurgical transfer, and are versatile and reliable. The anterolateral thigh (ALT) flap was first introduced as a free flap and has since gained popularity as a pedicled flap. Here we review our experience using pedicled ALT flaps for regional soft tissue reconstruction. Methods We retrospectively reviewed all patients who underwent loco-regional soft tissue reconstruction using pedicled ALT flaps between March 2014 and October 2018, with the goal of identifying potential applications of pedicled ALT flaps. The following aspects of each case were reviewed: patient demographics, defect location and size, comorbidities such as previous radiotherapy, flap details, clinical follow-up, and postoperative complications. Results Our analysis demonstrates the versatility of pedicled ALT flaps in a variety of indications to successfully cover large abdominal, perineal, and genital soft tissue defects. Depending on the patient’s needs to achieve more bulk or stability in the reconstruction, the ALT flap was individually tailored with underlying muscle or fascia. The average follow-up was 7 months (range: 3–13 months). Conclusions Pedicled ALT flaps are a valuable reconstructive option for soft tissue defects located within the pedicle’s range, from the lower abdomen to the perianal region. These flaps are usually raised from a non-irradiated donor site and are sufficient for covering extensive soft tissue defects. Three-dimensional reconstruction of the defect using pedicled ALT flaps allows for anatomical function and minor donor sites. Level of evidence: Level IV, therapeutic study.

COVERAGE CONSIDERATIONS AND OUTCOME ANALYSIS OF RECONSTRUCTION OF POST TRAUMATIC SOFT TISSUE DEFECTS AROUND THE ELBOW

2020 ◽  
pp. 70-72
Author(s):  
Vishwamitra B Dayal ◽  
M. Senthil Kumaran ◽  
S Raja Sabapathy
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Defect ◽  
Defect Size ◽  
Outcome Analysis ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Comparison Results ◽  
Average Defect ◽  
A Prospective Study ◽  
Tissue Defects

Introduction: Major crush injury of elbow joint following trauma with extensive injury to skin & soft tissue, bone, tendon, nerves and vessels remains a challenge to the reconstructive surgeon. Purpose of this study is to nd out whether the size of the defect, type of ap used and the location of the soft tissue defect inuence the outcome of soft tissue reconstruction. Material and methods: A prospective study was performed in all patients with soft tissue defects around the elbow in need of ap cover at Ganga Medical Centre Coimbatore, Tamilnadu India from April 2014 to December 2015.Patients demographics, defect size, location, type of ap used, complications and long – term outcomes analysed. Patients Mayo elbow performance score and Likert scale score were recorded for analysis of functional and aesthetic outcome respectively. The Kruskal wallis test was used for statistical comparison. Results: Forty three aps were performed primarily for coverage in forty patients. Three patients required two primary aps for reconstruction. The aps used in our study included 14 local fasciocutaneous aps (32.5%); 20 pedicled aps both locoregional and distant (46.5%) and 9 2 2 Anterolateral thigh free aps (20.9%) The average defect size was 151 cm . For local fasciocutaneous ap the average defect size was 44.7cm , 2 2 2 2 2 (range, 4-120 cm ), distant pedicled ap was181 cm (range 24- 600 cm ) and for the ALT free ap was 252.2 cm (range 80-450 cm ). Conclusion: The defect size is the main determinant of the type of ap used and their outcomes.

Preliminary Experience with Perforator Flaps in Reconstruction of Soft-Tissue Defects of the Foot and Ankle

2005 ◽  
Vol 26 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Frederick J. Duffy ◽  
James W. Brodsky ◽  
Christian T. Royer
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Foot And Ankle ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Microsurgical Reconstruction ◽  
Tissue Defects

Background: Microsurgical reconstruction has improved limb salvage in patients who because of many etiologies have soft-tissue loss from the lower extremities. Free-tissue transfer to the foot and ankle often interferes with postoperative function and footwear because of the bulk of a muscle flap. The foot and ankle often are best treated using thin flaps that will not contract and fibrose, particularly if secondary procedures are required. We hypothesized that perforator flaps, which are thin free-tissue transfers consisting of skin and subcutaneous tissue, both diminish donor site morbidity and are ideally suited for soft-tissue reconstruction of the foot and ankle. Methods: Ten patients had free- tissue transfers to the foot and ankle using perforator flaps during a 2-year period. Four had acute posttraumatic wounds, three had soft tissue defects with exposed hardware or bone graft after reconstructive surgery, and three had large soft-tissue defects after foot infection secondary to diabetes. Nine had reconstruction with anterolateral thigh perforator flaps and one had reconstruction with a deep inferior epigastric artery (DIEP) perforator flap. Results: All flaps survived. There were no deep infections. Three flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. There were no donor site complications and no interference of muscle function at the donor sites. Custom shoewear was not required to accommodate the flaps. Conclusion: This series highlights the success and utility of perforator flaps in microsurgical reconstruction of the foot and ankle. The greatest advantage of perforator flaps is the diminished donor site morbidity, which was achieved while maintaining high microsurgical success rates. These skin and fat flaps remained pliable and contracted less than muscle flaps, allowing for smooth tendon gliding and easy flap elevation for secondary orthopaedic procedures.

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