scholarly journals Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Adrian Ooi ◽  
Jonathan Ng ◽  
Christopher Chui ◽  
Terence Goh ◽  
Bien Keem Tan
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Case Review ◽  
Tissue Transfer ◽  
Tissue Reconstruction ◽  
Elbow Reconstruction

Background. Injuries to the elbow have led to consequences varying from significant limitation in function to loss of the entire upper limb. Soft tissue reconstruction with durable and pliable coverage balanced with the ability to mobilize the joint early to optimize rehabilitation outcomes is paramount. Methods. Methods of flap reconstruction have evolved from local and pedicled flaps to perforator-based flaps and free tissue transfer. Here we performed a review of 20 patients who have undergone flap reconstruction of the elbow at our institution. Discussion. 20 consecutive patients were identified and included in this study. Flap types include local (n=5), regional pedicled (n=7), and free (n=8) flaps. The average size of defect was 138 cm2 (range 36–420 cm2). There were no flap failures in our series, and, at follow-up, the average range of movement of elbow flexion was 100°. Results. While the pedicled latissimus dorsi flap is the workhorse for elbow soft tissue coverage, advancements in microvascular knowledge and surgery have brought about great benefit, with the use of perforator flaps and free tissue transfer for wound coverage. Conclusion. We present here our case series on elbow reconstruction and an abbreviated algorithm on flap choice, highlighting our decision making process in the selection of safe flap choice for soft tissue elbow reconstruction.

scholarly journals Contemporary reconstruction after complex facial trauma

2020 ◽  
Vol 8 ◽  
Author(s):  
Matthew R Zeiderman ◽  
Lee L Q Pu
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Facial Trauma ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Reconstruction Process ◽  
Optimal Outcomes ◽  
Reconstructive Process ◽  
Tissue Reconstruction

Abstract Complex facial trauma requires complex repair and solutions. This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result. Historically, the use of pedicled flaps, and then free tissue transfer, were the primary techniques utilized. Advancements in soft-tissue reconstruction, such as perforator flaps and pre-expanded and prefabricated flaps, allow refinement of the soft-tissue reconstruction process to create the best initial soft-tissue coverage. The advent of contemporary technologies, such as virtual surgical planning, stereolithography and customized implants and plates, facilitates a tailored approach to the patient’s reconstructive needs for precise bony reconstruction. When surgical and technological techniques are combined in complementary multistage reconstructions, better reconstructive and aesthetic outcomes are achievable than ever before. In this review, the authors present a summary of the management of complex facial trauma based on the senior author’s broad experience. Initial management and contemporary reconstructive techniques and technology to provide optimal outcomes are reviewed. A case series of complex facial traumas and their reconstructive process is also presented to demonstrate how complementary staged procedures can yield an optimal result. We believe the reconstructive surgeon managing complex facial trauma should strive to incorporate contemporary technologies and techniques into their armamentarium to provide the best patient care.

Cost and Outcome of Osteocutaneous Free-Tissue Transfer versus Pedicled Soft-Tissue Reconstruction for Composite Mandibular Defects

1996 ◽  
Vol 97 (6) ◽  
pp. 1167-1178 ◽  
Author(s):  
Andres Talesnik ◽  
Bernard Markowitz ◽  
Thomas Calcaterra ◽  
Christina Ahn ◽  
William Shaw
Keyword(s):  
Soft Tissue ◽  
Free Tissue Transfer ◽  
Soft Tissue Reconstruction ◽  
Tissue Transfer ◽  
Tissue Reconstruction

Soft Tissue Reconstruction Pyramid in the Diabetic Foot

2010 ◽  
Vol 3 (5) ◽  
pp. 241-248 ◽  
Author(s):  
Claire M. Capobianco ◽  
John J. Stapleton ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Weight Bearing ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Best Interest ◽  
Foot Complications ◽  
Uncontrolled Diabetes ◽  
Wound Healing Response ◽  
Tissue Reconstruction

Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non—weight bearing, all of which have been shown to adversely affect the patient’s quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient’s best interest and is crucial for resolution of the chronic nonhealing wound. The options for soft tissue coverage and the logical progression of application of these techniques in the diabetic foot will be described.

Timing of Soft Tissue Reconstruction

2020 ◽  
pp. 57-62
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Free Flap ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Fracture Union ◽  
Patient Factors ◽  
Tissue Reconstruction ◽  
Wound Excision

Soft tissue cover of a meticulously and comprehensively excised (debrided) wound is the cornerstone of achieving infection-free fracture union. Planning of the soft tissue reconstruction should ideally occur at the time of wound excision. Definitive soft tissue reconstruction should be performed within 72 hours of the injury unless precluded by patient factors, and at the same time as internal fixation of the fracture. Free flap reconstruction is ideally performed on scheduled lists in specialist orthoplastic centres.

Submental Flap for Soft Tissue Reconstruction following Radical Parotidectomy

2019 ◽  
Vol 160 (6) ◽  
pp. 1130-1132 ◽  
Author(s):  
Rodrigo Bayon ◽  
Andrew B. Davis
Keyword(s):  
Soft Tissue ◽  
Medical Center ◽  
Donor Site ◽  
Case Series ◽  
Island Flap ◽  
Hospital Length Of Stay ◽  
Soft Tissue Reconstruction ◽  
Submental Flap ◽  
Tissue Reconstruction ◽  
Submental Island Flap

This study analyzed our institution’s experience with a buried submental flap for soft tissue reconstruction following radical parotidectomy. A retrospective chart review was conducted of patients who had parotid malignancies requiring radical parotidectomy, who also underwent a buried submental flap reconstruction. Analysis included patient demographics and clinical, surgical, and outcome data. Three patients met criteria for this study who underwent a buried submental flap at a tertiary medical center between 2012 and 2016. All patients had oncologic surgery and reconstruction using a deepithelialized submental island flap, which was used to fill the radical parotidectomy surgical defect with no complications and good aesthetic results. Each patient received appropriate adjuvant therapy. This case series shows that the buried submental island flap is a versatile flap that is adequate bulk after radical parotidectomy. It also has no impact on hospital length of stay and provides excellent cosmetic outcomes with minimal donor site morbidity.

Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction

2017 ◽  
Vol 33 (07) ◽  
pp. 466-473 ◽  
Author(s):  
Akhil Seth ◽  
Matthew Iorio
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Venous Anastomosis ◽  
Distal Extremity ◽  
Anterolateral Thigh ◽  
Effective Option ◽  
Tissue Reconstruction ◽  
Extremity Reconstruction ◽  
Alt Flap

Background The anterolateral thigh (ALT) flap remains a workhorse for soft tissue reconstruction. However, the traditional ALT flap is often too bulky for resurfacing shallow, distal extremity defects, prohibiting adequate function, or well-fitted orthotics. This study evaluates extremity reconstruction using ALT flaps elevated in the suprafascial or super-thin plane. Methods Retrospective review of ALT free flap reconstruction from October 2014 to July 2016 was performed. Suprafascial and super-thin flaps were those elevated just above the crural fascia and within the superficial scarpal plane, respectively. Adjunct operative procedures, demographics, and complications were recorded. Results A total of 25 patients underwent suprafascial (n = 14) or super-thin (n = 11) ALT flap reconstruction for primarily lower extremity wounds (n = 19), with an average age and body mass index of 53.8 years and 26.3 kg/m2, respectively. Follow-up was 6.3 months. Comorbidities included smoking (n = 7), diabetes (n = 8), peripheral vascular disease (n = 6), and hypertension (n = 8). The presence of hardware (n = 9), trauma (n = 10), and chronic infection (n = 12) were common risk factors. Average flap size was 8.2 × 21.5 cm, with 64% (n = 16) taken on one perforator. Forty-eight percent (n = 12) were end-to-side anastomoses and 62% (n = 13) utilized one venous anastomosis. Mean hospital stay was 7.8 days with a 24% (n = 6) complication rate. There were no partial or complete flap losses. Conclusion The ALT flap, elevated in a suprafascial or super-thin plane, is a safe, effective option for extremity soft tissue reconstruction. The decreased flap volume and bulk provides the improved contour and pliability necessary for appropriate distal extremity function. The potential versatility of super-thin flaps reinforces the importance of continued innovation by reconstructive microsurgeons.

Combined Single-Stage Osseous and Soft Tissue Reconstruction of the Tibia With the Ilizarov Method and Tissue Transfer

2008 ◽  
Vol 22 (3) ◽  
pp. 183-189 ◽  
Author(s):  
Michael D McKee ◽  
Daniel J Yoo ◽  
Rad Zdero ◽  
Marc Dupere ◽  
Lisa Wild ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Single Stage ◽  
Ilizarov Method ◽  
Soft Tissue Reconstruction ◽  
Tissue Transfer ◽  
Tissue Reconstruction

Achilles Tendon Region Defects: Delayed Composite Anterolateral Thigh Flap With Stripping of Fascia Lata: A Case Series

2020 ◽  
Vol 66 (12) ◽  
pp. 13-22
Author(s):  
Cesare Tiengo ◽  
Regina Sonda ◽  
Andrea Monticelli ◽  
Francesco Messana ◽  
Alberto Crema ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Short Form ◽  
Case Series ◽  
Fascia Lata ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Reconstruction ◽  
Medical Outcomes ◽  
Anterolateral Thigh ◽  
Tissue Reconstruction

Defects of the Achilles tendon that include the surrounding soft tissue represent a challenge due to complex functionality and biomechanics. PURPOSE: The purpose of this study was to evaluate the functional and physical functioning score outcomes of patients following microsurgical reconstruction of the yarrow region, using a combination of objective, subjective, and semi-subjective measurements. METHODS: Between 2007 and 2018, 15 patients underwent delayed Achilles tendon region reconstruction with different anterolateral thigh flap types. Seven (7) patients underwent tendon and soft tissue reconstruction with a chimeric anterolateral thigh flap (ALT) and rolled-up fascia lata, and 8 patients underwent soft tissue reconstruction and only tendon coverage with fascia lata. Follow-up assessments included maximal range of motion (MROM) (plantarflexion and dorsiflexion), the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale score, and the Medical Outcomes Study 36-item Short-Form Health Survey physical functioning subscore. RESULTS: A total of 15 patients (11 males and 4 females with a mean age of 39.86 years) were evaluated during a mean follow-up time of 23 months (SD = 7.12). The MROM for plantarflexion and dorsiflexion was 42.71 degrees (SD = 2.9) and 24.8 degrees (SD = 4.29), respectively, in patients who underwent composite ALT with a rolled-up fascia lata. The MROM for plantarflexion and dorsiflexion was 43 degrees (SD = 5.37) and 27.37 degrees (SD = 3.2), respectively, in patients who underwent fasciocutaneous ALT. The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score was 82 for the first group and 86.87 for the second, whereas the mean Medical Outcomes Study 36-item Short-Form Health Survey scores were 82.57 and 81.5, respectively, for the 2 groups. Statistical analysis showed no significant difference between the 2 groups. CONCLUSIONS: The results of this case series suggest that the single-stage composite reconstruction with a fasciocutaneous flap with or without a strip of fascia lata is a safe and reliable strategy for composite reconstruction of the Achilles tendon region. Additional studies to evaluate these outcomes and instruments to evaluate functioning are necessary.

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