Defektdeckung: Stufenweise Modifikation der Lappenpräparation bringt Vorteile

2020 ◽  
Vol 8 (2) ◽  
pp. 58-59
Author(s):  
Marc André Quambusch ◽  
Michael Sand
Keyword(s):  
Soft Tissue ◽  
Wound Dehiscence ◽  
Skin Lesions ◽  
Tumor Ablation ◽  
Skin Tumor ◽  
Selection Strategy ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Average Size ◽  
Tissue Defects

Skin cancer and precancerous skin lesions cause significant soft-tissue defects following tumor ablation. Recently, keystone flaps have gained popularity due to their simplicity, versatility, and reliability. We evaluated the efficacy of modified keystone flaps for soft-tissue reconstruction following skin tumor ablation in 2 medical centers. We reviewed the medical records of patients who received modified keystone flaps following the removal of skin tumors from January 2017 to December 2017. The diagnosis, site, flap size, and complications were recorded. Forty-one modified keystone flaps were evaluated, and the wound dimensions ranged from 1 cm × 1 cm to 18 cm × 9.5 cm, with an average size of 9.8 cm × 6.4 cm. With our selection strategy, specific modified keystone flaps were designed for the soft-tissue defects. The flap dimensions ranged from 2.2 cm × 1 cm to 26 cm × 10 cm, with an average size of 14.3 cm × 7.5 cm. Two patients developed minor wound dehiscence (4.9%), and 1 patient developed partial flap loss (2.4%), but all of these patients healed after local wound care without the need for surgical intervention. Our selection strategy for modified keystone flaps is a feasible and reliable option for reconstruction following skin tumor excision.

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.

The Application of Distally Pedicled Peroneus Brevis Muscle Flaps and Retrograde Neurocutaneous Accompanying Artery Flaps for Treatment of Bony and Soft-Tissue 3-Dimensional Defects of the Lower Leg and Foot

2013 ◽  
Vol 12 (1) ◽  
pp. 53-62 ◽  
Author(s):  
Xiao-hua Hu ◽  
Wei-li Du ◽  
Zhong Chen ◽  
Ming Li ◽  
Cheng Wang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Muscle Flap ◽  
Lower Leg ◽  
Soft Tissue Defects ◽  
Muscle Flaps ◽  
3 Dimensional ◽  
Peroneus Brevis ◽  
Average Size ◽  
Thorough Debridement ◽  
Tissue Defects

To investigate the clinical effect of distally pedicled peroneus brevis muscle flaps and retrograde neurocutaneous flaps on treatment of bone and soft-tissue 3-dimensional defects of the lower leg and foot, the authors retrospectively studied all the patients admitted in their center in 3 consecutive years with bone and soft-tissue defects from March 2008 to February 2011; 21 patients suffering from traumatic and osteomyelitis were treated with peroneus brevis muscle flaps, for obliterating the hole-shaped bony defects after osteomyelitis debridement, and neurocutaneous flaps, for repairing associated soft-tissue defects. After thorough debridement, the average size of soft-tissue defects was 2 cm × 2 cm to 13 cm × 9 cm and that of bony defects was 2 cm × 2 cm × 2 cm to 6 cm × 3 cm × 3 cm. Neurocutaneous flaps completely survived in 20 cases, and the wounds healed at stage I; 1 case developed necrosis in the distal part of the peroneus brevis muscle flap and sural nerve flap, and the wound healed with a saphenous nerve flap. The flaps maintained good texture and shape during a follow-up of 6 to 24 months. Recurrence of osteomyelitis was not observed in any of the patients. In conclusion, distally pedicled peroneus brevis muscle flaps and retrograde neurocutaneous flaps are simple, safe, reliable, and suitable for clinical treatment of hole-shaped bony defects and reconstruction of soft-tissue defects within a single stage, especially when the 2 defects are located in different 3-dimensional spaces.

scholarly journals Revisiting the Trapezius Flap as a Reconstructive Option for Cervico-Occipital and Thoracic Spine Regions

2019 ◽  
Vol 52 (03) ◽  
pp. 322-323
Author(s):  
Ravikiran Naalla ◽  
Vijay Murthy ◽  
Shashank Chauhan ◽  
Kavya Chinta ◽  
Maneesh Singhal
Keyword(s):  
Soft Tissue ◽  
Thoracic Spine ◽  
Graft Loss ◽  
Wound Dehiscence ◽  
Free Flaps ◽  
Good Alternative ◽  
Soft Tissue Defects ◽  
Reconstructive Option ◽  
Upper Thoracic ◽  
Tissue Defects

Abstract Introduction Reconstruction of complex soft tissue defects around the cervico-occipital and thoracic spine regions is a challenging task. We want to share our experience with trapezius flap for the reconstruction of these complex cases. Materials and Methods A retrospective analysis of patients who underwent reconstruction using trapezius flaps from January 2016 to June 2019 was performed. The indications, technique, complications, and outcomes were analyzed and presented. Results Six patients (three males and three females, >10 years of age) underwent seven reconstructions using trapezius flaps (one of the patients underwent reconstruction using a bilateral trapezius flap). Trapezius flap was used to resurface the parieto-occipital (n = 2), cervico-occipital (n = 2), cervicothoracic (n = 1), and thoracic (n = 1) regions. All flaps showed successful outcomes; one patient had wound dehiscence, and one patient had partial skin graft loss. Conclusion Trapezius flap is a reliable and good alternative to free flaps for the coverage of complex cervical-occipital and upper thoracic soft tissue defects.

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 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 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.

scholarly journals Thoracodorsal artery perforator fasciocutaneous flap: A versatile alternative for coverage of various soft tissue defects

2012 ◽  
Vol 45 (03) ◽  
pp. 478-484 ◽  
Author(s):  
Celalettin Sever ◽  
Fatih Uygur ◽  
Yalcin Kulahci ◽  
Huseyin Karagoz ◽  
Cihan Sahin
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Reconstruction Method ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Reconstructive Procedures ◽  
Thoracodorsal Artery ◽  
Tdap Flap ◽  
Artery Perforator ◽  
Tissue Defects

ABSTRACT Objective: The thoracodorsal artery perforator (TDAP) flap has contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous tissue. The optimal reconstruction method should provide thin, and well-vascularized tissue with minimal donor-site morbidity. The indications for the use of this particular flap with other flaps are discussed in this article. Materials and Methods: Thirteen patients underwent soft tissue reconstruction using TDAP flaps between 2009 and 2011. Of those, there were four cases of antecubital burn contracture, three cases of axillary burn contracture, two cases of giant hair cell nevus of upper extremity, two cases of axillary reconstruction following severe recurrent hidradenitis, and two cases of crush injury. All patients were male and their ages ranged from 20 to 23 (average, 21 years). The mean follow-up period was 8 months (range, 4-22 months). Results: All reconstructive procedures were completed without any major complications. Minor complications related to transfered flaps were wound dehiscence in one case, transient venous congestion in two cases. Minor complication related to the donor site was seroma in one case. The success rate was 100%, with satisfactory cosmetic results. Conclusions: The TDAP flap is a safe and extremely versatile flap that offers significant advantages in acute and delayed reconstruction. Although the vascular anatomy may be variable, free and pedicled TDAP flap is a versatile alternative for soft tissue defects. It adapts very well to the soft tissue defects with acceptable donor site scar.

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.

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