[Use of pedicled dorsal muscle flap combined with negative pressure therapy in the management of postpneumonectomy septic complications]. / Utilisation du lambeau de muscle grand dorsal pédiculé combiné à la thérapie à pression négative dans la prise en charge des complications septiques post-pneumonectomie.

SUBJECT: The objective of this study is to report our experience in the management of septic complications arising from pulmonary resection surgery by placing a pedicled upper back muscle flap associated with dressings by therapy. Negative pressure in all patients supported in our center from November 2015 to March 2018. MATERIAL AND METHODS: Characteristics of fourteen patients with a pedicled dorsal muscle flap in the context of chronic empyema associated with bronchopulmonary fistula were identified. Flap placement time, complications, and success rate were assessed. RESULTS: The median flap placement after completion of the open window thoracostomy was 19days [3-65]. The median healing time was 3months. Healing was definitively achieved in 12 patients, a success rate of 86%. CONCLUSION: Through this series we have shown that our coverage by pneumonectomy cavity coverage with an early dorsal muscle flap associated with negative pressure therapy, has a similar mortality rate and success rate to those found in the literature.

Pedicled Serratus Anterior Flap as an Alternative Muscle Target for Targeted Muscle Reinnervation in Transhumeral Amputees.

Upper limb amputation is a universally devastating injury that results in substantial loss of function. Myoelectric prostheses represent a new generation of battery-powered programmable prostheses controlled by EMG signals. The aim of upper limb targeted muscle reinnervation (TMR) is to enhance the control of a myoelectric prosthesis by improving the number and quality of EMG signals that can be used to control prosthetic elbow, wrist, and hand movements. Current TMR techniques rely on preservation of parts of biceps and triceps to be used as reinnervated muscle targets. However, a subset of amputations exists in which the proximity or mechanism of injury results in loss of these local muscle targets, making these techniques less suitable. Alternative muscles beyond the zone of injury must be sought and imported as targets for residual nerves. Through its neurovascular anatomy and physical structure, the serratus anterior offers multiple potential targets in close vicinity to the upper limb, making the creation of additional signals through a single flap achievable in this challenging scenario. We present our technique using a pedicled serratus anterior muscle flap as an alternative muscle target in transhumeral amputees undergoing TMR.

Multivector functioning muscle transfer using superficial subslips of the serratus anterior muscle for longstanding facial paralysis.

Various donor muscles have been identified for restoring facial function due to longstanding facial paralysis. Donor muscles such as the gracilis and latissimus dorsi are frequently used and often produce one or two reliable vectors of force. However, there are drawbacks of using these muscles, including the instability of separating multivector functioning muscle units and limited amount of muscle contraction. Serratus anterior muscle transfer has the advantages of multiple independently functioning motor units that can be created with a single neurovascular pedicle. This article describes multivector muscle transfer using two or three superficial subslips of the serratus anterior muscle on a single neurovascular pedicle to produce an esthetic smile that is customized to imitate the function of the contralateral mimetic muscles. Twelve patients who had longstanding unilateral facial paralysis underwent muscle transfer consisting of multivector superficial subslips of the serratus anterior muscle innervated by the ipsilateral masseteric nerve. The procedure had an uneventful postoperative course, and patients obtained excellent results, with sufficient upper lip excursion, mouth angle, and lower lip working simultaneously. Functioning muscle transfer using multivector superficial subslips of the serratus anterior muscle is effective for treating longstanding facial paralysis. This technique avoids postoperative bulkiness of the cheek muscle and achieves a more natural and symmetrical smile.

Effect of Concentrated Growth Factor on Survival of Diced Cartilage Graft.

BACKGROUND: Diced cartilage grafts are important in rhinoplasty for raising the dorsum and eliminating dorsal irregularities. The most common problems with the use of diced cartilage are wrapping and cartilage resorption. OBJECTIVES: To histopathologically investigate and compare the viability of diced cartilage grafts wrapped with concentrated growth factor, fascia and fenestrated fascia, or blood glue. METHODS: Cartilage grafts were harvested from the ears of 10 New Zealand White rabbits and diced into 0.5 to 1 mm3 pieces. The grafts were divided into five groups for comparison: (1) bare diced cartilage; (2) diced cartilage wrapped with fascia; (3) diced cartilage wrapped with fenestrated fascia; (4) diced cartilage wrapped with concentrated growth factor (CGF); and (5) diced cartilage wrapped with blood glue. Each of the five grafts was autologously implanted into a subcutaneous pocket in the back of each rabbit. Three months later, the rabbits were sacrificed and the implants were harvested and examined histopathologically. RESULTS: Nucleus loss, calcification, inflammation, and giant cell formation differed significantly between the CGF group and both fascia groups. Chondrocyte proliferation was the highest in the CGF group. Nucleus loss rates were similar between the fascia and fenestrated fascia groups. CONCLUSIONS: Our findings suggest that CGF improves the viability of diced cartilage grafts, while fascia hampers it. Punching holes in the fascia does not improve diced cartilage graft viability and neither does blood glue wrapping.

Chest wall reconstruction with latissimus dorsi and an autologous thoracolumbar fascia graft in a dog.

A new technique for autogenous chest wall reconstruction using a latissimus dorsi muscle flap and a free graft of thoracolumbar fascia was utilised in a two-year-old Dobermann after resection of a high-grade osteosarcoma from the left thoracic wall. En bloc excision of the chest wall mass, including six ribs, was performed. The resulting chest wall defect was too large to be reconstructed with only a pedicled muscle flap and was reconstructed with a latissimus dorsi muscle flap cranially and a free graft of thoracolumbar fascia caudally. The graft was harvested easily, and there was no donor site morbidity or postoperative complications. A free graft of thoracolumbar fascia can be considered as an option to supplement autogenous reconstruction of the chest wall.

Use of the serratus anterior muscle flap for postoperative empyema -- a single center experience with 25 consecutive cases.

OBJECTIVE: The aim of this study is to analyse the possibilities and the results of using the serratus anterior muscle flap during reoperations in patients with a complicated course after major general thoracic procedures. MATERIAL AND METHODS: We performed a retrospective study on 25 consecutive patients operated in a single center between 01.01.2002-01.01.2012, in whom we used the serratus anterior muscle flap during complex thoracomyoplasty procedures for postoperative empyema. In all cases the serratus anterior was mobilized keeping both the thoraco-dorsal branch and the lateral thoracic vessels intact. The following parameters were followed: mortality rate, morbidity rate, hospitalization,viability of the flap and the functional status of the patients at 3 months after surgery. RESULTS: We encountered one postoperative death (4%) and one recurrence of the intrathoracic suppuration (4%). Intensive care unit hospitalization ranged between 1-9 days, with a median of 2 days. Overall postoperative hospitalization ranged between 8-87, with a median of 34 days. We have encountered no post-operative flap necrosis. At 3 months after surgery, 92% of the survivors returned to a normal life. The type of the first thoracotomy incision (postero-lateral versus antero-lateral) had no statistically significant impact on the outcome of the patients' hospitalization or rate of local complications(p 0.05). CONCLUSIONS: As a pure muscular flap, the serratus anterior is extremely useful to treat infectious complications after general thoracic surgery procedures. It can be used during thoracomyoplasty procedures with an acceptable mortality and morbidity and with good functional results.