Occipito-Cervico-Dorsal Flap for Neck Reconstruction After Postburn Contractures: A Case Report and Literature Review.

Because the head and neck are one of the most frequent locations of burns, it is of paramount importance that plastic surgeons and plastic surgical nurses understand the most effective surgical methods for treating neck contractures and the reconstructive technique required for each case. We introduce the case of a 42-year-old woman who presented with a severe postburn neck contracture that was reconstructed with a pedicled occipito-cervico-dorsal flap. We closed the donor-site wound primarily and completely covered the defect with good results. In addition to conventional skin grafts, dermal matrices, and microsurgical techniques, using an occipito-cervico-dorsal flap should be considered for reconstructing postburn neck contractures as it offers good aesthetic and functional outcomes, provides enough tissue and pliable skin, and results in minimal donor-site morbidity.

Reconstruction of a Large Thoracic Radiation-Induced Ulcer Using a Free Extended Vertical Rectus Abdominis Myocutaneous Flap.

Radiation therapy-induced skin ulcers are complex wounds that are unable to heal spontaneously. This affects the patient's quality of life and poses a major health problem. The most reliable curative treatment involves extensive debridement of the affected tissue and covering the wound with well-vascularized tissue. We report the case of a 76-year-old woman with a huge clavicle osteoradionecrosis ulcer that required complex resection and reconstruction with an extended vertical rectus abdominis myocutaneous flap.

Anterolateral Thigh Free Flap Donor-Site Morbidity: A Retrospective Cohort Study.

The ability to achieve a good functional outcome, quality of life, and patient satisfaction related to the donor site of free flaps is an important factor in flap selection. One of the main advantages of an anterolateral thigh (ALT) free flap is its minimal donor-site morbidity. We conducted a study to analyze healing of ALT flap donor sites based on the type of closure. A total of 65 patients were included in the study. We divided the participants into two cohorts (i.e., primary closure [n = 51] and skin grafting [n = 14]). There were no statistically significant differences between the two cohorts relative to age, gender, or risk factors for wound healing (e.g., tobacco use, obesity, diabetes mellitus, and cardiovascular disease). We found there was a statistically significant difference (p < .05) between the mean donor-site wound healing time in the primary closure group (n = 51; 22.41 days [±9.94]) compared with the skin grafting group (n = 14; 54.57 days [±21.59]). To reduce wound healing time, improve cosmetic results, and increase functional outcomes in patients undergoing ALT free flap, we recommend using primary closure for the donor sites and avoiding skin grafting whenever possible.

Vram flap transposition in pelviperineal reconstruction. A technical note.

The vertical rectus abdominis myocutaneous flap is a workhorse flap for perineal reconstruction after pelvic exenteration with low rate of complications. When flap viability is compromised, it is principally due to an incorrect inset or inadequate postoperative care. The aim of this article is to specify the technical details that must be taken into account during VRAM flap transposition inside the pelvis. Flap rotation will be completely different depending on two key factors: the resultant perineal defect after tumor resection and whether the patient is in the supine or prone position during the surgery. We expose an algorithmic approach to have in mind at the moment of the flap inset, step by step, in order not to compromise the vascular pedicle. In anterior perineal defects, we propose to rotate the flap 270º in the sagittal plane. In such manner, the cranial part of the flap covers the most anterior part of the defect, optimizing the arc of rotation of the flap. In posterior perineal defects, rotating the flap 180º in the coronal plane avoids tension on the pedicle. As a result, the cranial part of the flap covers the most posterior part of the defect. In our experience, these technical notes aid to guarantee the viability of the flap when performing perineal reconstructions, preventing from torsion or tension on the epigastric vessels during its transposition inside the pelvis.

IGF-I/PI3K/Akt and IGF-I/MAPK/ERK pathways in vivo in skeletal muscle are regulated by nutrition and contribute to somatic growth in the fine flounder.

The insulin-like growth factor-I (IGF-I) is a key regulator of skeletal muscle growth in vertebrates, promoting mitogenic and anabolic effects through the activation of the MAPK/ERK and the PI3K/Akt signaling pathways. Nutrition also affects skeletal muscle growth, activating intracellular pathways and inducing protein synthesis and accretion. Thus, both hormonal and nutritional signaling regulate muscle mass. In this context, plasma IGF-I levels and the activation of both pathways in response to food were evaluated in the fine flounder using fasting and refeeding trials. The present study describes for the first time in a nonmammalian species that the MAPK/ERK and PI3K/Akt are activated by exogenous circulating IGF-I, as well as showing that the MAPK/ERK pathway activation is modulated by the nutritional status. Also, these results show that there is a time-dependent regulation of IGF-I plasma levels and its signaling pathways in muscle. Together, these results suggest that the nutritionally managed IGF-I could be regulating the activation of the MAPK/ERK and the PI3K/Akt signaling pathways differentially according to the nutritional status, triggering different effects in growth parameters and therefore contributing to somatic growth in fish. This study contributes to the understanding of the nutrient regulation of IGF-I and its signaling pathways in skeletal muscle growth in nonmammalian species, therefore providing insight concerning the events controlling somatic growth in vertebrates.