RESUMEN
Pleomorphic hyalinizing angiectatic tumor of soft tissue (PHAT) is a rare, low-grade neoplasm of uncertain lineage that predominantly affects the lower limbs of middle-aged adults. We report the case of a male in his early 20s who presented with a progressively enlarging, mildly tender mass above the right knee, present for 6 years. Imaging studies revealed a well-circumscribed lesion with obvious contrast enhancement on magnetic resonance imaging and marked internal vascularity on color Doppler ultrasound, located anterior to the distal quadriceps femoris. Extended excision was performed, and histopathologic examination confirmed the diagnosis of pleomorphic hyalinizing angiectatic tumor of soft tissue with negative surgical margins (R0 resection). The patient remained disease-free at the short-term follow-up (as of mid-2025). This report highlights the clinicopathologic features that differentiate pleomorphic hyalinizing angiectatic tumor of soft tissue from mimics such as myofibroma and intramuscular hemangioma, particularly in younger patients and at unusual anatomical locations.
Asunto(s)
Neoplasias de los Tejidos Blandos , Muslo , Humanos , Masculino , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/diagnóstico , Muslo/patología , Muslo/diagnóstico por imagen , Muslo/cirugía , Adulto , Imagen por Resonancia Magnética , Diagnóstico Diferencial , Hialina/metabolismoRESUMEN
Vascular malformations often become symptomatic during childhood and require multidisciplinary intervention. However, reports of resection followed by free flap reconstruction in pediatric patients remain rare. We report two toddler cases of vascular malformations reconstructed with free anterolateral thigh (ALT) flaps. Case 1 was a 2-year-old boy with a submandibular venous malformation complicated by coagulopathy. After lesion resection with overlying skin (5 × 10 cm), an ALT flap (5.5 × 12 cm) was transferred. The flap artery was interposed with the transected facial artery, and the veins were anastomosed end-to-side to the internal and external jugular veins. The flap survived completely, and coagulation parameters normalized. Case 2 was a 3-year-old boy with a painful forearm ulcer caused by a capillary lymphatic venous malformation. After ulcer debridement (5.5 × 13 cm), the defect was reconstructed with an ALT flap (6 × 14 cm). The flap vessels were anastomosed to the radial artery and its concomitant veins in a flow-through manner. Partial flap necrosis required secondary wound closure, but the ulcer did not recur, and the pain resolved completely. No anastomotic failure or donor-site complications occurred in either case. Extensive resection followed by ALT flap reconstruction is a reliable option for pediatric vascular malformations. Meticulous microvascular techniques and multiple anastomoses may reduce microvascular complications in young patients.
Asunto(s)
Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Malformaciones Vasculares , Humanos , Masculino , Preescolar , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/trasplante , Malformaciones Vasculares/cirugía , Procedimientos de Cirugía Plástica/métodos , Muslo/cirugíaRESUMEN
INTRODUCTION: The aim of this study was to specify the morphology and relative importance of the types of arterial anastomoses between the different perforasomes constituting the anterolateral thigh (ALT) flap vascular tree. METHODS: 15 ALT flaps were injected on a single perforator with epoxy resin and then analyzed via 3D CT microangiography. Data were processed using a broad binary threshold based on the Hounsfield density of the various contrast-enhanced arteries. A virtual dissection of the 3D images associated with a virtual segmentation of the flap's vascular tree was then performed, enabling direct visualization of the various means of connection between the different perforasomes. RESULTS: The average surface area of the flap's vascular territory was 190.5â¯cm2. THE VARIOUS PERFORASOMES WERE LINKED VIA: 40â¯% of mixed anastomoses including both arteries from the subdermal plexus AND the suprafascial plexus, 35â¯% of exclusively suprafascial anastomoses, 25â¯% of exclusively subdermal anastomoses. Some connections via the dermal plexus could be identified, but their relative importance could not be established. No subcutaneous plexus connections were identified. DISCUSSION / CONCLUSION: This study demonstrates that ALT constitutive perforasomes are mostly linked with each other via anastomosing arteries located in the suprafascial plexus. The debulking of ALT flaps must take this data into account in order to preserve the supra fascial plexus linking arteries as much as possible to avoid loss of vascular territory and marginal necrosis of the flap in vivo.
Asunto(s)
Colgajo Perforante , Muslo , Humanos , Muslo/anatomía & histología , Muslo/irrigación sanguínea , Muslo/cirugía , Muslo/diagnóstico por imagen , Masculino , Femenino , Resinas Epoxi , Colgajo Perforante/irrigación sanguínea , Microdisección/métodos , Persona de Mediana Edad , Imagenología Tridimensional , Anciano , Arterias/anatomía & histología , AdultoRESUMEN
BACKGROUND: Free flap reconstruction (FFR) following transoral robotic surgery (TORS) is commonly performed using radial forearm free flaps (RFFF). This study compares patterns of functional recovery between RFFFs and anterolateral thigh flaps (ALTFs). METHODS: Retrospective cohort study of patients with oropharyngeal cancer who underwent TORS with FFR (2010-2023) at a tertiary care center. A 1:4 ALTF:RFFF propensity score match was performed. Functional Oral Intake Scale (FOIS) assessed outcomes. RESULTS: The 105 patients were included. ALTF patients had lower FOIS at 6 months (3[2.0, 5.0] vs. 5.0[2.0, 6.0], p = 0.045) and 1 year (5.0[2.0, 6.0] vs. 6.0[5.0, 6.8], p = 0.045), with higher PEG tube rates. ALTFs were used for larger defects (62.95 ± 20.25 cm2 vs. 51.17 ± 15.11 cm2, p = 0.014). Donor site morbidity or postoperative complications were similar between cohorts. CONCLUSIONS: ALTFs are suitable for larger defects and lead to slower early functional recovery with higher PEG tube rates compared to RFFFs, with no difference in complications.
Asunto(s)
Colgajos Tisulares Libres , Neoplasias Orofaríngeas , Procedimientos de Cirugía Plástica , Procedimientos Quirúrgicos Robotizados , Humanos , Colgajos Tisulares Libres/trasplante , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Muslo/cirugía , Antebrazo/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias Orofaríngeas/cirugía , Neoplasias Orofaríngeas/patología , Procedimientos de Cirugía Plástica/métodos , Anciano , Recuperación de la Función , Resultado del Tratamiento , Puntaje de Propensión , Complicaciones PosoperatoriasRESUMEN
OBJECTIVES: This study compares the outcomes of free ileocolonic and tube-shaped anterolateral thigh (ALT) fasciocutaneous flaps in reconstructing total hypopharyngeal defects. METHODS: A retrospective analysis was conducted on 76 patients who underwent reconstruction with either an ileocolonic flap (n = 20) or a tube-shaped ALT flap (n = 56) between 2011 and 2021. Primary outcomes included dietary tolerance at 1 and 3 years, pharyngocutaneous fistula rates, and survival. Statistical analyses assessed group differences in complications and dietary restrictions. RESULTS: The ileocolonic flap group demonstrated superior dietary outcomes at 1 and 3 years (90% vs. 62.5% and 90% vs. 51.4%, respectively) but had a higher fistula rate (25% vs. 7.1%, p = 0.048). No significant differences in survival were observed between the groups. CONCLUSION: The ileocolonic flap offers better long-term dietary outcomes despite higher early fistula rates. Further research is recommended to optimize flap selection for hypopharyngeal reconstruction.
Asunto(s)
Colgajos Tisulares Libres , Neoplasias Hipofaríngeas , Hipofaringe , Procedimientos de Cirugía Plástica , Humanos , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Anciano , Neoplasias Hipofaríngeas/cirugía , Neoplasias Hipofaríngeas/mortalidad , Neoplasias Hipofaríngeas/patología , Colgajos Tisulares Libres/trasplante , Adulto , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Hipofaringe/cirugía , Íleon/trasplante , Colon/trasplante , Fístula Cutánea/epidemiología , Fístula Cutánea/etiología , Muslo/cirugíaRESUMEN
Gepotidacin is a novel first-in-class triazaacenaphthylene antibiotic developed for the treatment of uncomplicated gonorrhea and uncomplicated urinary tract infections (uUTIs). To support uUTI, in vivo pharmacokinetics (PK)/pharmacodynamics (PD) studies have been conducted in the murine neutropenic thigh infection model evaluating gepotidacin against 17 isolates of Escherichia coli and 7 isolates of Klebsiella pneumoniae having MICs of 0.25 to 16 µg/mL. Exposure data were fit using a population PK model, and efficacy data were fit with an inhibitory effect sigmoid Imax model using free-drug area under the concentration-time curve (fAUC)/MIC as the primary index. The ratios associated with response were determined for each isolate, and the median fAUC/MIC (excluding strains with <1-log of growth from baseline) was 13. To retain the data for all isolates, an exploratory analysis was conducted using different criteria to determine the target for strains with <1-log of growth (6 of the 24 strains tested). While the median fAUC/MIC was similar regardless of the criteria used, this analysis highlights the importance of critically reviewing PK/PD data for trends related to isolate characteristics and/or individual study outputs. As previously reported, the systemic targets determined from PK/PD studies were applied to urine concentrations for probability of target attainment analyses, which led to successful clinical trials and regulatory approval for gepotidacin in the treatment of uUTI. However, further work is needed to confirm the translational validity of these approaches on a broader scale and their application in establishing PK/PD targets for cystitis.
Asunto(s)
Acenaftenos , Antibacterianos , Infecciones por Escherichia coli , Escherichia coli , Compuestos Heterocíclicos con 3 Anillos , Infecciones por Klebsiella , Klebsiella pneumoniae , Neutropenia , Klebsiella pneumoniae/efectos de los fármacos , Animales , Escherichia coli/efectos de los fármacos , Ratones , Antibacterianos/farmacocinética , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Pruebas de Sensibilidad Microbiana , Muslo/microbiología , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/microbiología , Acenaftenos/farmacocinética , Acenaftenos/farmacología , Acenaftenos/uso terapéutico , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Compuestos Heterocíclicos con 3 Anillos/farmacocinética , Compuestos Heterocíclicos con 3 Anillos/farmacología , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Femenino , Neutropenia/microbiología , Neutropenia/tratamiento farmacológico , Modelos Animales de Enfermedad , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiologíaRESUMEN
BACKGROUND: Limb salvage surgery for thigh soft tissue sarcomas (STSs) involving the femoral vasculature often necessitates arterial reconstruction. However, whether femoral vein reconstruction is needed remains controversial. PURPOSES: This study aimed to evaluate the outcomes of limb salvage procedures utilizing femoral vessel replacement in patients diagnosed with thigh soft tissue sarcomas involving the femoral vasculature. METHOD: We conducted a retrospective review of patients with thigh STSs who underwent limb salvage surgery and vascular reconstruction. Twelve patients were enrolled and divided into two groups on the basis of whether femoral vein was reconstructed. Five received femoral artery and vein reconstruction (group A) and seven were treated with femoral artery reconstruction alone (group B). In our cohort, vascular reconstructions were predominantly performed with prosthetic grafts due to the unavailability of suitable autologous conduits or patient preference, while only two patients received autologous venous grafts. We used the Enneking and Musculoskeletal Tumor Society (MSTS) systems to stage our patients. We assessed complications, MSTS function, local recurrence and survival. RESULTS: All patients were Enneking IIB. A wide margin excision was achieved in all patients. The great saphenous vein was preserved in group A (2/5) and group B (3/7). The mean age of the patients for group A and group B was 50.8 and 43.7 years, respectively. The median follow-up period for group A and group B was 50 months (range, 30-77 months) and 43 months (range, 24-62 months), respectively. The mean operation time of Group B was substantially less than that of group A (P<0.05). There was a significant difference in the venous embolism rate between group A(3/5) and group B in the perioperative period. No significant differences were found between the two groups in terms of hematoma formation, delayed wound healing, incision infection rate, reoperation rate, overall disease-free survival, 2-year arterial patency rate and limb salvage rate. No patient had local recurrence and one case in group B developed metastasis. The mean Musculoskeletal Tumor Society score of group A and group B at the final follow-up was 23 points and 25 points, respectively. CONCLUSIONS: Femoral arterial reconstruction alone effectively treats thigh STSs involving the femoral vasculature while femoral vein reconstruction does not significantly improve management in these cases. LEVEL OF EVIDENCE: IV.
Asunto(s)
Vena Femoral , Recuperación del Miembro , Procedimientos de Cirugía Plástica , Sarcoma , Neoplasias de los Tejidos Blandos , Muslo , Procedimientos Quirúrgicos Vasculares , Humanos , Vena Femoral/cirugía , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Adulto , Recuperación del Miembro/métodos , Recuperación del Miembro/efectos adversos , Sarcoma/cirugía , Sarcoma/mortalidad , Sarcoma/patología , Muslo/cirugía , Muslo/patología , Resultado del Tratamiento , Procedimientos de Cirugía Plástica/métodos , Anciano , Arteria Femoral/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
Objective:To investigate the clinical effect of free anterolateral thigh myocutaneous flap combined with oral repair membrane in the reconstruction of nasal mucosa defect after maxillary malignant tumor surgery. Methods:A total of 12 patients with maxillary gingival squamous cell carcinoma and maxillary sinus cancer who had been treated in Department of Oral and Maxillofacial Surgery, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, were selected from November 2020 to November 2023. Free anterolateral thigh musculocutaneous flap transplantation combined with oral repair membrane were used in all patients. Meanwhile, maxillary soft and hard tissue defects and nasal mucosa defects left after tumor operation were repaired and reconstructed. The clinical effect was evaluated after 6-12 months follow-up. Results:Subtotal maxillary resection was performed in 1 case, total maxillary resection in 9 cases and extended maxillary resection in 2 cases. The musculocutaneous flaps of all patients survived, the facial appearance was basically symmetrical, no obvious depression deformity, the swallowing and speech function recovered well, the mouth and nasal cavity were closed completely, the food could be eaten through the mouth, and the lower nasal passage was not blocked. Conclusion:The free anterolateral thigh musculoflap combined with oral repair membrane can be used to repair and reconstruct maxillary malignant tumor complicated with extensive maxillary tissue and nasal mucosa defect after operation, and the appearance and function can be recovered well after operation, which is a choice for maxillary malignant tumor complicated with nasal mucosa defect.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias Maxilares , Neoplasias del Seno Maxilar , Colgajo Miocutáneo , Procedimientos de Cirugía Plástica , Humanos , Procedimientos de Cirugía Plástica/métodos , Neoplasias Maxilares/cirugía , Carcinoma de Células Escamosas/cirugía , Masculino , Persona de Mediana Edad , Femenino , Mucosa Nasal/cirugía , Maxilar/cirugía , Muslo/cirugía , Neoplasias del Seno Maxilar/cirugíaRESUMEN
Objective: To investigate the clinical application effects of indocyanine green angiography (ICGA) combined with color Doppler ultrasound (CDU) in perforator localization of anterolateral thigh perforator flaps. Methods: This study was a retrospective observational study. From January to August 2024, the Department of Hand Surgery admitted 21 patients and the Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital admitted 35 patients that met the inclusion criteria. These patients underwent surgical repair of the extremity skin and soft tissue defects using anterolateral thigh perforator flaps designed under the assistance of CDU and ICGA. Among them, there were 44 males and 12 females, aged 16 to 71 years. After debridement, the wound area ranged from 7.0 cm×5.5 cm to 40.0 cm×10.0 cm. Before surgery, CDU and ICGA were used to locate the perforators of anterolateral thigh perforator flap. The area of harvested flap ranged from 8.0 cm×6.0 cm to 40.5 cm×11.0 cm. The wounds in flap donor sites were closed directly or covered with the full-thickness skin graft from the contralateral thigh. The number of perforators located by preoperative CDU or ICGA, and the number, origin, type, and caliber of perforators in intraoperative exploration, and flap thickness were recorded. The consistency between preoperative CDU or ICGA localization results and intraoperative exploration findings was assessed. The error distances between preoperative CDU or ICGA localization and intraoperative exploration of perforator, respectively, were measured. Using intraoperative exploration of perforator as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of preoperative CDU and ICGA for perforator localization were calculated. The independent influencing factor for the consistency between CDU or ICGA localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA were screened. Results: A total of 131 perforators were located by CDU and 130 perforators were located by ICGA preoperatively. Intraoperatively, 132 perforators were explored, including 64 perforators from the oblique branch, 49 perforators from the descending branch, 9 perforators from the transverse branch, and 10 perforators from the anterior branch. Among them, 46 perforators were septocutaneous perforators and 86 perforators were musculocutaneous perforators, with a mean caliber of (0.72±0.21) mm. The flap thickness was (1.5±0.6) cm. There was no statistically significant difference in the consistency between preoperative CDU localization results and intraoperative exploration findings and ICGA localization results and intraoperative exploration findings (P>0.05). There was no statistically significant difference in the error distance between preoperative CDU localization and intraoperative exploration of perforator and preoperative ICGA localization and intraoperative exploration of perforator (P>0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ICGA and CDU in locating perforators were 92.42%, 92.00%, 93.85%, 90.20%, and 92.24%, 84.09%, 80.00%, 84.73%, 79.21%, and 82.33%, respectively. Flap thickness was an influencing factor for the consistency between preoperative ICGA localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 0.20, 95% confidence interval of 0.06-0.66, P<0.05). Perforator type was an influencing factor for the consistency between preoperative CDU localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 3.07, 95% confidence interval of 1.11-8.46, P<0.05). After adjusting for sex, age, body mass index, perforator type, and perforator caliber, flap thickness was an independent influencing factor for the consistency between preoperative ICGA localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 0.15, 95% confidence interval of 0.03-0.73, P<0.05). After adjusting for sex, age, body mass index, flap thickness, and perforator caliber, perforator type was an independent influencing factor for the consistency between preoperative CDU localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 4.25, 95% confidence interval of 1.39-12.98, P<0.05). Conclusions: The combined application of ICGA and CDU for perforator localization in anterolateral thigh perforator flaps in clinic can complete each other to improve the accuracy of localization. Flap thickness significantly affects the accuracy of ICGA localization, while perforator type significantly affects the accuracy of CDU localization.
Asunto(s)
Angiografía , Verde de Indocianina , Colgajo Perforante , Muslo , Ultrasonografía Doppler en Color , Humanos , Colgajo Perforante/irrigación sanguínea , Masculino , Femenino , Persona de Mediana Edad , Adulto , Muslo/cirugía , Muslo/diagnóstico por imagen , Anciano , Estudios Retrospectivos , Ultrasonografía Doppler en Color/métodos , Adolescente , Angiografía/métodos , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel , Adulto JovenRESUMEN
Background and Objectives: Free tissue transfer for coverage of large defects is a common technique in plastic surgery. The kind of free tissue transfer depends on various factors such as the size of the defect, type and content of missing tissue, the location, and the weight-bearing demands of the area. Instead of performing bulky muscle free flaps, another alternative has bas been considered. Materials and Methods: This is a technical experience report for ALTP Flap Surgery conducted from 2013 to 2017 which included 15 surgery reviews out of 50 based on the inclusion criteria to identify the result of aesthetical reconstruction and to include such results with the current literature. In addition to that, a narrative review of the literature has been performed using PubMed and Google Scholar by using the ALT or ALTP Flap terms to determine the current practice and to compare with our results. Results: Single-stage debridement of all defects was followed by reconstruction in all surgeries. A total of 14 Flaps succeeded (93.3%) without any complications and only one of the flaps was complicated (6.7%) with vein thrombosis which resulted in the loss of that flap, leading to another revision being performed for that particular patient. No hematoma or infection has been noted. Conclusions: Using an extended-size ALTP flap can be a reliable option for the reconstruction of the weight-bearing area of the foot and offers a good postoperative function and esthetic result without the need of further subsequent debulking procedures.
Asunto(s)
Colgajo Perforante , Procedimientos de Cirugía Plástica , Muslo , Humanos , Colgajo Perforante/cirugía , Muslo/cirugía , Procedimientos de Cirugía Plástica/métodos , Femenino , Masculino , Persona de Mediana Edad , Adulto , EstéticaRESUMEN
OBJECTIVES: To compare the postoperative complications, speech function, quality of life (QoL), overall clinical outcomes and flap volume loss of tongue reconstruction using anterolateral thigh (ALT) versus innervated-thoracodorsal artery perforator (iTDAP) flaps following hemiglossectomy for tongue squamous cell carcinoma (TSCC). MATERIALS AND METHODS: Clinical data of 130 TSCC patients who underwent tongue reconstruction with ALT or iTDAP flaps were retrospectively analyzed. We compared two types of free flaps in terms of their characteristics and associated postoperative complications (including fistula, hematoma, infection, dehiscence and lower-limb venous thrombosis). Flap volume loss was assessed based on intraoperative and postoperative measurements. The University of Washington Quality of Life (UW-QOL) questionnaire, Speech Handicap Index (SHI) questionnaire and Vancouver Scar Scale (VSS) were used to evaluate quality of life (QoL), speech function and scar appearance at 3, 6 and 12 months postoperatively. RESULTS: The harvest time and length of the vascularized pedicle with vessels of a similar diameter were similar between the iTDAP and ALT groups (p > 0.05). Additionally, the postoperative complication rate and scar appearance were not significantly different between patients who underwent reconstruction with iTDAP flaps and those who underwent reconstruction with ALT flaps (p > 0.05). Notably, iTDAP flap recipients presented significantly improved QoL scores, higher SHI scores and shorter durations of bed rest (p < 0.05). Furthermore, flap volume loss was significantly lower in the iTDAP group compared with the ALT group (p < 0.05). CONCLUSION: ITDAP flaps provide similar safety and complication rates as ALT flaps while offering better quality of life, improved speech function, shorter recovery times and lower flap volume loss, making them a viable alternative for functional tongue reconstruction. TRIAL REGISTRATION: The study was retrospectively registered at ClinicalTrials.gov (registration number: NCT06599801) on September 30, 2024.
Asunto(s)
Carcinoma de Células Escamosas , Colgajos Tisulares Libres , Colgajo Perforante , Procedimientos de Cirugía Plástica , Neoplasias de la Lengua , Lengua , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma de Células Escamosas/cirugía , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/trasplante , Colgajos Tisulares Libres/inervación , Glosectomía/métodos , Colgajo Perforante/inervación , Colgajo Perforante/irrigación sanguínea , Colgajo Perforante/trasplante , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Estudios Retrospectivos , Muslo/cirugía , Lengua/cirugía , Neoplasias de la Lengua/cirugía , Neoplasias de la Lengua/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Complex abdominal wall reconstruction (AWR) is a technically demanding procedure often required in patients with large fascial defects and significant comorbidities. When primary closure is not feasible, thigh-based flaps can provide durable soft tissue coverage and structural support. However, literature on flap-based AWR remains limited. METHODS: A retrospective cohort study of patients who underwent thigh-based AWR between 2014 and 2024 at a single tertiary center was conducted. All patients had significant loss of domain and underwent reconstruction with pedicled or free flaps, with or without mesh. Data on demographics, defect characteristics, comorbidities, surgical techniques, and postoperative outcomes were analyzed. RESULTS: Fifteen patients (9 males, 6 females; mean age 53.7 ± 7 years; BMI 30.8 ± 5.9 kg/m2) underwent reconstruction. Comorbidities were common: 53% had a smoking history, 40% had diabetes, 67% had hypertension, and 93% of patients had a median of 8 previous abdominal surgeries. Defects averaged 840 cm2 (fascial) and 504 cm2 (skin). Mesh was used in all cases, and 67% of patients required free flaps. Flap types included anterolateral thigh (ALT), chimeric, and vastus lateralis myocutaneous configurations. The median hospital stay was 15 days. Any complications occurred in 80% of patients, with 20% experiencing Clavien-Dindo (CD) grade III events. Long-term outcomes included low rates of abdominal bulge (6.7%) and fistula recurrence (7%). CONCLUSIONS: Our 10-year experience demonstrates consistent achievement of definitive fascial closure, reliable flap survival, and manageable complication rates, even in the presence of significant comorbidities and prior surgical complexity.
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Pared Abdominal , Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Pared Abdominal/cirugía , Muslo/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Tisulares Libres/trasplante , Resultado del Tratamiento , Adulto , Anciano , Mallas Quirúrgicas , Complicaciones PosoperatoriasRESUMEN
BACKGROUND: Orocutaneous fistula is a challenging postoperative complication often encountered in head and neck reconstruction, typically resulting from surgical site dehiscence, infection, or compromised flap vascularity. While the pectoralis major myocutaneous flap has historically been a reliable option for reconstruction, its failure-though uncommon-can lead to persistent fistula formation. This case highlights the effective use of combined local tissue rearrangement and free anterolateral thigh flap for successful secondary reconstruction following pectoralis major myocutaneous flap failure. CASE PRESENTATION: A 31-year-old Indian male patient, previously treated with composite resection and pectoralis major myocutaneous flap reconstruction for carcinoma of the buccal mucosa, presented with orocutaneous fistula due to pectoralis major myocutaneous flap dehiscence and partial necrosis. Conservative wound care failed to achieve closure. The patient underwent secondary reconstruction using local tissue rearrangement and a free anterolateral thigh flap. Postoperative recovery was uneventful, with successful closure of the fistula and restoration of orofacial continuity. CONCLUSION: This case underscores the importance of timely secondary intervention using free tissue transfer and local flap adjustment in managing orocutaneous fistula following pectoralis major myocutaneous failure. The combined approach provided durable closure and functional restoration, offering a viable option in complex salvage scenarios.
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Colgajos Tisulares Libres , Neoplasias de la Boca , Colgajo Miocutáneo , Fístula Oral , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Humanos , Masculino , Adulto , Muslo/cirugía , Procedimientos de Cirugía Plástica/métodos , Neoplasias de la Boca/cirugía , Complicaciones Posoperatorias/cirugía , Fístula Oral/cirugía , Fístula Oral/etiología , Músculos Pectorales/trasplante , ReoperaciónRESUMEN
BACKGROUND: There is a growing need for a more visually pleasing silhouette through non-invasive body contouring procedures. AIM: This study evaluates the use of a 1060-nm laser system equipped with a temperature detector, for non-invasive fat reduction of the female and male abdomen and female culottes and thighs, which represent the prevalent areas among individuals requiring cosmetic contouring. MATERIAL AND METHOD: A total of 20 male and 40 female patients who were considering lipolysis without invasive procedures of the abdomen and coulottes/thighs areas were treated with a 1060-nm laser system. All patients underwent 4 laser treatment sessions spaced at least 4-6 weeks apart. The study's endpoints were photographic investigations by independent blinded physicians at 3 months follow-up, screening for adverse effects, abdomen and coulotte/thighs circumference measurements, BMI, and 4-point Global Aesthetic Improvement Scale (GAIS). Clinical measurements were evaluated before (T0) and at 3 months follow-up after the last laser treatment session (Tf). RESULTS: During the entire laser treatment, the skin temperature remained below 40°C, demonstrating the safety of the study device in preserving the skin from thermal damage. Clinician assessment from the photographic investigation, GAIS, BMI and circumference mean values showed good efficacy of laser treatment and visible aesthetic results for abdomen and coulotte/thighs areas both in men and women. CONCLUSIONS: The use of 1060 nm lasers offers an alternative therapy choice for patients who demand a non-surgical, non-invasive procedure for fat reduction with no serious consequences.
Asunto(s)
Contorneado Corporal , Láseres de Estado Sólido , Lipectomía , Humanos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Muslo , Resultado del Tratamiento , Temperatura Cutánea/efectos de la radiación , Lipectomía/métodos , Lipectomía/instrumentación , Estudios de Seguimiento , Contorneado Corporal/métodos , Estética , Abdomen , Láseres de Estado Sólido/uso terapéutico , Láseres de Estado Sólido/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: Soft tissue defects around the ankle are common for orthopaedic surgeons in clinical practice. This study aimed to compare the modified sural flaps and free anterolateral thigh (ALT) flaps in terms of their ability to cover soft tissue defects, patient satisfaction, infection rates, flap ischemia, and flap sensation. METHODS: This comparative study included 40 patients (24 males and 16 females) aged 5-60 years with defects in the lower one-fifth of their leg or foot, and less than 15 cm × 15 cm in size. Group A (20 patients) underwent a modified sural flap, whereas group B (20 patients) underwent free ALT flap. The study was performed in our specialized hand and reconstructive microsurgery unit from 2021 to 2023. RESULTS: The operation time was significantly longer for the free ALT flap group compared with the modified sural flap group (P value < .01). Patient satisfaction was higher with the modified sural flap. There were no significant differences in flap ischemia or donor site complications between the 2 groups. The sensation of the flap after 1 year favored the free anterolateral thigh flaps due to sensory nerve anastomosis, but after 1.5 years, good sensation was present in both flaps. CONCLUSION: The modified sural flap demonstrated superior efficiency with shorter operative times and higher patient satisfaction, whereas the free ALT flap provided better short-term sensory outcomes because of nerve micro-anastomosis capability. Both techniques achieved equivalent sensation recovery at 18 months, suggesting the modified sural flap may be preferable for most small to medium-sized defects foot and ankle defects.
Asunto(s)
Tobillo , Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Traumatismos de los Tejidos Blandos , Colgajos Quirúrgicos , Muslo , Humanos , Adulto , Masculino , Persona de Mediana Edad , Femenino , Procedimientos de Cirugía Plástica/métodos , Muslo/cirugía , Satisfacción del Paciente , Adolescente , Traumatismos de los Tejidos Blandos/cirugía , Niño , Tobillo/cirugía , Preescolar , Tiempo Operativo , Adulto JovenRESUMEN
BACKGROUND: Free anterolateral thigh flap (ALT) surgery is critical for managing extremity soft tissue defects, but postoperative complications limit its broader application. This study aimed to develop a nomogram to predict the risk of postoperative complications following ALT surgery, improving postoperative management. METHODS: This retrospective cohort study included 909 patients who underwent ALT surgery from January 2016 to January 2024. Patients were divided into a development group (606) and a validation group (303). Multivariable logistic regression identified independent predictors of complications, which were incorporated into a nomogram. The predictive performance was evaluated using the concordance index (C-index) and receiver operating characteristic (ROC) curve analysis. RESULTS: Independent risk factors for complications included vascular crisis, incomplete hemostasis, improper vascular anastomosis, flap length, flap length-to-width ratio, and prolonged surgery time. The nomogram demonstrated excellent predictive accuracy, with AUCs of 0.910 and 0.965 in the development and validation groups, respectively. CONCLUSION: We developed a nomogram that accurately predicts the risk of postoperative complications in ALT flap surgery, helping clinicians assess patient risk and tailor treatment strategies.
Asunto(s)
Colgajos Tisulares Libres , Nomogramas , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Muslo , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnóstico , Muslo/cirugía , Factores de Riesgo , Colgajos Tisulares Libres/efectos adversos , Anciano , Adulto , Curva ROC , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Medición de Riesgo/métodosRESUMEN
Objective: To investigate the clinical efficacy of free anterolateral thigh (ALT) tissue flap transplantation with a single-vein dual-drainage system at recipient site in repairing scalp high-voltage electrical burn wounds. Methods: This study was a retrospective observational study. From January 2015 to August 2024, five patients (4 males and 1 female, aged 33-64 years) with scalp defects caused by high-voltage electrical burns who met the inclusion criteria were treated at the Department of Burns, Plastic and Wound Repair of the Fifth Hospital of Harbin. After debridement, the scalp soft tissue defects of patients ranged from 16 cm×15 cm to 21 cm×18 cm. A tissue flap consisting of skin, subcutaneous tissue, deep fascia, and part of the vastus lateralis muscle was harvested and referred to as ALT tissue flap. Among the patients, the perforators included in the tissue flap were musculocutaneous perforators in three cases and septocutaneous perforators in two cases. The source vessel was consistently the descending branch of the lateral circumflex femoral artery, and each tissue flap contained two accompanying veins. The size of the harvested ALT skin flap ranged from 17 cm×12 cm to 22 cm×13 cm, with the vastus lateralis muscle area accounting for approximately 1/4 to 1/3 of the total wound area. The descending branch of the lateral circumflex femoral artery carried by the tissue flap was anastomosed end-to-end with the recipient artery. The recipient vein was transected horizontally. The vein with better conditions in tissue flap was anastomosed end-to-end anterogradely to the proximal end of the transected recipient vein, while the other vein was anastomosed end-to-end retrogradely to its distal end, thereby establishing a single-vein dual-drainage system. In all cases, the recipient artery used for anastomosis was the superficial temporal artery; the recipient veins included the posterior auricular vein in one case, the frontal branch of the superficial temporal vein in two cases, and the parietal branch of the superficial temporal vein in the other two cases. The skin paddle of the tissue flap was used to cover the main defect, while the vastus lateralis muscle was extended to cover the remaining wound, followed by wound edge suture. The stage â wound repair was completed by directly pulling and suturing the donor site wound. At three weeks postoperatively, the stage â ¡ procedure was performed. A split-thickness skin graft was harvested from the contralateral anterolateral thigh and used to cover the exposed muscle tissue at recipient site. The tissue flap harvesting time in the stage â was recorded. After the stage â surgery, the patient's tissue flap was observed for the occurrence of vascular crises and survival, the wound healing at donor sites was observed. After the stage â ¡ surgery, the wound healing at recipient sites was observed. During follow-up, the tissue flap appearance of patients was evaluated, and sensory recovery was assessed. The complications such as infection at donor sites were recorded, and it was evaluated whether the function of the donor limb had been affected. Results: The tissue flap harvesting time for the five patients in the stage â surgery ranged from 32-41 (37±3) min. After the stage â surgery, no arterial or venous vascular crisis occurred in any tissue flap, and all tissue flaps survived completely. The wounds at donor sites healed well. After the stage â ¡ surgery, the wounds at recipient sites achieved complete healing. During the follow-up period of 7 to 24 months after surgery, all tissue flaps of patients exhibited no significant bulkiness, possessed soft texture, and survived completely with partial recovery of sensation. No complications such as infection were observed at donor sites, and the function of donor limbs remained unaffected. Conclusions: For scalp soft tissue defects caused by high-voltage electrical burns with severely compromised recipient veins, the use of a free ALT tissue flap combined with a single-vein dual-drainage system at recipient site can effectively enhance venous outflow efficiency, reduce the risk of vascular crisis, shorten operative time, and decrease donor site morbidity.
Asunto(s)
Quemaduras por Electricidad , Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Cuero Cabelludo , Trasplante de Piel , Humanos , Masculino , Quemaduras por Electricidad/cirugía , Femenino , Adulto , Estudios Retrospectivos , Cuero Cabelludo/lesiones , Cuero Cabelludo/cirugía , Persona de Mediana Edad , Muslo/cirugía , Trasplante de Piel/métodos , Procedimientos de Cirugía Plástica/métodos , Colgajos Tisulares Libres/irrigación sanguínea , Resultado del Tratamiento , Colgajos QuirúrgicosRESUMEN
BACKGROUND: Noninvasive acoustic subcision uses rapid acoustic pulse (RAP) treatment to disrupt subdermal and dermal fibrous tissue, thereby improving cellulite appearance. A prior multicenter study showed that 1 RAP treatment improved cellulite appearance 12 weeks after treatment. OBJECTIVE: To evaluate whether treatment with acoustic subcision improved skin laxity appearance in participants with skin laxity seeking treatment for cellulite appearance. METHODS AND MATERIALS: This retrospective study used images collected from a prior study that evaluated adult participants ( n = 51) with severe cellulite on ≥1 thigh and/or buttock at baseline and 12 weeks after 1 RAP treatment. Outcomes included proportion of participants who achieved clinical improvement in skin laxity appearance via correct identification (≥60%) of blinded, randomized pretreatment and post-treatment photos; Global Aesthetic Improvement Scale (GAIS) responder rates ("improved" or "much improved") for skin laxity by ≥2 of three physician reviewers 12 weeks post-treatment. RESULTS: Among 51 participants, the mean age was 43 years. At least two of three physicians correctly identified 90.2% of photo sets (pretreatment vs week 12 post-treatment; 95% CI: 78.6%â96.7%). GAIS responder rate was 80.4% (95% CI: 66.9%â90.2%). CONCLUSION: RAP treatment targeting cellulite also improved the appearance of skin laxity.
Asunto(s)
Celulitis , Técnicas Cosméticas , Humanos , Adulto , Celulitis/terapia , Celulitis/cirugía , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Muslo , Nalgas , EstéticaRESUMEN
BACKGROUND: The quality of saphenous vein (SV) grafts can vary depending on the site from which they are harvested. However, few studies have compared SV grafts harvested from the thigh with those harvested from the calf to explore which is more appropriate for use in coronary artery bypass grafting (CABG). In this study, we evaluated the graft patency rates of thigh and calf SV grafts over 5 years. We also assessed the functional and structural viability of SV endothelial and smooth muscle cells. METHODS: This retrospective observational study included 265 patients who underwent CABG performed by the same surgical team between 2015 and 2019. Each patient received one SV graft from either the thigh or the calf to the right coronary territory. The 1-, 3-, and 5-year postoperative coronary computed tomography (CT) angiography results were compared between patients who received the thigh and calf SV grafts. Surgical specimens were collected from 2015, which were evaluated by western blotting and immunohistochemistry to evaluate the expression, stability, morphology, and localization of von Willebrand factor (vWF), matrix metalloproteinase (MMP)-2, MMP-9, vimentin, and caveolin-1 (CAV-1). RESULTS: The 5-year coronary CT angiography results demonstrated a significantly higher patency rate for thigh SV grafts than for calf SV grafts (69.2% vs. 51.7%, p = 0.030). The protein expression of vWF, MMP-2, MMP-9, vimentin, and CAV-1 was significantly higher in calf SV grafts than in thigh SV grafts (all p ï¼ 0.05). CONCLUSIONS: In this study, thigh SV grafts had significantly higher patency than calf SV grafts at 5 years after CABG. Moreover, the functional and structural viability of SV endothelial and smooth muscle cells in the thigh SV grafts were better preserved than those in the calf SV grafts. These findings suggest that thigh SV grafts appear to be more appropriate conduits than calf SV grafts for CABG.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria , Vena Safena , Muslo , Recolección de Tejidos y Órganos , Humanos , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Vena Safena/trasplante , Vena Safena/fisiopatología , Vena Safena/metabolismo , Vena Safena/diagnóstico por imagen , Vena Safena/patología , Estudios Retrospectivos , Grado de Desobstrucción Vascular , Masculino , Femenino , Anciano , Resultado del Tratamiento , Persona de Mediana Edad , Factores de Tiempo , Muslo/irrigación sanguínea , Oclusión de Injerto Vascular/fisiopatología , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Recolección de Tejidos y Órganos/efectos adversos , Angiografía CoronariaRESUMEN
A retrospective, comparative study of anterolateral thigh (ALT), jejunal free (JF), and radial forearm (RF) flap reconstruction of pharyngolaryngectomy defects between October 2012 and September 2024 was conducted. Data were collected from patient's electronic notes. Thirty-nine patients were included in the demographics and early complication analysis. Thirty-five patients were followed up for a minimum 3 months and included in the late complication and functional analysis. One ALT experienced partial flap loss requiring further reconstruction and one ALT was salvaged with a re-do anastomosis. All-cause return-to-theater rate was higher in the ALT (6/26) and RF (1/4) groups compared to the JF (1/9) group. ALT reconstructions had the lowest stricture rate (9/24) compared to JF (4/8) and RF (1/3). Fistula rates were the same in ALT and JF reconstruction, as were the rates of patients who achieved satisfactory long-term dietary outcomes. More JF reconstructions achieved satisfactory long-term speech outcomes (6/7) compared to ALT (12/23) and RF reconstructions (1/3). Better outcomes correlated with the surgeon's experience. We concluded that ALT and JF flaps are effective reconstructive options that should be performed by experienced surgeons in specialized centers.