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1.
J Surg Oncol ; 121(1): 168-174, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31168837

RESUMO

BACKGROUND AND OBJECTIVES: In patients with lymphedema, the disruption of the lymphatic network increases skin turgor and fibrosis of subcutaneous tissue, delays wound healing, causing recurrent ulcerations and infections. In these cases, management of ulcers can be challenging. METHODS: Between January 2016 and June 2018, patients presenting with lymphedema were enrolled at our Institution. We selected patients with severe lymphedema and ulcers of lower limbs and we performed a surgical approach, involving free gastroepiploic lymph nodes and omentum flap, harvested through laparoscopy. RESULTS: We enrolled 135 patients presenting for lymphedema. Among them, 10 eligible cases underwent excision of the ulcer and reconstruction with omentum flap. Mean age was 57.8 years and average follow-up 24.1 months. Circumferences and skin tonicity significantly decreased from the preoperative period. Lymphoscintigraphy showed improvement of the lymphatic drainage and restoration of lymphatic network. No episodes of infection were recorded in the postoperative period. CONCLUSIONS: Our combined procedure merges free flap techniques and lymphedema surgery: omentum covers the defect while providing a new source of lymph nodes, improving the lymphatic networks of the affected limb. This technique can highly increase the quality of life of the patient in a single-stage operation with fast recovery and low donor site morbidity.


Assuntos
Retalhos de Tecido Biológico/transplante , Úlcera da Perna/cirurgia , Linfonodos/transplante , Linfedema/cirurgia , Omento/transplante , Idoso , Doença Crônica , Feminino , Retalhos de Tecido Biológico/cirurgia , Humanos , Úlcera da Perna/complicações , Linfonodos/cirurgia , Linfedema/complicações , Masculino , Pessoa de Meia-Idade
2.
Plast Reconstr Surg ; 145(1): 164e-171e, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881626

RESUMO

BACKGROUND: Although venous thrombosis is a leading cause of flap failure, the majority of lower extremity free flap planning is centered on arterial system evaluation. Preoperative identification of relevant abnormality in lower extremity venous systems by means of duplex ultrasound may aid in the diagnosis of clinically important abnormality that could affect lower extremity flap outcomes. METHODS: Between November of 2014 and August of 2017, 57 patients underwent preoperative lower extremity venous duplex imaging and free tissue transfer for lower extremity wounds. A retrospective review was performed to describe lower extremity venous pathologic findings, relevant patient demographic data, comorbid conditions, and outcomes. Discovery of venous abnormality helped guide recipient vein selection. RESULTS: Fifty-seven consecutive patients underwent 59 free flap operations to treat chronic lower extremity wounds. Venous duplex ultrasonography detected venous insufficiency (defined as >0.5 second of reflux) in 23 patients (39.0 percent), including 16 (27.2 percent) with deep thigh reflux, six (10.2 percent) with superficial calf reflux, and four (6.78 percent) with deep calf reflux. Deep venous thrombosis was found in four patients (6.78 percent) and treated with anticoagulation. The flap success rate was 98.3 percent. Five patients (8.47 percent) progressed to amputation. At a mean follow-up time of 15.1 ± 9.51 months (range, 1.67 to 35.2 months), 53 patients (89.8 percent) were able to continue community ambulation. CONCLUSIONS: Lower extremity venous duplex testing before free tissue transfer may be useful for optimizing flap recipient vessel selection and for detecting potentially unknown venous abnormality. Development of free flap planning protocols incorporating preoperative vascular imaging is important to achieving good functional outcomes in this comorbid patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Rejeição de Enxerto/prevenção & controle , Traumatismos da Perna/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Insuficiência Venosa/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Humanos , Incidência , Perna (Membro)/irrigação sanguínea , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Ultrassonografia Doppler Dupla , Veias/diagnóstico por imagem , Insuficiência Venosa/complicações , Insuficiência Venosa/epidemiologia , Trombose Venosa/complicações , Trombose Venosa/epidemiologia , Adulto Jovem
3.
Anticancer Res ; 39(12): 6759-6768, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810941

RESUMO

BACKGROUND/AIM: Large full thickness abdominal wall defects following malignancies can be a reconstructive challenge. The purpose of this study was to analyze long-term outcomes and complications following abdominal wall reconstruction using composite antero-lateral thigh (ALT) flaps. PATIENTS AND METHODS: The study retrospectively investigated 16 consecutive patients who underwent abdominal wall reconstruction with autologous flap between May 2003 and March 2018. Volumetric flap analysis was used to assess flap atrophy over time, evaluating the role of denervation and reinnervation. The long-term outcome was assessed to compare the two groups (free vs. pedicled ALT flap reconstructions). RESULTS: All flaps successfully covered the defects. We found a significant increase in flap resorption in free flaps when compared to pedicled ones. Abdominal bulging was seen in 3 out of 16 (19%) patients after more than 12 months follow-up, in close correlation with mesh absence. CONCLUSION: Free flaps were shown to be equally effective as their pedicled counterparts, without significant increase in complication rate.


Assuntos
Parede Abdominal/cirurgia , Retalhos Cirúrgicos/transplante , Autoenxertos , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/inervação , Retalhos de Tecido Biológico/transplante , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/inervação , Coxa da Perna , Resultado do Tratamento
4.
Plast Reconstr Surg ; 144(5): 853e-863e, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688764

RESUMO

BACKGROUND: Extirpation of malignant tumors of the parotid results in creation of a complex facial defect often in combination with facial nerve palsy. This study presents the authors' experience using vastus lateralis muscle as a chimeric flap with anterolateral thigh flap to allow both soft-tissue reconstruction and dynamic reanimation in radical parotidectomy. METHODS: A retrospective review of the medical records of cancer patients who had undergone radical parotidectomy and reconstruction using a chimeric vastus lateralis and anterolateral thigh flap between March of 2013 and May of 2017 was performed using the Sydney Head and Neck Cancer Institute database. The return of dynamic midface movement was the primary outcome investigated. Electronic, clinician-graded facial function scale grades were used to formally assess postoperative outcomes. RESULTS: A total of 27 patients were included in the study with an average age of 72 years (range, 31 to 88 years). Thirteen patients (48 percent) had developed dynamic function by the end of the study period. Young age predicted a more rapid return to dynamic function (p = 0.018). Both being a woman and having an intact facial nerve before surgery improved dynamic midface movement (p = 0.005 and p = 0.036, respectively). On multivariable analysis, superior midface dynamic function was associated with neurotization using midface facial nerve branches as opposed to using nerve-to-masseter alone (p = 0.05). CONCLUSION: The chimeric vastus lateralis and anterolateral thigh flap is a suitable option for restoring defects and dynamic function following radical parotidectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Retalhos de Tecido Biológico/transplante , Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Músculo Quadríceps/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica/fisiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/patologia , Estudos Retrospectivos , Medição de Risco , Coxa da Perna/cirurgia , Quimeras de Transplante , Resultado do Tratamento , Cicatrização/fisiologia
5.
Zhonghua Shao Shang Za Zhi ; 35(11): 814-818, 2019 Nov 20.
Artigo em Chinês | MEDLINE | ID: mdl-31775471

RESUMO

Objective: To observe the clinical application effect of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flap. Methods: From March 2014 to March 2017, 6 patients with large area of skin and soft tissue defects of extremities were hospitalized in our unit, including 5 males and 1 female, aged 27-65 years, 1 case of electric injury, 2 cases of coal burn, 3 cases of traffic injury, 2 cases involving upper limb, and 4 cases involving lower limb. After debridement, the wound area ranged from 26 cm×8 cm to 36 cm×15 cm, and the bone exposure area ranged from 24 cm×7 cm to 35 cm×14 cm. The blood circulation enhancement technique was used when the wound with bone exposure was repaired with super large free anterolateral thigh flap. The area of flaps ranged from 28 cm×10 cm to 38 cm×16 cm. The donor site of flap and the primary wound without bone exposure were repaired with medial thigh split-thickness skin graft of the donor leg of flap. The blood circulation enhancement technique mode during operation and the survival of flaps after operation were recorded, and the recovery of donor and recipient areas and the occurrence of complications were followed up. Results: Three patients were treated with simple vascular supercharging technique during flap transplantation, and the other 3 patients were treated with vascular supercharging and turbocharging technique during flap transplantation. All the flaps survived well in 6 patients without vascular crisis. Follow-up for 3 to 12 months after surgery showed that the blood flow of the flaps was good and the depth and superficial sensation recovered to varying degrees. Except for 1 case of upper limb flap, the other flaps had no obvious swelling and needed no second thinning. There were only depressed scars in the donor sites, and no obvious scar hyperplasia in the area without bone exposure repaired by the skin grafts. No short-term or long-term complications were found. Conclusions: The application of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flaps provides reliable blood supply for the flaps and results in good effect after operation, which is worth popularizing.


Assuntos
Retalhos de Tecido Biológico/transplante , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Coxa da Perna , Resultado do Tratamento
6.
Zhonghua Shao Shang Za Zhi ; 35(9): 683-689, 2019 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594187

RESUMO

Objective: To explore the effects of autologous platelet-rich plasma (PRP) in the repair of soft tissue defects of rabbits with free flap. Methods: Thirty 6-month-old New Zealand white rabbits, male and female unlimited, were used to harvest blood from the heart. PRP was prepared by Aghaloo method, then free flap model with size of 5 cm×3 cm was reproduced on each ear of the rabbit. According to the random number table, one ear of each rabbit was recruited to PRP group, and the other ear was recruited to normal saline group. The base of flap on rabbit ear in PRP group was evenly spread with 1.0 mL autologous PRP, and equivalent volume of normal saline was applied to that in normal saline group. Then, the flap was replanted in situ. On post surgery day (PSD) 2, 3, 5, 7, and 14, 6 rabbits in each group were taken. The survival of flap was observed and recorded. The morphology of the basal tissue of flap was observed by hematoxylin-eosin staining. The expressions of CD31 and α smooth muscle actin (α-SMA) in the basal tissue of flap were detected by immunofluorescence method. Another 6-month-old male New Zealand white rabbit without making flap under the same experimental conditions was used for harvesting whole blood and preparing PRP. Then blood platelet count in whole blood and PRP was determined, and the content of vascular endothelial growth factor (VEGF) and transforming growth factor ß (TGF-ß) was detected by double-antibody sandwich enzyme-linked immunosorbent assay. Data were processed with analysis of variance of factorial design, paired sample t test, and Bonferroni correction. Results: (1) On PSD 2, the flaps of wounds of rabbits in PRP group were reddish and adhered well to the basal tissue; the flaps of wounds of rabbits in normal saline group were dark red and poorly attached to the basal tissue. On PSD 3, the flaps of wounds of rabbits in PRP group were ruddy and closely adhered to the basal tissue; the flaps of wounds of rabbits in normal saline group were scattered in the plaque-like dark red and generally attached to the base. On PSD 5, the flaps of wounds of rabbits in PRP group were reddish and closely adhered to the basal tissue, and the flaps were alive; while flaps of wounds of rabbits in normal saline group were rosy and closely adhered to the basal tissue. On PSD 7, the surface of flaps of wounds of rabbits in PRP group was covered with a medium amount of rabbit hair. The color of flap was similar to that of the surrounding skin. The flaps of wounds of rabbits in normal saline group were generally attached to the base, and the surface was only covered with a small amount of fluff. On PSD 14, the incisions were healed well in PRP group, while small wounds in normal saline group were not healed. (2) On PSD 2, inflammatory cell infiltration was observed in flaps of wounds of rabbits in both groups. On PSD 3, the flaps of wounds of rabbits in PRP group showed neovascularization, with less interstitial hemorrhage; while there were less neovascularization in the flaps of wounds of rabbits in normal saline group. On PSD 5, a medium number of inflammatory cell infiltration and a small amount of new microvessels were observed in flaps of wounds of rabbits in normal saline group. Many fibroblasts, a small amount of inflammatory cells, and scattered new microvessels were observed in flaps of wounds of rabbits in PRP group. On PSD 7, the number of new microvessels in normal saline group was significantly lower than that in PRP group. On PSD 14, the new microvessels in the flaps of wounds of rabbits in PRP group gradually matured, and a large number of fibroblasts distributed around them. Some of the newly formed microvessels in the flaps of wounds of rabbits in normal saline group were mature, and the healing was slower than that of PRP group. (3) On PSD 2, 3, 5, 7, and 14, the expressions of CD31 and α-SMA in the basal tissue of flaps of wounds of rabbits in PRP group were significantly higher than those in normal saline group (t=10.133, 5.444, 9.450, 6.986, 8.394, 14.896, 10.328, 9.295, 13.902, 10.814, P<0.01). (4) The platelet count in activated PRP of rabbits was (2 863±962)×10(9)/L, which was significantly higher than (393±49)×10(9)/L in whole blood (t=7.690, P<0.05). (5) The content of VEGF and TGF-ß in activated PRP of rabbits was (564.3±3.2) and (1 143±251) pg/mL, which was significantly higher than (99.7±0.4) and (274±95) pg/mL in whole blood, respectively (t=287.390, 9.648, P<0.05 or P<0.01). Conclusions: PRP of rabbits contains high concentrations of VEGF and TGF-ß. Therefore, PRP can effectively promote microvascular regeneration in free flap tissue and accelerate the survival of free flap.


Assuntos
Retalhos de Tecido Biológico/transplante , Plasma Rico em Plaquetas , Lesões dos Tecidos Moles/terapia , Cicatrização , Animais , Feminino , Masculino , Coelhos , Fator de Crescimento Transformador beta/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
7.
Zhonghua Shao Shang Za Zhi ; 35(10): 757-760, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31658548

RESUMO

Objective: To observe the clinical effects of sequential treatment with extensive lesion resection, vacuum sealing drainage (VSD) combined with irrigation of oxygen-loaded fluid, and tissue transplantation on hidradenitis suppurativa (HS) in buttocks which recurred after multiple surgeries. Methods: From January 2012 to March 2017, 15 male patients (aged 26-53 years) hospitalized in our burn ward with Hurley's stage Ⅲ HS in the buttocks recurred after 2-5 operations who met the inclusion criteria were enrolled in the prospective self pre- and post-control study. After extensive resection of the lesion, continuous VSD combined with intermittent irrigation of oxygen-loaded fluid was given, with negative pressure of -16.7 kPa and flow rate of pure oxygen of 1.0 L/min. After 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid, the negative pressure device was removed and autologous posterior thigh split-thickness skin grafts and/or local flaps were transplanted to repair the wounds. Six patients were performed with split-thickness skin grafting, 4 patients with local flap transplantation, and 5 patients with split-thickness skin grafting together with local flap transplantation. The donor sites of local flaps were sutured directly or transplanted with autologous posterior thigh split-thickness skin grafts, and the donor sites of split-thickness skin grafts with autologous thin split-thickness scalp. The wound tissue or wound granulation tissue was collected before lesion resection and 7 days after treatment with VSD combined with irrigation of oxygen-loaded fluid respectively for bacterial culture and detecting of the content of tumor necrosis factor-alpha (TNF-α) by enzyme-linked immunosorbent assay. Survival of skin grafts and flaps after operation was observed, hospitalization time was recorded, and recurrence and complications of HS were followed up. Data were processed with paired sample t test. Results: Bacterial culture result of wound tissue before lesion resection was positive in all patients, mainly Staphylococcus, Streptococcus, Proteus mirabilis, and anaerobic bacteria, etc., while that of wound granulation tissue after 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid was negative. The content of TNF-α in wound granulation tissue after 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid was (10.1±2.9) pg/L, significantly lower than (73.6±5.6) pg/L before lesion resection (t=33.47, P<0.01). The skin grafts and/or flaps of 15 patients survived post operation, and the wounds were healed. The patients were hospitalized for 17-31 days. During follow-up of 1 to 5 years, no recurrence of HS occurred in operative site of buttocks of 15 patients, but 1 patient had ulceration of healed perianal incision caused by high anal fistula and was healed after treatment. Conclusions: Sequential treatment with extensive resection, VSD combined with irrigation of oxygen-loaded fluid, and tissue transplantation can thoroughly remove HS lesions in the buttocks and improve the condition of wound bed for skin acceptance after debridement, which is conducive to the cure of HS in the buttocks which has undergone multiple operations but still recurs after operation.


Assuntos
Nádegas/microbiologia , Retalhos de Tecido Biológico/transplante , Hidradenite Supurativa/terapia , Tratamento de Ferimentos com Pressão Negativa/métodos , Lesões dos Tecidos Moles/cirurgia , Cicatrização/fisiologia , Adulto , Desbridamento , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplante de Pele , Resultado do Tratamento
8.
World J Surg Oncol ; 17(1): 154, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477142

RESUMO

BACKGROUND: The free flap transfer of a latissimus dorsi flap (LDF) for the closure of sacral wound defects after pelvic exenteration and radiation therapy offers a successful tool of the plastic surgeon. This case report shows the successful coverage using an upstream arterio-venous (AV) loop in combination with an LDF. CASE PRESENTATION: We describe the case of a patient who underwent a pelvic exenteration and radiation therapy due to a local recurrence of rectal cancer. The initially used VRAM flap could not ensure a satisfactorily wound closure. An interdisciplinary approach first yielded an AV loop using both greater saphenous veins and was connected to the arteria and vena femoris followed by a free LDF transfer, which was performed 11 days later. The result was an excellent reconstructive and plastic coverage of the sacral wound defect with a well-perfused LDF. The long-term result showed a perfectly integrated flap in the sacral region. CONCLUSION: We recommend the free LDF for the coverage of large wound defects in irradiated areas after the failure of VRAM flap. If an AV loop is necessary within the flap transfer, we recommend conducting two procedures to guarantee the perfusion of the AV loop.


Assuntos
Neoplasias Colorretais/cirurgia , Retalhos de Tecido Biológico/transplante , Recidiva Local de Neoplasia/cirurgia , Exenteração Pélvica/efeitos adversos , Períneo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sacro/cirurgia , Idoso , Neoplasias Colorretais/patologia , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Períneo/lesões , Períneo/patologia , Complicações Pós-Operatórias , Sacro/lesões , Sacro/patologia
9.
Zhonghua Shao Shang Za Zhi ; 35(8): 604-607, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31474041

RESUMO

Objective: To summarize the effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand. Methods: From May 2014 to May 2016, 7 patients of two skin and soft tissue defects of hand with exposures of phalanges and tendons were treated in Xuzhou Renci Hospital, including 5 males and 2 females, aged from 19 to 41 years. Each defect area ranged from 3.0 cm×1.5 cm to 6.0 cm×3.0 cm. The medial upper arm bilobed free flaps were used to repair the defects, and the area of each lobe of the flaps ranged from 4.0 cm×2.0 cm to 8.0 cm×3.5 cm. The donor sites were sutured directly. The survival of the flaps was recorded. During follow-up, the recovery of donor and recipient sites was observed, the two-point discrimination distance of the flaps was measured, and the hand function was assessed by the trial criteria of the upper limb functional assessment of the Hand Surgery Society of the Chinese Medical Association. Results: All flaps survived smoothly, and the wounds and donor site incisions were healed. All patients were followed up, and the follow-up time lasted for 6 to 15 months. The color and texture of the flaps were similar to the surrounding normal skin, and the shape of the flaps was good. There was no obvious scar in the donor site, and the elbow joint function was normal. One patient developed ulnar numbness one month after operation and relieved after 3 months of treatment with neurotrophic drugs and local physiotherapy, etc. Six months after operation, the two-point discrimination distance of the flaps was 5.5-8.0 mm, and the hand function evaluation was excellent in 3 cases, good in 3 cases, and middle in 1 case. Conclusions: The medial upper arm bilobed free flap has both good texture and good appearance, and the scar of donor site is concealed. It is a good method to repair two skin and soft tissue defects of hand.


Assuntos
Retalhos de Tecido Biológico/transplante , Mãos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles/cirurgia , Adulto , Braço , Feminino , Humanos , Masculino , Transplante de Pele , Cicatrização , Adulto Jovem
10.
Plast Reconstr Surg ; 144(5): 1202-1213, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31397793

RESUMO

BACKGROUND: Microsurgical lower extremity reconstruction remains a challenge. The use of perforator flaps in lower extremity reconstruction is expanding. The authors present an algorithm to guide in the selection of the ideal free perforator flap that can be tailored to each lower extremity defect. METHODS: The authors conducted a retrospective review of lower extremity reconstruction using free perforator flaps over a 7-year period. Demographics, comorbidities, defect characteristics, operative details, complications, and secondary procedures were documented. Pairwise comparisons of flap types were performed to differentiate flaps on the basis of flap size, thickness, and pedicle length. RESULTS: A total of 563 free perforator flaps were performed. The most common causes were trauma (36.5 percent) and diabetes (24.4 percent). Nine flaps were used, with the most common being superficial circumflex iliac perforator (51.2 percent) and anterolateral thigh (33.2 percent). Size differed significantly between flap types (p < 0.05), with the exception of thoracodorsal artery perforator versus gluteal artery perforator flaps (p = 0.26). The thinnest flaps were posterior interosseous artery perforator (3.7 ± 0.5 mm) and superficial circumflex iliac perforator (5.4 ± 0.8 mm). The thickest flaps were deep inferior epigastric perforator (11.1 ± 3.9 mm) and anterolateral thigh (9.0 ± 1.5 mm). The shortest pedicles were in posterior interosseous artery perforator (3.3 ± 0.3 cm) and superficial circumflex iliac perforator flaps (5.2 ± 0.8 cm). The longest pedicles were in deep inferior epigastric perforator (11.7 ± 1.4 cm), thoracodorsal artery perforator (9.3 ± 1.4 cm), and anterolateral thigh flaps (9.2 ± 0.8 cm). CONCLUSIONS: Free perforator flaps are reliable in lower extremity reconstruction. The authors believe their algorithm for flap selection helps to optimize form and function, decrease operative time, and minimize donor-site morbidity and secondary procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Pé Diabético/cirurgia , Retalhos de Tecido Biológico/transplante , Traumatismos da Perna/cirurgia , Retalho Perfurante/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cicatrização/fisiologia , Adulto , Idoso , Algoritmos , Estudos de Coortes , Bases de Dados Factuais , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Sobrevivência de Enxerto , Humanos , Traumatismos da Perna/diagnóstico , Masculino , Pessoa de Meia-Idade , Retalho Perfurante/irrigação sanguínea , Prognóstico , Estudos Retrospectivos , Medição de Risco
11.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383687

RESUMO

Reconstruction of neopharynx after total laryngectomy is a challenging task. Various locoregional flaps like pectoralis major myocutaneos/ latismus dorsi flaps and free flaps have their own limitations and advantages. To overcome this, we used facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy (DK Gupta technique). This flap is thin, pliable, without any gravitational pull and without any risk of anastomosis failure and hence has advantage of both locoregional and free flaps and eliminates the limitations of both. It is simple, reproducible and reliable reconstructive option for neopharynx. We present a case report, review of literature and this novel technique for an excellent outcome and recommend to use it as the new workhorse of neopharyngeal reconstruction.


Assuntos
Retalhos de Tecido Biológico/transplante , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Faringe/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Artérias/transplante , Face/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade
12.
Plast Reconstr Surg ; 144(3): 453e-462e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461040

RESUMO

BACKGROUND: Posterior mandibulectomy defects can be reconstructed using either soft tissue or vascularized bone. The authors hypothesize that advances in computer-aided design and manufacturing (CAD-CAM) have resulted in osteocutaneous free flaps now proving superior to soft-tissue flaps. METHODS: The authors conducted a retrospective review of all free flap reconstructions of posterior mandibulectomy defects where the condyle was resected from 2005 to 2016. RESULTS: Overall, 291 patients (mean age, 56.9 years; mean body mass index, 26.2 kg/m) underwent posterior mandible reconstruction with 169 soft-tissue flaps and 122 osteocutaneous free flaps (90 free-hand versus 32 CAD-CAM). Forty patients (13.7 percent) required two free flaps to reconstruct the defect, most commonly a fibula osteocutaneous flap for the mandibulectomy defect and a soft-tissue flap for external coverage. Postoperatively, there were no differences in the incidence of trismus between soft-tissue versus vascularized bone flaps; however, malocclusion was most common in patients with soft-tissue flaps (p < 0.001). Patients with CAD-CAM bone reconstruction experienced significantly less malocclusion (p < 0.001), were more likely to progress to a regular diet (p = 0.001), and trended to having superior speech (p = 0.057) compared with the other cohorts. There were six total flap losses, with no difference between soft-tissue and bony flaps. CONCLUSIONS: Although reconstruction of posterior mandibulectomy defects should be based on the patient's comorbidities, surgeon comfort, and available resources, patients undergoing reconstruction of posterior mandibulectomy defects reconstructed with CAD-CAM-assisted fibulas experienced superior postoperative function compared with soft-tissue flaps or free-hand fibula flaps. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Desenho Assistido por Computador , Retalhos de Tecido Biológico/transplante , Osteotomia Mandibular/efeitos adversos , Reconstrução Mandibular/métodos , Planejamento de Assistência ao Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Fíbula/transplante , Humanos , Incidência , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Reconstrução Mandibular/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Trismo/epidemiologia , Trismo/etiologia , Adulto Jovem
13.
Plast Reconstr Surg ; 144(3): 738-758, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461041

RESUMO

Lymphedema affects up to 250 million people worldwide. The understanding of the pathophysiology of the condition, however, is incomplete and a cure remains elusive. A growing body of evidence supports the effectiveness of modern surgical techniques in ameliorating the long-term disability and functional impairment inflicted by lymphedema on the lives of those affected. These procedures can be broadly categorized as physiologic, including lymphovenous bypass and using a vascularized lymph node transplant; or de bulking, by suction-assisted lipectomy or direct excisional procedures. The lymphovenous bypass procedure involves identification of obstructed lymphatic vessels and targeted bypass of these into neighboring venules. The vascularized lymph node transplant procedure involves microvascular anastomosis of functional lymph nodes into an extremity, either to an anatomical (orthotopic) or nonanatomical (heterotopic) location, to restore physiologic lymphatic function. In patients undergoing postmastectomy breast reconstruction, this may be performed by transferring a deep inferior epigastric artery perforator flap with a chimeric groin lymph node flap. For patients that have undergone breast-conserving surgery, in those for whom a free abdominal flap is contraindicated, or for those with lymphedema affecting the lower extremity, many other vascularized lymph node transplant options are available; these include flaps harvested from within the axillary, inguinal, or cervical lymph node basins, or from within the abdominal cavity. Chronic lymphedema is characterized by fibroadipose soft-tissue deposition that can only be removed by lipectomy, either minimally invasively using liposuction, or by direct excision. This article reviews the techniques and outcomes of surgical procedures used to treat lymphedema.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Lipectomia/métodos , Linfonodos/transplante , Vasos Linfáticos/cirurgia , Linfedema/cirurgia , Axila , Neoplasias da Mama/cirurgia , Doença Crônica/terapia , Feminino , Retalhos de Tecido Biológico/transplante , Virilha , Humanos , Linfonodos/irrigação sanguínea , Linfedema/diagnóstico , Linfedema/etiologia , Mastectomia/efeitos adversos , Seleção de Pacientes , Retalho Perfurante/transplante
14.
Plast Reconstr Surg ; 144(3): 759-767, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461042

RESUMO

BACKGROUND: Marko Godina, in his landmark paper in 1986, established the principle of early flap coverage for reconstruction of traumatic lower extremity injuries. The aim of this study was to determine how timing influences outcomes in lower extremity traumatic free flap reconstruction based on Godina's original findings. METHODS: A retrospective review identified 358 soft-tissue free flaps from 1979 to 2016 for below knee trauma performed within 1 year of injury. Patients were stratified based on timing of coverage: 3 days or less (early), 4 to 90 days (delayed), and more than 90 days (late). The delayed group was further divided into two groups: 4 to 9 days and 10 to 90 days. Flap outcomes were examined based on timing of reconstruction. RESULTS: Flaps performed within 3 days after injury compared with between 4 to 90 days had decreased risk of major complications (OR, 0.40, p = 0.04). A receiver operating curve demonstrated day 10 to be the optimal day for predicting flap success. Flaps performed less than or equal to 3 days versus 4 to 9 days had no differences in any flap outcomes. In contrast, flaps performed within 4 to 9 days of injury compared to within 10 to 90 days were associated with significantly lower total flap failure rates (relative risk, 0.29, p = 0.025) and major complications (relative risk, 0.37, p = 0.002). CONCLUSIONS: Early free flap reconstruction performed within 3 days of injury had superior outcomes compared with the delayed (4 to 90 day) group, consistent with Godina's original findings. However, as an update to his paradigm, this ideal early period of reconstruction can be safely extended to within 10 days of injury without an adverse effect on outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Microcirurgia/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/terapia , Tempo para o Tratamento , Adolescente , Adulto , Feminino , Retalhos de Tecido Biológico/transplante , História do Século XX , Humanos , Extremidade Inferior/lesões , Masculino , Microcirurgia/história , Microcirurgia/normas , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/história , Tratamento de Ferimentos com Pressão Negativa/normas , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Reconstrutivos/história , Procedimentos Cirúrgicos Reconstrutivos/normas , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
J Shoulder Elbow Surg ; 28(12): 2364-2370, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31371161

RESUMO

BACKGROUND: Recalcitrant clavicular nonunion is a rare but complicated problem of clavicular fracture fixation. Nonunion is most often treated with clavicular shortening or in extreme cases vascularized bone grafting. Herein we describe our experience using the vascularized medial femoral condyle (MFC) free flap for the reconstruction of segmental defects in cases of recalcitrant clavicular nonunion. METHODS: A retrospective chart review was conducted of patients with symptomatic recalcitrant nonunion of the clavicle who underwent reconstruction with the vascularized MFC free flap from June 2003 to January 2018. Patients' demographics, time to union, and postoperative complications were collected. RESULTS: A total of 7 patients (6 women; 39.8 ± 9.01 years old) underwent clavicular reconstruction after an average of 3.7 ± 1.3 previous surgical procedures. Average preoperative visual analog scale score for pain was 4.1. The graft size ranged from 2 to 5 cm in length with approximately 1 cm in width and depth. The average time of total nonunion was 66 ± 48.2 months before surgery. All flaps survived and all clavicles healed with an average time to radiographic union of 15 ± 6.7 months. Patients regained full shoulder motion, and average postoperative visual analog scale score was 1.6 ± 1.8. All patients returned to their preoperative employment status. Donor site morbidity from the knee was minimal. CONCLUSION: The MFC free flap is a good option for recalcitrant bone nonunion of the clavicle where larger vascularized flaps are not warranted. It is effective and offers minimal donor site morbidity.


Assuntos
Transplante Ósseo/métodos , Clavícula/cirurgia , Fêmur/transplante , Fraturas não Consolidadas/cirurgia , Retalhos de Tecido Biológico/transplante , Adulto , Clavícula/lesões , Epífises/transplante , Feminino , Fixação Interna de Fraturas , Fraturas não Consolidadas/complicações , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Medição da Dor , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Estudos Retrospectivos
16.
Zhonghua Shao Shang Za Zhi ; 35(7): 512-516, 2019 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-31357821

RESUMO

Objective: To explore the effects of free anterolateral femoral or medial calf flaps in the repair of severe facial burns. Methods: From January 2014 to October 2017, 18 patients with severe facial burns were admitted to Zhengzhou First People's Hospital, including 12 males and 6 females, aged 15-78 years. Autologous intermediate split-thickness skin grafts were transplanted to replace oral mucosa in 4 patients with perforating cheek defects, and 8 patients underwent early vacuum sealing drainage and autologous intermediate split-thickness skin grafting to reduce the wound area to 14 cm×6 cm-22 cm×14 cm before flap transplantation. The wounds of 15 patients were repaired with free anterolateral femoral flaps, and the wounds of the other 3 patients were repaired with free medial calf flaps. The area of flaps ranged from 16 cm×7 cm to 24 cm×17 cm. The facial artery or superficial temporal artery was anastomosed end-to-end with lateral femoral circumflex artery or posterior tibial artery under microscope routinely and manually, and the two accompanying veins were anastomosed end-to-end by Coupler microvascular anastomat. The donor site was sutured or transplanted with autologous intermediate split-thickness skin graft. The anastomosis time of veins was recorded. The patency rate of vascular was calculated. The survival status of flaps were observed. The recovery of recipient area was observed during follow-up. Results: The anastomosis time of two veins in this group was 6-10 minutes, with an average of 8.5 minutes. The patency rates of veins and arteries were 100%. There was no vascular crisis due to the anastomosis problem. The free flaps survived well in 16 patients; one patient had hemorrhage under the flap 6 hours after operation, and the blood circulation of flaps turned well after hemostasis by surgical exploration; the other patient had 3 cm necrosis at the distal end of flap after operation, and the wound was closed after dressing change and autologous intermediate split-thickness skin grafting. The patients were followed up for 2 to 24 months after discharge. Most of the five senses function recovered. The color and texture of the flaps were not consistent with those of the normal facial skin. Some flaps were slightly swollen. Oral integrity was restored in 4 patients with perforating cheek defect with mouth opening of 2.2-3.5 cm. Conclusions: Free anterolateral thigh flaps or medial calf flaps can repair severe facial burn wounds. It takes less time to anastomose venous vessels by microvascular anastomat during operation and can ensure the quality of venous anastomosis.


Assuntos
Queimaduras/cirurgia , Traumatismos Faciais/cirurgia , Retalhos de Tecido Biológico/transplante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pele , Cicatrização , Adulto Jovem
17.
J Pak Med Assoc ; 69(6): 905-907, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31201403

RESUMO

We report the case of a middle aged patient with biopsy proven squamous cell carcinoma of buccal mucosa who presented to us in Aga Khan University Hospital Karachi in April, 2017 and required reconstruction of buccal mucosa, upper lip and lower lip. As per protocol of our institute the lesion was excised by the head and neck surgeon and the defect was reconstructed by our team. The defect was large comprising of buccal mucosa including the left oral commissure, upper lip and the lower lip. It was reconstructed via a free flap and a radial forearm free flap. A specially designed radial forearm free flap was harvested and used for reconstruction which resulted in a good aesthetic and functional outcome.


Assuntos
Retalhos de Tecido Biológico/transplante , Mucosa Bucal/cirurgia , Neoplasias Bucais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Antebraço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
18.
AJR Am J Roentgenol ; 213(3): W143-W144, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31166756

RESUMO

OBJECTIVE. The objective of this video article is to discuss the use of the scapular osteocutaneous free flap in reconstructive procedures. We attempt to discuss normal and variant vascular anatomy, image acquisition via CT angiography, and image interpretation as well as computer-assisted design and manufacturing. CONCLUSION. The scapular osteocutaneous free flap is commonly used for maxillary and mandibular reconstructive surgery. The complex vasculature supplying the scapular region allows flap versatility. There are anatomic variations in the origin of the circumflex scapular and angular arteries. Our method of performing and reporting CT angiography for patients scheduled to undergo scapular osteocutaneous free flap procedures provides a reliable and reproducible means of communicating important elements of vasculature to surgeons. This in turn can facilitate the manufacturing of custom scapular cutting guides and improve surgical outcomes.


Assuntos
Transplante Ósseo/métodos , Angiografia por Tomografia Computadorizada , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Procedimentos Cirúrgicos Reconstrutivos , Escápula/irrigação sanguínea , Escápula/diagnóstico por imagem , Escápula/transplante , Humanos
20.
J Craniofac Surg ; 30(6): 1829-1832, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31058721

RESUMO

A patient was diagnosed with squamous cell carcinoma of the maxillary sinus and consequently underwent a unilateral total maxillectomy and reconstruction using an anterolateral thigh (ALT) free flap. Soft tissue transplantation without a bone graft at the large maxillary defect site caused a midfacial collapse, which worsened, especially after radiotherapy. The 3-dimensional positioning of the composite flap for wide maxillary reconstruction is aesthetically important. To achieve ideal symmetry and aesthetics, a mirror image was created using the normal contralateral side. Through computer simulation, the function and symmetry of the virtually reconstructed maxilla was evaluated, and the surgical guide was made using a 3D printing system. Based on the prepared surgical guide, a deep circumflex iliac artery (DCIA) free flap was harvested, and its implementation in the reconstruction ultimately led to satisfactory results. Utilization of mirror image based virtual surgical planning and a 3D printing guide is a significantly effective method for maxilla reconstruction with DCIA flaps.


Assuntos
Artéria Ilíaca/diagnóstico por imagem , Maxila/diagnóstico por imagem , Impressão Tridimensional , Simulação por Computador , Retalhos de Tecido Biológico/transplante , Humanos , Artéria Ilíaca/cirurgia , Masculino , Maxila/irrigação sanguínea , Maxila/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos
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