ABSTRACT
Back ground: Devastating defects are those defects where the major structures like bones, joints, nerves, and blood vessels are exposed. These defects may be due to road traffic accidents, train traffic accidents, post burn scar contracture release raw area etc. Skin grafting or simple flaps may not help in these cases making reconstruction challenge. To study the various flap options for the coverage of the elbow defects and its outcomes. Materials and methods: From the period of 2016 to 2017, all patients with elbow defects that required local or locoregional flaps were chosen for the study. Investigations included plain X-ray of the elbow. Hand held Doppler was done for patients in whom the perforator based flaps were selected for reconstruction. Results: In our study (23 patients) were males and (4 patients) were females. The most common cause was the road traffic accident (18 patients). Two patients were due to a post burn contracture release raw area. One of the patients was due to a work place accidental injury. Six patients were due to train traffic accident and of which 5 patients presented with total amputation (stump raw area). The site of the wound played a major role in determining the flap selection. In our series, most of the patients presented with defects over lateral (6 patients) and posterior lateral (7patients) elbow region. Conclusion: Meticulous planning for their construction of devastating elbow defects is necessary to achieve satisfactory results. The choice between different flaps depends on the nature of the defect, availability of donor tissues and the patient’s needs.
ABSTRACT
Introduction: Tracheo Oesophageal Fistula (TEF) is a major cause of morbidity and mortality necessitating complex clinical evaluation and decision making for optimal management. It is best treated in a specialty tertiary care setting by a multidisciplinary team approach. In acquired nonmalignant causes of airway-oesophageal fistulas, the patients suffer from significant morbidity due to recurrent pulmonary sepsis. These diseases are complex and mandate critical preoperative evaluation for optimal management. Prolonged endotracheal intubation combined with a nasogastric tube may lead to a TEF. This results from pressure necrosis generated by a ventilating cuff in the trachea and a prolonged feeding tube in the esophagus. Aim of the study: To study the results of function preserving pedicled perforator based sternocleidomastoid muscle as an inter position flap after primary repair of cervical tracheaoesophageal fistula. Materials and methods: The study was conducted from the period of one year from 2015-2016 at IRRH and Plastic Surgery Department of Government Stanley Medical College, Chennai. Totally 15 patients were included in the study. Patients with clinical presentation were evaluated, a pre operative P.S. Ganesh Babu, T.M Balakirshnan, Ramadevi. Clinical study of pedicled sternocleidomastoid muscle flap interposition for cervical tracheo oesophageal fistula repair at a tertiary care hospital. IAIM, 2017; 4(9): 105-109. Page 106 investigation like Bronchoscopy, OGD MRI, CECT of the neck was taken. All patients with tracheal oesophageal fistula in the cervical region following corrosive poisoning (organophosphates) on prolonged intubation who under went closure with the pedicled sternocleidomastoid muscle as an interposition flap. Results: All patients diagnosed with Tracheo oesophageal fistula following corrosive poisoning on prolonged intubation were included. (N = 15). The study period was from 2015 to 2016. Patient’s demographic data and clinical course were closely monitored and recorded. All Patients recovered well. Oral feeding started (liquids) on 4th post-operative day after doing gastro Graffin study, and solids on the 10th day. No recurrence in 1 year follows up. Conclusion: In our technique, we maintained the intramuscular cock screw perforators from the transverse cervical artery. This constant anatomy favored us to use sternal head component separate from the clavicular head and interposed them between the repaired trachea and esophagus. Preserving the clavicular head of SCM maintains the form and function of the muscle. The vascularized muscle flap prevents both tracheal and oesophageal strictures and stenosis.