Clinical outcome of the latissimus dorsi muscle flap in orthopedic reconstruction

INTRODUCTION@#The latissimus dorsi muscle has been the “workhorse” of reconstructive surgery because of its predictable neurovascular anatomy and ability to perform both wound coverage and restoration of function. @*OBJECTIVES@#We determined the flap viability, complications, and muscle function (if used as muscle transfer) of our latissimus dorsi flaps for orthopedic reconstruction.@*METHODS@#This is a retrospective review of all cases done in the Microsurgery Unit of the Philippine General Hospital and The Medical City from January 2005 to present using the latissimus dorsi muscle for reconstructive surgery. All patients were followed-up for six months.@*RESULTS@#There were 14 patients who had reconstructive surgeries using the latissimus dorsi muscle. Three patients had traumatic brachial plexus injuries where the latissimus dorsi muscle was used for the reconstruction of elbow flexion. Eleven patients required coverage of a large defect, where seven were secondary to tumor resection and four were secondary to trauma. Of the fourteen patients, nine were pedicled flaps and five were free flaps. We had one failure (free flap group/tumor resection). The rest of the flaps survived completely. The smallest flap was 10 x 8 cm, and the largest flap was 28 x 24 cm.@*CONCLUSION@#The latissimus dorsi muscle remains to be a versatile muscle in the field of orthopedic reconstructive surgery.

Progress in research of monitoring microcirculation of replanted tissue by Smartphone-based thermal imaging system / 中华显微外科杂志

Routine vascular observation is not conducive to the early detection of vascular crisis, thus influencing the success rate of replantation surgery. Infrared thermographic imaging (IRT) can be used to monitor the microcirculation of replanted tissue by visually presenting the value of human surface temperature and thermogram. With the rapid progress of science and technology, IRT technology has gradually become mature and reformed. This article reviewed the research on monitoring microcirculation of replanted tissue by Smartphone-based thermal imaging (SBTI) , in order to provide a basis for subsequent research and clinical application.

Limb Reconstruction Using Masquelet Technique in the Treatment of Post-traumatic Compound Tibial Fractures with Bone Loss

Introduction: Traumatic segmental bone defects of leg are difficult problem to manage with significant long-term morbidity.Historically, due to difficulty in managing segmental bone defects, amputation was the preferred treatment. Later over the lasthalf-century, limb salvage was done using various techniques such as vascularized fibular grafts, acute limb shortening, externalfixator application, and filling the defect with autograft or allograft. More recently, Masquelet described the use of cement spacerapplication within this defect and staged bone grafting within the induced biomembrane formed around the spacer as a potentialtreatment strategy to manage these bone defects.Method: This study describes the clinical, radiological, and functional outcome in 20 patients with traumatic bone loss of up to5 cm managed using Masquelet technique.Results: The outcome was analyzed using Association for the study and application of methods of ilizarov (ASAMI) scorewhich showed excellent results in 10 patients, good in 5 patients, fair in 2 patients, and poor in 3 patients.Conclusion: We conclude that the induced membrane technique can be a valuable addition to the armamentarium of limbreconstruction procedures in patients with small bone defects with or without soft tissue injury.

Reverse-flow anterolateral thigh flap for knee soft-tissue reconstruction: case report

The reconstruction of the injured tissue around the knee is a complex procedure for the plastic and orthopaedic surgeon. The objective is to provide an acceptable function and aesthetic result. Successful wound management includes meticulous debridement, planning and proper execution of the surgical procedure. An 11-year-old male patient with a right patellar fracture using an anterolateral thigh flap with reverse flow to cover the skin defect. For such purposes, the reverse flow anterolateral flap is an effective, trustworthy and well-documented option. The correct obtaining and implantation of the flap reduces the morbidity of the donor site, offers options in size and design, an adequate length of the pedicle and the possible combination with the fascia lata in case it is required. The versatility of the reverse flow anterolateral flap makes it a possible therapeutic alternative in reconstructive surgery since it is aesthetic and functional for the reconstruction of tissue near the knee joint.

O uso da matriz colágena porcina na reconstrução tecidual em Periodontia / The use of the porcin collagen matrix in the periodontal tissue reconstruction

A doença periodontal causa uma perda na estrutura de suporte dos elementos dentários. Como consequência, ocorre o aparecimento de sequelas provenientes dessa doença. Por conta disso foram desenvolvidos materiais com a fi nalidade de regeneração tecidual na estrutura de suporte, para que houvesse maior sobrevida desses elementos, aumento na quantidade de gengiva inserida e melhor otimização estética para os pacientes. Dentre os inúmeros materiais, temos a Matriz Colágena Porcina, que simplesmente é uma membrana obtida a partir de suínos, sendo que esta passa por uma cadeia de procedimentos, com a fi nalidade de minimizar e/ou eliminar qualquer tipo de interação alergênica no ser humano. A sua utilização é dada principalmente no aumento de tecidos moles ao redor de dentes afetados com a doença periodontal e em implantes osseointegrados, trazendo como principal vantagem a redução de morbidade do paciente, evitando, assim, a necessidade de um segundo sítio cirúrgico.

Periodontal disease results in the loss of structural support on dental elements. As such, sequels can be seen in the mouth. For this, materials were develop for tissue regeneration in order to increase the amount of attached gingiva and to optimize patient esthetics. The porcine collagen matrix is a product were the collagen undergoes a series of several treatments to minimize any type of allergic reaction to the human body. For example, it can be used for soft tissue augmentation around affected teeth and dental implants. Also, the porcine collagen matrix can reduce patient morbidity because it avoids autologous soft tissue harvesting.

Free Flaps for Hand Soft Tissue Reconstruction

Various soft tissue defects can be occurred in the hand. In determining the most suitable means of reconstruction a defect, the benefit of the reconstruction has to outweigh the risk of donor morbidity. Flap selection will be based on the size of the defect, the requirements for sensibility, the surgeon's comfort level, and the patient profile such as gender, age, or systemic disease. The hand is the most important tactile sensory organ, hence sensory restoration is critical. Neurosensory free flaps can provide sensibility, vascularity, and soft tissue coverage to an injured hand. This paper will discuss free flaps which can be used for soft tissue reconstruction of the hand.

The Treatment of Trochanteric Pressure Sore Using Superior or Inferior Gluteal Artery Perforator Flap

PURPOSE: Management of pressure sores has been improved, along with development of musculocutaneous flaps and perforator flaps. Nowadays, the treatment of pressure sore with perforator flaps has shown several advantages, including minimal donor site morbidity, relatively versatile flap design not only in primary cases but also in recurred cases and minimized anatomical rearrangement of regional muscle position. In this study, we report our clinical experience of gluteal perforator flap used in the treatment of a greater trochanteric pressure sore. METHODS: A clinical study was performed on 7 patients who underwent total 10 operations. 1 superior gluteal artery perforator flap and 9 inferior gluteal artery perforator flaps were used to reconstruct the defect, followed by the mean observation duration of 22 months. RESULTS: There were no total flap loss. We treated 2 cases of partial flap loss with debridement and primary repair. 2 recurred cases were successfully treated using the same method. Donor sites were all primarily repaired. CONCLUSION: The gluteal perforator flap could be considered as a safe and favorable alternative in the treatment of soft tissue defects in the greater trochanteric area. The advantages of the flap include low donor site morbidity and the possibility of versatile flap design not only in primary cases but also in recurred cases.

Clinical application of superficial temporal artery island flap in the reconstruction of eyelid and periorbital defect / 眼科研究

Serious defect of eyelid and periorbital tissue affects the appearance of patients and closure-eye function.Application of superficial temporal artery island flap to repair the defected tissue is considered to be an available method to reconstruct eyelid and periorbital tissue.ObjectiveThis study aims to investigate the indication,safety and effectivity of reconstructing the serious defect of eyelid and periorbital tissue by forward flow flap.MethodsEighteen eyes of 18 cases with serious eyelid and periorbital tissue defect were reconstructed by covering the defect zone with superficial temporal artery to form forward flow flap.The flap was made along the distribution of superficial temporal artery with the size over the tissue detect area and transferred to lesion via subcutaneous tunnel.The follow-up time was 6 months.Survival status of flap,plastic condition of lesion and surgical treatment were discussed.ResultsAmong 18 cases with eyelid and periorbital defect,the flaps were survived in 16 cases with the satisfactory repairing appearance,showing nice color,soft texture and normal sensation after plastic surgery.Reconstructed eyelids closed well.One case showed the temporary obstruction of venous refluence in early stage after operation and remained distal epidermal necrosis.Reoperation was performed in 6 patients because of flap hypertrophy and showed a successful outcome.One patients occurred the failure of plastic flap due to hypertrophy and underwent free-flap transplantation in 3 months following the first surgery and obtained a ultimately flap survival.ConclusionThe superficial temporal artery forward flow flap offers a stable and reliable blood supplying and provides adequate tissue of excellent color and texture match.It is an ideal and available flap for the reconstruction of serious eyelid and periorbital tissue defect.

Soft Tissue Reconstruction of the Thumb with the First Dorsal Metacarpal Artery Island Flap

PURPOSE: The aim of this study was to report the efficacy of the first dorsal metacarpal artery island flap for soft tissue defect of the thumb. MATERIAL AND METHODS: We performed the first dorsal metacarpal artery island flap for soft tissue defect of the thumb in 14 cases since 1992 to 2008. There were dorsal defect in 9 cases, volar defect in 2 cases and lateral defect in 3 cases. The cases are limited by defect size under 2.5 cm in width. We checked a vessel diameter in the flap pedicle, a mobile pedicle length in operative field. Evaluation results was based on flap quality, donor site quality, two-point sensory discrimination, scar contractures, total active movement of the thumb and donor digit. RESULTS: The flap quality was well vascularized and survived in 12 cases (success rate : 86%). Diameter of vessels in flap was estimated within 0.5 mm by operational findings. Dorsal vein was irregular and complicated. Average of the pedicle length was 3.2 cm. Sensory function were preserved in all cases after long term follow up, but the cases we could measure two-point discrimination were 9 cases and average was 5.3 mm. Donor sites were dermatized using skin graft and 2 cases were complained limitation of motion at joints of index finger. CONCLUSION: The failure rate of flap were about 14%. We considered that it need to prepare under operational microscopy because vessels distributed into flap are small and complex. Problems of donor site are not negligible. However it was regarded as a useful island flap which could preserve sensory function in case of soft tissue defect of thumb when it applied to appropriate cases and operated by skilled procedure.

One-stage Reverse Lateral Supramalleolar Adipofascial flap for Soft Tissue Reconstruction of the Foot and Ankle Joint

PURPOSE: To report the clinical results and efficacies of one stage reverse lateral supramalleolar adipofascial flap for soft tissue reconstruction of the foot and ankle joint. MATERIAL AND METHODS: We performed 5 cases of one stage reverse lateral supramalleolar adipofascial flap from Jan 2005 to Sept 2005. All patients were males and mean age was 50(36~59) years old. The causes of soft tissue defects were 1 diabetic foot, 2 crushing injuries of the foot, 1 open fracture of the calcaneus, and 1 chronic osteomyelitis of the medial cuneiform bone. Average size of the flap was 3.6(3~4)x4.6(4~6) cm. All flaps were harvested as adipofascial flap and were performed with the split-thickness skin grafts (STSG) above the flaps simultaneously. RESULTS: All flap survived completely and good taking of STSG on the flap was achieved in all cases. There were no venous congestion and marginal necrosis of the flap. In diabetic foot case, wound was healed at 4 weeks after surgery due to wound infection. There was no contracture on the grafted sites. Ankle and toe motion were not restricted at last follow up. All patients did not have difficulty in wearing shoes. CONCLUSION: The reverse lateral supramalleolar adipofascial flap and STSG offers a valuable option for repair of exposure of the tendon and bone around the ankle and foot. Also one stage procedure with STSG can give more advantages than second stage with FTSG, such as good and fast take-up, early ambulation and physical therapy, and good functional result.

Usefulness of Omental Flap for Various Soft Tissue Reconstruction

Extensive and complicated defects on the body call for an omnipotent tool for a perfect reconstruction. Flaps derived from the omentum has many advantages over the conventional flaps. From 1999 to 2004, Omental flaps were applied for various soft tissue reconstructions. Among total 20 total 7 cases were for immediate reconstruction, 2 cases for chronic infection, 3 cases for simultaneous reconstruction of two defects, 4 cases for functional joint reconstruction and 4 cases were for flow- through revascularization. Among these cases, 3 cases were operated with minimal incision harvest technique. There were no complete flap failures, partial necrosis of the distal parts were noted on three cases. The omental flap is indicated on a large contaminated defect reconstruction due to its large size, well-vascularized, and malleable properties. The omental flap provides several additional advantages over other flaps, which are; the availability of the one staged simultaneous reconstruction of two defects with one flap, providing gliding function for the joint motion, and a flow-through characteristics with long vascular pedicle. But there are some serious shortcomings, including a long abdominal scar and intraabdominal problems. However, these are rare and can be minimized with our minimal incision technique. Due to its unique characteristics. the omentum is one of the ideal tissues for the reconstruction of the complicated soft tissue defects due to its unique characteristics.