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Bieler D, Franke A, Völlmecke M, Hentsch S, Markewitz A, Kollig E. [Treatment regimen for deep sternal wound infections after cardiac surgical interventions in an interdisciplinary approach]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:211-220. [PMID: 38085276 PMCID: PMC10891204 DOI: 10.1007/s00113-023-01394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 02/24/2024]
Abstract
The aim of this article is to present the importance of a structured and situation-adapted approach based on the diagnostic and therapeutic strategy in the interdisciplinary treatment of 54 patients with deep sternal wound infections (DSWI) after cardiac surgical interventions and the results achieved. The patients were 41 men and 13 women with an average age of 65.1 years, who developed a DSWI after a cardiac surgical intervention during the period 2003-2016. The treatment strategy included a thorough debridement including the removal of indwelling foreign material, the reconstruction with a stable re-osteosynthesis after overcoming the infection and if necessary, situation-related surgical flaps for a defect coverage with a good blood supply and mandatory avoidance of dead spaces. A total of 146 operations were necessary (average 2.7 operations/patient, range 1-7 operations). In 24.1 % of the cases a one-stage approach could be carried out. In 41 patients negative pressure wound therapy (NPWT) with programmed sponge changing was used for wound conditioning (mean 5 changes, standard deviation, SD± 5.6 changes over 22 days, SD± 23.9 days, change interval every 3-4 days in 40.7% of the cases). In 33 patients a bilateral myocutaneous pectoralis major flap was used, in 4 patients a vertical rectus abdominis myocutaneous (VRAM) flap and in 7 patients both were carried out. A total of 43 osteosynthesis procedures were carried out on the sternum with fixed-angle titanium plates. Of the patients 7 died during intensive care unit treatment (total mortality 13 %, n = 5, 9.3 % ≤ 30 days) or in the later course. Of the patients 47 (87.1 %) could be discharged with a cleansed infection. In 2 patients the implant was removed after 2 years due to loosening.
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Affiliation(s)
- D Bieler
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland.
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
| | - A Franke
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
| | - M Völlmecke
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
| | - S Hentsch
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
| | | | - E Kollig
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
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Loanzon RS, Kim Y, Voit A, Cui CL, Southerland KW, Long CA, Williams ZF. Risk factors and consequences of wound complications following sartorius flap reconstruction. J Vasc Surg 2024; 79:323-329.e2. [PMID: 37802403 DOI: 10.1016/j.jvs.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Groin wound complications are common following vascular surgery and can lead to significant patient morbidity. Sartorius muscle flap coverage may help to prevent vascular graft infection in the setting of wound dehiscence or infection. However, risk factors and consequences of wound complications following sartorius flap reconstruction remain incompletely investigated. METHODS We retrospectively queried all patients who underwent sartorius flap reconstruction at a tertiary academic medical center. Data collected included patient demographics, medical comorbidities, surgical indication, index vascular procedure, and postoperative outcomes. The primary outcome was wound complication following sartorius flap procedure, which was defined as groin wound infection, dehiscence, or lymphocutaneous fistula. RESULTS From 2012 to 2022, a total of 113 patients underwent sartorius flap reconstruction. Of these, 66 (58.4%) were performed after the development of a prior groin complication, and 47 (41.6%) were prophylactic. A total of 88 patients (77.9%) had a prosthetic bypass graft adjacent to the flap. Twenty-nine patients (25.7%) suffered a wound complication following sartorius flap reconstruction, including 14 (12.4%) with wound dehiscence, 13 (11.5%) with wound infection, and two (1.8%) with lymphocutaneous fistula. Patients with wound complications had a higher body mass index (28.8 vs 26.4 kg/m2; P =.03) and more frequently active smokers (86.2% vs 66.7%; P = .04). Additionally, patients with wound complications had a higher unplanned 30-day hospital readmission rates (72.4% vs 15.5%; P < .001), reintervention rates (75.9% vs 8.3%; P < .001), and re-do flap reconstruction rates (13.8% vs 2.4%; P = .02). On multivariable analysis, higher body mass index was independently associated with post-flap wound complications (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.001-1.03; P = .037). Consequently, wound complications were associated with both surgical reintervention (aOR, 35.4; 95% CI, 9.9-126.3; P < .001) and unplanned hospital readmission (aOR, 17.8; 95% CI, 5.9-54.1; P < .001). CONCLUSIONS Sartorius flap reconstruction is an effective adjunct in facilitating wound healing of groin wounds. However, wound complications are common following sartorius flap reconstruction and may be associated with reintervention and unplanned hospital readmission. These data support the judicious and thoughtful utilization of sartorius flap procedures among high-risk patients.
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Affiliation(s)
- Roberto S Loanzon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Antanina Voit
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Kevin W Southerland
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Zachary F Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
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Evaluating physiological progression of chronic tibial osteomyelitis using infrared thermography. RESEARCH ON BIOMEDICAL ENGINEERING 2022. [PMCID: PMC9244558 DOI: 10.1007/s42600-022-00228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose Medical infrared thermography (IRT) was used as a complementary means for the clinical evaluation of musculoskeletal trauma and progression of chronic tibial osteomyelitis. Methods Twenty-two adult patients with a medical diagnosis of chronic tibial osteomyelitis were followed up by IRT performed along with standard radiography. Thermal data of the affected limb were compared with those of the healthy contralateral limb based on the thermal profile of the lower limbs as per the medical thermography guideline (32 °C). Data were acquired in the following regions of the lower limb: proximal tibia, diaphysis, and distal tibia, using a FLIR infrared camera, and data were processed using MATLAB®. Results For patients with active infections, an increase in the average temperature of the affected limb above + 1.0 °C was observed when compared with the temperature of the contralateral. The wound region of the patients showed an increased temperature (32.3 °C) compared with the temperature of the contralateral (31.4 °C). In contrast, in latent infections, the thermal differences were small, generally below 0.3 °C, and thus were within the threshold of normality. In contrast, in areas diagnosed with reduced blood supply, the affected limb showed an average temperature up to − 5.7 °C below normal. Additionally, the initial temperature range (26.5 to 34.5 °C) decreased during the treatment to 29.8 to 34.1 °C, indicating a convergence toward normality. Conclusion IRT has significant potential as a complementary imaging modality in the follow-up of patients with bone lesions with a diagnosis of osteomyelitis as it does not use ionizing radiation, thus allowing repetitive use as desired. Thermal images show important physiological information related to vascularization necessary for bone repair, as well as provide a good indication of the boundary of the infected area, adjacent to the trauma, which is useful for positioning the radiography equipment. However, it should be noted that IRT cannot replace other medical imaging techniques, as it provides information about the skin and cannot directly evaluate the interior of the body.
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Kim SH, Lee JH, Kim SE, Shin SH, Kim HJ, Lee SJ, Kim JH, Suh IS. Retrospective study of the efficacy of vascularized tissue transfer for treating antibiotic-resistant bacteria-infected wound: Comparison with clean and antibiotic-sensitive bacteria-infected wound. Medicine (Baltimore) 2021; 100:e25907. [PMID: 34114986 PMCID: PMC8202535 DOI: 10.1097/md.0000000000025907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/22/2021] [Indexed: 01/04/2023] Open
Abstract
If wounds are infected with bacteria resistant to an empirical antibiotic regimen, effective wound treatment will be delayed. This can delay wound healing and lengthen hospital stays, increasing the costs to patients. Long-term antibiotic use can also result in minor and major complications, such as diarrhea, antibiotic resistance, or life-threatening leukopenia. Multidrug-resistant (MDR) bacteria make wound treatment even more difficult. Traditionally, surgeons thought that adequate infection control should be established before soft tissue coverage. However, wounds infected by MDR do not heal well with this traditional method and there are no optimal treatment guidelines for MDR bacteria-contaminated wounds.We reviewed 203 patients who underwent vascularized flap surgery from 2012 to 2019 to cover wounds. Class IV and I wounds were compared according to the Centers for Disease Control and Prevention classification. Class IV was further classified as antibiotic-resistant (ARB) and antibiotic-sensitive (ASB) bacteria. Wound size, mode, location, pathogens, healing time, and basic demographics were evaluated. Data were compared using Cramer's V and one-way ANOVA or independent t tests.The average healing time was longer in the ARB (19.7 [range 7-44] days) and ASB (17.9 [range 2-36] days) groups than in the Clean group (16.5 [range 7-28] days). Healing time differed in the 3 groups (P = .036). It was longer in the class IV group than in the class I group (P = .01). However, it was not statistically different between the ARB and ASB groups (P = .164).In our study the difference in healing time was small when vascularized tissue transfer was done in ARB-infected wound compared with ASB-infected and clean wound. It is necessary to perform surgery using vascularized tissue for the infected wound of antibiotic-resistant bacteria.
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Affiliation(s)
- Seong Hwan Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul
| | - Ju Ho Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul
| | - Seong Eun Kim
- Department of Internal Medicine, Division of Infectious Diseases, Chonnam National University Hospital, Gwangju, Korea
| | - Se Ho Shin
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul
| | - Hyeon Jo Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul
| | - Seong Joo Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul
| | - Jae Hyun Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul
| | - In Suck Suh
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul
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Tabakan I, Eser C, Gencel E, Kokaçya Ö. Reconstruction of firearm and blast injuries in Syrian war refugees. Int J Clin Pract 2021; 75:e13995. [PMID: 33400319 DOI: 10.1111/ijcp.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/09/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND War injuries differ from other injuries owing to the large tissue defects they cause and their high risk of contamination. As fragments scattered by high-energy firearms and explosives cause serious composite tissue damage, repair of such injuries is difficult and requires a long treatment period. We discuss the treatment methods used for injured Syrian War refugees admitted to our clinic and present the most effective repair methods for war-related tissue defects for each region of the body. METHODS A total of 61 patients treated between June 2012 and April 2015 were retrospectively evaluated in terms of age, gender, duration of hospitalisation, injury site and repair method employed. The patients were grouped by region injured (head/neck, extremities and trunk). RESULTS The female-to-male ratio of the patients was 16/45, and their mean age was 25.2 (range, 3-51) years. Twenty-two patients were under the age of 18. The mean duration of hospitalisation was 28.5 days. A total of 130 operations were performed on the patients, including debridement and revisions. Repairs were conducted with free flaps in 17 patients (6 on the head/neck region, 11 on extremities) and with pedicle flaps in 28 patients (11 on the head/neck region, 12 on extremities, 5 on the trunk). Two patients experienced flap loss without other complications, and other patients experienced complications including bleeding, infection, flap detachment, hematoma and seroma. CONCLUSIONS War injuries cause tissue damage of a composite and extensive nature. Most affect the extremities, followed by the head/neck and trunk regions. They are primarily sustained by the young population, not usually easy to treat, and require long hospitalisation periods. A variety of methods may be preferred to treat these injuries.
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Affiliation(s)
- Ibrahim Tabakan
- Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Cengiz Eser
- Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Eyuphan Gencel
- Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ömer Kokaçya
- Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
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Zhang P, Tao FL, Li QH, Zhou DS, Liu FX. Salvage of vascular graft infections via vacuum sealing drainage and rectus femoris muscle flap transposition: A case report. World J Clin Cases 2021; 9:2296-2301. [PMID: 33869606 PMCID: PMC8026842 DOI: 10.12998/wjcc.v9.i10.2296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of vascular graft infections continues to be a significant challenge in a clinical situation. The aim of this report is to illustrate the novel vacuum sealing drainage (VSD) technique and rectus femoris muscle flap transposition for vascular graft infections, and to evaluate the prospective of future testing of this surgical procedure. CASE SUMMARY We report the case of a 32-year-old male patient, who presented a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure. Using the VSD and muscle flap trans-position, the groin wound and vascular graft infection were finally treated successfully. CONCLUSION Our case report highlights that VSD technique and rectus femoris muscle flap transposition could be considered in patients presenting with a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure, especially in consideration of treatable conditions.
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Affiliation(s)
- Peng Zhang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Fu-Lin Tao
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Qing-Hu Li
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Dong-Sheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Fan-Xiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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Senda H, Okamoto H. A case of pubic abscess after prostate cancer surgery and radiotherapy treated with rectus femoris muscle flap. JPRAS Open 2020; 26:54-59. [PMID: 33134471 PMCID: PMC7588652 DOI: 10.1016/j.jpra.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/27/2020] [Indexed: 11/18/2022] Open
Abstract
We report the case of a 95-year-old man with soft tissue deficiency associated with a pubic abscess that occurred 30 years after prostate cancer surgery and radiation therapy. A fistula with purulent discharge without any obvious cause appeared in the midline of the lower abdomen and progressed to a soft tissue defect in which several calcium phosphate stones of 5-8 mm in diameter were found. Computed tomography showed calcium deposits on the surface of the pubis and irregular zonal calcifications extending from the pubis to the medial region of both thighs. Conservative treatment did not improve the patient's condition; thus, surgical treatment was performed. The pedicled rectus femoris muscle flap was elevated from the left thigh and transferred to fill the tissue defect, then a split thickness skin graft was applied on it. The tissue defect was successfully repaired, and the patient was able to regain ambulation ability. In the present case, it was presumed that urine exudation around the bladder due to radiation cystitis was involved in the formation of ectopic calculi and subsequent infection. In reconstructing a complex defect associated with infection, using muscle flaps to fill the dead space with well vascularized tissue is considered to be appropriate. In our case, we chose a rectus femoris muscle flap, which has advantages in volume and versatility of transposition owing to long vascular pedicle and requires no microsurgical vascular anastomosis. As a result, the preoperative activity was maintained, the infection was treated, and a good course was obtained.
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Affiliation(s)
- H. Senda
- Department of Orthopaedic Surgery, Nagoya City East Medical Center, 2-23 Wakamizu 1, Chikusa, Nagoya, Aichi, 464-8547, Japan
| | - H. Okamoto
- Department of Orthopaedic Surgery, Nagoya City University
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Gibson AW, Gobillot TA, Bass DI, Zakarevicius Z, Rizvi ZH, Ravanpay AC. Case of Esophageal Perforation and Repair with a Supraclavicular Artery Island Fascial Flap 15 Years After Anterior Spine Surgery. World Neurosurg 2020; 143:102-107. [PMID: 32730966 DOI: 10.1016/j.wneu.2020.07.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Esophageal perforation represents a rare but potentially life-threatening complication of an anterior cervical diskectomy and fusion (ACDF). Delayed presentations of esophageal perforation more than 10 years following surgery are exceedingly rare and difficult to diagnose. Here, we discuss the case of an 80-year-old man who presented to the emergency department with progressive dysphagia 15 years after his ACDF. CASE DESCRIPTION While prior outpatient workup was suggestive of a diverticulum, there was no evidence of esophageal perforation. Progressive symptoms and repeat imaging on admission were suggestive of retropharyngeal phlegmon. Operative esophagoscopy revealed that the spinal hardware had eroded through the posterior wall of the esophagus, creating a traction diverticulum. The hardware was removed, and the esophageal perforation was closed primarily and buttressed with vascularized tissue from a supraclavicular artery island fascial flap. CONCLUSIONS This case emphasizes the importance of considering an esophageal perforation in patients who present with dysphagia at any interval following an ACDF, even in the extremely delayed setting. Furthermore, this is the first report, to the best of our knowledge, using a supraclavicular artery island fascial flap to reconstruct an esophageal perforation following an ACDF, and we introduce a novel strategy for managing these complicated injuries.
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Affiliation(s)
- Alec W Gibson
- School of Medicine, University of Washington, Seattle, Washington, USA
| | | | - David I Bass
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Zilvinas Zakarevicius
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA; Neurosurgery, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Zain H Rizvi
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA; Neurosurgery, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Ali C Ravanpay
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosurgery, VA Puget Sound Health Care System, Seattle, Washington, USA.
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Moucharafieh RC, Nehme AH, Badra MI, Rahal MJH. Rectus abdominis free tissue transfer in lower extremity reconstruction: Long term follow up in 58 cases. Injury 2019; 50 Suppl 5:S25-S28. [PMID: 31699350 DOI: 10.1016/j.injury.2019.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED This study evaluates the long-term results of rectus abdominis free-tissue transfer performed for lower extremity reconstruction. METHODS Over a period of 8 years 58 were available for long term follow-up. Indications for reconstruction included acute wounds with soft tissue defects, diabetic foot ulcers, and chronic osteomyelitis. RESULTS At a mean follow-up of 18 years, there were no major complications in the soft tissue defect coverage group except for one patient who continued to have recurrent folliculitis over the weight bearing heel area, which was treated by repeated debridement. Among the diabetic patients, two patients had recurrent ulcerations of the forefoot which were detected early and treated conservatively. In the osteomyelitis group, however, there were no recurrences of the foot infection. CONCLUSIONS The rectus abdominis free-tissue transfer provided an excellent method of soft tissue reconstruction with a very minimal long-term complication rate, and a very high rate of success in the treatment of diabetic foot ulcers and chronic osteomyelitis.
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Affiliation(s)
- Ramzi C Moucharafieh
- Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut 1100 2807, Lebanon; Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center affiliated with Johns Hopkins International, Clemenceau Beirut, Lebanon.
| | - Alexandre H Nehme
- Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut 1100 2807, Lebanon
| | - Mohammad I Badra
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center affiliated with Johns Hopkins International, Clemenceau Beirut, Lebanon
| | - Mohammad Jawad H Rahal
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center affiliated with Johns Hopkins International, Clemenceau Beirut, Lebanon
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Posterior Tibial Artery Perforator Flaps Carrying Partial Gastrocnemius Muscle for Repair of Soft Tissue Defects With Dead Space in the Ankle and Foot. Ann Plast Surg 2019; 82:552-559. [PMID: 30870168 DOI: 10.1097/sap.0000000000001748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Soft tissue defects with dead space in the ankle and foot remain a challenge for surgeons. The aim of the study was to evaluate the surgical technique and clinical significance of posterior tibial artery perforator flaps carrying partial gastrocnemius muscle for patients with soft tissue defects with dead space in the ankle area. METHODS Between August 2015 and August 2017, 14 patients (2 women and 12 men) between 20 and 58 years old (median age, 42 years) were hospitalized in The First Affiliated Hospital of Soochow University. All injuries involved damage to the ankle area and formation of soft tissue defects with dead space. In all patients, posterior tibial artery perforator flaps carrying partial gastrocnemius muscle were transplanted to cover soft tissue defects with dead spaces. RESULTS Hospitalization duration ranged from 10 to 20 days (mean, 16 days). All flaps survived and healed well. At follow-up after 6 to 24 months, all cases had recovered successfully in terms of aesthetic and functional aspects. CONCLUSIONS Posterior tibial artery perforator flaps carrying partial gastrocnemius muscle can be an optimal reconstruction method for repairing soft tissue defects with dead space in the ankle and foot.
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Buono P, Castus P, Dubois-Ferrière V, Rüegg EM, Uçkay I, Assal M, Pittet-Cuénod B, Modarressi A. Muscular Versus Non-Muscular Free Flaps for Soft Tissue Coverage of Chronic Tibial Osteomyelitis. World J Plast Surg 2018; 7:294-300. [PMID: 30560067 PMCID: PMC6290312 DOI: 10.29252/wjps.7.3.294] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eradication of chronic tibial osteomyelitis necessitates aggressive debridement is often followed by soft tissue reconstruction. Muscular flaps are said to be more effective than non-muscular flaps for infection treatment, while fasciocutaneous and perforator flaps are considered to be less invasive and offering a better aesthetic result. METHODS In this study, we reviewed 24 consecutive cases of chronic tibial osteomyelitis treated according to a specific protocol in a tertiary hospital. Soft tissue coverage was done with either muscular or non-muscular free flaps. Infection recurrence and complications were compared between different flap types. Additionally, we assessed the long-term functional and aesthetic results and patient’s satisfaction. RESULTS Muscular flap was used in 13 patients (13 latissimus dorsi and 1 serratus anterior) and 11 patients underwent fasciocutaneous/perforator flaps [1 anterolateral thigh flap, 4 lateral arm flaps, 5 thoracodorsal artery perforator (TAP) flaps and 1 radial forearm flap]. Infection was resolved for 84.6% of patients in the muscular flaps group and 90.9% in the non-muscular flaps group. None of the patients with muscular flaps were satisfied with the aesthetic appearance of their reconstructed leg when compared to 83.3% of patients with non-muscular flaps. Also, a slight regain of touch sensitivity was acknowledged in the non-muscular flap group compared to the muscular. CONCLUSION In this study of adult chronic tibial osteomyelitis cases, we demonstrated that fasciocutaneous and perforator free flaps offer a comparable efficacy to the muscle flaps for infection treatment, with a significantly higher patient satisfaction and aesthetic result.
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Affiliation(s)
- Pablo Buono
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland
| | - Pascal Castus
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland
| | - Victor Dubois-Ferrière
- Orthopaedic Surgery Department, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland
| | - Eva Meia Rüegg
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland
| | - Ilker Uçkay
- Orthopaedic Surgery Department, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland.,Unit of Infectious Diseases, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland
| | - Mathieu Assal
- Orthopaedic Surgery Department, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland
| | - Brigitte Pittet-Cuénod
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland
| | - Ali Modarressi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland
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Hong JP(J, Goh TLH, Choi DH, Kim JJ, Suh HS. The Efficacy of Perforator Flaps in the Treatment of Chronic Osteomyelitis. Plast Reconstr Surg 2017; 140:179-188. [DOI: 10.1097/prs.0000000000003460] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flap Reconstruction for Esophageal Perforation Complicating Anterior Cervical Spinal Fusion: An 18-year Experience. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e400. [PMID: 26090290 PMCID: PMC4457263 DOI: 10.1097/gox.0000000000000350] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/17/2015] [Indexed: 01/20/2023]
Abstract
Background: Esophageal injury following anterior cervical discectomy and fusion (ACDF) poses a significant reconstructive challenge. Buttressing flap repairs have proven beneficial; however, there remains a paucity of evidence to guide optimal flap selection. Methods: A retrospective chart review was performed for patients who presented to the senior author with esophageal perforations after ACDF from 1995 until present. Demographic, clinical, and postoperative details were collected. Outcomes of omental flap reconstructions were compared against other flap reconstructions. Results: A total of 13 flap reconstructions were performed in 11 patients with the following distribution: 7 free omental, 1 anterolateral thigh, 1 osteomuscular fibula, 2 radial forearm, and 2 pedicled pectoralis flaps. Patients receiving omental flap reconstructions demonstrated a significantly faster resolution of leak on contrast swallow imaging and earlier return to oral feeding compared with all other flap reconstructions (22.5 versus 268 days, respectively; P < 0.05). This relationship remained evident even when calculations excluded an outlying patient from the nonomental cohort (22.5 versus 111 days, respectively; P < 0.05). Length of hospital stay, complications, and success rates were also more favorable in the omental cohort but failed to reach statistical significance. Conclusions: Esophageal perforation after ACDF is an uncommon but devastating complication. The use of free omentum flap reconstruction is associated with a more rapid functional recovery and may prove beneficial in the management of these challenging cases.
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Free and pedicle flaps in lower extremity trauma. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-014-1056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Han SE, Lee KT, Mun GH. Muscle-chimaeric medial sural artery perforator flap: A new design for complex three-dimensional knee defect. J Plast Reconstr Aesthet Surg 2014; 67:571-4. [DOI: 10.1016/j.bjps.2013.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/14/2013] [Accepted: 09/13/2013] [Indexed: 11/16/2022]
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Moucharafieh R, Wehbe J, Maalouf G, Atiyeh B. Long-term follow-up on microsurgical free-tissue transfer in foot and ankle reconstruction. Foot Ankle Surg 2010; 14:82-8. [PMID: 19083620 DOI: 10.1016/j.fas.2007.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 10/29/2007] [Accepted: 11/12/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND We have previously reported on the efficacy of free-tissue transfer in ankle and foot reconstruction with a mean follow-up period of 3.7 years (9 months-7.5 years) postoperatively. This study will evaluate the long-term results of free-tissue transfer performed for soft tissue defect coverage, diabetic foot salvage and the treatment of chronic osteomyelitis in 38 patients. METHODS The long-term efficacy of free-tissue transfer for foot and ankle reconstruction was evaluated in a retrospective study among patients operated during a period of 5 years (January 1992-December 1996); 38 were available for follow-up. Indications for reconstruction included acute wounds with soft tissue defects, diabetic foot ulcers, and chronic osteomyelitis. RESULTS At a mean follow-up of 12 years, there were no major complications in the soft tissue defect group. Among the diabetic patients, two patients had recurrent ulcerations of the forefoot which were detected early and treated conservatively. In the osteomyelitis group, however, there were no recurrences of the foot infection. CONCLUSIONS The free-tissue transfer provided an excellent method of soft tissue reconstruction with a very minimal long-term complication rate, and a very high rate of success in the treatment of diabetic foot ulcers and chronic osteomyelitis.
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Fujioka M, Oka K, Kitamura R, Yakabe A. Cervical osteomyelitis and epidural abscess treated with a pectoralis major muscle flap. ACTA ACUST UNITED AC 2009; 72:761-4; discussion 764. [PMID: 19665205 DOI: 10.1016/j.surneu.2009.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 05/27/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Spinal osteomyelitis and epidural abscess are uncommon but have a potentially disastrous outcome, although the surgical techniques and antimicrobial therapy have advanced. CASE DESCRIPTION We present a case of cervical osteomyelitis and epidural abscess resulting from pharyngeal squamous cell carcinoma ablation, which were treated with a pectoralis major muscle flap successfully. CONCLUSION Muscle flap insertion to the cervical contaminated wound enables radical removal of the contaminated tissue, and the muscle flaps for dead-space obliteration and neovasculation were obligatory for successful management of the infected complex wound. Furthermore, the inserted pectoralis major muscle flap can divide vertebrae and epidural canal from these origins of infection. We believe that this technique is simple, can be performed in a one-stage management, has minimal associated morbidity, and thus, is advocated as a desirable treatment option in the treatment of cervical osteomyelitis and epidural abscess.
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Affiliation(s)
- Masaki Fujioka
- Department of Plastic and Reconstructive Surgery, National Hospital organization Nagasaki Medical Center, Nagasaki, Japan.
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Klonaris C, Katsargyris A, Vasileiou I, Markatis F, Liapis CD, Bastounis E. Hybrid repair of ruptured infected anastomotic femoral pseudoaneurysms: Emergent stent-graft implantation and secondary surgical debridement. J Vasc Surg 2009; 49:938-45. [DOI: 10.1016/j.jvs.2008.10.063] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 10/28/2008] [Accepted: 10/30/2008] [Indexed: 10/21/2022]
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Souza FID, Zumiotti AV, Mattar Junior R, Wei TH, Resende MRD, Torres LR. Emprego do músculo gastrocnêmio no tratamento das lesões infectadas do joelho. ACTA ORTOPEDICA BRASILEIRA 2009. [DOI: 10.1590/s1413-78522009000400010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar prospectivamente o emprego do retalho do músculo gastrocnêmio no tratamento de lesões infectadas do joelho. MÉDOTOS: foram operados 12 pacientes, onze do sexo masculino, com idade variando de 19 a 78 anos, média de 55 anos. A cobertura com músculo gastrocnêmio medial foi realizada em 11 pacientes, e lateral em um. A média de desbridamentos pré-operatórios foi de 3,2 procedimentos, variando de um a nove. RESULTADOS: todos os retalhos sobreviveram. O agente etiológico mais comum foi o S. aureus, em 54,5%. Após seguimento médio de 20,08 meses (13 a 31), todos os pacientes apresentam cobertura estável sem sinais ou sintomas de reinfecção. CONCLUSÃO: a utilização do músculo gastrocnêmio no tratamento de lesões infectadas do joelho proporcionou bons resultados com baixa morbidade.
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Erba P, Wettstein R, Rieger UM, Haug M, Pierer G, Kalbermatten DF. A Study of the Effect of Sartorius Transposition on Lymph Flow After Ilioinguinal Node Dissection. Ann Plast Surg 2008; 61:310-3. [DOI: 10.1097/sap.0b013e31815888df] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lower limb revascularisation preceding surgical wound coverage – An interdisciplinary algorithm for chronic wound closure. J Plast Reconstr Aesthet Surg 2008; 61:925-33. [DOI: 10.1016/j.bjps.2007.09.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 08/28/2007] [Accepted: 09/27/2007] [Indexed: 11/24/2022]
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Wound salvage with a fasciocutaneous flap after artificial vascular graft infection. Plast Reconstr Surg 2008; 121:1863-1864. [PMID: 18454025 DOI: 10.1097/prs.0b013e31816b1504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Wound Salvage with a Fasciocutaneous Flap after Artificial Vascular Graft Infection. Plast Reconstr Surg 2008. [DOI: 10.1097/prs.0b013e31816b1a58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Huang KC, Tsai YH, Hsu RWW. Hyperbaric oxygen therapy facilitates surgery on complex open elbow injuries: preliminary results. J Shoulder Elbow Surg 2007; 16:454-60. [PMID: 17507249 DOI: 10.1016/j.jse.2006.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Revised: 10/05/2006] [Accepted: 10/20/2006] [Indexed: 02/01/2023]
Abstract
Complex open elbow injuries present a significant challenge to orthopaedic surgeons because of the poor potential for achieving a good functional level, even given good anatomic realignment. Associated massive soft-tissue damage impedes surgical fixation, delays rehabilitation, and therefore, further deteriorates the functional outcome. We studied a prospective, consecutive series of 16 patients with complex open elbow injuries who were treated with a combination of treatment modalities including early bony stabilization, debridement of soft tissue, and early coverage. The treatment protocol also used hyperbaric oxygen therapy to facilitate immediate internal fixation. The median value of the Mangled Extremity Severity Score was 5.5 (range, 3-10). Successful reconstruction was achieved in all 16 patients. No deep infection occurred, but there were 3 self-limited superficial infections. The average elbow functional result at 12 months after surgery, based on the Mayo score system, was good (mean value, 80.9; range, 55-100). Of the patients, 75% achieved satisfactory functional results for the elbow. The results of this study demonstrate that the studied treatment protocol provides a promising alternative for managing these complex open elbow injuries.
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Papagelopoulos PJ, Mavrogenis AF, Tsiodras S, Vlastou C, Giamarellou H, Soucacos PN. Calcium sulphate delivery system with tobramycin for the treatment of chronic calcaneal osteomyelitis. J Int Med Res 2007; 34:704-12. [PMID: 17295005 DOI: 10.1177/147323000603400618] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The case of a 24-year-old woman with Pseudomonas aeruginosa and Proteus mirabilis chronic calcaneal osteomyelitis is presented. Extensive debridement of the necrotic bone and application of tobramycin-loaded polymethylmethacrylate beads was performed and ciprofloxacin was given post-operatively. Three months later, laboratory tests, including complete blood cell count, erythrocyte sedimentation rate and C-reactive protein, were normal. At this time, extensive surgical debridement and filling of the osseous defect with autologous iliac cancellous bone graft and tobramycin-impregnated calcium sulphate pellets and paste were performed. Oral ciprofloxacin was administered for 3 months after surgery. At the latest follow-up, 2 years later, the patient had full weight-bearing function; there was no recurrence of the infection, and complete incorporation of the autologous bone and calcium sulphate graft with the host bone was observed. This case demonstrates that two-stage surgical treatment with extensive debridement and tobramycin-impregnated calcium sulphate was effective in treating chronic calcaneal osteomyelitis.
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Affiliation(s)
- P J Papagelopoulos
- First Department of Orthopaedics, Athens University Medical School, Attikon University Hospital, Athens, Greece.
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Atiyeh BS, Hayek SN, Skaf GS, Al Araj A, Chamoun RB. Baclofen pump pocket infection: a case report of successful salvage with muscle flap. Int Wound J 2006; 3:23-8. [PMID: 16650208 PMCID: PMC7951267 DOI: 10.1111/j.1742-4801.2006.00179.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Programmable pump for continuous infusion of intrathecal baclofen, an agonist of the inhibitory neurotransmitter gamma-aminobutyric acid, is nowadays being widely used to control spasticity. The most common complications leading to explantation of the pumps are skin breakdown and infection at the pump implantation site which cannot be effectively treated without pump removal. We report a 37-year-old man who developed a baclofen pump pocket infection that did not respond to antibiotic therapy. Because the continuation of intrathecal baclofen administration was critical to the patient, and because the high cost of the pump precluded its prompt replacement, the pump was salvaged using the ipsilateral rectus abdominis muscle that was elevated on its inferior vascular pedicle and wrapped around the pump. Abdominal skin was then approximated, leaving a small portion of exposed muscle overlying the refill site that was covered by a split-thickness skin graft. Continuous intrathecal baclofen administration was never discontinued. Three months later, the pump's refill site could be easily identified manually for pump refill. There were no signs of recurrent infection during the 2-year follow-up period.
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Affiliation(s)
- Bishara S Atiyeh
- Division Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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28
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Abstract
The concept of delaying a skin flap is well established and has been implemented into plastic surgery practice for years. Some investigators have delayed musculocutaneous flaps to improve the perforator inflow. To our knowledge, the concept of delaying a muscle flap had previously never been tested in a model with segmental pedicles. Five cats each underwent 3 sequential operations providing them with a sartorius muscle whose blood supply was a single distal pedicle. The opposite leg was used as a control. Our delayed type IV muscle flap demonstrated perfusion to the proximal tip of the sartorius muscle without necrosis or loss of muscle mass (P < 0.0001). The control showed no evidence of perfusion beyond the distal portion of the muscle when infused through the distal pedicle. The delayed flap can survive on a distal blood supply that would not be adequate in a single-stage procedure. This flap has an increased arc of rotation that may provide solutions to difficult reconstructive problems in the groin, lower abdomen, genitalia, knee, proximal leg, and might be suitable as a free flap.
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Affiliation(s)
- Ned Snyder
- Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, 77555, USA
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Wu LC, Djohan RS, Liu TS, Chao AH, Lohman RF, Song DH. Proximal Vascular Pedicle Preservation for Sartorius Muscle Flap Transposition. Plast Reconstr Surg 2006; 117:253-8. [PMID: 16404276 DOI: 10.1097/01.prs.0000185670.15531.50] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A variety of muscle flaps have been described to treat complex groin wounds associated with infected and/or exposed femoral vessels or vascular grafts and persistent lymphatic leaks, and for prophylaxis against wound breakdown following inguinal lymphadenectomy. The sartorius muscle flap has several advantages over other muscle flaps: it is immediately adjacent to the groin, it is easy to prepare, and the harvest causes no functional morbidity. Despite these advantages, the flap's reliability has been questioned because of the segmental blood supply to the muscle and the flap's limited arc of rotation. To improve the reliability of the flap, the authors defined the proximal vascular anatomy of the sartorius muscle in 20 human cadavers and assessed the correlation with 20 clinical cases. They describe a technique for the harvest of the sartorius muscle transposition flap that preserves the most proximal pedicle. METHODS From July of 2000 to January of 2004, 40 sartorius muscles were dissected in 20 human preserved cadavers. During the same time period, 21 sartorius muscle transposition flap procedures were performed in 19 patients for a variety of complex groin wound complications, including infection (n = 10), lymphadenectomy (n = 4), lymphatic leak (n = 3), exposed femoral vessels (n = 3), and high-risk wound (n = 1). The location of the most proximal vascular pedicle with respect to the anterior superior iliac spine was measured in each cadaveric dissection as well as in each clinical case. Outcomes were assessed in the clinical cases with respect to wound healing. RESULTS The distance between the anterior superior iliac spine and the proximal vessels in the cadaver specimens was 6.6 +/- 1.3 cm (range, 5.0 to 9.5 cm). The distance between the anterior superior iliac spine and the proximal vessels in the clinical patients was 6.2 +/- 0.6 cm (range, 5.5 to 7.5 cm). Patients were followed for an average period of 30 months (range, 5 to 45 months). There were no incidences of partial or total flap necrosis. All wounds healed to completion. CONCLUSIONS The proximal pedicle of the sartorius muscle is consistently located at 6.5 cm from the anterior superior iliac spine. Preservation of the proximal pedicle during dissection ensures the viability of the sartorius muscle transposition flap for the treatment of complex groin wounds.
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Affiliation(s)
- Liza C Wu
- Section of Plastic and Reconstructive Surgery, University of Chicago Hospitals, Chicago, IL 60637, USA
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30
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The Use of Anterolateral Thigh Perforator Flaps in Chronic Osteomyelitis of the Lower Extremity. Plast Reconstr Surg 2005. [DOI: 10.1097/01.prs.0000138750.54859.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
A large prospective study of over 350 sternal wound problems is used to help establish evaluation and treatment options to successfully treat this complication. The initial evaluation includes history, physical examination, CT scans, and intraoperative evaluations. Reconstructive options include conservative local therapies (125 patients), rewiring (30 patients), and muscle flap reconstructions (205 patients). The patients were collected over a 9-year period (1990-1999) and treated by a single reconstructive surgeon. Follow-ups for all patients has been at least 2 years (range 2-11 years), and greater than 90% obtained a healed wound at 3 months. Of the patients treated with muscle flap reconstructions, 95% are alive and healed at a 2-year follow-up.
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Affiliation(s)
- Thomas J Francel
- Division of Plastic Surgery, St. Johns Mercy Medical Center Associate Clinical Professor of Surgery, St. Louis University School of Medicine, St. Louis, MO, USA
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Vitaz TW, Oishi M, Welch WC, Gerszten PC, Disa JJ, Bilsky MH. Rotational and transpositional flaps for the treatment of spinal wound dehiscence and infections in patient populations with degenerative and oncological disease. J Neurosurg 2004; 100:46-51. [PMID: 14748573 DOI: 10.3171/spi.2004.100.1.0046] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECT Wound-related complications following complex posterior spine procedures may result in the need for serial debridements and may place the instrumentation at risk. Numerous treatments have been advocated for this problem, but each has limitations. In this article the authors discuss the experience from two large teaching institutions at which rotational and transpositional flaps were used in the management of deep wound infections and dehiscences. METHODS The authors generated a list of patients treated via posterior or posterolateral approaches for metastatic tumors or complex degenerative disorders in whom wound complications subsequently developed. Data were obtained from the medical records and reviewed retrospectively. Thirty-seven patients were treated with rotational or transpositional flaps at the two institutions during the study period. Patients underwent a mean of 1.3 procedures for the treatment of wound healing problems, and cultures were positive in 70%. In three patients (8%) this treatment failed due to protrusion of hardware through the skin or repeated dehiscence requiring reclosure. Spinal instrumentation was salvaged in 97% of the cases. CONCLUSIONS The use of local tissue flaps is advantageous for treatment of posterior wound complications due to spine surgery. In this procedure highly vascularized tissue is used to increase healing, accelerate clearance of bacteria, and fill any dead space.
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Affiliation(s)
- Todd W Vitaz
- Division of Neurological, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Lorea P, Baeten Y, Chahidi N, Franck D, Moermans JP. A severe complication of muscle transfer: clostridial myonecrosis. ANN CHIR PLAST ESTH 2004; 49:32-5; discussion 36. [PMID: 15013531 DOI: 10.1016/j.anplas.2003.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Accepted: 12/03/2003] [Indexed: 10/26/2022]
Abstract
We present a case of gas gangrene as a severe complication of muscle transfer for opponensplasty. After debridement, the extensive palmar wound was covered by a free gracilis muscle transfer. This complication of muscle transfer has to our knowledge never been reported previously.
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Affiliation(s)
- Patrick Lorea
- SOS Main Strasbourg, Clinique des Diaconesses, 4, rue Ste Elisabeth, 67000 Strasbourg, France.
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Kakinoki R, Ikeguchi R, Nakamura T. Second dorsal metacarpal artery muscle flap: an adjunct in the treatment of chronic phalangeal osteomyelitis. J Hand Surg Am 2004; 29:49-53. [PMID: 14751103 DOI: 10.1016/j.jhsa.2003.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe a surgical approach for treating chronic osteomyelitis of the proximal phalanx in the hand. The procedure consisted of inserting the second dorsal metacarpal reverse adipofascial flap, including a small amount of interosseous muscle, into the bone marrow space of the phalanx after complete removal of the focus of infection. Two years after the procedure, the patient had full range of motion of the finger with no signs of infection or drainage. This operation resulted in minimal morbidity and a full range of motion of the finger.
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Affiliation(s)
- Ryosuke Kakinoki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shougoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Moosazadeh K. Successful reimplantation of retrieved large segment of open femoral fracture: case report. THE JOURNAL OF TRAUMA 2002; 53:133-8. [PMID: 12131406 DOI: 10.1097/00005373-200207000-00029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kioomars Moosazadeh
- Department of Orthopedic Surgery, Emdad Hospital, Medical Science University of Shahrood, Shahrood, Iran.
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36
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Francel TJ, Kouchoukos NT. A rational approach to wound difficulties after sternotomy: reconstruction and long-term results. Ann Thorac Surg 2001; 72:1419-29. [PMID: 11603489 DOI: 10.1016/s0003-4975(00)02009-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
One hundred fifty-one patients were reconstructed after median stemotomy by a single plastic surgeon over a 6-year period. The treatment included immediate reconstruction (63 patients) and delayed reconstructions (88 patients). Ninety eight percent of the patients had definitive healing at 6 weeks with an overall 30-day mortality of 4 percent. The issues of long-term intravenous antibiotics, perceived skin deficiency, cardiac decompensation, Candida infections, and reexploration of a healed mediastinum after flap reconstruction are discussed. Follow up (4 months to 6 years) of patients treated with reconstruction compared favorably with patients treated with rewiring procedures (20 patients) in regard to strength, chest wall stability, pulmonary function testing, and functional return to hobbies and employment.
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Affiliation(s)
- T J Francel
- Department of Surgery, St. Louis University, and St John's Mercy Medical Center, Missouri, USA
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38
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Wilhelmi BJ, Snyder N, Colquhoun T, Hadjipavlou A, Phillips LG. Bipedicle paraspinous muscle flaps for spinal wound closure: an anatomic and clinical study. Plast Reconstr Surg 2000; 106:1305-11. [PMID: 11083560 DOI: 10.1097/00006534-200011000-00011] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the vascular anatomy of the paraspinous muscles and review their clinical use as bipedicled flaps in spinal wound closure. Anatomically, through cadaver dissections, lead oxide injections, and radiographic imaging, the blood supply to the paraspinous muscles was determined. Clinically, 29 consecutive patients treated with spinal wounds and exposed bone or hardware were reviewed retrospectively. Of these patients, 19 underwent closure in delayed primary fashion, whereas 10 were referred to plastic surgery for reconstruction because of the complex nature of their wounds. The cadaver study demonstrated the paraspinous muscles to possess a segmental arterial supply through medial and lateral perforators. Division of the medial perforators allowed for medial advancement of the muscles. Lead oxide injection of the lateral perforators demonstrated adequate medial muscle perfusion with ligation of the medial perforators. Ten of the 29 patients (six women, four men, 32 to 62 years of age) were reconstructed with paraspinous (eight), latissimus (one), and trapezius (one) muscle flaps. A higher complication rate was found in wounds closed in delayed primary fashion (13 of 19 patients, 68 percent) than those reconstructed with muscle flaps (2 of 10 patients, 20 percent) (p = 0.021). Follow-up of the muscle flap reconstructed patients averaged 12 months (range, 3 to 27 months). Cadaver muscle injections predicted and clinical cases confirmed that the paraspinous muscles can be raised on lateral perforators and advanced medially to close lumbar spine wounds reliably with fewer complications.
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Affiliation(s)
- B J Wilhelmi
- Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston 77555-0724, USA
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Kuzbari R, Ehrenreich A, Worseg AP, Schlenz I, Holle J. Die Verwendung von Muskellappen in der Therapie der chronischen Osteomyelitis der Tibia. Eur Surg 1998. [DOI: 10.1007/bf02620095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fahie MA, Smith BJ, Ballard JB, Moon ML, Smith MM. Regional peripheral vascular supply based on the superficial temporal artery in dogs and cats. Anat Histol Embryol 1998; 27:205-8. [PMID: 9652150 DOI: 10.1111/j.1439-0264.1998.tb00181.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cutaneous arterial blood supply to the temporal region was evaluated in 8 dogs and 8 cats. Subtraction radiography and angiography of the carotid and superficial temporal arteries were used in 4 dogs and 4 cats to determine arterial blood supply to the temporal region and frontalis muscle. A myocutaneous axial pattern flap based on the superficial temporal artery and frontalis muscle may be indicated for cosmetic reconstruction in dogs and cats following surgical resection of neoplastic lesions or traumatic wounds in the maxillofacial region. The frontalis muscle was identified as the thin subcutaneous continuation of the platysma muscle extending cranially and rostrally. Dissection of the temporal region in 4 dogs and 4 cats revealed the subcutaneous location of the superficial temporal artery as it continues rostrally from the caudal aspect of the zygomatic arch.
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Affiliation(s)
- M A Fahie
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg 24061, USA
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Management of chronic calcaneal osteomyelitis with pull-through abductor hallucis muscle flap -a report of three cases. EUROPEAN JOURNAL OF PLASTIC SURGERY 1997. [DOI: 10.1007/bf01152197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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42
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Lin SD, Lai CS, Chiu YT, Lin TM, Chou CK. Adipofascial flap of the lower leg based on the saphenous artery. BRITISH JOURNAL OF PLASTIC SURGERY 1996; 49:390-5. [PMID: 8881786 DOI: 10.1016/s0007-1226(96)90008-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The adipofascial flap of the lower leg based on the saphenous artery is a modification of the saphenous artery flap. It has been used successfully in 5 patients for reconstruction of soft tissue defects around the knee and superior third of the tibia. The size of these flaps ranged from 5 x 12 cm to 5 x 18 cm. All flaps survived completely. These cases had minimal donor site morbidity because their donor sites were closed primarily with the preserved overlying skin.
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Affiliation(s)
- S D Lin
- Department of Surgery, Kaohsiung Medical College, Taiwan
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Schliephake H, Schmelzeisen R, Neukam FW. The free revascularized rectus abdominis myocutaneous flap for the repair of tumour related defects in the head and neck area. Br J Oral Maxillofac Surg 1996; 34:18-22. [PMID: 8645676 DOI: 10.1016/s0266-4356(96)90129-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The present work reviews a series of 11 consecutive patients who have received free revascularized rectus abdominis myocutaneous flaps for primary reconstruction of soft tissues after ablative tumour surgery in the head and neck area. In 10 patients, a total or subtotal glossectomy had been performed and the flap was used to replace the resected tongue volume. In 5 of these cases, extensive perforating defects had resulted after additional resection of large portions of the chin and the cheek. Mandibular continuity was restored by a metal plate and the flap was divided into an intraoral and extraoral portion in these patients. In one patient, the flap had been used for closure of a full thickness defect of the calvarium. 9 of the 11 flaps healed uneventfully. In one case, a partial flap loss was encountered after thrombosis of the venous pedicle due to compression as a result of an unfavourable defect anatomy and flap positioning. Primary closure of the abdominal wall was achieved in all cases. A subcutaneous hematoma occurred at the donor site in one patient. According to our present experience, the rectus abdominis free flap may serve as an alternative to the frequently employed latissimus dorsi flap in maxillofacial reconstructions while it offers the possibility for flap elevation simultaneously to the surgical procedures in the head and neck area.
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Affiliation(s)
- H Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical School, Medizinishe Hochshule Hannover, Germany
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Myocutaneous versus fasciocutaneous free flap in the treatment of lower leg osteitis. ACTA ACUST UNITED AC 1995; 5:27-31. [DOI: 10.1007/bf02716210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/1994] [Accepted: 01/10/1995] [Indexed: 10/22/2022]
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Guelinckx PJ, Sinsel NK. Refinements in the one-stage procedure for management of chronic osteomyelitis. Microsurgery 1995; 16:606-11. [PMID: 8747284 DOI: 10.1002/micr.1920160906] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Posttraumatic osteomyelitis remains a frequent problem and requires aggressive surgical treatment to be cured. Radical debridement of all involved soft and hard tissues, obliteration of dead space, and neovascularization of the involved area are obligatory for successful management of the disease. Microvascular free tissue transfer provides the necessary tissue bulk and neovascularization to reconstruct the resulting defect. The transplanted muscle can be optimally mobilized and adjusted in size to obliterate the dead space in contrast to local transposition flaps. This is facilitated by smoothening the bony cavity using a rotating drill system. With an optimal interface between the muscle and the wall of the cavity, small foci of infection can be eliminated. Moreover after free muscle transfer, the optimal environment for secondary bone reconstruction is created. These principles of radical debridement combined with muscle transfer for dead space obliteration, are generally accepted in literature. Nevertheless to achieve this goal several different treatment schedules of repetitive debridements, prolonged antibiotic regimes, and finally various flap transfers have been advocated. We present 16 patients with chronic osteomyelitis treated with radical debridement and immediate free muscle transfer using the latissimus dorsi muscle preferably. Postoperatively an antibiotic course of only 12 days was given. With a mean follow-up of 2 years all patients remained symptom free. Therefore, our results indicate that this long-term problem can be solved by a one-stage procedure using a free flap combined with a short course of antibiotics. However definite conclusions should be reserved for 20 years.
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Affiliation(s)
- P J Guelinckx
- Department of Plastic and Reconstructive Surgery, Hand and Microsurgery, Catholic University Leuven, Belgium
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46
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Pierer G, Jüttner FM, Tscheliessnigg KH, Dacar D, Hoflehner H, Hellbom B, Scharnagl E. Möglichkeiten von Muskellappen im Rahmen der Herz- und Thoraxchirurgie. Eur Surg 1994. [DOI: 10.1007/bf02629713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Browne EZ, Stulberg BN, Sood R. The use of muscle flaps for salvage of failed total knee arthroplasty. BRITISH JOURNAL OF PLASTIC SURGERY 1994; 47:42-5. [PMID: 8124565 DOI: 10.1016/0007-1226(94)90116-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Deep infections occur in 1-5% of all patients undergoing total knee arthroplasty, and may result in failure of the prosthesis and subsequent arthrodesis. Two-stage reimplantation is often successful, but depends upon the presence of good soft tissue coverage. We have treated 9 patients in whom chronic infection developed which required removal of the prosthesis, debridement, and implantation of antibiotic impregnated spacers for control. These patients all had poor quality soft tissue cover precluding prosthesis reimplantation. The use of muscle flaps resulted in 7 of the 9 patients having successful reimplantation of a prosthesis and remaining free of infection in a follow-up ranging from 1-5 years.
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Affiliation(s)
- E Z Browne
- Department of Plastic Surgery, Cleveland Clinic Foundation, Ohio
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48
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Rao VK, Baertsch A. Microvascular reconstruction of the upper extremity with the rectus abdominis muscle. Microsurgery 1994; 15:746-50. [PMID: 7885223 DOI: 10.1002/micr.1920151015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Large soft-tissue defects of the upper extremity are difficult to reconstruct. Defects in 21 patients (15-75 years old) were treated by free tissue transfer of the rectus abdominis muscle. The defects were the result of trauma or resection of tumor and measured more than 15 x 15 cm. The muscle was transferred on the inferior epigastric pedicle and covered with a skin graft within 48 hours. All transfers were successful, and early soft-tissue healing occurred. This procedure offers the advantages of easy positioning, large donor vessels, and a highly vascular soft tissue reconstruction. The long-term functional and cosmetic results have been excellent.
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Affiliation(s)
- V K Rao
- Department of Plastic and Reconstructive Surgery, University of Wisconsin Medical School, Madison 53792
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Gayle LB, Lineaweaver WC, Oliva A, Siko PP, Alpert BS, Buncke GM, Yim K, Buncke HJ. Treatment of Chronic Osteomyelitis of the Lower Extremities with Debridement and Microvascular Muscle Transfer. Clin Plast Surg 1992. [DOI: 10.1016/s0094-1298(20)30805-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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