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Temporoparietal Fascia Free Flap for a Large Nasal Septal Perforation 颞顶筋膜游离瓣治疗鼻中隔大穿孔
Pub Date : 2019-01-01 DOI: 10.1055/s-0039-1692145
Nicholas G. Cuccolo, R. Cauley, Brady A. Sieber, S. Hussain, Laurel K. Chandler, Ahmed M. S. Ibrahim, Samuel J. Lin
Abstract Reconstruction of large nasal septal perforations can be a considerable challenge for surgeons. Reconstructive modalities are often determined by the size of the defect and the quality of local tissue and vasculature. Local and regional flaps may not provide enough tissue to achieve successful closure in patients with large perforations and those with baseline compromise of the nasal mucosa and blood supply from prior intervention or underlying medical condition. Microvascular free tissue transfer is a possible approach to reconstruction in these patients. We report a case of a 30-year-old man who presented with a large, symptomatic, 4 × 3.5 cm perforation as a result of prior functional septoplasty at an outside hospital. Reconstruction of the defect was accomplished in this setting with a free temporoparietal fascia (TPF) flap anastomosed to the columellar branch of the labial artery and the angular vein. Postoperative follow-up visits showed successful closure of the perforation without complications. As illustrated by this case, TPF flap is a versatile tool for complex nasal reconstructions. With minimal donor-site morbidity and rich vascularity capable of promoting remucosalization without the need for prelamination, the TPF flap may be suited for the repair of large nasoseptal perforations.
摘要鼻中隔大穿孔的重建对外科医生来说是一个相当大的挑战。重建方式通常由缺损的大小以及局部组织和脉管系统的质量决定。局部和区域皮瓣可能无法提供足够的组织来成功闭合大穿孔患者以及那些因先前干预或潜在医疗状况而导致鼻粘膜和血液供应基线受损的患者。在这些患者中,游离微血管组织移植是一种可能的重建方法。我们报告了一例30岁的男性,他出现了一个巨大的,有症状的,4 × 3.5厘米穿孔,这是先前在外部医院进行功能性隔膜成形术的结果。在这种情况下,用与唇动脉和角静脉的小柱支吻合的游离颞顶筋膜(TPF)瓣完成了缺损的重建。术后随访显示穿孔成功闭合,无并发症。如本例所示,TPF皮瓣是一种用于复杂鼻腔重建的通用工具。由于供区发病率最低,且血管丰富,能够在不需要预层压的情况下促进粘膜再成盐,TPF皮瓣可能适合修复大的鼻中隔穿孔。
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引用次数: 0
Can ReGeneraTing Agents Improve Functional Recovery of Transected Peripheral Nerve through a Nerve Gap Bridged with an Artery Graft? 再生药物能改善动脉桥接神经缺损后周围神经的功能恢复吗?
Pub Date : 2019-01-01 DOI: 10.1055/s-0039-1692453
G. Alexopoulos, L. Pavlidis, M. Tsagarakis, A. Delimpaltas, Antonios Tsimponis, A. Papalois, A. Batistatou, A. Papoudou-Bai, D. Barritault, E. Demiri, G. Spyropoulou
Abstract Background The purpose of this study was to use artery grafts filled with CACIPLIQ20 and see if they promote nerve regeneration. Methods Sixty male Wistar rats were used. The rats were randomly divided into four experimental groups (n = 15): transected control group (negative control group [NCG]), sham-operated group (positive control group [SO]) artery graft group filled with saline (AG/NS), and CACIPLIQ20-treated group (AG/CACIPLIQ20). Fifteen rats were used as artery graft donors. In the SO group, the sciatic nerve was dissected from the surrounding tissues and left intact. In the NCG, AG/NS and AG/CACIPLIQ20) groups, a 10-mm gap was created in the left sciatic nerve. In the NCG group, the gap was not bridged with a graft. In the AG/NS group, the gap was bridged with a graft filled with saline. In the AG/CACIPLIQ20 group, the graft was filled with CACIPLIQ20. Walking track analysis was performed at 4, 8, 12, and 16 weeks after surgery. At 16 weeks postoperatively, the rats were sacrificed, nerve sections were harvested for histopathology analysis, and the weight ratio of the gastrocnemius muscle was measured. Results There was no significant difference in myelin sheath thickness between the AG/NS and AG/CACIPLIQ20 groups. Muscle weight in the AG/CACIPLIQ20 group was higher but not statistically significant (p = 0.168) compared with the AG/NS group. Also, AG/CACIPLIQ20 mean was better than AG/NS mean, although there was no statistically significant difference (p = 0.605). Conclusion There could be an indication that CACIPLIQ20 improves functional recovery of a transected peripheral nerve through a nerve gap bridged with an artery graft.
本研究的目的是使用填充CACIPLIQ20的动脉移植物,观察其是否促进神经再生。方法选用雄性Wistar大鼠60只。将大鼠随机分为4个实验组(n = 15):横切对照组(阴性对照组[NCG])、假手术组(阳性对照组[SO])、生理盐水灌注动脉移植组(AG/NS)、CACIPLIQ20治疗组(AG/CACIPLIQ20)。15只大鼠作为动脉移植供体。在SO组中,将坐骨神经从周围组织中剥离并保持完整。在NCG、AG/NS和AG/CACIPLIQ20组中,左侧坐骨神经形成10mm间隙。在NCG组中,缺口没有用移植物桥接。在AG/NS组,用填充生理盐水的移植物桥接间隙。在AG/CACIPLIQ20组,移植物充满CACIPLIQ20。在术后4、8、12和16周进行行走轨迹分析。术后16周处死大鼠,取神经切片进行组织病理学分析,测量腓肠肌重量比。结果AG/NS组和AG/CACIPLIQ20组大鼠髓鞘厚度差异无统计学意义。AG/CACIPLIQ20组肌肉质量高于AG/NS组,但差异无统计学意义(p = 0.168)。AG/CACIPLIQ20平均值优于AG/NS平均值,但差异无统计学意义(p = 0.605)。结论CACIPLIQ20可通过动脉桥接的神经间隙改善周围神经的功能恢复。
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引用次数: 0
Transverse Cervical Artery Flap Repair of Benign Acquired Tracheoesophageal Fistula 颈横动脉瓣修复良性获得性气管食管瘘
Pub Date : 2019-01-01 DOI: 10.1055/s-0039-1678576
Jourdain D. Artz, Daniel Yoo, Juan José Gilbert-Fernández, R. Walvekar, W. Risher, C. Dupin
Abstract Acquired tracheoesophageal fistulas are rare but associated with significant morbidity and mortality. The majority of cases are due to prolonged or complicated endotracheal intubation, tracheostomy, or esophageal malignancy, or subsequent to radiation or chemotherapy for treatment of the latter. Other etiologies include esophageal stenting and complications secondary to endoscopic procedures. The pathophysiology involves chronic inflammation of the esophagus or posterior wall of the trachea, ultimately promoting fistulization between these two structures. Risk factors primarily depend on the etiology; however, excessive balloon pressures and prolonged intubation are among the strongest predictors of acquired tracheoesophageal fistula. In two reported cases, intubation with persistent air leaks resulted in fistulization. Patients present with refractory pneumonia, aspiration, hypoxemia, acute respiratory distress, enteral feed in endotracheal aspirate, or gastric distention following extubation. It can be difficult to distinguish normal functional deterioration from deterioration secondary to intubation. Up to 51% of patients intubated for at least 48 hours may experience dysphagia following extubation. Ultimately, the diagnostic algorithm includes an esophagogram, followed by imaging with computed tomography (CT) scan, and, more recently, CT scan with three-dimensional reconstructions, a bronchoscopy, and an esophagoscopy. Spontaneous closure rarely occurs, and the primary treatment modalities include interventional therapy with stenting via bronchoscopy, esophagoscopy, or surgical correction. Surgical intervention is associated with higher risks due to surrounding vital anatomy and, often, technical challenges requiring multispecialty care. Our case study presents a novel and effective method of repairing a benign acquired tracheoesophageal fistula utilizing the transverse cervical artery flap.
摘要获得性气管食管瘘是罕见的,但与显著的发病率和死亡率相关。大多数病例是由于长期或复杂的气管插管、气管造口术或食道恶性肿瘤,或随后进行放疗或化疗。其他病因包括食管支架置入术和内镜手术继发的并发症。病理生理学涉及食道或气管后壁的慢性炎症,最终促进这两个结构之间的瘘管形成。危险因素主要取决于病因;然而,球囊压力过大和插管时间过长是获得性气管食管瘘最有力的预测因素之一。在两例报告的病例中,持续漏气的插管导致造瘘。患者表现为顽固性肺炎、误吸、低氧血症、急性呼吸窘迫、气管内吸出物中的肠内营养或拔管后的胃胀。很难区分正常功能恶化和插管后的恶化。多达51%的插管至少48小时的患者可能在拔管后出现吞咽困难。最终,诊断算法包括食道造影,然后是计算机断层扫描成像,以及最近的三维重建CT扫描、支气管镜检查和食道镜检查。自发性闭合很少发生,主要的治疗方式包括通过支气管镜、食道镜或手术矫正进行支架置入的介入治疗。由于周围的重要解剖结构,以及通常需要多专业护理的技术挑战,手术干预与更高的风险相关。我们的病例研究提出了一种利用颈横动脉瓣修复良性获得性气管食管瘘的新的有效方法。
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引用次数: 0
Limb Salvage for Primary Malignant Bone Tumors of the Distal Leg in Skeletally Immature Patients: Ankle Arthrodesis Using Vascularized Ipsilateral or Contralateral Fibular Flap 骨骼发育不全患者小腿远端原发性恶性骨肿瘤的保肢术:应用带血管的同侧或对侧腓骨瓣固定踝关节
Pub Date : 2019-01-01 DOI: 10.1055/s-0039-1688762
A. E. El Ghoneimy, M. Sokar, Nehal Kamal
Abstract Background Malignant bone tumors of the distal tibia or fibula in children are rare. Quality of functional outcome following limb salvage surgery is still controversial. This is a retrospective review of the functional outcome of ankle arthrodesis using vascularized fibular flap. Methods A total of seven patients were reviewed. The diagnosis was osteosarcoma in five and Ewing's sarcoma in two patients. The primary tumor site was the distal tibia in six patients and the distal fibula in one patient. The average age at presentation was 10.6 years (range, 6.7–14 years). The average follow-up period was 24.5 months (range, 13–69 years). A pedicled fibular graft was harvested from the ipsilateral leg in two patients and a free vascularized osteocutaneous fibular flap from the contralateral leg in five patients. External fixation was used in five and internal fixation in two patients. Patients were allowed full weight bearing following radiographic evidence of complete bone union. Results The mean time to complete bone union and full weight bearing was 7.1 months (range, 4–13 months). One patient developed nonunion at graft-host junction and one patient had stress fracture of the fibular graft. The mean limb length inequality was 0.57 cm (range, 0–3 cm). The average Musculoskeletal Tumor Society (MSTS) score was 84.5% (range, 73–100%). Conclusion Skeletally immature patients treated by ankle arthrodesis using vascularized fibular flap can return to full weight bearing within the first year following surgery. A contralateral fibular flap has the advantage of preserving the contour of the ankle and reserving the ipsilateral fibula for initial stability at the fusion site. This study is of level IV evidence.
摘要背景 儿童胫骨或腓骨远端的恶性骨肿瘤非常罕见。保肢手术后功能结果的质量仍然存在争议。这是一篇使用带血管腓骨瓣的踝关节融合术的功能结果的回顾性综述。方法 共对7名患者进行了复查。诊断为骨肉瘤5例,尤因肉瘤2例。6名患者的主要肿瘤部位为胫骨远端,1名患者的肿瘤部位为腓骨远端。呈现时的平均年龄为10.6岁(范围为6.7-14岁)。平均随访时间为24.5个月(13-69年)。两名患者从同侧腿获得带蒂腓骨移植物,五名患者从对侧腿获得游离带血管蒂骨皮腓骨瓣。外固定5例,内固定2例。根据影像学证据显示完全骨愈合后,允许患者完全负重。后果 完成骨愈合和完全承重的平均时间为7.1个月(4-13个月)。一名患者在移植物-宿主连接处出现骨不连,一名患者腓骨移植物应力性骨折。平均肢体长度不等为0.57厘米(范围为0-3厘米)。肌肉骨骼肿瘤学会(MSTS)的平均得分为84.5%(范围为73–100%)。结论 使用带血管的腓骨瓣进行踝关节融合术的骨骼发育不全的患者可以在手术后的第一年内恢复完全负重。对侧腓骨瓣的优点是保留踝关节的轮廓,并保留同侧腓骨以在融合部位保持初始稳定性。本研究为四级证据。
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引用次数: 0
Autologous Breast Reconstruction Skin Paddle Designs: Classification and Aesthetic Outcomes 自体乳房重建皮肤桨设计:分类和美学结果
Pub Date : 2019-01-01 DOI: 10.1055/s-0039-1688725
I. Pestana, N. Walker
Abstract Objective Present study was conducted to identify common mastectomy patterns and autologous skin paddle designs, to identify patient characteristics that influence these patterns, and assess aesthetic outcomes associated with each pattern. Methods Autologous breast reconstructions over 5 years were reviewed. Mastectomy type and resultant skin paddle were categorized into four mastectomy type/skin paddle design groups based on the amount of native “Skin Spared” after mastectomy and the resultant flap skin paddle designed. Groups were designated as skin-sparing mastectomy 1 (SS1)/large elliptical skin paddle, skin-sparing mastectomy 2 (SS2)/small elliptical skin paddle, skin-sparing mastectomy 3 (SS3)/areola skin paddle, and skin-sparing mastectomy 4 (nipple-sparing mastectomy, SS4)/no skin paddle. Surveys were performed to validate the classification system and critique aesthetic outcomes. Results A total of 89 autologous breast reconstructions were included. Radiotherapy was used in 45.6% of SS1 patients versus 29.2% in SS2 and 12.5% in SS3/SS4. Mean body mass index (BMI) was 30 in SS1/SS2 and 26 in SS3/SS4 mastectomy types (p = 0.045). Delayed reconstruction was performed in 96.5% SS1 versus 62.5% in SS2 and only 25% of SS3/SS4 (p < 0.0001). Physicians and Non-MD personnel correctly categorized 85.8 and 76.1% of skin paddle designs, respectively. Over 75% of those surveyed rated the reconstruction aesthetic outcome as “good-excellent” regardless of the pattern group. Conclusions Patients in SS1/SS2 groups had a higher incidence of radiotherapy, delayed reconstruction, and higher BMI compared with the SS3/SS4 groups. The classification system is recognizable and may provide improved patient education and communication between healthcare providers. All mastectomy type/skin paddle designs received high aesthetic ratings.
抽象目标 本研究旨在确定常见的乳房切除术模式和自体皮肤桨设计,确定影响这些模式的患者特征,并评估与每种模式相关的美学结果。方法 回顾了5年来自体乳房重建的情况。根据乳房切除术后天然“皮肤稀疏”的数量和设计的皮瓣皮肤桨,将乳房切除术类型和由此产生的皮肤桨分为四个乳房切除术/皮肤桨设计组。组被指定为保留皮肤乳房切除术1(SS1)/大椭圆形皮肤桨、保留皮肤乳腺切除术2(SS2)/小椭圆形皮肤桨,保留皮肤乳乳房切除术3(SS3)/乳晕皮肤桨和保留皮肤乳乳切除术4(保留乳头乳房切除术,SS4)/无皮肤桨。进行调查以验证分类系统并对美学结果进行评判。后果 共包括89个自体乳房重建。45.6%的SS1患者使用了放射治疗,而SS2患者为29.2%,SS3/SS4患者为12.5%。SS1/SS2乳房切除术的平均体重指数(BMI)为30,SS3/SS4乳房切除术为26(p = 96.5%的SS1患者进行了延迟重建,而SS2患者为62.5%,SS3/SS4患者仅为25%(p < 0.0001)。医生和非医学博士人员分别对85.8%和76.1%的皮肤桨设计进行了正确分类。超过75%的受访者将重建美学结果评为“良好-优秀”,无论图案组如何。结论 与SS3/SS4组相比,SS1/SS2组的患者放疗发生率更高,重建延迟,BMI更高。分类系统是可识别的,并且可以提供改进的患者教育和医疗保健提供者之间的通信。所有乳房切除术类型/皮肤桨设计都获得了很高的美学评价。
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引用次数: 1
Soft Tissue Augmentation Using Free Tissue Transfer for Artificial Bone Infection or Skull Bone Sequestration after Neurosurgery 游离组织移植用于神经外科术后人工骨感染或颅骨隔离的软组织增强
Pub Date : 2019-01-01 DOI: 10.1055/s-0039-1678702
Masayuki Okochi, H. Okochi, Takao Sakaba, K. Ueda
Abstract Background We performed soft tissue augmentation using free flap and secondary cranioplasty combined with soft tissue augmentation for cases with artificial or autologous skull exposure after neurosurgery. We evaluated operative result and the relationship between the cause of infection and the infected site. Methods Twenty-four patients were included. Data included age, sex, indications for neurosurgery, causes of infection, infection sites, medical comorbidities, time between last neurosurgery and reconstruction, types of reconstruction, and types of secondary cranioplasty. Results The causes of neurosurgery were subarachnoid hemorrhage (n = 9), trauma (n = 5), brain tumor (n = 5), brain hemorrhage (n = 3), and meningioma (n = 3). The mean size of infected bone was 67.3 cm2. The mean duration between last neurosurgery and reconstruction was 5.2 years. Types of infected bone were artificial bone (n = 19) and autologous skull (n = 6). The soft tissue augmentation was performed using latissimus dorsi myocutaneous flap (n = 14) and anterolateral thigh flap (n = 10). The infection sites were the frontal (n = 13), temporal (n = 4), parietal (n = 4), and occipital regions (n = 4). Bone defects included the frontal sinus in all patients who had infections in the frontal region. The patients who had infections in non-frontal region received multiple surgeries (n = 7). Nine patients received secondary cranioplasty using custom-made hydroxyapatite block. Conclusion To achieve good results during soft tissue augmentation, the cause of infection should be eliminated.
摘要背景我们对神经外科手术后人工或自体颅骨外露的病例采用游离皮瓣和二次颅骨成形术联合软组织增强术。我们评估了手术结果以及感染原因与感染部位的关系。方法对24例患者进行回顾性分析。数据包括年龄、性别、神经外科手术指征、感染原因、感染部位、医疗合并症、最后一次神经外科手术和重建之间的时间、重建类型和二次颅骨成形术的类型。结果神经外科原因为蛛网膜下腔出血(9例)、外伤(5例)、脑肿瘤(5例)、脑出血(3例)、脑膜瘤(3例)。感染骨的平均大小为67.3 cm2。从最后一次神经外科手术到重建的平均时间为5.2年。感染骨类型为人工骨(19例)和自体颅骨(6例)。采用背阔肌肌皮瓣(n = 14)和大腿前外侧皮瓣(n = 10)行软组织增强术。感染部位为额叶区(n = 13)、颞叶区(n = 4)、顶叶区(n = 4)和枕叶区(n = 4)。在所有额区感染的患者中,骨缺损包括额窦。非额叶区感染患者接受多次手术治疗(n = 7)。9例患者采用定制的羟基磷灰石块进行二次颅骨成形术。结论软组织隆胸术中应消除感染的原因,以达到良好的效果。
{"title":"Soft Tissue Augmentation Using Free Tissue Transfer for Artificial Bone Infection or Skull Bone Sequestration after Neurosurgery","authors":"Masayuki Okochi, H. Okochi, Takao Sakaba, K. Ueda","doi":"10.1055/s-0039-1678702","DOIUrl":"https://doi.org/10.1055/s-0039-1678702","url":null,"abstract":"Abstract Background We performed soft tissue augmentation using free flap and secondary cranioplasty combined with soft tissue augmentation for cases with artificial or autologous skull exposure after neurosurgery. We evaluated operative result and the relationship between the cause of infection and the infected site. Methods Twenty-four patients were included. Data included age, sex, indications for neurosurgery, causes of infection, infection sites, medical comorbidities, time between last neurosurgery and reconstruction, types of reconstruction, and types of secondary cranioplasty. Results The causes of neurosurgery were subarachnoid hemorrhage (n = 9), trauma (n = 5), brain tumor (n = 5), brain hemorrhage (n = 3), and meningioma (n = 3). The mean size of infected bone was 67.3 cm2. The mean duration between last neurosurgery and reconstruction was 5.2 years. Types of infected bone were artificial bone (n = 19) and autologous skull (n = 6). The soft tissue augmentation was performed using latissimus dorsi myocutaneous flap (n = 14) and anterolateral thigh flap (n = 10). The infection sites were the frontal (n = 13), temporal (n = 4), parietal (n = 4), and occipital regions (n = 4). Bone defects included the frontal sinus in all patients who had infections in the frontal region. The patients who had infections in non-frontal region received multiple surgeries (n = 7). Nine patients received secondary cranioplasty using custom-made hydroxyapatite block. Conclusion To achieve good results during soft tissue augmentation, the cause of infection should be eliminated.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"04 1","pages":"e1 - e8"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1678702","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43722434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Rheumatoid Lymphedema Successfully Treated with Lymphaticovenular Anastomosis: A Case Report 淋巴结吻合成功治疗类风湿性淋巴水肿1例
Pub Date : 2019-01-01 DOI: 10.1055/s-0039-1688763
Y. Ichinose, Y. Yasunaga, S. Yuzuriha
Abstract Background A 76-year-old woman presented with rheumatoid lymphedema (RL) distal to the left elbow after 20 years of affliction with rheumatoid arthritis (RA). Although the RA was controlled by medication, the patient could not receive full-scale compression therapy for her edema with a medium-pressure compression sleeve (pressure: 20–25 mm Hg) due to hand dysfunction caused by long-term RA. Methods Lymphaticovenular anastomosis (LVA) was performed after compression therapy with a low-pressure sleeve (14–18 mm Hg) proved ineffective for edema relief. Two anastomoses were created in a side-to-end fashion at the cubital fossa. Results The edema improved rapidly after LVA and was maintained with a low-pressure compression sleeve. Conclusion LVA represents a treatment option for remaining RL in RA treatment. As some RL patients are ineligible for full-scale compression therapy due to hand dysfunction caused by RA, LVA may help to reduce RL and enable edema management using a low-pressure compression garment without concern for hand dysfunction.
摘要背景一名76岁女性在患类风湿关节炎(RA) 20年后出现左肘远端类风湿淋巴水肿(RL)。虽然药物控制了RA,但由于长期RA引起的手部功能障碍,患者无法接受中压压套(压力:20-25 mm Hg)对其水肿的全面压迫治疗。方法采用低压套筒(14 ~ 18 mm Hg)加压治疗,对水肿缓解无效后,行淋巴小囊吻合。在肘窝处以侧对端方式创建两个吻合口。结果LVA术后水肿迅速改善,采用低压压套维持。结论LVA是RA治疗中剩余RL的一种治疗选择。由于一些RL患者由于RA引起的手部功能障碍而不适合进行全面的压迫治疗,LVA可能有助于减少RL并使用低压压迫服进行水肿管理,而无需担心手部功能障碍。
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引用次数: 1
Novel Interpositional Vein Grafting for Pedicle Extension of Island Pedicle Flaps 新型位间静脉移植物用于岛状皮瓣的椎弓根扩张
Pub Date : 2018-07-01 DOI: 10.1055/s-0038-1669452
Shuhei Yoshida, I. Koshima, S. Nagamatsu, K. Yokota, Shuji Yamashita, M. Harima, K. Tashiro
Abstract Background Island pedicle flaps often have the problem of limited reach. In such cases, free flaps are useful for reconstruction but often have the issue of unavailability of suitable recipient vessels. Therefore, it would be helpful if the pedicle of an island flap could be extended as far as necessary. Methods Here, we describe the use of interpositional vein grafts to extend island pedicle flaps for the reconstruction of an ischemic above-knee amputation stump in one case and to seal an intractable fistula on the buttock after radiation therapy in another case. In the patient with the ischemic stump, a deep inferior epigastric perforator flap was extended by 6 cm using the great saphenous vein harvested from the contralateral side, allowing successful coverage of the stump. In the patient with an intractable fistula on the buttock, a thoracodorsal artery and vein graft that was extended by 25 cm using the cephalic vein harvested from the right forearm to upper arm allowed successful sealing of the fistula. Results Circulation was satisfactory in both cases and both flaps survived. The operative procedure was straightforward. Conclusion Interpositional vein grafts may be a feasible option for the extension of island pedicle flaps to include the features of an island pedicle flap and a free flap.
摘要背景 岛状蒂皮瓣通常存在着覆盖范围有限的问题。在这种情况下,游离皮瓣可用于重建,但通常存在无法获得合适受体血管的问题。因此,如果岛状皮瓣的蒂可以尽可能地延伸,这将是有帮助的。方法 在这里,我们描述了在一个病例中,使用插入静脉移植物来延伸岛状蒂皮瓣来重建缺血性膝上截肢残端,在另一个病例的放射治疗后,使用植入静脉移植物密封臀部顽固性瘘管。在缺血性残端患者中,使用从对侧采集的大隐静脉将上腹部下穿支皮瓣延长6厘米,从而成功覆盖残端。在臀部有顽固性瘘管的患者中,使用从右前臂到上臂采集的头静脉,将胸背动脉和静脉移植物延长25厘米,从而成功密封了瘘管。后果 两个病例的循环均令人满意,两个皮瓣均存活。手术过程很简单。结论 位置间静脉移植物可能是一个可行的选择岛状蒂皮瓣的扩展,包括岛状蒂瓣和游离瓣的特点。
{"title":"Novel Interpositional Vein Grafting for Pedicle Extension of Island Pedicle Flaps","authors":"Shuhei Yoshida, I. Koshima, S. Nagamatsu, K. Yokota, Shuji Yamashita, M. Harima, K. Tashiro","doi":"10.1055/s-0038-1669452","DOIUrl":"https://doi.org/10.1055/s-0038-1669452","url":null,"abstract":"Abstract Background Island pedicle flaps often have the problem of limited reach. In such cases, free flaps are useful for reconstruction but often have the issue of unavailability of suitable recipient vessels. Therefore, it would be helpful if the pedicle of an island flap could be extended as far as necessary. Methods Here, we describe the use of interpositional vein grafts to extend island pedicle flaps for the reconstruction of an ischemic above-knee amputation stump in one case and to seal an intractable fistula on the buttock after radiation therapy in another case. In the patient with the ischemic stump, a deep inferior epigastric perforator flap was extended by 6 cm using the great saphenous vein harvested from the contralateral side, allowing successful coverage of the stump. In the patient with an intractable fistula on the buttock, a thoracodorsal artery and vein graft that was extended by 25 cm using the cephalic vein harvested from the right forearm to upper arm allowed successful sealing of the fistula. Results Circulation was satisfactory in both cases and both flaps survived. The operative procedure was straightforward. Conclusion Interpositional vein grafts may be a feasible option for the extension of island pedicle flaps to include the features of an island pedicle flap and a free flap.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"3 1","pages":"e50 - e54"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1669452","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49384228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap 腓骨游离皮皮瓣腓骨静脉深静脉血栓形成一例
Pub Date : 2018-07-01 DOI: 10.1055/s-0038-1675410
S. Hayashi, K. Kawamura, Naoki Maegawa, Akito Nakanishi, Yasushi Mizutani, Akinori Okuda, Shinpei Kurata, Takamasa Shimizu, T. Kira, S. Omokawa, Yasuhito Tanaka
Abstract Background Deep venous thrombosis (DVT) of the lower leg is a widespread medical problem and is associated with hypercoagulable states. Although spontaneous thrombosis of the peroneal vein of a fibula flap is theoretically possible, few cases of asymptomatic DVT of the peroneal vein encountered during fibula flap harvest have been reported. Case Report A 45-year-old man presented with segmental bone defects of the tibia resulting from a fall. Treatment with a free vascularized osteocutaneous fibula flap from the contralateral lower leg was scheduled. Intraoperatively, diffuse thrombi were found in the peroneal venous system. After removal of thrombi, the fibula was grafted with anastomosis of the peroneal vessels to the recipient posterior tibial vessels. The skin paddle of the flap became congested after surgery; exsanguination of the skin paddle was performed with multiple skin incisions to relieve congestion. Despite treatment, the skin paddle became partially necrotic and additional skin grafting was performed. Bone union of the grafted fibula was achieved 5 months after initial surgery. Conclusions To the best of our knowledge, only six cases of pre-existing DVT in the peroneal vein of a free osteocutaneous fibula flap have been reported. In three of these cases, the fibula flap was successfully grafted. Although successful free osteocutaneous fibula flap surgery might be possible in patients with peroneal venous thrombosis, careful preoperative evaluation is recommended for high-risk patients.
背景下肢深静脉血栓形成(DVT)是一个广泛存在的医学问题,与高凝状态有关。虽然腓骨皮瓣腓骨静脉自发血栓形成在理论上是可能的,但在腓骨皮瓣切除过程中,腓骨静脉无症状血栓形成的病例很少报道。病例报告一名45岁男性因跌倒导致胫骨节段性骨缺损。计划采用对侧小腿带血管的游离腓骨皮皮瓣进行治疗。术中腓骨静脉系统发现弥漫性血栓。去除血栓后,腓骨与腓骨血管与受体胫后血管吻合,进行腓骨移植。皮瓣的皮肤桨叶术后充血;用多个皮肤切口对皮肤进行放血以缓解充血。尽管进行了治疗,但皮肤桨叶部分坏死,并进行了额外的皮肤移植。移植腓骨在初次手术后5个月实现骨愈合。结论据我们所知,仅报道了6例游离腓骨皮瓣腓骨静脉内原有深静脉血栓的病例。其中3例腓骨瓣移植成功。尽管腓骨静脉血栓形成的患者可以成功进行游离骨皮腓骨皮瓣手术,但对于高危患者,建议进行仔细的术前评估。
{"title":"A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap","authors":"S. Hayashi, K. Kawamura, Naoki Maegawa, Akito Nakanishi, Yasushi Mizutani, Akinori Okuda, Shinpei Kurata, Takamasa Shimizu, T. Kira, S. Omokawa, Yasuhito Tanaka","doi":"10.1055/s-0038-1675410","DOIUrl":"https://doi.org/10.1055/s-0038-1675410","url":null,"abstract":"Abstract Background Deep venous thrombosis (DVT) of the lower leg is a widespread medical problem and is associated with hypercoagulable states. Although spontaneous thrombosis of the peroneal vein of a fibula flap is theoretically possible, few cases of asymptomatic DVT of the peroneal vein encountered during fibula flap harvest have been reported. Case Report A 45-year-old man presented with segmental bone defects of the tibia resulting from a fall. Treatment with a free vascularized osteocutaneous fibula flap from the contralateral lower leg was scheduled. Intraoperatively, diffuse thrombi were found in the peroneal venous system. After removal of thrombi, the fibula was grafted with anastomosis of the peroneal vessels to the recipient posterior tibial vessels. The skin paddle of the flap became congested after surgery; exsanguination of the skin paddle was performed with multiple skin incisions to relieve congestion. Despite treatment, the skin paddle became partially necrotic and additional skin grafting was performed. Bone union of the grafted fibula was achieved 5 months after initial surgery. Conclusions To the best of our knowledge, only six cases of pre-existing DVT in the peroneal vein of a free osteocutaneous fibula flap have been reported. In three of these cases, the fibula flap was successfully grafted. Although successful free osteocutaneous fibula flap surgery might be possible in patients with peroneal venous thrombosis, careful preoperative evaluation is recommended for high-risk patients.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"3 1","pages":"e74 - e77"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675410","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47070856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Using the Saphenous Artery and Great Saphenous Vein Combined with Anterolateral Thigh Flap to Treat Skin Defects after Amputation 应用Saphenous动脉和大隐静脉联合股前外侧皮瓣治疗截肢后皮肤缺损
Pub Date : 2018-07-01 DOI: 10.1055/s-0038-1675407
L. Kong, H. Cheng, Tao Nie, Min Dai
Abstract Background Aim of this study was to determine the feasibility of using the saphenous artery (SA) and great saphenous vein (GSV) as recipient vessels, combined with anterolateral thigh (ALT) flap, in the treatment of skin defects after lower limb amputation. Methods From June 2015 to June 2017, 12 patients (average age, 33.5 years; range, 14–56 years; males, 9; female, 3) with large skin defects and symptoms of bone exposure in the proximal lower extremity were included in our study. The patients underwent emergency treatment and multiple debridement combined with vacuum sealing drainage therapy, followed by free flap surgery using the SA and GSV as recipient vessels, and ALT to cover the wound. Results All 12 patients who underwent free flap surgery survived, but two patients had distal flap necrosis, which, however, was salvaged with conservative measures. All patients were satisfied with the postoperative outcome at the 3 and 6-month follow-up. Conclusion The SA and GSV can be used as recipient vessels, combined with ALT, to treat skin defects after lower limb amputation.
摘要背景 本研究的目的是确定使用大隐动脉(SA)和大隐静脉(GSV)作为受体血管,结合股前外侧(ALT)皮瓣治疗下肢截肢后皮肤缺陷的可行性。方法 从2015年6月到2017年6月,我们的研究包括12名患者(平均年龄33.5岁;年龄范围14-56岁;男性9岁;女性3岁),他们有较大的皮肤缺陷和近端下肢骨暴露症状。患者接受了紧急治疗和多次清创结合真空密封引流治疗,然后使用SA和GSV作为受体血管进行游离皮瓣手术,并用ALT覆盖伤口。后果 接受游离皮瓣手术的12名患者全部存活,但有两名患者出现远端皮瓣坏死,但通过保守措施挽救了远端皮瓣坏死。所有患者在3个月和6个月的随访中均对术后结果感到满意。结论 SA和GSV可作为受体血管,与ALT联合治疗下肢截肢后的皮肤缺陷。
{"title":"Using the Saphenous Artery and Great Saphenous Vein Combined with Anterolateral Thigh Flap to Treat Skin Defects after Amputation","authors":"L. Kong, H. Cheng, Tao Nie, Min Dai","doi":"10.1055/s-0038-1675407","DOIUrl":"https://doi.org/10.1055/s-0038-1675407","url":null,"abstract":"Abstract Background Aim of this study was to determine the feasibility of using the saphenous artery (SA) and great saphenous vein (GSV) as recipient vessels, combined with anterolateral thigh (ALT) flap, in the treatment of skin defects after lower limb amputation. Methods From June 2015 to June 2017, 12 patients (average age, 33.5 years; range, 14–56 years; males, 9; female, 3) with large skin defects and symptoms of bone exposure in the proximal lower extremity were included in our study. The patients underwent emergency treatment and multiple debridement combined with vacuum sealing drainage therapy, followed by free flap surgery using the SA and GSV as recipient vessels, and ALT to cover the wound. Results All 12 patients who underwent free flap surgery survived, but two patients had distal flap necrosis, which, however, was salvaged with conservative measures. All patients were satisfied with the postoperative outcome at the 3 and 6-month follow-up. Conclusion The SA and GSV can be used as recipient vessels, combined with ALT, to treat skin defects after lower limb amputation.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"3 1","pages":"e70 - e73"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47109425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Reconstructive Microsurgery Open
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