• Archives of Plastic Surgery
• /
• v.47 no.4
• /
• pp.340-346
• /
• 2020

Background Adipofascial flaps covered with a skin graft address the challenges involved in reconstructing dorsal foot defects. The purpose of this study was to describe a large adipofascial flap based on the perforators of the dorsalis pedis artery for large foot defects. Methods Twelve patients aged 5-18 years with large soft tissue defects of the dorsal foot due to trauma were treated with an extended dorsalis pedis adipofascial flap from May 2016 to December 2018. The flap was elevated from the non-injured half of the dorsum of the foot. Its length was increased by fascial extension from the medial or lateral foot fascia to the plantar fascia to cover the defect. All perforators of the dorsalis pedis artery were preserved to increase flap viability. The dorsalis pedis artery and its branches were kept intact. Results The right foot was affected in 10 patients, and the left foot in two patients. All flaps survived, providing an adequate contour and durable coverage with a thin flap. Follow-up lasted up to 2 years, and patients were satisfied with the results. They were able to wear shoes. Donor-site morbidity was negligible. Two cases each of partial skin graft loss and superficial necrosis at the tip of the donor cutaneous flap occurred and were healed by a dressing. Conclusions The hinged multiperforator-based extended dorsalis pedis adipofascial flap described herein is a suitable method for reconstructing dorsal foot defects, as it provides optimal functional and aesthetic outcomes with minimal donor site morbidity.

• Archives of Plastic Surgery
• /
• v.38 no.5
• /
• pp.655-662
• /
• 2011

Purpose: The anterolateral thigh flap is versatile flap for soft-tissue reconstruction for defects located at various sites of the body. This useful flap offers a thick and vascular fascia lata component with large amounts that can be soft tissue coverage for different reconstructive purposes. We present our clinical experience with the use of vascular fascia lata, combined with anterolateral thigh flap for various reconstructive goals. Methods: From April 2008 to February 2011, we transferred anterolateral thigh flaps with fascia lata component to reconstruct soft-tissue defects for different purposes in 11 patients. The fascia lata component of the flap was used for tendon gliding surface in hand/forearm reconstruction in 4 patients, for reconstruction medial and lateral patellar synovial membrane and retinaculum in 2 patients, for reconstruction of plantar aponeurosis in the foot in 2 patients, for reconstruction of fascial and peritoneal defect in the abdominal wall in 2 patient, and for dural defect reconstruction in the scalp in the remaining one. Results: Complete loss of the flap was not seen in all cases. Partial flap necrosis occurred in 2 patients. These complications were treated successfully with minimal surgical debridement and dressing. Infection occurred in 1 patient. In this case, intravenous antibiotics treatment was effective. Conclusion: Anterolateral thigh flap has thick vascular fascia with large amounts. This fascial component of the flap is useful for different reconstructive aims, such as for tendon, ligament, aponeurosis defects, abdominal wall or dura reconstruction. It should be considerated as an important advantage of the flap, together with other well-known advantages.

• Clinics in Shoulder and Elbow
• /
• v.23 no.2
• /
• pp.62-70
• /
• 2020

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8%±4.2% (range, 20.4%-37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24-86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

• Archives of Reconstructive Microsurgery
• /
• v.11 no.2
• /
• pp.167-172
• /
• 2002

The only treatment method for crushed soft tissue injuries in the proximal leg involving the knee joint is the microsurgical free flap transplantation, especially latissimus dorsi myocutaneous free flap is useful to cover the extensive soft tissue defects, therefore prevents iatrogenic below knee amputation and facilitates early wound healing, early ambulation and shortens hospital stay. Authors have treated the open amputation with crushed soft tissue and bone injuries in the proximal leg, and the repeated abrasion and infectious wound with traumatic neuroma in the below knee with myocutaneous free flap and succeeded to wear below knee amputation prosthesis and return to normal activities of the daily living in the relatively shorter period than usual.

• Archives of Plastic Surgery
• /
• v.36 no.5
• /
• pp.571-577
• /
• 2009

Purpose: The Provision of thin and pliable tissue and the adequate coverage of tendon - gliding surface is necessary for a soft tissue defect of the hand with exposure of bone, tendon and muscle. This report will discuss our experience with anterolateral thigh fascial free flap for the reconstruction of the soft tissue defect of the hand. Methods: Between February 2004 and August 2008, seven patients with full - thickness soft tissue defects of the hand were reconstructed by means of a composite anterolateral thigh fascial free flap. There were soft tissue defects associated with trauma (n=5), scar contracture (n=1) and necrosis due to ischemia (n=1). Flaps were harvested from the anterolateral thigh as adipofascial flaps with only a small sheet of fascia and fatty tissue above it. The fascia and the skin of the donor site was closed directly and delayed split - thickness skin graft was performed. Result: All flaps survived completely. The size of the transferred flap ranged from $2{\times}4cm$ to $5{\times}8cm$. Thin flap coverage was possible without secondary debulking operations. It left minimal donor site morbidity with a linear scar. In one case, the thigh muscle herniation in the donor site was developed. Conclusion: The anterolateral thigh fascial free flap provided thin and pliable tissue which can establish a tendon - gliding mechanism, minimal bulk, minimal donor site morbidity. The disadvantages of this technique were the need for a skin graft and the muscle herniation of donor site.

• Archives of Craniofacial Surgery
• /
• v.19 no.3
• /
• pp.235-239
• /
• 2018

Intraoperative expansion has been used to cover small to large defects without disadvantages of the conventional tissue expanders. Various materials, for example, expanders and Foley catheters are being used. We introduce a new, convenient and economical device immediately available in the operating room, according to the defect size for intraoperative expansion, with latex gloves or balloons. The retrospective study was done with 20 patients who presented with skin and soft tissue defects. During the operation, expansion was done with latex gloves or balloons inflated with saline through an intravenous line and a three-way stopcock. After the inflation, the glove was removed and skin was covered with expanded tissue. A careful decision was made regarding the inflation volume and placement of the expander according to the defect size. There were no postoperative complications. The skin contracture and tension was minimal with a texture similar to the adjacent tissue. The new intraoperative expansion devices with latex gloves and balloons were cheap and made easily right in the operation room. The reconstruction of small to large sized skin defects can be done successfully, functionally and aesthetically without using expensive commercial materials.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.20 no.2
• /
• pp.127-132
• /
• 1998

$Medpor^{(R)}$(porous polyethylene) Surgical Implants are used for the augmentation or restoration of bony contour in craniofacial defects. The purpose of this study is to evaluate the ingrowth of soft tissue and bone after application in calvaria of rats. The experiment was carried out in 60 rats. The reflected periosteum was resutured after implantation of $Medpor^{(R)}$ as a experimental site, while in the calvarial bone the reflected periosteum resutured without implantation as a control site. The histologic examination was performed after 1-, 2-, 4-, 8-, 12-, 24-weeks implantation in calvaria of rats. I concluded that there was abundant ingrowth of soft tissue and bone without any adverse tissue response and that it shows good stability.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.30 no.1
• /
• pp.1-10
• /
• 2008

Purpose: This study was aimed to examine the resorption rate, the healing pattern, and the response of the surrounding tissue after the graft of the acellular dermal matrix ($AlloDerm^{(R)}$) and the autogenous dermis, and to report the clinical result of the use of $AlloDerm^{(R)}$ in order to restore the soft tissue defects. Methods: Twenty mature rabbits, weighing about 3 ㎏, were used for the experimental study. The $10\times10$ mm-size autogenous dermis and the $AlloDerm^{(R)}$ were grafted to the space between the external abdominal oblique muscle and the fascia of the rabbits. And the $AlloDerm^{(R)}$ was grafted to the pocket between the skin and the underlying perichondrium of rabbit ear. The resorption rate of the grafted sites was calculated, and the tissue specimens were histologically examined at 1, 2, 4, and 8 weeks after the graft. The five patients with the cleft-lip nasal deformity and the one patient with the saddle nose deformity, who received the $AlloDerm^{(R)}$ graft to restore the facial soft tissue defects, were reviewed for the clinical study. Results: The resorption rate at 8 weeks after the graft was 21.5% for the autogenous dermis, and 16.0% $AlloDerm^{(R)}$. In microscopic examinations, the infiltration of the inflammatory cells and the epidermal inclusion cyst were observed in the autogenous dermis graft. However, the neovascularization and the progressive growth of the new fibroblasts were shown in the $AlloDerm^{(R)}$ graft. And the six patients, who received the $AlloDerm^{(R)}$ graft, demonstrated the good stability of the grafts and improved appearance. There were no remarkable complications such as inflammation, rejection, dislocation, and severe absorption in the clinical cases. Conclusion: These results suggest that $AlloDerm^{(R)}$ can be an useful graft material for restoration of soft tissue defects because of the good stability and the tissue response without the remarkable clinical complications.

• Archives of Reconstructive Microsurgery
• /
• v.23 no.2
• /
• pp.101-104
• /
• 2014

Reconstruction of soft tissue defects of the knee has always been a challenging task for plastic surgeons. Various reconstructive choices are available depending on the location, size, and depth of the defect relative to the knee joint. Defects on the knee joint have several characteristic features. The use of a free flap is preferred for reconstructions involving obliteration of large-cavity defects, but recipient pedicle isolation can be difficult because of the extent of the injury zone. Furthermore, the true defect during knee joint flexion is larger than during knee joint extension, and a durable flap is necessary for joint movement. We report for the first time on the use of pedicled perforator flaps for reconstruction of bilateral knee defects in a 76-year-old woman. The operative procedure required skeletonizing the perforators of an antero-lateral thigh flap and antero-medial thigh flap and rotating the flap in the defect. The patient returned to normal daily activity and had a full range of motion two months after the accident. The shorter operating time with decreased donor site morbidity and its durability make this flap a valuable alternative for soft tissue reconstruction of the knee.

• Archives of Plastic Surgery
• /
• v.50 no.1
• /
• pp.82-95
• /
• 2023

Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.