Asunto(s)

Arteria Ilíaca , Colgajo Perforante , Procedimientos de Cirugía Plástica , Traumatismos de los Tejidos Blandos , Pulgar , Humanos , Masculino , Colgajo Perforante/irrigación sanguínea , Colgajo Perforante/trasplante , Pulgar/lesiones , Pulgar/cirugía , Adolescente , Procedimientos de Cirugía Plástica/métodos , Arteria Ilíaca/cirugía , Arteria Ilíaca/lesiones , Arteria Ilíaca/trasplante , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Tisulares Libres/trasplante , Colgajos Tisulares Libres/irrigación sanguínea

RESUMEN

BACKGROUND: The reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications. METHODS: From June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases. RESULTS: Altogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps. CONCLUSIONS: The free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.

Asunto(s)

Traumatismos de la Mano , Colgajo Perforante , Procedimientos de Cirugía Plástica , Arteria Radial , Humanos , Femenino , Masculino , Colgajo Perforante/irrigación sanguínea , Adulto , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Arteria Radial/trasplante , Traumatismos de la Mano/cirugía , Mano/cirugía , Mano/irrigación sanguínea , Adulto Joven , Estudios de Seguimiento , Resultado del Tratamiento , Estudios de Factibilidad

RESUMEN

The internal mammary artery perforator (IMAP) flap has been widely used for chest wall and neck reconstruction. The color of its skin paddle closely resembles that of facial skin, making it attractive for facial reconstruction. However, there has been insufficient investigations reporting the use of free IMAP flap. Furthermore, even in such studies, somewhat invasive procedures, including rib cartilage resection, were employed to ensure sufficient pedicle length, potentially increasing donor morbidity. Our report presents two cases of successful facial defect reconstruction using a free IMAP flap harvested with minimal donor site damage, showing its feasibility. In the first case, a 48-year-old male underwent wide excision for a malignant melanoma on his right cheek, resulting in a 4 × 4.5 cm full-thickness defect. A free IMAP flap with a 2.5 cm pedicle, was harvested without rib cartilage resection, preserving IMA main trunk, and transferred with anastomosed to the angular vessels within the defect. The second patient presented with a 4.5 × 3.5 cm basal cell carcinoma on the left cheek, necessitating wide excision and leaving a 6 × 5 cm defect. A free IMAP flap was harvested with the same approach and successfully reconstructed the defect with connected to the superficial temporal vessels using vascular bridge. Both patients were discharged complication-free, with no recurrence during 24 and 15 months of follow-up, respectively. They were highly satisfied with the final skin color and texture outcomes. Harvesting a free IMAP flap while minimizing donor morbidity may offer an attractive option for facial reconstruction.

Asunto(s)

Colgajo Perforante , Procedimientos de Cirugía Plástica , Neoplasias Cutáneas , Humanos , Masculino , Persona de Mediana Edad , Colgajo Perforante/irrigación sanguínea , Procedimientos de Cirugía Plástica/métodos , Neoplasias Cutáneas/cirugía , Arterias Mamarias/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Carcinoma Basocelular/cirugía , Neoplasias Faciales/cirugía , Melanoma/cirugía , Colgajos Tisulares Libres/trasplante , Recolección de Tejidos y Órganos/métodos , Mejilla/cirugía

RESUMEN

INTRODUCTION: The use of free-style and propeller perforator-based flaps has been popularized for the reconstruction of moderate size defects in the trunk and extremities, while their application in the field of abdominal reconstruction is seldom reported. The purpose of this report is to describe the authors experience with the use of pedicled perforator-based flaps in abdominal wall reconstruction, presenting the innovative concept of transition from angiosomal to bi-angiosomal and extra-angiosomal perforator flaps and showing applications of the different flap designs according to the multiple clinical scenarios. PATIENTS AND METHODS: A total of 15 patients underwent abdominal wall reconstruction with angiosomal, bi-angiosomal, and extra-angiosomal pedicled perforator-based flaps harvested from the surrounding abdominal subunits for superficial or full thickness defects of the abdominal wall of moderate and large dimensions. The defects were consequent to soft-tissue sarcomas (STS) and non-melanoma skin cancer (NMSC) resection in 11 and 4 cases, respectively. Operative data, post-operative course, and complications were recorded. Moreover, at 12 months follow-up, patients were asked to rate the esthetic and functional outcomes of the reconstructive procedure on a 5-point Likert scale. RESULTS: Ten angiosomal perforator flaps (4 DIEP, 4 SCIP, 1 SEAP, and 1 LICAP flaps) and 5 bi-angiosomal and extra-angiosomal conjoined perforator flaps including different vascular territories (3 bilateral DIEP, 1 bilateral SEAP, and 1 ipsilateral DIEP-SEAP flap) were successfully transferred in 15 patients. In two patients, microsurgical anastomoses were performed to guarantee proper vascularization of the additional cutaneous territory. Mean age was 59.3 years. Defect sizes ranged from 98 to 408 cm2 (mean size was 194.7 cm2). Mean operative time was 280 min. Flap surface ranged from 108 to 336 cm2 (mean surface was 209.3 cm2). No major complications were registered. One bi-angiosomal bilateral DIEP flap suffered from partial necrosis and required an additional flap reconstruction. All patients underwent a 12-month follow-up except one, who did not show for clinical follow-up but responded at the Likert scale at clinical follow-up at 9 months. Overall patients' satisfaction was high, with mean esthetic and functional ratings of 4.27 and 3.87. CONCLUSION: The use of local tissues is an under-utilized solution in the field of abdominal wall reconstruction. Angiosomal, bi-angiosomal, and extra-angiosomal perforator flaps proved to be a reliable option to provide the transfer of a significant amount of tissue and offer like with like reconstruction while maximizing flap survival.

Asunto(s)

Pared Abdominal , Colgajo Perforante , Procedimientos de Cirugía Plástica , Humanos , Colgajo Perforante/irrigación sanguínea , Colgajo Perforante/trasplante , Pared Abdominal/cirugía , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Masculino , Femenino , Anciano , Adulto , Neoplasias Cutáneas/cirugía , Resultado del Tratamiento , Estudios de Seguimiento , Estudios Retrospectivos , Sarcoma/cirugía

RESUMEN

PURPOSE: The purpose of this study is to retrospect and summarize clinical efficiency and experience of the free superficial palmar branch of radial artery (SPBRA) flap for soft-tissue reconstruction in distal digital injury. METHOD: 13 patients with soft-tissue defect of finger, reconstructed by the free superficial palmar branch of radial artery (SPBRA) flap in our department from January 2020 to January 2022, were reviewed. After 6-12 months of follow-up, evaluated the treatment effect of the fingers reconstructed by SPBRA flap. RESULTS: All the flaps in our series application were survival uneventful, and all the donor sites were closed primarily without complications or obvious scarring. The flaps were soft in texture and satisfactory in appearance and function. The flaps with the median nerve palmar cutaneous branch had a good sensation recovery. Measurement of two-point discrimination (TPD) ranged from 6 to 10 mm. All patients were satisfied with the aesthetic appearance. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, the results were graded as excellent in 11 cases and good in 2 cases. CONCLUSION: The SPBRA perforator flap has the advantages of simple operation, soft texture, good appearance and function, and is credible and useful for reconstructing various finger injuries.

Asunto(s)

Traumatismos de los Dedos , Procedimientos de Cirugía Plástica , Arteria Radial , Traumatismos de los Tejidos Blandos , Humanos , Arteria Radial/trasplante , Masculino , Procedimientos de Cirugía Plástica/métodos , Adulto , Persona de Mediana Edad , Traumatismos de los Dedos/cirugía , Femenino , Traumatismos de los Tejidos Blandos/cirugía , Estudios Retrospectivos , Colgajo Perforante/irrigación sanguínea , Adulto Joven , Resultado del Tratamiento , Estudios de Seguimiento

RESUMEN

Soft-tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin and account for only 1% of adult malignancies. They tend to occur most commonly in the lower extremities. Reconstruction after sarcoma resection can be challenging, especially when important structures are involved and recurrences occur. Additionally, more attention is now being paid to reconstructing the lymphatic system to prevent lymphatic complications. In this case report, we presented the management of recurrent medial thigh sarcoma that necessitated multiple challenging reconstructions to provide valuable insights for lectures on similar cases. A 50-year-old male patient was diagnosed with an undifferentiated pleomorphic cell sarcoma (UPS) of the anteromedial thigh. After preoperative radiotherapy, a mass of 23 × 15 cm was removed, and reconstruction with a pedicled deep inferior epigastric artery perforator (p-DIEP) flap-based lymphatic flow through (LyFT) was performed. Six months later, the patient developed the first local recurrence with the presence of a distant metastasis. Following the tumor resection, the medial part of the DIEP flap was de-epithelized and buried in the defect for dead space obliteration. Another local recurrence arose 7 months after the second surgery. Therefore, a major debulking surgery involving the femoral neurovascular bundle was performed. The femoral artery was reconstructed with a synthetic graft, and the femoral vein with the great saphenous vein harvested from the contralateral thigh. A composite myocutaneous neurotized anterolateral thigh (ALT) flap from the contralateral thigh was used to obliterate the defect and restore the loss of function of the quadriceps femoris. Two lymphaticovenular anastomoses (LVAs) were performed at the ankle to reduce the risk of lymphatic sequelae. This case report highlights the importance of integrating various techniques to create a tailored approach that effectively addresses complex surgical requirements to avoid limb amputation and maintain functionality.

Asunto(s)

Anastomosis Quirúrgica , Arterias Epigástricas , Colgajos Tisulares Libres , Recurrencia Local de Neoplasia , Colgajo Perforante , Procedimientos de Cirugía Plástica , Sarcoma , Neoplasias de los Tejidos Blandos , Muslo , Humanos , Masculino , Persona de Mediana Edad , Muslo/cirugía , Colgajo Perforante/irrigación sanguínea , Colgajos Tisulares Libres/trasplante , Colgajos Tisulares Libres/irrigación sanguínea , Arterias Epigástricas/trasplante , Neoplasias de los Tejidos Blandos/cirugía , Anastomosis Quirúrgica/métodos , Sarcoma/cirugía , Recurrencia Local de Neoplasia/cirugía , Procedimientos de Cirugía Plástica/métodos , Músculo Cuádriceps

RESUMEN

OBJECTIVE: To evaluate the clinical effectiveness of antibiotic bone cement combined with the lobulated perforator flap based on the descending branch of the lateral circumflex femoral artery (d-LCFA) in the treatment of infected traumatic tissue defects in the foot, in accordance with the Enhanced Recovery after Surgery (ERAS) concept. METHODS: From December 2019 to November 2022, 10 patients with infected traumatic tissue defects of the foot were treated with antibiotic bone cement combined with the d-LCFA lobulated perforator flap. The cohort comprised 6 males and 4 females, aged 21 to 67 years. Initial infection control was achieved through debridement and coverage with antibiotic bone cement, requiring one debridement in nine cases and two debridements in one case. Following infection control, the tissue defects were reconstructed utilizing the d-LCFA lobulated perforator flap, with the donor site closed primarily. The flap area ranged from 12 cm×6 cm to 31 cm×7 cm. Postoperative follow-up included evaluation of flap survival, donor site healing, and ambulatory function of the foot. RESULTS: The follow-up period ranged from 7 to 24 months, averaging 14 months. Infection control was achieved successfully in all cases. The flaps exhibited excellent survival rates and the donor site healed by first intention. Based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, pain and function were evaluated as excellent in 3 cases, good in 5 cases, and moderate in 2 cases. CONCLUSION: The application of antibiotic bone cement combined with the d-LCFA lobulated perforator flap is an effective treatment for infected traumatic tissue defects of the foot with the advantages of simplicity, high repeatability, and precise curative effects. The application of the d-LCFA lobulated perforator flap in wound repair causes minimal damage to the donor site, shortens hospital stays, lowers medical expenses, and accelerates patient rehabilitation, aligning with the ERAS concept. Therefore, it is a practice worth promoting in clinical use.

Asunto(s)

Antibacterianos , Cementos para Huesos , Desbridamiento , Arteria Femoral , Traumatismos de los Pies , Colgajo Perforante , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Colgajo Perforante/irrigación sanguínea , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Traumatismos de los Pies/cirugía , Cementos para Huesos/uso terapéutico , Arteria Femoral/cirugía , Desbridamiento/métodos , Adulto Joven , Procedimientos de Cirugía Plástica/métodos , Resultado del Tratamiento , Traumatismos de los Tejidos Blandos/cirugía , Estudios Retrospectivos , Cicatrización de Heridas

RESUMEN

Objective:To investigate the clinical effect of a segmented perforator flap of free peroneal artery to repair a complex defect after oral cancer. Methods:Forty-eight patients with oral cancer admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2022, including 8 of buccal cancer, 7 of floor cancer, 14 of tongue cancer, 5 of retromolar cancet, 9 of maxillary gingival cancer and 5 of mandibular gingival cancer. After lesion resection, 24 patients in the experimental group used the partial perforator flap to repair the defect, and 24 patients in the control group used the single flap to repair the defect. Compared with the general data of the two groups, the difference was not statistically significant（P>0.05）, which was comparable. The flap cutting range of the experimental group was 38.5-74.5 cm², and tension-reduced suture for the donor area. In the control group, the myocutaneous flap incision range was 61.0-76.5 cm², and skin graft suture for the donor area. Flap survival and patient survival were recorded and compared. The patients were followed up at 6 and 12 months after surgery, and their swallowing function and speech function, including the drinking water test, functional oral food intake scale and the Chinese language clarity test word table, were evaluated respectively, and their subjective satisfaction with the repair appearance was recorded. Patients in both groups were followed up for 12 to 60 months. Kaplan-Meier method was used to calculate the cumulative survival rate of patients, and survival curves were plotted. log-rank test was used to compare the survival curves between groups. Results:The survival rate of the two groups was 100%. The 5-year survival rate was 62.5% in the experimental group and 54.2% in the control group. There was no significant difference between the two groups （P>0.05）. According to the results of the functional recovery evaluation, the groups in swallowing and speech function and subjective satisfaction（P>0.05）, and at 12 months after surgery（P<0.05）. Conclusion:The segmented perforator flap of free peroneal artery is flexible and can repair different anatomical structures of postoperative composite defect of oral cancer, which can effectively improve postoperative functional recovery and patient satisfaction. Therefore, the peroneal artery segmented perforator flap is the ideal flap for reconstructing postoperative composite defect of oral cancer.

Asunto(s)

Neoplasias de la Boca , Colgajo Perforante , Procedimientos de Cirugía Plástica , Humanos , Masculino , Neoplasias de la Boca/cirugía , Femenino , Procedimientos de Cirugía Plástica/métodos , Persona de Mediana Edad , Peroné/trasplante , Periodo Posoperatorio , Trasplante de Piel/métodos , Anciano , Adulto

RESUMEN

BACKGROUND: When performing breast reconstruction using a deep inferior epigastric artery (DIEA) perforator (DIEP) flap, including Hartrampf zone IV, the bipedicled DIEP flap has been argued to be necessary to ensure stable perfusion. However, a proximal medial branch (PMB), which is the most proximal perforator of DIEA, may make it possible to obtain adequate perfusion in a unilateral DIEP flap. This study aimed to clarify the detailed anatomical characteristics of PMB and its potential clinical applications in breast reconstruction. METHODS: This retrospective study was conducted on breast reconstruction using the DIEP flap between May 2020 and July 2023. Data on PMB anatomy were collected from preoperative contrast-enhanced computed tomography angiography, and contralateral perfusion of the flap was estimated using intraoperative indocyanine green angiography. RESULTS: PMB was present in approximately 85% of the cases, arising near the lateral border of the rectus abdominis, branching caudomedially in more than half of the cases, and perforating 2.3 cm laterally and 8.8 cm caudally, on average, from the umbilicus. The average perfusion area of zones II and IV significantly expanded to 96.5% and 74.2%, respectively, when PMB was included in the DIEP flap, and 9 of 22 cases showed contrast extending to the entire zone IV. CONCLUSIONS: The use of the DIEP flap with PMB is a good option for substantial-volume breast reconstruction. When utilizing PMB, it is important to consider its specific anatomy, location of the main perforator, and pedicle length.

Asunto(s)

Angiografía por Tomografía Computarizada , Arterias Epigástricas , Mamoplastia , Colgajo Perforante , Humanos , Mamoplastia/métodos , Colgajo Perforante/irrigación sanguínea , Femenino , Estudios Retrospectivos , Arterias Epigástricas/trasplante , Persona de Mediana Edad , Adulto , Anciano

RESUMEN

BACKGROUND: The extent of perfusion of a deep inferior epigastric artery perforator (DIEP) flap is a primary concern for surgeons. This study aimed to determine whether the flap area or volume can be estimated using perforator and flap characteristics. METHODS: Intraoperative flap perfusion was assessed using indocyanine green angiography in patients who underwent DIEP flap breast reconstruction between November 2018 and February 2023. The area perfused by a single dominant perforator was delineated on the surface of the flap and measured using the ImageJ software. Multiple linear regression analysis was conducted to estimate the 'perfusion ratio,' defined as the perfused area divided by the total flap area. Potential predictor variables included flap size (cm2), flap thickness (mm), perforator diameter (mm), perforator rows (medial/lateral), vertical location of perforator (at or above/below the umbilicus), and perforator eccentricity (vertical distance from upper flap margin to perforator, cm). RESULTS: In total, 101 patients were included in this analysis. The mean 'perfusion ratio' was 67.8% ± 11.5%, predicted by perforator diameter (p = 0.022) and vertical location below umbilicus (p < 0.001) with positive correlations and negatively correlated with flap thickness (p = 0.003) in the multivariable analysis. Both perfusion area and weight were predicted by perforator diameter, vertical location of perforator, flap size, and flap thickness (p < 0.001). The coefficient of determination (adjusted R2) for prediction of perfusion weight was higher than that for the perfusion area (75.5% vs. 69.4%). CONCLUSIONS: Flap volume, rather than area, is determined by a perforator of a given diameter and location.

Asunto(s)

Arterias Epigástricas , Mamoplastia , Colgajo Perforante , Humanos , Colgajo Perforante/irrigación sanguínea , Femenino , Arterias Epigástricas/trasplante , Mamoplastia/métodos , Persona de Mediana Edad , Adulto , Verde de Indocianina , Angiografía/métodos , Estudios Retrospectivos

RESUMEN

Autologous breast reconstruction using abdominally based perforator flaps has become increasingly popular following mastectomy for breast cancer. Of these, the deep inferior epigastric artery perforator (DIEP) flap represents one of the most popular techniques. However, surgeons must remain cognizant of anatomic variations in the abdominal wall vasculature that could complicate or preclude planned DIEP flaps. In this case, a 64-year-old female with a history of prior tubal ligations and caesarean sections underwent preoperative computed tomographic angiography (CTA) for planned autologous breast reconstruction with a DIEP flap. CTA revealed complete absence of the left deep inferior epigastric artery, with a sizeable left abdominal wall perforator visualized receiving retrograde flow from a crossing midline branch originating from the contralateral right deep inferior epigastric system. This vessel traversed the midline in a superficial plane in the subcutaneous tissue. Despite this aberrant anatomy, the surgical team successfully raised a unilateral DIEP flap based on the right pedicle. This case represents a unique anatomical variation of the abdominal wall and emphasises the importance of preoperative imaging when planning abdominally based free flaps.

Asunto(s)

Variación Anatómica , Angiografía por Tomografía Computarizada , Arterias Epigástricas , Mamoplastia , Colgajo Perforante , Humanos , Femenino , Arterias Epigástricas/anomalías , Arterias Epigástricas/anatomía & histología , Arterias Epigástricas/diagnóstico por imagen , Mamoplastia/métodos , Persona de Mediana Edad , Colgajo Perforante/irrigación sanguínea , Pared Abdominal/irrigación sanguínea , Pared Abdominal/anomalías , Pared Abdominal/cirugía , Pared Abdominal/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Mastectomía , Trasplante Autólogo

RESUMEN

BACKGROUND: The free deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. Asian patients often present with a smaller body mass index with relatively insufficient tissue. To restore appropriate symmetry, a larger flap inset ratio must be transferred. Supercharging of the second vein or inclusion of bilateral pedicle is commonly required. Current paradigm shifts in mastectomy has also resulted in more minimally invasive surgeries (MIS) espousing smaller lateral incisions, leading to a significant change in available recipient vessels. This study aimed to demonstrate our experience in changing strategies of DIEP flaps following the evolution of mastectomy techniques. METHODS: Between October 2008 and March 2022, retrospective data was gathered for 278 patients who underwent breast reconstruction surgery utilizing DIEP flaps by a single plastic surgeon. These patients were divided into two distinct groups based on their operation dates, with November 2018 marking a pivotal moment when the first MIS, including endoscopic-assisted and robot-assisted mastectomy, was introduced. RESULTS: A total of 278 patients were included. Bipedicle vessel utilization for flap supercharge saw a significant increase (15.9% vs. 7%, p < 0.001), while the use of the superior inferior epigastric vein (SIEV) decreased (5.1% vs. 17.1%, p = 0.01). Preceding MIS, SIEV was the primary choice for flap supercharge (96.0%, p < 0.001), whereas post-introduction, the contralateral DIEP pedicle gained prominence (75.9%, p < 0.001). There was also an increased utilization of thoracodorsal artery and lateral thoracic artery following MIS. CONCLUSION: These findings underscore the profound impact of MIS on the strategic choices made in DIEP flap-based breast reconstruction. TRIAL REGISTRATION: This study is retrospectively registered on ClinicalTrials.gov (NCT06321549).

Asunto(s)

Neoplasias de la Mama , Arterias Epigástricas , Mamoplastia , Mastectomía , Procedimientos Quirúrgicos Mínimamente Invasivos , Colgajo Perforante , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Neoplasias de la Mama/cirugía , Estudios Transversales , Arterias Epigástricas/cirugía , Arterias Epigástricas/trasplante , Mamoplastia/métodos , Mastectomía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Estudios Retrospectivos , Adulto Joven

RESUMEN

INTRODUCTION: Although higher preoperative physical activity levels have been shown to be beneficial to postoperative recovery at large, their effect on patient-reported outcomes after deep inferior epigastric perforator (DIEP) flap breast reconstruction has yet to be investigated. This study aimed to correlate patient physical activity levels with patient-reported outcome measures. METHODS: A prospectively maintained database of patients who underwent DIEP flap breast reconstruction between July 2021 and June 2022 was analysed. Physical activity levels were assessed using the Global Physical Activity Questionnaire (GPAQ) and patient-reported outcomes were measured using the BREAST-Q questionnaire, both preoperatively and 1 year postoperatively. Patients were stratified into low (<1000 METs) and high (>1000 METs) physical activity groups. RESULTS: Of the 136 patients who underwent surgery, 51 completed both questionnaires, with 34 responses meeting completeness criteria for statistical analysis. The low-MET group (n = 19) and high-MET group (n = 15) were comparable in age and comorbidities. Postoperatively, the low-MET group exhibited a 54% increase in physical activity levels, whereas the high-MET group showed a 17% decrease (p < 0.01). The low-MET group experienced significant declines in psychosocial well-being (9.3%, p = 0.04) and sexual well-being (14%, p = 0.02), whereas the high-MET group did not show significant changes in these domains. Satisfaction with the unclothed abdomen increased significantly in the low-MET group (2.9 from 2, p = 0.001), while the high-MET group showed a nonsignificant decrease (3.2 from 2.9, p = 0.43). However, abdominal well-being significantly decreased in both groups, with a 56% decline in the high-MET group (p = 0.006) and a 51% decline in the low-MET group (p = 0.0002). The latter reflects the perceived difference between aesthetic appearance and well-being. CONCLUSIONS: Patients with lower preoperative physical activity levels showed improved activity postsurgery, potentially due to motivational factors from the reconstructive process. Conversely, those with higher preoperative activity levels faced greater challenges in maintaining their activity levels postsurgery, potentially arising from disruptions in daily routines and donor site symptoms, indicating a need for targeted interventions to support this group. Concurrently, patients with higher baseline exercise levels did not show a decrease in psychosocial and sexual well-being, possibly reflecting a higher resilience to the operative process. These findings underscore the importance of integrating physical activity assessments into preoperative evaluations to inform patient-centred care and optimise recovery outcomes.

Asunto(s)

Arterias Epigástricas , Ejercicio Físico , Mamoplastia , Medición de Resultados Informados por el Paciente , Colgajo Perforante , Humanos , Mamoplastia/métodos , Femenino , Colgajo Perforante/irrigación sanguínea , Persona de Mediana Edad , Arterias Epigástricas/trasplante , Adulto , Neoplasias de la Mama/cirugía , Encuestas y Cuestionarios , Calidad de Vida , Estudios Prospectivos , Satisfacción del Paciente

RESUMEN

Objective: To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds. Methods: The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm. Results: All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively. Conclusion: The two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.

Asunto(s)

Traumatismos de la Mano , Colgajo Perforante , Procedimientos de Cirugía Plástica , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Traumatismos de la Mano/cirugía , Adolescente , Estudios Retrospectivos , Anciano , Adulto Joven , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel/métodos , Cicatrización de Heridas , Desbridamiento/métodos , Resultado del Tratamiento , Mano/cirugía , Traumatismos de los Tejidos Blandos/cirugía

RESUMEN

BACKGROUND: The neurocutaneous flap was developed based on the understanding that every superficial cutaneous nerve includes vessels, also known as vasa nervorum or paraneural vessels, which run around and inside the nerves and deliver blood to the skin above. A cutaneous perforator connected to paraneural vessels that vascularize the skin and nerves is referred to as a neurocutaneous perforator. The lateral antebrachial cutaneous nerve (LACN), the most dependable blood supply from the primary underlying veins of the neurocutaneous flap, is the subject of this study. METHODS: We reviewed the results of 30 flap coverage procedures in 10 children. The applied flap was based distally along the radial aspect of the hand and wrist. The pivot point of the flap was located dorsally. This study considered patients with posttraumatic tissue loss, vital structure exposure, or hand contractures with an LACN flap. There was a case-by-case assessment. RESULTS: Thirteen male patients were included; their ages ranged from 6 to 65 years. Demographic data, preoperative cause of trauma, and postoperative complications were collected. Statistically significant improvements were observed after flap healing. CONCLUSIONS: The LACN flap is a more versatile flap with less morbidity than other alternative flaps for coverage of soft tissue defect restoration around the hand, wrist, and distal forearm.

Asunto(s)

Procedimientos de Cirugía Plástica , Humanos , Masculino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Anciano , Adulto Joven , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/cirugía , Colgajo Perforante/irrigación sanguínea , Colgajo Perforante/trasplante , Colgajo Perforante/inervación , Resultado del Tratamiento , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/inervación , Colgajos Quirúrgicos/trasplante , Traumatismos de la Mano/cirugía

RESUMEN

Soft tissue calcifications frequently cause debilitating pain and functional impairments, considerably affecting patients' quality of life. As they are rare entities, evidence remains sparse, especially regarding treatment effectiveness and recurrence rates. While both pharmacological and surgical treatments may alleviate symptoms, complete resection is currently believed to prevent long-term recurrence of deposits. To improve understanding and raise awareness for soft tissue calcifications, the goal of this study was to review the current state of treatment and to compare benefits and possibilities of flap reconstruction versus simple excision in improving quality of life. Furthermore, we include a successful case report of complete resolution of symptoms following quadruple perforator flap reconstruction. By systematic literature review, studies published in MEDLINE between 1980 and 2024 reporting on surgical treatment and outcome of soft tissue calcifications were included, in addition to a detailed description of our case report. A total of 53 studies reporting on 197 patients with soft tissue calcifications were included. Simple surgical excision was the most commonly (85.9%) employed procedure, demonstrating a substantial recurrence rate of 13.3%. In contrast, no patients who underwent radical excision experienced recurrence. Dermal matrix grafts and flap reconstruction were successfully used in patients requiring substantial tissue coverage, highlighting their value in complex defect reconstruction following radical excision. The combination of complete surgical resection and flap reconstruction reduces recurrence rates and improves postoperative outcomes and quality of life of these patients, supporting early radical surgical intervention as the gold standard treatment for soft tissue calcifications.

Asunto(s)

Calcinosis , Colgajo Perforante , Procedimientos de Cirugía Plástica , Humanos , Calcinosis/cirugía , Procedimientos de Cirugía Plástica/métodos , Calidad de Vida , Resultado del Tratamiento , Masculino , Femenino , Persona de Mediana Edad , Dolor/cirugía , Dolor/etiología

RESUMEN

BACKGROUND: Enhanced recovery after surgery (ERAS) pathways have been widely shown to yield positive outcomes, including in plastic surgery. Our group has previously validated ERAS in our deep inferior epigastric perforator flap breast reconstruction population. OBJECTIVES: We evaluated whether the ERAS protocol and addition of liposomal bupivacaine affected patient outcomes at the time of mastectomy and first-stage tissue expander reconstruction. METHODS: All patients treated between July 2021 and May 2022 were reviewed retrospectively. The ERAS protocol was implemented in December 2021. Two patient groups were compared: pre-ERAS and ERAS. The ERAS protocol included use of liposomal bupivacaine in the pectoralis nerve block 1/2 planes. Primary outcomes were observed with postoperative length of stay and hospital narcotic use. RESULTS: Eighty-one patients were analyzed in this cohort. The pre-ERAS group was composed of 41 patients, the ERAS group was composed of 83 patients. Postoperative length of stay was significantly reduced in the ERAS group (1.7 pre-ERAS vs 1.1 ERAS, P = .0004). When looking at morphine equivalents during the hospital stay, the degree of narcotics in the recovery room was relatively similar. Average PACU pain morphine equivalents were 6.1 pre-ERAS vs 7.1 ERAS (P = .406). However, total hospital morphine equivalents were significantly lower in the ERAS group (65.0 pre-ERAS vs 26.2 ERAS, P = <.001). CONCLUSIONS: The introduction of an enhanced recovery after surgery protocol with liposomal bupivacaine pectoralis 1/2 nerve blocks decreased postoperative opioid consumption and hospital length of stay in mastectomy patients undergoing tissue expander-based reconstruction.

Asunto(s)

Anestésicos Locales , Bupivacaína , Recuperación Mejorada Después de la Cirugía , Tiempo de Internación , Mamoplastia , Mastectomía , Bloqueo Nervioso , Dolor Postoperatorio , Dispositivos de Expansión Tisular , Humanos , Femenino , Mastectomía/efectos adversos , Persona de Mediana Edad , Bupivacaína/administración & dosificación , Mamoplastia/métodos , Mamoplastia/efectos adversos , Estudios Retrospectivos , Adulto , Tiempo de Internación/estadística & datos numéricos , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/diagnóstico , Anestésicos Locales/administración & dosificación , Bloqueo Nervioso/métodos , Neoplasias de la Mama/cirugía , Expansión de Tejido/métodos , Expansión de Tejido/instrumentación , Resultado del Tratamiento , Anciano , Liposomas , Colgajo Perforante

RESUMEN

INTRODUCTION: The use of allotransplants for breast reconstruction in surgical stage of the the breast cancer treatment requires tissue perfusion control. The aim of the study was to analyze the effectiveness of using indocyanine green as a drug for determining the perfusion of perforant flaps in breast reconstructive surgery. MATERIAL AND METHODS: A retrospective series of observations of 27 breast reconstructions using autologous transplants is presented: 19 reconstructions with DIEP-flap, 2 with SIEA-flap, 5 with TD-flap; 1 with thoracoepigastric flap. Intraoperative fluorescence angiography was performed using a Stryker device (5900 Optical Court, USA). The intensity of the flap fluorescence was recorded after intravenous bolus injection of 7.5 mg indocyanine green. RESULTS AND DISCUSSION: The optimal time interval from the moment of drug administration to indicative visualization of flap perfusion was 55-60 seconds. In all patients, the area of insufficient blood flow was excised within intensively blood-supplied tissues, according to mapping data with the indocyanine green. With free transplant of flaps postoperative complications during follow-up were recorded in 1 (4.8%) case (marginal necrosis), which is associated with insufficient compression of auxiliary vessels (violation of the dominant vessel contrast technique). With non-free transplant of flaps no complications were detected in the postoperative period. CONCLUSIONS: Indocyanine green allows to prevent necrotic changes and reduce the rehabilitation period. The optimal time for the indicative visualization of flap perfusion was 55-60 seconds. The use of indocyanine green in free transplant of flaps ensured a postoperative period without complications in 20 (95.2%) cases, in non-free flap transplantation - in 6 (100%) cases.

Asunto(s)

Neoplasias de la Mama , Verde de Indocianina , Mamoplastia , Colgajo Perforante , Humanos , Verde de Indocianina/administración & dosificación , Femenino , Mamoplastia/métodos , Mamoplastia/efectos adversos , Colgajo Perforante/irrigación sanguínea , Persona de Mediana Edad , Neoplasias de la Mama/cirugía , Estudios Retrospectivos , Adulto , Angiografía con Fluoresceína/métodos , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Colorantes/administración & dosificación , Mastectomía/métodos , Mastectomía/efectos adversos

RESUMEN

BACKGROUND: Autologous breast reconstruction is considered high-risk for deep vein thrombosis (DVT) and thromboembolism (PE). It is therefore recommended to treat patients undergoing these complex and lengthy procedures with DVT chemoprophylaxis. The optimal anticoagulation protocol is still not established. The objective of our study was to evaluate the need of a prolonged anticoagulation in patients undergoing microsurgical breast reconstruction. METHODS: This retrospective cohort study compares our former anticoagulation protocol, which was given during the in-hospital stay, with our new protocol consisting of extended anticoagulation until postoperative day 25, in terms of DVT/PE risk reduction. A logistic regression was used to evaluate the risk of DVT/PE between the two groups, while adjusting for several covariates. RESULTS: Our cohort consisted of 205 patients in the short-term anticoagulation group and 219 in the extended protocol group. Five patients (2.4%) in the short-term anticoagulation group had a DVT/PE event versus 4 patients (1.8%) in the extended protocol group. Logistic regression revealed no difference in the incidence of DVT/PE between the two groups. Similarly, there was no differences in terms of hematoma and infection rate between the two groups. Finally, we found an increased risk of DVT/PE in patients with a Caprini score equal or greater than 8. CONCLUSION: In our experience, short-term anticoagulation during the hospital stay is equivalent to extended thromboprophylaxis in terms of DVT/PE prevention.

Asunto(s)

Anticoagulantes , Mamoplastia , Tromboembolia Venosa , Humanos , Estudios Retrospectivos , Mamoplastia/métodos , Mamoplastia/efectos adversos , Femenino , Persona de Mediana Edad , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/etiología , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Colgajo Perforante/efectos adversos , Adulto , Quimioprevención/métodos , Esquema de Medicación , Trombosis de la Vena/prevención & control , Trombosis de la Vena/etiología

RESUMEN

OBJECTIVES: To compare the clinical outcomes of anterolateral femoral interregional flap with turbocharge technique and traditional anterolateral femoral flap in repair of large limb wounds. METHODS: Clinical data of 38 patients with large limb surface wound (11 cm×39 cm-16 cm×65 cm) admitted to the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from May 2018 to May 2022 were retrospectively analyzed. Eighteen patients were treated by anterolateral thigh perforator flap combined with superficial circumflex iliac artery flap (ALTP-SCIAP) with turbocharge technique (interregional flap group); while 20 patients were treated with unilateral or bilateral anterolateral femoral flaps, combined with skin grafting if necessary (traditional anterolateral femoral flap group). The survival of skin flap, repair of donor area, complications and patient satisfaction were compared between the two groups. RESULTS: In interregional flap group, 18 flaps were harvested and transplanted, the flap width, length and the viable area were (9.9±2.0) cm, (44.2±3.5) cm and (343.2±79.9) cm2, respectively. In traditional anterolateral femoral flap group, 29 flaps were harvested and transplanted, the flap width, length and the viable area were (11.0±2.8) cm, (21.7±3.2) cm and (186.4±49.2) cm2, respectively. There were significant differences in the flap length and the viable area between the two groups (t=22.365 and 8.345, both P<0.05). In the interregional flap group, the donor site of flap was closed by direct suture in 11 flaps, by skin retractor assisted suture in 6 flaps, and by skin grafting in one flap. In traditional anterolateral femoral flap group, the donor site of flap was closed by direct suture in 12 flaps, by skin retractor assisted suture in 11 flaps, and by skin grafting in 6 flaps. The skin graft rates of the two groups were 5.6% (1/18) and 20.7% (6/29), respectively (χ2=2.007, P>0.05). The interregional flap group had lower postoperative complications rate (5.6% vs. 35.0%, χ2=4.942, P<0.05) and higher patient satisfaction rate (94.4% vs. 70.0%, χ2=4.448, P<0.05) than traditional anterolateral femoral flap group. CONCLUSIONS: Compared with the traditional anterolateral femoral flap, the anterolateral femoral interregional flap with turbocharge technique has a larger flap area, most of the donor areas of the flap can be sutured directly without skin grafting and with less complications and a higher patient satisfaction rate.

Asunto(s)

Colgajo Perforante , Procedimientos de Cirugía Plástica , Trasplante de Piel , Colgajos Quirúrgicos , Humanos , Estudios Retrospectivos , Trasplante de Piel/métodos , Procedimientos de Cirugía Plástica/métodos , Masculino , Femenino , Satisfacción del Paciente , Fémur/cirugía , Muslo/cirugía , Arteria Ilíaca/cirugía , Cicatrización de Heridas , Persona de Mediana Edad , Adulto