Efficacy of Flap-based Posterior Trunk Reconstruction after Vertebrectomy and Radiation Therapy: A Retrospective Cohort Study
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ABSTRACT:
SUBMITTER: Amendola F
PROVIDER: S-EPMC10489417 | biostudies-literature | 2023 Sep
REPOSITORIES: biostudies-literature
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Project description:The posterior trunk roughly encompasses the upper back from the shoulders to the lumbar area above the iliac crests. Long-term outcomes in the treatment of defects of the spine and bony thorax have been proved superior if flaps were used. Many local muscle and fasciocutaneous flaps are available alternatives. A guideline, patterned according to arbitrary anatomic territories of the back, is suggested as a starting point for the selection of appropriate primary and secondary flap options. Depending on flap availability, the latissimus dorsi and trapezius muscles are the workhorse flaps for the upper back, whereas perforator flaps have become a useful alternative for the lumbar region in lieu of free flaps.
| S-EPMC3140241 | biostudies-other
Project description:Both free posterior tibial flap (FPTF) and free radial forearm flap (FRFF) are commonly used for head and neck defects. They have many similarities in embryology, histology, and anatomy, but their advantages and disadvantages in head and neck repair have not been fully recognized. This study aimed to compare the cadaveric anatomy and clinical application of FPTF and FRFF for the reconstruction of head and neck defects after tumor resection. Anatomical dissection was performed on 10 fresh adult cadavers. The general characteristics of both flaps and the sites of recipients and donors were collected. A total of 31 and 25 patients underwent FPTF and FRFF construction, respectively. The patient medical records were assessed to obtain the clinical characteristics. Characteristics of the flap such as size, pedicle length, and clinical process data were collected and compared. The appearance, sensory disturbance, and effect on quality of life and daily activity were evaluated. The posterior tibial artery was present and observed in all patients. The posterior vascular pedicle was longer than the radial artery. There was no difference between the diameters of arteries of FPTF and FRFF; however, the diameters of their veins differed. In terms of flap characteristics, FPTF was significantly larger and had a longer vascular pedicle than FRFF (40.68±11.07 vs. 53.77±29.02 cm2, P=0.03; 8.48±1.66 vs. 11.10±2.39 cm, P=0.00). Patients in the FPTF group had a significantly shorter total hospital stay (FRFF: 26.48±8.33 d; FPTF: 18.58±6.68 d), postoperative hospital stay (FRFF: 17.60±5.53 d; FPTF: 10.94±3.62 d), and flap harvest time (FRFF: 87.00±20.92 min; FPTF: 65.00±17.56 min) than FRFF group. There were far more complications of the donor site in the FRFF group than in the FPTF group. Also, according to the patients' subjective evaluations of the donor site, FPTF was superior to FRFF (P=0.00). FPTF is a reliable alternative to FRFF for head and neck reconstruction. These techniques share similar certain embryogenesis and anatomical characteristics but FPTF possesses unique aesthetic and clinical application advantages.
| S-EPMC9761164 | biostudies-literature
Project description:Latissimus dorsi (LD) flaps are ideal for reconstructing deep and complex anterolateral chest defects because they provide both coverage and volume with relatively short surgery and acceptable donor-site morbidity. The LD flap is suitable for patients who have undergone lung surgery and should avoid prolonged or invasive reconstruction surgery. However, the LD main pedicle, the thoracodorsal artery (TDA), is often damaged in these patients. A hitherto poorly known alternative is an LD flap that is based on a posterior intercostal artery perforator (P-ICAP). Here, we present the case of a 65-year-old man with a postpleurectomy anterolateral chest defect involving exposed lung tissue who was planned to undergo reconstruction with an ipsilateral TDA-pedicled musculocutaneous LD flap. In preoperative imaging and intraoperative exploration, the TDA was found to be damaged, but the eighth dorsal branch P-ICAP was identified and shown to have a strong Doppler signal. Thus, it served as the pedicle, and the entire LD muscle was elevated. The cutaneous part of the flap was designed as a superoposteriorly based transposition flap that maintained a skin bridge to reduce the risk of venous congestion. The donor site was closed primarily. The postoperative course was uneventful. This case supports the use of a P-ICAP-based LD musculocutaneous flap for reconstructing anterolateral chest defects in cases where the TDA is damaged.
| S-EPMC11902951 | biostudies-literature
Project description:UnlabelledComplex hand trauma presents multifaceted problems for the surgeon. Soft tissue defects of the upper extremity must be carefully assessed to determine the most appropriate method of coverage of hand. In this article, the reversed posterior interosseous flap was used for coverage of the hand. The injured areas include: dorsum of the hand (10 cases), the wrist (3 cases) and the dorsal thumb (2 cases). All flaps survived completely and none exhibited venous compromise. All donor sites were skin grafted. The reversed posterior interosseous flap is a versatile option for coverage of moderate sized defects of the hand and is specifically indicated for coverage of injuries of the wrist, dorsal hand and dorsal thumb.Electronic supplementary materialThe online version of this article (doi:10.1007/s12593-011-0042-y) contains supplementary material, which is available to authorized users.
| S-EPMC3172356 | biostudies-literature
Project description:The profunda artery perforator (PAP) flap, commonly used for small- to medium-sized breast reconstructions, offers easy harvest and inconspicuous donor-site scars. However, its shorter vascular pedicle compared with the deep inferior epigastric perforator flap limits its reach to lateral recipient vessels. This often requires strategic placement of perforators at the flap's edge to extend reach, potentially causing congestion in the distal part of the flap. To address these challenges, using the posterior accessory saphenous vein (pASV) has proven effective. Using the pASV as a vein graft significantly extends the pedicle length of the PAP flap, enhancing anastomosis success with recipient vessels. Additionally, in cases of flap congestion, the proximal segment of the pASV can be used as an additional venous outflow pathway, while grafting the distal segment further extends its length. This dual approach improves overall flap viability and reduces venous congestion risks. This discussion highlights two cases demonstrating the innovative use of the pASV within the PAP flap. In case 1, the pASV extended the pedicle length, enhancing the flap's placement flexibility and facilitating anastomosis with thoracodorsal vessels. In case 2, the pASV served as a secondary venous outflow pathway, with the distal segment grafted to extend the proximal portion. This adaptation provided additional venous drainage and effectively managed positioning constraints imposed by recipient vessel locations. These examples illustrate the significant benefits of utilizing the pASV in PAP flap breast reconstructions, offering a novel strategy to improve viability and expand its use in complex scenarios requiring extended vascular reach.
| S-EPMC11374242 | biostudies-literature
Project description:BackgroundWhile the trend towards immediate breast reconstruction is growing, data on the long-term outcomes of patients receiving irradiation afterwards are scarce. We retrospectively reviewed the long-term complication rates in patients who received adjuvant radiation therapy after immediate breast reconstruction in our institution.MethodsWe included 134 patients with breast cancer who underwent single-stage immediate breast reconstruction between January 2008 and December 2018. Sixty-eight patients received adjuvant irradiation and 66 patients did not. Autologous tissue, implant-based, and combined (implant and flap) reconstruction were performed in 40, 55, and 39 patients, respectively. Flap and implant complications data were collected. Baker's classification was used to assess capsular contracture.ResultsThe average follow-up was 47 months. Both groups had similar baseline clinical characteristics and treatments received. The irradiated-group had a higher incidence of adjuvant chemotherapy (P<0.01) and a significantly higher rate of grade III/IV capsular contracture (42.1% vs. 26.9%; P=0.004) than that of the non-irradiated group. The median time to the development of capsular contracture was 37 vs. 41 months in the irradiated vs. the non-irradiated group, respectively. There were no differences in the incidence of flap complications between both groups. The only significant risk factor associated with grade III/IV capsular contracture was adjuvant post-mastectomy irradiation. The irradiated group had a higher risk of developing grade III/IV capsular contracture [odds ratio (OR), 4.35; 95% confidence interval (CI): 1.55-12.27].ConclusionsPostmastectomy radiotherapy adversely affects implant-based immediate one-stage reconstruction by increasing the rate of moderate to severe capsular contracture but is not associated with flap complications.
| S-EPMC10493629 | biostudies-literature
Project description:SummaryProximal, posterior thigh wounds from oncologic or traumatic defects can be difficult wounds to reconstruct if local flap options have been sacrificed during the trauma or oncologic resection. Free flap options to cover these defects are also difficult because of the lack of convenient recipient vessels in the region. The authors present 2 cases (oncologic and traumatic) wherein a myocutaneous anterolateral thigh (ALT) flap was harvested and tunneled from the anterior muscle compartment to the posterior muscle compartment of the thigh through a medially based transmuscular tunnel, decreasing the required pedicle distance to the wound. This technique of transmuscular tunneling of the ALT flap expands the indications and utility of the ALT flap to cover posterior thigh wounds.
| S-EPMC4174101 | biostudies-literature
Project description:Nasal tip reconstruction requires a meticulous approach due to the complexity of the nasal anatomy and its aesthetic importance. Many procedures have been described to restore this aesthetic unit, including the paramedian forehead flap, which is one of the workhorse flaps. However, despite excellent final outcomes, this procedure may be refused by patients, due to its temporary conspicuous appearance possibly associated with serious psychological implications, and the need of multiple interventions. We aimed to present an approach combining the Rintala flap and the posterior perichondrial cutaneous graft as a valuable alternative to treat large nasal tip defects.
| S-EPMC9076444 | biostudies-literature
Project description:IntroductionAdvancing approaches to locally invasive pelvic malignancy creates a large tissue defect resulting in perineal wound complications, dehiscence, and perineal hernia. Use of reconstructive flaps such as vertical rectus abdominus myocutaneous (VRAM) flap, gracilis, anterolateral thigh (ALT) and gluteal flaps have been utilised in our institution to address perineal closure. We compared outcomes using different flap techniques along with primary perineal closure in advanced pelvic oncological resection.MethodsA prospectively maintained database of patients undergoing advanced pelvic oncological resection in a single tertiary hospital was retrospectively analysed. This study included consecutive patients between 2014 and 2021 according to the Strengthening The Reporting of Cohort Studies in Surgery (STROCSS) criteria. Primary outcome measures were the frequency of post-operative perineal complications between primary closure, VRAM, gluteal and thigh (ALT and gracilis) reconstruction.Results122 patients underwent advanced pelvic resection with perineal closure. Of these, 40 patients underwent extra-levator abdominoperineal resection (ELAPE), and 70 patients underwent pelvic exenteration. Sixty-four patients received reconstructive flap closure, which included VRAM (22), gluteal (21) and thigh flaps (19). Perineal infection and dehiscence rates were low. Infection rates were lower in the flap group despite a higher rate of radiotherapy ( P <0.050). Reoperation rates were infrequent (<10%) but specific for each flap, such as donor-site hernia following VRAM and flap dehiscence after thigh flap reconstruction.ConclusionsIn patients who are at high risk of post-operative perineal infections, reconstructive flap closure offers acceptable outcomes. VRAM, gluteal and thigh flaps offer comparable outcomes and can be tailored to the individual patient.
| S-EPMC10651229 | biostudies-literature
Project description:PurposeTo assess the availability, success rate and complications of microvascular iliac crest free flap for reconstruction of mandibular segmental defects.MethodsIn this retrospective-descriptive study, we report patients who had undergone segmental mandibular resection for pathologic lesions and received reconstruction with iliac crest microvascular free flap between 2016 and 2019. Clinical and demographic data of all the cases were collected. Success was regarded as complete consolidation of the bone graft in panoramic radiograph. Postoperative complications were defined as major or minor based on the need for intervention. T-test, Kolomogorov_Smirnov, and multivariate analysis were used and the p-value<0.05 was considered to be statistically significant.ResultsOf all 30 patients, 16 were women and 14 were men with an average age of 27.2 years (range 14-40). Patients were followed for 12-60 month (mean: 38.4). One flap was lost due to unsalvageable venous thrombosis. Six other cases had post-op complications while smoking and diabetes were associated with more complications (P = 0.036). Twenty-three patients received primary reconstruction which was more successful than secondary ones (P = 0.003). Osteogenic sarcoma was associated with greater risk of complications (P < 0.01).ConclusionsThe results of this study suggest that iliac crest microvascular free flap serves as a promising option for the reconstruction of mandibular defects, providing excellent contour and acceptable success rate with low donor site morbidity. Future studies will focus on the role of systemic diseases in post-op complications and flap failures.
| S-EPMC8121997 | biostudies-literature