Three-dimensional reconstruction of hip and groin region by division and rotation of skin paddle using oblique rectus abdominis musculocutaneous flap after squamous cell carcinoma resection
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ABSTRACT:
SUBMITTER: Morita K
PROVIDER: S-EPMC11338050 | biostudies-literature | 2024 Jul
REPOSITORIES: biostudies-literature
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Project description:Ectopia cordis is a rare congenital condition resulting in extrathoracic positioning of the heart. The severity of presentation may vary with partial or complete displacement through sternal or diaphragmatic defects. Operative management is typically required, but due to the rarity of the condition, no standard exists for optimal closure. Reconstruction techniques can include compound local flap placement including pectoralis major, rectus abdominis, or latissimus dorsi flaps as well as synthetic material placement, autologous bone, and cartilage grafts to correct sternal deformity. This case report outlines the successful utilization of bilateral composite pectoralis major and rectus abdominal musculocutaneous flaps for complex staged closure of a sternal wound after creation of a cavopulmonary anastomosis in a 5-year-old patient with concomitant single-ventricle congenital heart disease. This single-staged closure after cardiac repair was performed without intra- or postoperative complications, and the patient demonstrated satisfactory healing with stable cardiac coverage at follow-up visit. This technique may present as an effective approach in complex sternal wound closure in patients with ectopia cordis.
| S-EPMC11573324 | biostudies-literature
Project description:Purpose/aimPerianal wound healing and/or complications are common following abdominoperineal resection (APR). Although primary closure is commonly undertaken, myocutaneous flap closure such as vertical rectus abdominis myocutaneous flap (VRAM) is thought to improve wound healing process and outcome. A comprehensive meta-analysis was performed to compare outcomes of primary closure versus VRAM flap closure of perineal wound following APR.MethodsPubMed, MEDLINE, EMBASE, and Cochrane Central Registry of Controlled Trials were comprehensively searched until the 8th of August 2023. Included studies underwent meta-analysis to compare outcomes of primary closure versus VRAM flap closure of perineal wound following APR. The primary outcome of interest was perineal wound complications, and the secondary outcomes were abdominal wound complications, dehiscence, wound healing time, length of hospital stay, and mortality.ResultsTen studies with 1141 patients were included. Overall, 853 patients underwent primary closure (74.8%) and 288 patients underwent VRAM (25.2%). Eight studies reported on perineal wound complications after APR: 38.2% (n = 263/688) in the primary closure group versus 32.8% (n = 80/244) in the VRAM group. Perineal complication rates were statistically significantly lower in the VRAM group versus primary closure ((M-H OR, 1.61; 95% CI 1.04-2.49; <p = 0.03).ConclusionWe highlight the advantage of VRAM flap closure over primary closure for perineal wounds following APR. However, tailoring operative strategy based on patient and disease factors remains important in optimising outcomes.
| S-EPMC11294374 | biostudies-literature
Project description:Few studies have assessed the efficacy and safety of reconstruction of sternal infection using a pectoralis muscle flap combined with a rectus abdominis muscle (RAM) sheath fasciocutaneous flap. We report here our experience with this procedure to reconstruct the sternal defect in patients (n = 46) with a deep sternal wound infection (DSWI) after cardiac surgery. After wound reconstruction, the proportion of prolonged mechanical ventilation use and intensive care unit (ICU) stay were 17.4% (n = 8) and 21.7% (n = 10), respectively. The 30-day all-cause mortality was 15.2%; recurrence rate was 17.4%; postoperative complications were 15.2%; and median hospital stay was 31 (0-157) days. Multivariate logistic regression analysis revealed that hypertension (β = 21.32, 95%CI 4.955-37.68, P = .014), drainage-tube use (β = 0.944, 95%CI 0.273-1.614, P = .008), and prolonged intensive care unit stay (β = 53.65, 95%CI 31.353-75.938, P < .001) were significantly correlated with hospital stay. In conclusion, a procedure including surgical debridement, sternal reconstruction with bilateral PM and RAM sheath flap, long-term antibiotics, and adequate drainage is a beneficial technique in the reconstruction of deep sternal wound infection after cardiac surgery. Duration of drainage tube use may be as an index for a hospital stay or wound healing.
| S-EPMC9615267 | biostudies-literature
Project description:Background Bronchopleural fistula (BPF) is a seldom encountered yet serious complication after thoracic surgery, and is often difficult to treat. Large BPFs usually require surgical intervention, and a variety of different surgical reconstruction options have been previously described. This case report presents the first description of a successful vertical rectus abdominis myocutaneous (VRAM) free flap repair of a BPF after pneumonectomy. Case Description A 46-year-old male with a cough was found to have a right upper lobe lung mass with hilar involvement initially remarkable for epithelioid malignant mesothelioma on biopsy. After neoadjuvant chemotherapy, he underwent right extrapleural pneumonectomy and developed a late right mainstem BPF with associated empyema from adjuvant chemotherapy and COVID-19 pneumonia. He was treated with open Clagett window (OCW) to address the infection and then staged VRAM free flap coverage of the BPF. The patient recovered successfully and has since been able to pursue more demanding activities at home. Conclusions This case presents the only successful VRAM free flap for a BPF involving the entire right mainstem bronchus at the carina. VRAM free flap repair offers a useful treatment option for BPFs, especially in patients with large pleural cavity defects.
| S-EPMC9634460 | biostudies-literature
Project description:To evaluate the oncological outcomes of patients with breast cancer after nipple-sparing mastectomy (NSM)/skin-sparing mastectomy (SSM), followed by immediate reconstruction, as compared to conventional mastectomy (CM).SSM/NSM has been increasingly used to treat women with breast cancer who wish to preserve the overlying breast skin, but concern exist regarding its oncological safety due to the potential for residual breast tissue. We report our experience performing SSM/NSM for breast cancer treatment compared to CM with a long follow-up period.All consecutive patients who underwent mastectomy for breast cancer at Asan Medical Center between January 1993 and December 2008 were identified by retrospective medical chart review. The patients who underwent NSM/SSM, followed by immediate breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap (TRAM), were compared to the patients who underwent CM in terms of breast-cancer specific survival (BCSS) rate, distant metastasis-free survival (DMFS) rate, and local recurrence (LR) rate.During the study period, 6028 patients underwent mastectomy for breast cancer. Of these, 1032 and 4996 underwent NSM/SSM with TRAM and CM, respectively. Their median follow-up durations were 94.4 (range, 8.1-220.2) and 110.8 (range, 6.1-262.0) months, respectively. Their 5 year BCSS rates were 95.4% and 88.1%, respectively (log-rank, P < .001). Their 5 year DMFS rates were 93.0% and 85.6%, respectively (log-rank, P < .001).Relative to CM, NSM/SSM, followed by immediate breast reconstruction, may be a viable and oncologically safe surgical treatment in selected patients with breast cancer.
| S-EPMC6393080 | biostudies-literature
Project description:BackgroundEven with patent deep inferior epigastric vein anastomoses, venous congestion can occur during free transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) flap surgery and lead to flap compromise if not recognized and managed.ObjectivesTo identify the incidence of intraoperative venous congestion and describe the best available prevention and treatment methods.MethodsSystematic electronic searches of the PubMed database including Medline were performed to identify studies published until 2014. The following keywords were used: "DIEP" or "free TRAM" and "venous insufficiency" or "venous congestion". Supplemental searches were conducted to identify referenced studies. Statistical analysis using the χ(2) test was performed.ResultsNine studies representing 4747 free abdominal flaps cases were included and demonstrated an overall incidence of intraoperative venous congestion of 2.8%. The incidence in DIEP flaps (3.3%) was significantly higher than that in the free TRAM flaps (1.0%). All nine articles reported using the superficial inferior epigastric vein to treat venous insufficiency.ConclusionThe risk for developing intraoperative venous congestion following free abdominal flap breast reconstruction is influenced by inadequate perforator selection and persistent dominance in the superficial venous system. The solution is establishing another venous draining route using the superficial inferior epigastric vein.
| S-EPMC4664142 | biostudies-literature
Project description:BACKGROUND:Thoracodorsal vessels (TDVs) and internal mammary vessels (IMVs) have both been widely employed as recipient vessels for use in free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps. However, whether TDVs or IMVs are preferable as recipient vessels for autologous breast reconstruction with a free MS-TRAM flap remains controversial. The purpose of this study was to compare the clinical outcomes when TDVs were used as recipient vessels to those obtained when IMVs were used as recipient vessels for autologous breast reconstruction with a free MS-TRAM flap. METHODS:A retrospective matched-cohort study was performed. We retrospectively reviewed data collected from patients who underwent a free MS-TRAM flap for autologous breast reconstructions after mastectomy between March 2003 and June 2013. After a one-to-one matching using age, 100 autologous breast reconstructions were selected in this study. Of the 100 breast reconstructions, 50 flaps were anastomosed to TDVs and 50 to IMVs. Patient demographics and clinical outcomes including operation time, length of hospital stay, postoperative complications, and aesthetic score were compared between the two groups. RESULTS:No statistically significant differences were found between the two groups in patient demographics and clinical outcomes, including the complication rates and aesthetic scores. There were no major complications such as total or partial flap loss in either group. CONCLUSIONS:The results of our study demonstrate that both TDVs and IMVs were safe and efficient as recipient vessels in terms of the complication rates and aesthetic outcomes.
| S-EPMC6446025 | biostudies-literature
Project description:Background: The purpose of this study was to introduce a new surgical technique for pedicled TRAM flap that removes a part of the rectus abdominis muscle inserting into ribs, and to analyze this technique in comparison with classical pedicled TRAM flap. Methods: A retrospective review of patient charts from May 2006 to February 2016 was performed. The patient group that underwent the removal of the part of the rectus abdominis that inserts into the thorax (partial muscle resection; PMR group) was compared with the group that did not undergo this muscle resection (Classical group). The complications and aesthetic effects of surgery between the two groups were analyzed. Results: There were 34 patients in the classical group and 28 in the PMR group. There were no significant differences in postoperative complications between these two groups. The rates of fat necrosis were 32.1% in the PMR group and 36.1% in the classical group. The postoperative aesthetic outcome of the inframammary fold showed no significant differences in outcome between the classical and PMR groups. However, all items received higher scores in the PMR group. Conclusions: The authors’ new surgical method was associated with a positive cosmetic effect of improving inframammary fold aesthetics and could thus represent a new option for pTRAM breast reconstruction.
| S-EPMC9698679 | biostudies-literature
Project description:IntroductionThe conventional techniques for management of complex duodenal injuries are duodenal diverticularisation, pyloric exclusion or triple tube decompression. We here present a salvage technique of primary reinforcement with pedicled rectus abdominis muscle flap (RAMF) for a tenuous post traumatic duodenal perforation (PTDP). The majority of the studies in the literature are on the use RAMF for the secondary repair of peptic duodenal perforations.Presentation of caseA 38 year old male presented with an acute abdomen, three days after sustaining a blunt abdominal trauma. The clinical and radiological findings in the abdomen were subtle and not contributory. An emergency laparotomy with a high index of suspicion revealed a large perforation in the anterolateral wall of the second portion of the duodenum with a friable unhealthy wall and shearing of the serosa around the perforation site. The entire omentum was unhealthy, contused with areas of gangrene and omentectomy done. The perforation site was closed using 3.0 vicryl and reinforced with a pedicled right RAMF based on the superior epigastric artery. The patient recovered uneventfully and was discharged.DiscussionThe addition of conventional diversion techniques to primary duodenorrhaphy is sophisticated, time consuming and adds morbidity.ConclusionRAMF is a good tissue substitute to buttress tenuous duodenal injuries presenting late with inflamed, friable perforation sites and associated tissue loss, where duodenorrhaphy alone may not be successful. RAMF is a valuable salvage technique when the omentum is not available and the local tissue condition negates the effectiveness of other simpler techniques.
| S-EPMC7452464 | biostudies-literature
Project description:Mesh repair is currently the mainstay of treatment for abdominal wall incisional hernias and is considered the standard of care. However, if radiotherapy is used, the possibility of complications such as exposure or infection of the prosthesis after the surgery as a complication of the radiotherapy is a concern. The patient was a 51-year-old woman who underwent laparotomy by a mid-abdominal incision for ovarian tumors. Approximately 2 years later, the patient presented with a hypertrophic scar of the wound and mild pain in the scar. The hypertrophic scar was improved gradually by corticosteroid injection. However, she had a bulge on the left side of the umbilicus just below the hypertrophic scar. Computed tomography showed a 65 × 69 mm2 hernial orifice on the left side of the umbilical abdominal wall, and an abdominal wall incisional hernia was diagnosed. The patient underwent closure by the ACS technique and reinforcement by unilateral inversion of the anterior rectus abdominis sheath for the abdominal wall incisional hernia. No recurrence of the hypertrophic scar or abdominal wall incisional hernia was observed during the follow-up period. In the present case, the hernial orifice was closed by a modified ACS technique that was combined with the anterior rectus abdominis sheath turnover flap. This technique is likely a less invasive and relatively simple method resulting in a tighter repair of the abdominal hernia than the ACS method alone, without prostheses.
| S-EPMC10325745 | biostudies-literature