BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal c...BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.展开更多
Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reco...Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center.Methods: A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit,Hospital Universiti Sains Malaysia(HUSM),Kelantan,for wound coverage from to 1997–2023.Data on patient demographics,defect size,reconstruction methods,operation duration,flap-related complications,and secondary repairs were collected and analyzed.Results: Thirteen patients were identified in this retrospective study,comprising 5 female patients,7 male patients,and 1 ambiguous gender patient.Wound closures were performed using primary closure method,local flaps,or regional flap closure.Nine(69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap,three(23.1%) underwent primary closure,and only one(7.7%) patient underwent wound closure with a regional flap.Flap-related complications were observed in four of the thirteen patients,including wound breakdown in two cases and partial flap necrosis in two cases.Of these four patients,secondary repair was required in three: split-thickness skin grafting was performed in two,and primary closure in one.The remaining patient was managed conservatively with dressings.Patients were followed up for a mean duration of56.6(±62.4) months,and complete healing was achieved in all cases.Conclusion: Myelomeningocele repair remains challenging,and a multidisciplinary approach is recommended.We demonstrated various local and regional flap closure methods with good outcomes.Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.展开更多
Purpose： To express the versatility of a variety of non-microsurgical skin flaps used for coverage of difficult wounds in the lower third of the leg and the foot over 4 years period. Five kinds of flaps were used. Ea...Purpose： To express the versatility of a variety of non-microsurgical skin flaps used for coverage of difficult wounds in the lower third of the leg and the foot over 4 years period. Five kinds of flaps were used. Each flap was presented with detailed information regarding indication, blood supply, skin territory and technique. Methods： Altogether 26 patients underwent lower leg reconstruction were included in this study. The reconstructive procedures applied five flaps, respectively distally based posterior tibial artery perforator flap （n - 8）, distally based peroneal artery perforator flap （n = 4）, distally based sural flap （n - 6）, medial planter artery flap （n - 2） and cross leg flaps （n - 6）. Results： In all cases, there were no signs of osteomyelitis of underlying bones or discharge from the undersurface of the flaps. Fat necrosis occurred at the distal end of posterior tibial artery perforator flap in one female patient. The two cases of medial planter artery flap showed excellent healing with closure of donor site primarily. One cross leg flap had distal necrosis. Conclusion： Would at lower third of leg can be efficiently covered by posterior tibial, peroneal artery and sural flaps. Heel can be best covered by nearby tissues such as medial planter flap. In presence of vascular compromise of the affected limb or exposure of dorsum of foot, cross leg flap can be used.展开更多
Scalp reconstruction requires keen insight into underlying anatomy and surgical armamentarium.The reconstructive surgeon must consider a plethora of complexities to devise a safe and cosmetically maximized outcome.The...Scalp reconstruction requires keen insight into underlying anatomy and surgical armamentarium.The reconstructive surgeon must consider a plethora of complexities to devise a safe and cosmetically maximized outcome.The purpose of this article is to review scalp reconstruction techniques and the current literature in the framework of the reconstructive ladder,with special emphasis on local flap consideration,design,and execution.展开更多
Background Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons. We investigated the application of local flaps and Ilizar...Background Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons. We investigated the application of local flaps and Ilizarov osteogenesis in the reestablishment of severe combined defects of tibial bone and soft tissue. Methods Sixteen patients with bone and soft tissue defects were included. The mean age of the patients was 31.5 years. The average time from injury to initial surgery was 14.4 weeks. The average soft tissue and bone defect sizes were 92.9 cm2 and 8.7 cm, respectively. Local flaps were created to reconstruct the soft tissue defects. The Ilizarov external fixator or the Orthofix Limb Reconstruction System was used to reconstruct bony defects using delayed distraction osteogenesis. Results Two myocutaneous flaps and 14 reverse island flaps were applied. All transferred flaps survived. Fifteen patients healed with equal leg length, and one healed with a residual leg-length discrepancy of 1.5 cm. One patient with an Ilizarov external fixator developed ankle joint stiffening and a pin-track infection that was successfully treated with oral antibiotics. No patient developed pin loosening. All patients walked without assistance. Fifteen patients returned to their work, and one lost her job. The results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 14 and good in two patients. Functional assessment scores were excellent in 13, good in two, and fair in one patient. Conclusion The combination of local flaps and sequential distraction osteogenesis can be used for successful reconstruction of defects of incorporated bone and soft tissue.展开更多
Perforator-pedicled propeller flaps, which base their blood supply on isolated perforators, have been gaining popularityamong plastic surgeons over the past two decades. They have proven to be of great value in the re...Perforator-pedicled propeller flaps, which base their blood supply on isolated perforators, have been gaining popularityamong plastic surgeons over the past two decades. They have proven to be of great value in the reconstruction of soft tissue defects in different areas of the body but are, thanks to their maximal mobility, mostly used in the reconstruction of extremities. In this article, we focus on perforator-pedicled propeller flaps in lower limb reconstruction, where they can be implemented in the coverage of primary as well as secondary soft tissue defects. Firstly, a brief literature review on evolution of propeller flap use in lower extremity is provided. Moreover, we present our surgical technique including the use of indocyanine green real-time angiography for reliable flap transfer. In addition, we report 3 cases of patients in whom we used a local propeller flap for the closure of skin defects in different parts of the leg.展开更多
Reconstructive defects of the human face pose unique challenges to even the most experienced surgeon given their myriad of presentations and the individuality of each patient’s anatomy,clinical presentation,and persp...Reconstructive defects of the human face pose unique challenges to even the most experienced surgeon given their myriad of presentations and the individuality of each patient’s anatomy,clinical presentation,and perspective or preferences.A robust armamentarium of reconstructive options must be cultivated for each facial subunit so that experience and artistry can be best utilized to rebuild the patient’s structure and function.This review will outline a subset of local rotation and transposition flaps that are most useful for facial reconstruction,organized by facial subunit.展开更多
Objective:The reconstruction of large scalp defects poses both functional and cosmetic challenges.While free tissue transfer remains the standard for defects larger than 30 cm^(2),prolonged anesthesia and postoperativ...Objective:The reconstruction of large scalp defects poses both functional and cosmetic challenges.While free tissue transfer remains the standard for defects larger than 30 cm^(2),prolonged anesthesia and postoperative complications remain significant limitations.The purpose of this study is to evaluate the use of O-Z flaps for the reconstruction of large scalp defects and to describe the techniques employed.Methods:This is a retrospective analysis of ten patients who underwent reconstructive surgery using an O-Z flap approach for large scalp defects between July 2017 and June 2019.The parameters included in this study were patient demographics,tumor characteristics,and postoperative management,collected for at least a year after surgery.Results:In this cohort,the mean age was 76.1 years and 90%were male.All patients were treated for neoplastic skin lesions,with 70%located on the vertex and 30%located on the temporoparietal region.The mean size of defect was 52.0 cm^(2)(range:38.6 to 63.8 cm^(2)).The maximum hospital stay was two days,and no patients were readmitted within 30 days of surgery.There were no cases of wound infection or flap necrosis.All patients reported pain control with acetaminophen and ibuprofen.Four patients received adjuvant radiation,and there was no delay to receiving treatment following surgery.Conclusions:The O-Z flap is a reliable alternative for the reconstruction of non-irradiated scalp defects in the vertex and temporoparietal regions up to 63 cm^(2).This technique provides advantages for patients,including hairline preservation,shorter hospital stays,and decreased postoperative complications.展开更多
Scars are the final result of the four processes that constitute cutaneous wound healing,namely,coagulation,inflammation,proliferation,and remodeling.Permanent scars are produced if the wounds reach the reticular derm...Scars are the final result of the four processes that constitute cutaneous wound healing,namely,coagulation,inflammation,proliferation,and remodeling.Permanent scars are produced if the wounds reach the reticular dermis.The nature of these scars depends on the four wound healing processes.If the remodeling process is excessive,collagen degradation exceeds collagen synthesis and atrophic scars are produced.If the inflammation phase is prolonged and/or more potent for some reason,inflammatory/pathological scars such as keloids or hypertrophic scars can arise.If these pathological scars are located on joints or mobile regions,scar contractures can develop.When used with the appropriate timing and when selected on the basis of individual factors,surgical techniques can improve mature scars.This review paper focuses on the surgical techniques that are used to improve mature scars,burn scars,and scar contractures.Those methods include z-plasties,w-plasties,split-thickness skin grafting,full-thickness skin grafting,local flaps(including the square flap method and the propeller flap),and expanded flaps,distant flaps,regional flaps,and free flaps.展开更多
Objective:To review our experience with infrahyoid myocutaneous flap in reconstruction after oral cancer resection.Methods:Chart reviews were completed for all patients who underwent oral reconstruction with an infrah...Objective:To review our experience with infrahyoid myocutaneous flap in reconstruction after oral cancer resection.Methods:Chart reviews were completed for all patients who underwent oral reconstruction with an infrahyoid myocutaneous flap by a single surgeon in the Department of Otolaryngology at Chonburi Cancer Hospital from 2011 to 2017.Characteristics of the patients and postoperative complications were analyzed.Results:Of the 34 patients in the study,10(29.4%)developed partial flap loss and 1(2.9%)developed total flap loss.All cases of partial flap loss resolved with conservative treatment.Apparent cancer involvement of a cervical lymph node was significantly associated with flap failure(odds ratio:5.0,95%CI:1.03e24.28).Conclusions:The infrahyoid myocutaneous flap is a fairly reliable reconstruction method.The flap should be performed with caution in cases with gross lymph node involvement.展开更多
The preference for a specific head shape can be influenced by people's culture,religious beliefs and race.Modern Chinese people prefer a"talented"head shape,which is rounded and has a long profile.To obt...The preference for a specific head shape can be influenced by people's culture,religious beliefs and race.Modern Chinese people prefer a"talented"head shape,which is rounded and has a long profile.To obtain their preferred head shape,some parents try to change their neonates'sleeping position.Due to these forced sleeping positions,positional skull deformities,such as plagiocephaly,may be present during the first few months of life.In this article,we report two neonatal cases,of Hui nationality and Dongxiang nationality,with occipital pressure sores that were caused by using hard objects as pillows with the intention of obtaining a flattened occiput.The pressure sores were deep to the occipital bone and needed surgical management.These pressure sores caused wounds that were repaired by local skin flaps,after debridement,and the use of external constraints from a dense sponge-made head frame for approximately two weeks.One case recovered with primary healing after surgical operation.The other case suffered from a disruption of the sutured wound,and a secondary operation was performed to cover the wound.These occipital pressure sores are avoidable by providing guidance to the parents in ethnic minorities'area regarding the prevention,diagnosis and management of positional skull deformity.展开更多
Aim:Soleus muscle flaps have traditionally been a reliable tool in the plastic surgeon’s armamentarium for lower extremity reconstruction and limb salvage.In the modern era,many surgeons prefer free flaps.This study ...Aim:Soleus muscle flaps have traditionally been a reliable tool in the plastic surgeon’s armamentarium for lower extremity reconstruction and limb salvage.In the modern era,many surgeons prefer free flaps.This study sought to evaluate trends and outcomes of soleus flap reconstruction after lower extremity injury in a large cohort at a Level 1 trauma center.Methods:This is an Institutional Review Board-approved,retrospective chart review that was undertaken at Los Angeles County+University of Southern California Medical Center from 2007 to 2021.Patient demographics,Gustilo-Anderson fracture classification,flap characteristics,and outcomes were collected and analyzed.Outcomes of interest included failure rates,postoperative complications,and long-term ambulatory status.Results:Of 187 local leg flaps,68(36.4%)were soleus flaps,with 84% of soleus flaps performed prior to 2016.The flap loss rate was 0.0%.Eighteen(26.1%)flaps demonstrated>1 complication,including osteomyelitis/hardware infection(n=12),flap revision(n=6),and amputation(n=2).Long-term follow-up demonstrated 35.3% of patients ambulating independently after an average of 7.5±7.2 months,with the remainder needing a wheelchair or walking assistance device.Conclusion:Although soleus flap loss rate was 0%,the findings demonstrate more infections than expected;this must be considered in light of pre-existing patient comorbidities possibly deterring free flap placement.Additionally,our results reveal that only 16% of soleus flaps were performed after 2015.As surgeons consider the reconstructive ladder for lower extremity trauma,a rotational soleus muscle flap should not be overlooked in the modern era of free flap tissue transfers and might be a more optimal flap choice in certain patients with multiple comorbidities.展开更多
文摘BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.
文摘Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center.Methods: A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit,Hospital Universiti Sains Malaysia(HUSM),Kelantan,for wound coverage from to 1997–2023.Data on patient demographics,defect size,reconstruction methods,operation duration,flap-related complications,and secondary repairs were collected and analyzed.Results: Thirteen patients were identified in this retrospective study,comprising 5 female patients,7 male patients,and 1 ambiguous gender patient.Wound closures were performed using primary closure method,local flaps,or regional flap closure.Nine(69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap,three(23.1%) underwent primary closure,and only one(7.7%) patient underwent wound closure with a regional flap.Flap-related complications were observed in four of the thirteen patients,including wound breakdown in two cases and partial flap necrosis in two cases.Of these four patients,secondary repair was required in three: split-thickness skin grafting was performed in two,and primary closure in one.The remaining patient was managed conservatively with dressings.Patients were followed up for a mean duration of56.6(±62.4) months,and complete healing was achieved in all cases.Conclusion: Myelomeningocele repair remains challenging,and a multidisciplinary approach is recommended.We demonstrated various local and regional flap closure methods with good outcomes.Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.
文摘Purpose： To express the versatility of a variety of non-microsurgical skin flaps used for coverage of difficult wounds in the lower third of the leg and the foot over 4 years period. Five kinds of flaps were used. Each flap was presented with detailed information regarding indication, blood supply, skin territory and technique. Methods： Altogether 26 patients underwent lower leg reconstruction were included in this study. The reconstructive procedures applied five flaps, respectively distally based posterior tibial artery perforator flap （n - 8）, distally based peroneal artery perforator flap （n = 4）, distally based sural flap （n - 6）, medial planter artery flap （n - 2） and cross leg flaps （n - 6）. Results： In all cases, there were no signs of osteomyelitis of underlying bones or discharge from the undersurface of the flaps. Fat necrosis occurred at the distal end of posterior tibial artery perforator flap in one female patient. The two cases of medial planter artery flap showed excellent healing with closure of donor site primarily. One cross leg flap had distal necrosis. Conclusion： Would at lower third of leg can be efficiently covered by posterior tibial, peroneal artery and sural flaps. Heel can be best covered by nearby tissues such as medial planter flap. In presence of vascular compromise of the affected limb or exposure of dorsum of foot, cross leg flap can be used.
文摘Scalp reconstruction requires keen insight into underlying anatomy and surgical armamentarium.The reconstructive surgeon must consider a plethora of complexities to devise a safe and cosmetically maximized outcome.The purpose of this article is to review scalp reconstruction techniques and the current literature in the framework of the reconstructive ladder,with special emphasis on local flap consideration,design,and execution.
文摘Background Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons. We investigated the application of local flaps and Ilizarov osteogenesis in the reestablishment of severe combined defects of tibial bone and soft tissue. Methods Sixteen patients with bone and soft tissue defects were included. The mean age of the patients was 31.5 years. The average time from injury to initial surgery was 14.4 weeks. The average soft tissue and bone defect sizes were 92.9 cm2 and 8.7 cm, respectively. Local flaps were created to reconstruct the soft tissue defects. The Ilizarov external fixator or the Orthofix Limb Reconstruction System was used to reconstruct bony defects using delayed distraction osteogenesis. Results Two myocutaneous flaps and 14 reverse island flaps were applied. All transferred flaps survived. Fifteen patients healed with equal leg length, and one healed with a residual leg-length discrepancy of 1.5 cm. One patient with an Ilizarov external fixator developed ankle joint stiffening and a pin-track infection that was successfully treated with oral antibiotics. No patient developed pin loosening. All patients walked without assistance. Fifteen patients returned to their work, and one lost her job. The results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 14 and good in two patients. Functional assessment scores were excellent in 13, good in two, and fair in one patient. Conclusion The combination of local flaps and sequential distraction osteogenesis can be used for successful reconstruction of defects of incorporated bone and soft tissue.
文摘Perforator-pedicled propeller flaps, which base their blood supply on isolated perforators, have been gaining popularityamong plastic surgeons over the past two decades. They have proven to be of great value in the reconstruction of soft tissue defects in different areas of the body but are, thanks to their maximal mobility, mostly used in the reconstruction of extremities. In this article, we focus on perforator-pedicled propeller flaps in lower limb reconstruction, where they can be implemented in the coverage of primary as well as secondary soft tissue defects. Firstly, a brief literature review on evolution of propeller flap use in lower extremity is provided. Moreover, we present our surgical technique including the use of indocyanine green real-time angiography for reliable flap transfer. In addition, we report 3 cases of patients in whom we used a local propeller flap for the closure of skin defects in different parts of the leg.
文摘Reconstructive defects of the human face pose unique challenges to even the most experienced surgeon given their myriad of presentations and the individuality of each patient’s anatomy,clinical presentation,and perspective or preferences.A robust armamentarium of reconstructive options must be cultivated for each facial subunit so that experience and artistry can be best utilized to rebuild the patient’s structure and function.This review will outline a subset of local rotation and transposition flaps that are most useful for facial reconstruction,organized by facial subunit.
文摘Objective:The reconstruction of large scalp defects poses both functional and cosmetic challenges.While free tissue transfer remains the standard for defects larger than 30 cm^(2),prolonged anesthesia and postoperative complications remain significant limitations.The purpose of this study is to evaluate the use of O-Z flaps for the reconstruction of large scalp defects and to describe the techniques employed.Methods:This is a retrospective analysis of ten patients who underwent reconstructive surgery using an O-Z flap approach for large scalp defects between July 2017 and June 2019.The parameters included in this study were patient demographics,tumor characteristics,and postoperative management,collected for at least a year after surgery.Results:In this cohort,the mean age was 76.1 years and 90%were male.All patients were treated for neoplastic skin lesions,with 70%located on the vertex and 30%located on the temporoparietal region.The mean size of defect was 52.0 cm^(2)(range:38.6 to 63.8 cm^(2)).The maximum hospital stay was two days,and no patients were readmitted within 30 days of surgery.There were no cases of wound infection or flap necrosis.All patients reported pain control with acetaminophen and ibuprofen.Four patients received adjuvant radiation,and there was no delay to receiving treatment following surgery.Conclusions:The O-Z flap is a reliable alternative for the reconstruction of non-irradiated scalp defects in the vertex and temporoparietal regions up to 63 cm^(2).This technique provides advantages for patients,including hairline preservation,shorter hospital stays,and decreased postoperative complications.
文摘Scars are the final result of the four processes that constitute cutaneous wound healing,namely,coagulation,inflammation,proliferation,and remodeling.Permanent scars are produced if the wounds reach the reticular dermis.The nature of these scars depends on the four wound healing processes.If the remodeling process is excessive,collagen degradation exceeds collagen synthesis and atrophic scars are produced.If the inflammation phase is prolonged and/or more potent for some reason,inflammatory/pathological scars such as keloids or hypertrophic scars can arise.If these pathological scars are located on joints or mobile regions,scar contractures can develop.When used with the appropriate timing and when selected on the basis of individual factors,surgical techniques can improve mature scars.This review paper focuses on the surgical techniques that are used to improve mature scars,burn scars,and scar contractures.Those methods include z-plasties,w-plasties,split-thickness skin grafting,full-thickness skin grafting,local flaps(including the square flap method and the propeller flap),and expanded flaps,distant flaps,regional flaps,and free flaps.
文摘Objective:To review our experience with infrahyoid myocutaneous flap in reconstruction after oral cancer resection.Methods:Chart reviews were completed for all patients who underwent oral reconstruction with an infrahyoid myocutaneous flap by a single surgeon in the Department of Otolaryngology at Chonburi Cancer Hospital from 2011 to 2017.Characteristics of the patients and postoperative complications were analyzed.Results:Of the 34 patients in the study,10(29.4%)developed partial flap loss and 1(2.9%)developed total flap loss.All cases of partial flap loss resolved with conservative treatment.Apparent cancer involvement of a cervical lymph node was significantly associated with flap failure(odds ratio:5.0,95%CI:1.03e24.28).Conclusions:The infrahyoid myocutaneous flap is a fairly reliable reconstruction method.The flap should be performed with caution in cases with gross lymph node involvement.
文摘The preference for a specific head shape can be influenced by people's culture,religious beliefs and race.Modern Chinese people prefer a"talented"head shape,which is rounded and has a long profile.To obtain their preferred head shape,some parents try to change their neonates'sleeping position.Due to these forced sleeping positions,positional skull deformities,such as plagiocephaly,may be present during the first few months of life.In this article,we report two neonatal cases,of Hui nationality and Dongxiang nationality,with occipital pressure sores that were caused by using hard objects as pillows with the intention of obtaining a flattened occiput.The pressure sores were deep to the occipital bone and needed surgical management.These pressure sores caused wounds that were repaired by local skin flaps,after debridement,and the use of external constraints from a dense sponge-made head frame for approximately two weeks.One case recovered with primary healing after surgical operation.The other case suffered from a disruption of the sutured wound,and a secondary operation was performed to cover the wound.These occipital pressure sores are avoidable by providing guidance to the parents in ethnic minorities'area regarding the prevention,diagnosis and management of positional skull deformity.
文摘Aim:Soleus muscle flaps have traditionally been a reliable tool in the plastic surgeon’s armamentarium for lower extremity reconstruction and limb salvage.In the modern era,many surgeons prefer free flaps.This study sought to evaluate trends and outcomes of soleus flap reconstruction after lower extremity injury in a large cohort at a Level 1 trauma center.Methods:This is an Institutional Review Board-approved,retrospective chart review that was undertaken at Los Angeles County+University of Southern California Medical Center from 2007 to 2021.Patient demographics,Gustilo-Anderson fracture classification,flap characteristics,and outcomes were collected and analyzed.Outcomes of interest included failure rates,postoperative complications,and long-term ambulatory status.Results:Of 187 local leg flaps,68(36.4%)were soleus flaps,with 84% of soleus flaps performed prior to 2016.The flap loss rate was 0.0%.Eighteen(26.1%)flaps demonstrated>1 complication,including osteomyelitis/hardware infection(n=12),flap revision(n=6),and amputation(n=2).Long-term follow-up demonstrated 35.3% of patients ambulating independently after an average of 7.5±7.2 months,with the remainder needing a wheelchair or walking assistance device.Conclusion:Although soleus flap loss rate was 0%,the findings demonstrate more infections than expected;this must be considered in light of pre-existing patient comorbidities possibly deterring free flap placement.Additionally,our results reveal that only 16% of soleus flaps were performed after 2015.As surgeons consider the reconstructive ladder for lower extremity trauma,a rotational soleus muscle flap should not be overlooked in the modern era of free flap tissue transfers and might be a more optimal flap choice in certain patients with multiple comorbidities.
