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PubMed1985

Internal oblique muscle pedicle flap for coverage of a major soft tissue defect of the groin.

We describe a new muscle flap, using the internal oblique muscle as a transposition flap based on the ascending branch of the deep circumflex iliac artery, for coverage of a groin defect with exposed femoral vessels. This muscle also has potential usefulness as a pedicle flap for coverage of the anterior perineum and midline lower abdominal defects. It is a thin, flat muscle with excellent vascularity and is safe and reliable to use. The donor site scar is well concealed. The disadvantages are a possibly bloody and tedious dissection, and the long-term potential for abdominal wall weakness or herniation. In the case reported, no abdominal wall laxity or herniation were noted at eight and one-half months. We believe that the internal oblique muscle flap is a useful technique that complements the already popular methods of reconstruction for groin defects.

Abdominal Muscles↗
PubMed1988

Fasciocutaneous flap closure of a grade III lower third tibial fracture: an alternative to free flap coverage.

We present a patient who sustained a close-range shotgun wound resulting in a grade III fracture of the lower tibia. The wound was debrided on several occasions and, on day 4, was closed with a flexor digitorum muscle and pedicled fasciocutaneous flap. Grades III and IV lower one-third tibial fractures generally require a free flap to accomplish stable soft-tissue coverage. Free-tissue transfer, however, remains a tedious and lengthy procedure. Occasionally a fasciocutaneous flap may be available to facilitate wound closure and spare the patient a lengthy procedure and distant donor site. The established principles of compound tibial coverage must be adhered to when choosing a local fasciocutaneous flap.

Adult↗
PubMed1992

Expanded midline forehead flap for coverage of nonnasal facial defects.

A 13-month-old infant with a giant hairy nevus of the superior portion of the right cheek, which measured 3.5 x 5.5 cm, was treated by excision and coverage using expanded midline forehead flap. This approach stands in contrast both to the standard technique of excision and full-thickness grafting for large facial defects as well as to the use of the midline forehead flap for nonnasal reconstruction. Although this approach did necessitate the placement of a midline forehead scar, the overall result was sufficiently superior to justify its use. The child has good, stable, soft coverage with no contour or landmark distortion. The child is presented in an 18-month follow-up with photographic documentation.

Cheek↗
PubMed1996

Free flap coverage for knee salvage.

Soft-tissue reconstruction using free flaps was reviewed in 11 consecutive knee wounds complicated by joint exposure or adjacent osteomyelitis and unavailability of adequate local flaps. Ten free muscle flaps and one fasciocutaneous flap were used successfully. Eight limbs presented with wide exposure of the knee joint, including 4 patients with wound infection involving the joint. Three other patients suffered osteomyelitis immediately adjacent to the knee. All knees were successfully salvaged with a single free flap operation, except for one knee that required a second free flap after flap necrosis. Follow-up in nine flaps ranged from 7 weeks to 19 months (mean, 12 months). For patients without preexisting conditions affecting the knee, free flap coverage provided excellent return of knee function. The choice of recipient vessels was determined mainly by the region of the knee requiring coverage. The recipient arteries utilized included the distal superficial femoral artery, anterior tibial artery, popliteal artery, and small arteries, which included the saphenous artery and descending branch of the lateral circumflex femoral artery. The use of small arteries and venae comitantes as recipient vessels increased the effective reach of the free flaps and eliminated the need for vein grafts.

Adolescent↗
PubMed1999

Reverse neurofasciocutaneous flaps for soft-tissue coverage of the lower leg.

The evolution of neurocutaneous flaps has created a new concept in reconstructive surgery. These flaps, based on the arterial network around the superficial sensory nerves, are gaining popularity in soft-tissue coverage. Various flaps can be planned based on the neurocutaneous perforators. These kinds of flaps are available for extremity reconstruction. In the lower leg, reverse neurocutaneous flaps have been used successfully. Although these flaps in the lower leg are called neurocutaneous, they have been elevated with the underlying fascia like fasciocutaneous flaps, and thus the authors call these flaps neurofasciocutaneous flaps. They have used 11 reverse neurofasciocutaneous flaps (6 saphenous and 5 sural) since 1995. All flaps survived completely, and stable coverage of soft-tissue defects of the lower leg was achieved in all patients.

Adult↗
PubMed2001

Severe, traumatic soft-tissue loss in the antecubital fossa and proximal forearm associated with radial and/or median nerve palsy: nerve recovery after coverage with a pedicled latissimus dorsi muscle flap.

A total of 6 patients with complex, traumatic wounds of the antecubital fossa and proximal forearm were included in this study. All patients presented with radial and/or median nerve palsies in addition to their soft-tissue defect. Except for 1 patient with a 15-cm defect of the radial nerve, all other traumatized nerves appeared in-continuity at the time of surgery. However, the nerve injury was severe enough to induce Wallerian degeneration (i.e., axonotmesis in traumatized nerves in-continuity). Three patients required brachial artery reconstruction with a reverse saphenous vein graft. Wound coverage was accomplished using a pedicled latissimus dorsi muscle flap, which was covered with a split-thickness skin graft. Successful reconstruction was obtained in all patients. Follow-up ranged from 2 to 6 years. The range of motion at the elbow and forearm was considered excellent in 5 patients and good in the remaining patient who had an intra-articular fracture. Motor recovery of traumatized nerves in-continuity was observed in all but 1 patient who had persistent partial anterior interosseous nerve palsy. The grip strength of the injured hand measured 70% to 85% of the contralateral uninjured hand. Median nerve sensory recovery was excellent in all patients. The versatility of the pedicled latissimus dorsi muscle flap for coverage of these complex wounds with traumatized neurovascular bundles around the elbow is discussed.

Adult↗
PubMedDate not supplied

Lack of long-term durability of cultured keratinocyte burn-wound coverage: a case report.

Cultured epithelial autografts have been advocated for permanent closure of skin surfaces after massive thermal injuries. A 10-year-old boy sustained a nearly 100% total body surface area burn (98% full-thickness) in an explosion accident. Cultured epithelial autograft was used to cover 70% of the total body surface area on postburn day 26. In spite of early success of coverage, 60% of cultured epithelial autograft areas blistered and sloughed over the ensuing weeks. Electron microscopic examination of a biopsy specimen of the healed cultured epithelial autograft (80 days after placement) revealed a lack of dermal attachments of the anchoring fibrils. Additionally, blister fluid that was taken from the bullae of the cultured epithelial autograft revealed levels of 18 ng/ml thromboxane and 24 ng/ml prostaglandin E2. These levels are significantly higher than those seen in acute burn blister fluid and indicate an ongoing inflammatory process. Cultured keratinocytes, although they provide early wound closure, may not provide adequate long-term coverage for patients with massive burns.

Biopsy↗
PubMed1996

Local-advancement soft-tissue coverage in a child with ipsilateral grade IIIB open tibial and ankle fractures.

This case describes the successful treatment of a child with a vascular injury and two ipsilateral grade IIIB open lower leg fractures using two local-advancement soft-tissue techniques. Multiple relaxing skin incisions were used for closure of the wound associated with the patient's midshaft tibial fracture, whereas a randomly patterned rotational fasciocutaneous flap was used for coverage of the wound associated with the patient's medial malleolar fracture. These straightforward local-advancement soft-tissue coverage techniques allowed for treatment of a child with vascular injuries, ensuring the viability of the foot, while preventing distant donor site morbidity and functional sacrifice. Additionally, no special microsurgical or specialty training is necessary to achieve a similar result.

Ankle Injuries↗
PubMed2003

The use of early flap coverage in severe open physeal fractures: a report of two cases.

Open physeal fractures associated with severe overlying soft tissue loss present significant challenges to the pediatric orthopaedic surgeon. In addition to providing adequate soft tissue coverage, preventing chronic infection, and achieving bony healing, surgical care should attempt to preserve the physis to maintain growth for the best long-term outcomes. Here we present two cases of open physeal disruptions with severe soft tissue loss. In each case, early use of vascularized flap coverage assisted in fracture healing and contributed to preservation of the physis and subsequent bony growth.

Child↗
PubMed1983

Heel coverage by a plantar myocutaneous island pedicle flap.

Defects of the heel represent a difficult reconstructive problem. Previously described methods have not always been ideal especially for the posterior heel. The weight-bearing functional requirements of the heel tissue over the calcaneus are a sensitive, well padded, durable cover. The technique of choice should provide local similar tissue plus involve a single reliable operative procedure. Skin grafts placed on the calcaneus or on a muscle transposition flap, such as the flexor digitorum brevis, abductor hallucis, or abductor digiti minimi muscle, provide a thin, insensitive, and dissimilar surface. The cross-foot, cross-leg, cross-thigh, and buttock flaps provide more bulk and thicker skin. These flaps involve a prolonged hospitalization, multiple procedures, increased morbidity, and insensitive tissue. The dorsal foot island flap and microvascular free flaps are a one-stage procedure with less morbidity. The donor tissue is still too dissimilar to provide the protection and durability to this area. Random plantar flaps have provided a functional replacement with similar tissue having adequate sensation. However, these random flaps are not always reliable, have limited motion, and are limited usually to small defects. Recently the myocutaneous flap has been proposed using the flexor digitorum brevis muscle. This neurovascularized flap is larger and more reliable. Our dissection study of plantar tissue using microlatex injected feet has expanded the plantar flap for easier heel coverage and provided a predictable flap area. By mobilizing the pedicle proximally to the posterior tibial artery, the flap has an expanded coverage arc. Thus the heel is covered with a sensitive and durable tissue to allow weight bearing, frictional trauma, and ambulation.

Adolescent↗
PubMed1987

Biosynthetic skin substitute versus frozen human cadaver allograft for temporary coverage of excised burn wounds.

During the past 2 years a multicenter study was performed comparing Biobrane (Woodroof) and frozen cadaver allograft as temporary dressings on freshly excised full-thickness burns before the application of autograft. Each biologic dressing was evaluated with respect to the other on the same patient. Seventy-one patients were evaluated. The mean burn size was 35 +/- 20% with a mean full-thickness burn of 28 +/- 20%. Mean patient age was 34 +/- 21 years. Overall survival was 82%. The mean time of wound coverage was 10.2 +/- 6.7 days. There was no significant difference in the number of dressing changes, area changed, purulence, autograft take, and final results between allograft- and Biobrane-covered sites. There were no complications following use of either Biobrane or allograft. We conclude that Biobrane is as effective as frozen human cadaver allograft for the temporary coverage of freshly excised full-thickness burn wounds before autografting.

Adult↗
PubMed1989

Experience with the island radial forearm flap in local hand coverage.

Use of the island radial forearm flap (RFF) for soft-tissue coverage of hand and forearm following mutilating injuries, chemotherapeutic injection sloughs, and tumor excisions are discussed. Twenty-eight flaps were used in 28 injured upper extremities. Partial flap loss occurred in three patients. Minor sloughing of the skin graft of the donor site occurred in four. Twelve patients had persistent dysesthesias and paresthesias in the injured extremity. All patients complained of some degree of weakness in the injured extremity. Our experience supports the use of this flap for local hand and forearm coverage when local tissue is unavailable and skin grafting is deemed inadvisable. Donor site problems have been acceptable in our patient population.

Adolescent↗
PubMed1991

Four types of venous flaps for wound coverage: a clinical appraisal.

Venous flaps were used for coverage of hand wounds over exposed bones, joints, and tendons in 28 patients. Four types of operations were performed. Among them type IV was the best. It included the advantages of perfusion in types I and III, but excluded their disadvantages. The viability of venous flaps was confirmed. Clinical observation showed that a venous flap is not merely a composite graft. The presence of a vascular network in the flap helps to ensure initial survival before the establishment of neovascularization between the venous flap and the recipient site. Partial loss of a flap was observed in two cases and complete failure was seen in one case. Viability versus flap size and modality of perfusion are analyzed. With total venous perfusion, small venous flaps usually survive better than large ones. For large venous flaps, arterialized venous perfusion is better than total venous perfusion. Venous flaps are useful for wound coverage of fingers and hand, but they do not replace cross-finger flaps or other conventional flaps when these simpler flaps are available.

Adolescent↗
PubMed2002

Use of AlloDerm for coverage of radial forearm free flap donor site.

OBJECTIVES: To evaluate and discuss the role of acellular human dermal matrix (AlloDerm, LifeCell Corp., Branchburg, NJ) graft for coverage of radial forearm free flap donor site. STUDY DESIGN: Prospective, nonrandomized study. METHODS: Fifty-two consecutive patients underwent harvest of 52 radial forearm fasciocutaneous free flaps. All 52 donor sites were covered by AlloDerm graft. Split-thickness skin graft was not used to reinforce the acellular dermal graft in the series. Clinical phases of healing, duration of healing, and donor site complications were studied. RESULTS: No donor site complications except seroma formation in five patients was noted. This was treated by conservative measures. Full range of hand motion was allowed in 3 days. Complete healing occurred within 8 to 12 weeks. Scar contracture after complete healing was minimum in all patients. Range of motion of the hand and fingers during flexion, extension, supination, and pronation was identical on the operated and nonoperated sides. CONCLUSION: AlloDerm graft is a viable alternative to split-thickness skin graft for coverage of the radial forearm free flap donor site.

Adult↗
PubMed2001

Pertussis outbreak in an elementary school with high vaccination coverage.

BACKGROUND: An outbreak of pertussis in a US elementary school with high vaccination coverage was investigated to evaluate vaccine effectiveness and to identify potential contributing factors. METHODS: Survey and cohort study of all 215 students of an elementary school (including 36 case patients) and 16 secondary cases among contacts. RESULTS: Fifty-two pertussis cases were identified (attack rate among students, 17%). Receipt of <3 doses of pertussis-containing-vaccine compared with receipt of complete vaccination series was a significant risk factor for pertussis [relative risk, 5.1; 95% confidence interval (CI), 3 to 8.6]. The effectiveness of the complete vaccination series was 80% (95% CI 66 to 88). No evidence of waning immunity among students was found. The following contributing factors for the outbreak were identified: multiple introductions of pertussis from the community; delays in identification and treatment of early cases; and high contact rates among students. Antimicrobial treatment initiated >14 days after cough onset was associated with increased risk of further transmission of pertussis (relative risk, 10.1; 95% CI 1.5 to 70.3) compared with treatment within 14 days of onset. CONCLUSIONS: This investigation demonstrated the potential for pertussis outbreaks to occur in well-vaccinated elementary school populations. Aggressive efforts to identify cases and contacts and timely antimicrobial treatment can limit spread of pertussis in similar settings. High vaccination coverage should be maintained, because vaccination significantly reduces the risk of the disease throughout the elementary school years, and to ensure timely diagnosis and treatment health care providers should maintain a high index of suspicion for pertussis among elementary school age children.

Adult↗
PubMed1976

Sensory skin flaps for coverage of pressure sores in paraplegic patients. A preliminary report.

Sensory skin flaps represent a possible solution for the paraplegic who has the problem of recurrent pressure sores. An intercostal neurovascular island flap has been used in 3 cases to provide coverage for sacral ulcers. Sensation was retained to a variable degree in both adults and children. An attempt at coverage of an ischial ulcer with an intercostal neurovascular free flap is also reported. The practical and theoretical aspects of these procedures are discussed.

Adult↗
PubMed1990

Heel coverage with a deepithelialized distally based fasciocutaneous flap.

A distally based fasciocutaneous flap for heel coverage is reported. Its blood supply depends on distal septocutaneous perforators interconnected with the suprafascial plexus. A "turn-down" transposition and distal deepithelialization were utilized to avoid kinking of the pedicle. After a 1-year follow-up, it has provided stable coverage with normal function.

Child↗