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Chandrasekar S, Tiwari R, Ganesan K, Singhal M. Double microvascular free flap reconstruction for bilateral lower extremity injury in a paediatric patient. BMJ Case Rep 2024; 17:e257181. [PMID: 38272514 PMCID: PMC10826477 DOI: 10.1136/bcr-2023-257181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Many challenges have been described by microsurgeons in paediatric free flaps. With the advancement in microsurgical expertise, it is now possible to achieve excellent results. We present a case of a female child with car-tyre friction injury of bilateral feet with associated extradural haemorrhage who underwent emergency bilateral anterolateral thigh flap. A secondary tendon reconstruction of the left foot was performed at 6 months. No complications were observed in the postoperative period after both procedures and good functional recovery was achieved at 1 year follow-up. The problems unique to this case were the presence of head injury and bilateral extremity injury in the paediatric patient. The technical details of planning, execution, difficulties and recommendations to minimise the risk in such cases are discussed. To the best of our knowledge, this is the only case report of bilateral lower limb paediatric emergency free flap with associated head injury.
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Affiliation(s)
- Shruthi Chandrasekar
- Plastic Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Raja Tiwari
- Plastic Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Karthick Ganesan
- Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Maneesh Singhal
- Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Manas RK, Chatterji SK. Management of Post-Electric Burn Microstomia by Free Radial Artery Forearm Flap in a 1-Year-Old Child. Indian J Plast Surg 2023; 56:535-539. [PMID: 38105870 PMCID: PMC10721360 DOI: 10.1055/s-0043-1776008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Management of post-electric burn microstomia is a challenging task, especially in children, as it causes difficulty in feeding and airway problems (secondary to nasal airway blockage). The recreated defect is often full thickness and requires full-thickness tissue for reconstruction. The free flap can provide adequate normal tissue for the restoration of functions and aesthesis of the perioral region. However, performing free flaps in children is equally demanding due to small-diameter vessel anastomosis and postoperative monitoring. We present a case of postburn microstomia that was managed by contracture release and reconstruction by free radial artery forearm flap in a 1-year-old child. Postoperatively, at 6 months of follow-up, the flap settled well and the child was able to open his mouth fully with good aesthetic outcome. The free flap can be considered a good and safe option for perioral contracture release and reconstruction for better functional and aesthetic outcomes.
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Affiliation(s)
- Raj Kumar Manas
- Department of Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sujoy Kumar Chatterji
- Department of Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
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Innocenti M, Delcroix L, Lucattelli E, Bastoni S, Daolio PA. Functional Forearm Reconstruction With a Latissimus Dorsi Free Flap and Tendon Transfer After Congenital Soft-Tissue Sarcoma Resection in a 29-Week-Old Girl: A Case Report. HSS J 2022; 18:161-165. [PMID: 35087346 PMCID: PMC8753537 DOI: 10.1177/1556331621994104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Marco Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Luca Delcroix
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy,Elena Lucattelli, MD, Plastic and Reconstructive Microsurgery, Careggi University Hospital, AOU Careggi Largo Piero Palagi 1, 50139 Florence, Italy.
| | - Stefano Bastoni
- C.O.O., Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
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He J, Qing L, Wu P, Zhou Z, Yu F, Tang J. Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow-through anterolateral thigh perforator flap transfer. Microsurgery 2021; 41:533-542. [PMID: 33988868 DOI: 10.1002/micr.30754] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 04/24/2021] [Accepted: 05/06/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Management of large wounds of the lower extremities remains a challenge for plastic and reconstructive surgeons. Herein, a surgical technique and clinical algorithm using the combined transfer of a latissimus dorsi (LD) musculocutaneous flap and flow-through anterolateral thigh (ALT) perforator flap for the treatment of extensive soft-tissue defects is described. METHODS From January 2012 to September 2018, 12 patients (six men and six women) aged 6-37 years, sustained injuries in road traffic accidents with large soft-tissue defects in the lower extremities. Seven cases were Gustillo Anderson type IIIB open fractures and two cases were Gustillo Anderson type IIIC open fractures. Two wounds were located in the knee joint, four in the calf, and six in the ankle and foot. The skin defect size ranged from 25 × 20 cm2 to 36 × 25 cm2 . All patients in this series underwent reconstruction using combined transfer of the LD musculocutaneous flap and flow-through ALT perforator flap, wherein the LD was attached through its pedicle to the distal continuation of the ALT flap. RESULTS The size of the flow-through ALT perforator flaps ranged from 13.5 × 6.5 cm2 to 31 × 8.5 cm2 . The size of the LD musculocutaneous skin paddle ranged from 25 × 6 cm2 to 34 × 7 cm2 , and that of the muscle paddle ranged from 13 × 3.5 cm2 to 30 × 11 cm2 . One patient experienced postoperative thrombosis of the venous pedicle, and the flap was salvaged after emergency re-exploration and thrombectomy. No other complications were observed postoperatively. The mean follow-up period was 26.8 months. All patients were able to ambulate independently at the end of the follow-up period. CONCLUSIONS The combined transfer of the LD musculocutaneous flap and flow-through ALT perforator flap ensured adequate surface coverage, making it a feasible procedure for large soft-tissue defects.
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Affiliation(s)
- Jiqiang He
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Liming Qing
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Panfeng Wu
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Zhengbing Zhou
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Fang Yu
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Juyu Tang
- Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
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Claes KE, Roche NA, Opsomer D, De Wolf EJ, Sommeling CE, Van Landuyt K. Free flaps for lower limb soft tissue reconstruction in children: Systematic review. J Plast Reconstr Aesthet Surg 2019; 72:711-728. [PMID: 30898501 DOI: 10.1016/j.bjps.2019.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Since the first reports on microsurgery in children, there has been an evolution in the reconstruction of soft tissue defects as evidenced by a shift to free flaps as the first-line treatment. METHODS The primary objective of this systematic review was to compare the complication rate of free perforator/fasciocutaneous flaps with free muscular/myocutaneous flaps in pediatric lower limb soft tissue reconstructions. The secondary objective was to evaluate the frequency and severity of complications for both reconstructive options. A search was performed in the databases PubMed, Web of Science, Embase, Scopus, and Cochrane Library depending on predefined inclusion criteria. RESULTS The evolution to perforator flaps from muscular and myocutaneous flaps is reflected in this systematic review as demonstrated by the anterolateral thigh (ALT) flap, which is the most common reconstructive option with a very low complication rate (11.3%) and flap loss. The latissimus dorsi (LD) flap was the second most frequently reported reconstruction with a complication rate comparable with that of the thoracodorsal artery perforator (TDAP) flap (32% vs. 39%, respectively), but the former suffers few failures. The radial forearm (RFA) fasciocutaneous flap can be considered a good alternative for ALT and TDAP flaps with a very low complication rate (16%) and no flap loss. CONCLUSIONS The ALT flap is considered the best reconstructive method for pediatric lower limb soft tissue defects. More adequate prospective studies specifically concerning free flap reconstructions for lower limb defects in children are necessary in the future to provide guidelines for treatment and optimize outcomes in the long term.
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Affiliation(s)
- Karel Ey Claes
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium.
| | - Nathalie A Roche
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Dries Opsomer
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Edward J De Wolf
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Casper E Sommeling
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Koenraad Van Landuyt
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
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Free Latissimus Dorsi Myocutaneous Flap in a 6-Month-Old Child for Reconstruction of a Temporal Fossa Defect After Teratoma Resection. Ann Plast Surg 2019; 82:62-63. [DOI: 10.1097/sap.0000000000001629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Microsurgical Reconstruction of Traumatic Lower Extremity Defects in the Pediatric Population. Plast Reconstr Surg 2017; 139:998-1004. [PMID: 28002282 DOI: 10.1097/prs.0000000000003156] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few reports focus exclusively on microsurgical reconstruction of traumatic lower extremity defects in children. Hence, the authors felt it prudent to contribute to this area of clinical research. The authors hypothesized that reconstructive success would be comparable to success rates reported in adults, and that young age or concerns regarding vessel size or behavior do not negatively impact surgical outcome. METHODS A retrospective review of microsurgical lower extremity reconstruction cases at two academic medical centers was performed. All pediatric patients who underwent microsurgical reconstruction of traumatic lower extremity defects between 1997 and 2012 were included for analysis. RESULTS Forty flaps transferred in 40 patients with a mean age of 11.4 years (range, 1 to 17 years) were included for analysis. Muscle flaps were predominantly used [n = 23 (57.5 percent)]; however, there was a recent increase in use of fasciocutaneous flaps [n = 16 (40 percent)]. Postoperative complications were seen in 25 percent of patients, with a total flap loss rate of 5 percent. No donor-site complications were observed. The mean postoperative length of hospital stay was 12.9 days (range, 4 to 41 days), with patients returning to full weight-bearing after a mean of 2.6 months (range, 1 to 8 months). CONCLUSIONS Microsurgical reconstruction of traumatic lower extremity defects in the pediatric population is safe. Concerns related to patient age, vessel size, or vessel behavior (i.e., vasospasm) should not detract from offering free flap reconstruction, as they do not negatively impact outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Matsumine A, Tsujii M, Nakamura T, Asanuma K, Matsubara T, Kakimoto T, Yada Y, Takada A, Ii N, Nomoto Y, Sudo A. Minimally invasive surgery using intraoperative electron-beam radiotherapy for the treatment of soft tissue sarcoma of the extremities with tendon involvement. World J Surg Oncol 2016; 14:214. [PMID: 27514518 PMCID: PMC4982423 DOI: 10.1186/s12957-016-0968-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022] Open
Abstract
Background When a soft tissue sarcoma (STS) is located at the distal part of an extremity and involves the tendon, a wide excision usually causes severe functional disability. We therefore developed a minimally invasive surgical technique using intraoperative electron-beam radiotherapy (IOERT) to reduce the incidence of post-operative functional disability in patients with peri-/intra-tendinous STS. We assessed the clinical outcomes of the novel minimally invasive surgery. Methods The study population included five patients who received treatment for distal extremity STSs. After elevating the tumor mass, including the tendon and nerve from the tumor bed with a wide margin, a lead board was inserted beneath the tumor mass to shield the normal tissue. IOERT (25–50 Gy) was then applied, and the tumor excised with care taken to maintain the continuity of the tendon. Results In a desmoid patient, local recurrence was observed outside the irradiated field. No cases of neuropathy or bone necrosis were observed. The mean limb function score was excellent in all patients. None of the high-grade sarcoma patients had local recurrence or distant metastasis. Conclusions Although the current study is only a pilot study with a small number of patients, it shows that this minimally invasive procedure has the potential to become a standard treatment option for selected patients. Trial registration H17-250 (registered 2 November 2005) and H25-250 (modified from H17-250, registered 5 December 2013)
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Affiliation(s)
- Akihiko Matsumine
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Masaya Tsujii
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Takao Matsubara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Takuya Kakimoto
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Yuki Yada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akinori Takada
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Noriko Ii
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Yoshihito Nomoto
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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Microvascular Free Tissue Transfer for Head and Neck Reconstruction in Children. J Craniofac Surg 2016; 27:846-56. [DOI: 10.1097/scs.0000000000002515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pediatric lower extremity sarcoma reconstruction: A review of limb salvage procedures and outcomes. J Plast Reconstr Aesthet Surg 2016; 69:91-6. [DOI: 10.1016/j.bjps.2015.08.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 07/19/2015] [Accepted: 08/28/2015] [Indexed: 11/21/2022]
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Abstract
BACKGROUND The latissimus dorsi muscle is a workhorse of reconstructive surgery. Traditional harvest technique requires a long, posterior donor-site incision. Endoscopic harvest is limited by technical challenges. Robotic technology permits a simpler, minimally invasive harvest technique. METHODS Seven consecutive robotic latissimus dorsi muscle harvests were performed by a single surgeon. Two were used as free flaps for scalp reconstruction and the remaining five as pedicled flaps for breast reconstruction; three were for immediate, implant-based reconstruction with nipple-areola complex-sparing mastectomies, and two were for radiated breasts when the expander was exchanged for an implant. Harvest technique employed a short, axillary incision for pedicle dissection and two to three additional ports for robotic instrumentation. RESULTS All seven muscle flaps were harvested without converting to an open technique. Both free flaps were successfully transferred. All pedicled flaps resulted in successful breast reconstructions. Flap harvest complications included a single, temporary radial nerve palsy in the contralateral extremity, likely from positioning. There were no donor-site hematomas, seromas, or cutaneous thermal injuries. Robotic harvest time decreased from over 2 hours to about an hour over the study period. CONCLUSIONS Robotic harvest of the latissimus dorsi is a novel and effective method of muscle harvest. It offers technical advantages over endoscopic harvest and aesthetic advantages over the open technique. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Wechselberger G, Radauer W, Schimpl G, Kholosy H, Ensat F, Edelbauer M, Hladik M. Lower limb salvage in a 7-month-old infant using free tissue transfer. J Pediatr Surg 2011; 46:1852-4. [PMID: 21930003 DOI: 10.1016/j.jpedsurg.2011.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/11/2011] [Accepted: 06/22/2011] [Indexed: 11/30/2022]
Abstract
Free flap reconstruction in infants is extremely rare. A seven-and-a-half-month-old male infant sustained an extensive soft tissue defect on his left knee caused by extravasation of an intraosseous arterenol infusion. A free latissimus dorsi flap was successfully performed for soft tissue reconstruction. Indications, advantages, and outcome of the procedure are discussed.
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Affiliation(s)
- Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzigen Brüder, Teaching Hospital of the Medical University Salzburg, Kajetanerplatz 1, 5020 Salzburg, Austria
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