1
|
Ribeiro LM, Bhindi N, Fox C, Ramakrishnan A. Cranioplasty is not required in the reconstruction of small combined scalp and calvarial defects. J Plast Reconstr Aesthet Surg 2024; 93:18-23. [PMID: 38608533 DOI: 10.1016/j.bjps.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Treatment of scalp malignancies may include the need for craniectomy. The decision to perform cranioplasty is not straightforward and is frequently subjective. The purpose of this study was to assess the clinical outcomes after reconstruction of complex scalp and calvarial defects by comparing patients with and without cranioplasty. METHODS Retrospective review of the clinical records of a consecutive series of patients who underwent scalp soft tissue reconstruction after craniectomy for malignancy or osteoradionecrosis between 2014 and 2022 at Royal Melbourne Hospital was conducted. Demographics, previous treatments, surgical details, and post-operative complications were assessed. Traumatic injuries and decompressive craniectomies were excluded. Minimum follow-up of 6 months. RESULTS Thirty-seven patients were included in the study. Indications for surgery included skin malignancies, osteoradionecrosis, or both. There was one reconstructive failure (in the non-cranioplasty group). Infection and metalware exposure were common complications in patients who underwent cranioplasty (38.5%). No patient developed neurological symptoms subsequent to craniectomy. One patient needed revision surgery due to esthetic reasons (cranioplasty group). Transposition flaps were associated with more complications and revision procedures. CONCLUSION Combined scalp and calvarial defects pose a difficult reconstructive challenge. Stable soft tissue coverage is more reliably achieved with free flap reconstruction. Cranioplasty is not always mandatory and should be reserved for cases with a very large bony defect or when the defect is located in a cosmetically sensitive area.
Collapse
Affiliation(s)
- Luís M Ribeiro
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Nayan Bhindi
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
| | - Carly Fox
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Anand Ramakrishnan
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; Department of Surgery, Melbourne Medical School, Royal Melbourne Hospital, University of Melbourne, Parkville VIC 3050, Australia
| |
Collapse
|
2
|
Qing L, Luo G, Li X, Wu P, Tang J. Individualized design of thoracodorsal artery perforator chimeric flap for customized reconstruction of complex three-dimensional defects in the extremities. J Orthop Surg Res 2023; 18:367. [PMID: 37198689 DOI: 10.1186/s13018-023-03852-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND It was always challenging to accurately and effectively reconstruct the complicated defects with three-dimensional tissue deficits in the extremities. Muscle-chimeric perforator flap is an excellent choice for repairing those complicated wound. However, problems like donor-site morbidity and time-consuming intramuscular dissection still exist. This purpose of this study was to present a novel design of the thoracodorsal artery perforator (TDAP) chimeric flap for the customized reconstruction of complex three-dimensional tissue defects in the extremities. METHODS From January 2012 to June 2020, 17 patients with complex three-dimensional deficits in the extremities were retrospectively analyzed. All patients in this series underwent extremity reconstruction using latissimus dorsi (LD)-chimeric TDAP flap. Three different types of LD-chimeric TDAP flaps were performed. RESULTS A total of seventeen TDAP chimeric flaps were successfully harvested for the reconstruction of those complex three-dimensional defects in extremities. Among them, Design Type A flaps were used in 6 cases, Design Type B flaps were performed in 7 cases, and Design Type C flaps were used in the remaining 4 cases. The sizes of the skin paddles ranged from 6 cm × 3 cm to 24 cm × 11 cm. Meanwhile, the sizes of the muscle segments ranged from 3 cm × 4 cm to 33 cm × 4 cm. All the flaps survived. Nevertheless, one case required re-exploration owing to venous congestion. Moreover, the primary closure of the donor site was successfully achieved in all patients, and the mean follow-up time was 15.8 months. Most of the cases displayed satisfactory contour. CONCLUSION The LD-chimeric TDAP flap is available for the reconstruction of complicated defects with three-dimensional tissue deficits in the extremities. It provided a flexible design for customized coverage of complex soft tissue defects with limited donor site morbidity.
Collapse
Affiliation(s)
- Liming Qing
- Department of Microsurgery and Hand Surgery, Xiangya Hospital of Central South University, Changsha, 410008, China
| | - Gaojie Luo
- Department of Microsurgery and Hand Surgery, Xiangya Hospital of Central South University, Changsha, 410008, China
| | - Xiaoxiao Li
- Department of Pathology, Changsha Medical University, Changsha, China
| | - Panfeng Wu
- Department of Microsurgery and Hand Surgery, Xiangya Hospital of Central South University, Changsha, 410008, China
| | - Juyu Tang
- Department of Microsurgery and Hand Surgery, Xiangya Hospital of Central South University, Changsha, 410008, China.
| |
Collapse
|
3
|
Fuzzard SK, Seifman MA, Hunter-Smith DJ, Rozen WM. Converting a previous fasciocutaneous free flap into a flow-through flap for scalp reconstruction. ANZ J Surg 2021; 91:1929-1930. [PMID: 33411957 DOI: 10.1111/ans.16549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sibon K Fuzzard
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | - Marc A Seifman
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | - David J Hunter-Smith
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne, Victoria, Australia.,Department of Plastic and Reconstructive Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Ettyreddy AR, Chen CL, Zenga J, Simon LE, Pipkorn P. Complications and Outcomes of Chimeric Free Flaps: A Systematic Review. Otolaryngol Head Neck Surg 2019; 161:568-575. [PMID: 31109239 DOI: 10.1177/0194599819844997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ablations of locally advanced or recurrent head and neck cancer commonly result in large composite orofacial defects. Chimeric flaps represent a unique surgical option for these defects, as they provide diverse tissue types from a single donor site. The purpose of the study was to consolidate the literature on chimeric flaps with regard to postoperative complication rates to help inform surgical decision making. DATA SOURCES The librarian created search strategies with a combination of keywords and controlled vocabulary in Ovid Medline (1946), Embase (1947), Scopus (1823), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrails.gov (1997). REVIEW METHODS Candidate articles were independently reviewed by 2 authors familiar with the subject material, and inclusion/exclusion criteria were uniformly applied for article selection. Articles were considered eligible if they included patients who received a single chimeric flap for reconstruction of head and neck defects and if they provided data on complication rates. RESULTS A total of 521 chimeric flaps were included in the study. The major complication rate was 22.6%, while the minor complication rate was 14.0%. There were 7 flap deaths noted in the series. Median operative time and harvest time were 15.0 and 2.5 hours, respectively. CONCLUSION Chimeric flaps represent a viable option for reconstruction of complex head and neck defects and have complication rates similar to those of double free flaps and single free flaps with locoregional flap while only modestly increasing total operative time.
Collapse
Affiliation(s)
- Abhinav R Ettyreddy
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Collin L Chen
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura E Simon
- Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| |
Collapse
|
5
|
Qing L, Wu P, Zhou Z, Yu F, Tang J. Customized reconstruction of complex three-dimensional defects in the extremities with individual design of vastus lateralis muscle-chimeric multi-lobed anterolateral thigh perforator flap. J Plast Surg Hand Surg 2019; 53:271-278. [PMID: 31032709 DOI: 10.1080/2000656x.2019.1606004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The anterolateral thigh perforator (ALTP) chimeric flap is one of the most popular procedures for the reconstruction of three-dimensional defects in the extremities. However, the problems of donor-site morbidity and inability to repair very large defects in a one-stage procedure remain. The purpose of this study was to present a novel design of ALTP chimeric flap and its various designs for customized reconstruction of complex three-dimensional defects in the extremities. From January 2009 to June 2017, we retrospectively analyzed 25 patients with complex three-dimensional defects in the extremities. All patients in this series underwent extremity reconstruction using vastus lateralis (VL) muscle-chimeric multi-lobed ALTP flaps, consisting of multi-lobed skin paddles and muscle segment on the same pedicle from the descending branch of the lateral circumflex femoral artery. Three different types of VL muscle-chimeric multi-lobed ALTP flaps were created in this study. The sizes of the multi-lobed skin paddles range from 10 × 6 cm and 9 × 7 cm to 19 × 9 cm and 20 × 9 cm, and the sizes of muscle segments ranged from 9 × 6 cm to 4 × 4 cm. All of the flaps survived. Only one case required re-exploration because of venous congestion. The primary closure of the donor site was successfully achieved in all patients. The mean follow-up time was 14 months. Most of the cases showed satisfactory contour. The VL muscle-chimeric multi-lobed ALTP flap is a reliable option for reconstruction of complex three-dimensional defects of the extremities. It provided flexible design for customized coverage of complex three-dimensional defects with limited donor-site morbidity.
Collapse
Affiliation(s)
- Liming Qing
- Department of Hand & Microsurgery, Xiangya Hospital of Central South University , Changsha , China
| | - Panfeng Wu
- Department of Hand & Microsurgery, Xiangya Hospital of Central South University , Changsha , China
| | - Zhengbing Zhou
- Department of Hand & Microsurgery, Xiangya Hospital of Central South University , Changsha , China
| | - Fang Yu
- Department of Hand & Microsurgery, Xiangya Hospital of Central South University , Changsha , China
| | - Juyu Tang
- Department of Hand & Microsurgery, Xiangya Hospital of Central South University , Changsha , China
| |
Collapse
|
6
|
The Efficacy of Continuous Negative Pressure and Irrigation Treatment Inside the Wound by a Closed System in Reconstruction of All Layers of the Cranium Accompanying Infection and Cerebrospinal Fluid Leakage. J Craniofac Surg 2016; 27:e10-3. [DOI: 10.1097/scs.0000000000002278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
7
|
Ludolph I, Apel H, Horch RE, Beier JP. Treatment of a chronic vesicocutaneous fistula and abdominal wall defect after resection of a soft tissue sarcoma using a bipedicled latissimus dorsi and serratus anterior free flap. Int J Urol 2014; 21:1178-80. [PMID: 25040066 DOI: 10.1111/iju.12545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/28/2014] [Indexed: 12/25/2022]
Abstract
We present a surgical treatment for bladder reconstruction in a case of chronic vesicocutaneous radiation-induced fistula and reconstruction of the abdominal wall after resection of a liposarcoma in the rectus abdominis muscle. Fistulas are sequelae after radiotherapy. To regain bladder function and reconstitute abdominal wall stability, a microsurgical flap approach should be considered. A male patient underwent resection of a liposarcoma in the rectus abdominis muscle with adjuvant radiotherapy, suffering from a chronic vesicocutaneous fistula. A bipedicled combined latissimus dorsi and serratus anterior flap was carried out after resection of the fistula for reconstruction of the urine bladder and the abdominal wall. Ascending urethrography 4 weeks postoperatively showed no leakage. In the 4-month follow-up period, no signs of recurrence of the fistula or herniation occurred. A bipedicled flap allowed reconstruction of the urine bladder and the abdominal wall. Using non-irradiated, well-perfused intra-abdominal muscle tissue over the urine bladder prevented recurrence of the fistula.
Collapse
Affiliation(s)
- Ingo Ludolph
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University of Erlangen-Nuernberg, Erlangen, Germany
| | | | | | | |
Collapse
|
8
|
Sittitavornwong S, Morlandt ABP. Reconstruction of the scalp, calvarium, and frontal sinus. Oral Maxillofac Surg Clin North Am 2013; 25:105-29. [PMID: 23642666 DOI: 10.1016/j.coms.2013.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Scalp and cranial deformities are common after trauma or ablative surgery. Local flaps and free flaps may be used in reconstruction of soft tissue defects, and autogenous bone or alloplastic bone substitutes may be used for cranioplasty procedures. Injuries to the frontal sinus, particularly when complicated by leak of cerebrospinal fluid or obstruction of the nasofrontal outflow tract, represent special challenges. Further studies are recommended to improve the multidisciplinary management of these complex, debilitating conditions, in anticipation of enhanced function and cosmesis, reduced donor site morbidity, and improved surgical outcomes.
Collapse
|
9
|
Kwee MM, Rozen WM, Ting JW, Mirkazemi M, Leong J, Baillieu C. Total scalp reconstruction with bilateral anterolateral thigh flaps. Microsurgery 2012; 32:393-6. [DOI: 10.1002/micr.21954] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 11/26/2011] [Accepted: 12/12/2011] [Indexed: 11/06/2022]
|
10
|
Osteoradionecrosis of the Skull After Radiation Therapy for Invasive Carcinoma. J Craniofac Surg 2011; 22:1677-81. [DOI: 10.1097/scs.0b013e31822e5f83] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
11
|
Reconstruction of the scalp with a calvarial defect. Surg Today 2011; 41:189-96. [PMID: 21264753 DOI: 10.1007/s00595-009-4262-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 07/24/2009] [Indexed: 10/18/2022]
Abstract
PURPOSE To review our clinical cases and devise a protocol for selecting the best operative methods to reconstruct the scalp with a calvarial defect. METHODS We reviewed the original disease, the areas and depths of the scalp and calvarial defects, the methods of reconstruction, and complications in 20 patients. RESULTS The defect was caused by secondary cranial infection following decompressive craniectomy for intracranial hemorrhage (ICH) in 11 patients; extensive removal of the scalp and calvaria for resection of a malignant tumor in 6 patients; and by secondary cranial infection following removal of a malignant tumor in 3 patients. Cranial infection was frequently associated with abscess formation around the fixation screws and plates, suggesting that artificial materials induced the infection. We reconstructed the defect using free flaps in 15 patients and using local flaps in 5 patients. CONCLUSIONS When restoring the calvaria in the primary operation, the use of metal screws and plates should be minimized to prevent cranial infection and subsequent scalp and calvaria defects. Local flaps are appropriate for reconstructing relatively small defects (<20 cm(2)), whereas free flaps are better for reconstructing relatively large defects (>25 cm(2)).
Collapse
|
12
|
Lee JW, Hsueh YY, Lee JS. Composite skull and dura defect reconstruction using combined latissimus dorsi musculocutaneous and serratus anterior muscle-rib free flap coupled with vascularized galea transfer: A case report. Microsurgery 2010; 30:632-5. [DOI: 10.1002/micr.20808] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 05/10/2010] [Indexed: 11/11/2022]
|
13
|
Chabas JF, Dellavolpe C, Riah Y, Bron T, Reynier Y, Kaya JM, Casanova D. Cranial reconstruction after a post-craniotomy empyema. J Plast Reconstr Aesthet Surg 2009; 62:e131-5. [DOI: 10.1016/j.bjps.2008.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 07/11/2008] [Accepted: 09/29/2008] [Indexed: 10/21/2022]
|
14
|
|