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Fauconnet R, Heitz A, Walch A, Druel T, Gazarian A, Cambon A, Mathieu L. Elbow coverage by the descending superficial radial artery flap: a clinical series and literature review. Eur J Trauma Emerg Surg 2024; 50:1733-1740. [PMID: 38609715 DOI: 10.1007/s00068-024-02527-6] [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] [Received: 02/17/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Soft tissue coverage of the posterior aspect of the elbow requires thin and flexible flaps to adapt to movements without constraining them. The authors report a clinical series of reconstruction by the descending superficial radial artery (DSRA) flap, a proximal forearm perforator flap which use is rarely reported in the literature. METHODS Seven patients with a mean age of 50 years (range 24-88 years) were treated for a posterior elbow defect using the DSRA flap with an adipofascial pedicle. The flap was tunneled to the defect in the subcutaneous tissue or raised using the racket-like technique to avoid any pedicle compression. RESULTS The mean follow-up was 3.3 months (range 1-12 months). A partial necrosis of the skin paddle occurred in an 88-year-old patient. In the other cases, the flap evolution was straightforward. At the last follow-up, the appearance of the flaps was satisfactory in terms of color, texture, and thickness. No complications were observed at the donor site. CONCLUSION The DSRA flap with an adipofascial pedicle is a simple, reliable, and reproducible method for reconstruction of small to moderate-sized defect on the posterior aspect of the elbow. Its use is easier for defects on the posterolateral side, but it can reach the medial olecranon.
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Affiliation(s)
- Robin Fauconnet
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Arthémon Heitz
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Arnauld Walch
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Thibault Druel
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Aram Gazarian
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Adeline Cambon
- Department of Hand and Upper Extremity Surgery, Saint-Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Laurent Mathieu
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France.
- Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Paris, Clamart, France.
- Department of Surgery, French Military Health Service Academy, 1 Place Alphonse Laveran, 75005, Paris, France.
- Military Biomedical Research Institute (IRBA), 1 Place Général Valérie André, 91220, Brétigny-Sur-Orge, France.
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Fulchignoni C, Cianni L, Matrangolo MR, Cerrone M, Cavola F, Pataia E, Vitiello R, Maccauro G, Farsetti P, Rovere G. A Two-Step Approach to the Surgical Treatment of Soft-Tissue Sarcomas. Curr Oncol 2024; 31:2805-2816. [PMID: 38785494 PMCID: PMC11119024 DOI: 10.3390/curroncol31050213] [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] [Received: 03/28/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Nowadays, limb-sparing procedures are the gold standard in the treatment of soft-tissue sarcomas of the limbs. Wide tumor resection with appropriate oncological margins, reconstruction, and stabilization of the involved bone and joint and restoration of the soft tissue lost are essential in order to obtain good clinical and functional outcomes. Tumor excision and soft-tissue reconstruction performed in one-step surgery is chosen by many centers as the preferred approach; however, according to our experience in some selected patients, two-step surgery performed using a dermal regeneration template first and then a margin revision, taking into account the definitive results of the anatomopathological exam conducted over the surgical specimen from the previous surgery, associated with definitive reconstruction surgery over a healthy bed of granulated tissue, showed many potential benefits. Methods: A retrospective observational study was conducted on thirteen patients who underwent a two-step reconstruction procedure using dermal substitution after soft-tissue sarcoma excision. Results: Clinically, the enrolled patients achieved excellent contour and cosmesis of their surgical wounds, with a mean VSS value of 3.07. During the follow-up period, no local recurrences were observed in any patient. Conclusions: Two-step surgery represents the most suitable solution to allow surgical radicality with minimal recurrency and adequate soft-tissue reconstruction, avoiding the possibility of wasting autologous tissue. Our patients generally embraced this approach and the management that followed.
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Affiliation(s)
- Camillo Fulchignoni
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Luigi Cianni
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Maria Rosaria Matrangolo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Mariagrazia Cerrone
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Francesco Cavola
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Elisabetta Pataia
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy;
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