Use of intercostal perforating veins and long arterial grafts for latissimus myocutaneous free flap reconstruction of radiated low back wounds

Total Gluteal Reconstruction with "IGA-based V-Y Myocutaneous Advancement Flap"

Introduction  A 44-year-old man was presented with chronic discharging multiple perianal fistula and squamous cell carcinoma of the left buttock.

Report  The patient was subjected to wide local excision of the entire left gluteal and adjacent sacral regions and reconstruction with extended island inferior gluteal artery based V–Y myocutaneous advancement flap.

Result and Conclusion  Extended island inferior gluteal based V–Y flap can be a good option for extensive defects involving the gluteal region and the sacrum.

Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm

Background:

Lumbar spinal defects present a distinct challenge for the reconstructive surgeon and are often complicated by previous spinal surgery, the presence of hardware, and prior radiation. There are a variety of reconstructive options described but no clear treatment algorithm for these challenging defects.

Methods:

A literature search was performed to review the described treatment options for lumbar spinal soft-tissue defects. Treatments for myelomeningocele or pressure ulcers were excluded. In addition, a retrospective case review was performed for patients with lumbar defects treated with pedicled superior gluteal artery perforator (SGAP) flap reconstruction.

Results:

A literature review revealed 2,022 articles pertaining to lumbar defect reconstruction, of which 56 met inclusion criteria. These articles described 13 individual reconstructive techniques for this anatomic area. The most commonly described techniques were evaluated and a treatment algorithm designed based on patient and wound characteristics. The clinical course of 5 patients with radiated lumbar spinal defects treated with SGAP flaps is presented.

Conclusions:

There are many treatment options for lumbar spinal defects and treatment should be tailored to the patient and the characteristics of the defect. For large or radiated lumbar wounds, the pedicled SGAP flap is an excellent reconstructive choice, as it has reliable anatomy that is outside the zone of injury, adequate bulk, and minimal donor-site deficits.