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Ryoo HJ, Park JH, Kim DY. Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case Series. Orthop Surg 2023; 15:2612-2620. [PMID: 37621127 PMCID: PMC10549862 DOI: 10.1111/os.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE Most paraplegic patients with complicated trochanter sores or ischial sores present with lower limb muscle atrophy. Therefore, in patients who have undergone Girdlestone arthroplasty, filling the dead space and replacing the volume defect through an appropriate surgical technique is extremely challenging. This study presents a case series of vastus lateralis and vastus intermedius myocutaneous flap reconstruction after extended proximal femoral osteotomy in paraplegic patients. The aim of study is to investigate (i) whether sufficient volume replacement was achieved, (ii) whether muscle volume was maintained during long-term follow-up, and (iii) the presence of donor site morbidity. METHOD A retrospective review was conducted with eight patients who underwent this method from March 2017 to December 2021. A total of nine flaps was elevated, and the defect was successfully reconstructed without dead space. Computed tomography was performed to identify the changes in thickness and volume of the muscle portion. The Wilcoxon signed-rank test was performed to assess the significance of the differences in muscle thickness between pre- and post-measurements. RESULTS After surgery, all patients healed within 1 month; three patients experienced minor complications. The average follow-up period was 14.5 months, during which only one patient with an ischial pressure ulcer developed wound disruption and recurrence. The average thickness of the rotated muscle was 51.95 mm at 2 to 4 weeks postoperatively and 53.07 mm at 6 months postoperatively (𝑝 = 0.071). CONCLUSION All nine cases healed well without major complications. When comparing the volume of the rotated muscle on radiological examinations before and after surgery, no significant differences were observed. Our modified Girdlestone resection technique provides a simple and reliable method for reconstructing complex trochanteric or ischial sores in paraplegic patients. It ensures anatomical consistency, ample volume, and structural stability by leaving the rectus femoris (RF) in place. Careful tension management is required when using this flap in the ischial area.
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Affiliation(s)
- Hyun Jung Ryoo
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Ji Hwan Park
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Dong Yeon Kim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
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Mishra JK, Sahu SA, De M, Saha A. Pedicled anterolateral thigh flap: A versatile flap for complex regional defect reconstruction. GMS Interdiscip Plast Reconstr Surg DGPW 2023; 12:Doc04. [PMID: 37577728 PMCID: PMC10413255 DOI: 10.3205/iprs000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Objectives Soft-tissue defects of the lower abdomen, perineum, groin, and trochanteric area often involve the loss of composite tissue components and are technically challenging to reconstruct. The goals of reconstruction should include the replacement of the defect with a suitable soft-tissue flap that provides stable coverage while protecting important exposed structures. However, there are limited locations in this region for the creation of pedicled flaps for complex defect reconstruction. The pedicled anterolateral thigh (ALT) flap is considered superior to other comparable flaps due to its varying soft-tissue components and long pedicle with consistent anatomy that allow the reconstruction of locations that are difficult to reach without significant flap donor site morbidity. Herein, we present a case series of our experience of using a pedicled ALT flap to reconstruct regional defects over a range of locations. Methods The present study comprised ten patients who underwent surgical reconstruction of soft-tissue defects of the lower abdomen, groin, trochanteric, scrotal, and penoscrotal defects using a pedicled ALT flap over a two-year period. The flap was customized according to the defect when required. Results In our case series, flap loss was not observed with only a few minor complications. All patients accepted the aesthetic appearance of the flap recipient site area without requesting revision surgery. The donor site was closed primarily in half of all cases, with split skin grafting applied in the remaining patients. Graft take at the flap donor site was satisfactory in all cases. Conclusion A pedicled ALT flap is a reliable and suitable option for complex soft-tissue reconstruction for regional soft-tissue defects of the lower abdomen and perineum.
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Affiliation(s)
- Jiten Kumar Mishra
- Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Shamendra Anand Sahu
- Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Moumita De
- Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Aparajita Saha
- Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Raipur, India
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Geber B, Landscheidt K, Goertz O, Hernekamp JF. Die gestielte DIEP-Lappenplastik zur Weichteilrekonstruktion eines großen Leistendefektes nach komplikativer gefäßchirurgischer Vorversorgung. Gefässchirurgie 2022. [DOI: 10.1007/s00772-022-00948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sharma A, Kalra S, Aggarwal M, Gupta S. Abdominal Wall Reconstruction Using Pedicled Antero Lateral Thigh Flap. World J Plast Surg 2022; 11:63-71. [PMID: 36694686 DOI: 10.52547/wjps.11.3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background Reconstructing abdominal wall defects has been a difficult task for surgeons. The abdominal wall defects range from defects of only soft tissue to full thickness defects including all the three layers of the abdomen. Only soft tissue defects are commonly caused by peritonitis and laparotomies, and full thickness defects can occur from en bloc resection of tumours as well as trauma. Treatment options available include component separation, partition technique, flap coverage, and more recently acellular dermal matrix. Methods This retrospective study done between 2016 and 2020 where 20 patients were operated for abdominal wall defect using Pedicled ALT flap in the Department of Plastic and Reconstructive Surgery, Sawai Man Singh Hospital, Jaipur, Rajasthan, India. Results The study consisted of total 20 patients, 14 males and 6 females. Eight patients were post electric burn, 5 patients had suffered trauma, 4 patients underwent resection of abdominal wall tumour and 3 patients were post laparotomy for peritonitis. Mean age of patients was 48 years (range from 36 to 62 years). Mean fascia defect size was 14.2 cm (range 12.2 to 16.4 cm). Mean operative time was 170 minutes (range from 140 minutes to 220 minutes). Postoperative hospital stay ranged from 8 days to 24 days (mean- 12 days). Conclusion Pedicled ALT flap has expanded the armamentarium of plastic surgeons for reconstruction of abdominal wall defects.
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Bøkset MI, Söderman M, Thomsen JB, Sørensen JA. Reconstruction of a knee defect in a morbidly obese patient with a pedicled reverse anterolateral thigh flap. BMJ Case Rep 2022; 15:15/7/e249365. [DOI: 10.1136/bcr-2022-249365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The anterolateral thigh (ALT) flap is widely used in the reconstruction of a variety of soft tissue defects. Descriptions of patients with severe obesity in the literature are scarce. We report a case where a reverse pedicled fasciocutaneous ALT flap was successfully used for resurfacing of a knee defect measuring 12×6 cm in a patient with a body mass index (BMI) of 47.3. The flap was supercharged to the greater saphenous vein to optimise flap survival. Reconstruction of the soft tissue of the knee was achieved as planned. There were no flap or donor site complications.
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Passemard L, Burgaud M, Thaveau F, Pham Dang N. [Coverage of an infected Deep femoral arteria vascular graft bypass by pediculated chimeric antero- lateral thigh flap associated with a vastus lateral muscle]. ANN CHIR PLAST ESTH 2022; 67:245-248. [PMID: 35781394 DOI: 10.1016/j.anplas.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/01/2022]
Abstract
Scarpa triangle defects with exposure of femoral bypass are challenging to treat. The authors present the case of a 46 years-old male with a groin defect of 10×18cm with an exposure on 5cm of an allograft of the deep femoral artery. Bypass was performed in emergency because of a limb ischemia with deep femoral artery thrombosis and aneurysm of the superficial femoral artery. The reconstructive surgery may propose a large musculo-cutaneous flap to fill the dead spaces surrounding the infected bypass, the flap should be vascularized by the deep femoral arteria, could not be the rectus abdominals flap because of the precedent abdominal incision. The homolateral pediculated ALT-flap with vastus lateral component appeared to be a good solution because of its versatility and the low morbidity of the donor site.
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Affiliation(s)
- L Passemard
- University hospital of Clermont-Ferrand, CHU de Clermont-Ferrand, department of oral and maxillofacial surgery, 63000 Clermont-Ferrand, France
| | - M Burgaud
- University Hospital of Clermont-Ferrand, CHU de Clermont-Ferrand, department of vascular surgery, 63000 Clermont-Ferrand, France
| | - F Thaveau
- University Hospital of Clermont-Ferrand, CHU de Clermont-Ferrand, department of vascular surgery, 63000 Clermont-Ferrand, France
| | - N Pham Dang
- University hospital of Clermont-Ferrand, CHU de Clermont-Ferrand, department of oral and maxillofacial surgery, 63000 Clermont-Ferrand, France; UMR Inserm/UdA, U1107, Neuro-Dol, trigeminal pain and migraine, université d'Auvergne, 63003 Clermont-Ferrand, France.
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Azevedo RA, Roxo AC, Alvares SHB, Baptista DP, Favorito LA. Use of flaps in inguinal lymphadenectomy in metastatic penile cancer. Int Braz J Urol 2021; 47:1108-1119. [PMID: 34115457 PMCID: PMC8486440 DOI: 10.1590/s1677-5538.ibju.2021.99.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/20/2021] [Indexed: 04/04/2024] Open
Abstract
PURPOSE Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer. MATERIAL AND METHODS We reviewed the current literature of the Pubmed database according to PRISMA guidelines. The search terms used were "advanced penile cancer", "groin reconstruction", and "inguinal reconstruction", both alone and in combination. The bibliographic references used in the selected articles were also analyzed to include recent articles into our research. RESULTS A total of 54 studies were included in this review. About one third of penile cancers are diagnosed with locally advanced disease, often presenting with large lymph node involvement. Defects in the inguinal region resulting from the treatment of metastatic penile cancer are challenging for the surgeon and cause high patient morbidity, rendering primary closure unfeasible. Several fasciocutaneous and myocutaneous flaps of the abdomen and thigh can be used for the reconstruction of the inguinal region, transferring tissue to the affected area, and enabling tensionless closure. CONCLUSIONS The reconstruction of defects in the inguinal region with the aid of flaps allows for faster postoperative recovery and reduces the risk of complications. Thus, the patient will be able to undergo potential necessary adjuvant treatments sooner.
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Affiliation(s)
- Roberta Alvares Azevedo
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
- Universidade do Estado do Rio de JaneiroDepartamento de Cirurgia GeralRio de JaneiroRJBrasilDepartamento de Cirurgia Geral, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| | - Ana Claudia Roxo
- Universidade do Estado do Rio de JaneiroDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Departamento de Cirurgia Geral, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| | - Silvia Helena Baima Alvares
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
| | - Daniel Pereira Baptista
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
| | - Luciano A. Favorito
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
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Acartürk TO, Bengür FB. Individually Tailored Approach to Reconstruction of Complex Defects Using Versatility of the Lateral Circumflex Femoral Artery System-Based Pedicled Flaps. J Plast Reconstr Aesthet Surg 2021; 75:199-209. [PMID: 34645586 DOI: 10.1016/j.bjps.2021.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/04/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Lateral circumflex femoral artery (LCFA) system is one of the most versatile donor sites in the body. We present our experience with pedicled flaps from the LCFA system, including different components for a wide variety of etiologies and locations. Twenty-three consecutive pedicled flaps were performed on 22 patients (10 females and 12 males; age 4-71 years) between 2007 and 2015 by a single surgeon. Flap size, type, and composition were tailored according to the requirements of the defects, including (1) location; (2) surface area; (3) depth; (4) number of defects; (5) presence of exposed critical structures; (6) presence of exposed foreign bodies; (7) prior use of other options; (8) history of radiation; and (9) other comorbidities. Defect locations were 10 abdominal wall (including groin and pubis), 9 ischio-gluteo-trochanteric and 4 perineal. Defect sizes ranged from 6 × 6 to 30 × 35 cm. Maximum depth of wounds ranged between 7 and 18 cm. The flap sizes ranged from 9 × 6 to 38 × 20 cm. Two flaps were fasciocutaneous perforator, 4 were myocutaneous with "muscle sparing" vastus lateralis, 10 were myocutaneous with "segmental" vastus lateralis, 5 were myocutaneous "tri-muscle," 1 was "tri-muscle," and 1 was rectus femoris only. Donor sites were closed primarily in 20 cases and with split thickness skin grafting in 3 cases. All flaps survived completely without any partial loss or congestion. Pedicled flaps from the LCFA system can be tailored individually for a wide variety of etiologies and locations. Muscles can be harvested and used as "muscle sparing," "segmental," and "tri-muscle" to accommodate the requirements of the defects.
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Affiliation(s)
| | - Fuat Barış Bengür
- University of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
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Steiner SA, Schweizer R, Klein H, Waldner M, Giovanoli P, Plock JA. Abdominal, perineal, and genital soft tissue reconstruction with pedicled anterolateral thigh perforator flaps. Eur J Plast Surg 2021; 44:669-77. [DOI: 10.1007/s00238-021-01830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Background
Pedicled perforator flaps have become a contemporary alternative to muscle flaps for soft tissue reconstruction as they have reduced donor site morbidity, avoid the need for microsurgical transfer, and are versatile and reliable. The anterolateral thigh (ALT) flap was first introduced as a free flap and has since gained popularity as a pedicled flap. Here we review our experience using pedicled ALT flaps for regional soft tissue reconstruction.
Methods
We retrospectively reviewed all patients who underwent loco-regional soft tissue reconstruction using pedicled ALT flaps between March 2014 and October 2018, with the goal of identifying potential applications of pedicled ALT flaps. The following aspects of each case were reviewed: patient demographics, defect location and size, comorbidities such as previous radiotherapy, flap details, clinical follow-up, and postoperative complications.
Results
Our analysis demonstrates the versatility of pedicled ALT flaps in a variety of indications to successfully cover large abdominal, perineal, and genital soft tissue defects. Depending on the patient’s needs to achieve more bulk or stability in the reconstruction, the ALT flap was individually tailored with underlying muscle or fascia. The average follow-up was 7 months (range: 3–13 months).
Conclusions
Pedicled ALT flaps are a valuable reconstructive option for soft tissue defects located within the pedicle’s range, from the lower abdomen to the perianal region. These flaps are usually raised from a non-irradiated donor site and are sufficient for covering extensive soft tissue defects. Three-dimensional reconstruction of the defect using pedicled ALT flaps allows for anatomical function and minor donor sites.
Level of evidence: Level IV, therapeutic study.
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Dhakre VW, Bhuta P. Successful use of a pedicled anterolateral thigh flap for reconstruction of an abdominal wound and peristomal dehiscence. Tech Coloproctol 2020; 25:347-348. [PMID: 32666359 DOI: 10.1007/s10151-020-02300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- V W Dhakre
- Department of General Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.
| | - P Bhuta
- Department of General Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.,Department of Surgical Gastroenterology, Jaslok Hospital and Research Center, Mumbai, India
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Li J, Jiang H, Liang Y, Yao S, Zhu Q, Chen S. Multidisciplinary treatment of abdominal wall endometriosis: A case report and literature review. Eur J Obstet Gynecol Reprod Biol 2020; 250:9-16. [DOI: 10.1016/j.ejogrb.2020.04.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022]
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Madsen CB, Sørensen JA. Versatility of the pedicled anterolateral thigh flap for surgical reconstruction, a case series. JPRAS Open 2020; 25:52-61. [PMID: 32642534 PMCID: PMC7334399 DOI: 10.1016/j.jpra.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background The pedicled anterolateral thigh flap is a versatile flap that offers many advantages. These include a long and reliable pedicle that enables a wide arch of rotation, the possibility to harvest a large skin area, raising the flap with underlying fascia and muscle and minimal donor site morbidity. Methods From 2009 to 2018 nine patients were reconstructed with a pedicled anterolateral thigh flap. The flap was applied for coverage of knee infections, trochanteric defects, an abdominal defect, a gluteal defect, and a defect of the inguinal region. The patient group consisted of five males and four females. The age range was 30–90 years with a mean age of 61 years. Results Flap size ranged from 10 x 5 cm (50 cm2) to 15 x 30 cm (450 cm2) with a mean size of 222 cm2. We experienced no flap loss. The donor site was closed directly in seven out of nine patients, and the remaining two patients were closed by split-thickness skin grafting. Satisfactory aesthetic and functional outcome was achieved in all patients. Conclusion Our experience illustrates the versatility in the clinical application of the pedicled anterolateral thigh flap. The many advantages of the flap, such as the long and reliable pedicle, a large area of skin that can be harvested, the potential to supercharge the flap and the minimal donor site morbidity highlights the diversity of defects that can be reconstructed using this flap.
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Affiliation(s)
- Christoffer Bing Madsen
- Research Unit for Plastic Surgery, Odense University Hospital, J. B. Winsløwsvej 4, Penthouse 2. floor, 5000 Odense C, Denmark
- University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
- Corresponding author at: Research Unit for Plastic Surgery, Odense University Hospital, J. B. Winsløwsvej 4, Penthouse 2. floor, 5000 Odense C, Denmark.
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, J. B. Winsløwsvej 4, Penthouse 2. floor, 5000 Odense C, Denmark
- University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Maacha S, Sidahmed H, Jacob S, Gentilcore G, Calzone R, Grivel JC, Cugno C. Paracrine Mechanisms of Mesenchymal Stromal Cells in Angiogenesis. Stem Cells Int 2020; 2020:4356359. [PMID: 32215017 DOI: 10.1155/2020/4356359] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/05/2020] [Indexed: 12/11/2022] Open
Abstract
The role of the mesenchymal stromal cell- (MSC-) derived secretome is becoming increasingly intriguing from a clinical perspective due to its ability to stimulate endogenous tissue repair processes as well as its effective regulation of the immune system, mimicking the therapeutic effects produced by the MSCs. The secretome is a composite product secreted by MSC in vitro (in conditioned medium) and in vivo (in the extracellular milieu), consisting of a protein soluble fraction (mostly growth factors and cytokines) and a vesicular component, extracellular vesicles (EVs), which transfer proteins, lipids, and genetic material. MSC-derived secretome differs based on the tissue from which the MSCs are isolated and under specific conditions (e.g., preconditioning or priming) suggesting that clinical applications should be tailored by choosing the tissue of origin and a priming regimen to specifically correct a given pathology. MSC-derived secretome mediates beneficial angiogenic effects in a variety of tissue injury-related diseases. This supports the current effort to develop cell-free therapeutic products that bring both clinical benefits (reduced immunogenicity, persistence in vivo, and no genotoxicity associated with long-term cell cultures) and manufacturing advantages (reduced costs, availability of large quantities of off-the-shelf products, and lower regulatory burden). In the present review, we aim to give a comprehensive picture of the numerous components of the secretome produced by MSCs derived from the most common tissue sources for clinical use (e.g., AT, BM, and CB). We focus on the factors involved in the complex regulation of angiogenic processes.
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Sörelius K, Schiraldi L, Giordano S, Oranges CM, Raffoul W, DI Summa PG. Reconstructive Surgery of Inguinal Defects: A Systematic Literature Review of Surgical Etiology and Reconstructive Technique. In Vivo 2019; 33:1-9. [PMID: 30587595 DOI: 10.21873/invivo.11431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to evaluate the literature regarding surgical etiology demanding inguinal reconstructive surgery, associated reconstructive techniques and outcomes. MATERIALS AND METHODS A systematic literature search was performed according to the PRISMA statement between 1996-2016. RESULTS A total of 64 articles were included, comprising 816 patients. Two main subgroups of patients were identified: Oncological resections (n=255, 31%), and vascular surgery (n=538, 66%). Oncological resection inguinal defects were treated with pedicled myocutaneous flaps (n=166, 65%), fasciocutaneous flaps (77, 31%), muscle flaps (7, 3%) and direct closure (3, 1%). Vascular surgery complications were treated with muscle flaps (n=513, 95%). Complications for the respective subgroup (oncological resections, vascular surgery) were: infection (24%, 14%), seroma (34%, 7.5%), flap dehiscence/delayed healing (20.6%, 40.8%,). The total reintervention rate was 20%. CONCLUSION Reconstruction of inguinal defects should be addressed on a case-by-case basis. Myocutaneous flaps were favoured after oncological resections, while muscle flaps were preferred after vascular surgery.
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Affiliation(s)
- Karl Sörelius
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Luigi Schiraldi
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Salvatore Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Carlo M Oranges
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pietro G DI Summa
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Luca‐Pozner V, Boissiere F, Rodriguez T, Karra A, Herlin C, Chaput B. Complex abdominopelvic reconstruction by combined tensor fascia latae and superficial circumflex iliac artery perforator flaps. Microsurgery 2018; 40:25-31. [DOI: 10.1002/micr.30391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/24/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022]
Affiliation(s)
- V Luca‐Pozner
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - F Boissiere
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - T Rodriguez
- Department of Orthopedic and Trauma Surgery, Upper Limb and Spine Surgery UnitCHU Lapeyronie Montpellier France
| | - A Karra
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - C Herlin
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - B Chaput
- Department of Plastic, Reconstructive, Aesthetic Surgery and BurnsCHRU Rangueil Toulouse France
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Chiang IH, Wang CH, Tzeng YS. Surgical treatment and strategy in patients with multiple pressure sores. Int Wound J 2018; 15:900-908. [PMID: 29956467 DOI: 10.1111/iwj.12942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/10/2018] [Indexed: 02/03/2023] Open
Abstract
Pressure sores remain a common health problem, particularly among the physically limited or bedridden elderly, and can cause significant morbidity and mortality. This study aimed to present our surgical treatment and strategy for patients with multiple pressure sores. Between January 2010 and December 2016, 18 patients were enrolled. After adequate debridement, pressure sores were managed based on our treatment protocol. Patients' age, aetiology, defect size and location, flap reconstruction, outcome, and follow-up period were reviewed. A total of 10 men and 8 women (average age, 82.3 years) with a mean follow-up period of 28.3 months (6-72 months) were included. The mean defect area was 63.7 cm2 . The most common aetiology of the bedridden state was cerebrovascular accident (38.89%), and the most frequent sores were trochanteric pressure sores (53.57%). The average operative time and blood loss were 105.5 minutes and 100.8 mL, respectively. No haemodynamic variation or blood transfusion was noted during the surgery. The complication rate for each sore was 10.7%, including late recurrence. In conclusion, treating pressure ulcers requires careful patient education, intensive multidisciplinary optimisation, and meticulous wound care, and our treatment protocol ensures a shorter surgery time, less bleeding, and low complication rate.
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Affiliation(s)
- I-Han Chiang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chih-Hsin Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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