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Reconstruction of Radiated Gluteal Defects following Sarcoma Resection with Pedicled Sensate Tensor Fascia Lata Flaps.

Chao AH, Kearns PN - Case Rep Oncol Med (2015)

Bottom Line: Sarcomas of the gluteal region often result in sizable defects following resection that are challenging to reconstruct due to their location, particularly in patients who have received radiation therapy.A pedicled tensor fascia lata (TFL) flap was therefore performed in both cases, which resulted in durable sensate reconstruction with good functional outcomes and no complications.We believe the pedicled TFL flap represents an important option for the reconstruction of oncologic gluteal defects that provides well-vascularized and sensate tissue from outside the zone of radiation without the need for microsurgical techniques.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery, The Ohio State University, Columbus, OH 43212, USA.

ABSTRACT
Sarcomas of the gluteal region often result in sizable defects following resection that are challenging to reconstruct due to their location, particularly in patients who have received radiation therapy. Reconstruction of these defects has been seldom discussed in the literature. We present two patients with large radiated gluteal defects following sarcoma resection, of which one patient received neoadjuvant radiation and the other received intraoperative radiation therapy. As a result of the resection and radiation, local tissues and recipient vessels were unsuitable for use in reconstruction. A pedicled tensor fascia lata (TFL) flap was therefore performed in both cases, which resulted in durable sensate reconstruction with good functional outcomes and no complications. We believe the pedicled TFL flap represents an important option for the reconstruction of oncologic gluteal defects that provides well-vascularized and sensate tissue from outside the zone of radiation without the need for microsurgical techniques.

No MeSH data available.


Related in: MedlinePlus

Design of a tensor fascia lata flap.
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Related In: Results  -  Collection


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fig3: Design of a tensor fascia lata flap.

Mentions: Flap elevation is performed from a lateral decubitus position. The ASIS and lateral tibial condyle are marked, as is a line adjoining these two points, which approximates the anterior border of the TFL. The flap is designed based on the dimensions of the defect, preferably along the proximal two-thirds of the thigh where perfusion is more reliable (Figure 3). Dissection of the flap begins distally, where the TFL is identified and disinserted, and then it is raised from inferior to superior. In the proximal thigh, great care is exercised to identify and preserve the vascular pedicle along the deep aspect of the flap. Further proximal flap and pedicle dissection are performed to adequately mobilize the flap. Sensory innervation to the flap is maintained by preserving both the lateral cutaneous branch of T12 and the lateral femoral cutaneous nerve. The lateral cutaneous branch of T12 is located subcutaneously 6 cm posterior to the ASIS and is thus proximal relative to flap dissection and is easily maintained during standard harvest. The lateral femoral cutaneous nerve is located subcutaneously 10 cm inferior to the ASIS and can be identified when dissecting through the subcutaneous tissues of the anterior flap incision, where it is identified and mobilized, if necessary. The intervening skin bridge between the donor and recipient sites is divided in order to prevent constriction of the flap beneath a subcutaneous tunnel. In addition, this allows for rotation and advancement of the posterior thigh tissues that facilitates donor site closure and also reduces the size of the defect (Figure 2). Closed suction drains are placed, and primary donor site closure can typically be accomplished when the flap is less than 9 cm wide; otherwise split-thickness skin grafting may be necessary.


Reconstruction of Radiated Gluteal Defects following Sarcoma Resection with Pedicled Sensate Tensor Fascia Lata Flaps.

Chao AH, Kearns PN - Case Rep Oncol Med (2015)

Design of a tensor fascia lata flap.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4539060&req=5

fig3: Design of a tensor fascia lata flap.
Mentions: Flap elevation is performed from a lateral decubitus position. The ASIS and lateral tibial condyle are marked, as is a line adjoining these two points, which approximates the anterior border of the TFL. The flap is designed based on the dimensions of the defect, preferably along the proximal two-thirds of the thigh where perfusion is more reliable (Figure 3). Dissection of the flap begins distally, where the TFL is identified and disinserted, and then it is raised from inferior to superior. In the proximal thigh, great care is exercised to identify and preserve the vascular pedicle along the deep aspect of the flap. Further proximal flap and pedicle dissection are performed to adequately mobilize the flap. Sensory innervation to the flap is maintained by preserving both the lateral cutaneous branch of T12 and the lateral femoral cutaneous nerve. The lateral cutaneous branch of T12 is located subcutaneously 6 cm posterior to the ASIS and is thus proximal relative to flap dissection and is easily maintained during standard harvest. The lateral femoral cutaneous nerve is located subcutaneously 10 cm inferior to the ASIS and can be identified when dissecting through the subcutaneous tissues of the anterior flap incision, where it is identified and mobilized, if necessary. The intervening skin bridge between the donor and recipient sites is divided in order to prevent constriction of the flap beneath a subcutaneous tunnel. In addition, this allows for rotation and advancement of the posterior thigh tissues that facilitates donor site closure and also reduces the size of the defect (Figure 2). Closed suction drains are placed, and primary donor site closure can typically be accomplished when the flap is less than 9 cm wide; otherwise split-thickness skin grafting may be necessary.

Bottom Line: Sarcomas of the gluteal region often result in sizable defects following resection that are challenging to reconstruct due to their location, particularly in patients who have received radiation therapy.A pedicled tensor fascia lata (TFL) flap was therefore performed in both cases, which resulted in durable sensate reconstruction with good functional outcomes and no complications.We believe the pedicled TFL flap represents an important option for the reconstruction of oncologic gluteal defects that provides well-vascularized and sensate tissue from outside the zone of radiation without the need for microsurgical techniques.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery, The Ohio State University, Columbus, OH 43212, USA.

ABSTRACT
Sarcomas of the gluteal region often result in sizable defects following resection that are challenging to reconstruct due to their location, particularly in patients who have received radiation therapy. Reconstruction of these defects has been seldom discussed in the literature. We present two patients with large radiated gluteal defects following sarcoma resection, of which one patient received neoadjuvant radiation and the other received intraoperative radiation therapy. As a result of the resection and radiation, local tissues and recipient vessels were unsuitable for use in reconstruction. A pedicled tensor fascia lata (TFL) flap was therefore performed in both cases, which resulted in durable sensate reconstruction with good functional outcomes and no complications. We believe the pedicled TFL flap represents an important option for the reconstruction of oncologic gluteal defects that provides well-vascularized and sensate tissue from outside the zone of radiation without the need for microsurgical techniques.

No MeSH data available.


Related in: MedlinePlus