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A novel endoscopic-assisted harvesting of pedicled freestyle fasciocutaneous flaps.

Huang JW, Lin YY, Wu NY, Yen DH - Medicine (Baltimore) (2015)

Bottom Line: None of the patients had intraoperative complications, and intraoperative bleeding was minimal (<50 mL).All of the patients had surviving flaps.Our results demonstrated that the endoscopic-assisted method could be a valuable and reliable alternative in harvesting pedicled freestyle fasciocutaneous flaps.

View Article: PubMed Central - PubMed

Affiliation: From the Institute of Emergency and Critical Care Medicine (J-WH, Y-YL, DH-TY), School of Medicine, National Yang-Ming University, Taipei; Department of Surgery (J-WH), National Yang-Ming University Hospital, National Yang-Ming University, Yilan; Department of Pediatrics (Y-YL), Heping Fuyou Branch, Taipei City Hospital; Institute of Biomedical Informatics (N-YW), National Yang-Ming University; and Department of Emergency Medicine (DH-TY), Taipei Veterans General Hospital, Taipei, Taiwan.

ABSTRACT
The endoscopy-assisted technique has been demonstrated in harvesting muscle flaps; however, for pedicled freestyle fasciocutaneous flaps, few studies have applied this technique. We present a surgical procedure utilizing endoscopic-assisted method to identify the perforators of pedicled freestyle fasciocutaneous flaps for the reconstruction of soft tissue defects. From August to December 2012, 9 consecutive patients underwent endoscopic-assisted harvesting of fasciocutaneous flaps for the reconstruction of soft tissue defects. All of the defects were caused by trauma with tendon or bone exposure. Postoperatively, all patients were requested to return for outpatient follow-up visits for at least 3 months. The age of the 9 patients (8 men and 1 woman) ranged from 20 to 79 years (median 59 years). The defects ranged in size from 2 × 2 to 6 × 8 cm2. Two patients received anterolateral thigh transmuscular perforator flaps, 5 patients received fibular septocutaneous perforator flaps, and 2 patients received medial gastrocnemius transmuscular perforator flaps. The median incision length was 10 cm, and the median operative time was 120 minutes. None of the patients had intraoperative complications, and intraoperative bleeding was minimal (<50 mL). At the end of the 3-month follow-up period, none of the patients had any complications on either recipient or donor site, including total or partial necrosis of the flaps, flap dehiscence, hematomas, seromas, wound infections, or any conditions that indicated additional unplanned operative procedures. All of the patients had surviving flaps. Our results demonstrated that the endoscopic-assisted method could be a valuable and reliable alternative in harvesting pedicled freestyle fasciocutaneous flaps.

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Related in: MedlinePlus

Endoscopic-assisted harvesting of pedicled fasciocutaneous flap. A man aged 20 years had a soft tissue defect with exposure of bone and tendon at the left pretibia region (A). After marking the border of the temporary-designed flap on the skin, a 1-cm endoscopic incision was made. E: endoscopic incision (B). Under endoscopy, a perforator was identified under direct vision. F: fascia, P: perforator, M: muscle (C). The exact location of the perforator was marked on the skin, and the flap was also designed and marked. E: endoscopic incision (D). The perforator was harvested with preservation of its perforator pedicle (E and F). The flap advancement was done (G), and the skin defect of the donor site was closed (H). Postoperatively, the wounds in recipient site (I) and donor site (J) both healed well, and the fasciocutaneous flap survived well.
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Figure 1: Endoscopic-assisted harvesting of pedicled fasciocutaneous flap. A man aged 20 years had a soft tissue defect with exposure of bone and tendon at the left pretibia region (A). After marking the border of the temporary-designed flap on the skin, a 1-cm endoscopic incision was made. E: endoscopic incision (B). Under endoscopy, a perforator was identified under direct vision. F: fascia, P: perforator, M: muscle (C). The exact location of the perforator was marked on the skin, and the flap was also designed and marked. E: endoscopic incision (D). The perforator was harvested with preservation of its perforator pedicle (E and F). The flap advancement was done (G), and the skin defect of the donor site was closed (H). Postoperatively, the wounds in recipient site (I) and donor site (J) both healed well, and the fasciocutaneous flap survived well.

Mentions: The inclusion criteria were patients who had traumatic soft tissue defects with tendon or bone exposure (Figure 1A). The exclusion criteria were patients who had peripheral arterial occlusive disease, soft tissue defects with severe infections, or a medical history suggesting a higher risk of local or general complications. Intraoperative bleeding, operative time, and complications were monitored. Postoperatively, all patients were requested to return for outpatient follow-up visits for at least 3 months.


A novel endoscopic-assisted harvesting of pedicled freestyle fasciocutaneous flaps.

Huang JW, Lin YY, Wu NY, Yen DH - Medicine (Baltimore) (2015)

Endoscopic-assisted harvesting of pedicled fasciocutaneous flap. A man aged 20 years had a soft tissue defect with exposure of bone and tendon at the left pretibia region (A). After marking the border of the temporary-designed flap on the skin, a 1-cm endoscopic incision was made. E: endoscopic incision (B). Under endoscopy, a perforator was identified under direct vision. F: fascia, P: perforator, M: muscle (C). The exact location of the perforator was marked on the skin, and the flap was also designed and marked. E: endoscopic incision (D). The perforator was harvested with preservation of its perforator pedicle (E and F). The flap advancement was done (G), and the skin defect of the donor site was closed (H). Postoperatively, the wounds in recipient site (I) and donor site (J) both healed well, and the fasciocutaneous flap survived well.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554153&req=5

Figure 1: Endoscopic-assisted harvesting of pedicled fasciocutaneous flap. A man aged 20 years had a soft tissue defect with exposure of bone and tendon at the left pretibia region (A). After marking the border of the temporary-designed flap on the skin, a 1-cm endoscopic incision was made. E: endoscopic incision (B). Under endoscopy, a perforator was identified under direct vision. F: fascia, P: perforator, M: muscle (C). The exact location of the perforator was marked on the skin, and the flap was also designed and marked. E: endoscopic incision (D). The perforator was harvested with preservation of its perforator pedicle (E and F). The flap advancement was done (G), and the skin defect of the donor site was closed (H). Postoperatively, the wounds in recipient site (I) and donor site (J) both healed well, and the fasciocutaneous flap survived well.
Mentions: The inclusion criteria were patients who had traumatic soft tissue defects with tendon or bone exposure (Figure 1A). The exclusion criteria were patients who had peripheral arterial occlusive disease, soft tissue defects with severe infections, or a medical history suggesting a higher risk of local or general complications. Intraoperative bleeding, operative time, and complications were monitored. Postoperatively, all patients were requested to return for outpatient follow-up visits for at least 3 months.

Bottom Line: None of the patients had intraoperative complications, and intraoperative bleeding was minimal (<50 mL).All of the patients had surviving flaps.Our results demonstrated that the endoscopic-assisted method could be a valuable and reliable alternative in harvesting pedicled freestyle fasciocutaneous flaps.

View Article: PubMed Central - PubMed

Affiliation: From the Institute of Emergency and Critical Care Medicine (J-WH, Y-YL, DH-TY), School of Medicine, National Yang-Ming University, Taipei; Department of Surgery (J-WH), National Yang-Ming University Hospital, National Yang-Ming University, Yilan; Department of Pediatrics (Y-YL), Heping Fuyou Branch, Taipei City Hospital; Institute of Biomedical Informatics (N-YW), National Yang-Ming University; and Department of Emergency Medicine (DH-TY), Taipei Veterans General Hospital, Taipei, Taiwan.

ABSTRACT
The endoscopy-assisted technique has been demonstrated in harvesting muscle flaps; however, for pedicled freestyle fasciocutaneous flaps, few studies have applied this technique. We present a surgical procedure utilizing endoscopic-assisted method to identify the perforators of pedicled freestyle fasciocutaneous flaps for the reconstruction of soft tissue defects. From August to December 2012, 9 consecutive patients underwent endoscopic-assisted harvesting of fasciocutaneous flaps for the reconstruction of soft tissue defects. All of the defects were caused by trauma with tendon or bone exposure. Postoperatively, all patients were requested to return for outpatient follow-up visits for at least 3 months. The age of the 9 patients (8 men and 1 woman) ranged from 20 to 79 years (median 59 years). The defects ranged in size from 2 × 2 to 6 × 8 cm2. Two patients received anterolateral thigh transmuscular perforator flaps, 5 patients received fibular septocutaneous perforator flaps, and 2 patients received medial gastrocnemius transmuscular perforator flaps. The median incision length was 10 cm, and the median operative time was 120 minutes. None of the patients had intraoperative complications, and intraoperative bleeding was minimal (<50 mL). At the end of the 3-month follow-up period, none of the patients had any complications on either recipient or donor site, including total or partial necrosis of the flaps, flap dehiscence, hematomas, seromas, wound infections, or any conditions that indicated additional unplanned operative procedures. All of the patients had surviving flaps. Our results demonstrated that the endoscopic-assisted method could be a valuable and reliable alternative in harvesting pedicled freestyle fasciocutaneous flaps.

Show MeSH
Related in: MedlinePlus