Background/aim Since their introduction in 1991, propeller flaps are increasingly used as a surgical approach to loss of substance. The aim of this study was to evaluate the indications and to verify the outcomes and the complication rates using this reconstructing technique through a literature review. Materials and methods A search on PubMed was performed using "propeller flap", "fasciocutaneous flap", "local flap" or "pedicled flap" as key words. We selected clinical studies using propeller flaps as a reconstructing technique. Results We found 119 studies from 1991 to 2015. Overall, 1,315 propeller flaps were reported in 1,242 patients. Most frequent indications included loss of substance following tumor excision, repair of trauma-induced injuries, burn scar contractures, pressure sores and chronic infections. Complications were observed in 281/1242 patients (22.6%) occurring more frequently in the lower limbs (31.8%). Partial flap necrosis and venous congestion were the most frequent complications. The complications' rate was significantly higher in infants ( 70 years old) but there was not a significant difference between the sexes. Trend of complication rate has not improved during the last years. Conclusion Propeller flaps showed a great success rate with low morbidity, quick recovery, good aesthetic outcomes and reduced cost. The quality and volume of the transferred soft tissue, the scar orientation and the possibility of direct donor site closure should be considered in order to avoid complications. Indications for propeller flaps are small- or medium-sized defects located in a well-vascularized area with healthy surrounding tissues.

Propeller Flaps: A Literature Review.

We designed a new pedicled fasciocutaneous flap for large sacral defects that combined a classic superior gluteal artery perforator flap and an acentric axis perforator pedicled propeller flap. We asked whether this technique would be simple and result in few complications. Six patients with large sacral defects had reconstruction using this technique in one stage. The size of the defect and postoperative complications in each patient were assessed. The minimum followup was 6 months (mean, 20.1 months; range, 6–38 months). All wounds healed with no recurrence during followup. Five patients achieved healing primarily, and another with minimal drainage achieved healing by secondary intention after a dressing change. No patients had deep infection, wound dehiscence, necrosis, or partial loss or shrinkage of the flap at final followup. The buttocks were symmetric. We consider this a good alternative for reconstructing large sacral defects because it is a relatively simple procedure and results in few complications. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

/pdf/pedicled-fasciocutaneous-flap-of-multi-island-design-for-1o1vrljibu.pdf

Pedicled Fasciocutaneous Flap of Multi-island Design for Large Sacral Defects

Background Abdominoperineal resection (APR), which involves resection of the rectum, anal canal, and perianal skin, results in a large dead space in the pelvis, devascularized tissues, and high bacterial loads. This predisposes to wound complications, especially in the setting of neoadjuvant chemoradiotherapy. Additional sacral resection further compounds these effects. We aimed to assess perineal wound outcomes and complications in patients who underwent flap reconstruction for APR with sacrectomy (APRS) at our institution. Methods We reviewed the charts of all patients who underwent flap reconstruction for APRS over a 20-year period (1999–2018). Medical comorbidities, details of the surgical procedure, and major and minor wound complications were recorded and analyzed. Results Forty-six patients underwent flap reconstruction following APRS—28 (60%) for colorectal cancer, 8 (17%) for sacral chordoma, and 10 diagnosed with other malignant histologies. Rectus abdominis myocutaneous (RAM) flap reconstruction was used in 42 patients (91%). The median time to the first major perineal complication was 111 days (interquartile range: 22–660 days). Half of our cohort (n = 23) experienced a major perineal complication. No significant differences were found in major or minor perineal or abdominal wall complications between RAM flap and other flaps. APR with high sacrectomy was performed in 27 patients (59%) and was associated with significantly increased full-thickness dehiscence in the perineal region when compared with APR with low sacrectomy, 33 versus 0%, respectively (p = 0.0076). Complete flap loss occurred in one patient. Conclusion The RAM flap was the workhorse flap for pelvic reconstruction following APRS in our cohort. Wound complications are common following APRS. High sacrectomy is associated with higher incidence of complications compared with low sacrectomy. Optimal surgical planning and patient counseling is fundamental to improve current surgical outcomes.

Surgical Outcomes after Abdominoperineal Resection with Sacrectomy and Soft Tissue Reconstruction: Lessons Learned.

To compare the actual with the reported incidence of pressure sores to determine the accuracy of data (classification errors) and completeness of data (differences between manual and computer generated figures), retrospective data was collected regarding pressure sore rates following primary elective total hip arthroplasty operations carried out in 2001. Pressure sores rates were noted by nursing staff and entered into a computer database. Four consultant orthopaedic surgeons were involved, across 2 sites – 1 NHS (PRH) and 1 local private hospital. Preliminary audit reports indicated an alarmingly high pressure sore rate across the two units – 17/172 (9.9%) PRH and 23/71 (32.4%) private hospital. Two major errors were revealed. In terms of accuracy of data, grade 1 areas (erythema without active ulceration) were included at both sites. These are only potential sites of pressure sores and should not have been used to calculate actual pressure sore rate. In terms of completeness of data, manual verification of the number of operations performed revealed a discrepancy between the theatres’ logbook entries and private unit computer figures. 97 rather than 71 operations were performed. There was no such discrepancy at the NHS site. The data was reanalysed to obtain the actual pressure sore rate. For the NHS unit, grade 1areas were subtracted, causing the rate to fall from 32.4% to 1.0%. The two errors caused a dramatic and significant difference between reported and actual pressure sore rate. Poor data collection leads to inaccurate audit, leading to inappropriate management. The concern is that similar errors, accumulated across key complication targets and specialities, will have a profound impact on NHS star ratings.

Pressure sores following elective total hip arthroplasty: pitfalls of misinterpretation

Background Dorsal intercostal artery perforator (DICAP) flap is an ideal flap to be used for posterior trunk defects since it leads to lower donor-site morbidity and shorter operative times, offers easy surgical planning, and uses a reliable and easily identifiable artery. Materials and methods The study retrospectively reviewed 52 patients with meningomyelocele defects that were closed with DICAP flap between January 2007 and May 2015. Surgical technique Each of the 4th to 12th posterior intercostal arteries can be used as dorsal perforators. The dominant direct cutaneous perforators derive from the 4th, 5th, 6th, 10th, and 11th posterior intercostal arteries. These perforators are located 5 cm medial to the spinous processes of the thoracic vertebrae and can be easily identified. Conclusion Dorsal intercostal artery perforator flap is a reliable flap alternative for the defects seen in neonates, including myelomeningocele, oncologic resections, burn defects, and radiation burns since it is a thin flap and offers easy surgical planning and shorter operative times.

An Ideal Flap Alternative for Closure of Myelomeningocele Defects: Dorsal Intercostal Artery Perforator Flap.

Cubital tunnel syndrome is the second most common peripheral compression neuropathy in adults. Close correlation between elbow trauma and cubital tunnel syndrome has been reported before. Factors causing cubital tunnel syndrome as a result of trauma may involve regional hemorrhages, edema, fibrosis, bone fracture, or displacement of bone fracture fragments into the cubital tunnel, causing narrowing of the tunnel. The pathogenesis due to delayed intraneural hematoma of ulnar nerve is extremely rare. In the present report we describe the first case of cubital tunnel syndrome due to delayed intraneural hematoma of ulnar nerve. A successful outcome may be expected if an appropriate surgical technique is chosen as early as more when worsening numbness or severe pain appears in the ring finger and little finger.

	 

	Key words: Cubital tunnel syndrome, ulnar nerve, hematoma.

Cubital tunnel syndrome resulted from delayed intraneural hematoma of ulnar nerve

OBJECTIVE To explore a safe, highly-efficient and rapid approach to the repair of the sacrum soft tissue defect and/or partial exposure of the bone METHODS From February 2003 to April 2006, 6 patients (4 males, 2 femals; aged 28-67 years) with the sacrum soft tissue defect were surgically treated by the multi-island flap with shallow branches of the gluteus upper artery The soft tissue defects ranged in area from 15 cm x 12 cm to 25 cm x 20 cm, averaged 20 cm x 16 cm The obtained flaps ranged in area from 18 cm x 15 cm to 30 cm x 25 cm Of the patients, 5 had a sacral ulcer (Grade III in 3 patients, Grade IV in 2) and 1 had a tumor, with their illness course from 3 weeks to 20 years RESULTS All the flaps survived completely in the 6 patients, in whom 5 had an incision healing of the first intention, and the remaining 1 had a healing of the second intention 32 days after the treatment for the minor ischemia and necrosis at the edges of the flap The follow-up for 2-38 months (average, 193 months) revealed that all the flaps grew well with no recurrence of the sacral ulcer CONCLUSION The surgical treatment with the multi-island flap with shallow branches of the gluteus upper artery is a safe, highly-efficient and rapid approach to repair of the sacrum soft tissue defect and/or partial exposure of the bone This kind of treatment has advantages of simpler procedures, better blood circulation of the flap, fewer complications, and higher success rates

An effect of multi-island flap with shallow branch of gluteus upper artery on repair of sacrum soft tissue defect

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Pedicled Fasciocutaneous Flap of Multi-island Design for Large Sacral Defects

Cubital tunnel syndrome resulted from delayed intraneural hematoma of ulnar nerve

An effect of multi-island flap with shallow branch of gluteus upper artery on repair of sacrum soft tissue defect