Interest of using muscle flaps in the coverage of small ankle and distal leg defects

The author reports his experience and the interest in using small pedicled muscle flaps in the coverage of small cutaneous size defects around the ankle and the distal leg. In such defects, the bad cutaneous status often precludes the use of fasciocutaneous flaps, and the use of wider muscle pedicled flaps or even free flaps is excessive. Because of their small sizes, the muscles used in our series, often considered as accessories, appear very useful.     

First treatment of distal loss of tissue on lower limbs. About 15 cases

Distal extremity of lower limb sustains the complications of loss of tissue: problem of coverage (cutaneous and tendon necrosis, osteoarticular infection. The whole point of the surgery is to fight against the infection by repeated debridments, against the deformations or their correction by early osteosynthesis (pins and external fixation). The coverage is very important in this treatment: either with Vacuum-Assisted Closure (VAC) and skin graft or fasciocutaneous flap. In spite of this management, the after-effects are important although the conservative treatment is the determining factor of satisfaction.     

Extra-abdominal desmoid tumor in a scar of donor-site of a latissimus dorsi flap: case report

Tumefaction arising lately after latissimus dorsi flap harvest are rare and observed in 1 or 2% of the cases. These lesions are frequently related to kystic sero-hematoma and are easily and efficiently treated with surgical excision. In some rare circumstances, a tumoral evolution can mimic a kystic sero-hematoma. We will discuss one case of desmoid tumor arising from a latissimus dorsi flap donor-site scar. The subject was a 45 years old woman who had a breast reconstruction following mastectomy. A dorsal tumefaction, with a benign aspect, was observed during the follow-up period. The biopsy showed an extra-abdominal desmoid tumor. The patient was treated with a large excision of the lesion and reconstructed using two opposing local cutaneous advancing flaps. No radicalization was necessary. No sign of recurrence has been observed at 4 years follow-up.     

Use of a vascularized fibula for spinal reconstruction in neurofibromatosis

We report a case of reconstruction of a dysplasic thoracic spine with vascularized fibula in Recklinghausen's disease. We present the case of a thirteen-year-old lady with neurofibromatosis type 1 who developed a dystrophic thoracic kyphoscoliosis. A T9 compression due to a severe scaloping of the thoracic spine caused an important deformation and a medullar compression (with dorsal pain, right sciatica and a pyramidal syndrome). The surgery consisted in medullar liberation by a T9-T10 corporectomy and an osteosynthesis with arthrodesis T3-L3. A free vascularized fibula bone graft, with an end-to-end anastomosis on a thoracic pedicle, was realized to fill the T8-T11 spinal defect. All the symptoms decreased after surgery and the patient could walk normally few months later. At one-year follow-up the radiographs showed a stable montage and a solid bony fusion. Analysing the literature, vascularized bone graft can be recommended to fill the bony spinal defect due to surgery in cases of tumor, infection, trauma or severe scoliosis. Compared to non-vascularized grafts, which are exposed to resorption, fatigue fracture and then instability, the vascularized fibula grafts provide a rapid fusion, a biomechanically stable and long-standing support with low risks of infection.     

Distally based sural neuro-fasciocutaneous island flap to cover tissue loss in the distal third of the leg

The distally based sural neurofasciocutaneous flap is based on the vascular contribution furnished by the arterial network that accompanies the sural nerve and on its neurocutaneous perforating branches. This flap provides a solution that can be effectively used for various reconstructions in the distal third of the lower extremity, thus offering a valid alternative to solutions involving microsurgical repair. The main advantages of this flap are the need for a single operation, limited donor area morbidity, and the structural characteristics of the soft tissue of the flap, which makes it ideal for covering defects in this region. The authors present their clinical experience using this technique.     

Efficiency of the combination of Mersilene-musculocutaneous flap in the reconstruction of full-thickness chest wall defects. A retrospective study of 14 cases

SUBJECT: The tumors of chest wall can be responsible of large full-thickness defects. The skeletal stabilization by different synthetic materials with numerous modalities of use and the superficial coverage of the defect by a musculocutaneous flap are the two imperatives parts of this reconstruction. PATIENTS AND METHODS: From January 1997 to January 2006, 14 patients, 10 males and 4 females, aged between 17 and 63 years old and suffering from full-thickness chest wall defects secondary to tumor resection have benefited from a simple reconstruction, wherever the defect, by a Mersilene Mesh and a muscular or musculocutaneous flap. These defects measured between 8 x 12 cm and 14 x 16 cm and were located in the anterior part of the chest in 3 cases, with resection of the upper half of the sternum and the internal part of both clavicles and the first three ribs, and in the lateral part of the chest in 11 cases with resection between 3 and 5 ribs. The histological diagnoses of these tumors were 3 chondrosarcomas, 3 sternum and 1 rib metastases, 2 desmoid tumors, 1 Ewing's sarcoma, 4 benign tumors. The flaps used were pedicled in 13 cases and based on the latissimus dorsi muscle, the serratus muscle and the pectoralis major muscle; in 1 case, the latissimus dorsi musculocutaneous flap was free. RESULTS: The skeletal stabilisation seems satisfying. There was no problems with the pulmonary function except in 4 cases where a dyspnea appears in sustained effort. No vascular complication on these flaps was noted. With a mean follow up of 46 months, there was no local recurrence of the malignant tumors. Two patients were deceased 1 year after surgery.0. CONCLUSION: The Mersilene mesh associated with a locoregional musculocutaneous flap represent a simple and efficient solution for the treatment of such defects.     

Distally based sural fasciomusculocutaneous flap for treatment of wounds of the distal third of the leg and ankle with exposed internal hardware

Soft tissue reconstruction of the distal third of the lower limb with exposure of the internal hardware is a challenging problem with several potential complications, such as exposure of the fracture line, fracture instability and bacterial contamination. The treatment of these lesions usually consists of substitution of the internal hardware with external fixation devices and further flap coverage. We propose a different reconstructive approach, characterized by harvesting a sural fasciomusculocutaneous flap on the exposed internal hardware once a sterile ground has been obtained. Four patients were retrospectively analyzed. Soft tissue reconstruction was achieved in all cases. In one case hardware removal was necessary for complete healing. The sural fasciomusculocutaneous flap is a safe alternative to other pedicled and free flaps. Moreover, it allows direct coverage of internal fixators, thus completing the reconstruction in less time. This flap fits best to the morphology of the wound and internal hardware, leaving the main vascular trunk of the leg intact and at the same time providing a reliable vascular supply.     

Latissimus dorsi muscular flap in cosmetic sequelae of breast cancer conserving surgery: a case report

The correction of type II sequelae of breast conservative surgery is a difficult problem to solve. The authors present the case of a 39 years old woman, in which the repair has been carried out in two steps. A latissimus dorsi muscular flap is first realised, then a breast implant and a double-opposing Z plasty on the areola finish the reconstruction. The final result is very satisfactory in a cosmetic point of view, with a little cost in terms of scars. This difficult case presents the muscular variant of the latissimus dorsi flap, as a technique of choice in the post-quadrantectomy sequelae.