Experiences in the use of pedicled muscle flaps in reconstructive accident surgery

The one year-experience with muscle and musculocutaneous flaps in 16 patients with 18 flaps in different regions of the body is represented. The indications were open fractures with extensive loss of soft tissue, infectious complications after joint-replacement or osteomyelitis, defects after tumor resection or irradiation therapy and decubital ulcers. In 11 patients there was a satisfactory result. Complications with partial loss of the flap resulted from primary transposition in open fractures with marked contusion of the muscle, neglection of the specific vascularisation pattern or irradical necrectomy. Viewing the relatively simple operative techniques with muscle and musculocutaneous transposition or island flaps, free microvascular tissue transfer may be unnecessary in many situations.     

Use of scarred flaps and secondary flaps for reconstructive surgery of extensive burns

We report the usefulness of scar flaps and secondary flaps in the surgical repair of extensively burned patients. Burn scar contractures repaired with scarred axial pattern flaps, scarred musculocutaneous flaps and scarred fasciocutaneous flaps are described. However, it is our contention that their application should be strictly limited. An example of the use of scarred secondary axial pattern and musculocutaneous flaps for reconstruction of a burned ear is shown.     

Skin-muscle flaps in reconstructive plastic surgery of the breast

The authors' experience with treatment of 20 patients has shown that musculo-cutaneous thoracodorsal and TRAM flaps are the best methods of breast plasty after mastectomy. These operations provide oncologically safe performing radical mastectomy with the simultaneous restoration of the shape and volume of the breast and give reliable results. The additional application of the axillary fascial-fatty graft from the lateral surface of the chest improves the esthetic results of the breast reconstruction with the thoraco-dorsal flap. Using the TRAM flap for subcutaneous mastectomy can be the operation of choice in surgical rehabilitation of certain forms of tumor-like lesions of mammary glands.     

Immediate reconstruction of oral cavity and oropharyngeal defects using microvascular free flaps.

Eighteen patients underwent immediate reconstruction of defects involving the oral cavity and oropharynx with free groin and dorsalis pedis flaps. One partial and four complete failures occurred. In the successfully reconstructed patients, the functional results were equal to conventional flaps while the cosmetic improvements were dramatic.     

Cutaneo-fascial flaps in restorative and reconstructive surgery of burns

On the basis of experience with the treatment of more than 1,500 patients with post-burn defects, deformities, and trophic ulcers, the authors distinguished types of affection in which the traditional methods are ineffective. These 133 patients were subjected to plasty with ++cutaneo-fascial grafts; the zones of donor areas from which the grafts are taken are determined. Plasty with ++cutaneo-fascial grafts is indicated in defects of the face, deformity of the neck, total adduction contracture of the arm, defect of the breast, and affections of the hand, leg, and foot. Concrete grafts and the site from which they are taken for restoration of certain regions of the body are suggested. ++Cutaneo-fascial grafts make it possible to restore the shape, function, and the skin of the involved region.     

Use of cutaneo-fascial flaps in reconstructive surgery of the lower extremities

Defects in the soft tissues of the lower extremities after burns and traumas in 10 patients were managed by plastic surgery using ++cutaneo-fascial grafts formed from the leg of the same or contralateral side. The operation was performed in two or three stages. ++Cutaneo-fascial grafts formed on the posteromedial or posterolateral surface of the leg may have a width:length ratio of 1:3. In cross plastics the proximal one third of the graft is folded like a tube. Inclusion of the vena saphena magna in the graft and measures aimed at prevention of separation of the fascia from the layer of fat increase the viability of the graft. Secondary deformity is significantly reduced by modelling the edges of the donor wound and closing it with an unperforated graft of split skin.     

Muscular flaps and reconstructive surgery of empyema: about 12 cases

SUBJECT: The chronic empyema is a dreadfull outcome of pulmonary resection. Its management is difficult: a thoracostomy or a thoracoplasty by resection of rib segments are rarely efficient. A large debridement associated with a muscular flap is helpfull in the treatment of these cavities. These flaps allow the filling of these pleural spaces and the treatment of the bronchopleural fistulae which are constant and responsible of the perenniality of such infection. PATIENTS AND METHODS: From June 1997 to December 2006, 12 patients, aged from 25 to 45 years old, were treated for chronic empyema following total pulmonary resection by using muscular flaps. The causes were: post-tuberculosis pulmonary deterioration in 8 cases, bronchic cancer in 3 cases, post-traumatic tracheobronchic breaking in 1 case. An open window thoracostomy was performed for all the patients and with a follow-up of 2 years, there was no healing of this infection. In our procedure, the patients underwent in the same time a large thoracoplasty that involved 3 to 5 rib segments (10 cm in length) to reduce the pleural space and a myoplasty. The muscular flaps used were pedicled in 8 cases: a latissimus dorsi in 6 cases, a latissimus dorsi with an anterior serratus in 2 case, and were free in 4 cases: a latissimus dorsi in 3 cases, a latissimus dorsi with an anterior serratus in 1 case. These flaps were sufficient to fill the cavities and were applied and stitched around the fistulae. RESULTS: There was no complication during or after the operations with a mean follow-up of 3 years. These chronic empyema were completely healed in all cases without recurrence of the suppuration or the bronchopleural fistulae. CONCLUSION: The one-stage thoracomyoplasty including the resection of rib segments and local or regional muscular flaps is a very efficient treatment of the chronic pleural empyemas. It is very important, for an easy treatment of such cavities, to teach the thoracic surgeons the great interest of preserving the local muscular flap during the initial thoracotomy.     

Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer

BACKGROUND: Therapeutic decisions in recurrent oral and oropharyngeal squamous carcinoma (SCC) remain controversial. METHODS: Two hundred forty-six consecutive patients who underwent salvage surgery for recurrent squamous cell carcinoma (SCC) of the oral cavity and oropharynx were studied. The tumor sites were lip, 33 cases; oral cavity, 143; oropharynx, 70. The previous treatment was surgery in 73 patients, radiotherapy in 96, combined surgery and radiotherapy in 76, and chemotherapy in one. The clinical stage of recurrence was I/II in 51 cases and III/IV in 195 cases. The disease-free interval (DFI) was less than 1 year in 156 cases and greater than 1 year in 90 cases. RESULTS: The rate of recurrence was 54.9%, and the overall 5-year actuarial survival rate was 32.3%. The significant prognostic factors in multivariate analysis were restage (p = .049) and DFI (p = .045). CONCLUSION: Patients with recurrent oral and oropharyngeal SCC at initial clinical stages (rCS I and II) and with a DFI greater than 1 year had a favorable prognosis.