Soft-tissue reconstruction of the leg associated with the use of the Hoffmann external fixator.

Soft-tissue injuries and defects associated with severe fractures of the tibia treated with the Hoffmann external fixator were reviewed. Of 84 cases of open tibia fractures (classified as Gustilo's Type II and III), 54 patients with 55 injured limbs required soft-tissue reconstruction other than skin grafts or small rotational flaps. These 55 cases were constructed with 37 local musculocutaneous flaps (20 gastrocnemius, 17 soleus and other smaller muscle flaps), 15 free musculocutaneous flaps (14 latissimus dorsi, and one tensor fascia lata), and three medial gastrocnemius cross leg flaps.

The platysma musculocutaneous flap: experience with 24 cases.

The platysma musculocutaneous flap has been used in 24 patients for reconstruction in the head and neck area. In 22 patients, the superior vascular pedicle, the submental branch of the facial artery, was used, and in two other patients, the inferior pedicle, the superficial branch of the transverse cervical artery, was used. Twelve patients had reconstruction of the intraoral lining with a skin paddle on the platysma.

Use of free latissimus dorsi musculocutaneous flaps in various neurosurgical disorders.

Musculocutaneous (skin-muscle) flaps have been used predominantly by plastic surgeons for a variety of reconstructive purposes. With the advent of microvascular techniques, the area to be reconstructed is no longer limited to the arc of rotation of the vascular pedicle of the muscle. Instead, the muscle and overlying skin that is best suited for the reconstructive procedure may be dissected out as a free flap, with microvascular anastomosis of an arterial supply and venous drainage to locally existing vessels.

Platysma musculocutaneous flap: clinical and anatomic considerations in head and neck reconstruction.

The platysma musculocutaneous flap was used in 14 patients for reconstruction of the oral lining and external skin coverage in the head and neck area. Complications occurred in five patients. Only one patient, however, required further surgery and this was for correction of a poor cosmetic result.

The omentum: its use as a free vascularized graft for reconstruction of the head and neck.

The experience at Emory University Affiliated Hospitals with transplantation of the greater omentum as a free revascularized graft in 18 patients is presented. In each instance, there was realization of the therapeutic objective, either 1) the amelioration of congenital or acquired somatic deformity (14 patients) or 2) the control of infection (4 patients). Because the omentum is a syncytium of blood vessels and a variable amount of fat within redundant leaves of peritoneal membrane laden with macrophages, it is a tissue that serves admirably its extended role as an extracelomic free transplant.

Chest wall reconstruction--management of the difficult chest wound.

Full-thickness chest wall defects after ablative surgery for metastatic cancer, trauma, infection, or irradiation injury have posed major and often impossible dilemmas for reconstruction. At times, resection has had to be abandoned because reconstruction was deemed infeasible. However, recent knowledge of the multicentric blood supply and anatomy of the latissimus dorsi and pectoralis major muscle make it possible to use these muscles and myocutaneous units (even following division of their major blood supply) for reconstruction of the chest wall.

Aesthetic aspects of breast reconstruction.

Implant exposure, malposition, and capsular contracture, problems often seen with subcutaneous placement of implants in breast reconstruction, have been largely eliminated by submuscular placement of the implant. The pectoralis major, serratus anterior, rectus abdominus, and the latissimus dorsi are available as muscle and musculocutaneous flaps for coverage of implants in breast reconstruction. As symmetry is the goal in breast reconstruction, the shape and form of the opposite breast is taken into account in selecting a suitable flap for breast reconstruction.

Surgical management of heel ulcers--a comprehensive approach.

Reconstruction of the ankle, heel, and foot remains a challenging, often frustrating problem for surgeon and patient alike. Little local soft tissue is available for the reconstruction, and often the underlying disorder precludes use of some procedures. The ankle and the heel are vital musculoskeletal structures, responsible for shock absorption, weight-bearing, and locomotion, and their dysfunction inflicts discomfort and disability on the individual that commonly lasts many months or even over a year.

Free jejunal grafts for reconstruction of pharynx and cervical esophagus.

Reconstruction of the pharynx and cervical esophagus is a surgical challenge associated with high complications, multiple-staged procedures, and prolonged hospitalizations. In a series of cases, single-stage transfer-free jejunal graft reconstructions had a 85% success rate with low complications in a series of patients who received preoperative, postoperative, and curative radiation treatment. There are advantages to this reconstruction procedure; however, there can also be complications.

Evaluation of strategic nerve section in myocutaneous flaps.

Manipulation of the muscle blood supply by denervation was undertaken to see if it affected the amount of the myocutaneous unit that survived. Nineteen dogs were studied, using the gracilis muscle as a model. The gracilis muscle was denervated on one side, with the other, innervated muscle serving as a control.

Classification of the vascular anatomy of muscles: experimental and clinical correlation.

Five patterns of muscle circulation, based on studies of the vascular anatomy of muscle, are described. Clinical and experimental correlation of this classification is determined by the predictive value of the vascular pattern of each muscle currently useful in reconstructive surgery in regard to the following parameters: arc of rotation, skin territory, distally based flaps, microvascular composite tissue transplantation, and design of muscle-delay experimental models. This classification is designed to assist the surgeon both in choice and design of the muscle and musculocutaneous flap for its use in reconstructive surgery.

Persistent tracheostomy stoma.

Prolonged presence of a tracheostomy tube or prolonged tracheostomy stoma can result in a failure of spontaneous closure. The stoma may remain open until surgically closed. Muscle flaps as well as skin flaps can be used to close the persistent tracheostomy stoma.

Muscle flap transposition with function preservation: technical and clinical considerations.

Techniques for transposition of muscles are described when function preservation may be important. Anatomic and clinical data are presented to support the technique of muscle transposition with function preservation.

Avoiding the flat breast in reduction mammaplasty.

The reliance on retained superior breast tissue beneath the reduced skin envelope may not provide adequate breast projection in reduction mammaplasty. Placement of preserved inferior dermal-breast pedicle beneath the tailored skin envelope in this group of patients has allowed control of both breast projection and size, but there are alternatives in the management of the nipple--areola complex with the use of this technique.

The "reverse" latissimus dorsi muscle and musculocutaneous flap: anatomical and clinical considerations.

A "reverse," posteriorly based transposition of a latissimus dorsi musculocutaneous flap on its segmental blood supply is presented. This adds new possibilities to this versatile and reliable musculocutaneous unit. The variable modes of blood supply to the musculocutaneous units are discussed, and the question of the strategic vascular and neurosympathetic delays are raised.

Experiences with the tensor fascia lata flap.

Our experience with 60 TFL flaps is reviewed. The anatomy and the arcs of rotation of this flap are described. Our clinical experience--particularly in reconstruction of the groin and abdominal wall, and in free flap transfers--has been detailed, including the use of a free osteomyocutaneous sensory TFL flap for reconstruction of the heel.

Repairs in the lower abdomen, groin, or perineum with myocutaneous or omental flaps.

Our experiences with omental and myocutaneous flaps for the closure of the lower abdomen, groin, and perineum are outlined. The relative advantages and disadvantages of the various flaps are discussed.