1/9. Free flaps for reconstruction of the lower back and sacral area.Free flap reconstruction of the lower back and sacrum is complicated by a paucity of recipient vessels and difficulties in postoperative care. From 1983 to 1997, six patients with intractable wounds of the lower back and sacral area were treated with free flaps. The flaps used were latissimus dorsi (three), combined latissimus dorsi and serratus anterior (one), and filleted leg tissue (two). The recipient vessels were the deep femoral vessels, the perforator vessels of the deep femoral system, the inferior epigastric vessels, and the superior gluteal and inferior gluteal vessels. The patients were observed in the intensive care unit for 1 week and kept in prone position for 4 weeks. All flaps survived and wounds healed primarily. For large or multiple defects of the lower back and sacrum, free tissue transfer is effective in achieving primary healing, particularly when local flaps are inadequate or have failed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/9. Reconstruction of recurrent pressure sores using free flaps.The authors describe two successful reconstructions of recurrent pressure sores with free fasciocutaneous flaps. In Case 1, a free lateral thigh flap pedicled on the first and third direct cutaneous branches of the deep femoral vessels was used to cover a large recurrent sacral pressure sore. The vascular pedicle was dissected to the deep femoral trunk proximally and anastomosed to the inferior gluteal vessels. In Case 2, a free medial plantar flap was transferred to a recurrent ischial pressure sore. The vascular pedicle was dissected to the posterior tibial vessels proximally. The long vascular pedicle of the flap was passed through the femoral subcutaneous tunnel, and end-to-side microvascular anastomoses were performed to the superficial femoral trunk without any vein grafts. The authors advocate the use of free tissue transfer for recurrent pressure sore reconstruction.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/9. The gluteal perforator-based flap in repair of pressure sores.The gluteal perforator-based flap is designed according to the localisation of sacral perforator vessels. These vessels penetrate the gluteus maximus muscle and reach the intrafascial and suprafascial planes, and the overlying skin forming a rich vascular plexus. The gluteal perforator-based flaps described in this paper are highly-vascularised, have minimal donor site morbidity, do not require the sacrifice of the gluteus maximus muscle and rarely lead to post-operative complications. We believe these easy-to-perform flaps might be considered as the first choice in the repair of gluteal pressure sores.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |
4/9. Managing and caring for a patient with a complicated wound.The patient discussed in this care study is a 91-year-old woman admitted to hospital from her own home. She presented with reduced mobility, constipation, increased confusion and reduced oral intake. Her history included small vessel disease and a stroke. On admissions she also had a number of grade two pressure ulcers on her buttocks. The surrounding skin appeared macerated and the patient complained of pain when the skin was cleaned after she was incontinent of both urine and faeces. It was expected that the wound would be fast healing, as it was superficial, but the healing rate proved otherwise. This article will focus on incontinence management as well as ways of aiding in healing a pressure ulcer where skin is macerated and the patient has many risk factors.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
5/9. Tensor fasciae latae perforator flap: minimizing donor-site morbidity in the treatment of trochanteric pressure sores.BACKGROUND: To report a new technique with less morbidity for coverage of trochanteric defects, an anatomical and clinical study was performed. methods: Twenty-four fresh cadavers were dissected. The following parameters were measured: origin, location, number, and length of the perforating vessels. In addition, a clinical study was performed on 21 patients with trochanteric pressure sores. RESULTS: The anatomical study of 24 fresh cadavers revealed the constant presence of perforator pedicles anterior to the greater trochanter, which provides an adequate arc of rotation arc for flap harvest without sacrificing the underlying muscles. The mean length of the pedicles was 9.59 /- 2.16 cm. This flap is nourished by perforator vessels arising from the ascending branch of the lateral circumflex femoral artery, which arises from the deep femoral artery and runs through the intermuscular septum, tensor fasciae latae, and rectus femoralis muscles. In this study, flaps were raised based on perforators located preoperatively using a unidirectional Doppler probe. Good results were obtained with primary closure of the donor site, with only two donor-site dehiscences. CONCLUSIONS: This flap is an alternative to myocutaneous flaps, as it preserves local musculature without functional sequelae in patients who walk. It also preserves the local musculature in the event of recurrence, as is usually seen in paralytic patients with pressure sores.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |
6/9. Internal pudendal pseudoaneurysm complicating an ischial pressure sore.A 23-year-old paraplegic patient experienced two episodes of substantial hemorrhage from an ischial pressure sore. Computed tomography showed that the wound extended into the pelvis and retroperitoneum, and arteriography demonstrated a pseudoaneurysm of the internal pudendal artery. The artery was selectively embolized, permitting debridement and flap coverage uncomplicated by bleeding. Bleeding from a pelvic extension of a pressure sore can be a catastrophic combination of distorted anatomy and relatively inaccessible vessels. As in hemorrhagic complications of pelvic trauma, tumors, and radiation, arteriography and transcatheter embolization can localize and control the source of bleeding.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
7/9. Coverage of multiple extensive pressure sores with a single filleted lower leg myocutaneous free flap.A large free flap from an amputated lower extremity based on popliteal vessels was used for coverage of three extensive decubitus ulcers in a single operative procedure. The procedure was easy, reliable, and actually time- and cost-saving. It provided a quick solution and early rehabilitation for a difficult problem.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
8/9. Bilateral gluteus maximus V-Y advancement musculocutaneous flaps for the coverage of large sacral pressure sores: revisit and refinement.Surgical management of the sacral defect using the gluteal muscle or musculocutaneous flap has been well accepted over the years. In this study, refinements in the bilateral gluteus maximus V-Y advancement musculocutaneous flaps were made. These refinements include having sharper angle (60 degrees or less) at the donor sites of the flap, cutting the edges of the gluteal muscle of 3 cm beyond the skin flap, and cutting most parts of the gluteal muscle at a depth of only 2.5 cm (at the level of upper third portion). These improvements result in less tension closure of the donor site, easier closure of the advanced flaps in two planes without tension, and better preservation of most parts of the gluteal muscular insertions to the femur and their functions. The design of V-Y advancement has successfully maintained the superior and inferior gluteal vessels and inferior gluteal nerve. In this study, the average sacral defect was more than 12 cm in diameter, and each advanced flap was 15 x 12 x 3 cm in size. Of the 63 consecutive patients undergoing bilateral gluteus maximus V-Y advancement musculocutaneous flaps with refinements for coverage of large sacral pressure sores, 59 (93%) achieved complete healing after an average follow-up period of 28 months. Only 4 patients had recurrences of sacral sore. In this study, the duration of hospital stay for flap coverage averaged 38.5 days. Four patients (6%) had superficial dehiscences of the donor site requiring skin grafting. Ten patients (16%) developed stitch abscesses and 9 patients (14%) had wound infections, but no flap was lost. No significant functional impairment related to the flap procedure was noted. The operative technique described in this paper is not only simple and noninvasive, but with our refinements of flap design, the bilateral gluteus maximus V-Y advancement musculocutaneous flaps also provide reliable and durable coverage for large sacral pressure sores.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
9/9. Multiple brain metastases from adenoid cystic carcinoma of the parotid gland. Case report and review of the literature.BACKGROUND: Adenoid cystic carcinoma is a slow-growing malignant tumor occurring in the head and neck. Intracranial involvement usually results from direct skull invasion from adjacent primary sites. To our knowledge, this is the first reported case of multiple brain parenchymal metastases manifesting with hemorrhage. CASE DESCRIPTION: A 60-year-old male experienced sudden onset of hemiparesis caused by an intracerebral hematoma in a brain metastasis from adenoid cystic carcinoma. The primary parotid tumor was treated 15 months before the appearance of the brain metastases. The hemorrhagic metastasis was resected, and cranial irradiation was performed. The brain metastasis had increased cellular atypism compared with the primary tumor. The patient remained well and free of neurologic dysfunctions until 5 months after the radiotherapy was completed; he died of systemically advanced disease 8 months after the craniotomy. CONCLUSION: Hematogeneous brain metastases of adenoid cystic carcinoma are quite rare and cannot be distinguished from those of other cancers radiologically. We assume that the intratumoral hemorrhage is related to the tendency of the tumor to spread around the vessels. Although radiation therapy is not curative, it is beneficial in controlling tumor regrowth.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |