Soft tissue sarcomas occur most commonly in the lower and upper extremities. The standard treatment is limb salvage surgery combined with radiotherapy. Postoperative radiotherapy is associated with wound complications. This systematic review aims to summarise the available evidence and review the literature of the last 10 years regarding postoperative wound complications in patients who had limb salvage surgical excision followed by direct closure vs flap coverage together with postoperative radiotherapy and to define the optimal timeframe for adjuvant radiotherapy after soft tissue sarcomas resection and flap reconstruction. A literature search was performed using PubMed. The following keywords were searched: limb salvage, limb‐sparing, flaps, radiation therapy, radiation, irradiation, adjuvant radiotherapy, postoperative radiotherapy, radiation effects, wound healing, surgical wound infection, surgical wound dehiscence, wound healing, soft tissue sarcoma and neoplasms. In total, 1045 papers were retrieved. Thirty‐seven articles were finally selected after screening of abstracts and applying dates and language filters and inclusion and exclusion criteria. Plastic surgery provides a vast number of reconstructive flap procedures that are directly linked to decreasing wound complications, especially with the expectant postoperative radiotherapy. This adjuvant radiotherapy is better administered in the first 3–6 weeks after reconstruction to allow timely wound healing and avoid local recurrence.
Background: Periorbital hyperpigmentation is a common worldwide problem, which makes a person appear tired, sad, and aged. A number of factors can cause dark circles around the eyes including excessive pigmentation, thin and translucent lower eyelid skin overlying the orbicularis oculi muscle, and shadowing due to skin laxity and tear trough. Although a number of treatment options are available, autologous fat transplantation is an effective method for the treatment of lower lid dark circles, but irregularities caused by leaving visible lumps of the fat can occur. Mechanical emulsification of harvested fat achieves much more finer fat particles than micro-fat called nano-fat which acts primarily by the plenty the active transplanted stem cells the purpose of this study is to evaluate the effectiveness of the nanofat grafting technique in correcting infraorbital dark circles.Pateints and Methods: Nanofat grafting was performed in 10 female patients for dark lower eyelids. The grafts were injected into intra-dermal and sub-dermal layers using sharp 27G needle and were harvested from different sites according to the ease of accessibility and to improve the patient's body contours. The mean follow-up period was 4.6 months, ranging from 2 to 8 months. All patients were clinically evaluated using standardized serial digital photographs by two plastic surgeons, who were blinded to the type of procedure performed at each of the follow-up visits.Results: In this study, there was significant improvement of the peri-ocular dark halos in 5 cases (50%), moderate improvement was encountered in 2 cases (20%), 2 cases (20%) showed mild improvement and no improvement in one case (10%). As regards patient satisfaction, 8 cases (80%) were satisfied with the final result, while 2 patients (20%) were not satisfied. Post-operative edema and ecchymosis were minimal in 5 cases (50%) and mild in 5 cases (50%). No cases were presented with either post injection infection or lumps and contour irregularities during the follow-up period.
Conclusion:In conclusion, nano fat injections for the treatment of infra orbital dark circles is a simple, cost effective procedure. In addition, nanofat grafting technique provided a significant improvement in skin quality. Our results suggest that the stem cell activity of the nanofat grafting technique has great potential as a treatment modality for dark circles as well as for skin rejuvenation in general.
Small recalcitrant non-unions with poor perfusion require reconstruction with vascularized bone flaps. Cases with concomitant large soft tissue defects are especially challenging, since vascularized soft tissue transfer is often indicated and distant microvascular anastomoses may be required. We introduce a sequential chimeric free flap composed of a medial femoral condyle corticoperiosteal flap anastomosed to an anterolateral thigh flow-through flap (MFC-ALT flap) and report its use for reconstruction of small non-unions with concomitant large soft tissue defects in three exemplary patients. Two female and one male patients ages 39-58 years suffered from composite bone and soft tissue defects of the lower extremity and clavicle caused by tumor resection and postoperative radiation resp. infected tibial pilon fracture. The sizes of the soft tissue defects ranged from 15-23 × 4.5-6 cm and the sizes of the bone defects ranged from 1.5-4 × 2-4 cm. Defect reconstructions were performed in all cases with sequential chimeric MFC-ALT flaps with sizes ranging from 2-4 × 1.6-4 cm for the MFC and 21-23 × 7-8 cm for the ALT skin paddles. Functional reconstructions were achieved in all cases resulting in stable unions and soft tissue coverage enabling the patients to bear full weight without assistance on 5-months follow-up. Postoperative course was uneventful and complications were restricted to a small skin necrosis at the suture line in one case. MFC-ALT flaps may be a safe, and effective procedure for one-stage reconstructions of small, irregularly shaped bone defects with concomitant large soft tissue loss or surrounding instable scarring, particularly in cases of recalcitrant non-unions after radiation exposure.
Farouk (2021) Comparative study between fisher anatomical subunit approximation technique and millard rotation-advancement technique in unilateral cleft lip repair,
Background: Wide cleft palate is a problem faced by plastic surgeons. Many techniques have been described for cleft palate repair, but not all of them can be used in cases of wide cleft palate. The most common post-operative complication is palatal fistula. Oronasal fistulae causes several problems such as nasal food regurgitation, bad oral odor, hypernasal speech. This study was performed to evaluate two modifications of cleft palate repair techniques aiming to decrease the rate of post-operative fistulae.Patients and Methods: In this series of cleft palate patients, we used the two flap palatoplasty technique combined with an anterior triangular flap based anteriorly at the cleft margin which is utilized as a turnover flap to decrease tension at the anterior nasal mucosal layer especially in wide clefts. Moreover, in wider clefts modifications such as greater palatine osteotomy and mobilization of the flap pedicles were used to provide more anterior and medial mobility of the flaps and thus decreasing the tension at the suture line in the midline.
Results:The study included 20 patients. Healing of the flap suture lines was uneventful. No complications were recorded.
Conclusion:The two modifications of cleft palate repair help to decrease tension during repair and thus decreasing the incidence of palatal fistulae.
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