Very limited literature described the use of the free anterolateral thigh (ALT) among other flaps for pediatric lower limb reconstruction. The aim of this study is to present our experience using the free ALT flap for reconstruction of soft tissue defects over the dorsum of the foot and ankle in children. The study included 42 children aged 2.5-13 years with a mean of 6.18 years. Three children had crush injuries while the rest were victims of run over car accidents. All of the flaps were vascularized by at least two perforators; 88.23% were musculocutaneous and 11.77 were septocutaneous perforators. All flaps were raised in a subfascial plane. Initial thinning was performed in five flaps and 35% required subsequent debulking. Mean Flap surface area was 117.11 cm(2). The recipient arteries were the anterior tibial artery in 38 cases and posterior tibial artery in four cases. Venous anastomosis was performed to one vena commitant and in nine cases the long saphenous vein was additionally used. Mean ischemia time of the flap was 2 hours while total operative time averaged 6.3 hours. About 41% of donor sites were closed primarily while 59% required skin grafting. Primary flap survival rate was 92.8% (39/42 cases). Three flaps showed venous congestion. After venous reanastomosis, two flaps showed partial loss and one flap was lost completely. Post-operative hospital stay averaged 7.5 days. The free ALT flap could be as safe, reliable, and aesthetically appealing option for foot/ankle resurfacing in children after traumatic soft tissue loss.
Background
Thoracodorsal artery perforator (TDAP) flap and muscle‐sparing latissimus dorsi (MSLD) flap have been frequently used for axillary coverage after hidradenitis suppurativa (HS) excision. However, none showed superiority to others. This study compared both flaps to define the ideal option, highlighting flap outcomes and functional and aesthetic results.
Methods
A retrospective study was conducted to compare both flaps that were used for axillary reconstruction in nine patients with bilateral HS Hurley stage III between 2017 and 2020. Eight TDAP and 10 MSLD flaps underwent functional evaluation using shoulder abduction angle (SA); the Disabilities of the Arm, Shoulder, and Hand (DASH) score; visual analog scale (VAS) for pain; and the Dermatology Life Quality Index (DLQI) questionnaires. Aesthetic assessment included the Scar Cosmesis Assessment and Rating (SCAR) scale and arm–chest interval.
Results
The mean operating time was 194.4 ± 51.58 and 128.5 ± 31.45 min for TDAP and MSLD (p = .009), respectively. Flap complications were significantly higher in the TDAP group (p = .034). There was no significant difference between both groups regarding SA; DASH, DLQI, VAS, and SCAR scale (p > .05). The mean arm–chest interval was significantly longer in the MSLD than in the TDAP group by 6.9 mm (p = .001).
Conclusions
TDAP and MSLD are comparable versatile flaps to eradicate axillary HS with higher TDAP flap complications. Although the TDAP flap is less bulky than the MSLD flap, the MSLD flap shortens the harvesting time without a significant difference in functional outcomes and scar results.
Background:
Abdominal contouring is a common procedure after bariatric surgery, but few studies on its outcomes have been conducted. The authors measured surgical and functional outcomes after postbariatric abdominal contouring and their effects on quality of life.
Methods:
Thirty patients, male and female, of different age groups, underwent postbariatric abdominal contouring using traditional abdominoplasty, fleur-de-lis abdominoplasty, or belt lipectomy. The technical approach was decided according to each patient’s presentation regarding the amount and extent of skin redundancy. All patients were given a booklet containing simplified questionnaires to assess quality of life and appearance to fill out both before and 6 months after the procedure. Data were collected face-to-face at the outpatient clinic during follow-up, by e-mail, or by messaging.
Results:
The authors performed traditional abdominoplasty (seven cases), fleur-de-lis abdominoplasty (eight cases), or belt lipectomy (15 cases). Surgical outcomes (operative time, resection weight, blood transfusion, postoperative hemoglobin level, postoperative albumin level, hospital stay, drain period, and complications) were influenced significantly by the procedure type (p ≤ 0.01). Health-related quality-of-life and appearance scale scores changed significantly from the precontouring stage to the postcontouring stage. This significant change in functional outcome was not correlated to the technical approach.
Conclusion:
Abdominal contouring surgery improves quality of life after bariatric surgery irrespective of the procedure type.
CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
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