Multiple pedicled flaps cover for large defects following resection of malignant tumors with partition concept

Ji, Chenyang; Li, Ruiting; Shen, Grace L. C.; Zhang, Jinming; Liang, Wenjie

doi:10.1097/md.0000000000007455

Cited by 8 publications

(8 citation statements)

References 29 publications

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“…Random skin flaps are a useful tool in plastic and reconstructive surgery to address various skin defects caused by trauma, tumour resection, and diabetic wounds [1][2][3]. However, owing to an inadequate blood supply, when the ratio of width to length of the flap exceeds 1 to 1.5-2, necrosis of the distal flap occurs [4].…”

Section: Introductionmentioning

confidence: 99%

Liraglutide, a TFEB‐Mediated Autophagy Agonist, Promotes the Viability of Random‐Pattern Skin Flaps

Zhu

Lou

et al. 2021

Oxidative Medicine and Cellular Longevity

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Random skin flaps are commonly used in reconstruction surgery. However, distal necrosis of the skin flap remains a difficult problem in plastic surgery. Many studies have shown that activation of autophagy is an important means of maintaining cell homeostasis and can improve the survival rate of flaps. In the current study, we investigated whether liraglutide can promote the survival of random flaps by stimulating autophagy. Our results show that liraglutide can significantly improve flap viability, increase blood flow, and reduce tissue oedema. In addition, we demonstrated that liraglutide can stimulate angiogenesis and reduce pyroptosis and oxidative stress. Through immunohistochemistry analysis and Western blotting, we verified that liraglutide can enhance autophagy, while the 3-methylladenine- (3MA-) mediated inhibition of autophagy enhancement can significantly reduce the benefits of liraglutide described above. Mechanistically, we showed that the ability of liraglutide to enhance autophagy is mediated by the activation of transcription factor EB (TFEB) and its subsequent entry into the nucleus to activate autophagy genes, a phenomenon that may result from AMPK-MCOLN1-calcineurin signalling pathway activation. Taken together, our results show that liraglutide is an effective drug that can significantly improve the survival rate of random flaps by enhancing autophagy, inhibiting oxidative stress in tissues, reducing pyroptosis, and promoting angiogenesis, which may be due to the activation of TFEB via the AMPK-MCOLN1-calcineurin signalling pathway.

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Section: Introductionmentioning

confidence: 99%

Liraglutide, a TFEB‐Mediated Autophagy Agonist, Promotes the Viability of Random‐Pattern Skin Flaps

Zhu

Lou

et al. 2021

Oxidative Medicine and Cellular Longevity

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“…Anyway, in large defects the donor site closure remains a problem (Liu et al, 2011; Qing, Wu, Yu, Zhou, & Tang, 2011). By dividing a large defect into several subunits, the coverage can be achieved with multiple adjacent perforator flaps, facilitating the donor site closure (Ji, Li, Shen, Zhang, & Liang, 2017). This suggested us the idea of performing another propeller flap close to the original one, in a sequential manner, to obtain a safe and tension‐free coverage of the donor site, as we already described in a previous case report (Scaglioni, Franchi, & Fritsche, 2019).…”

Section: Introductionmentioning

confidence: 99%

Soft tissue coverage of a total gluteal defect with a combination of perforator‐based flaps: A case report

et al. 2020

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Soft tissue defects in the buttock area are often related to decubitus ulcers, which are usually small to medium-large size and can be regularly treated with local flaps. However, when the defects have bigger size, such as those involving the whole gluteal region, the coverage can become more challenging, since this specific area needs both a good resistance to pressure and an acceptable functional result. The most common solution for similar cases is the use of multiple local flaps, or, in extreme situations, a free flap. In particular, local flaps based on perforator vessels are, in selected cases, a consolidated alternative to free flap allowing an efficient reconstruction of soft tissue defects using adjacent similar tissues, providing the benefit of "like with like" coverage. Here we present a case of a large mycosis fungoides nidus of the gluteal region measuring 25 cm × 18 cm reconstructed using two large perforator flaps adjacent to the defect combined with a remote one for coverage of the donor site. The cranial flap was designed based on a perforator arising from the superior gluteal artery and transferred into the defect by means of a V-Y advancement, while the two caudal propeller flaps in the posterior thigh were both based on perforators of the profunda femoris artery and rotated 180 , respectively. To obtain a tension-free cover of the donor site defect we applied the concept of "sequential" propeller flaps. Post-operative course was uneventful and the patient was ambulatory with assistive devices after 1 week. At 6 months follow-up, wounds were completely healed without complications and a good functional result was obtained. This report showed the great coverage potential of multiple perforator-based local flaps when properly combined allowing primary closure of the donor site. In particular, we managed to reconstruct a total gluteal defect using just ipsilateral side tissue, reducing morbidity, and obtaining a stable result.

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“…However, in large, full-thickness chest wall defects, a single flap may not be able to provide adequate or complete coverage. Moreover, the high tension required to close the donor site can lead to an increased risk of local complications such as wound dehiscence and tissue deformity [18,19]. Free flap reconstruction also relies on adequate microvascular anastomoses, the potential for which may be compromised in the event of any preprocedural radiotherapy, and often requires longer and more complex surgery for which the patient may not be suitable.…”

Section: Discussionmentioning

confidence: 99%

Reverse Abdominoplasty: A Novel Practical Approach Using Oncoplastic Reconstruction in Managing Major Chest Wall Defects for Patients With Loco-Regional Recurrence Following Breast Cancer Surgery

Teklebrhan¹,

Mahir²,

Clark³

et al. 2021

Cureus

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BackgroundLoco-regional recurrence of breast cancer in patients with large chest wall defects following mastectomy poses significant oncoplastic challenges. Reverse abdominoplasty is most commonly used to treat patients with excess upper abdominal soft tissue and laxity following massive weight loss. Widely employed as a technique for aesthetic contouring of the upper anterior trunk, as well as in augmentation mammoplasty, its use to date for reconstructive purposes is mainly limited to burns and large site surgical tumour ablation. MethodHere we review our experience of using reverse abdominoplasty as a novel approach to filling major anterior chest wall defects in patients with cutaneous manifestations of loco-regional or distant recurrence of breast cancer. ResultsSeven patients with metastatic breast cancer underwent reverse abdominoplasty for disease recurrence following mastectomy, with good patient-reported outcomes, and minimal surgical complications. Moreover, follow-up data in the patients surveyed also showed minimal to no limitations on their activities of daily living following the procedure. ConclusionHere we demonstrate the successful employment of reverse abdominoplasty -a technique not usually reserved in breast oncoplastic surgery -to treat fungating breast lesions and/or other manifestations of loco-regional recurrence in metastatic breast cancer. This may herald a paradigm shift in the way surgeons approach breast cancer recurrence in patients with pre-existing major chest wall defects.

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Multiple pedicled flaps cover for large defects following resection of malignant tumors with partition concept

Cited by 8 publications

References 29 publications

Liraglutide, a TFEB‐Mediated Autophagy Agonist, Promotes the Viability of Random‐Pattern Skin Flaps

Liraglutide, a TFEB‐Mediated Autophagy Agonist, Promotes the Viability of Random‐Pattern Skin Flaps

Soft tissue coverage of a total gluteal defect with a combination of perforator‐based flaps: A case report

Reverse Abdominoplasty: A Novel Practical Approach Using Oncoplastic Reconstruction in Managing Major Chest Wall Defects for Patients With Loco-Regional Recurrence Following Breast Cancer Surgery

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