Muscle Flaps and their Role in Limb Salvage

Klebuc, Michael; Menn, Zachary K.

doi:10.14797/mdcj-9-2-95

Cited by 22 publications

(12 citation statements)

References 13 publications

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“…VML patients face the challenging psychological consequences of a relevant loss in tissue mass, muscle strength and function, often leading to a permanent disability [ 13 ]. Muscle and fasciocutaneous flaps, taken from autologous donor sites are currently the most utilized approach for VML and limb trauma repair [ 14 , 15 ]. In the case of skin grafting, a portion of autologous tissue can be surgically transposed to the injured site without its nourishing blood supply (free-grafting), significantly improving the healing process at the implanted site [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Perfusion decellularization of a human limb: A novel platform for composite tissue engineering and reconstructive surgery

et al. 2018

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Muscle and fasciocutaneous flaps taken from autologous donor sites are currently the most utilized approach for trauma repair, accounting annually for 4.5 million procedures in the US alone. However, the donor tissue size is limited and the complications related to these surgical techniques lead to morbidities, often involving the donor sites. Alternatively, recent reports indicated that extracellular matrix (ECM) scaffolds boost the regenerative potential of the injured site, as shown in a small cohort of volumetric muscle loss patients. Perfusion decellularization is a bioengineering technology that allows the generation of clinical-scale ECM scaffolds with preserved complex architecture and with an intact vascular template, from a variety of donor organs and tissues. We recently reported that this technology is amenable to generate full composite tissue scaffolds from rat and non-human primate limbs. Translating this platform to human extremities could substantially benefit soft tissue and volumetric muscle loss patients providing tissue- and species-specific grafts. In this proof-of-concept study, we show the successful generation a large-scale, acellular composite tissue scaffold from a full cadaveric human upper extremity. This construct retained its morphological architecture and perfusable vascular conduits. Histological and biochemical validation confirmed the successful removal of nuclear and cellular components, and highlighted the preservation of the native extracellular matrix components. Our results indicate that perfusion decellularization can be applied to produce human composite tissue acellular scaffolds. With its preserved structure and vascular template, these biocompatible constructs, could have significant advantages over the currently implanted matrices by means of nutrient distribution, size-scalability and immunological response.

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Section: Introductionmentioning

confidence: 99%

Perfusion decellularization of a human limb: A novel platform for composite tissue engineering and reconstructive surgery

et al. 2018

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“…Muscle flaps are more effective in obliterating dead space than skin or fasciocutaneous flaps. 3 Additionally, in canine models, musculocutaneous flaps were found to suppress bacterial colonization more effectively than their fasciocutaneous counterparts. 16,17 This difference was attributed to the robust blood flow and increased tissue ingrowth associated with the muscle flap.…”

Section: Discussionmentioning

confidence: 99%

“…For complex or hostile wounds, the addition of muscle to create a musculocutaneous flap is an effective method to obliterate dead space, inhibit bacterial colonization, and promote healing and tissue growth. 3 However, most musculocutaneous flaps are very thick and pose a significant challenge to reconstructing a defect that requires thin tissue to attain a favorable functional result. To achieve this goal, the transfer of an RFFF in conjunction with muscle such as the brachioradialis and flexor carpi radialis has been described in several reports.…”

Section: Introductionmentioning

confidence: 99%

Radiation necrosis of the pharyngeal soft tissue: Unique clinical entity reconstructed with a previously unreported composite brachioradialis and flexor digitorum superficialis radial forearm flap

et al. 2020

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Background The radial forearm free flap (RFFF) is a versatile flap commonly used in head and neck reconstructive surgery. We describe the use of a composite RFFF that includes muscle for reconstruction of a hostile wound of the posterior pharyngeal wall. Methods A 54‐year‐old male with a history of recurrent right palatine tonsil HPV+ squamous cell carcinoma developed severe soft tissue necrosis of the posterior pharyngeal wall secondary to reirradiation. The defect was reconstructed with a composite RFFF that included the brachioradialis (BR) muscle and the flexor digitorum superficialis (FDS) muscle. Results Restoration of this complex defect was successfully accomplished with minimal donor site functional deficits and satisfactory functional outcomes including decannulation and resumption of oral intake. Conclusion This composite RFFF can be effectively used to reconstruct a hostile wound of the posterior pharyngeal wall. Incorporation of muscle in the reconstruction of complex wounds with soft tissue necrosis is beneficial.

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“…One study by Anthony et al demonstrated a 96% success rate in 34 patients by use of this strategy (144). Drawbacks, however, include recurrent infection in cases of chronic osteomyelitis, which can result in infection of the muscle flap (145).…”

Section: Dead Space Managementmentioning

confidence: 99%

Staphylococcal Osteomyelitis: Disease Progression, Treatment Challenges, and Future Directions

et al. 2018

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Osteomyelitis is an inflammatory bone disease that is caused by an infecting microorganism and leads to progressive bone destruction and loss. The most common causative species are the usually commensal staphylococci, with and responsible for the majority of cases. Staphylococcal infections are becoming an increasing global concern, partially due to the resistance mechanisms developed by staphylococci to evade the host immune system and antibiotic treatment. In addition to the ability of staphylococci to withstand treatment, surgical intervention in an effort to remove necrotic and infected bone further exacerbates patient impairment. Despite the advances in current health care, osteomyelitis is now a major clinical challenge, with recurrent and persistent infections occurring in approximately 40% of patients. This review aims to provide information about staphylococcus-induced bone infection, covering the clinical presentation and diagnosis of osteomyelitis, pathophysiology and complications of osteomyelitis, and future avenues that are being explored to treat osteomyelitis.

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Muscle Flaps and their Role in Limb Salvage

Cited by 22 publications

References 13 publications

Perfusion decellularization of a human limb: A novel platform for composite tissue engineering and reconstructive surgery

Perfusion decellularization of a human limb: A novel platform for composite tissue engineering and reconstructive surgery

Radiation necrosis of the pharyngeal soft tissue: Unique clinical entity reconstructed with a previously unreported composite brachioradialis and flexor digitorum superficialis radial forearm flap

Staphylococcal Osteomyelitis: Disease Progression, Treatment Challenges, and Future Directions

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