Use of Suture Anchors in the Reconstruction of Soft Tissue Defects With Pedicled Muscle Flaps

Abstract

Suture anchors have been commercially developed to facilitate stable attachment of soft tissues to bone. Although their use is well characterized in orthopedic literature, suture anchors may also be of benefit in the reconstruction of large soft tissue defects by plastic surgeons. Suture anchors (Mitek Surgical Products, Inc., Westwood, MA) were used to fasten pedicled muscle flaps to exposed bone in 7 patients at Duke University undergoing reconstruction of large soft tissue defects. The suture anchor appeared to provide stability for the advancement flap, and there were no suspected postoperative muscle dehiscences or suture breakages. The suture anchor provides an easy, secure method to attach soft tissue to exposed bone, and preliminary experience appears to support their use in certain soft tissue reconstruction procedures by plastic surgeons. Suture anchors should be reserved for cases in which a large muscle flap is needed to cover exposed bone and poses a risk of shearing away from the bone, or adequate periosteum and soft tissue is not available for standard suture techniques.

Biomechanical Analysis of Suture Anchors and Suture Materials in the Canine Femur

“…Suture anchors are an effective alternative to the use of staples, transosseous tunnels and screw‐washer combinations for anchorage of suture–soft tissue to bone, 2–4 their use in human and veterinary surgery has been reported 1–9 . Suture anchors have been used extensively in human surgery through arthroscopic and open techniques for ligament, joint capsule and tendon reattachment or prosthesis placement, head and neck soft‐tissue reconstruction, urologic and gynecologic applications 3,4,10–18 . Reported veterinary applications include tarsal and phalangeal ligament deficiencies, coxofemoral luxation, shoulder luxation, elbow luxation, extracapsular stifle stabilization for cranial cruciate ligament (CCL) and/or collateral ligament deficiency, common calcaneal tendon avulsion, triceps avulsion, carpal extensor avulsion, gastrocnemius avulsion and acetabular fracture 6–9,19 …”

Improving Pressure Ulcer Reconstruction: Our Protocol and the COP (Cone of Pressure) Flap

“…9–13 Anchoring the flap over ischial tissues can be difficult, and bone anchors have been advocated for this purpose. 10 …”

The Use of Suture Anchors in Reconstruction of Sacral Pressure Ulcers With Gluteal Fasciocutaneous Advancement Flaps

“…3,5,8 In this study, the anchors were used not only to ensure secure midline attachment of the flaps and obliteration of the dead space but also to recreate the natal cleft. According to our results, all targets were hit since all patients healed well and no cases of infection or wound dehiscence were recorded.…”

“…1,2 The promising results reported expanded their use in plastic, maxillofacial, and ophthalmologic surgery. [3][4][5][6][7][8] Pressure ulcers, especially grades III and IV, rarely respond to conservative treatment. The thorough surgical debridement needed to remove necrotic tissues often leaves areas of exposed bone, in addition to the already existing soft-tissue defect, rendering coverage with well-vascularized tissue mandatory.…”