Versatility of perforator‐based V‐Y advancement flaps in reconstruction of complex mid back wounds

Gözü, Aydın; Akkuş, Ali Murat; Seyithanoglu, Hakan; Özkan, Nezi̇h; Özsoy, Zafer

doi:10.1002/micr.20847

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…Several studies have described successful use of fasciocutaneous flaps supplied by perforators in the lumbosacral region, with the major advantage of preserving muscle function. 23,24 The 3 patients who were reconstructed with fasciocutaneous perforator flaps in our series all underwent posterior-only partial sacrectomies and had overall favorable results. Two of 3 patients healed with no postoperative complications.…”

Section: Discussionmentioning

confidence: 95%

Soft Tissue Reconstruction After Sacral Neoplasm Resection

Falade,

Knox,

Piper

et al. 2024

Ann Plast Surg

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Purpose Resection of sacral neoplasms such as chordoma and chondrosarcoma with subsequent reconstruction of large soft tissue defects is a complex multidisciplinary process. Radiotherapy and prior abdominal surgery play a role in reconstructive planning; however, there is no consensus on how to maximize outcomes. In this study, we present our institution's experience with the reconstructive surgical management of this unique patient population. Methods We conducted a retrospective review of patients who underwent reconstruction after resection of primary or recurrent pelvic chordoma or chondrosarcoma between 2002 and 2019. Surgical details, hospital stay, and postoperative outcomes were assessed. Patients were divided into 3 groups for comparison based on reconstruction technique: gluteal-based flaps, vertical rectus abdominus myocutaneous (VRAM) flaps, and locoregional fasciocutaneous flaps. Results Twenty-eight patients (17 males, 11 females), with mean age of 62 years (range, 34–86 years), were reviewed. Twenty-two patients (78.6%) received gluteal-based flaps, 3 patients (10.7%) received VRAM flaps, and 3 patients (10.7%) were reconstructed with locoregional fasciocutaneous flaps. Patients in the VRAM group were significantly more likely to have undergone total sacrectomy (P < 0.01) in a 2-stage operation (P < 0.01) compared with patients in the other 2 groups. Patients in the VRAM group also had a significantly greater average number of reoperations (2 ± 3.5, P = 0.04) and length of stay (29.7 ± 20.4 days, P = 0.01) compared with the 2 other groups. The overall minor and major wound complication rates were 17.9% and 42.9%, respectively, with 17.9% of patients experiencing at least 1 infection or seroma. There was no association between prior abdominal surgery, surgical stages, or radiation therapy and an increased risk of wound complications. Conclusions Vertical rectus abdominus myocutaneous flaps are a more suitable option for patients with larger defects after total sacrectomy via 2-staged anteroposterior resections, whereas gluteal myocutaneous flaps are effective options for posterior-only resections. For patients with small- to moderate-sized defects, local fasciocutaneous flaps are a less invasive and effective option. Paraspinous flaps may be used in combination with other techniques to provide additional bulk and coverage for especially long postresection wounds. Furthermore, mesh is a useful adjunct for any reconstruction aimed at protecting against intra-abdominal complications.

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Section: Discussionmentioning

confidence: 95%

Soft Tissue Reconstruction After Sacral Neoplasm Resection

Falade,

Knox,

Piper

et al. 2024

Ann Plast Surg

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“…The average level of evidence was 4.29, with 4 level 3 studies, 32 level 4 studies, and 20 level 5 studies. Multiple options for reconstruction were described including free style perforator flap, 3–9 lumbar artery perforator (LAP) flap, 6,8,10–12 paraspinous muscle flap, 2,13–17 SGAP, 10,14,18–22 inferior gluteal artery perforator, 19 intercostal artery perforator flap, 8,10,11,20,23,24 gluteus maximus musculocutaneous flap, 1,2,13,25–29 reverse latissimus dorsi flap, 2,7,13,27,30–35 lateral intercostal artery perforator–based latissimus dorsi flap, 36 external oblique musculocutaneous pedicled flap, 37 pedicled omental flap, 38–40 free flap, 7,13,14,41–55 and total leg flap. 56 The most frequently described method of lumbar wound reconstruction was free flap with 18 articles, followed by reverse latissimus dorsi flap reconstruction with 10 articles (Fig.…”

Section: Resultsmentioning

confidence: 99%

Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm

Daly

Ortíz

Shin

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: Lumbar spinal defects present a distinct challenge for the reconstructive surgeon and are often complicated by previous spinal surgery, the presence of hardware, and prior radiation. There are a variety of reconstructive options described but no clear treatment algorithm for these challenging defects. Methods: A literature search was performed to review the described treatment options for lumbar spinal soft-tissue defects. Treatments for myelomeningocele or pressure ulcers were excluded. In addition, a retrospective case review was performed for patients with lumbar defects treated with pedicled superior gluteal artery perforator (SGAP) flap reconstruction. Results: A literature review revealed 2,022 articles pertaining to lumbar defect reconstruction, of which 56 met inclusion criteria. These articles described 13 individual reconstructive techniques for this anatomic area. The most commonly described techniques were evaluated and a treatment algorithm designed based on patient and wound characteristics. The clinical course of 5 patients with radiated lumbar spinal defects treated with SGAP flaps is presented. Conclusions: There are many treatment options for lumbar spinal defects and treatment should be tailored to the patient and the characteristics of the defect. For large or radiated lumbar wounds, the pedicled SGAP flap is an excellent reconstructive choice, as it has reliable anatomy that is outside the zone of injury, adequate bulk, and minimal donor-site deficits.

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Multidisciplinary approach of lumbo‐sacral chordoma: From oncological treatment to reconstructive surgery

Garofalo

Summa

Christoforidis

et al. 2015

Journal of Surgical Oncology

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Lumbo-sacral chordoma is a rare, slow-growing tumor, arising from embryonic nothocordal remnants. Wide en bloc excision with clear margins remains mandatory to achieve satisfactory recurrence rates and disease-free survival. No chemotherapy has been demonstrated to be effective and radiotherapy is only marginally effective. Tyrosine kinase receptor inhibitors have showed encouraging results in locally advanced and metastatic chordoma. Reconstructive surgery may become very complex. Multidisciplinary approach in tertiary hospitals is always necessary.

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Versatility of perforator‐based V‐Y advancement flaps in reconstruction of complex mid back wounds

Cited by 5 publications

References 26 publications

Soft Tissue Reconstruction After Sacral Neoplasm Resection

Soft Tissue Reconstruction After Sacral Neoplasm Resection

Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm

Multidisciplinary approach of lumbo‐sacral chordoma: From oncological treatment to reconstructive surgery

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