New developments in regenerative medicine are bound to revolutionize the way we approach loss of function and form in human organisms. Especially in the field of reconstructive plastic surgery new biotechnologies find...New developments in regenerative medicine are bound to revolutionize the way we approach loss of function and form in human organisms. Especially in the field of reconstructive plastic surgery new biotechnologies find their way from bench to bed. Biofabrication is an evolving field that aims to combine natural biologic processes with bioartificial constructs with the scope of reconstituting tissue without having to rely on autotransplantation. In this brief review we present the concepts of intrinsic vs. extrinsic neovascularization and we discuss the use of neovascularization in three dimensional matrices. In a clinical context matrix flaps for application in reconstructive surgery can be fabricated this way.展开更多
Necrotizing fasciitis (NF) is a severe soft tissue infection which has to be treated with a radical debridement as the key element. In the further course often large tissue defects occur, so that a long-term stable de...Necrotizing fasciitis (NF) is a severe soft tissue infection which has to be treated with a radical debridement as the key element. In the further course often large tissue defects occur, so that a long-term stable defect reconstruction plays a crucial role after any successful debridement. The reconstruction can include split skin grafting or local and free flaps. Here we present a case of a 41-year-old male patient with a NF in the trochanter major region after spondylodesis and spinal cord stimulation (SCS) device implantation. After multiple operations including local and free flaps we performed a defect reconstruction using an arteriovenous (AV) loop and subsequent free latissimus dorsi transplantation leading to no further operations. This complex reconstruction can be considered as the final stage of any reconstruction latter.展开更多
Aim: Soft tissue defects with or without exposed bones in the lower extremity, ankle and the foot-with or without bone defects or exposed hardware-often require coverage with vascularized flaps. Free flaps, which add ...Aim: Soft tissue defects with or without exposed bones in the lower extremity, ankle and the foot-with or without bone defects or exposed hardware-often require coverage with vascularized flaps. Free flaps, which add healthy tissue especially to the lower extremity instead of further injuring a limb, are the first choice in high volume microsurgical centres. Nevertheless, in some instances pedicled flaps may have indications when free flaps are not suitable. Methods: The distally based peroneus brevis flap is harvested from the lateral compartment of the leg based on the distal perforating arterial supply and covered with split skin. Results: We performed a total of 69 peroneus flaps between 2003 and 2017. Minor flap necroses at the distal tip were noted in 8% of the peroneus brevis reconstructions. Total flap loss occurred in 1 peroneus flap. Defect etiology and patient age were not associated with surgical outcome. Conclusion: While nowadays the first choice of lower extremity reconstruction is an appropriate free flap solution,the peroneus brevis muscle flap can also be seen as a valuable tool to reconstruct small to medium sized defects at the ankle, distal tibia, and the heel with an acceptable donor site morbidity. Despite the easily available variety of free flaps to achieve this purpose, still proper indications remain where a local flap can be a viable option in the hand of experienced plastic surgeons. However, caution is advisable in patients with peripheral arterial occlusive disease or venous insufficiency.展开更多
文摘New developments in regenerative medicine are bound to revolutionize the way we approach loss of function and form in human organisms. Especially in the field of reconstructive plastic surgery new biotechnologies find their way from bench to bed. Biofabrication is an evolving field that aims to combine natural biologic processes with bioartificial constructs with the scope of reconstituting tissue without having to rely on autotransplantation. In this brief review we present the concepts of intrinsic vs. extrinsic neovascularization and we discuss the use of neovascularization in three dimensional matrices. In a clinical context matrix flaps for application in reconstructive surgery can be fabricated this way.
文摘Necrotizing fasciitis (NF) is a severe soft tissue infection which has to be treated with a radical debridement as the key element. In the further course often large tissue defects occur, so that a long-term stable defect reconstruction plays a crucial role after any successful debridement. The reconstruction can include split skin grafting or local and free flaps. Here we present a case of a 41-year-old male patient with a NF in the trochanter major region after spondylodesis and spinal cord stimulation (SCS) device implantation. After multiple operations including local and free flaps we performed a defect reconstruction using an arteriovenous (AV) loop and subsequent free latissimus dorsi transplantation leading to no further operations. This complex reconstruction can be considered as the final stage of any reconstruction latter.
文摘Aim: Soft tissue defects with or without exposed bones in the lower extremity, ankle and the foot-with or without bone defects or exposed hardware-often require coverage with vascularized flaps. Free flaps, which add healthy tissue especially to the lower extremity instead of further injuring a limb, are the first choice in high volume microsurgical centres. Nevertheless, in some instances pedicled flaps may have indications when free flaps are not suitable. Methods: The distally based peroneus brevis flap is harvested from the lateral compartment of the leg based on the distal perforating arterial supply and covered with split skin. Results: We performed a total of 69 peroneus flaps between 2003 and 2017. Minor flap necroses at the distal tip were noted in 8% of the peroneus brevis reconstructions. Total flap loss occurred in 1 peroneus flap. Defect etiology and patient age were not associated with surgical outcome. Conclusion: While nowadays the first choice of lower extremity reconstruction is an appropriate free flap solution,the peroneus brevis muscle flap can also be seen as a valuable tool to reconstruct small to medium sized defects at the ankle, distal tibia, and the heel with an acceptable donor site morbidity. Despite the easily available variety of free flaps to achieve this purpose, still proper indications remain where a local flap can be a viable option in the hand of experienced plastic surgeons. However, caution is advisable in patients with peripheral arterial occlusive disease or venous insufficiency.
