Provisional resection of the nutrient artery in free anterolateral thigh flap debulking surgery
Summary: Fix and flap surgery is the standard treatment for severe open-limb fractures. In cases of complex injuries, secondary surgeries such as additional osteosynthesis, implant removal, bone grafting, and debulking surgery may be required after the soft tissue condition has stabilized. During se...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | JPRAS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352587823001079 |
| _version_ | 1797291805884022784 |
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| author | Yuta Izawa Hiroko Murakami Kazuo Sato Yoshihiko Tsuchida |
| author_facet | Yuta Izawa Hiroko Murakami Kazuo Sato Yoshihiko Tsuchida |
| author_sort | Yuta Izawa |
| collection | DOAJ |
| description | Summary: Fix and flap surgery is the standard treatment for severe open-limb fractures. In cases of complex injuries, secondary surgeries such as additional osteosynthesis, implant removal, bone grafting, and debulking surgery may be required after the soft tissue condition has stabilized. During secondary surgery, if the nutrient vessels of the flap are resected haphazardly and an additional procedure is performed, flap necrosis may occur owing to insufficient blood flow. Creating a hemodynamic system that can withstand secondary surgery through increasing blood flow surrounding the flap is necessary in preventing necrosis. We report a case in which “provisional resection” of the nutrient artery was performed prior to the debulking surgery of a free anterolateral thigh flap.A 45-year-old man sustained an extensive degloving injury on the dorsum of the hand during a car accident. On the fifth day after injury, soft tissue reconstruction with a free anterolateral thigh flap was performed. Although the soft tissue condition was stable, debulking surgery was planned 4 months after the injury because of the thickness of the flap. Flap necrosis may occur if the nutrient artery was resected and debulking surgery was performed simultaneously. Therefore, staged surgery using “provisional resection” of the nutrient artery was selected. First, the nutrient artery was resected. After waiting for 1 week, skin graft removal and flap thinning were performed as the second step. No flap necrosis was observed.“Provisional resection” changes the hemodynamics of the flap to a random pattern due to the delay phenomenon and can prevent flap necrosis caused by secondary surgeries, such as debulking surgery. |
| first_indexed | 2024-03-07T19:42:05Z |
| format | Article |
| id | doaj.art-f9d7851c1e2443d79c2d06a86037780c |
| institution | Directory Open Access Journal |
| issn | 2352-5878 |
| language | English |
| last_indexed | 2024-03-07T19:42:05Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JPRAS Open |
| spelling | doaj.art-f9d7851c1e2443d79c2d06a86037780c2024-02-29T05:19:36ZengElsevierJPRAS Open2352-58782024-03-0139191197Provisional resection of the nutrient artery in free anterolateral thigh flap debulking surgeryYuta Izawa0Hiroko Murakami1Kazuo Sato2Yoshihiko Tsuchida3Corresponding author at: Department of Orthopaedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, Japan.; Department of Orthopaedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, JapanDepartment of Orthopaedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, JapanDepartment of Orthopaedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, JapanDepartment of Orthopaedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 Jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, JapanSummary: Fix and flap surgery is the standard treatment for severe open-limb fractures. In cases of complex injuries, secondary surgeries such as additional osteosynthesis, implant removal, bone grafting, and debulking surgery may be required after the soft tissue condition has stabilized. During secondary surgery, if the nutrient vessels of the flap are resected haphazardly and an additional procedure is performed, flap necrosis may occur owing to insufficient blood flow. Creating a hemodynamic system that can withstand secondary surgery through increasing blood flow surrounding the flap is necessary in preventing necrosis. We report a case in which “provisional resection” of the nutrient artery was performed prior to the debulking surgery of a free anterolateral thigh flap.A 45-year-old man sustained an extensive degloving injury on the dorsum of the hand during a car accident. On the fifth day after injury, soft tissue reconstruction with a free anterolateral thigh flap was performed. Although the soft tissue condition was stable, debulking surgery was planned 4 months after the injury because of the thickness of the flap. Flap necrosis may occur if the nutrient artery was resected and debulking surgery was performed simultaneously. Therefore, staged surgery using “provisional resection” of the nutrient artery was selected. First, the nutrient artery was resected. After waiting for 1 week, skin graft removal and flap thinning were performed as the second step. No flap necrosis was observed.“Provisional resection” changes the hemodynamics of the flap to a random pattern due to the delay phenomenon and can prevent flap necrosis caused by secondary surgeries, such as debulking surgery.http://www.sciencedirect.com/science/article/pii/S2352587823001079Open fractureFree anterolateral thigh flapDebulking surgeryFlap necrosisProvisional resection |
| spellingShingle | Yuta Izawa Hiroko Murakami Kazuo Sato Yoshihiko Tsuchida Provisional resection of the nutrient artery in free anterolateral thigh flap debulking surgery JPRAS Open Open fracture Free anterolateral thigh flap Debulking surgery Flap necrosis Provisional resection |
| title | Provisional resection of the nutrient artery in free anterolateral thigh flap debulking surgery |
| title_full | Provisional resection of the nutrient artery in free anterolateral thigh flap debulking surgery |
| title_fullStr | Provisional resection of the nutrient artery in free anterolateral thigh flap debulking surgery |
| title_full_unstemmed | Provisional resection of the nutrient artery in free anterolateral thigh flap debulking surgery |
| title_short | Provisional resection of the nutrient artery in free anterolateral thigh flap debulking surgery |
| title_sort | provisional resection of the nutrient artery in free anterolateral thigh flap debulking surgery |
| topic | Open fracture Free anterolateral thigh flap Debulking surgery Flap necrosis Provisional resection |
| url | http://www.sciencedirect.com/science/article/pii/S2352587823001079 |
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