Plastic surgery of extensive soft tissue defects of the lower leg in children with the use of a parotid flap after its prefabrication with tissue expanders (preliminary report)

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Abstract

Background. Extensive deep soft tissue defects in children are an indication for the microsurgical reconstruction using autotransplantation of a tissue complex. The use of a flap prefabrication before their microsurgical transplantation to various segments and areas is a promising approach in reconstructive surgery.

Aim. The aim of this study was to evaluate the possibilities and immediate results of plastic surgery of extensive soft tissue defects of the lower leg with a tissue complex, after its prefabrication with a tissue expander, and the state of the donor area in different surgical treatment options.

Materials and methods. Six patients aged 13 ± 2.3 years were operated on for deep scar deformities of the lower leg and foot. For plastic surgery, a pericarpial flap was used. In two patients, the flap was prefabricated with tissue expanders at a volume of 720 ml. After filling the expander, the second stage of surgical treatment was performed. First, the expander was removed. Next, the flap on the artery surrounding the scapula was isolated. Last, it was transplanted into a soft tissue defect of the lower leg with the imposition of microvascular anastomoses. A layer-by-layer suture was applied to the donor wound. The Vancouver scale was used to assess the quality of the scar tissue in the donor area.

Results. The removal of the tissue complex after the prefabrication with expanders made it possible to perform plastic surgery of extensive soft tissue defects of the lower leg in one stage of surgical treatment with the application of a cosmetic suture in the donor area. There were no complications in the postoperative period.

At the examination after six months, patients who did not undergo flap prefabrication complained of cosmetic defects and discomfort when moving in the donor area.

The evaluation of the quality of scar tissue by the Vancouver scale showed that the scars in patients after flap prefabrication were similar to optimal (total score in two patients is 2). In two patients without flap prefabrication, the total score was 7, and in two patients, it was 9, which indicated unsatisfactory cosmetic parameters of the postoperative scar.

Conclusion. The prefabrication of a tissue complex using tissue expanders before microsurgical transplantation enables the collection of a large volume of tissue for plastic surgery of extensive defects. It also reduces the risk of trophic complications in the postoperative period and creates optimal conditions for closing the donor site.

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About the authors

Olga V. Filippova

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: olgafil-@mail.ru
ORCID iD: 0000-0002-1002-0959
SPIN-code: 8055-4840
http://www.rosturner.ru/kl7.htm

MD, PhD, D.Sc., leading research associate of the Department of Trauma Sequelae and Rheumatoid Arthritis

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Anton V. Govorov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: agovorov@yandex.ru
ORCID iD: 0000-0002-7015-5580

MD, PhD, Associate Professor of the Department of Plastic and Reconstructive Surgery

Russian Federation, 2, Litovskay street, Saint-Peterburg, 194100

Yaroslav N. Proshchenko

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: yar-2011@list.ru
ORCID iD: 0000-0002-3328-2070

MD, PhD, senior research associate of the Department of Trauma Sequelae and Rheumatoid Arthritis

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Konstantin A. Afonichev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: afonichev@list.ru
ORCID iD: 0000-0002-6460-2567

MD, PhD, D.Sc., Head of the Department of Trauma Sequelae and Rheumatoid Arthritis

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Natalia S. Galkina

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: galkinadoc@gmail.com
ORCID iD: 0000-0001-9201-7827

MD, orthopedic surgeon of the Department of Reconstructive Microsurgery and Hand Surgery

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

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Supplementary files

Supplementary Files
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1. Fig. 4. Donor sites after removal of the scapular flap without prefabrication with a tissue expander: a - extension of the postoperative scar line; b - multiple striae of intact skin due to tissue tension

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2. Fig. 1. Patient A, 13 years old. Diagnosis of post-traumatic cicatricial deformity of the lower leg and foot, post-traumatic bone ankylosis of the ankle joint”: а — extensive post-traumatic cicatricial deformity of the lower leg and foot with soft tissue deficiency; b — tissue expander implanted in the soft tissue of the chest at the stage of filling; c — a wound of the medial surface of the lower leg and foot after excision of scar tissue; d — the formed complex of tissues on the isolated vascular pedicle (artery enveloping the scapula, and vein); e — a graft after application of microvascular anastomoses, fixed to the bottom and edges of the wound; f — cosmetic suture of the donor site after removal of a large scapular graft; g — postoperative scar before discharge of the patient

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3. Fig. 2. Patient K (15 years old). Diagnosis of post-burn cicatricial deformity of the lower leg and ankle joint region, fibrous ankylosis of the ankle joint: а — cicatricial mass of the posterior surface of the lower leg and ankle joint with multiple trophic ulcers; b — filled tissue expander in the soft tissues of the chest; c — an established scapular graft on the posterior surface of the lower leg and ankle joint; d — cosmetic suture of the donor site after removal of a large scapular graft

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4. Fig. 3. Patient B (12 years old). Diagnosis of post-traumatic deformity of soft tissues and bones of the lower leg and foot, post-traumatic bone ankylosis of the ankle joint: а — extensive cicatricial deformity of the lower leg and foot with pronounced soft tissue deficiency; b — a wound after excision of scar tissue and arthrotomy; c — a graft after application of microvascular anastomoses, attached to the bottom and edges of the wound; d — interrupted suture of the donor site after removal of the scapular graft; e — an established scapular graft on the medial surface of the lower leg and ankle joint

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5. Fig. 4. Donor sites after removal of the scapular graft without prefabrication with a tissue expander: a — extension of the postoperative scar line; b — multiple striae of intact skin due to tissue tension

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Copyright (c) 2020 Filippova O.V., Govorov A.V., Proshchenko Y.N., Afonichev K.A., Galkina N.S.

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