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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)
- Authors: Filippova O.V.1, Govorov A.V.1, Proshchenko Y.N.1, Afonichev K.A.1, Galkina N.S.1
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Affiliations:
- H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
- Issue: Vol 8, No 2 (2020)
- Pages: 197-206
- Section: Exchange of experience
- URL: https://journals.eco-vector.com/turner/article/view/25799
- DOI: https://doi.org/10.17816/PTORS25799
- ID: 25799
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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, 196603Anton 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, 194100Yaroslav 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, 196603Konstantin 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, 196603Natalia 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, 196603References
- Сачков А.В. Реваскуляризированные фасциальные аутотрансплантаты в пластической и реконструктивной микрохирургии: Автореф. дис. … канд. мед. наук. – М., 1999. [Sachkov AV. Revaskulyarizirovannye fastsial’nye autotransplantaty v plasticheskoy i rekonstruktivnoy mikrokhirurgii. [dissertation] Moscow; 1999. (In Russ.)]
- Wang W, Zhao M, Tang Y, et al. Long-term follow-up of flap prefabrication in facial reconstruction. Ann Plast Surg. 2017;79(1):17-23. https://doi.org/10.1097/SAP.0000000000000992.
- Быстров А.В., Гассан Т.А., Исаев И.В., Цховребова Л.Э. Возможности префабрикации кожного лоскута в пластической хирургии // Российский вестник хирургии, анестезиологии и реаниматологии. – 2014. – Т. 4. – № 2 – C. 98–103. [Bystrov AV, Gassan TA, Isaev IV, Tskhovrebova LE. Vozmozhnosti prefabrikatsii kozhnogo loskuta v plasticheskoy khirurgii. Rossiyskiy vestnik khirurgii, anesteziologii i reanimatologii. 2014;4(2):98-104. (In Russ.)]
- Chen B, Song H, Xu M, Gao Q. Reconstruction of cica-contracture on the face and neck with skin flap and expanded skin flap pedicled by anterior branch of transverse cervical artery. J Craniomaxillofac Surg. 2016;44(9):1280-1286. https://doi.org/10.1016/ j.jcms.2016.04.020.
- Aggarwal A, Singh H, Mahendru S, et al. Minimising the donor area morbidity of radial forearm phalloplasty using prefabricated thigh flap: A new technique. Indian J Plast Surg. 2017;50(1):91-95. https://doi.org/10.4103/ijps.IJPS_158_16.
- Wang C, Zhang J, Yang S, et al. The clinical application of preexpanded and prefabricated super-thin skin perforator flap for reconstruction of post-burn neck contracture. Ann Plast Surg. 2016;77 Suppl 1:S49-52. https://doi.org/10.1097/SAP.0000000000000711.
- Li Y, Zhou C, Yang M, et al. Repair of face soft tissue defect with prefabricated neck expander flap with the vessels of temporalis superficialis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005;19(2):130-132.
- Chen S, Li Y, Yang Z, et al. Surgical treatment for facial port wine stain by prefabricated expanded cervical flap carried by superficial temporal artery. J Craniofac Surg. 2019;30(7):2124-2127. https://doi.org/10.1097/SCS.0000000000005612.
- Song B, Jin J, Liu Y, Zhu S. Prefabricated expanded free lower abdominal skin flap for cutaneous coverage of a forearm burn wound defect. Aesthetic Plast Surg. 2013;37(5):956-959. https://doi.org/10.1007/s00266-013-0155-8.
- Wang AW, Zhang WF, Li JY, et al. Fabricated expanded thoracodorsal artery perforator flap to repair cervical scar in children. Zhonghua Zheng Xing Wai Ke Za Zhi. 2010;26(3):161-165.
- Пасичный Д.А. Дермотензия в лечении повреждений покровных тканей стопы и голени // Международный медицинский журнал. – 2009. – № 3. – С. 85–89. [Pasichnyy DA. Dermotenziya v lechenii povrezhdeniy pokrovnykh tkaney stopy i goleni. International medical journal. 2009;(3):85-89. (In Russ.)]
- Баиндурашвили А.Г., Филиппова О.В., Афоничев К.А., Вашетко Р.В. Устранение деформирующих рубцов голени и в области ахиллова сухожилия с использованием тканевой дермотензии у детей. Пособие для врачей. – СПб., 2014. – 16 с. [Baindurashvili AG, Filippova OV, Afonichev KA, Vashetko RV. Ustranenie deformiruyushchikh rubtsov goleni i v oblasti akhillova sukhozhiliya s ispol’zovaniem tkanevoy dermotenzii u detey. Posobie dlya vrachey. Saint Petersburg; 2014. 16 p. (In Russ.)]
- Белоусов А.Е. Пластическая реконструктивная и эстетическая хирургия. – СПб.: Гиппократ, 1998. – 774 с. [Belousov AE. Plasticheskaya rekonstruktivnaya i esteticheskaya khirurgiya. Saint Petersburg: Gippokrat; 1998. 774 p. (In Russ.)]
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