The Experts below are selected from a list of 351 Experts worldwide ranked by ideXlab platform
Bruno Coessens - One of the best experts on this subject based on the ideXlab platform.
-
one stage elbow interposition arthroplasty with a fasciocutaneous distally planned Lateral Arm Flap
Acta Orthopaedica Belgica, 2002Co-Authors: Michel Vancabeke, Guyve Lamraski, Jeanvalery Berthe, Bruno CoessensAbstract:We report a case of severe posttraumatic ankylosis of the elbow with chronic osteomyelitis of the Lateral condyle of the humerus. The triple problem of restoring elbow mobility, providing for coverage, and controlling infection was treated in a one-stage procedure. A distally planned fasciocutaneous Lateral Arm Flap was used for elbow interposition arthroplasty. Clinical examination at 27 months showed restoration of a useful range of elbow motion and good pain relief.
-
evaluation of the donor site morbidity after Lateral Arm Flap with skin paddle extending over the elbow joint
British Journal of Plastic Surgery, 2000Co-Authors: Moustapha Hamdi, Bruno CoessensAbstract:Summary The free Lateral Arm Flap may be extended to include the skin over the Lateral aspect of the elbow and the foreArm. However, extending the Flap beyond the Lateral condyle has been thought to interfere with the elbow function. The aim of this study was to assess the donor site morbidity after placement of the skin paddle across the Lateral aspect of the elbow joint. Seventeen consecutive Lateral Arm Flaps with a skin paddle designed over the elbow joint were performed for different indications. Eleven patients were followed up postoperatively for a minimum of 6 months. The range of motion, torque, power and endurance of the elbow joint were recorded using a Cybex 340 isometric dynamometer. The values of the operated elbow were compared to those of the unoperated elbow and the deficits were expressed in percentages. The touch sensation in the territory of the posterior cutaneous nerve of the foreArm was assessed using Semmes-Weinstein monofilaments. Patient satisfaction was evaluated with a self-assessment scale. The donor site scar was stretched in one patient. No patient complained of elbow pain or cold intolerance. Elbow mobility was not significantly affected by Flap harvesting ( P =0.06). An extension deficit of 4% was found in four patients. The mean torque, power and endurance deficits were 7.3%, 7.5% and 4.4% respectively as compared to the contraLateral side. Complete loss of sensation was not present in any of the donor sites. However, an area of hypoaesthesia with a mean size of 45 cm 2 (range 20–75 cm 2 ) was found on the posteroLateral surface of the foreArm. Patient satisfaction with the donor site was rated high. From this retrospective review it appears that elbow function was not significantly affected by extending or planning the Lateral Arm Flap over the Lateral condyle.
-
one stage reconstruction of an infected skin and achilles tendon defect with a composite distally planned Lateral Arm Flap
Plastic and Reconstructive Surgery, 1998Co-Authors: Jeanvalery Berthe, Daniel Toussaint, Bruno CoessensAbstract:In this paper, the treatment of a complicated Achilles tendon defect with a composite Lateral Arm Flap with distal design of the skin paddle has been presented. The extended portion of the Flap was sufficient to restore adequate contour to the posterior aspect of the ankle, and reinervation showed good protective sensation at 1 year. In terms of resurfacing, the use of the reinervated Lateral Arm Flap with a distal design of the skin paddle seems advantageous. The weakening of the reconstructed Achilles tendon, although without clinical incidence and impairment of elbow extensors at this stage, may indicate that a better substitute than the triceps tendon has to be found. Nevertheless, we would best reconstruct such an Achilles tendon defect by the same technique because of the well vascularized autologous tissue it provides, limiting the risk of infection.
-
The distally planned Lateral Arm Flap in hand reconstruction.
Chirurgie de la main, 1998Co-Authors: Bruno Coessens, Moustapha HamdiAbstract:The Lateral Arm Flap is a versatile free Flap with straightforward dissection and low donor site morbidity. However, it presents some drawbacks: the vascular pedicle is relatively short (2-6 cm), and the Flap is rather thick. Further surgery is often needed to decrease Flap volume. An anastomotic network between the posterior colLateral radial artery and the recurrent radial artery allows the skin paddle to be safety located over the epicondylar region and proximal foreArm. This modification increases pedicle length up to 100% and limits the amount of subcutaneous fat. A series of eight consecutive distally planned Lateral Arm Flaps used for hand reconstruction is presented. The medical records and operative notes were reviewed. Six patients were reviewed. The minimum follow-up was six months. Flap size ranged from 11 x 5.5 cm to 23 x 7 cm (average 15 x 6 cm), pedicle length ranged from 8 to 10 cm (average 9 cm), no venous grafts were needed for the microanastomosis. The mean Flap harvesting time was 50 minutes. All donor sites were closed primarily. All Flaps survived totally despite postoperative arterial thrombosis in one case that was salvaged by a skin graft over the surviving fascia. To date, no further surgery was needed to debulk the Flaps. The donor site scar was enlarged in one patient. Elbow mobility was unaffected by surgery. Patient self-assessment of appearance of both reconstruction and donor site showed a high satisfaction rate. The distally planned Lateral Arm Flap presents decreased bulk and a longer pedicle than the classical Lateral Arm Flap with no added technical difficulties.
-
the distally based Lateral Arm Flap for intraoral soft tissue reconstruction
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 1997Co-Authors: Pierre Vico, Bruno CoessensAbstract:Background: The radial foreArm Flap is probably the most frequently used among free Flaps for intraoral soft tissue reconstruction. However, this Flap is not always available. The other fasciocutaneous Flaps may be too bulky or less pliable or may have a short vascular pedicle; their use is therefore less than ideal. We present a variant of the Lateral Arm Flap located distally to the Lateral epicondyle and having the same advantages as the radial foreArm Flap. Methods: Vascular study (dissection and radiography) was previously undertaken to determine the vascular anastomotic network in the epicondylar area, between the posterior radial colLateral artery and recurrent arteries running in front of the Lateral epicondyle. This demonstrated the possibility of taking a skin paddle on and below the Lateral epicondyle, based on the proximal pedicle. Results: We used this Flap on three patients for intraoral soft tissue reconstruction (tonsil, floor of the mouth, and piriform sinus). No complication with the Flap itself was encountered. In all cases, direct closure of the donor site was possible, with no local complication. Conclusion: The distal Lateral Arm Flap (LAF) represents an interesting and reliable altemative to the fasciocutaneous radial foreArm Flap. The positioning of the skin paddle over the Lateral epicondyle and the proximal third of the Lateral aspect of the foreArm increases pedicle length, thus avoiding the use of vein grafts. Dissection is straightforward with a reliable vascular anatomy. Moreover, in this area, the limited amount of subcutaneous fatty tissue ensures easier placement and more pliability when compared with the standard LAF. Sons, Inc. Head Neck 19: 33-36, 1997.
Pierre Vico - One of the best experts on this subject based on the ideXlab platform.
-
the distally based Lateral Arm Flap for intraoral soft tissue reconstruction
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 1997Co-Authors: Pierre Vico, Bruno CoessensAbstract:Background: The radial foreArm Flap is probably the most frequently used among free Flaps for intraoral soft tissue reconstruction. However, this Flap is not always available. The other fasciocutaneous Flaps may be too bulky or less pliable or may have a short vascular pedicle; their use is therefore less than ideal. We present a variant of the Lateral Arm Flap located distally to the Lateral epicondyle and having the same advantages as the radial foreArm Flap. Methods: Vascular study (dissection and radiography) was previously undertaken to determine the vascular anastomotic network in the epicondylar area, between the posterior radial colLateral artery and recurrent arteries running in front of the Lateral epicondyle. This demonstrated the possibility of taking a skin paddle on and below the Lateral epicondyle, based on the proximal pedicle. Results: We used this Flap on three patients for intraoral soft tissue reconstruction (tonsil, floor of the mouth, and piriform sinus). No complication with the Flap itself was encountered. In all cases, direct closure of the donor site was possible, with no local complication. Conclusion: The distal Lateral Arm Flap (LAF) represents an interesting and reliable altemative to the fasciocutaneous radial foreArm Flap. The positioning of the skin paddle over the Lateral epicondyle and the proximal third of the Lateral aspect of the foreArm increases pedicle length, thus avoiding the use of vein grafts. Dissection is straightforward with a reliable vascular anatomy. Moreover, in this area, the limited amount of subcutaneous fatty tissue ensures easier placement and more pliability when compared with the standard LAF. Sons, Inc. Head Neck 19: 33-36, 1997.
-
clinical experience with the reverse Lateral Arm Flap in soft tissue coverage of the elbow
Plastic and Reconstructive Surgery, 1993Co-Authors: Bruno Coessens, Pierre Vico, A De MeyAbstract:Coverage of soft-tissue defects of the posterior aspect of the elbow is a difficult problem. Many techniques have been published, mostly case reports. The radial recurrent fasciocutaneous Flap as described by Maruyama and Takeuchi represents one of the best solutions for medium-sized defects. We used it successfully in five clinical cases. The anatomy of this Flap, based on the radial recurrent artery, has been confirmed by our cadaver studies, and a technique to raise this Flap safely will be described.
Erwin Scharnagl - One of the best experts on this subject based on the ideXlab platform.
-
reconstruction of combined defects of the achilles tendon and the overlying soft tissue with a fascia lata graft and a free fasciocutaneous Lateral Arm Flap
Annals of Plastic Surgery, 2003Co-Authors: F Haas, Horst Koch, Gerhard Pierer, Franz J Seibert, Martin Hubmer, H Moshammer, Erwin ScharnaglAbstract:A new approach to reconstruction of the Achilles tendon and overlying soft tissue is presented. A fascia lata graft is used to reconstruct the tendon and is enwrapped by the fascia that is included in a fasciocutaneous Lateral Arm Flap. Five patients were treated with this technique; three of them after surgical Achilles tendon repair, rerupture, and consecutive infection, one after a full-thickness burn with loss of the tendon and one with a history of ochronosis and necrosis of the whole tendon and overlying soft tissue. There were no anastomotic complications and all Flaps healed primarily. Functional evaluation with the Cybex II dynamometer was done at least 49 months after reconstruction. A good functional and cosmetic result was obtained in all patients and donor site morbidity was acceptable. These results are well within the results of other surgical treatment options reported in the literature.
-
free osteocutaneous Lateral Arm Flap anatomy and clinical applications
Microsurgery, 2003Co-Authors: Franz Haas, Thomas Rappl, Horst Koch, Petra Pittler, Erwin ScharnaglAbstract:For many surgeons, the potential to reconstruct skin, fascia, tendon, or bone in a single-stage procedure has made the Lateral Arm Flap the technique of choice for reconstruction of complex defects. The aim of this study was to examine more closely how the humeral bone is supplied by the posterior colLateral radial artery. To this end, we dissected 30 cadaver Arms to determine the vascular relationship of the Lateral Arm Flap to the humerus. The number of directly supplying vessels, and height to the Lateral epicondyle of the humerus, were examined. The reconstructive potential of the osteocutaneous Flap in different indications is analyzed in a series of five clinical cases. In all dissected extremities, we found one or two branches of the posterior colLateral artery directly and constantly supplying the bone between 2-7 cm proximal to the Lateral epicondyle. In five cases, combined defects, including bone, were successfully reconstructed with Lateral Arm Flaps, including vascularized bone.
M Sauerbier - One of the best experts on this subject based on the ideXlab platform.
-
the free Lateral Arm Flap a reliable option for reconstruction of the foreArm and hand
Hand, 2012Co-Authors: M Sauerbier, Gunter Germann, Goetz A Giessler, Sedigh M Salakdeh, M DollAbstract:Background This retrospective study was performed to verify the advantages and disadvantages of the free Lateral Arm Flap for defect reconstruction of the foreArm and hand.
-
outcome assessment after reconstruction of complex defects of the foreArm and hand with osteocutaneous free Flaps
Plastic and Reconstructive Surgery, 2006Co-Authors: Thomas Kremer, B Bickert, Gunter Germann, Christoph Heitmann, M SauerbierAbstract:Background: Complex defects of the foreArm and hand often require microvascular reconstruction with osteocutaneous free Flaps for limb salvage. Methods: Fifteen patients with osseous and soft-tissue defects of the foreArm and hand were treated with osteocutaneous Flaps (1992 to 2004) and evaluated for postoperative results. Assessment focused on range of motion, pain, grip strength, and Disabilities of Arm, Shoulder, and Hand questionnaire score. Donor- and recipient-site morbidity was documented. Results: The defects resulted from trauma, infection, or malignancy. Reconstruction was possible by microvascular osteoseptocutaneous fibula transplantation (n = 8), osteocutaneous scapular or parascapular Flaps(n = 6), and osteocutaneous Lateral Arm Flap (n = 1). The average patient age was 38 years. The median osseous defect was 11.7 cm, and all patients needed additional soft-tissue reconstruction. All defects could be reconstructed in a one-step procedure after serial debridement or oncologic resection. Patients' hand function was markedly reduced compared with the unaffected extremity, but functional results were still satisfactory, with a mean Disabilities of Arm, Shoulder, and Hand score of 25.3 reflecting a moderate disability in activities of daily living. Two patients developed pseudarthrosis, and one had to undergo an ablation procedure because of persistent infection. Two patients developed wound dehiscence at the donor site, and one patient required a fasciotomy due to an imminent compartment syndrome after fibula harvest. For all patients, the functional results were acceptable when the potential alternatives were taken into consideration. This was also reflected by a high individual satisfaction rate. Conclusion: This analysis demonstrates that limb salvage with osteocutaneous free Flaps is the treatment of choice for three-dimensional defects of the foreArm and hand.
Coessens Bruno - One of the best experts on this subject based on the ideXlab platform.
-
Evaluation of the donor site morbidity after Lateral Arm Flap with skin paddle extending over the elbow joint
'Elsevier BV', 2000Co-Authors: Hamdi Moustapha, Coessens BrunoAbstract:The free Lateral Arm Flap may be extended to include the skin over the Lateral aspect of the elbow and the foreArm. However, extending the Flap beyond the Lateral condyle has been thought to interfere with the elbow function. The aim of this study was to assess the donor site morbidity after placement of the skin paddle across the Lateral aspect of the elbow joint. Seventeen consecutive Lateral Arm Flaps with a skin paddle designed over the elbow joint were performed for different indications. Eleven patients were followed up postoperatively for a minimum of 6 months. The range of motion, torque, power and endurance of the elbow joint were recorded using a Cybex 340 isometric dynamometer. The values of the operated elbow were compared to those of the unoperated elbow and the deficits were expressed in percentages. The touch sensation in the territory of the posterior cutaneous nerve of the foreArm was assessed using Semmes-Weinstein monofilaments. Patient satisfaction was evaluated with a self-assessment scale. The donor site scar was stretched in one patient. No patient complained of elbow pain or cold intolerance. Elbow mobility was not significantly affected by Flap harvesting (P = 0.06). An extension deficit of 4% was found in four patients. The mean torque, power and endurance deficits were 7.3%, 7.5% and 4.4% respectively as compared to the contraLateral side. Complete loss of sensation was not present in any of the donor sites. However, an area of hypoaesthesia with a mean size of 45 cm2 (range 20-75 cm2) was found on the posteroLateral surface of the foreArm. Patient satisfaction with the donor site was rated high. From this retrospective review it appears that elbow function was not significantly affected by extending or planning the Lateral Arm Flap over the Lateral condyle. (C) 2000 The British Association of Plastic Surgeons.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
-
The distally planned Lateral Arm Flap in hand reconstruction
'Elsevier BV', 1998Co-Authors: Coessens Bruno, Hamdi MoustaphaAbstract:The Lateral Arm Flap is a versatile free Flap with straightforward dissection and low donor site morbidity. However, it presents some drawbacks: the vascular pedicle is relatively short (2-6 cm), and the Flap is rather thick. Further surgery is often needed to decrease Flap volume. An anastomotic network between the posterior colLateral radial artery and the recurrent radial artery allows the skin paddle to be safety located over the epicondylar region and proximal foreArm. This modification increases pedicle length up to 100% and limits the amount of subcutaneous fat. A series of eight consecutive distally planned Lateral Arm Flaps used for hand reconstruction is presented. The medical records and operative notes were reviewed. Six patients were reviewed. The minimum follow-up was six months. Flap size ranged from 11 x 5.5 cm to 23 x 7 cm (average 15 x 6 cm), pedicle length ranged from 8 to 10 cm (average 9 cm), no venous grafts were needed for the microanastomosis. The mean Flap harvesting time was 50 minutes. All donor sites were closed primarily. All Flaps survived totally despite postoperative arterial thrombosis in one case that was salvaged by a skin graft over the surviving fascia. To date, no further surgery was needed to debulk the Flaps. The donor site scar was enlarged in one patient. Elbow mobility was unaffected by surgery. Patient self- assessment of appearance of both reconstruction and donor site showed a high satisfaction rate. The distally planned Lateral Arm Flap presents decreased bulk and a longer pedicle than the classical Lateral Arm Flap with no added technical difficulties.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
-
One-stage reconstruction of an infected skin and achilles tendon defect with a composite distally planned Lateral Arm Flap
'Ovid Technologies (Wolters Kluwer Health)', 1998Co-Authors: Berthe Jean-valéry, Toussaint Daniel, Coessens BrunoAbstract:In this paper, the treatment of a complicated Achilles tendon defect with a composite Lateral Arm Flap with distal design of the skin paddle has been presented. The extended portion of the Flap was sufficient to restore adequate contour to the posterior aspect of the ankle, and reinervation showed good protective sensation at 1 year. In terms of resurfacing, the use of the reinervated Lateral Arm Flap with a distal design of the skin paddle seems advantageous. The weakening of the reconstructed Achilles tendon, although without clinical incidence and impairment of elbow extensors at this stage, may indicate that a better substitute than the triceps tendon has to be found. Nevertheless, we would best reconstruct such an Achilles tendon defect by the same technique because of the well vascularized autologous tissue it provides, limiting the risk of infection.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
-
Distally planned Lateral Arm Flap
'Wiley', 1997Co-Authors: Hamdi Moustapha, Coessens BrunoAbstract:The Lateral Arm Flap presents some drawbacks: the vascular pedicle is short (2-6 cm), and the Flap is rather thick. An anastomotic network between the posterior radial colLateral artery and the recurrent radial artery, demonstrated by our previous anatomical dissections, enables one to locate the skin paddle solely over the epicondylar region and the proximal foreArm. Furthermore, since no skin is harvested over the Lateral aspect of the Arm, a random-type vascularisation for the distal skin can be excluded. This modification increases pedicle length up to 100% and limits the amount of subcutaneous fat. A series of 13 consecutive distally based Lateral Arm Flaps was performed, and eight patients were followed up for a minimum of 12 months postoperatively. Flap size ranged from 8 x 5.5 cm to 23 x 7 cm (average, 14 x 6 cm), and pedicle length ranged from 9 to 14 cm (average, 10.5 cm). No venous grafts were needed. The mean Flap harvesting time was 60 minutes. All the donor sites were closed primarily. One Flap suffered from an arterial thrombosis and only partially survived, and another healed uneventfully after successful re-exploration of a venous thrombosis. Only one Flap had to be partially debulked. The donor site scar was enlarged in one patient. Elbow mobility was unaffected by surgery. Patient self-assessment on the appearance of both the reconstruction and the donor site showed a high satiSfaction rate. The distally planned Lateral Arm Flap presents decreased bulk and a longer pedicle when compared with the classical Lateral Arm Flap with no added technical difficulties or morbidity.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe
-
The distally based Lateral Arm Flap for intraoral soft tissue reconstruction
1997Co-Authors: Vico Pierre, Coessens BrunoAbstract:Background: The radial foreArm Flap is probably the most frequently used among free Flaps for intraoral soft tissue reconstruction. However, this Flap is not always available. The other fasciocutaneous Flaps may be too bulky or less pliable or may have a short vascular pedicle; their use is therefore less than ideal. We present a variant of the Lateral Arm Flap located distally to the Lateral epicondyle and having the same advantages as the radial foreArm Flap. Methods: Vascular study (dissection and radiography) was previously undertaken to determine the vascular anastomotic network in the epicondylar area, between the posterior radial colLateral artery and recurrent arteries running in front of the Lateral epicondyle. This demonstrated the possibility of taking a skin paddle on and below the Lateral epicondyle, based on the proximal pedicle. Results: We used this Flap on three patients for intraoral soft tissue reconstruction (tonsil, floor of the mouth, and piriform sinus). No complication with the Flap itself was encountered. In all cases, direct closure of the donor site was possible, with no local complication. Conclusion: The distal Lateral Arm Flap (LAF) represents an interesting and reliable alternative to the fasciocutaneous radial foreArm Flap. The positioning of the skin paddle over the Lateral epicondyle and the proximal third of the Lateral aspect of the foreArm increases pedicle length, thus avoiding the use of vein grafts. Dissection is straightforward with a reliable vascular anatomy. Moreover, in this area, the limited amount of subcutaneous fatty tissue ensures easier placement and more pliability when compared with the standard LAF.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
