The Experts below are selected from a list of 153 Experts worldwide ranked by ideXlab platform
Dimitra Kotsougiani - One of the best experts on this subject based on the ideXlab platform.
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evaluation of perfusion by near infrared fluorescence imaging in late pedicle obstruction of a Parascapular Flap to the lower extremity a case report
Microsurgery, 2018Co-Authors: Felix Strubing, Amir K Bigdeli, Volker J Schmidt, Spyridoula Maraka, Ulrich Kneser, Dimitra KotsougianiAbstract:Late free Flap failures due to pedicle obstruction are rare adverse events. The purpose of this report is to present a case in which the near-infrared indocyanine green video angiography (ICG-NIR-VA) was used to evaluate the perfusion in a compromised fasciocutaneous Flap in the late postoperative period. A 55-year-old male patient, who initially suffered from an open tibial fracture, developed concurrent osteomyelitis with fistulae of the proximal tibia requiring excision. Reconstruction was achieved using a Parascapular Flap of 25 × 8 cm, anastomosed to an arterio-venous (AV) Loop in the adductor canal. On the 2nd postoperative day the patient developed a thrombosis of the AV-Loop. After thrombectomy, the postoperative course was uneventful. Seven weeks postoperatively the patient presented with a mottled, partially bluish and cold Flap. Anticoagulation prophylaxis was stopped 2 days earlier. Angiography confirmed a thrombus in the arterial pedicle leading to Flap ischemia. Near infrared guided fluorescence imaging revealed a delayed recapillarization of the proximal part of the Flap closest to the vascular pedicle, albeit Flap overall perfusion remained intact. Thus, no surgical intervention was undertaken. However, anticoagulation and prostaglandin therapy was initiated and the Flap was salvaged. Genetic analysis uncovered a polymorphism in the prothrombin genes. The Flap remained viable and without further complications until the last follow-up visit at 36 weeks after microsurgical reconstruction. The patient was fully mobilized with complete return to function. Near-infrared guided fluorescence imaging may be a viable tool for the assessment of late fasciocutaneous free Flap complications and guide the decision-making process.
Vipin Kumar Barala - One of the best experts on this subject based on the ideXlab platform.
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a comparative study of tissue expansion and free Parascapular Flaps in extensive facial burn scar reconstruction
International journal of burns and trauma, 2017Co-Authors: G S Kalra, Mitesh Bedi, Vipin Kumar BaralaAbstract:BACKGROUND: Large post burn scars are a very difficult problem to treat. Available methods include skin grafts and tissue expansion. The reconstructive method used should be tailored according to individual patient rather than following a textbook approach in each. PATIENTS AND METHODS: A retrospective analysis was done of cases with extensive facial burn scars in whom secondary reconstruction was done with either free Parascapular Flap cover or tissue expansion and Flap advancement following facial burn scar excision by a single surgeon (GSK) in Department of Burns, Plastic and reconstructive surgery. RESULTS: A total of 15 patients with free Parascapular Flap and 15 patients with tissue expansion followed by Flap advancement were analyzed in the group. There were no free Flap failures, but 2 patients required skin graft at donor site. In patients undergoing tissue expansion, minor complication was noted in 1 patient. CONCLUSION: Tissue expansion is a useful technique in reconstruction of post burn scars, but has its limitations, especially in patients with extensive burns in head and neck region with limited local tissue availability. Parascapular free Flap may provide a good alternative option for reconstruction in such cases.
Bernd Kinner - One of the best experts on this subject based on the ideXlab platform.
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Osteo-fasciocutaneous Parascapular Flap transfer for reconstruction of the first ray of the foot.
Archives of Orthopaedic and Trauma Surgery, 2008Co-Authors: Christina Roll, Lukas Prantl, Michael Nerlich, Bernd KinnerAbstract:Background Severe bone and soft tissue defects of the first metatarsal bone after trauma, tumor resection or osteomyelitis are challenging to treat. Partial amputation of the foot may be the consequence. However, due to its significance for gait, salvage of the first ray should be considered, whenever possible. One option for bone and soft tissue reconstruction, therefore, might be an osteo-fasciocutaneous Parascapular Flap transfer.
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functional donor site morbidity following osteo fasciocutaneous Parascapular Flap transfer
Annals of Plastic Surgery, 2007Co-Authors: Christina Roll, Lukas Prantl, Michael Nerlich, Dominik K Feser, Bernd KinnerAbstract:Problem: The Parascapular Flap is extremely versatile in the armamentarium of the plastic surgeon. However, little is known about the donor-site morbidity. Our purpose was to investigate limitations and problems arising at the donor site of Parascapular Flaps. Methods: Twenty patients with free Parascapular Flaps were followed up over a period of 3 years. Donor-site morbidity was evaluated using standardized evaluation forms. Constant score was calculated to judge shoulder function, SF-36 score was used to evaluate patient satisfaction. Results: All Flaps survived in our series. In 2 patients, delayed wound healing was recorded at the donor site. In 3 patients, shoulder function was limited. In 1 patient, the brachial plexus was affected, and another had preexisting rotator cuff disease. Scar dimensions varied considerably; however, cosmetic aspects of the donor site were not a complaint. Discussion: This is the first report evaluating donor-site morbidity of Parascapular Flaps. Limitations in shoulder function are low if correct operative technique with refixation of the musculature is maintained. In general, patients did not have any complaints about the cosmetic appearance of the donor site.
G S Kalra - One of the best experts on this subject based on the ideXlab platform.
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resurfacing in facial burn sequelae using Parascapular free Flap a long term experience
Journal of Burn Care & Research, 2021Co-Authors: G S Kalra, Sushrut Kalra, Samarth GuptaAbstract:BACKGROUND It is difficult to treat large post burn sequelae (scars and defects) over face. Available methods include skin grafts, local Flaps, tissue expansion, and free Flaps. These surgical options should be chosen wisely, depending upon individual patient requirements and area involved. In patients with large post burn scars and defects in which the surrounding tissue is also involved, use of free tissue transfer is extremely useful. PATIENTS AND METHODS A retrospective analysis was done between 2011 and 2019 of fifty-two cases with extensive facial burn deformities in whom secondary reconstruction was done with free Parascapular Flap cover in or department. Outcome was assessed by direct questionnaire. RESULTS There was no complete Flap loss in the series. Two cases were re-explored for venous insufficiency and suffered partial marginal necrosis. Twenty patients had to undergo further debulking procedure. Forty-seven patients were satisfied by the final outcome. CONCLUSION Post burn facial deformities are difficult to treat, in many cases there are no local options and tissue from different regions is to be used for reconstruction. Free Parascapular Flaps can be used as an effective method in such cases with a high level of patient satisfaction.
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a comparative study of tissue expansion and free Parascapular Flaps in extensive facial burn scar reconstruction
International journal of burns and trauma, 2017Co-Authors: G S Kalra, Mitesh Bedi, Vipin Kumar BaralaAbstract:BACKGROUND: Large post burn scars are a very difficult problem to treat. Available methods include skin grafts and tissue expansion. The reconstructive method used should be tailored according to individual patient rather than following a textbook approach in each. PATIENTS AND METHODS: A retrospective analysis was done of cases with extensive facial burn scars in whom secondary reconstruction was done with either free Parascapular Flap cover or tissue expansion and Flap advancement following facial burn scar excision by a single surgeon (GSK) in Department of Burns, Plastic and reconstructive surgery. RESULTS: A total of 15 patients with free Parascapular Flap and 15 patients with tissue expansion followed by Flap advancement were analyzed in the group. There were no free Flap failures, but 2 patients required skin graft at donor site. In patients undergoing tissue expansion, minor complication was noted in 1 patient. CONCLUSION: Tissue expansion is a useful technique in reconstruction of post burn scars, but has its limitations, especially in patients with extensive burns in head and neck region with limited local tissue availability. Parascapular free Flap may provide a good alternative option for reconstruction in such cases.
Allende Nores, Christian Antonio - One of the best experts on this subject based on the ideXlab platform.
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Colgajo paraescapular en pérdidas postraumáticas de tejidos blandos de las extremidades. [Parascapular Flap in post-traumatic soft-tissue loss at the limbs.]
2018Co-Authors: Vanoli Fernando, Murillo Bernardo, Lobos Centeno Esteban, Gentile Luciano, Gutierrez Olivera Natalia, Allende Nores, Christian AntonioAbstract:IntroductionThe aim of this study is to present the results after the use of paraescapular free Flaps to cover severe soft tissue defects at the extremities.MethodsA retrospective, descriptive study of 20 patients who underwent Parascapular free Flaps to cover massive combined soft tissue lesions at the extremities as a salvage procedure from 2006 to 2017 was performed. Patients age averaged 30 years (18 men, 2 women). Sites of lesions were: ten at the forearm and wrist, one at the inguinal region, seven at the leg and two at the ankle/foot.ResultsFollow-up averaged 3.6 years. Successful coverage was achieved in 17 cases. Flap size averaged 24.8 x 10.7 cm. There were six cases with neurovascular lesions that needed grafting, six cases had associated bone loss, eleven patients needed skin graft and four required tendon reconstructions. Donor area closed primarily without functional limitations in all patients. In three cases the Flap was combined with a scapular Flap and in three cases with a latissimus dorsi Flap. Two Flaps failed and the injured limb was amputated; one patient died due to massive embolism seven days after surgery.ConclusionsParascapular free Flaps allowed salvage and reconstruction of 17 out of 20 severely injured limbs, without morbidity for the donor area. But its use is not free of complications, and a multidisciplinary approach is necessary to reduce this morbidity.IntroducciónEl objetivo de este artículo es comunicar los resultados obtenidos con el uso del colgajo paraescapular para cubrir defectos severos postraumáticos de tejidos blandos en las extremidades. Materiales y Métodos Estudio retrospectivo, descriptivo, de una serie de 20 pacientes a los que se les realizó un colgajo libre paraescapular para cubrir lesiones masivas combinadas postraumáticas de tejidos blandos en las extremidades, entre 2006 y 2017. La edad de los pacientes promedió 30 años (18 hombres, 2 mujeres). La localización de las lesiones fue: 10 en antebrazo y muñeca, una en la región inguinal, siete en la pierna y dos en tobillo/pie.ResultadosEl seguimiento promedió fue de 3.6 años. Se logró la cobertura exitosa en 17 casos. El tamaño de los colgajos promedió 24,8 x 10,7 cm. Seis casos presentaron lesiones vasculonerviosa que necesitaron injerto, seis se asociaron a pérdidas óseas, once requirieron injerto de piel y cuatro, reconstrucciones tendinosas. En todos los pacientes, el área donante cerró en forma primaria y sin secuelas funcionales. Dicho colgajo se combinó con el escapular en tres casos y con colgajo de dorsal ancho en tres casos. Dos colgajos fallaron y debió amputarse la extremidad lesionada; un paciente falleció por embolia masiva al séptimo día de la cirugía.ConclusionesEl colgajo paraescapular permitió salvar y reconstruir satisfactoriamente defectos masivos extensos en 17 de 20 extremidades, sin morbilidad para la zona donante del colgajo, pero su uso no está exento de complicaciones, y un abordaje multidisciplinario es necesario para disminuir esta morbilidad
