Catastrophic rhabdomyolysis following breast reconstruction operation using an abdominal flap: a case report
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SUBMITTER: Kang M
PROVIDER: S-EPMC10506112 | biostudies-literature | 2023 Jun
REPOSITORIES: biostudies-literature
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Project description:BackgroundWound healing problems at the donor site in free abdominal flap breast reconstruction cause significant morbidity to patients. No studies have investigated what impact the use of the internal mammary artery in free abdominal flap breast reconstruction has on abdominal skin perfusion. We hypothesized that harvesting the internal mammary vessels (IMV) has a negative effect on abdominal skin perfusion.MethodsThe abdomen and anterior thoracic wall of 17 patients scheduled for secondary free abdominal flap breast reconstruction using IMV was pre-, intra-, and postoperatively examined with dynamic infrared thermography. Qualitative and quantitative analyses of the rate and pattern of recovery in Huger's vascular zones were made with each patient being its own control. Zone III on the side where IMV were used was numbered zone IV. The contralateral zone III was used as reference.ResultsPostoperative abdominal skin perfusion in zone IV was always significantly reduced compared with zone III (1-tailed t test, P < 0.05). The difference between zones II and III was statistically significant for day 1 and 3, but not for day 6 (2-tailed t test, P < 0.05). Skin perfusion in zones II and IV increased during consecutive postoperative days with an increase of hot spots in these areas.ConclusionsUsing the IMV in free abdominal flap breast reconstruction had a significant effect on abdominal skin perfusion and may contribute to abdominal wound healing problems. The reperfusion of the abdominal skin was a dynamic process showing an increase in perfusion in the affected areas during the postoperative days.
| S-EPMC5889442 | biostudies-literature
Project description:IntroductionAcute appendicitis is one of the most common surgical diseases. Perforated appendicitis resulting in catastrophic complication because of a burst abdomen with necrotizing fasciitis of the abdominal wall is exceedingly a rare case.Presentation of caseA 13-year-old girl with perforated appendicitis who had undergone laparotomy had to experience a burst abdomen with necrotizing fasciitis of the abdominal wall. The patient has temporarily closed the abdominal cavity with a urine bag (modified Bogota bag). After 23 times replacement of the Bogota bag and the condition of the sepsis and nutrition had improved, the abdominal wall reconstruction was performed by carrying out two random rotational flaps to close the abdominal defect. One year later, the patient came for ileocolostomy closure; then the patient was sent home with uneventful condition.DiscussionPerforated appendicitis is a type of acute appendicitis with a low morbidity rate. Compared to other complications, burst abdomen and necrotizing fasciitis (NF) in perforated appendicitis are exceptionally rare events. Surgery with sepsis and recurrent intra-abdominal abscesses as a result of previous surgery are the causes of burst abdomen. The use of abdominal drainage has also been shown to cause NF. Both of these conditions will increase the cost and length of stay, and reduce the quality of life. The rotational flap procedure is the procedure of choice for a large burst abdomen.ConclusionSurgeons should and have to perform a meticulous operation to prevent catastrophic complication and to increase the quality of life.
| S-EPMC7804340 | biostudies-literature
Project description:A 43-year-old woman treated with radical hysterectomy 1 year ago for cervical cancer presented with a suprapubic abdominal mass. A 15 cm necrotic mass from the abdominal wall along with 2 small bowel loops and the dome of the bladder were resected. The peritoneal defect was reconstructed with a pedicled anterolateral thigh and Vastus Lateralis muscle composite flap. Pathology showed invasive non-keratinizing moderately differentiated squamous cell carcinoma, consistent with metastatic cervical cancer, involving urinary bladder, bowel and soft tissue. With advancement in reconstructive surgery, extensive resection with defect closure in properly selected cases of metastatic cervical cancer to the abdominal wall may be considered in an attempt at improving quality of life and overall survival.
| S-EPMC6302027 | biostudies-literature
Project description:Introduction and importanceThe only treatment option for full-thickness burn injury is surgical management, either skin grafting or a skin flap. Treatment may be challenging due to the multiple procedures that need to be performed and multiple factors that can affect treatment outcomes especially to do fingers reconstruction.Case presentationA 25-years-old man was admitted because of a burn injury on the palm of his left hand. There are waxy and leathery appearances of burn injuries on the palm and 2nd to 5th digits of the left hand and diagnosed with a full-thickness contact burn injury and compartment syndrome. The patient underwent a pedicled abdominal skin flap followed by necrotomy, flap thinning, and digit separation as a reconstruction management.Clinical discussionPedicled abdominal skin flap is one of the best surgical techniques available for full thickness burn injury reconstruction because it is believed to regain the closest natural-looking appearance and extremity functions. Abdominal flap as random flap is safe to be divided into small part to cover the fingers.ConclusionThorough examinations and appropriate management such as pedicled abdominal skin flaps are important to perform in patients with full-thickness burn injuries.
| S-EPMC10800593 | biostudies-literature
Project description:Introduction and importanceTotal breast reconstruction with autologous fat transfer (AFT) has a low complication rate. Fat necrosis, infection, skin necrosis and hematoma are the most common complications. Infections are usually mild and manifested by a unilateral red painful breast and treated with oral antibiotics with or without superficial irrigation of the wound.Case presentationOne of our patients reported an ill-fitting pre-expansion device several days after surgery. This was due to a severe bilateral breast infection following a session of total breast reconstruction with AFT despite perioperative and postoperative antibiotic prophylaxis. Surgical evacuation was performed in combination with both systemic and oral antibiotic treatment.Clinical discussionMost infections can be prevented in the early post-operative period with antibiotic prophylaxis. If an infection does occur, it is treated with antibiotics or superficial irrigation of the wound. A delay in identification of an alarming course could be reduced by monitoring the fit to the EVEBRA device, implementing video consultations on indication, limiting the means of communication and better informing the patient on what complications to monitor. The recognition of an alarming course following a subsequent session of AFT is not guaranteed after a session without complication.ConclusionBesides temperature and redness of the breast, a pre-expansion device that doesn't fit can be an alarming sign. Patient communication should be adapted as severe infections can be insufficiently recognized by phone. Evacuation should be considered when an infection does occur.
| S-EPMC9958470 | biostudies-literature
Project description:The profunda femoris artery perforator (PAP) flap has been recently popularized as an alternative option for microsurgical reconstruction. The use of PAP flap has never been reported and described for reconstruction of the upper extremities, in particular the forearm. The purpose of this case report is to describe a case suggesting the PAP flap as a further reconstructive option in the upper limb. A 16-year-old girl who sustained a traumatic injury to her right dominant forearm resulting in subtotal circumferential tissue loss following a road traffic accident was referred to the authors' department 2 years post-trauma. The disabling fibrotic sequelae on her volar forearm (15 × 10 cm) resulted in a nonfunctional hand. She was unable to perform any active movement of her wrist or digits. Passive movements in the finger joints were preserved. Following debridement and reconstruction of nerves and tendons, soft tissues were resurfaced with a PAP flap. The transverse skin paddle, 12 × 7 cm, was placed distally with the adipofascial portion positioned proximally above the muscle bellies and anastomoses site. A small raw area (4 × 3 cm) was covered with an acellular dermal matrix (ADM). The postoperative course was uneventful. At 9 months postoperatively, the patient demonstrated active flexion and extension of the fingers with independent function. The patient reported satisfaction with the flap donor site and forearm resurfacing. The PAP flap can be a further option for areas requiring soft tissue coverage in patients refusing visible scars. This flap had both the advantage of reducing the morbidity and visibility of the donor site, as well as the ability to resurface a large recipient site with soft and pliable tissue, covering exposed nerves and tendons.
| S-EPMC9796947 | biostudies-literature
Project description:Microsurgical reconstruction is nowadays the treatment of choice of several head and neck deformities that otherwise could be repaired with limited or unsatisfactory results. The forearm free flap has its own goals expecially the possibility to reconstruct small and extremely specialized anatomical structures such as the soft palate. The abuse of drugs like cocaine, generally taken by sniffing, can produce vascular impairment in nasal and oral tissues producing, as long as the abuse is kept, necrosis of facial anatomical structures and increase of the empty space in the depth of the face or nose. The consequences are generally represented by palatal fistulas or defect, leak of food or drink from the nose, and rhinolalia. Prelamination of the flap before microvascular transfer ensures not only preparation ofadequate tissue volume to resurface the defect but also optimization of the venous outflow. This two times approach, consisting first in preparation and then elevation/transfer of the flap, gives the chances to ensure viability of the flap itself and organize the surgical strategy several times to reduce forthcoming complications. The authors believe that this technical modification could be used for many other chronic defects in the head and neck region but could also be extended, with experience, to bigger defects.Supplementary informationThe online version contains supplementary material available at 10.1007/s12070-023-03870-7.
| S-EPMC10645686 | biostudies-literature
Project description:Introductionand importance: Large cutaneous defects may result from excision of skin malignancies. Typically, skin grafting is used to manage such defects, but the final result may be compromised by inadequate take and poor cosmesis. Accordingly, transposition flaps may be indicated.Case Presentation and clinical discussion: A 93-year-old female presented with a painful, necrotic 12 cm × 12 cm Squamous Cell Cancer of left upper back. She underwent wide excision followed by a rhomboid transposition fasciocutaneous flap. The flap was easily designed, quickly executed, and did not require any special instruments. The overall result was a good cosmetic outcome with no complications.ConclusionOur case outlines successful use of rhomboid flap instead of a more complicated option to reconstruct a very large cutaneous defect. The flap healed with excellent contour, texture, thickness, and color match.
| S-EPMC7848721 | biostudies-literature
Project description:Total loss of columella causes significant aesthetic and functional deformities due to its important functions which provides assistance and extension to the nose pointer. Noma is described as one of the developed sources of total columellar loss, and is also contagious, with the ability to intensely damage facial tissues and immediate structures. However, the condition is predominantly suffered in Africa, with an estimation of 20 instances per 100,000 individuals. Furthermore, the reformation of a columellar disorder offers a complex process, due to the structural features of the location. A 24-year-old female patient with total columellar loss caused by Noma. We performed a two stage reconstruction. First, we used double nasolabial flaps to create a new columella. Second, we inserted costal cartilage and dermofat graft to support it. The double nasolabial flap demonstrated 100% survival. Both nasal airway and the final appearance showed functionally and cosmetically remarkable results. The nasolabial angle projected better than the preoperative measurement. The patient was satisfied. The patient was followed up until a year after surgery. The double nasolabial flaps combined with costal cartilage graft is one of the best surgical options to obtain astonishing columellar reconstruction.
| S-EPMC7995488 | biostudies-literature
Project description:Nasal reconstruction is a difficult and complex surgery due to highlights and shadows of three-dimensional central structure of the face. Similarity of tissues, units-subunits, and invisibility of the scar are very important principles for reconstruction. In this case report, we present reconstruction of subunits of the nose by an expanded forehead scalping flap in a 12-year-old boy, whose tip and columellar subunits had been avulsed by a dog bite, in a hidden scar manner.
| S-EPMC8929519 | biostudies-literature