Dataset Information

Simultaneous Reconstruction of Achilles Tendon and Soft-Tissue Defects with a Composite Anterolateral Thigh Free Flap with Vascularized Fascia Lata.

ABSTRACT:

Introduction

Reconstruction to treat segmental loss of the Achilles tendon combined with soft-tissue defects can be challenging, particularly after the recurrent ruptures that may occur during intense physical activity.

Step 1 preoperative planning

Design flap and use Doppler ultrasound for perforator mapping.

Step 2 debride wound and prepare recipient vessels

Use a two-team approach, one for the affected side and one for the unaffected side.

Step 3 harvest the composite alt flap

Take care to include one or two perforator vessels in the flap and to avoid vessel damage throughout the dissection.

Step 4 perform vascular anastomosis

Use the posterior tibial vessel as the recipient site for the microvascular anastomosis.

Step 5 reconstruct the achilles tendon

Suture the rolled up vascularized fascia lata sheet; then check for tension.

Step 6 postoperative care

Gradual, protected weight-bearing begins at twelve weeks.

Results & preop/postop images

For recurrent tendon rupture, this single-step reconstruction saves both time and expense and it provides a functional tendon reconstruction (enabling normal daily activities) with limited donor-site morbidity and an acceptable cosmetic result without the need for a later debulking procedure.

What to watch for

IndicationsContraindicationsPitfalls & Challenges.

SUBMITTER: Duhamel P

PROVIDER: S-EPMC8318354 | biostudies-literature | 2011 Jul-Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Simultaneous Reconstruction of Achilles Tendon and Soft-Tissue Defects with a Composite Anterolateral Thigh Free Flap with Vascularized Fascia Lata.

Duhamel Patrick P Fossat Sébastien S Brachet Michel M Mathieu Laurent L Rigal Sylvain S Bey Eric E

JBJS essential surgical techniques 20110727 2

<h4>Introduction</h4>Reconstruction to treat segmental loss of the Achilles tendon combined with soft-tissue defects can be challenging, particularly after the recurrent ruptures that may occur during intense physical activity.<h4>Step 1 preoperative planning</h4>Design flap and use Doppler ultrasound for perforator mapping.<h4>Step 2 debride wound and prepare recipient vessels</h4>Use a two-team approach, one for the affected side and one for the unaffected side.<h4>Step 3 harvest the composite ...[more]

PMID: 34377585

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Project description:Using a perfusion decellularization protocol, we developed a decellularized skin/adipose tissue flap (DSAF) comprising extracellular matrix (ECM) and intact vasculature. Our DSAF had a dominant vascular pedicle, microcirculatory vascularity, and a sensory nerve network and retained three-dimensional (3D) nanofibrous structures well. DSAF, which was composed of collagen and laminin with well-preserved growth factors (e.g., vascular endothelial growth factor, basic fibroblast growth factor), was successfully repopulated with human adipose-derived stem cells (hASCs) and human umbilical vein endothelial cells (HUVECs), which integrated with DSAF and formed 3D aggregates and vessel-like structures in vitro. We used microsurgery techniques to re-anastomose the recellularized DSAF into nude rats. In vivo, the engineered flap construct underwent neovascularization and constructive remodeling, which was characterized by the predominant infiltration of M2 macrophages and significant adipose tissue formation at 3months postoperatively. Our results indicate that DSAF co-cultured with hASCs and HUVECs is a promising platform for vascularized soft tissue flap engineering. This platform is not limited by the flap size, as the entire construct can be immediately perfused by the recellularized vascular network following simple re-integration into the host using conventional microsurgical techniques.Statement of significanceSignificant soft tissue loss resulting from traumatic injury or tumor resection often requires surgical reconstruction using autologous soft tissue flaps. However, the limited availability of qualitative autologous flaps as well as the donor site morbidity significantly limits this approach. Engineered soft tissue flap grafts may offer a clinically relevant alternative to the autologous flap tissue. In this study, we engineered vascularized soft tissue free flap by using skin/adipose flap extracellular matrix scaffold (DSAF) in combination with multiple types of human cells. Following vascular reanastomosis in the recipient site, the engineered products successful regenerated large-scale fat tissue in vivo. This approach may provide a translatable platform for composite soft tissue free flap engineering for microsurgical reconstruction.

Dataset Information

Simultaneous Reconstruction of Achilles Tendon and Soft-Tissue Defects with a Composite Anterolateral Thigh Free Flap with Vascularized Fascia Lata.

Introduction

Step 1 preoperative planning

Step 2 debride wound and prepare recipient vessels

Step 3 harvest the composite alt flap

Step 4 perform vascular anastomosis

Step 5 reconstruct the achilles tendon

Step 6 postoperative care

Results & preop/postop images

What to watch for

Publications

Simultaneous Reconstruction of Achilles Tendon and Soft-Tissue Defects with a Composite Anterolateral Thigh Free Flap with Vascularized Fascia Lata.

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