Clinical outcomes and complications associated with surgical resection of chest wall sarcoma.

Introduction: Chest wall sarcomas are rare malignant mesenchymal tumors arising from soft tissue, cartilage and bones. Wide resection is usually the treatment option but often results in postoperative complications after resection of the chest wall. In this study, we reviewed cases of chest wall sarcoma treated with resection of the sternum or ribs and examined the factors that could cause complications.

Extended Anterolateral Thigh Flaps: Maximum Size for Covering Cancerous Defects.

Background: The anterolateral thigh perforator flap is frequently used for massive soft-tissue defect reconstruction. Cadaver perfusion examinations of isolated anterolateral thigh flaps have suggested a maximum skin area that may be vascularized based on the perforating vessels (ie, 250 cm 2 ). Therefore, this study aimed to evaluate a series of consecutive cases involving use of extended anterolateral thigh flaps for oncologic reconstruction of massive soft-tissue defects.

Managing Wound Complications After Osteosarcoma Resection: Stopping Adjuvant Therapy and Performing Secondary Closure.

Purpose Adjuvant chemotherapy (AC) following limb-sparing surgery with endoprosthesis is the gold standard treatment for osteosarcoma (OS). However, AC can impair wound healing, leading to endoprosthesis exposure, making the decision to continue or pause AC important. We propose standard guidelines for managing this situation.

Correction: The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.

[This corrects the article DOI: 10.1371/journal.pone.

Nonreversed great saphenous vein grafts for vascular reconstruction after resection of lower-limb sarcoma.

Objective: Reversed great saphenous vein (GSV) graft is widely used for revascularization in limb-sparing surgery for sarcoma invading great vessels. However, a mismatch in caliber between the reverse graft and cut end of the artery can threaten graft patency. Recently, we introduced the use of a venous valvulotome to allow nonreversed GSV graft.

Pectoralis Major Muscle Flap Utilization in Salvage Esophagectomy Including Great Vessel Resection Reconstructed by Prosthetic Grafts.

Background: Salvage surgery is a therapeutic option for recurrent or residual esophageal cancer after definitive chemoradiation therapy. This report aimed to describe the procedure of reconstruction after salvage esophagectomy involving great vessel resection using prosthetic grafts, a pectoralis major muscle (PM) flap, and free jejunal transfer, if required. To the best of our knowledge, no previous report has described the reconstruction of the defect after combined esophageal and great vessel resection.

The Ischemic Tolerance up to Four Hours of Free Jejunum Flap: A Retrospective Cohort Study.

Background:  While free jejunum transfer (FJT) following total pharyngo-laryngo-esophagectomy (TPLE) is a reliable reconstruction technique, the jejunum flap is viewed as more susceptible to ischemia than a standard free flap. Animal studies have indicated that the jejunum can tolerate ischemia for as little as 2 to 3 hours. Clinical studies also reported increased complications after the FJT with more than 3 hours of ischemia.

Soft Tissue Reconstruction Using the Free Forearm Fillet Flap in the Salvage of Forequarter Amputations for Recurrent Sarcoma: A Report of 2 Cases.

Reconstruction after radical forequarter amputation for recurrent proximal extremity sarcoma is challenging because the defect is significant, and the axillary or subclavian vessels are resected with the tumor, indicating that the pedicle of nearby flaps is often cut off. Free flaps are commonly used to cover the defect, but the donor site morbidity is problematic. Another problem with resecting the axillary or subclavian vessels is difficulty obtaining recipient vessels with matching calibers for another free flap.

Wearable, wireless, multi-sensor device for monitoring tissue circulation after free-tissue transplantation: a multicentre clinical trial.

Wearable sensors have seen remarkable recent technological developments, and their role in healthcare is expected to expand. Specifically, monitoring tissue circulation in patients who have undergone reconstructive surgery is critical because blood flow deficiencies must be rescued within hours or the transplant will fail due to thrombosis/haematoma within the artery or vein. We design a wearable, wireless, continuous, multipoint sensor to monitor tissue circulation.

Superficial Temporal Vein and Alternative Middle Temporal Vein as Recipient Veins for Free-flap Reconstruction.

The superficial and middle temporal veins (STV and MTV) have been used as recipient veins for free-flap reconstruction; however, the STV is sometimes small and cannot be used, while the MTV is not fully recognized or utilized as a recipient vein. The purpose of the present study was to evaluate the reliability of the STV/MTV as recipient veins and to verify the utility and availability of the MTV by comparing the two veins. Thirty-five consecutive cases of free-flap reconstruction utilizing recipient vessels in the temporal region were retrospectively reviewed.

Free Flap Reconstruction of Oncologic Gluteal Defects.

A number of studies have already examined gluteal reconstruction with free flaps. Thus, the aim of this study was to investigate the reliability of free flap reconstruction for oncologic gluteal defects. This retrospective cohort study included 23 patients who underwent immediate soft tissue reconstruction for an oncologic gluteal defect.

The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.

Background: Previous studies have reported on the abundant cutaneous perforating blood vessels around the latissimus dorsi (LD) lateral border, such as a thoracodorsal artery perforator (TDAP) of septocutaneous type (TDAP-sc) and muscle-perforating type (TDAP-mp), or the lateral thoracic artery perforator (LTAP). These perforators have been clinically utilized for flap elevation; however, there have been few studies that accurately examined all the cutaneous perforators (TDAP-sc, TDAP-mp, LTAP) around the LD lateral border. Here, we propose a new "whole perforator system" (WPS) concept in the lateral thoracic region and a methodology that enables elevating large flaps with reliable perfusion in a muscle-preserving manner.

A Quantitative Evaluation of the Flow-Increasing Effect of Flow-Through Arterial Anastomosis in the Vascular Pedicle of Free Flaps: A Prospective Clinical Before-and-After Study.

Background: The clinical application of flow-through anastomosis has been reported in various studies; however, no studies have quantitatively evaluated and compared the actual hemodynamics in flow-through anastomosis and end-to-end anastomosis. This study quantitatively evaluated the blood inflow (volumetric flow rate) and vascular resistance (pulsatility index) of flow-through arterial anastomosis using an ultrasonic flowmeter, and compared these values with those of end-to-end anastomosis in actual clinical settings. In addition, factors affecting the outcomes have also been examined.

Chronological flap volume and distribution changes after reconstruction of total maxillectomy defect using a rectus abdominis myocutaneous flap.

Background/purpose: After total or subtotal maxillectomy, reconstruction using a free rectus abdominis myocutaneous (RAMC) flap is a fundamental and useful option. The purpose of the present study was to clarify the degree of flap volume change and volume distribution change with time after total or subtotal maxillectomy and free RAMC flap reconstruction and to examine the factors affecting the results.

Methods: A total of 20 patients who underwent total or subtotal maxillectomy with free RAMC flap reconstruction were examined, and the flap volume change rate (volume at final evaluation [POD 181-360] / volume at initial evaluation [POD 5-30]) was investigated using the results of imaging tests.

Olfactory Preservation in Craniofacial Resection of Tumor Invading Hemianterior Skull Base: Operative Video.

In traditional craniofacial resection of tumors invading the anterior skull base, the bilateral olfactory apparatus is resected. Recently, transnasal endoscopy has been used for olfactory preservation in resections of unilateral low-grade malignancies. However, for tumors that invade the orbita or for high-grade malignancies, the transnasal endoscopic skull base surgery has been controversial.

Risk Factors for Delayed Surgical Recovery and Massive Bleeding in Skull Base Surgery.

Background: To determine factors that delay surgical recovery and increase intraoperative hemorrhage in skull base surgery.

Methods: Factors related to delayed postoperative recovery were retrospectively reviewed in 33 patients who underwent open skull base surgery. Early and late recovery phases were assessed as "days required to walk around the ward (DWW)" and "length of hospital stay (LHS)," respectively.

Boomerang-shaped Lateral-to-back Flap Utilizing Multiple Thoracodorsal Artery Perforators around the Lateral Border of Latissimus Dorsi Muscle for Reconstruction of Large Circular Defect.

We herein report the successful reconstruction of an extensive circular skin defect of the elbow region using a boomerang-shaped lateral-to-back muscle-sparing latissimus dorsi myocutanous flap utilizing multiple thoracodorsal artery perforators around the lateral border of the latissimus dorsi. The patient was a 74-year-old woman who presented with pleomorphic sarcoma in the left elbow region. The tumor was extensively resected and the skin defect was 13.

Exposed Artificial Plate Covered With Perifascial Areolar Tissue as a Nonvascularized Graft.

Perifascial areolar tissue (PAT) is a loose connective tissue on deep fascia, such as on the groin, thigh, or temporal region, which has abundant vascular plexus and mesenchymal stem cells. Nonvascularized PAT grafts can survive even on hypovascular wound beds. Therefore, PAT grafting is a possible alternative to conventional flap surgery to cover exposed bone or artifacts.

Simple-safe-sure Fluid Drainage Just above Breast Tissue Expander using 18-Gauge Blunt Cannula.

The presence of seroma after breast tissue expander (TE) insertion for a long duration can cause infection and purulency; thus, obvious fluid collection around TEs should be drained as early as possible. However, due to the risk of puncture, it may not be possible to completely drain the fluid if it is located above the TE. To manage such cases, we used an 18-gauge blunt cannula and achieved good results.

Takotsubo Cardiomyopathy after Head and Neck Reconstructive Surgery.

Takotsubo cardiomyopathy (TCM) is a form of transient heart failure that clinically mimics acute coronary syndrome and is characterized by left ventricular wall motion abnormalities. The pathophysiology of TCM is not well established. TCM is often preceded by emotional or physical stress and may occur after surgery.

Identification of the cause of severe skin infection by Fournier transform infrared spectroscopy: a case of Fournier's gangrene caused by fish bone.

Fournier's gangrene (FG) is an infrequent but highly lethal infection. Here we report a 74-year-old man who presented with genital swelling and severe malaise. Based on the physical and imaging examination results, the diagnosis of FG was confirmed.

The versatile perifascial areolar tissue graft: adaptability to a variety of defects.

Reconstruction using flaps with good blood circulation is appropriate for covering an intractable ulcer or a fistula in which tendon or bones are exposed. A non-vascularised perifascial areolar tissue (PAT) graft can also survive in such an area. This study reports the versatile application of a PAT graft for use as a non-vascularised graft material.