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Defect Coverage after Forequarter Amputation—A Systematic Review Assessing Different Surgical Approaches

Autologous fillet flaps are a common reconstructive option for large defects after forequarter amputation (FQA) due to advanced local malignancy or trauma. The inclusion of osseous structures into these has several advantages. This article therefore systematically reviews reconstructive options afte...

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Autores principales: Ehrl, Denis, Wachtel, Nikolaus, Braig, David, Kuhlmann, Constanze, Dürr, Hans Roland, Schneider, Christian P., Giunta, Riccardo E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9031327/
https://www.ncbi.nlm.nih.gov/pubmed/35455676
http://dx.doi.org/10.3390/jpm12040560
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author Ehrl, Denis
Wachtel, Nikolaus
Braig, David
Kuhlmann, Constanze
Dürr, Hans Roland
Schneider, Christian P.
Giunta, Riccardo E.
author_facet Ehrl, Denis
Wachtel, Nikolaus
Braig, David
Kuhlmann, Constanze
Dürr, Hans Roland
Schneider, Christian P.
Giunta, Riccardo E.
author_sort Ehrl, Denis
collection PubMed
description Autologous fillet flaps are a common reconstructive option for large defects after forequarter amputation (FQA) due to advanced local malignancy or trauma. The inclusion of osseous structures into these has several advantages. This article therefore systematically reviews reconstructive options after FQA, using osteomusculocutaneous fillet flaps, with emphasis on personalized surgical technique and outcome. Additionally, we report on a case with an alternative surgical technique, which included targeted muscle reinnervation (TMR) of the flap. Our literature search was conducted in the PubMed and Cochrane databases. Studies that were identified were thoroughly scrutinized with regard to relevance, resulting in the inclusion of four studies (10 cases). FQA was predominantly a consequence of local malignancy. For vascular supply, the brachial artery was predominantly anastomosed to the subclavian artery and the brachial or cephalic vein to the subclavian or external jugular vein. Furthermore, we report on a case of a large osteosarcoma of the humerus. Extended FQA required the use of the forearm for defect coverage and shoulder contour reconstruction. Moreover, we performed TMR. Follow-up showed a satisfactory result and no phantom limb pain. In case of the need for free flap reconstruction after FQA, this review demonstrates the safety and advantage of osteomusculocutaneous fillet flaps. If the inclusion of the elbow joint into the flap is not possible, we recommend the use of the forearm, as described. Additionally, we advocate for the additional implementation of TMR, as it can be performed quickly and is likely to reduce phantom limb and neuroma pain.
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spelling pubmed-90313272022-04-23 Defect Coverage after Forequarter Amputation—A Systematic Review Assessing Different Surgical Approaches Ehrl, Denis Wachtel, Nikolaus Braig, David Kuhlmann, Constanze Dürr, Hans Roland Schneider, Christian P. Giunta, Riccardo E. J Pers Med Review Autologous fillet flaps are a common reconstructive option for large defects after forequarter amputation (FQA) due to advanced local malignancy or trauma. The inclusion of osseous structures into these has several advantages. This article therefore systematically reviews reconstructive options after FQA, using osteomusculocutaneous fillet flaps, with emphasis on personalized surgical technique and outcome. Additionally, we report on a case with an alternative surgical technique, which included targeted muscle reinnervation (TMR) of the flap. Our literature search was conducted in the PubMed and Cochrane databases. Studies that were identified were thoroughly scrutinized with regard to relevance, resulting in the inclusion of four studies (10 cases). FQA was predominantly a consequence of local malignancy. For vascular supply, the brachial artery was predominantly anastomosed to the subclavian artery and the brachial or cephalic vein to the subclavian or external jugular vein. Furthermore, we report on a case of a large osteosarcoma of the humerus. Extended FQA required the use of the forearm for defect coverage and shoulder contour reconstruction. Moreover, we performed TMR. Follow-up showed a satisfactory result and no phantom limb pain. In case of the need for free flap reconstruction after FQA, this review demonstrates the safety and advantage of osteomusculocutaneous fillet flaps. If the inclusion of the elbow joint into the flap is not possible, we recommend the use of the forearm, as described. Additionally, we advocate for the additional implementation of TMR, as it can be performed quickly and is likely to reduce phantom limb and neuroma pain. MDPI 2022-04-01 /pmc/articles/PMC9031327/ /pubmed/35455676 http://dx.doi.org/10.3390/jpm12040560 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Ehrl, Denis
Wachtel, Nikolaus
Braig, David
Kuhlmann, Constanze
Dürr, Hans Roland
Schneider, Christian P.
Giunta, Riccardo E.
Defect Coverage after Forequarter Amputation—A Systematic Review Assessing Different Surgical Approaches
title Defect Coverage after Forequarter Amputation—A Systematic Review Assessing Different Surgical Approaches
title_full Defect Coverage after Forequarter Amputation—A Systematic Review Assessing Different Surgical Approaches
title_fullStr Defect Coverage after Forequarter Amputation—A Systematic Review Assessing Different Surgical Approaches
title_full_unstemmed Defect Coverage after Forequarter Amputation—A Systematic Review Assessing Different Surgical Approaches
title_short Defect Coverage after Forequarter Amputation—A Systematic Review Assessing Different Surgical Approaches
title_sort defect coverage after forequarter amputation—a systematic review assessing different surgical approaches
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9031327/
https://www.ncbi.nlm.nih.gov/pubmed/35455676
http://dx.doi.org/10.3390/jpm12040560
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