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RISS 인기검색어
- 검색키워드
- 저자 : Rakesh Kumar Khazanchi (검색결과 3 건)
- 무료
- 기관 내 무료
- 유료
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Challenges in Microsurgical Free Tissue Transfer for a 1-Year-Old Child
Hardeep Singh,Rakesh Kumar Khazanchi,Sanjay Mahendru,Ankit Jain 대한창상학회 2020 Journal of Wound Management and Research Vol.16 No.2
Challenges faced during complex reconstructions in the pediatric age group are rarely discussed in literature. This study is to share our experience in a 1-year-old patient. The patient had an exposed knee joint following trivial trauma, which was resurfaced with a free latissimus dorsi flap. On the patient’s 5th day in the ward, the flap was discolored and inadequate perfusion was noted. The patient also had loose stools overnight. Before she was re-examined, the dressings were loosened and the patient was kept warm and was started on intravenous fluids. When examined in the operating room, the vascularity of the flap had improved without any intervention. The monitoring skin paddle necrosed while the muscle survived. The patient then underwent skin grafting and had uneventful recovery. The postoperative monitoring in children is critical as they have poor reserves and are prone to complications. We believe pediatric microsurgery should be done in specialized microsurgical centers that also have good intensive care units.
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Hatchet Thigh Flap with Hemi-gluteus Flap for Recurrent Ischial Sore Reconstruction
Hardeep Singh,Ankit Jain,Sanjay Mahendru,Rakesh Kumar Khazanchi 대한창상학회 2020 Journal of Wound Management and Research Vol.16 No.3
Background: Ischial pressure sores are the most challenging sores to treat because of associated bursa and high rate of recurrence. Reconstruction flaps originating in the thigh have a disadvantage as movement may increase shear forces, and tension during closure may lead to wound dehiscence. To circumvent these problems, we hereby present a hatchet thigh flap with good mobility, which can be used for recurrent cases as well.Methods: All patients treated at our hospital in the last 5 years for ischial pressure sores were included in the study. The flap is elevated in the subfascial plane from lateral to medial until the medial circumflex artery perforators are revealed. In recurrent cases the lower half of the gluteus maximus muscle is used to fill in the cavity while the flap from the previous surgery is re-advanced.Results: Sixteen patients (11 males and five females) were in the study. The median age of the patient was 54 years (range, 25–82 years). All the flaps survived fully. Two patients had recurrence at three sites, which were successfully reconstructed by advancing the same flap and hemi-gluteus muscle. An average of 6 months follow-up after surgery for recurrence showed stable reconstruction.Conclusion: The hatchet thigh flap is easy to dissect and reliable for ischial pressure sores. It can be used effectively in recurrent cases when combined with hemi-gluteus flaps.
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Hardeep Singh,Ankit Jain,Rahul Jain,Sanjay Mahendru,Rakesh Kumar Khazanchi 대한창상학회 2023 Journal of Wound Management and Research Vol.19 No.1
The free fibula flap is sometimes associated with partial flap loss. A 62-year-old man with squamous carcinoma of the lower alveolus underwent anterior arch resection and reconstruction with a fibula osteocutaneous flap containing three bony segments. There were two perforators in the skin flap; the first perforator was proximal to the bony segments and the other perforator was at the level of the middle segment. Atherosclerosis was observed in the anastomotic vessels. During surgery, thrombosis occurred in the arterial anastomosis, but was revised before the operation was over. The patient’s early postoperative course was uneventful. In the second week, purulent discharge was observed from the drains. Flap exploration showed devascularization of bony segments and periosteum, but the skin paddle was viable. The peroneal vessel had thrombosed distal to the takeoff of the proximal perforator and the viable skin paddle perfused by proximal perforators falsely indicated the well-being of underlying bones. The de-vascularized bones and sloughed periosteum were removed at the time of exploration, after which the skin paddle was reoriented for coverage of the defect. The patient completed chemoradiation without any bony reconstruction afterwards. This is the only reported case of early total bony flap portion loss with a viable skin paddle in free fibula flap transfer.
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