The triple conjoined scapular–latissimus dorsi–groin flap for reconstruction of long lower extremity degloving injury: A case report

Amendola, Francesco; Spadoni, Davide; Velazquez-Mujica, Jonathan; Platsas, Loukas; Chen, Hung-Chi

doi:10.1002/micr.30827

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…After removal of duplicates, 457 articles were screened by the authors. After primary screening, 239 articles were sought for retrieval, of which 110 studies satisfied the final inclusion criteria (Figure 1) (Akcal et al, 2013; Al‐Benna et al, 2014; Allensworth et al, 2017; Amendola et al, 2022; Ang et al, 2003; Angrigiani, 1994; Angrigiani et al, 2017; Angrigiani & Grilli, 1997; Antohi & Tibirna, 1994; Asato et al, 1993; Aviv et al, 1991; Azizeddin et al, 2018; Azouz et al, 2019; Bannasch et al, 2008; Bartholomew et al, 2018; Barton et al, 2023; Barton, Blumberg, & Patel, 2022; Barton, Pappa, et al, 2022; Blackwell et al, 1996; Blumberg et al, 2019; Chauvel‐Picard et al, 2021; Chim et al, 2022; Choi et al, 2015; Cinar et al, 2007; Clark et al, 2008; Coleman et al, 2000; Coleman & Sultan, 1991; Cronenwett et al, 1989; Datiashvili et al, 1992; Datiashvili & Yueh, 2012; De Lorenzi et al, 2001; Deane et al, 2022; Dowthwaite et al, 2013; Erdmann et al, 2002; Ettinger et al, 2020; Evans & Luethke, 1993; Fairbanks & Hallock, 2002; Ferrari et al, 2015; Ferrari et al, 2020; Ferri et al, 2021; Fujii et al, 2018; Granick et al, 1986; Granick et al, 1990; Haas et al, 2000; Hamdi et al, 2000; Hamilton & Morrison, 1982; Haring et al, 2021; Hasan et al, 2013; Hernando et al, 2018; Ho et al, 2017; Holmberg & Ekerot, 1986; Hutchison et al, …”

Section: Resultsmentioning

confidence: 99%

The versatility of the scapular free flap: A workhorse flap? A systematic review and meta‐analysis

Escobar‐Domingo,

Bustos,

Akintayo

et al. 2024

Microsurgery

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BackgroundThe scapular free flap (SFF) is essential in complex reconstructive surgery and often indicated in complex defects with compromised or poor local tissue integrity. This review aims to assess the versatility and reliability of the SFF during reconstruction.MethodsA comprehensive literature review of multiple databases was conducted following the PRISMA guidelines. An analysis of pooled data was performed to evaluate flap failure rate for any anatomical unit using SFF as the primary endpoints. Secondary endpoints included other complication rates after reconstruction such as partial flap loss, revision surgery, fistula, hematoma, and infection.ResultsA total of 110 articles were included, with 1447 pooled flaps. The main recipient site was the head and neck region (89.0%). Major indications for reconstruction were malignancy (55.3%), burns (19.2%), and trauma (9.3%). The most common types of flaps were osteocutaneous (23.3%), cutaneous (22.6%), and chimeric (18.0%). The pooled flap failure rate was 2% (95%CI: 1%–4%). No significant heterogeneity was present across studies (Q statistic 20.2, p = .69; I2 .00%, p = .685). Nonscapular supplementary flaps and grafts were required in 61 cases. The average length and surface area of bone flaps were 7.2 cm and 24.8cm2, respectively. The average skin paddle area was 134.2cm2.ConclusionThe SFF is a useful adjunct in the reconstructive surgeon's armamentarium as evidence by its intrinsic versatility and diverse clinical indications. Our data suggest a low failure rate in multicomponent defect reconstruction, especially in head and neck surgery. SFFs enable incorporation of multiple tissue types and customizable dimensions—both for vascularized bone and cutaneous skin—augmenting its value in the microsurgeon's repertoire as a chimeric flap. Further research is necessary to overcome the conventional barriers to SFF utilization and to better comprehend the specific scenarios in which the SFF can serve as the preferred alternative workhorse flap.

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Section: Resultsmentioning

confidence: 99%

The versatility of the scapular free flap: A workhorse flap? A systematic review and meta‐analysis

Escobar‐Domingo,

Bustos,

Akintayo

et al. 2024

Microsurgery

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“…Massive soft-tissue defect of the right lower limb was reconstructed with type IV conjoined flap successfully. 5,6 With regard to perfusion in the middle section of the flap, the angiosomes of the two flaps overlap in the middle of the conjoined flap, and routinely support the design of the conjoined flap. In addition, when we punctured the middle part (the zone between the two flaps), there was very good bleeding, with fresh pink blood oozing out, and no sign of congestion.…”

Section: Discussionmentioning

confidence: 99%

“…Massive soft-tissue defect of the right lower limb was reconstructed with type IV conjoined flap successfully. 5,6…”

Section: Discussionmentioning

confidence: 99%

The classification of the conjoined latissimus dorsi – groin flap and the indications for the four types of the flaps

Velazquez-Mujica

Donfrancesco

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Summary: The conjoined latissimus dorsi–groin flap is a versatile flap that not only can serve as an osteocutaneous flap to provide large soft tissue and bone for reconstruction of extensive defects but also can offer functioning muscle transfer and lymph node transfer for prevention of lymphedema after wide excision of tumors or major trauma. Over the past 24 years, the authors have classified the conjoined latissimus dorsi–groin flap into four categories. They propose precautions for application of the conjoined flaps.

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Practical Guidelines for the Orthoplastic Approach: A Systematic Review of High-Quality Evidence for the Lower Extremity Trauma

Amendola,

Cottone,

Alessandri-Bonetti

et al. 2023

Preprint

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Background: The aim of this review is to produce a high-quality evidence-based protocol for lower extremity traumas, from the immediate wound management to the final reconstruction, summarizing only the high-quality evidence present in literature. Methods: Pubmed, EMBASE and Cochrane libraries were searched for high-quality studies on the orthoplastic approach for lower limb traumas. Search terms were: “trauma” OR “fracture”, “lower extremity” OR “lower limb” OR “leg” OR “tibia” OR “fibula”, “bone infection” OR “osteomyelitis”, “orthoplastic”, “flap” OR “reconstruction”. Inclusion criteria were cohort study, clinical trial, randomized controlled trial, systematic review or meta-analysis; lower extremity open fractures; detailed reports about patient and treatment; defined follow-up and outcomes. The PRISMA statement was followed. Exclusion criteria were diabetic foot, open fractures of the foot, not clearly defined protocol of treatment, case series and case reports. Three independent authors (MAB, GC and RC) searched the literature and extracted data from studies, based on eligibility criteria. Results: We summarized the available evidence in three main time settings: fracture management in the emergency department; optimal management during the first 24 hours; optimal management and final goal within 72 hours. Conclusions: The optimal goal is to achieve bone fixation and definitive coverage in a single surgery within 24 hours from injury. If not possible, the main purpose of the orthoplastic team should be the definitive coverage within 72 hours. A dedicated operating room and efficient referral to a specialized trauma center are paramount to reduce infection and costs. Level of evidence: Level II, therapeutic study

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The triple conjoined scapular–latissimus dorsi–groin flap for reconstruction of long lower extremity degloving injury: A case report

Cited by 3 publications

References 22 publications

The versatility of the scapular free flap: A workhorse flap? A systematic review and meta‐analysis

The versatility of the scapular free flap: A workhorse flap? A systematic review and meta‐analysis

The classification of the conjoined latissimus dorsi – groin flap and the indications for the four types of the flaps

Practical Guidelines for the Orthoplastic Approach: A Systematic Review of High-Quality Evidence for the Lower Extremity Trauma

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