Clinical Presentation A 68-year-old Asian woman had radiation therapy for early-stage cervical cancer about 40 years ago in Asia and remained cancer free for a long time but unfortunately developed recurrent cervical cancer. She was offered an anterior pelvic exenteration by the gynecological oncology service and an ileal conduit by the urology service. The plastic surgery service was asked to perform a vaginal reconstruction after anterior…

Clinical Presentation An 86-year-old White female underwent a wide local excision (WLE) for a vulvar squamous cell cancer (SCC) by the gynecologic oncology service. A 15 × 8-cm large soft tissue defect remained over the vulva down to the deep muscles and tissues. The plastic surgery service was asked to help to close this large vulvar wound once the WLE was confirmed to be adequate for a…

Clinical Presentation A 34-year-old White male was diagnosed with advanced rectal cancer and had been scheduled for an abdominoperineal resection (APR) by the colorectal service. Because his perineal resection could be extensive with a potential dead space within the pelvic cavity, the plastic surgery service was asked to perform a perineal reconstruction with a filling of the flap tissue into the pelvic cavity after an APR.…

Case 1 Clinical Presentation A 63-year-old White female had chronic recurrent drainage from her right buttock for the past 2 years. She had a resection of malignant fibrohistiocytoma and postoperative irradiation in the region approximately 20 years ago. She was evaluated by the surgical oncology service and multiple biopsy specimens from the region were negative for recurrent sarcoma ( Fig. 34.1 ). Wide local resection was performed…

Case 1 Clinical Presentation A 35-year-old Hispanic paraplegic female developed a sacral pressure sore when she was in hospital to give birth ( Fig. 33.1 ). This was the first time she had a pressure sore since she became paraplegic as a result of an accident. She was offered a flap reconstruction to close the sacral pressure sore after excision of the entire wound because she was…

Case 1 Clinical Presentation A 64-year-old White male with a history of hypertension and two previous coronary artery bypass grafting surgeries underwent uneventful heart transplantation for severe congestive heart failure. During his cardiac transplant surgery, the left femoral artery and vein were cannulated for cardiopulmonary bypass. He was placed on routine immunosuppression protocol for postoperative heart transplant care. Three months after the successful heart transplantation, the…

Case 1 Clinical Presentation A 68-year-old White male had a complicated postoperative course after an osteocutaneous flap harvest from his right hip by another surgical service. He had a significantly large open wound over the right hip, measuring 25 × 10 cm, with exposed pelvic structures ( Fig. 31.1 ). This patient had previous wound debridement and a wound vacuum-assisted closure (VAC) by the primary service. Some granulation tissue…

Case 1 Clinical Presentation A 14-year-old Black American morbidly obese female underwent hemipelvectomy for a pelvis osteosarcoma. She subsequently underwent pelvic reconstruction with a free fibular vascularized bone graft and a reconstruction plate by the orthopedic oncology and hand surgery services. Unfortunately, she developed complex and pending lower back, gluteal, and sacral wounds with potential exposure of the fibular bone graft and hardware. The plastic surgery…

Case 1 Clinical Presentation A 45-year-old White female sustained a chronic radiation wound, measuring 10 × 9 cm, over her upper lumbar area with exposed spinal processes ( Fig. 29.1 ). This wound was a complication of radiation to the area for treatment of a soft tissue sarcoma. She was referred by a surgical oncologist from outside hospital to our plastic surgery service for definitive soft tissue reconstruction. This…

Clinical Presentation A 63-year-old White male underwent a wide local excision of his upper back soft tissue sarcoma by the surgical oncology service, which left a 12 × 12 cm large soft tissue defect down to the deep muscle. The plastic surgery service was asked to help to close this wound after the wide local excision had been made for the primary sarcoma resection leaving an adequate margin.…

Clinical Presentation A 66-year-old White male had a renal transplantation for end-stage renal disease secondary to polycystic kidney disease by the transplant surgery service. He also had 50 pack-year of smoking history. He had chronic hypoalbuminemia caused by peritoneal dialysis. Although he underwent successful deceased-donor transplantation, he required peritoneal dialysis because his early allograft function was delayed. One week after surgery, he was found to have…

Clinical Presentation A 36-year-old White male sustained extensive thermal burn and had excisions and skin graft procedures on his trunk, axilla, and upper extremity. He also developed compartment syndrome and subsequently underwent a decompression procedure for compartment syndrome release. He unfortunately developed a large ventral hernia and previous abdominal wall reconstructions by the general surgery service failed. The plastic surgery service was asked by the primary…

Case 1 Clinical Presentation The plastic surgery service was asked by the surgical oncology service to evaluate a 53-year-old White male with esophageal discontinuity after esophagectomy for cancer and failure of two previous esophageal reconstructions. The patient’s condition began 5 years ago when he was diagnosed with a thoracic esophageal cancer (stage III) during esophagogastroduodenoscopy (EGD). The EGD caused perforation of the cancer into the chest.…

Case 1 Clinical Presentation A 49-year-old White female underwent right total pneumonectomy for stage IIIA nonsmall cell lung cancer. She had preoperative radiation and chemotherapy for treatment of her advanced cancer. About 2 weeks postoperatively, she was found to have right bronchopleural fistula with air leak and vancomycin-resistant enterococcus infection as well as methicillin-resistant Staphylococcus aureus infection. A right thoracoplasty was performed initially by the thoracic surgeon…

Clinical Presentation A 19-year-old White female had a large soft tissue mass in her lower chest and sternal area. Preoperative biopsy showed desmoid type of fibromatosis. She underwent resection of this soft tissue mass by the pediatric cardiothoracic surgery service and the plastic surgery service was asked to provide lower chest wall reconstruction after the tumor resection. After resection, the entire skin defect of the lower…

Clinical Presentation A 74-year-old White female suffered a lateral chest wound and had a partial breast defect secondary to wound debridement, complicated by the previous minimally invasive right lobectomy. Apparently, she had a seroma formation in the area, which had been managed by the thoracic surgery service. The plastic surgery service was asked to provide soft tissue coverage for the wound and to facilitate healing of…

Case 1 Clinical Presentation A 72-year-old Iranian male with multiple medical problems, including coronary artery disease, severe aortic valve stenosis, chronic occlusive pulmonary disease, and congestive heart failure, underwent coronary artery bypass grafting and aortic valve replacement as part of the preparation for a total gastrectomy because of a newly diagnosed large gastric carcinoma. He had a complicated postoperative course with prolonged treatment in the intensive…

Clinical Presentation A 29-year-old White female had a thermal burn injury to her right hand. She sustained a large soft tissue open wound, measuring 9 × 6 cm, over her palmar hand with the underlying bones and flexor tendons exposed. The palmar wound also extended to the volar thumb. She was managed initially by the burn service and the plastic surgery service was consulted for soft tissue reconstruction…

Clinical Presentation A 41-year-old White male had a degloving injury of his right hand as a result of a motor vehicle accident. He sustained a large soft tissue open wound, measuring 9 × 8 cm, over his dorsal hand with the underlying bones and extensor tendons exposed. He was managed initially by the trauma service and the plastic surgery service was consulted for soft tissue reconstruction of the…

Clinical Presentation A 24-year-old Black American female sustained an avulsion injury to her left forearm wound secondary to a motor vehicle accident. She sustained a large complex soft tissue wound, measuring 18 × 8 cm, in the left volar forearm with multiple flexor digitorum superficialis muscle injuries and a transection of the median nerve with a 5-cm gap. The radial artery and its accompanied veins within the wound…