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首页> 外文期刊>Annals of Plastic Surgery >Coracobrachialis myofascial flap: Management of a synovio-cutaneous fistula following rotator cuff repair
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Coracobrachialis myofascial flap: Management of a synovio-cutaneous fistula following rotator cuff repair

机译：Coracobrachialis肌筋膜瓣：肩袖修复后滑膜-皮肤瘘的处理

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Background: Synovio-cutaneous fistulae (SCF) are a rare but known complication after joint trauma, inflammation, or infection. Practitioners with first-hand experience treating this complication are limited. To date, treatment methodology has not been standardized, which may, in part, account for high recurrence rates. The coracobrachialis muscle (CBM) has been established as a feasible muscle flap. However, there is limited literature with respect to its potential applications and no literature regarding its use for management of glenohumeral SCF. Rationale for selection and utilization of the CBM for this Purpose is presented. Methods: Pertinent literature is reviewed. The article presents a case of a 48-year-old white man with a persistent SCF located at the superior incisional margin after revision of a rotator cuff repair, following failed conservative management. Definitive treatment included culture, excision of the fistula tract, and a CBM flap over the exposed joint space followed by a V-Y type advancement flap to close the wound. The drain was removed postoperatively at 1 week. Gentle range of motion was started at 2 weeks. Results: Range of motion was satisfactory after the procedure. The patient had no recurrence of the fistula, and no morbidity was noted at the donor site at 1-year follow-up. Discussion: Treatment strategies should begin with culture to determine the presence of a sterile versus infected SCF. Infected SCF should be treated with an appropriate culture-sensitive course of antibiotics. A trial of immobilization may be the next step in management. SCF should be distinguished from persistent SCF, which may help guide management. Those fistulae that persist past 14 days of immobilization should receive consideration for definitive treatment utilizing a muscle flap to provide tension-free water-tight closure. Local irrigation, excision of the fistula tract, and debridement alone, with or without primary closure, has been associated with a high recurrence rate. Conclusion: The CBM can be used as a myofascial flap with multiple advantageous attributes and minimal resultant morbidity from use. It can be used as a primary treatment strategy for glenohumeral SCF and should be considered principally in cases of conservative management failure.
机译：背景：滑膜皮肤瘘（SCF）是关节外伤，炎症或感染后罕见但已知的并发症。具有治疗这种并发症的第一手经验的医生是有限的。迄今为止，治疗方法尚未标准化，这可能部分解释了高复发率。肱臂肌（CBM）已被确定为可行的皮瓣。然而，关于其潜在应用的文献有限，而没有关于其在盂肱SCF处理中的应用的文献。介绍了为此目的选择和利用煤层气的理由。方法：回顾相关文献。本文介绍了一名48岁白人，在保守治疗失败后，经修复肩袖修复后，永久性SCF位于切开上缘。明确的治疗方法包括培养，切除瘘管，在裸露的关节间隙上覆盖CBM皮瓣，然后使用V-Y型推进皮瓣闭合伤口。术后1周去除引流管。在2周时开始轻柔的运动范围。结果：手术后的运动范围令人满意。该患者没有瘘管复发，并且在1年的随访中未在供体部位发现任何病态。讨论：治疗策略应从培养开始，以确定是否存在无菌和感染的SCF。感染的SCF应使用对细菌敏感的适当培养过程进行治疗。进行固定试验可能是下一步管理。 SCF应该与持久性SCF相区别，后者可能有助于指导管理。那些在固定期超过14天仍持续存在的瘘管，应考虑采用肌肉瓣提供无张力的水密性封闭治疗。局部冲洗，瘘管切除和单纯清创（有或没有初次闭合）均与高复发率相关。结论：CBM可以作为肌筋膜瓣使用，具有多种优势属性，使用后产生的发病率极低。它可以作为盂肱SCF的主要治疗策略，主要在保守治疗失败的情况下应考虑使用。

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