WorldWideScience

Sample records for artery perforator flap

  1. Thoracodorsal artery perforator flap for upper limb reconstruction

    International Nuclear Information System (INIS)

    Thoracodorsal artery perforator flap (TAP) is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required. Methods: This case series was carried out at department of Plastic and Reconstructive Surgery Combined Military Hospital Rawalpindi. A total of 5 patients with upper limb defects were reconstructed with thoracodorsal artery musculocutaneous perforator flaps. Among them, 3 were pedicled and two free TAP flaps. All flaps except one pedicled flap were raised on a single perforator pedicle. Recipient sites were one axilla, two shoulder regions and two hands. The soft tissue defects in the patients had resulted from burns, trauma, wide local excision of synovial sarcoma and surgery for hidradenitis suppurativa. Preoperative hand held Doppler ultrasound was used to locate and mark the perforator. Results: All flaps survived without significant complications. All flaps were hyperemic in the immediate postoperative period. We designed and raised all the five flaps on eccentrically placed perforators. All the raised perforators originated from the descending branch of the thoracodorsal artery. The donor sites were closed primarily with linear scars in all cases except one, in which partial closure was accomplished with split thickness skin grafting (STSG). Conclusion: The thoracodorsal artery perforator flap has great potential for reconstructing large, relatively shallow, defects of upper limb because of its suitable skin quality, texture and appropriate thickness, as well as hidden donor site, a reliable pedicle and sparing of muscle unit. (author)

  2. Extended thoracodorsal artery perforator flap for breast reconstruction.

    Science.gov (United States)

    Angrigiani, Claudio; Rancati, Alberto; Escudero, Ezequiel; Artero, Guillermo

    2015-12-01

    A total of 45 patients underwent partial or total autologous breast reconstruction after skin-sparing mastectomy, skin-reducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator (TDAP) flap. The detailed surgical technique with its variations is explained in this report. The propeller, flip-over, conventional perforator, and muscle-sparing flaps have been described and evaluated. The flaps were partially or completely de-epithelialized. The conventional TDAP can be enlarged or "extended" as the traditional latissimus dorsi musculocutaneous (LD-MC) flap by incorporating the superior and inferior fat compartments. It can be referred to as the "extended TDAP flap". This technique augments the flap volume. In addition, this flap can serve as a scaffold for lipofilling to obtain autologous breast reconstruction in medium to large cases. There were two complete failures due to technical errors during flap elevation. Distal partial tissue suffering was observed in four flaps. These flaps were longer than usual; they reached the midline of the back. It is advisable to discard the distal medial quarter of the flap when it is designed up to the midline to avoid steatonecrosis or fibrosis. A retrospective analysis of the 39 flaps that survived completely revealed a satisfactory result in 82% of the cases. The main disadvantage of this procedure is the final scar. The TDAP flap is a reliable and safe method for partial or total breast autologous reconstruction. PMID:26645006

  3. The Versatile Extended Thoracodorsal Artery Perforator Flap for Breast Reconstruction

    DEFF Research Database (Denmark)

    Jacobs, Jordan; Thomsen, Jørn Bo; Børsen-Koch, Mikkel; Gunnarsson, Gudjon Leifur; Tos, Tina; Siim, Elsebeth; Udesen, Ann; Hölmich, Lisbet Rosenkrantz; Salzberg, Andrew

    2016-01-01

    flap in reconstructive surgery. METHODS: A multicenter, retrospective review was performed on all patients undergoing TAP flap reconstruction from August 2011 to November 2014. Data were collected from patient records as well as outpatient interviews. RESULTS: A total of 106 TAP flaps were performed in...... reconstruction as well as breast conserving surgery. This large, multicenter series describes our techniques of preoperative perforator mapping and a fast, reliable harvest. Reconstructive goals are accomplished in the great majority of patients.......BACKGROUND: The thoracodorsal artery perforator (TAP) flap is a versatile tool that can be used to reconstruct the breast. The authors use preoperative perforator mapping using color Doppler ultrasonography and present a safe, efficient harvesting technique to demonstrate reliable use of the TAP...

  4. Propeller thoracodorsal artery perforator flap for breast reconstruction

    Science.gov (United States)

    Angrigiani, Claudio; Escudero, Ezequiel; Artero, Guillermo; Gercovich, Gustavo; Deza, Ernesto Gil

    2014-01-01

    Background The thoracodorsal artery perforator (TDAP) flap has been described for breast reconstruction. This flap requires intramuscular dissection of the pedicle. A modification of the conventional TDAP surgical technique for breast reconstruction is described, utilizing instead a propeller TDAP flap. The authors present their clinical experience with the propeller TDAP flap in breast reconstruction alone or in combination with expanders or permanent implants. Methods From January 2009 to February 2013, sixteen patients had breast reconstruction utilizing a propeller TDAP flap. Retrospective analysis of patient characteristics, clinical indications, procedure and outcomes were performed. The follow-up period ranged from 4 to 48 months. Results Sixteen patients had breast reconstruction using a TDAP flap with or without simultaneous insertion of an expander or implant. All flaps survived, while two cases required minimal resection due to distal flap necrosis, healing by second intention. There were not donor-site seromas, while minimal wound dehiscence was detected in two cases. Conclusions The propeller TDAP flap appears to be safe and effective for breast reconstruction, resulting in minimal donor site morbidity. The use of this propeller flap emerges as a true alternative to the traditional TDAP flap. PMID:25207210

  5. The Internal Pudendal Artery Perforator Thigh Flap: A New Freestyle Pedicle Flap for the Ischial Region

    Directory of Open Access Journals (Sweden)

    Ichiro Hashimoto, MD

    2014-05-01

    Conclusions: The perforator vessels of the internal pudendal artery are very close to the ischial tuberosity. Blood flow to the flap is reliable when careful debridement of the pressure sore is performed. The iPap thigh flap is a new option for soft-tissue defects in the ischial region, including ischial pressure sores.

  6. [Free rectus abdominis muscle perforating artery flaps for reconstruction of the head and neck defects].

    Science.gov (United States)

    Koshima, I; Handa, T; Satoh, Y; Akisada, K; Orita, Y; Yamamoto, H

    1995-01-01

    During the past eight years, tissue defects of the head and neck region in a total of 45 patients were repaired with free rectus abdominis muscle perforating artery flaps. These flaps are subclassified into (1) reduced musculocutaneous flaps, (2) thin reduced musculocutaneous flaps, (3) paraumbilical perforator-based flaps, and (4) thin paraumbilical perforator-based flaps. The advantages of these flaps are as follows. Since the flaps involve no or only a small portion of the rectus abdominis muscle, (1) the muscle can be left intact on the abdominal wall, and (2) a thin flap can be easily created by simple defatting of the flap. These flaps overcome the major disadvantages of the conventional rectus abdominis musculocutaneous flap, i.e., bulkiness of the flap and frequent postoperative abdominal herniation. The territory of the thin flaps is within 10 cm around the perforator. These flaps are suitable for defects in the head and neck region, because simultaneous flap elevation is possible at the time of tumor resection. Paraumbilical perforator-based flaps are suitable for young females and elderly patients. PMID:7897566

  7. Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects

    Directory of Open Access Journals (Sweden)

    Lei Zhu

    2014-01-01

    Full Text Available Background: Fingertip defect can be treated with many flaps such as random pattern abdominal flap, retrograde digital artery island flap, V-Y advancement flap, etc. However, swelling in the fingertip, dysfunction of sensation, flexion and extension contracture or injury in the hemi-artery of the finger usually occurs during the recovery phase. Recently, digital artery perforator flaps have been used for fingertip reconstructions. With the development of super microsurgery techniques, free flaps can be more effective for sensory recovery and durability of the fingertip. Materials and Methods: Six cases (six fingers of fingertip defects were treated with free digital artery perforator flaps of appropriate size and shape from the proximal phalanx. During surgery, the superficial veins at the edge of flap were used as reflux vessels and the branches of the intrinsic nerve and dorsal digital nerve toward the flap were used as sensory nerves. The proximal segment of the digital artery (cutaneous branches towards the flap was cut off to form the pedicled free flap. The fingertips were reconstructed with the free flap by anastomosing the cutaneous branches of digital artery in the flap with the distal branch or trunk of the digital artery, the flap nerve with the nerve stump and the veins of the flap with the digital artery accompanying veins or the superficial veins in the recipient site. Results: Six flaps survived with successful skin grafting. Patients were followed up for 6-9 months. The appearance and texture of the flaps was satisfactory. The feeling within the six fingers recovered to S4 level (BMRC scale and the two point discrimination was 3-8 mm. Conclusion: Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.

  8. Inferior epigastric artery angiography applied in the transplantation with the deep inferior epigastric perforator free flap

    International Nuclear Information System (INIS)

    Objective: To observe the effect of inferior epigastric artery angiography applied in the transplantation with the deep inferior epigastric perforator free flap. Methods: Seven patients who had undergone the deep inferior epigastric perforator free flap transplantation, received angiography of the inferior epigastric artery. The value of the angiography was discussed. Results: All patients were successful in angiography without any adverse reaction. All patients were successful in transplantation except one because of personal reason. Conclusion: Inferior epigastric artery angiography facilitates the transplantation with the deep inferior epigastric perforator free flap. (authors)

  9. Surgical management for large chest keloids with internal mammary artery perforator flap.

    Science.gov (United States)

    Xue, Dan; Qian, Huan

    2016-01-01

    Therapy for large symptomatic keloids is often plagued with complicated reconstruction manner and recurrence. This article reports a rare treatment combination for a chest keloid with internal mammary artery perforator flap reconstruction and radiation therapy. We excised the keloid and covered the defect with an internal mammary artery perforator flap. Immediate electron-beam irradiation therapy was applied on the second postoperative day. There was no sign of recurrence over the follow-up period of 18 months. The combination of internal mammary artery perforator flap and immediate radiation therapy is useful when faced with chest keloids of similar magnitude and intractability. PMID:26982790

  10. Superficial peroneal neurocutaneous flap based on an anterior tibial artery perforator for forefoot reconstruction.

    Science.gov (United States)

    Wang, Chun-Yang; Chai, Yi-Min; Wen, Gen; Han, Pei; Cheng, Liang

    2015-06-01

    The distally based superficial peroneal neurocutaneous (SPNC) island flap has been widely used for foot reconstruction. It is based on the descending branch of the peroneal artery perforator. However, damage to the perimalleolar vascularization or anatomic variations of the descending branch often causes flap necrosis. Because septocutaneous perforators from the anterior tibial artery participate in the vascular network of superficial peroneal nerve in the distal lower leg, a modified SPNC flap is designed based on the anterior tibial artery perforator. Seven patients with soft tissue defect over the forefoot were treated by this modified technique. Six patients had accompanied injuries at the lateral perimalleolar region, and 1 patient had an anatomic variation of the descending branch of the peroneal artery perforator. The size of defect ranged from 12 × 5 to 15 × 9 cm. All 7 flaps survived completely without complications. The size of the flaps ranged from 13 × 6 to 16 × 10 cm. No severe venous congestion occurred. The mean follow-up was 9.4 months (range, 6-14 months). All patients were satisfied with the texture and color of the flaps. Two patients complained about the thickness of the flaps, but did not want further operation. The donor sites healed uneventfully and no painful neuroma occurred. In conclusion, the modified SPNC flap based on an anterior tibial artery perforator is a feasible salvage procedure when the traditional design is unreliable. It can provide sufficient and superior coverage for large forefoot defect. PMID:25969973

  11. Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction.

    Science.gov (United States)

    Narushima, Mitsunaga; Iida, Takuya; Kaji, Nobuyuki; Yamamoto, Takumi; Yoshimatsu, Hidehiko; Hara, Hisako; Kikuchi, Kazuki; Araki, Jun; Yamashita, Shuji; Koshima, Isao

    2016-06-01

    For hand and finger reconstruction, thin and flexible skin coverage is ideally required. A free flap is one of the surgical options used for large defects. However, a flap containing the fat layer is bulky. Several debulking surgeries are often needed for aesthetic and functional purposes. To overcome this disadvantage, we herein report our experience of six cases of hand and finger reconstruction using a pure skin perforator (PSP) flap concept. A PSP flap is a thin skin flap that is vascularized by a perforator branch penetrating the dermis. The thickness of the PSP flap could be approximately ≤2 mm as needed. The superficial circumflex iliac artery and superficial inferior epigastric artery were used as a flap pedicle. Secondary defatting operations were not required. For the success of PSP flap elevation, we applied three techniques: the microdissection technique for vessel separation, thin flap elevation at the superficial fascial layer, and the temporary clamping method. Temporary clamping was applied for the main trunk of pedicle vessels during debulking to prevent unwanted bleeding, which allowed us to freely perform three-dimensional defatting. Using these three techniques, the PSP flap can be elevated and adjusted for complex contouring of the hand and finger. Although the use of the PSP flap requires further study, the PSP flap is an effective, superthin flap with the advantages of both skin graft and perforator flaps. PMID:27085610

  12. Reconstruction of high voltage electric burn wound with exposed shoulder joint by thoracoacromial artery perforator propeller flap

    Science.gov (United States)

    Rout, Debesh Kumar; Nayak, Bibhuti Bhusan; Choudhury, Arun Kumar; Pati, Ajit Kumar

    2014-01-01

    We describe the reconstruction of high voltage electric burn injury with exposed shoulder joint by thoracoacromial artery perforator propeller flap based on the delto-pectoral perforators of thoracoacromial artery. The successful use of this propeller flap to cover the exposed shoulder joint in a case with limited local flap options demonstrates its use as an alternative technique. PMID:25190925

  13. Reconstruction of high voltage electric burn wound with exposed shoulder joint by thoracoacromial artery perforator propeller flap

    Directory of Open Access Journals (Sweden)

    Debesh Kumar Rout

    2014-01-01

    Full Text Available We describe the reconstruction of high voltage electric burn injury with exposed shoulder joint by thoracoacromial artery perforator propeller flap based on the delto-pectoral perforators of thoracoacromial artery. The successful use of this propeller flap to cover the exposed shoulder joint in a case with limited local flap options demonstrates its use as an alternative technique.

  14. The in vivo anatomy of the deep circumflex iliac artery perforators: defining the role for the DCIA perforator flap.

    Science.gov (United States)

    Ting, Jeannette W C; Rozen, Warren M; Grinsell, Damien; Stella, Damien L; Ashton, Mark W

    2009-01-01

    The deep circumflex iliac artery (DCIA) provides a dependable option for use as an osteo-musculo-cutaneous flap, particularly in mandibular reconstruction. Modifications to flaps based on DCIA perforators have been sought to prevent donor site morbidity as a consequence of muscle cuff harvest. Previous studies have been inconsistent in their descriptions of perforator anatomy, and means of assessing these preoperatively have not been widely described. A clinical anatomical study was undertaken, with a cohort of 44 hemiabdominal walls in 22 consecutive patients undergoing preoperative computed tomographic angiography (CTA) before free flap surgery. The feasibility of CTA and the regional vascular anatomy were both assessed. The use of CTA was shown to demonstrate DCIA perforators with high resolution and to be able to assess vessel size and location. In 44 hemiabdominal walls, there were 44 perforators of >0.8 mm diameter. There were no suitable perforators in 40% of sides, with 32% of sides having one perforator >0.8 mm diameter, 16% having two perforators, DCIA perforators, and for selecting patients who may be suitable for a DCIA perforator flap given the variable perforator anatomy. PMID:19296521

  15. The distally-based island ulnar artery perforator flap for wrist defects

    Directory of Open Access Journals (Sweden)

    Karki Durga

    2007-01-01

    Full Text Available Background: Reconstruction of soft tissue defects around the wrist with exposed tendons, joints, nerves and bone represents a challenge to plastic surgeons, and such defects necessitate flap coverage to preserve hand functions and to protect its vital structures. We evaluated the use of a distally-based island ulnar artery perforator flap in patients with volar soft tissue defects around the wrist. Materials and Methods: Between June 2004 and June 2006, seven patients of soft tissue defects on the volar aspect of the wrist underwent distally-based island ulnar artery perforator flap. Out of seven patients, five were male and two patients were female. This flap was used in the reconstruction of the post road traffic accident defects in four patients and post electric burn defects in three patients. Flap was raised on one or two perforators and was rotated to 180°. Results: All flaps survived completely. Donor sites were closed primarily without donor site morbidity. Conclusion: The distally-based island Ulnar artery perforator flap is convenient, reliable, easy to manage and is a single-stage technique for reconstructing soft tissue defects of the volar aspect of the wrist. Early use of this flap allows preservation of vital structures, decreases morbidity and allows for early rehabilitation.

  16. Bilateral Breast Reconstruction with Extended Thoracodorsal Artery Perforator Propeller Flaps and Implants

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon L; Børsen-Koch, Mikkel; Nielsen, Henrik Toft;

    2015-01-01

    We present our experience of bilateral total breast reconstruction using a double-sided extended thoracodorsal artery perforator propeller flap in a case series of 10 patients. Reconstruction was successfully achieved in all cases with few complications. The median time for surgery was 275 minutes...... (200-330), and the average implant size used was 350 cm(3) (195-650). We demonstrate how the extended thoracodorsal artery perforator propeller flap allows for a swift and reliable direct to implant bilateral total breast reconstruction in a simple setting and is a valuable adjunct to our armamentarium...

  17. Dorsal Intercostal Artery Perforator Propeller Flaps: A Reliable Option in Reconstruction of Large Meningomyelocele Defects.

    Science.gov (United States)

    Basterzi, Yavuz; Tenekeci, Goktekin

    2016-04-01

    Several options have been reported for the reconstruction of myelomeningocele defects. In this article, we present our experience on soft tissue reconstruction of myelomeningocele defects by using island propeller dorsal intercostal artery perforator (DIAP) flaps. Between January 2008 and February 2014, all newborns with large myelomeningocele defects (13 newborns) were reconstructed with island propeller DIAP flaps. All flaps survived completely. In 8 patients out of 13, venous insufficiency was observed which then resolved spontaneously. Flap donor sites were closed primarily. Myelomeningocele defects with a diameter larger than 5 cm require reconstruction with flaps. To mobilize a well-vascularized tissue over the defect without tension in which the suture lines will not overlap over the midline where the dura is repaired and over the meninges is one of the goals of reconstruction for such defects. Perforator propeller flaps enable us to reach those goals. Use of perforator flaps provides 2 important advantages, namely, more predictability and also more freedom in mobilizing flaps toward the defect. This study proves the reliability of DIAP propeller flaps in the reconstruction of myelomeningocele defects. PMID:26010351

  18. Profunda Femoris Artery Perforator Propeller Flap: A Valid Method to Cover Complicated Ischiatic Pressure Sores.

    Science.gov (United States)

    Scalise, Alessandro; Tartaglione, Caterina; Bolletta, Elisa; Pierangeli, Marina; Di Benedetto, Giovanni

    2015-08-01

    We report the case of a 50-year-old paraplegic man with a complicated grade III/IV ischiatic pressure sore treated with a propeller flap based on the first perforator of the profunda femoris artery. Our aim was to surgically reconstruct an ischiatic pressure sore in a patient with ankylosis using a fasciocutaneous perforator propeller flap obtained from the posterior region of the thigh. Our decision to perform a profunda femoris artery perforator propeller flap reconstruction was mainly due to the anatomical contiguity of the flap with the site of the lesion and the good quality of the skin harvested from the posterior region of the thigh. The use of the perforator fasciocutaneous flap represents a muscle-sparing technique, providing a better long-term result in surgical reconstruction. The choice of the 180-degree propeller flap was due to its ability to provide a good repair of the pressure ulcer and to pass over the ischiatic prominence in the patient in the forced decubitus position. The operatory course did not present any kind of complication. Using this reconstructive treatment, we have obtained complete coverage of the ischiatic pressure sore. PMID:26495200

  19. Perforator Flaps for Perineal Reconstructions

    OpenAIRE

    Niranjan, Niri S.

    2006-01-01

    Whenever there is soft tissue loss from the perineum there are many options for reconstruction. These include allowing the wound to heal by secondary intention and the use of local random or axial pattern flaps, regional flaps, or free flaps. The axial skin flap can be defined as a flap based on known constant vessels of the subcutaneous tissue and its vena comitantes. The perforator flap on the other hand is a randomly selected perforator consisting of an artery with vena comitantes, which p...

  20. Pedicled perforator flaps

    DEFF Research Database (Denmark)

    Demirtas, Yener; Ozturk, Nuray; Kelahmetoglu, Osman; Demir, Ahmet

    2009-01-01

    Described in this study is a surgical concept that supports the "consider and use a pedicled perforator flap whenever possible and indicated" approach to reconstruct a particular skin defect. The operation is entirely free-style; the only principle is to obtain a pedicled perforator flap to...... reconstruct the defect. The perforators are marked with a hand-held Doppler probe and multiple flaps are designed. The appropriate flap is elevated after identifying the perforator(s). Dissection of the perforator(s) or complete incision of the flap margins are not mandatory if the flap is mobilized...... adequately to cover the defect. Defects measuring 3 x 3 cm up to 20 x 20 cm at diverse locations were successfully reconstructed in 20 of 21 patients with 26 flaps. Pedicled perforator flaps offer us reliable and satisfactory results of reconstruction at different anatomic territories of the body. It sounds...

  1. Unilateral Breast Reconstruction Using Bilateral Inferior Gluteal Artery Perforator Flaps

    Directory of Open Access Journals (Sweden)

    Toshihiko Satake, MD

    2015-03-01

    Conclusions: Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side. In patients with moderate-to-high projection breast whose abdominal tissue cannot be used for reconstruction, IGAP flaps may be a suitable alternative.

  2. Delay by Staged Elevation of Flaps and Importance of Inclusion of the Perforator Artery

    OpenAIRE

    Acartürk, Tahsin Oğuz; Dinçyürek, Hüseyin; Dağlıoğlu, Kenan

    2014-01-01

    “Surgical delay” is aimed at increasing blood flow to adjacent angiosomes by opening choke vessels, to obtain larger and more reliable flaps. We hypothesized that staged elevation (delay) from distal to proximal, in addition to preservation perforator artery near the base will improve survival. Thirty-two Sprague–Dawley rats were divided into 4 groups and 3x8cm caudal McFarlane flaps were elevated. In “delay” groups the 3 × 4 cm distal part was elevated and sutured back, with complete elevati...

  3. Novel use of a supraclavicular transverse cervical artery customised perforator flap: a paediatric emergency.

    LENUS (Irish Health Repository)

    Dolan, R T

    2013-08-01

    Perforation of the piriform fossa is a rare, potentially life-threatening paediatric emergency. Prompt diagnosis and early operative intervention is key to patient survival, yet restoring aerodigestive continuity can pose a significant reconstructive challenge. A seven-month old baby girl presented to an emergency department acutely unwell with a twenty-four-hour history of haemoptysis, cough and worsening respiratory distress. A contrast swallow demonstrated extension of contrast into the retropharyngeal region necessitating immediate surgical intervention. A 3.0 cm×1.0 cm perforation within the left posterolateral piriform fossa was identified. The defect was repaired with a supraclavicular transverse cervical artery customised perforator flap. This was inset into the piriform fossa luminal defect as a life-saving procedure. Following a stormy post-operative course, the child was discharged home on day 28 of admission and admitted electively 6 weeks later for division of flap pedicle. This case highlights the novel use of this fasciocutaneous island flap to reconstruct an extensive, potentially fatal, piriform fossa defect in an acute paediatric setting. This simple flap design offers timely mobilisation, reliable blood supply, adequate tenuity and surface area, to reconstruct this extensive defect as a life-saving intervention in a profoundly septic child.

  4. Free thin paraumbilical perforator-based flaps.

    Science.gov (United States)

    Koshima, I; Moriguchi, T; Soeda, S; Tanaka, H; Umeda, N

    1992-07-01

    A free paraumbilical perforator-based flap fed by a muscle perforator from the inferior deep epigastric artery and with no muscle was used in 13 patients. Among them, a free thin paraumbilical perforator-based flap with a thin layer of fat, to protect the subdermal plexus of the vessels, was used in seven patients. The dominant pedicle perforator of this thin flap is usually located around the umbilicus and a large flap can be obtained. Its critical length-to-breath ratio is considered to be 4:3. The advantages of this flap are a long and large vascular pedicle, rare postoperative abdominal herniation, little bulkiness of the flap, and a relatively large skin territory. The disadvantages are technical difficulties in dissection of the perforator and anatomical variation in the location of the perforator. We believe this flap largely overcomes the problems of the conventional rectus abdominis musculocutaneous flap. PMID:1386718

  5. Comparative study of software techniques for 3D mapping of perforators in deep inferior epigastric artery perforator flap planning

    Science.gov (United States)

    Hunter-Smith, David J.; Rozen, Warren Matthew

    2016-01-01

    Background Computed tomographic (CT) angiography (CTA) is widely considered the gold standard imaging modality for preoperative planning autologous breast reconstruction with deep inferior epigastric artery (DIEA) perforator (DIEP) flap. Improved anatomical understanding from CTA has translated to enhanced clinical outcomes. To achieve this, the use of appropriate CT hardware and software is vital. Various CT scanners and contrast materials have been demonstrated to consistently produce adequate scan data. However, the availability of affordable and easily accessible imaging software capable of generating 3D volume-rendered perforator images to clinically useful quality has been lacking. Osirix (Pixmeo, Geneva, Switzerland) is a free, readily available medical image processing software that shows promise. We have previously demonstrated in a case report the usefulness of Osirix in localizing perforators and their course. Methods In the current case series of 50 consecutive CTA scans, we compare the accuracy of Osirix to a commonly used proprietary 3D imaging software, Siemens Syngo InSpace 4D (Siemens, Erlangen, Germany), in identifying perforator number and location. Moreover, we compared both programs to intraoperative findings. Results We report a high rate of concordance with Osirix and Siemens Syngo InSpace 4D (99.6%). Both programs correlated closely with operative findings (92.2%). Most of the discrepancies were found in the lateral row perforators (90%). Conclusions In the current study, we report the accuracy of Osirix that is comparable to Siemens Syngo InSpace 4D, a proprietary software, in mapping perforators. However, it provides an added advantage of being free, easy-to-use, portable, and potentially a superior quality of 3D reconstructed image. PMID:27047778

  6. Delay by Staged Elevation of Flaps and Importance of Inclusion of the Perforator Artery.

    Science.gov (United States)

    Acartürk, Tahsin Oğuz; Dinçyürek, Hüseyin; Dağlıoğlu, Kenan

    2015-06-01

    "Surgical delay" is aimed at increasing blood flow to adjacent angiosomes by opening choke vessels, to obtain larger and more reliable flaps. We hypothesized that staged elevation (delay) from distal to proximal, in addition to preservation perforator artery near the base will improve survival. Thirty-two Sprague-Dawley rats were divided into 4 groups and 3x8cm caudal McFarlane flaps were elevated. In "delay" groups the 3 × 4 cm distal part was elevated and sutured back, with complete elevation (3 × 8 cm) after 4 days. The deep circumflex iliac artery (DCIA) at the base was either preserved or transected. The groups were: group A (Delay/DCIA preserved), group B (Delay/DCIA transected), group C (No Delay/DCIA preserved), group D (No Delay/DCIA transected). The percentage of surviving flap area was measured after 7 days with digital planimetrics. Statistics were done with ANOVA and unpaired T-test. The survivals were: 98.44 ± 3.13 %(group A), 69.33 ± 5.51 %(group B), 76.50 ± 8.91 %(group C) and 52.89 ± 3.15 %(group D). Delay lead to a greater degree of survival whether the arteries were preserved (p = 0.002) or transected (p = 0.01). In groups where the DCIA was preserved, the delay lead to a greater area of survival (p = 0.002). Inclusion of arteries lead to a greater degree of survival whether delay was performed (p = 0.003) or not (p = 0.005). Necropsy showed that the DCIAs were dilated bilaterally when preserved with vascular arcades reaching all viable areas. When the DCIA was transected, the gluteal perforators were dilated bilaterally with the vascular arcades reaching all viable areas. Staged elevation is an effective method of delay in both random and rando-axial flaps. When this is combined with preserving the perforator artery, survival rates are further enhanced. PMID:26078495

  7. Inferior Gluteal Perforator Flaps for Breast Reconstruction

    OpenAIRE

    Allen, Robert J.; LoTempio, Maria M.; Granzow, Jay W.

    2006-01-01

    Perforator flaps represent the latest in the evolution of soft tissue flaps. They allow the transfer of the patient's own skin and fat in a reliable manner with minimal donor-site morbidity. The powerful perforator flap concept allows transfer of tissue from numerous, well-described donor sites to almost any distant site with suitable recipient vessels. The inferior gluteal artery perforator (I-GAP) flap is one option that allows a large volume of tissue to be used for breast reconstruction w...

  8. Immediate breast reconstruction using the free lumbar artery perforator flap and lateral thoracic vein interposition graft for recipient lateral thoracic artery anastomosis

    Directory of Open Access Journals (Sweden)

    Toshihiko Satake

    2016-01-01

    Full Text Available The lumbar artery perforator (LAP flap, which contains excess skin and fat tissue, love handles, that extends from the lower back to upper buttock, may provide an alternate tissue source for autologous breast reconstruction. However, LAP flap use during this procedure frequently requires vessel interposition grafts to correct the short flap pedicle length and mismatched recipient vessel calibre. A 46-year-old patient underwent a right nipple-sparing mastectomy using a lateral approach for ductal carcinoma in situ and immediate LAP flap breast reconstruction. The lateral thoracic vessel served as the recipient vessel, and a lateral thoracic vein interposition graft from the distal remnant was performed to adjust the arterial length and size discrepancy between the recipient lateral thoracic artery and pedicle artery. This procedure facilitates microsurgical anastomosis and medialisation of LAP flap to make a natural decollete line and create a cleavage for the reconstructed breast.

  9. Basic Perforator Flap Hemodynamic Mathematical Model

    Science.gov (United States)

    Tao, Youlun; Ding, Maochao; Wang, Aiguo; Zhuang, Yuehong; Chang, Shi-Min; Mei, Jin; Hallock, Geoffrey G.

    2016-01-01

    Background: A mathematical model to help explain the hemodynamic characteristics of perforator flaps based on blood flow resistance systems within the flap will serve as a theoretical guide for the future study and clinical applications of these flaps. Methods: There are 3 major blood flow resistance network systems of a perforator flap. These were defined as the blood flow resistance of an anastomosis between artery and artery of adjacent perforasomes, between artery and vein within a perforasome, and then between vein and vein corresponding to the outflow of that perforasome. From this, a calculation could be made of the number of such blood flow resistance network systems that must be crossed for all perforasomes within a perforator flap to predict whether that arrangement would be viable. Results: The summation of blood flow resistance networks from each perforasome in a given perforator flap could predict which portions would likely survive. This mathematical model shows how this is directly dependent on the location of the vascular pedicle to the flap and whether supercharging or superdrainage maneuvers have been added. These configurations will give an estimate of the hemodynamic characteristics for the given flap design. Conclusions: This basic mathematical model can (1) conveniently determine the degree of difficulty for each perforasome within a perforator flap to survive; (2) semiquantitatively allow the calculation of basic hemodynamic parameters; and (3) allow the assessment of the pros and cons expected for each pattern of perforasomes encountered clinically based on predictable hemodynamic observations.

  10. A reliable method for the treatment of lower third soft tissue defects of the leg: Use of a posterior tibial artery perforator flap

    Directory of Open Access Journals (Sweden)

    Fikret Eren

    2015-12-01

    Full Text Available Management of lower third limb defects is a common challenge for the reconstructive surgeon due to a lack of soft tissue in that anatomic area. Traditionally, lower third of the limb defects were usually reconstructed with free flaps. The evolution of reconstructive surgery enabled thinner and pliable flaps to be harvested for the purpose of minimizing morbidity from muscle inclusion into the flap. With the introduction of perforator flaps, repairing of small and medium size defects of the distal lower third of leg and ankle region is possible with minimal donor site morbidity. Perforator flaps are based on cutaneous, small diameter vessels that arise from a main pedicle that adjacently perforates the fascia to reach the skin. In this article, we present our experience with two cases involving the repair of these defects by using posterior tibial artery perforator flaps. [Hand Microsurg 2015; 4(3.000: 67-70

  11. Treatment of the Secondary Defect on the First Metatarsophalangeal Joint Using the Medial Plantar Hallucal Artery Dorsal Perforator Flap.

    Science.gov (United States)

    Zhang, Xu; Bai, Guangqi; Zhang, Zhihong; Chen, Chao; Yu, Yadong; Shao, Xinzhong

    2016-05-01

    Injuries or burns to the dorsum of the first metatarsophalangeal (MTP) joint may develop scar formation, resulting in hyperextension contracture. Surgical correction of the deformity often produces a secondary defect. The purpose of this study is to report on the use of the medial plantar hallucal artery dorsal perforator flap for the treatment of such defect. From February 2010 to June 2011, 16 patients were treated. The mean preoperative hyperextension of the first MTP joint was 48 degrees. The mean size of the defects was 3.6 × 6 cm. The mean flap size was 4 × 6.5 cm. The mean pedicle length was 4 cm. All flaps survived completely. Patient follow-up lasted a mean of 14 months. At the final follow-up, the mean hyperextension of the first MTP joint was 9 degrees. After surgery, the mean Foot Function Index improved from 62 to 7. Almost all patients were satisfied with the results. Transferring the medial plantar hallucal artery dorsal perforator flap is a useful and reliable technique for the reconstruction of the secondary defect on the first MTP joint. PMID:25275474

  12. Inferior Gluteal Artery Perforator Flap for Sacral Pressure Ulcer Reconstruction: A Retrospective Case Study of 11 Patients.

    Science.gov (United States)

    Lin, Chin-Ta; Ou, Kuang-Wen; Chiao, Hao-Yu; Wang, Chi-Yu; Chou, Chang-Yi; Chen, Shyi-Gen; Lee, Tzu-Peng

    2016-01-01

    Despite advances in reconstruction techniques, sacral pressure ulcers continue to present a challenge to the plastic surgeon. The flap from the gluteal crease derives blood supply from the inferior gluteal artery perforator (IGAP) and reliably preserves the entire contralateral side as a donor site. To incorporate the IGAP in the reconstruction of sacral pressure ulcers, a skin paddle over the gluteal crease was created and implemented by the authors. Data from 11 patients (8 men, 3 women; mean age 67 [range 44-85] years old) whose sacral ulcers were closed with an IGAP flap between June 2006 and May 2012 were retrieved and reviewed. All patients were bedridden; 1 patient in a vegetative state with a diagnosis of carbon monoxide intoxication was referred from a local clinic, 2 patients had Parkinson's disease, and 8 patients had a history of stroke. The average defect size was 120 cm(2) (range 88-144 cm(2)). The average flap size was 85.8 cm(2) (range 56-121 cm(2)). Only 1 flap failure occurred during surgery and was converted into V-Y advancement flap; 10 of the 11 flaps survived. After surgery, the patients' position was changed every 2 hours; patients remained prone or on their side for approximately 2 weeks until the flap was healed. After healing was confirmed, patients were discharged. Complications were relatively minor and included 1 donor site wound dehiscence that required wound reapproximation. No surgery-related mortality was noted; the longest follow-up period was 24 months. In this case series, flaps from the gluteal crease were successfully used for surgical closure of sacral pressure ulcers. This flap design should be used with caution in patients with hip contractures. Studies with larger sample sizes are needed to ascertain which type of flap is best suited to surgically manage extensive pressure ulcers in a variety of patient populations. PMID:26779702

  13. Distal posterior tibial artery perforator flaps for the management of calcaneal and Achilles tendon injuries in diabetic and non-diabetic patients

    Directory of Open Access Journals (Sweden)

    Ioannis A. Ignatiadis

    2011-08-01

    Full Text Available Management of Achilles tendon and heel area defects is a common challenge for the reconstructive surgeon due to the lack of soft tissue availability in that region. In this article, we present our experience in covering these defects by using the distal perforator propeller flaps based on the posterior tibial artery. Perforator flaps are based on cutaneous, small diameter vessels that originate from a main pedicle and perforate the fascia or muscle to reach the skin. Their development has followed the understanding of the blood supply from a source artery to the skin. Six patients (five males and one female underwent reconstruction by using the posterior tibial artery distal perforator flap for covering defects in the distal Achilles tendon region in patients with and without diabetes mellitus. Postoperative complications included a hypertrophic scar formation in one patient, partial marginal flap necrosis in another patient, and a wound infection in a third patient. All wounds were eventually healed by the last postoperative visit. In conclusion, perforator flaps based on the distal posterior tibial artery may be a reliable option for the coverage of small to moderate size defects of the Achilles tendon and heel area regions.

  14. The Evolution of Perforator Flaps

    OpenAIRE

    Khan, Farah N.; Spiegel, Aldona J.

    2006-01-01

    Perforator flaps have recently become ubiquitous in the field of plastic surgery. To understand and appreciate their unique nature, it is necessary to compare and contrast them with the development of other types of flaps. A complete yet abridged version of the history of flap surgery is presented in this article. Beginning with Sushruta's Indian cheek flap method for nasal reconstruction, a trip through time and space is taken to highlight the milestones leading to the evolution of the perfo...

  15. Pedicled superficial inferior epigastric artery perforator flap for salvage of failed metoidioplasty in female-to-male transsexuals.

    Science.gov (United States)

    Schmidt, Manfred; Grohmann, Martin; Huemer, Georg M

    2015-07-01

    Metoidioplasty represents a viable option for female-to-male transsexual patients seeking gender reassignment surgery. The aim of this procedure is to create a microphallus with lengthening of the urethra to the tip of the hypertrophied and released clitoris. However, fistula formation and urethral obstruction might occur in the long term and reconstruction represents a challenging problem in this setting. In this report, we present the tubed superficial inferior epigastric artery perforator island flap as an option for urethral reconstruction after failed metoidioplasty in a female-to-male transsexual patient. In a 26-year-old transsexual patient a combination of urethral fistula, urethral stenosis, and disintegrated distal neourethra had developed as a consequence of postoperative hematoma formation. Metoidioplasty was reconstructed by means of a tubed, pedicled superficial inferior epigastric artery perforator flap from the left lower abdomen. The long-term result was stable with pleasing genital appearance, adequate functional outcome, and satisfactory donor site morbidity. In our opinion, this procedure may represent a viable alternative for urethral reconstruction in thin patients. PMID:25469907

  16. In-vivo quantitative evaluation of perfusion zones and perfusion gradient in the deep inferior epigastric artery perforator flap

    Science.gov (United States)

    Saint-Cyr, Michel; Lakhiani, Chrisovalantis; Cheng, Angela; Mangum, Michael; Liang, Jinyang; Teotia, Sumeet; Livingston, Edward H.; Zuzak, Karel J.

    2013-03-01

    The selection of well-vascularized tissue during DIEP flap harvest remains controversial. While several studies have elucidated cross-midline perfusion, further characterization of perfusion to the ipsilateral hemiabdomen is necessary for minimizing rates of fat necrosis or partial fat necrosis in bilateral DIEP flaps. Eighteen patients (29 flaps) underwent DIEP flap harvest using a prospectively designed protocol. Perforators were marked and imaged with a novel system for quantitatively measuring tissue oxygenation, the Digital Light Hyperspectral Imager. Images were then analyzed to determine if perforator selection influenced ipsilateral flap perfusion. Flaps based on a single lateral row perforator (SLRP) were found to have a higher level of hemoglobin oxygenation in Zone I (mean %HbO2 = 76.1) compared to single medial row perforator (SMRP) flaps (%HbO2 = 71.6). Perfusion of Zone III relative to Zone I was similar between SLRP and SMRP flaps (97.4% vs. 97.9%, respectively). These differences were not statistically significant (p>0.05). Perfusion to the lateral edge of the flap was slightly greater for SLRP flaps compared SMRP flaps (92.1% vs. 89.5%, respectively). SMRP flaps had superior perfusion travelling inferiorly compared to SLRP flaps (88.8% vs. 83.9%, respectively). Overall, it was observed that flaps were better perfused in the lateral direction than inferiorly. Significant differences in perfusion gradients directed inferiorly or laterally were observed, and perforator selection influenced perfusion in the most distal or inferior aspects of the flap. This suggests broader clinical implications for flap design that merit further investigation.

  17. The deep circumflex iliac artery perforator flap (DCIAP)--a reconstructive option for the large composite oro-mandibular cutaneous defect.

    Science.gov (United States)

    Bisase, Brian; Sloane, James; Coombes, Darryl M; Norris, Paul M

    2013-12-01

    The deep circumflex iliac artery (DCIA) flap is often used for mandibular reconstruction but it is bulky and causes additional donor-site morbidity because of the inclusion of an "obligatory internal oblique muscle". Large composite segmental mandibular resections that consist of floor of mouth, subtotal tongue, and adjacent facial skin are a challenge in terms of reconstruction. They often require 2 free flaps or a free scapular flap and both have disadvantages. The deep circumflex iliac artery perforator (DCIAP) flap with a cutaneous component overcomes the disadvantages. We describe reconstructions with DCIAP flaps in 3 patients with large mandibular composite segmental defects. We report our experience of the flap and discuss some of the difficulties we encountered and the points we learned perioperatively. PMID:23891263

  18. Color Duplex Assessment of 4th and 5th Internal Mammary Artery Perforators: The Pedicles of the Medially Based Lower Pole Breast Flaps

    OpenAIRE

    Abdel-Monem, Kareem; Elshahat, Ahmed; Abou-Gamrah, Sherif; Eldin Abol-Atta, Hossam; Abd Eltawab, Reda; Massoud, Karim

    2012-01-01

    Objective: Reconstruction of a breast after mastectomy using the contralateral lower pole breast flap is an appealing procedure because it uses the tissues that were going to be excised during reduction of the sound breast to achieve symmetry. Literature mentioned that these flaps are supplied by the lower internal mammary artery perforators (IMAPs) with no further details. The aim of this study was to determine the site, size, and number of the 4th and 5th IMAPs by using preoperative color D...

  19. Clinical aspects of reconstruction of the lower third of the leg with fasciocutaneous flap based on peroneal artery perforators

    OpenAIRE

    Terzić Zoran; Đorđević Boban

    2014-01-01

    Background/Aim. Fasciocutaneous flaps are tissue flaps that include the skin, subcutaneous tissue and underlying fascia, and are based on the septocutaneous system of blood vessels. They have a number of characteristics that give them an advantage in many cases, especially in treatment of lower extremity defects. The aim of this study was to clinically analyse the outcomes of patients surgically treated with a. peroneae perforator-based reverse flaps of the...

  20. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: A chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty.

    Science.gov (United States)

    Yamamoto, Takumi; Saito, Takafumi; Ishiura, Ryohei; Iida, Takuya

    2016-09-01

    Total ankle arthroplasty (TAA) is becoming popular in patients with rheumatoid arthritis (RA)-associated ankle joint degeneration. However, ankle wound complications can occur after TAA, which sometimes requires challenging reconstruction due to anatomical complexity of the ankle. Superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been reported to be useful for various reconstructions, but no case has been reported regarding a chimeric SCIP flap for complex ankle reconstruction. We report a case of complex ankle defect successfully reconstructed with a free quadruple-component chimeric SCIP flap. A 73-year-old female patient with RA underwent TAA, and suffered from an extensive ankle soft tissue defect (13 × 5 cm) with exposure of the implanted artificial joint and the extensor tendons. A chimeric SCIP flap was raised based on the deep branch and the superficial branch of the SCIA, which included chimeric portions of the sartorius muscle, the deep fascia, the inguinal lymph node (ILN), and the skin/fat. The flap was transferred to the recipient ankle. The sartorius muscle was used to cover the artificial joint, the deep fascia to reconstruct the extensor retinaculum, the ILN to prevent postoperative lymphedema, and the adiposal tissue to put around the extensor tendons for prevention of postoperative adhesion. Postoperatively, the patient could walk by herself without persistent leg edema or bowstringing of the extensor tendons, and was satisfied with the concealable donor scar. Although further studies are required to confirm efficacy, multicomponent chimeric SCIP has a potential to be a useful option for complex defects of the ankle. PMID:27423250

  1. The freestyle pedicle perforator flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Jackson, Ian T; Westvik, Tormod S; Thomsen, Jorn Bo

    2015-01-01

    not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso. METHODS: We retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle...... aspects in the context of current literature. RESULTS: The reconstructive goals were achieved in all cases without any total flap loss or major complications. Minor complications occurred in 7/34 (21 %) cases consisting of venous congestion leading to distal tip necrosis or epidermolysis; partial flap...... loss was significant in 4 cases, however never more than 10 % of the total flap size. Reconstruction was performed on the lower limb in 13 cases, upper limb in 12, and 9 cases were on the truncus. The angle of rotation was 90° in 21 cases and 180° in 13 cases. The most common indication was...

  2. Perforator propeller flaps for sacral and ischial soft tissue reconstruction

    Directory of Open Access Journals (Sweden)

    Korambayil Pradeoth

    2010-01-01

    Full Text Available The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18% suffered complications.

  3. Perforator propeller flaps for sacral and ischial soft tissue reconstruction

    Science.gov (United States)

    Korambayil, Pradeoth M.; Allalasundaram, KV; Balakrishnan, TM

    2010-01-01

    The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18%) suffered complications. PMID:21217972

  4. [Osteo-cutaneous Mycobacterium marinum infection of the elbow and reconstruction with radial collateral artery perforator-based propeller flap].

    Science.gov (United States)

    Gabert, P-E; Lievain, L; Vallée, A; Joly, P; Auquit Auckbur, I

    2016-08-01

    Mycobacterium marinum is an atypical and non-tuberculosis mycobacterium that mainly leads to cutaneous infections. Infections occur through inoculation of the organism through injury to the skin in the presence of contaminated water or fish. The patient often presents with unspecific symptoms and the evolution, in the absence of adequate treatment, is characterized by an expansion of the cutaneous lesion and a spread to deep structures. Infections of tendon sheaths and joints are described, rarely osteomyelitis. Sure diagnosis is hard to obtain and is established from the medical history and microbiological examination. There are no specific therapeutic guidelines. Double or triple antibiotherapy is often effective and should be continued several months after complete resolution of clinical signs. Surgical debridement is required in cases of invasive or resistant infections. We report the case of a young immunocompetent fishmonger with a rare osteocutaneous M. marinum infection of the elbow. Treatment included large surgical excision of infected skin and bone areas and a triple antibiotics administration. Reconstruction have been ensured by a radial collateral artery perforator-based propeller flap, satisfying appropriates functional and cosmetical concerns of this anatomical region. Surgery and appropriate antibiotics treatment were effective and allowed healing of an invasive cutaneous and bone M. marinum infection. PMID:26748858

  5. Clinical aspects of reconstruction of the lower third of the leg with fasciocutaneous flap based on peroneal artery perforators

    Directory of Open Access Journals (Sweden)

    Terzić Zoran

    2014-01-01

    Full Text Available Background/Aim. Fasciocutaneous flaps are tissue flaps that include the skin, subcutaneous tissue and underlying fascia, and are based on the septocutaneous system of blood vessels. They have a number of characteristics that give them an advantage in many cases, especially in treatment of lower extremity defects. The aim of this study was to clinically analyse the outcomes of patients surgically treated with a. peroneae perforator-based reverse flaps of the lower leg. Methods. This prospective study was conducted on a group of 22 patients with tissue defects in the lower third of the lower leg and foot. All the 22 patients underwent standard diagnostic procedures and the preoperative preparation for spinal anesthesia. During the surgery, the location of the recipient site with a future flap and an accompanying vascular stem was marked. Having prepared the recipient site in accordance with the surgical principles, the lobe was prepared, rotated and positioned in the defect region. Results. The proportion of male to female patients in our study group was 19 (86% to 3 (14%, respectively. The maximal defect frequency (14 or 63% was found in the age group of 30-50 years, i.e. working-age people. Trauma in 16 (72% of patients was the most common reason for surgical treatment. The most common defects our patients had were found in the distal third of the leg (5, 22%, medial malleolus (4, 18%, the dorsum of the foot (3, 13% and the foot (4, 18%. The number of lobes (18, 81% applied in the course of our clinical study was statistically more significant (p < 0.05 than the number of lobes applied along with the skin autografts (4, 19%. During the final follow-up of the applied lobes, 6 (27.2% of early and 2 (9% of late complications were observed, making a total of 36.2% of complications occurring in the applied lobes, of which only 1 was lost. Conclusion. Clinical application of a.suralis superficialis mediani-based reverse flap is justified by a high

  6. Nipple reconstruction with banked costal cartilage after vertical-type skin-sparing mastectomy and deep inferior epigastric artery perforator flap.

    Science.gov (United States)

    Mori, Hiroki; Uemura, Noriko; Okazaki, Mutsumi

    2015-01-01

    We recently used skin-sparing mastectomy (SSM), the deep inferior epigastric artery perforator (DIEP) flap, and delayed nipple reconstruction with banked costal cartilage. Eight patients who underwent these reconstructions between 2008 and 2010 were reviewed. SSM was performed by vertical-type incision. We transferred the DIEP flap using an internal thoracic vessel and banked costal cartilage into an abdominal wound. Three to 6 months later, we removed the cartilage and cut it into a cylindrical shape. We fixed the cartilage on the dermal base of a modified C-V flap. No flap necrosis or exposure of cartilage was seen and the scar was acceptable in all cases. At a mean follow-up of 12.6 months, 59% of the nipple projection was maintained in comparison to immediately postoperatively. Our new concept is the combination of SSM, DIEP, and banked cartilage, and furthermore putting the cartilage on a dermal base. With support from the dermis, a large, complicated cartilage form is unnecessary. PMID:22246867

  7. Colgajos de perforantes de las arterias epigástricas inferiores profunda y superficial Deep and superficial inferior epigastric artery perforator flaps

    Directory of Open Access Journals (Sweden)

    A. R. Gagnon

    2006-12-01

    Full Text Available Con el desarrollo de los colgajos miocutáneos de recto abdominal (TRAM, el abdomen inferior ha sido reconocido como la principal área dadora de tejidos autólogos de alta calidad, especialmente útiles en reconstrucción mamaria. Más recientemente la habilidad para obtener componentes adiposocutáneos similares sin sacrificar el músculo recto ha revolucionado el campo de la Cirugía Reconstructiva. El advenimiento de los colgajos de perforantes ha permitido a los cirujanos plásticos lograr los mismos buenos resultados estéticos que con los colgajos miocutáneos tradicionales, pero con un considerable descenso en la morbilidad del área donante. Con los colgajos de perforantes de la arteria epigástrica inferior profunda (DIEP y de la arteria epigástrica inferior superficial (SIEA, los pacientes han incrementado sus opciones de reconstrucción. Este artículo revisa la anatomía quirúrgica de la pared abdominal relativa a los colgajos SIEA y DIEP. Se explican detalladamente los pasos principales para la preparación preoperatoria, la técnica quirúrgica y los cuidados postoperatorios. Se discuten las ventajas y desventajas y se presen- tan los trucos técnicos que pueden ayudar a mejorar el resultado final. Además se ilustran con ayuda de casos clínicos las indicaciones típicas y atípicas.Following the development of the transverse rectus abdominis myocutaneous (TRAM flap, the lower abdomen has been recognized as a prime source of high quality autogenous tissue, especially useful in breast reconstruction. More recently, the ability to harvest a similar adipocutaneous component without sacrifice of the rectus muscle has revolutionized the field of reconstructive surgery. The advent of perforator flaps has allowed plastic surgeons to achieve the same highly esthetic results as with the former myocutaneous flaps while significantly decreasing the donor site morbidity. With the deep inferior epigastric artery perforator (DIEP flap and

  8. Reconstruction of hand contracture by reverse ulnar perforator flap

    Directory of Open Access Journals (Sweden)

    Cengiz Eser

    2016-04-01

    Full Text Available Hand burn scar contractures affect patients in aesthetic and functional aspects. After releasing these scars, the defects should be repaired. The reconstruction methods include primary suturation, Z plasty, skin grafting, local or free flaps, etc. All methods have their own advantages and disadvantages. One of the most useful flaps is the reverse ulnar perforator flap. We performed a two-staged procedure for repairing a post-burn contracture release defect in a 40-year-old male. In the first stage we applied reverse ulnar perforator flap for the hand defect, and ulnar artery and vein repair in the second stage. In conclusion, this two-staged procedure is a non-primary but useful option for hand and finger defects and prevents major vascular structure damage of the forearm. [Hand Microsurg 2016; 5(1.000: 40-43

  9. Abdominal perforator vs. muscle sparing flaps for breast reconstruction.

    Science.gov (United States)

    Butler, Paris D; Wu, Liza C

    2015-06-01

    Abdominally based free flaps have become the mainstay for women that desire to use their own tissue as a means of breast reconstruction after mastectomy. As the techniques have evolved, significant effort has been invested in finding the best means of minimizing morbidity to the abdominal donor site while ensuring a viable reconstructed breast that is aesthetically pleasing. This manuscript reviews and compares the muscle sparing free transverse rectus abdominis myocutaneous (MsfTRAM), the deep inferior epigastric artery perforator (DIEP), and the superficial inferior epigastric artery (SIEA) flaps, regarding flap success rate, operative times, abdominal donor site morbidity and residual functionality, hospital lengths of stay and associated costs, impact of co-morbid conditions, and resilience after adjuvant radiation treatment. PMID:26161306

  10. Radial artery perforating branch island flap for repair of defects of the wrist and forearm%桡动脉穿支蒂岛状皮瓣修复腕及前臂创面

    Institute of Scientific and Technical Information of China (English)

    孙振中; 寿奎水; 宋骁军; 盛鹏; 王建兵; 马运宏; 韦旭明; 刘军

    2011-01-01

    目的 探讨桡动脉穿支蒂岛状皮瓣的解剖以及修复腕及前臂创面的手术方法和临床疗效.方法 以桡动脉搏动及体表投影为中心,采用多普勒血管仪探测桡动脉穿支的部位,以靠近缺损创面部的皮支作为血管蒂及旋转点,根据缺损创面大小、形状设计皮瓣,修复腕及前臂创面12例.结果 术后12例皮瓣中有2例出现静脉危象,经拆除部分缝线后存活,创面愈合,其余10例皮瓣均顺利存活.随访时间3~18个月,皮瓣质地软,外形及功能满意.结论 桡动脉穿支在桡骨茎突近端2.0cm、4.0~ 5.0 cm、7.0cm处较恒定,以此为蒂的岛状皮瓣血供可靠,操作简单,不损伤主干血管,修复后外形好,是修复腕及前臂皮肤软组织缺损的有效方法之一.%Objective To discuss the operative method and clinical results of the radial artery perforating branch island flap.Methods The radial artery perforating branch island flap was used to repair defects of the wrist and forearm in 12 cases.Radial artery pulse and surface projection was used as the centre to probe the cutaneous perforating branches with Doppler ultrasonography.The perforator that was close to the defect was chosen as the vascular pedicle and pivoting point of the island flap.The flap was designed based on the size and shape of the defect to repair the wound of the wrist and forearm.Results Vein crisis occurred in 2 cases of 12patients.The 2 flaps partially survived after removing the sutures.The rest 10 flaps survived uneventfully.After 3 to 18 months' follow-up,the texture of the flap was found to be soft and the shape and function satisfactory.Conclusion The perforating branch of the radial artery was relatively constant at 2 cm,4 to 5 cm and 7 cm above radial styloid process.Island flaps with pedicles of these perforators have reliable blood supply.Flap harvesting is simple,without damaging the main vessel.Postoperative appearance is good.This flap is an effective method to

  11. Video Capture of Perforator Flap Harvesting Procedure with a Full High-definition Wearable Camera.

    Science.gov (United States)

    Miyamoto, Shimpei

    2016-06-01

    Recent advances in wearable recording technology have enabled high-quality video recording of several surgical procedures from the surgeon's perspective. However, the available wearable cameras are not optimal for recording the harvesting of perforator flaps because they are too heavy and cannot be attached to the surgical loupe. The Ecous is a small high-resolution camera that was specially developed for recording loupe magnification surgery. This study investigated the use of the Ecous for recording perforator flap harvesting procedures. The Ecous SC MiCron is a high-resolution camera that can be mounted directly on the surgical loupe. The camera is light (30 g) and measures only 28 × 32 × 60 mm. We recorded 23 perforator flap harvesting procedures with the Ecous connected to a laptop through a USB cable. The elevated flaps included 9 deep inferior epigastric artery perforator flaps, 7 thoracodorsal artery perforator flaps, 4 anterolateral thigh flaps, and 3 superficial inferior epigastric artery flaps. All procedures were recorded with no equipment failure. The Ecous recorded the technical details of the perforator dissection at a high-resolution level. The surgeon did not feel any extra stress or interference when wearing the Ecous. The Ecous is an ideal camera for recording perforator flap harvesting procedures. It fits onto the surgical loupe perfectly without creating additional stress on the surgeon. High-quality video from the surgeon's perspective makes accurate documentation of the procedures possible, thereby enhancing surgical education and allowing critical self-reflection. PMID:27482504

  12. Clinical application of free peroneal artery perforator flap transplantation for forefoot defects reparation%腓动脉穿支皮瓣游离移植修复前足创面的临床应用

    Institute of Scientific and Technical Information of China (English)

    官士兵; 寇伟; 许兰伟; 赵雁

    2014-01-01

    目的 分析小腿外侧腓动脉穿支皮瓣的特点,探讨腓动脉穿支皮瓣游离移植修复前足创面的临床应用. 方法 回顾性分析小腿外侧腓动脉穿支皮瓣游离移植修复前足创面患者9例,皮肤缺损面积为4.5 cm×4.0cm~13.5 cm×6.5 cm;着重分析前足创面的特点以及小腿外侧腓动脉穿支皮瓣的设计、切取、血管吻合匹配等,术后随访皮瓣的成活、外观及踝足的功能恢复情况等. 结果 9例均在小腿外侧以腓骨小头与外踝连线中点稍上方附近找到发自腓动脉的较大肌皮穿支,且有明显的2条静脉伴行.移植皮瓣静脉修复:1例腓动脉穿支动脉伴行静脉-足(跖)背动脉伴行静脉端端吻合2条,5例腓动脉穿支动脉伴行静脉-足(跖)背动脉伴行静脉端端吻合1条;3例腓动脉穿支动脉伴行静脉-足(跖)背动脉伴行静脉端端吻合1条加腓动脉穿支动脉伴行静脉-足背浅静脉端端吻合1条.术后9例皮瓣全部成活,未发生血管危象,修复1条静脉与修复2条静脉皮瓣肿胀情况肉眼观察无明显差异;受区、供区创面均一期愈合;术后随访2~6个月,1例因皮瓣臃肿术后5个月行皮瓣整形,其他皮瓣皮肤质地、颜色满意. 结论 小腿外侧腓动脉穿支皮瓣游离移植摆脱了带蒂皮瓣的束缚,使手术设计和实施相对自由,对皮瓣供区、受区的创伤均得到有效控制.该皮瓣的血管解剖相对稳定、血供可靠、切取简单、皮肤质地与足部接近修复效果好、供区受区可在同一麻醉同一个止血带下完成,是修复前足部创面一个很好的选择.%Objective To analyze features of the lateral leg peroneal artery perforator free flap,and study the clinical application of free peroneal artery perforator flap transplantation for repairing forefoot defects.Methods Retrospectively analyzed 9 patients with forefoot defects which had been repaired with free lateral leg peroneal artery perforator flap

  13. 肋间后动脉外侧穿支皮瓣的解剖与临床应用%Anatomy of the lateral perforator flap supplied by posterior intercostal artery and its clinical application

    Institute of Scientific and Technical Information of China (English)

    徐家钦; 潘云川; 梅劲; 石小田; 梁尊鸿; 邱勋永

    2012-01-01

    Objective To provide the applied anatomy of the posterior intercostal artery perforator flap and the clinical results of repairing the soft tissue defects with lateral perforator flap. Methods Six fresh adult cadavers were injected with a lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 64-slice spiral computed tomography scanner and specialized software (Materiaise's interactive medical image control system,MIMICS).The origin,course,diameter,and distribution of the the 6-10th posterior intercostal artery perforators in the thoroax region were observed and measured.Clinically,nine cases were treated with the lateral perforator flap supplied by 7-10th posterior intercostal artery transplantation for repairing wounds in upper limbs.The flap size was 9 cm × 7 cm-16 cm × 12 cm. Results The 6-10th posterior intercostal artery perforator (outer diameter 1.70 ± 0.14 mm) were from the artery in the chest region, which pierce in deep fascia near midaxillary line. The average pedicle length from the deep fascia was (87.56 ± 6.48) mm.All of 9 cases were repaired successfully,the clinical results were satisfactory.Conclusion The posterior intercostal artery perforator flap can be used to form many kinds of axial skin flaps,it is a good option for repairing soft-tissue defect.%目的 为肋间后动脉外侧皮穿支皮瓣临床应用提供解剖学基础. 方法 选用新鲜成人标本6具,行血管造影、三维重建及层次解剖,观测第6~ 10肋间后动脉外侧穿支的类型、管径、走行、出筋膜后轴向等.临床应用第7~ 10肋间后动脉外侧穿支皮瓣修复软组织缺损9例,皮瓣面积9.0 cm×7.0 cm~16.0 cm×12.0 cm. 结果 第6~ 10肋间后动脉外侧皮穿支来源于胸主动脉发出的肋间后动脉,于腋中线前后经肋间肌穿出深筋膜.肋间后动脉外侧皮穿支平均外径( 1.70±0.14)mm.其前支穿出深筋膜后走行长度(87.56±6.48) mm.临床上应用肋间后动脉外

  14. Perforator plus flaps: Optimizing results while preserving function and esthesis

    Directory of Open Access Journals (Sweden)

    Mehrotra Sandeep

    2010-01-01

    Full Text Available Background: The tenuous blood supply of traditional flaps for wound cover combined with collateral damage by sacrifice of functional muscle, truncal vessels, or nerves has been the bane of reconstructive procedures. The concept of perforator plus flaps employs dual vascular supply to flaps. By safeguarding perforators along with supply from its base, robust flaps can be raised in diverse situations. This is achieved while limiting collateral damage and preserving nerves, vessels, and functioning muscle with better function and aesthesis. Materials and Methods: The perforator plus concept was applied in seven different clinical situations. Functional muscle and fasciocutaneous flaps were employed in five and adipofascial flaps in two cases, primarily involving lower extremity defects and back. Adipofascial perforator plus flaps were employed to provide cover for tibial fracture in one patients and chronic venous ulcer in another. Results: All flaps survived without any loss and provided long-term stable cover, both over soft tissue and bone. Functional preservation was achieved in all cases where muscle flaps were employed with no clinical evidence of loss of power. There was no sensory loss or significant oedema in or distal to the flap in both cases where neurovascular continuity was preserved during flap elevation. Fracture union and consolidation were satisfactory. One patient had minimal graft loss over fascia which required application of stored grafts with subsequent take. No patient required re-operation. Conclusions: Perforator plus concept is holistic and applicable to most flap types in varied situations. It permits the exercise of many locoregional flap options while limiting collateral functional damage. Aesthetic considerations are also addressed while raising adipofascial flaps because of no appreciable donor defects. With quick operating times and low failure risk, these flaps can be a better substitute to traditional flaps and at

  15. Repair of soft tissue defect in hand or foot with lobulated medial sural artery perforator flap%腓肠内侧动脉分叶皮瓣修复手、足软组织缺损

    Institute of Scientific and Technical Information of China (English)

    赵风景; 姚建民; 张兴群; 马亮; 张龙春; 徐一波; 王鹏; 祝震

    2015-01-01

    Objective To explore the clinical effect of the lobulated medial sural artery perforator flap in repairing soft tissue defect in hand or foot.Methods Since March 2012 to September 2014, 6 cases with soft tissue defects in hands or feet were treated by lobulated medial sural artery flaps pedicled with 1st musculo-cutaneous perforator and 2st musculo-cutaneous perforator of the medial sural artery.The size of the flaps ranged from 4.5 cm × 10.0 cm to 6.0 cm × 17.0 cm.Results 5 cases of lobulated flap survived smoothly, only 1 lobulated flap had venous articulo, but this flap also survived after the articulo was removed by vascular exploration.All flaps had desirable appearance and sensation and the two-point discrimination was 6 mm in mean with 4 to 12 months follow-up(average, 7 months).Linear scar was left in donor sites in 3 cases and skin scar in 3 cases.There was no malfunction in donor sites.Conclusions Lobulated medial sural artery perforator flap is feasible and ideal method for the treatment of soft tissue defect in hand or foot with satisfactory effect.%目的 探讨腓肠内侧动脉分叶皮瓣修复手、足软组织缺损的临床效果.方法 2012年3月至2014年9月,以腓肠内侧动脉为主干,第1、2肌皮穿支构成分叶皮瓣移植修复手、足部软组织缺损6例,皮瓣面积4.5 cm×10.0 cm~6.0 cm×17.0 cm.结果 5例腓肠内侧动脉分叶皮瓣顺利成活,1例分叶皮瓣因皮瓣下产生积血,出现静脉危象,经血管探查、清除积血后危象解除,皮瓣成活.术后随访4~12个月,平均7个月,皮瓣外观和功能恢复良好,分叶皮瓣平均两点辨距觉为6 mm;3例皮瓣供区遗留线性瘢痕,3例遗留植皮瘢痕,肢体活动不受影响.结论 腓肠内侧动脉分叶皮瓣游离移植修复手、足软组织缺损,方法可靠,效果较好.

  16. Tensor fascia latae perforator flap: An alternative reconstructive choice for anterolateral thigh flap when no sizable skin perforator is available

    Directory of Open Access Journals (Sweden)

    Federico Contedini

    2013-01-01

    Full Text Available Introduction: The anterolateral thigh flap (ALT is a versatile flap and very useful for the reconstruction of different anatomical districts. The main disadvantage of this flap is the anatomical variability in number and location of perforators. In general, absence of perforators is extremely rare. In literature, it is reported to be from 0.89% to 5.4%. If no sizable perforators are found, an alternative reconstructive strategy must be considered. Tensor fascia lata (TFL perforator flap can be a good alternative in these cases: Perforator vessels are always present, the anatomy is more constant and it is possible to harvest it through the same surgical access. The skin island of the flap can be very large and can be thinned removing a large part of the muscle allowing its use for almost the same indications of the ALT flap. Materials and Methods: We report 11 cases of reconstruction firstly planned with the ALT flap, then converted into TFL perforator flap. Results and Conclusion: The result was always satisfactory in terms of the donor site morbidity and reconstructive outcome.

  17. The Versatility of Perforator-Based Propeller Flap for Reconstruction of Distal Leg and Ankle Defects

    Directory of Open Access Journals (Sweden)

    Durga Karki

    2012-01-01

    Full Text Available Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. Material and Methods. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm × 3.5 cm to 7 cm × 5 cm. Results. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result.

  18. The Versatility of Perforator-Based Propeller Flap for Reconstruction of Distal Leg and Ankle Defects

    Science.gov (United States)

    Karki, Durga; Narayan, R. P.

    2012-01-01

    Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. Material and Methods. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm × 3.5 cm to 7 cm × 5 cm. Results. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result. PMID:22567253

  19. 桡动脉穿支逆行皮瓣修复手及腕部创伤的临床疗效%Clinical application of radial artery perforator flap for repair of defect in hand and wrist

    Institute of Scientific and Technical Information of China (English)

    胥学冰; 史昌乾; 张博; 唐亦复; 张桂全; 林麟

    2015-01-01

    目的:探讨桡动脉穿支逆行皮瓣修复手及腕部创伤的临床疗效。方法对应用桡动脉穿支逆行皮瓣修复手及腕部创伤26例,根据缺损部位、大小及形状,6例以桡骨茎突上6 cm为轴点(位于肱桡肌腱外侧),8例以桡骨茎突上2 cm为轴点和桡动脉的体表投影线为轴心线,12例以鼻烟窝中点为轴点,桡骨茎突至桡骨小头的连线为轴心线,分别设计面积最大10 cm ×8 cm,最小4 cm ×3 cm的皮瓣。结果3例皮瓣远端浅表坏死,经换药后愈合,其余23例完全成活,随访6个月,手及腕部外形和功能良好。结论桡动脉穿支逆行皮瓣血供可靠,操作简单,不损伤主要血管,术后手及腕部外形和功能恢复良好,是一种较理想的修复方法。%Objective To evaluate the clinical curative effect of radial artery perforator reverse flap was utilized to repair the defect in hand and wrist .Methods From June 2007 to June 2014, 26 patients with defect in hand and wrist were treated with radial artery perforator reverse flap .According to the site , size and shape of defect , 6 cm above the radial styloid process as pivot point in 6 cases, located laterally to the tendon brachioradialis .Pivot point of the flap at 2 cm above the radial styloid process in 8 cases with body surface projection of radial artery as axial line .Midpoint of nasopharyngeal fossa as pivot point in 12 cases with axial line from ra-dial styloid process to radial head .The biggest flap at 10 cm ×8 cm and the smallest flap at 4 cm ×3 cm were designed .Results 23 flaps completely survived, distal necrosis was seen in 3 flaps which healed by changing dressings .Followed up for 6 months, the func-tion and appearance of hand and wrist were satisfying .Conclusions The radial artery perforator reverse flap is an ideal method for re-pairing the defect in hand and wrist due to its reliable and convenient qualities , no damage to the main blood vessel and

  20. Reconstruction of Heel With Propeller Flap in Postfasciotomy and Popliteal Artery Revascularization State.

    Science.gov (United States)

    Kang, Jin Seok; Choi, Hwan Jun; Tak, Min Sung

    2016-06-01

    Free flaps are still the gold standard for large defects of the lower limb, but propeller perforator flaps have become a simpler and faster alternative to free flaps because of some advantages such as reliable vascular pedicle, wide mobilization and rotation, great freedom in design, low donor site morbidity, and easy harvest with no requirement for anastomosis. But when the vessels show insufficient findings in preoperative evaluation using a Doppler probe or the vessel is injured, the surgeon should avoid performing free flap surgery to prevent flap failure and should select a propeller perforator flap as an alternative method on the condition that more than one perforator is intact. In this study, we report reconstruction of soft tissue defects of the heel with a pedicled propeller flap in postfasciotomy and popliteal artery revascularization state by making an incision on the central portion above the Achilles tendon, which can be covered by the posterior tibial artery perforator or the peroneal artery perforator based flaps. In conclusion, we showed that although the popliteal artery was injured, the soft tissue defect can be reconstructed using a perforator propeller flap if intact distal flow in the anastomosis site was confirmed. PMID:25673623

  1. Autologous reconstruction of a complex form of Poland syndrome using 2 abdominal perforator free flaps.

    Science.gov (United States)

    Masia, Jaume; Pons, Gemma; Loschi, Pietro; Sanchez Porro-Gil, Lidia; Nardulli, Maria Luisa; Olivares, Leyre

    2015-05-01

    Poland syndrome is the most frequent cause of congenital breast aplasia and hypoplasia. Breast and possible chest wall deformities can be treated with several surgical techniques, including implants, and pedicled or free flaps.We describe the case of a young patient with severe Poland syndrome with amastia, athelia, and deformity of the chest wall, and aplasia of 2 ribs. Marked hypoplasia of the ipsilateral latissimus dorsi muscle ruled out a reliable reconstructive option.Two perforator flaps were performed in a single-stage operation. A hemi-deep inferior epigastric perforator flap was harvested to correct the chest deformity, whereas the contralateral superficial inferior epigastric artery flap allowed breast reconstruction.No complications occurred and a subjectively and objectively pleasing cosmetic result was maintained at 3-year follow-up. PMID:24322640

  2. Effects of venous supercharging in deep inferior epigastric artery perforator flap Efeitos da vascularização venosa ampliada na viabilidade do retalho perfurante da artéria epigástrica profunda

    Directory of Open Access Journals (Sweden)

    Anne Karoline Groth

    2007-12-01

    Full Text Available PURPOSE: To evaluate the effects of venous supercharging in deep inferior epigastric artery perforator flap in rats. METHODS: 20 Wistar rats were randomized in 2 groups: control group (C, all had flaps raised based on the deep inferior epigastric perforator vessels (DIEP, and experimental group (E, which was identical to group C, except that the contralateral superficial inferior epigastric vein was also kept with the flap. Flow studies using laser Doppler flowmetry where performed daily in the four zones of the flap. On the 7th postoperative day rats were killed and flap survival was determined using digital planimetry. RESULTS: Flow values were presented as a percentage of the baseline flow after incision of the flap edges. The surviving flap area was demonstrated as a percentage of the total flap area. Evaluation by digital planimetry showed that flap survival in group E was higher than in group C (97,38%±1,32%vs.44,13%±4,83%, p=0,0006. CONCLUSION: This study shows that venous supercharging of the rat DIEP flap results in greater flap survival.OBJETIVO: Avaliar o efeito da vascularização venosa ampliada na viabilidade do retalho perfurante da artéria epigástrica profunda em ratos. MÉTODOS: Vinte ratos foram divididos em 2 grupos: controle(C, no qual se realizou o retalho perfurante da artéria epigástrica profunda e experimento(E, no qual se realizou o mesmo retalho e se manteve a veia epigástrica superficial inferior contralateral ao pedículo. Foi realizada determinação diária do fluxo sanguíneo por fluxometria por laser-doppler em quatro quadrantes do retalho previamente estabelecidos e a viabilidade foi determinada, no 7º pós-operatório, através de planimetria. RESULTADOS: A análise do fluxo sangüíneo demonstrou não haver diferença entre o grupo C e E nas médias de fluxo entre as zonas do retalho (Zona I:103,44±8,09vs.84,70±7,98, p=0,114(Zona II: 109,18±6,99 vs. 113,67±26,89, p=0,401(Zona III: 89,15±11,11 vs

  3. Comparison of the Multidetector-row Computed Tomographic Angiography Axial and Coronal Planes' Usefulness for Detecting Thoracodorsal Artery Perforators

    OpenAIRE

    Jong Gyu Kim; Soo Hyang Lee

    2012-01-01

    Background During the planning of a thoracodorsal artery perforator (TDAP) free flap, preoperative multidetector-row computed tomographic (MDCT) angiography is valuable for predicting the locations of perforators. However, CT-based perforator mapping of the thoracodorsal artery is not easy because of its small diameter. Thus, we evaluated 1-mm-thick MDCT images in multiple planes to search for reliable perforators accurately. Methods Between July 2010 and October 2011, 19 consecutive patients...

  4. Optimización en el uso del colgajo de segunda perforante intercostal de la arteria mamaria interna Optimizing the use of the second intercostal perforator flap of the internal mammary artery

    Directory of Open Access Journals (Sweden)

    D. Sicilia Castro

    2012-06-01

    Full Text Available El colgajo en isla basado en perforantes de la arteria mamaria interna (colgajo IMAP se emplea de manera reciente como técnica reconstructiva en cabeza y cuello. El objetivo de esta revisión es corroborar las posibilidades del arco de rotación de dicho colgajo cuando se realiza una amplia disección de su pedículo vascular. Presentamos 4 pacientes de edades comprendidas entre 46 y 75 años, todos ellos varones, con defectos faríngeos parciales, en los que empleamos un colgajo pediculado basado en la segunda perforante de la arteria mamaria interna para reconstrucción del defecto faríngeo. El tamaño medio del defecto a cubrir fue de 3,2 cm (desviación estándar +/- 1,5 cm en sentido horizontal y 4,5 cm (desviación estándar +/- 2,2 cm en sentido vertical. En todos los casos se disecó un colgajo en isla con un tamaño medio de 6 X 8 cm. La longitud media del pedículo fue de 5,5 cm (desviación estándar +/- 1,51 cm. En todos los casos fue posible sellar el defecto faríngeo sin necesidad de resecar costilla o de incorporar parte de la arteria mamaria interna correspondiente. El colgajo IMAP es un colgajo rápido de realizar que permite la reconstrucción de defectos faríngeos parciales de la región anterior del cuello y hasta la base de la lengua sin necesidad de resección costal o incorporación parcial de los vasos mamarios.The island flap based on perforators of the internal mammary artery (IMAP flap is recently used in reconstruction of head and neck defects. The aim of this review is to verify the possibilities of the arc of rotation of the flap when it's necessary to carry out an extensive dissection of the vascular pedicle. We present reconstruction of partial pharyngeal defects in 4 patients, aged between 46 and 75 years and all men, using a pedicle flap based on the second perforator of the internal mammary artery. The average size of the defect was 3.2 cm (SD +/- 1.5 cm horizontally and 4.5 cm (SD +/- 2.2 cm vertically. In

  5. Anatomical study of terminal peroneal artery perforators and their clinical applications

    Directory of Open Access Journals (Sweden)

    Rajendran Purushothaman

    2013-01-01

    Full Text Available Introduction: Peroneal artery gives off plenty of perforators that pass through fascial septum to supply skin and tenosynovium of peroneal muscles. Aim: The aim of this study was to study the anatomical basis of perforators from terminal part of peroneal artery axiality and to make use of this knowledge in reconstructing defects of posterior heel with the advantage of reducing the morbidity of conventional flaps. Materials and Methods: Our study was conducted at Department of Plastic surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, India. We have carried out eleven cadaver dissections (from six cadavers-four fresh cadavers and two preserved cadavers and delineated all septocutaneous and septosynovial perforators of distal peroneal axis and studied their relation with short saphenous vein (SSV and sural nerve. Using this anatomical knowledge we have fashioned perforator based flaps in 13 patients (three propeller, four V-Y advancement, six tenosynovial flaps for reconstruction of defects over tendo achilles and pericalcaneal region . Results: In all cases, SSV and sural nerve were preserved and donor site was closed primarily. No total flap loss was noted. Conclusion: Perforator based flaps from distal most part of peroneal artery provide a good and reliable method for reconstruction of pericalcaneal and tendo achilles region defects with preservation of SSV and sural nerve. It also avoids contour deformity of the grafted donor site of the classical lateral calcaneal artery axial flap.

  6. Non-invasive vascular imaging in perforator flap surgery

    International Nuclear Information System (INIS)

    Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered

  7. Non-invasive vascular imaging in perforator flap surgery

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Piga, Mario [Dept. of Radiology, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy)], e-mail: lucasaba@tiscali.it; Atzeni, Matteo; Ribuffo, Diego [Dept. of Surgery, Section of Plastic Surgery, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy); Rozen, Warren Matthew [Jack Brockhov Reconstructive Plastic Surgery Research Unit, Dept. of Anatomy and Cell Biology, The Univ. of Melbourne, Parkville, Victoria (Australia); Alonso-Burgos, Alberto [Dept. of Radiology, Clinica Univ., Univ. de Navarra, Pamplona (Spain); Bura, Raffaella [Dept. of Surgery, Section of Vascular Surgery, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy)

    2013-02-15

    Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered.

  8. The use of propeller perforator flaps for diabetic limb salvage: a retrospective review of 25 cases

    Directory of Open Access Journals (Sweden)

    Alexandru V. Georgescu

    2012-10-01

    Full Text Available Background : Peripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG with or without negative pressure wound therapy and local random flaps have been used with varying degrees of success to cover diabetic lower leg or foot ulcerations. Other methods include: local or regional muscle and fasciocutaneous flaps, free muscle and fasciocutaneous, or perforator flaps, which also have varying degrees of success. Patients and methods : This article reviews 25 propeller perforator flaps (PPF which were performed in 24 diabetic patients with acute and chronic wounds involving the foot and/or lower leg. These patients were admitted beween 2008 and 2011. Fifteen PPF were based on perforators from the peroneal artery, nine from the posterior tibial artery, and one from the anterior tibial artery. Results : A primary healing rate (96% was obtained in 18 (72% cases. Revisional surgery and SG for skin necrosis was performed in six (24% cases with one complete loss of the flap (4% which led to a lower extremity amputation. Conclusions : The purpose of this article is to review the use of PPF as an effective method for soft tissue coverage of the diabetic lower extremity and/or foot. In well-controlled diabetic patients that present with at least one permeable artery in the affected lower leg, the use of PPF may provide an alternative option for soft tissue reconstruction of acute and chronic diabetic wounds.

  9. The use of propeller perforator flaps for diabetic limb salvage: a retrospective review of 25 cases

    Science.gov (United States)

    Georgescu, Alexandru V.; Matei, Ileana R.; Capota, Irina M.

    2012-01-01

    Background Peripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG) with or without negative pressure wound therapy and local random flaps have been used with varying degrees of success to cover diabetic lower leg or foot ulcerations. Other methods include: local or regional muscle and fasciocutaneous flaps, free muscle and fasciocutaneous, or perforator flaps, which also have varying degrees of success. Patients and methods This article reviews 25 propeller perforator flaps (PPF) which were performed in 24 diabetic patients with acute and chronic wounds involving the foot and/or lower leg. These patients were admitted beween 2008 and 2011. Fifteen PPF were based on perforators from the peroneal artery, nine from the posterior tibial artery, and one from the anterior tibial artery. Results A primary healing rate (96%) was obtained in 18 (72%) cases. Revisional surgery and SG for skin necrosis was performed in six (24%) cases with one complete loss of the flap (4%) which led to a lower extremity amputation. Conclusions The purpose of this article is to review the use of PPF as an effective method for soft tissue coverage of the diabetic lower extremity and/or foot. In well-controlled diabetic patients that present with at least one permeable artery in the affected lower leg, the use of PPF may provide an alternative option for soft tissue reconstruction of acute and chronic diabetic wounds. PMID:23050066

  10. Anatomical study of terminal peroneal artery perforators and their clinical applications

    OpenAIRE

    Rajendran Purushothaman; Balakrishnan, T. M.; Alalasundaram, K. V.

    2013-01-01

    Introduction: Peroneal artery gives off plenty of perforators that pass through fascial septum to supply skin and tenosynovium of peroneal muscles. Aim: The aim of this study was to study the anatomical basis of perforators from terminal part of peroneal artery axiality and to make use of this knowledge in reconstructing defects of posterior heel with the advantage of reducing the morbidity of conventional flaps. Materials and Methods: Our study was conducted at Department of Plastic surgery,...

  11. 逆行胫后动脉穿支蒂隐神经营养血管(肌)皮瓣修复足踝部软组织缺损%Clinical Application of Reversed Tibialis Posterior Artery Perforator-Based Saphenous Neurocutaneous Flap for Treatment of Skin and Soft Tissue Defect Around the Foot and Ankle Joint

    Institute of Scientific and Technical Information of China (English)

    陈明; 文根; 吕一鸣; 汪春阳; 柴益民

    2012-01-01

    Objective To discuss clinical application of reversed tibialis posterior artery perforator-based saphe-nous neurocutaneous flap for treatment of skin and soft tissue defect around the foot and ankle joint. Methods 48 patients had been treated with perforator-based saphenous neurocutaneous flap for repairing skin and soft tissue defect around the foot and ankle joint. Simple reversed tibialis posterior artery perforator-based saphenous neurocutaneous flap was applied in 43 cases; musculocutaneous flap was applied in 5 cases. There are 29 fascial-perforator-based saphenous neurocutaneous flaps and 19 perforator-based saphenous neurocutaneous flaps. The area of soft tissue defects ranged from 10 cm X 9 cm to 4 cm X 3 cm. The area of flaps ranged from 11 cm × 9. 5 cm to 6 cm × 5 cm. Results 43 flaps survived completely;5 flaps encountered partial necrosis of distal portion,were treated by dressing change or secondary skin graft. All flaps were slightly swelling postoperatively without congestion. All the patients have been followed up for 6 to 18 months. The cosmetic appearance and texture of flaps were satisfied without corpulenced pedicle, the protective sensation was renewed in donor site after transplanting cellulocutaneous flap. Conclusion Reversed tibialis posterior artery perforator-based saphenous neurocutaneous flap with reliable in blood-supply and modest texture is a good option for repair of skin and soft tissue defect around the foot and ankle joint.%目的 报道逆行胫后动脉穿支蒂隐神经营养血管(肌)皮瓣修复足踝关节周围软组织缺损的手术方法和临床效果.方法 对48例足踝关节周围皮肤软组织缺损的患者采用逆行胫后动脉穿支蒂隐神经营养血管(肌)皮瓣修复,单纯逆行胫后动脉穿支蒂隐神经营养血管皮瓣39例,肌皮瓣9例;其中胫后动脉穿支筋膜蒂神经营养血管皮瓣29例,胫后动脉穿支血管蒂营养血管皮瓣19例,软组织缺损大小12 cm×9 cm~4 cm

  12. Clinical applications of preoperative perforator planning using CT angiography in the anterolateral thigh perforator flap transplantation

    International Nuclear Information System (INIS)

    Aim: To evaluate the reliability and utility of preoperative perforator planning using computed tomography angiography (CTA) in anterolateral thigh perforator flap (ALTPF) transplantation. Materials and methods: Thirty-two consecutive patients who underwent extremity reconstruction using the ALTPF were retrospectively reviewed from 2008 to 2012. These patients were divided into two groups. In group I (n = 16), suitable perforators were designed based on four criteria using CTA. These were used for the operation and compared with the intraoperative findings. In group II (n = 16), all patients underwent operation using conventional methods without preoperative perforator planning. The surgical results of all patients were evaluated for flap complications, alteration of the donor site, donor site morbidity, and the incidence of reoperation. Results: In group I, there were no statistically significant differences between the parameters, including the calibre and location of the origin (perpendicular and horizontal distance from the origin of the perforator to both the superior lateral border of the patella and the lateral region of the thigh) of all planning perforators and the operative measurement results (p-values were 0.3, 0.422, and 0.129, respectively). The types were consistent with the operative findings; the rate of the septocutaneous type was 31.25% (5/16), and the rate of the musculocutaneous type was 68.75% (11/16). The use of preoperative perforator planning in group I was associated with a significant reduction in flap complications (p = 0.009) compared with group II. There was no difference between the two groups in alteration of the donor site, donor site morbidity, or the incidence of reoperation (p-values were 0.225, 0.225, and 0.33, respectively). Conclusion: Preoperative perforator planning using CTA in ALTPF transplantation is a reliable and useful method resulting in safer operation with optimal outcome

  13. The Effect of Epigallocatechin Gallate on Flap Viability of Rat Perforator Abdominal Flaps.

    Science.gov (United States)

    Aksakal, İbrahim Alper; Küçüker, İsmail; Önger, Mehmet Emin; Engin, Murat Sinan; Keleş, Musa Kemal; Demir, Ahmet

    2016-05-01

    Background Epigallocatechin gallate (EGCG) is a substance abundant in green tea. In this study, the effects of EGCG on perforator flap viability were investigated. Methods A total of 40 rats were assigned to four groups of 10 each. In each subject, a 4 × 6 cm abdominal skin flap was raised and adapted back onto its place. In the control group, no further procedures were taken. In the flap group, 40 mg/kg/d EGCG was injected into the flap. In the gavage group, 100 mg/kg/d EGCG was given through a feeding tube. In the intraperitoneal group, 50 mg/kg/d EGCG was injected intraperitoneally. On the 7th postoperative day, flaps were photographed and the viable areas were measured and compared via a one-way analysis of variance. Results The ratios of viable and contracted flap area were 9.15/12.01, 4.59/16.46, 11.56/11.20, and 11.65/10.77 cm(2) for the control, flap group, gavage group, and intraperitoneal group, respectively. While the flap group yielded the worst results in the sense of flap contraction and viability (p < 0.001), the gavage and intraperitoneal groups were significantly better than those of the control group (p = 0.03). Histologically, epidermal, papillary dermal, and capillary tissue volumes were evaluated. In comparison to the control group, the flap group yielded significantly increased epidermal and dermal volumes (p = 0.03), however, these values were significantly decreased (p = 0.04) in the gavage and intraperitoneal groups. Capillary volumes were significantly decreased in EGCG treatment groups (p < 0.01). Conclusion Our experiment has shown that oral and intraperitoneal administration of EGCG increases the perforator flap viability when compared with controls, while direct injection decreases the viability. PMID:26919381

  14. Preliminary evaluation of the deep inferior epigastric artery perforator with CT angiography

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical value of multislice-CT angiography (MSCTA) in planning for the patients undergoing deep inferior epigastric artery perforator (DIEAP) flap operations. Methods: Eighteen patients were performed with a 16-slice CT scanner to evaluate the deep inferior epigastric artery perforator prior to DIEAP flap operations. Axial, multiplanar reconstruction (MPR), maximum intensity projection (MIP) and volume rendered( VR) images were analysed and the origins, calibers, courses and anatomic relationships of the deep inferior epigastric artery perforator were evaluated. The anastomosis between the superficial inferior epigastric artery and the main perforator was observed as well. The images were classified into three grades based on the vessels' appearance. A + indicated the vessel appeared clear, continuous and thick. A - indicated the vessel appeared foggy, discontinuous and thin or the vessel partly showed. B indicated no related vessel can be seen. Other 18 patients undergoing conventional abdomen-pelvis CT scans for other reasons were used for control group t o compare their CT findings of the deep inferior epigastric artery perforator. Results: MSCTA well showed the course of the deep inferior epigastric artery (DIEA). Of the 18 cases, 17 cases appeared as A +, another one A -. It precisely displayed the origins, subcutaneous and intramuscular courses, relations of the main perforators on all cases of showing A +. The exact points where the chosen perforator vessels emerged from the rectus abdominis muscle fascia were located precisely. The superficial inferior epigastric arteries were mostly displayed and the connection between the arteries and the largest-caliber perforator from the deep system could also be shown clearly. Strict concordance with operative findings was found in CTA. Conclusion: MSCTA can precisely locate the chosen perforator vessels emerging from the rectus abdominis muscle fascia and it may be a feasible, fast, safe

  15. Propeller Perforator Flaps in Distal Lower Leg:Evolution and Clinical Applications

    OpenAIRE

    Georgescu, Alexandru V.

    2012-01-01

    Simple or complex defects in the lower leg, and especially in its distal third, continue to be a challenging task for reconstructive surgeons. A variety of flaps were used in the attempt to achieve excellence in form and function. After a long evolution of the reconstructive methods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. T...

  16. Tensor fascia lata flap versus tensor fascia lata perforator-based island flap for the coverage of extensive trochanteric pressure sores.

    Science.gov (United States)

    Kim, Youn Hwan; Kim, Sang Wha; Kim, Jeong Tae; Kim, Chang Yeon

    2013-06-01

    Tensor fascia lata (TFL) musculocutaneous flaps often require a donor site graft when harvesting a large flap. However, a major drawback is that it also sacrifices the muscle. To overcome this disadvantage, we designed a TFL perforator-based island flap that was harvested from a site near the defect and involved transposition within 90 degrees without full isolation of the pedicles. We performed procedures on 17 musculocutaneous flaps and 23 perforator-based island flaps, and compared the outcomes of these surgeries. The overall complication rate was 27.5% (11 regions). There were 7 complications related to the musculocutaneous flaps and 4 complications related to the perforator flaps. Although there were no statistical differences between those groups, lower complication rates were associated with procedures involving perforator flaps. The TFL perforator procedure is a simple and fast operation that avoids sacrificing muscle. This decreases complication rates compared to true perforator flap techniques that require dissection around the perforator or pedicle. PMID:23392259

  17. Comparison of the Multidetector-row Computed Tomographic Angiography Axial and Coronal Planes' Usefulness for Detecting Thoracodorsal Artery Perforators

    Directory of Open Access Journals (Sweden)

    Jong Gyu Kim

    2012-07-01

    Full Text Available Background During the planning of a thoracodorsal artery perforator (TDAP free flap,preoperative multidetector-row computed tomographic (MDCT angiography is valuablefor predicting the locations of perforators. However, CT-based perforator mapping of thethoracodorsal artery is not easy because of its small diameter. Thus, we evaluated 1-mm-thickMDCT images in multiple planes to search for reliable perforators accurately.Methods Between July 2010 and October 2011, 19 consecutive patients (13 males, 6females who underwent MDCT prior to TDAP free flap operations were enrolled in this study.Patients ranged in age from 10 to 75 years (mean, 39.3 years. MDCT images were acquired ata thickness of 1 mm in the axial, coronal, and sagittal planes.Results The thoracodorsal artery perforators were detected in all 19 cases. The reliableperforators originating from the descending branch were found in 14 cases, of which 6 hadtransverse branches. The former were well identified in the coronal view, and the latter in theaxial view. The location of the most reliable perforators on MDCT images corresponded wellwith the surgical findings.Conclusions Though MDCT has been widely used in performing the abdominal perforatorfree flap for detecting reliable perforating vessels, it is not popular in the TDAP free flap.The results of this study suggest that multiple planes of MDCT may increase the probabilityof detecting the most reliable perforators, along with decreasing the probability of missingavailable vessels.

  18. Planning digital artery perforators using color Doppler ultrasonography: A preliminary report.

    Science.gov (United States)

    Shintani, Kosuke; Takamatsu, Kiyohito; Uemura, Takuya; Onode, Ema; Okada, Mitsuhiro; Kazuki, Kenichi; Nakamura, Hiroaki

    2016-05-01

    Digital artery perforator (DAP) flaps have been applied for the coverage of finger soft tissue defects. Although an advantage of this method is that there is no scarification of the digital arteries, it is difficult to identify the location of the perforators during intraoperative elevation of the DAP flap. In this study, anatomically reliable locations of DAPs were confirmed using color Doppler ultrasonography (US) in healthy volunteers. A successful case using an adiposal-only DAP flap for the coverage of a released digital nerve using preoperative DAP mapping with color Doppler US is also described. A total of 40 digital arteries in 20 fingers of the right hands of five healthy volunteers (mean age: 32.2 years old) were evaluated. The DAPs were identified using color flow imaging based on the beat of the digital artery in the short axial view. In total, 133 perforators were detected, 76 (an average of 3.8 per finger) arising from the radial digital artery and 57 (an average of 2.9 per finger) arising from ulnar digital artery. Sixty-three perforators (an average of 3.2 per finger) in the middle phalanges and 70 (an average of 3.5 per finger) in the proximal phalanges were found. Overall, an average of 1.7 perforators from each digital artery was detected in the proximal or middle phalanges. Moreover, at least one DAP per phalanx was reliably confirmed using color Doppler US. Preoperative knowledge of DAP mapping could make elevating the DAP flap easier and safer. PMID:26947673

  19. DEVELOPMENT AND CURRENT STATUS OF PERFORATOR FLAPS%穿支皮瓣的发展与现状

    Institute of Scientific and Technical Information of China (English)

    徐达传; 张世民; 唐茂林; 欧阳钧

    2011-01-01

    Objective To provide a comprehensive review for development and existing problems of the perforator flaps. Methods The related home and abroad literature concerning perforator flaps was extensively reviewed. Results The perforator flaps are defined as the axial flaps nourished solely by small cutaneous perforating vessels (perforating arteries and veins), which are exclusively composed of skin and subcutaneous fat. The perforator flaps have the advantages as follows: less injury at donor site, less damage to the contour of the donor site, good reconstruction and appearance of the recipient site flexible design, and short time of postoperative recovery, which have been widely used in reconstructive surgery. Conclusion The perforator flaps are the new development of the microsurgery, which usher an era of small axial flaps; However, the controversies of the definition, vascular classification, the nomenclature, and the clinical application of the perforator flaps still exist, which are therefore the hot spot for future study.%目的 对穿支皮瓣的发展和存在的问题进行综述. 方法 广泛查阅国内外穿支皮瓣相关文献,并进行综述. 结果 穿支皮瓣是仅以管径细小的皮肤穿支血管供血,切取包括皮肤和皮下组织的一种轴型皮瓣,其轴心血管为穿支(穿动脉和穿静脉).穿支皮瓣具有对供区损伤小、不破坏供区外形、受区修复重建功能和外形好、设计灵活,以及患者术后康复快等诸多优点,已广泛应用于临床. 结论 穿支皮瓣的出现开创了小型轴型皮瓣时代,是显微外科皮瓣移植的新发展,但对穿支皮瓣的定义、血管分类、皮瓣的命名以及临床应用的原则等方面存在争议,依然是讨论和研究的热点.

  20. Freestyle facial perforator flaps-a safe reconstructive option for moderate-sized facial defects

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Jackson, Ian Thomas; Thomsen, Jorn Bo

    2014-01-01

    BACKGROUND: Perforators are a constant anatomical finding in the facial area and any known flap can in theory be based on the first perforator located at the flap rotation axis. METHODS: A case series of single stage reconstruction of moderate sized facial defects using 21 perforator based local...... flaps in 19 patients from 2008-2013. RESULTS: A sufficient perforator was located in every case and the flap rotated along its axis (76 %) or advanced (24 %). Reconstruction was successfully achieved with a high self reported patient satisfaction. Two minor complications occurred early on in the series...... and corrective procedures were performed in four patients. CONCLUSIONS: The random facial perforator flap seems to be a good and reliable option for the reconstruction of facial subunits, especially the periorbital, nasal and periocular area with a minimal morbidity and a pleasing result in a one...

  1. Reconstrucción de la extremidad inferior con colgajos de perforantes locales Perforator local flaps in lower limb reconstruction

    Directory of Open Access Journals (Sweden)

    T. C. Teo

    2006-12-01

    Full Text Available Las innovaciones técnicas en el diseño y elevación de colgajos y los recientes avances en el conocimiento de la perfusión arterial de los mismos, ha conducido hacia un tipo de reconstrucción más refinada para todas las partes del cuerpo. El concepto de colgajos basados en vasos perforantes ha evolucionado a partir de estos avances. La reconstrucción de la extremidad inferior se ha beneficiado particularmente de este desarrollo de los colgajos de perforantes, tanto pediculados como libres. El colgajo fasciocutáneo en isla de base distal, basado en una sola perforante, permite la reconstrucción de defectos del tercio inferior de la extremidad inferior, con una técnica de rápida ejecución y con una instrumentación básica. Describimos la anatomía, diseño, ejecución, aplicaciones y ventajas de los colgajos de perforantes locales en la reconstrucción del miembro inferior.Technical innovations in the approach to flap design and dissection and recent advances in unders tanding of the arterial basis of flap perfusion have led to more refined reconstruction in all areas of the body. The concept of perforator vessel based flap has evol ved from this improved knowledge. Lower limb reconstruction has certainly benefited from this development of perforator flaps, both pedi cled and free. The distally based island fasciocutane ous flap, based on a single perforator, has allowed defects on the often awkward distal third of the lower limb to be covered reliably, with a quicker procedure and the simplest of instrtuments. We describe the anatomy, design, technique, appli cations and advantages of perforator local flaps in lower limb reconstruction.

  2. Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!

    Science.gov (United States)

    Panse, Nikhil; Sahasrabudhe, Parag

    2014-01-01

    Background: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. Materials and Methods: We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. Results: 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Conclusion: Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Level of Evidence: Therapeutic IV. PMID:24987209

  3. Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!

    Directory of Open Access Journals (Sweden)

    Nikhil Panse

    2014-01-01

    Full Text Available Background: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. Materials and Methods: We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. Results: 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Conclusion: Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Level of Evidence: Therapeutic IV.

  4. Cross-leg repair of large soft-tissue defects in distal sites of the feet by distally based neuro-fasciocutaneous flaps with perforating vessels.

    Science.gov (United States)

    Wang, Z Q; Cao, Y L; Huang, Y F; Liu, D Q; Li, X F

    2014-01-01

    The objective of this study was to introduce a method for repairing large soft-tissue defects on the foot. Distally based neuro-fasciocutaneous flaps with perforating vessels were designed along the saphenous and sural neurovascular axes. The cutaneous perforating branches of the major arteries of the lower extremities were used as pedicles, which provided a rotation arc for the cross-leg flap to cover the large-sized soft-tissue defects on the foot. We transferred 6 neurocutaneous vascular axial flaps, including 4 saphenous neurocutaneous axial flaps (ranging from 25 x 13 to 17 x 9 cm in area) with posterior tibial perforators as the pedicle, and 2 sural neurocutaneous axial flaps (ranging from 29 x 12 to 18 x 7 cm in area) supplied by the perforating branches of the peroneal vessels. These 6 cases of neuro-fasciocutaneous flaps survived with satisfactory cosmetic appearances and functional results on follow-up at 8 to 17 months post-surgery. Placing a distally based neuro-fasciocutaneous cross-leg flap with perforating vessels is an effective method for repairing large-sized soft-tissue defects on the foot. PMID:25117303

  5. Propeller Perforator Flaps in Distal Lower Leg: Evolution and Clinical Applications

    Science.gov (United States)

    2012-01-01

    Simple or complex defects in the lower leg, and especially in its distal third, continue to be a challenging task for reconstructive surgeons. A variety of flaps were used in the attempt to achieve excellence in form and function. After a long evolution of the reconstructive methods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. This era began in 1989, when Koshima and Soeda, and separately Kroll and Rosenfield described the first applications of such flaps. Perforator flaps, whether free or pedicled, gained a high popularity due to their main advantages: decreasing donor-site morbidity and improving aesthetic outcome. The use as local perforator flaps in lower leg was possible due to a better understanding of the cutaneous circulation, leg vascular anatomy, angiosome and perforasome concepts, as well as innovations in flaps design. This review will describe the evolution, anatomy, flap design, and technique of the main distally pedicled propeller perforator flaps used in the reconstruction of defects in the distal third of the lower leg and foot. PMID:22783507

  6. Facial artery flaps in facial oncoplastic reconstruction.

    Science.gov (United States)

    Fabrizio, Tommaso

    2013-10-01

    The face is one of the common sites for cutaneous cancer localization. It is well known that the face is the localization of more than 50% of skin cancers. Nowadays, the principles of modern "oncoplasty" recommend the complete excision of the cancer and the reconstruction with respect to cosmetic features of the face in terms of good color, good softness, and good texture of the flaps, utilized in cancer repair. The oncological and cosmetic results of facial reconstruction are strictly linked and the modern plastic and reconstructive surgeon must respect both oncological and cosmetic aspects. For that reason the best solution in facial cancer repair is the utilization of locoregional flaps based on the tributary vessels of the facial artery. In consideration of the dimension of recipient area to repair, the retroangular flap (RAF) or the submental flap could be used. This article is voted to illustrate a very large and long-term casuistry dedicated to these flaps. PMID:24037925

  7. Shape-based 3D vascular tree extraction for perforator flaps

    Science.gov (United States)

    Wen, Quan; Gao, Jean

    2005-04-01

    Perforator flaps have been increasingly used in the past few years for trauma and reconstructive surgical cases. With the thinned perforated flaps, greater survivability and decrease in donor site morbidity have been reported. Knowledge of the 3D vascular tree will provide insight information about the dissection region, vascular territory, and fascia levels. This paper presents a scheme of shape-based 3D vascular tree reconstruction of perforator flaps for plastic surgery planning, which overcomes the deficiencies of current existing shape-based interpolation methods by applying rotation and 3D repairing. The scheme has the ability to restore the broken parts of the perforator vascular tree by using a probability-based adaptive connection point search (PACPS) algorithm with minimum human intervention. The experimental results evaluated by both synthetic and 39 harvested cadaver perforator flaps show the promise and potential of proposed scheme for plastic surgery planning.

  8. Free anterolateral thigh perforator flap for sacroiliac defect: First case report in pediatric population

    Directory of Open Access Journals (Sweden)

    Alejandro E. Ramirez

    2016-08-01

    Full Text Available Soft tissue defects of the sacroiliac area, usually can be covered by local flaps. However, for more complex defects, free flap transfers became necessary. We report a case of reconstruction with a free anterolateral thigh (ALT perforator flap for coverage of a sacroiliac bone exposure in a child. A six-years-old boy, suffered a car accident, resulting in pelvic and sacral fractures, as well as degloving injuries of the left thigh, buttocks, and trunk. The patient evolved with an unstable scar over the sacroiliac region with bone exposure. ALT free flap was performed. Left superior gluteal vessels were used as the recipient vessels. A stable coverage was achieved without complications. This is the first case reported of a free ALT perforator flap for sacroiliac coverage in the pediatric population. In cases of complex reconstruction in children, free perforator flap is a safe choice and should be considered in the algorithm of treatment.

  9. Planning deep inferior epigastric perforator flaps for breast reconstruction: a comparison between multidetector computed tomography and magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Cina, A.; Rinaldi, P.; Cipriani, A.; Bonomo, L. [Agostino Gemelli Hospital, Catholic University of Sacred Heart, Department of Radiological Sciences, Rome (Italy); Barone-Adesi, L.; Salgarello, M. [Agostino Gemelli Hospital, Catholic University of Sacred Heart, Department of Surgery, Plastic and Reconstructive Surgery Unit, Rome (Italy); Masetti, R. [Agostino Gemelli Hospital, Catholic University of Sacred Heart, Department of Surgery, Breast Surgery Unit, Rome (Italy)

    2013-08-15

    Deep inferior epigastric perforator (DIEP) flaps have become the state of the art in breast reconstruction. We compared the diagnostic performance of multidetector computed tomography (CTA) and magnetic resonance angiography (MRA) in DIEP flap planning. Twenty-three women (mean age 48.0 years, range 26-72 years) underwent preoperative blinded evaluation using 64-slice CTA and 1.5-T MRA. Perforator identification, measurement of their calibre, intramuscular course (IMC), assessment of direct venous connections (DVC) with main superficial veins, superficial venous communications (SVC) between the right and left hemi-abdomen and deep inferior epigastric artery (DIEA) branching type were performed. Surgery was carried out by the same team. Intraoperative findings were the standard of reference. Accuracy in identifying dominant perforators was 91.3 % for both techniques and mean error in calibre measurement 1.18 {+-} 0.35 mm for CTA and 1.63 {+-} 0.39 mm for MRA. Accuracy in assessing perforator IMCs was 97.1 % for CTA and 88.4 % for MRA, DVC 94.4 % for both techniques, SVC 91.3 % as well, and DIEA branching type 100 % for CTA and 91.3 % for MRA. Image acquisition and interpretation time was 21 {+-} 3 min for CTA (35 {+-} 5 min for MRA). In a strategy to optimise DIEP flap planning avoiding radiation exposure, MRA can be proposed alternatively to CTA. (orig.)

  10. Planning deep inferior epigastric perforator flaps for breast reconstruction: a comparison between multidetector computed tomography and magnetic resonance angiography

    International Nuclear Information System (INIS)

    Deep inferior epigastric perforator (DIEP) flaps have become the state of the art in breast reconstruction. We compared the diagnostic performance of multidetector computed tomography (CTA) and magnetic resonance angiography (MRA) in DIEP flap planning. Twenty-three women (mean age 48.0 years, range 26-72 years) underwent preoperative blinded evaluation using 64-slice CTA and 1.5-T MRA. Perforator identification, measurement of their calibre, intramuscular course (IMC), assessment of direct venous connections (DVC) with main superficial veins, superficial venous communications (SVC) between the right and left hemi-abdomen and deep inferior epigastric artery (DIEA) branching type were performed. Surgery was carried out by the same team. Intraoperative findings were the standard of reference. Accuracy in identifying dominant perforators was 91.3 % for both techniques and mean error in calibre measurement 1.18 ± 0.35 mm for CTA and 1.63 ± 0.39 mm for MRA. Accuracy in assessing perforator IMCs was 97.1 % for CTA and 88.4 % for MRA, DVC 94.4 % for both techniques, SVC 91.3 % as well, and DIEA branching type 100 % for CTA and 91.3 % for MRA. Image acquisition and interpretation time was 21 ± 3 min for CTA (35 ± 5 min for MRA). In a strategy to optimise DIEP flap planning avoiding radiation exposure, MRA can be proposed alternatively to CTA. (orig.)

  11. Giant trochanteric pressure sore: Use of a pedicled chimeric perforator flap for cover

    Directory of Open Access Journals (Sweden)

    Mehrotra Sandeep

    2009-01-01

    Full Text Available Pressure sores are increasing in frequency commensurate with an ageing population with multi-system disorders and trauma. Numerous classic options are described for providing stable wound cover. With the burgeoning knowledge on perforator anatomy, recent approaches focus on the use of perforator-based flaps in bedsore surgery. A giant neglected trochanteric pressure sore in a paraplegic is presented. Since conventional options of reconstruction appeared remote, the massive ulcer was successfully managed by a chimeric perforator-based flap. The combined muscle and fasciocutaneous flaps were raised as separate paddles based on the anterolateral thigh perforator branches and provided stable cover without complications. Perforators allow versatility in managing complex wounds without compromising on established principles.

  12. Posterior interosseous artery flap, fasciosubcutaneous pedicle technique: a study of 25 cases.

    Science.gov (United States)

    Puri, Vinita; Mahendru, Sanjay; Rana, Roshani

    2007-01-01

    This study was undertaken in an attempt to improve the versatility of the posterior interosseous artery flap (PIA flap) and to decrease flap complication rate. The PIA flap was used for resurfacing 25 cases of the hand and distal forearm over a 2-year period. Observations were made on the anatomy of the PIA flap and its distal reach. Doppler analysis was made a mandatory part of the preoperative planning. Flaps were also raised from the zone of injury if Doppler confirmed the presence of good perforators. No attempt was made to identify the anastomosis between the anterior interosseous artery (AIA) and the PIA prior to flap raising since its presence was ascertained preoperatively with a Doppler and flap raising could begin straightway, saving precious tourniquet time. The surgical technique was further modified to include a large amount of fascia and subcutaneous tissue with the flap. This could perhaps be the reason for survival of larger flaps, absence of venous congestion and the low complication rate seen in our series. These flaps were used to resurface defects involving the dorsum of the hand, palm, distal forearm, wrist and fingers (both dorsal and volar surfaces). The distal reach of the flap was improved by exteriorising the pedicle and bowstringing it across the wrist which was kept in extension. The flap could thus easily reach the distal interphalangeal joint. This exteriorised pedicle was covered with a split thickness skin graft and was divided 3 weeks later under local anaesthesia making it a two-stage procedure. Adipofascial and osteocutaneous PIA flaps were also used depending on the requirement. Out of 25 flaps, 23 were of the adipofascial variety and one each of the fascial and osteocutaneous type. The majority of the patients were between 21 and 30 years old. Trauma was the leading cause of tissue deficit in our series (19/25). Within the trauma group occupational mishap (entrapment of hand in roller machine, presser machine, etc.) was the

  13. Salvage of Intraoperative Deep Inferior Epigastric Perforator Flap Venous Congestion with Augmentation of Venous Outflow: Flap Morbidity and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Oscar Ochoa, MD

    2013-10-01

    Conclusions: Arterial and venous anatomies play unique roles in flap reliability. DIEP flap venous congestion must be treated expeditiously with venous augmentation to relieve venous congestion and mitigate flap morbidity.

  14. Venous-supercharged freestyle posterior thigh flap without a descending branch of the inferior gluteal artery for reconstruction in the infragluteal region.

    Science.gov (United States)

    Fukunaga, Yutaka; Miyamoto, Shimpei; Kobayashi, Eisuke; Sakuraba, Minoru

    2014-12-01

    The posterior thigh flap is a workhorse flap for reconstruction in the gluteal region. The main vascular pedicle of the flap is commonly the descending branch of the inferior gluteal artery, although it is at risk for transection during sarcoma resection. We report successful reconstruction of an infragluteal defect resulting from sarcoma resection with a venous-supercharged freestyle posterior thigh flap in the absence of the descending branch of the inferior gluteal artery. A 77-year-old man underwent sarcoma resection in the infragluteal region. The descending branch of the inferior gluteal artery was sacrificed. We found a sizable perforator through the long head of the biceps femoris and harvested a posterior thigh flap on the basis of that perforator with a freestyle approach. The flap gradually developed a congestive appearance after transfer. We therefore anastomosed the vein of the second perforator to an accompanying vein of the sciatic nerve at the recipient site. The complete flap survived, and the postoperative course was uneventful. We believe that combined use of the freestyle approach and the perforator-supercharging technique can enhance the versatility and the safety of pedicled perforator flap transfer. PMID:25193397

  15. The dog-ear flap as an alternative for breast reconstruction in patients who have already undergone a DIEAP flap.

    Science.gov (United States)

    Colebunders, Britt; Depypere, Bernard; Van Landuyt, Koenraad

    2016-05-01

    Breast reconstruction in patients who have previously undergone deep inferior epigastric artery perforator flap (DIEAP) reconstruction or abdominoplasty is often challenging. Depending on patients' body habitus, several second-choice flaps have been described such as the transverse upper gracilis (TUG) flap, profundus femoris artery perforator (PFAP) flap, superior gluteal artery perforator (SGAP) flap, and lumbar artery perforator (LAP) flap. Patients who have undergone a DIEAP flap reconstruction or abdominoplasty occasionally present with dog ears on both sides of the abdominal scar. The adipose tissue and skin of these dog ears are supplied by perforators of the deep circumflex iliac artery (DCIA). The DCIA flap was first described in 1979 by Taylor. We introduce this abdominal "dog-ear" flap for autologous breast reconstruction. PMID:26951847

  16. Propeller Perforator Flaps in Distal Lower Leg:Evolution and Clinical Applications

    Directory of Open Access Journals (Sweden)

    Alexandru V. Georgescu

    2012-03-01

    Full Text Available Simple or complex defects in the lower leg, and especially in its distal third, continue to bea challenging task for reconstructive surgeons. A variety of flaps were used in the attemptto achieve excellence in form and function. After a long evolution of the reconstructivemethods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps andfasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor andPalmer opened the era of perforator flaps. This era began in 1989, when Koshima and Soeda,and separately Kroll and Rosenfield described the first applications of such flaps. Perforatorflaps, whether free or pedicled, gained a high popularity due to their main advantages:decreasing donor-site morbidity and improving aesthetic outcome. The use as local perforatorflaps in lower leg was possible due to a better understanding of the cutaneous circulation, legvascular anatomy, angiosome and perforasome concepts, as well as innovations in flaps design.This review will describe the evolution, anatomy, flap design, and technique of the main distallypedicled propeller perforator flaps used in the reconstruction of defects in the distal third ofthe lower leg and foot.

  17. The Free-style Gluteal Perforator Flap in the Thinning and Delay Process for Perineal Reconstruction After Necrotizing Fasciitis.

    Science.gov (United States)

    Horta, Ricardo; Nascimento, Ricardo; Silva, Alvaro; Amarante, Jose

    2016-06-01

    Perineal wounds present a special challenge for reconstructive surgeons. The vacuum-assisted closure device is useful as a temporizing measure or for wounds too large or contaminated for immediate reconstruction. Compared to traditional myocutaneous flaps, perforator flaps provide thinner fasciocutaneous flaps for perineal reconstruction with favorable results and fewer donor site morbidities. The upper and lower gluteal regions are rich in perforators, which allow for more versatile flap design according to the defect. The authors combined the principles of free-style perforator flaps, flap delay, and thinning of perforator flaps to restore perineal function and aesthetics. The procedure was undertaken in a 72-year-old female who was obese with the diagnosis of necrotizing fasciitis secondary to perineal abscess. After 3 months, the flap achieved adequate and durable reconstruction with acceptable aesthetic contour and patient satisfaction; there was no loss of function at donor sites. Clinical applications and technical refinements of freestyle pedicled perforator flaps can be extended to the perineal region. Because of its many advantages and its versatility, freestyle pedicled perforator flaps constitute a valued reconstructive option and, when indicated, an alternative to pedicled axial flaps or even free flaps, in addition to vacuum therapy, to simplify the reconstructive procedure. PMID:27434419

  18. Maxillofacial reconstruction with nasolabial and facial artery musculomucosal flaps.

    Science.gov (United States)

    Braasch, Daniel Cameron; Lam, Din; Oh, Esther S

    2014-08-01

    The nasolabial and facial artery musculomucosal (FAMM) flaps are predictable methods to reconstruct perioral and intraoral defects with vascularized tissue. The nasolabial flap can be harvested as an axial or random patterned flap, whereas the FAMM flap is truly an axial patterned flap, with either a superior or an inferior base. Both flaps have been widely used to provide predictable results, with low morbidity. Future studies are needed to further prove their use in compromised patients, including patients with a history of head and neck radiation and neck dissections. PMID:25086694

  19. "Mini-Flow-Through" Deep Inferior Epigastric Perforator Flap for Breast Reconstruction with Preservation of Both Internal Mammary and Deep Inferior Epigastric Vessels

    Science.gov (United States)

    Sugawara, Jun; Yasumura, Kazunori; Mikami, Taro; Kobayashi, Shinji; Maegawa, Jiro

    2015-01-01

    This procedure was developed for preservation of the rectus muscle components and deep inferior epigastric vessel after deep inferior epigastric perforator (DIEP) flap harvesting. A 53-year-old woman with granuloma caused by silicone injection underwent bilateral nipple-sparing mastectomies and immediate reconstruction with "mini-flow-through" DIEP flaps. The flaps were dissected based on the single largest perforator with a short segment of the lateral branch of the deep inferior epigastric vessel that was transected as a free flap for breast reconstruction. The short segments of the donor deep inferior epigastric vessel branch are primarily end-to-end anastomosed to each other. A short T-shaped pedicle mini-flow-through DIEP flap is interposed in the incised recipient's internal mammary vessels with two arterial and four concomitant venous anastomoses. Although it requires multiple vascular anastomoses and a short pedicle for the flap setting, the mini-flow-through DIEP flap provides a large pedicle caliber, enabling safer microsurgical anastomosis and well-vascularized tissue for creating a natural breast without consuming time or compromising the rectus muscle components and vascular flow of both the deep inferior epigastric and internal mammary vessels. PMID:26618128

  20. L-positioned Perforator Propeller Flap for Partial Breast Reconstruction with Axillary Dead Space

    Science.gov (United States)

    Yamamoto, Mao; Shimizu, Daisuke; Yokoyama, Akiko; Ito, Osamu

    2016-01-01

    Summary: Partial breast reconstruction using perforator flaps harvested from the lateral chest wall has become a well-established surgical technique recently. In the case of a partial mastectomy with an axillary lymph node dissection, there are 2 main defects; one is a partial breast defect and the other is an axillary dead space. To reconstruct the 2 separate defects with local flaps, basically 2 different flaps are needed, and usually, it is rather difficult to harvest 2 different local flaps in the adjacent area. To resolve this problem, we introduce the L-positioned perforator propeller flap (PPF). We used an L-positioned PPF on 2 female patients, aged 46 and 47 years old, who were suffering from breast cancer in the upper outer quadrant. The concept of this flap design is as follows: the partial breast defect is reconstructed with the longer lobe of the L-positioned PPF and the axillary defect is filled with the smaller lobe of the L-positioned PPF at the same time. The reconstruction time was 2 hours and 0 minutes and 1 hour and 46 minutes in each case. The patients were successfully provided with aesthetically acceptable breast reconstruction without postoperative complications. Moreover, both patients had consecutive postoperative radiotherapy on the reconstructed area without complications. With this flap design, it is possible for patients to have safe and aesthetic reconstruction with only 1 local flap and fewer invasive procedures.

  1. L-positioned Perforator Propeller Flap for Partial Breast Reconstruction with Axillary Dead Space.

    Science.gov (United States)

    Yamamoto, Mao; Yano, Tomoyuki; Shimizu, Daisuke; Yokoyama, Akiko; Ito, Osamu

    2016-06-01

    Partial breast reconstruction using perforator flaps harvested from the lateral chest wall has become a well-established surgical technique recently. In the case of a partial mastectomy with an axillary lymph node dissection, there are 2 main defects; one is a partial breast defect and the other is an axillary dead space. To reconstruct the 2 separate defects with local flaps, basically 2 different flaps are needed, and usually, it is rather difficult to harvest 2 different local flaps in the adjacent area. To resolve this problem, we introduce the L-positioned perforator propeller flap (PPF). We used an L-positioned PPF on 2 female patients, aged 46 and 47 years old, who were suffering from breast cancer in the upper outer quadrant. The concept of this flap design is as follows: the partial breast defect is reconstructed with the longer lobe of the L-positioned PPF and the axillary defect is filled with the smaller lobe of the L-positioned PPF at the same time. The reconstruction time was 2 hours and 0 minutes and 1 hour and 46 minutes in each case. The patients were successfully provided with aesthetically acceptable breast reconstruction without postoperative complications. Moreover, both patients had consecutive postoperative radiotherapy on the reconstructed area without complications. With this flap design, it is possible for patients to have safe and aesthetic reconstruction with only 1 local flap and fewer invasive procedures. PMID:27482501

  2. Reducing radiation dose without compromising image quality in preoperative perforator flap imaging with CTA using ASIR technology.

    Science.gov (United States)

    Niumsawatt, Vachara; Debrotwir, Andrew N; Rozen, Warren Matthew

    2014-01-01

    Computed tomographic angiography (CTA) has become a mainstay in preoperative perforator flap planning in the modern era of reconstructive surgery. However, the increased use of CTA does raise the concern of radiation exposure to patients. Several techniques have been developed to decrease radiation dosage without compromising image quality, with varying results. The most recent advance is in the improvement of image reconstruction using an adaptive statistical iterative reconstruction (ASIR) algorithm. We sought to evaluate the image quality of ASIR in preoperative deep inferior epigastric perforator (DIEP) flap surgery, through a direct comparison with conventional filtered back projection (FBP) images. A prospective review of 60 consecutive ASIR and 60 consecutive FBP CTA images using similar protocol (except for radiation dosage) was undertaken, analyzed by 2 independent reviewers. In both groups, we were able to accurately identify axial arteries and their perforators. Subjective analysis of image quality demonstrated no statistically significant difference between techniques. ASIR can thus be used for preoperative imaging with similar image quality to FBP, but with a 60% reduction in radiation delivery to patients. PMID:25058789

  3. Medial circumflex femoral artery flap for ischial pressure sore

    OpenAIRE

    Palanivelu S

    2009-01-01

    A new axial pattern flap based on the terminal branches of the medial circumflex femoral artery is described for coverage of ischial pressure sore. Based on the terminal branches of the transverse branch of medial circumflex femoral artery, which exit through the gap between the quadratus femoris muscle above and the upper border of adductor magnus muscle below, this fascio cutaneous flap is much smaller than the posterior thigh flap but extremely useful to cover ischeal pressure sores. The s...

  4. Microanatomy of the perforators of the anterior communicating artery complex.

    Science.gov (United States)

    Camuscu, H; Dujovny, M; Abd el-Bary, T; Beristain, X; Viñas, F C

    1997-12-01

    We describe the microanatomy of the perforating arteries arising from the anterior communicating artery complex (5 mm distal of the anterior cerebral artery, the anterior communicating artery, and 5 mm proximal of the distal anterior cerebral artery). Thirteen unfixed human brains were used in this study. The origin and number of perforators are described, as is the site of brain penetration, and results are correlated with previous studies. The hemodynamics of blood flow in relation to the formation of an anterior communicating artery aneurysm and different surgical approaches are mentioned. The neuropsychological outcome after aneurysm clipping with regards to the pattern of blood supply from the anterior cerebral artery complex is also discussed. PMID:9427956

  5. STUDY OF VARIOUS MODIFICATIONS OF REVERSE SURAL ARTERY FLAP

    Directory of Open Access Journals (Sweden)

    Jainath

    2013-10-01

    Full Text Available A BS T R ACT : Soft tissue reconstruction of distal third leg, heel and ankle reg ion is a challenging problem because of poor vascularity and limited mobility of skin. The reverse sural artery with ideal flap thickness, minimal donor site morbidity, lack of functional muscle loss, short recovery time, wide arc of rotation and safe vasc ularity makes it a preferable flap for covering such defects. AIMS A N D OBJECTIVES : To study various modifications of distally based reverse sural artery flap to suit the defects and for better survival of flaps. RESULTS : It is a retrospective study conduct ed in our institute to cover the distal leg and foot defects.60 cases of distal leg defects exposing vital structure who underwent reverse sural artery flap coverage were included in the study .5 of the 60 flaps had complete flap necrosis and another11 fla ps had partial necrosis.73.4% of the flaps survived during the follow up period of 1 years with good functional outcome. CONCLUSIONS : Reverse sural artery flap with its modifications is a good flap for the defects of distal leg, heel and ankle defects

  6. 穿支皮瓣移植修复四肢软组织缺损108例%Transplantation of perforator flaps: Systematic review of 108 case series

    Institute of Scientific and Technical Information of China (English)

    唐举玉; 李康华; 廖前德; 何洪波; 林涨源; 梁捷予; 罗令; 吴攀峰; 宋达疆

    2010-01-01

    Objective To explore the clinical outcome of perforator flaps for reconstruction of limb soft tissue defects. Methods In this case series, from 2007 July to 2009 May, 108 cases of perforator flap to reconstruct the defects of the extremities were performed, of these, 98 were free perforator flaps, 10 were pedicled flaps. The perforator flaps included deep inferior epigastric artery perforator flap, anterolateral thigh perforator flap, thoracodorsal artery perforator flap, lateral thigh perforator flap, posterior interosseous artery perforator flap, collateral radial artery perforator flap, medial sural artery perforator flap, posterior tibial artery perforator flap, deep circumflex iliac artery perforator flap and peroneal artery perforator flap. The maximum size of the perforator flap was 44 cmx 9 cm, the minimum size of the perforator flap was 4 em x 2 cm.The donor defect was closed directly. Results Venous congestion occurred in 5 flaps, in 1 case venous congestion was overcomed after released the dressing, 4 flaps requiring reexploration for venous insufficiency,2 had a successful outcome, the other 2 flaps failed . The other 103 flaps were successful. The wounds healed without any infection complications. The follow-up ranges from 6-24 months( 10 months on average). The flaps were of good appearance and not bulky; there were only linear scars on the donor sites, the cosmesis and function of the donor sites were satisfying. Conclusion The muscle, deep fascia and motor nerve are not contained in the flap, the advantages of this type of flap is reducing morbidity of the donor site and its reliable blood supply and suitable thickness for resurfacing, no secondary debuiking is necessary. The perforator flaps can be chosen as the first option to deal with superficial extremity wounds.%目的 探讨应用穿支皮瓣修复四肢皮肤软组织缺损的临床效果. 方法2007年7月至2009年5月,分别采用腹壁下动脉穿支皮瓣、股前外侧穿支皮瓣、

  7. Medial circumflex femoral artery flap for ischial pressure sore

    Directory of Open Access Journals (Sweden)

    Palanivelu S

    2009-01-01

    Full Text Available A new axial pattern flap based on the terminal branches of the medial circumflex femoral artery is described for coverage of ischial pressure sore. Based on the terminal branches of the transverse branch of medial circumflex femoral artery, which exit through the gap between the quadratus femoris muscle above and the upper border of adductor magnus muscle below, this fascio cutaneous flap is much smaller than the posterior thigh flap but extremely useful to cover ischeal pressure sores. The skin redundancy below the gluteal fold allows a primary closure of the donor defect. It can also be used in combination with biceps femoris muscle flap.

  8. Monocortical Deep Circumflex Iliac Artery Flap in Jaw Reconstruction.

    Science.gov (United States)

    Moon, Seong-Yong

    2015-06-01

    Conventionally deep circumflex iliac artery (DCIA) flap had been harvested as bicortical form. However, several complications and adverse effects occurred such as abnormal hip contour, hernia, severe bleeding tendency, gait disturbance, and hypoesthesia. All the 9 patients required reconstruction of the jaw with microvascular free flaps after radical resection. Monocortical bone segment was harvested from the anterior iliac crest, and the amount of bone harvested was from 47 to 90 mm (mean, 63 ± 14.6). Monocortical deep circumflex iliac artery flap has sufficient advantages in donor-site morbidity, which is one of the factors to choose flap. PMID:26080179

  9. Dorsalis pedis arterialized venous flap for hand and foot reconstruction

    Institute of Scientific and Technical Information of China (English)

    YU Guang; LEI Hong-yu; GUO Shuang; HUANG Jian-hua; YU Hao

    2012-01-01

    Objective:To report the results of repair of skin defects in the extremities with arterialized venous flap harvested from the lateral aspect of the dorsum of the foot.Methods:Six cases of skin and soft tissue defects over the foot and hands were resurfaced by free arterialized venous flaps,including five patients with skin defects of the hands,and one with defects at the dorsum of the foot.The flaps were harvested from the lateral aspect of the dorsum of the foot with the sizes ranging from 2 cm×5.5 cm to 6 cm×11 cm.Two veins at the proximal margin of the flap were retained,one of which was anastomosed to a recipient bed artery to provide arterial inflow and the other was anastomosed to a recipient bed vein for venous outflow.Results:All flaps demonstrated mild edema and survived completely.Blisters appeared on four flaps.Using this technique,we achieved good functional and cosmetic results in this series.Conclusions:Dorsalis pedis arterialized venous flap with rich vascular communications could enhance peripheral perfusion and decrease congestion of venous flaps,thereby improves reliability and utility for extremity reconstruction.

  10. Cyanoacrylate repair of laser in situ keratomileusis corneal flap perforation by a snake bite.

    Science.gov (United States)

    Korn, Bobby S; Korn, Tommy S

    2005-11-01

    A 30-year-old man who had laser in situ keratomileusis (LASIK) for myopia 1 year earlier developed a corneal perforation in the left eye from a boa constrictor. The patient presented to the emergency room, and a small corneal perforation just outside the visual axis was diagnosed within the LASIK flap. Cyanoacrylate adhesive was used to close the corneal perforation. The patient went on to full visual recovery with an uncorrected visual acuity of 20/20. This is the first reported case of a penetrating corneal injury from a serpent in an eye that had LASIK. Cyanoacrylate may be used to repair small traumatic corneal perforations with a favorable visual outcome in eyes that have had LASIK. PMID:16412943

  11. Clinical study of dorsal ulnar artery flap in hand reconstruction

    Directory of Open Access Journals (Sweden)

    Khan Manal

    2009-01-01

    Full Text Available Soft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.

  12. Vulvar reconstruction should be performed using gluteal-fold perforator flap because of less morbidities and complications

    Directory of Open Access Journals (Sweden)

    Masaki Fujioka

    2014-04-01

    Full Text Available The autors present a case of bilateral vulvar defects after abrasion of malignant skin neoplasm, reconstructed with a gluteal-fold perforator flap, resulting in a successful outcome.

  13. What Is Safe Limit of the Perforator Flap in Lower Extremity Reconstruction? Do We Have Answers Yet?

    Directory of Open Access Journals (Sweden)

    Nikhil S. Panse

    2011-01-01

    Full Text Available We make an attempt to define the safe extent of local perforator flap for lower limb reconstruction by comparing it with the limb length of the patient. The maximum flap length from the perforator was compared to the limb length in 35 patients using EPI info 6.04 D software. On comparison of flaps that were less than one-third of limb length to those which were more than one-third of limb length, the statistical values were significant. The odds ratio calculated was 6, which means that there is a six times more chance that a local perforator flap will necrose if it is more than one-third of the limb length as compared to a flap which is less than one-third of the limb length.

  14. The use of a combined bipedicled axial perforator based fasciocutaneous flap for the treatment of a traumatic diabetic foot wound: a case report

    Directory of Open Access Journals (Sweden)

    Ioannis A. Ignatiadis

    2011-02-01

    Full Text Available The axial and perforator vascularised fasciocutaneous flaps are reliable and effective treatment methods for covering lower limb post-traumatic, septic, Charcot, and diabetic foot wounds. The authors describe the unique utilisation of a hybrid flap as an axial-perforator flap combination for the treatment of a traumatic diabetic foot wound.

  15. Medial retromalleolar perforator adipofascial flap: anatomical and clinical study%内踝后穿支筋膜皮下瓣的解剖与临床研究

    Institute of Scientific and Technical Information of China (English)

    张英琪; 张世民

    2011-01-01

    目的 介绍内踝后穿支筋膜皮下瓣的血管解剖基础与初步临床应用效果. 方法 解剖24侧新鲜下肢灌注标本,观察内踝后间隙内胫后动脉发出的穿支血管情况.临床切取内踝后穿支筋膜皮下瓣,翻转修复跟内侧创伤缺损5例.结果 内踝后间隙长约4cm,前界为内踝及趾长屈肌腱,后方为跟腱,表面为深筋膜覆盖,间隙内有疏松脂肪组织.在内踝后间隙内走行的胫后动脉发出2~3条皮肤穿支血管,口径0.1~0.7mm,一般小于0.5 mm,但数量恒定.内踝后穿支与上方的胫后动脉最远侧肌间隔穿支血管间有互补性,在筋膜表面和皮下组织中有丰富血管吻合.临床上以内踝后穿支血管为轴点(内踝最下缘上方1~2 cm),设计切取远端蒂筋膜皮下瓣,面积5~6 cm×6~12 cm,修复5例跟骨开放性骨折的内侧创面,筋膜瓣均成活.结论 内踝后穿支筋膜皮下瓣相对传统的肌间隔穿支血管组织瓣,其旋转轴点下移,减少小腿供区损伤,无静脉回流障碍,受区组织柔软活动度好,更适合修复足跟内侧的创面.%Objective To introduce the anatomical study and clinical experience of medial retromalleolar perforator adipofascial flap. Methods Microsurgical anatomic study was carried out on 24 fresh cadaver limbs, and was focused on the distal perforators of the posterior tibial artery. Then five clinical cases of distally based medial retromalleolar perforator flaps were raised for medial wound coverage of the calcaneus after open fracture. Results The terminal part of posterior tibial artery run distally in the medial retromalleolar space. The space was usually 4cm long, with its anterior border of medial malleolus and flexor digitorum longus tendon, medial border of Achilles tendon, covered by deep fascia, and filled with areolar fatty tissue, hi the space, there were about 2-3 fasciocutaneous perforators with caliber ranged 0.1-0.7 mm, usually less than 0.5mm with an average 0.47mm

  16. Indications, Outcomes, and Complications of Pedicled Propeller Perforator Flaps for Upper Body Defects: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Davide Lazzeri

    2013-01-01

    Full Text Available Background The aim of this investigation was to systematically review the current literatureto provide the best data for indications, outcomes, survival, and complication rates ofpedicled propeller perforator flaps for upper body defects.Methods A comprehensive literature review for articles published from January 1991 toDecember 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articleswithout available full-text, single case reports or papers with excessive missing data wereexcluded. Papers reporting pedicle-perforator (propeller flaps used for lower extremityreconstruction were excluded from meta-analysis.Results From the initial 1,736 studies our search yielded, 343 studies qualified for the secondstage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusionand exclusion criteria. Of the selected 41 articles, 26 were case series, original papers orretrospective reviews and were included, whereas 15 were case report papers and thereforewere excluded. Two hundred ninety-five propeller flaps were reported to have been used ina total of 283 patients. Indications include repair of trauma-induced injuries, post-traumarevision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with amajor complication rate (3.3% comparable to that of free flaps. No specific exclusion criteriafor the procedure were presented in the studies reviewed.Conclusions Pedicled propeller flaps are a versatile and safe reconstructive option that areeasy and quick to raise and that provide unlimited clinical solutions because of the theoreticalpossibility of harvesting them based on any perforator chosen among those classified in the body.

  17. Research progress in reconstruction of lower extremity soft-tissue defects using perforator flaps%穿支皮瓣在下肢创面修复中的临床应用研究进展

    Institute of Scientific and Technical Information of China (English)

    冯仕明; 王爱国

    2015-01-01

    Objective To review the progress in reconstruction of lower extremity soft-tissue defects using perforator flaps. Methods Articles about perforator flaps using for the lower-limb wound reconstruction from January 1980 to April 2014 from databases such as PubMed, EMbase, CNKI and Cochrane Library were manually searched. The 264 articles were selected after they were inspected by the excluded and included standards. The safety, anatomical basis, advantages and disadvantages for the flaps were analysed. Results Perforator flaps, like musculocutaneous flaps, have a direct axial blood supply, and are just as effective as muscle flaps in the setting of radiation, hardware infection, or osteomyelitis. The major perforator flaps for the lower extremity reconstruction including anterolateral thigh flap, deep inferior epigastric perforator flap, thoracodorsal artery perforator flap, gluteal artery perforator flap and lower leg perforator flap. All these perforator flaps have each advantage, and can be selected according to the defect feature and the requirement of reconstruction. Conclusions Reconstruction the lower extremity soft-tissue defect using perforator flap is an effective method with low donor site morbidity. It is a new technology for lower extremity soft-tissue defect reconstruction, and the newest trend of development in flap surgery.%目的:探讨穿支皮瓣在下肢创面修复中的应用价值。方法计算机检索 PubMed、EMbase、中国知网以及Cochrane数据库于1980年1月—2014年4月期间公开发表的应用穿支皮瓣治疗下肢创面的文献,语种限定为中文和英文。经筛选有264篇文献入选。对皮瓣的安全性、解剖学基础及优缺点进行分析总结。结果目前应用于下肢创面修复的穿支皮瓣主要有股前外侧皮瓣、腹壁下深动脉穿支皮瓣、胸背动脉穿支皮瓣、臀动脉穿支皮瓣以及小腿穿支皮瓣等。不同皮瓣各有其特点,临床应根据其特点和创面

  18. The use of a combined bipedicled axial perforator based fasciocutaneous flap for the treatment of a traumatic diabetic foot wound: a case report

    OpenAIRE

    Ignatiadis, Ioannis A.; Georgakopoulos, Georgios D.; Tsiampa, Vassiliki A.; Matei, Ileana R.; Georgescu, Alexandru V.; Polyzois, Vasilios D.

    2011-01-01

    The axial and perforator vascularised fasciocutaneous flaps are reliable and effective treatment methods for covering lower limb post-traumatic, septic, Charcot, and diabetic foot wounds. The authors describe the unique utilisation of a hybrid flap as an axial-perforator flap combination for the treatment of a traumatic diabetic foot wound. Keywords: diabetic foot; trauma; calcaneus; fasciocutaneous flap; plastic surgery(Published: 7 February 2011)Citation: Diabetic Foot & Ankle 2011, 2: ...

  19. STUDY OF VARIOUS MODIFICATIONS OF REVERSE SURAL ARTERY FLAP

    OpenAIRE

    Jainath; Peddi; Ramesha; Shankarappa; Smitha; Amaresh

    2013-01-01

    A BS T R ACT : Soft tissue reconstruction of distal third leg, heel and ankle reg ion is a challenging problem because of poor vascularity and limited mobility of skin. The reverse sural artery with ideal flap thickness, minimal donor site morbidity, lack of functional muscle loss, short recovery time, wide arc of rotation and safe vasc ularity makes it a preferable flap for covering such defects. AIMS A N D OBJECTIVES : To study various modi...

  20. First dorsal metacarpal artery islanded flap: A useful flap for reconstruction of thumb pulp defects

    Directory of Open Access Journals (Sweden)

    Satish Chetan

    2009-01-01

    Full Text Available Thumb pulp defects are commonly due to avulsion injuries. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. A very good option for coverage of these defects is the islanded first dorsal metacarpal artery flap. Our study was done over a period of 2 years and involved 9 consecutive cases of thumb pulp defects treated at our institution. The patients included 8 males and 1 female, ranging in age from 16 to 51 years old. The flap size ranged from 2 x 1.5 cm to 5 x 3 cm. We had only one complication in the form of partial flap necrosis, which fortunately healed following debridement without the need for a secondary procedure. All our cases were done under local anesthesia with tourniquet control. All the patients had good fine touch and average two-point discrimination of 6 mm, which was satisfactory. Our good results further reinforce the islanded first dorsal metacarpal artery flap as one the best flaps for sensate reconstruction of thumb pulp defects. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation.

  1. Angiotomografía computerizada, colgajos de perforante, cirujano y OsiriX Computed tomography angiography, perforator flaps, surgeon and OsiriX

    Directory of Open Access Journals (Sweden)

    M. Rodríguez-Vegas

    2013-03-01

    consecuencia, parece aconsejable que el cirujano plástico relacionado con los colgajos de perforante se involucre decididamente en el postprocesamiento de las imágenes de angiotomografía computerizada. El visor de imágenes DICOM gratuito OsiriX es una alternativa eficiente, comparable a aplicaciones más profesionales sólo disponibles en servicios de Radiología.With the advent of perforator-based skin transfer, computed tomography angiography has emerged as an invaluable tool in the preoperative planning of perforator flaps. But most likely, the exploitation of the technique is less than desirable. Through our experience with 144 patients, we evaluate the use of the free DICOM viewer OsiriX for Mac in the preoperative planning of perforator flaps with three objectives: 1 increase the present knowledge related with the preoperative planning of perforator flaps with computed tomography angiography, 2 evaluate the OsiriX application in the image post-processing of perforator flaps and 3 evaluate the performance of the procedure when performed by a surgeon (not specialized in Radiology. The experience has shown that the image post-processing performed by the surgeon with the OsiriX application usually allows an adequate evaluation of different structures and parameters of great preoperative interest in perforator flap surgery: 1 source artery, 2 diameter of artery and vein/s at the hypothetical site of microsurgical anastomoses, 3 course and branching pattern of the flap pedicle, 4 perforator course in the subcutaneous fat (theoretical flap axis, 5 measurement of the skin and fat where the perforator pierces the deep fascia (theoretical flap thickness , 6 measurement of the distance between the point of entrance of the perforator in the subcutaneous fat to the source artery (theoretical maximal pedicle length and 7 measurement of the perforator diameter where it pierces the deep fascia. Ultimately, in the authors' opinion, those plastic surgeons involved in perforator flap

  2. Quantifying Blood Flow in the DIEP Flap: An Ultrasonographic Study

    Science.gov (United States)

    Pennington, David G.

    2014-01-01

    Background: The maximum weight of tissue that a single perforator can perfuse remains an important question in reconstructive microsurgery. An empirically based equation, known as the flap viability index (FVI), has been established to determine what weight of tissue will survive on one or more perforators. The equation is FVI = Sum d(n)^4/W, where d is the internal diameter of each perforator and W is the final weight of the flap. It has been shown that if FVI exceeds 10, total flap survival is likely, but if under 10, partial flap necrosis is probable. The aim of this study was to measure absolute flow rates in deep inferior epigastric perforator (DIEP) flap pedicles and assess correlation with the determinants of the FVI, perforator diameter and flap weight. Methods: Color Doppler ultrasound was used to quantify arterial flow in 10 consecutive DIEP flap pedicles 24 hours after anastomosis. Results: In single-perforator DIEP flaps, flow rate was highly correlated with perforator diameter (r = 0.82, P = 0.01). Mean arterial flow rate was significantly reduced in DIEP flaps with 2 or more perforators (6 vs 38 cm3/min; P perforator size is a critical factor in optimizing blood flow in perforator-based free tissue transfer. Further research is required to understand the flow dynamics of perforator flaps based on multiple perforators. However, surgeons should be cognizant that a single large perforator may have substantially higher flow rates than multiple small perforators. Routine FVI calculation is recommended to ensure complete flap survival. PMID:25426345

  3. 穿支皮瓣床旁护理记录单的设计与应用%Design and application of perforator flaps bedside nursing records

    Institute of Scientific and Technical Information of China (English)

    徐晓燕; 钟玲; 董凯旋; 李霞; 徐兰; 白艳; 周智

    2015-01-01

    Objective To investigate the effects of using perforator flap nursing records. Methods Nursing records for perforator flap was designed and applied to 108 cases perforator flap surgery patients. Results Four cases had arterial crisis,8 cases had venous crisis,2 cases of flap infection,all flaps were sur-vived by symptomatic treatment timely. The qualified rate of nursing records was 97. 22%. The writing time delrease from( 4. 70 ± 0. 62 ) min to 1. 51(P﹤0. 01),%patient satisfaction with care was 98. 56%,doctor satisfaction reached to 96. 37%. Conclusion The bedside nursing records is scientific, comprehensive and convenient. It is not only objective,timely reflect the information for the flap,but also can improve work efficiency of nurses.%目的探讨穿支皮瓣术后患者床旁护理记录单的使用效果。方法将穿支皮瓣床旁护理记录单应用于108例穿支皮瓣术后患者,观察使用记录单的书写质量、书写时间及患者、医生的满意度。结果术后发现动脉危象4例,静脉危象8例,皮瓣感染2例,经及时对症治疗后皮瓣均存活;记录单书写合格率为97.22%,护士单次书写时间由(4.70±0.62)min缩短到1.51 min(P﹤0.01),患者对护理服务满意度为98.56%,医生满意度为96.37%。结论床旁护理记录单记录方法科学,不仅能客观、及时地反映皮瓣的动态信息,还能提高护士的工作效率。

  4. Bowel obstruction following deep circumflex iliac artery free flap harvesting.

    Science.gov (United States)

    Tan, Neil C-W; Brennan, Peter A; Senapati, Asha; Puxeddu, Roberto

    2009-12-01

    The deep circumflex iliac artery flap (DCIA) has been well described as an autograft flap used in head and neck reconstructions, particularly for large maxillary and mandibular defects. Complications, particularly at the donor site, have been well documented. Although it is considered a minor complication, herniation should not be underestimated as it can potentially lead to bowel obstruction, necessitating an emergency operation. We report a case of acute obstruction of the small bowel secondary to herniation at the donor site after harvesting a DCIA free flap for a maxillary defect, a complication that to our knowledge has been reported only once. We review the pathogenesis and possible ways to reduce the likelihood of developing this serious complication. PMID:19249144

  5. Combined free toe and free deep inferior epigastric perforator flap for reconstruction of the thumb and thumb web space.

    Science.gov (United States)

    Li, X J; Tong, J; Wang, Y

    2000-08-01

    To repair a complexly injured hand with composite loss of the thumb and the thumb web space in one stage, the combined transfer of a free second toe and a free deep inferior epigastric perforator flap was designed. It was used to simultaneously reconstruct the thumb and thumb web space of the injured hand in five cases. All flaps survived and there were no complications at any donor site after the reconstructions. In follow-up averaging 35.6 months, the final functional and cosmetic outcomes of the reconstructed thumbs and thumb web spaces were satisfactory. Results demonstrated that the combined transfer of a free second toe and a free deep inferior epigastric perforator flap is a valid method for simultaneous reconstruction of the thumb and the thumb web space of the injured hand. PMID:10993088

  6. Modern Perforator Flap Imaging with High-Resolution Blood Pool MR Angiography.

    Science.gov (United States)

    Kagen, Alexander C; Hossain, Rydhwana; Dayan, Erez; Maddula, Soumya; Samson, William; Dayan, Joseph; Smith, Mark L

    2015-01-01

    Advances in microsurgical techniques have improved autologous reconstructions by providing new donor site options while decreasing donor site morbidity. Various preoperative imaging modalities have been studied to assess the relevant vascular anatomic structures, with magnetic resonance (MR) angiography traditionally lagging behind computed tomography (CT) with respect to spatial resolution. Blood pool MR angiography with gadofosveset trisodium, a gadolinium-based contrast agent with extended intravascular retention, has allowed longer multiplanar acquisitions with resultant voxel sizes similar to or smaller than those of CT and with improved signal-to-noise ratio and soft-tissue contrast while maintaining the ability to depict flow with time-resolved imaging. The resultant vascular detail enables precise evaluation of the relevant vascular anatomic structures, including the vessel course, size, and branching pattern, as well as the venous arborization pattern. In addition, any architectural distortion, vessel alteration, or injury from prior surgery can be depicted. The reporting radiologist should be aware of pertinent and incidental findings relevant to the planned surgery and the patient's disease so that he or she can assist the microsurgeon in flap design as a member of the multidisciplinary team. Given the lack of ionizing radiation exposure in patients who often have an elevated body mass index, high-spatial-resolution blood pool MR angiography has become the imaging reference standard for the preoperative assessment of perforator flap vascular and soft-tissue morphology in our practice. PMID:25884098

  7. Propeller TAP flap

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Bille, Camilla; Wamberg, Peter;

    2013-01-01

    The aim of this study was to examine if a propeller thoracodorsal artery perforator (TAP) flap can be used for breast reconstruction. Fifteen women were reconstructed using a propeller TAP flap, an implant, and an ADM. Preoperative colour Doppler ultrasonography was used for patient selection to...... major complications needing additional surgery. One flap was lost due to a vascular problem. Breast reconstruction can be performed by a propeller TAP flap without cutting the descending branch of the thoracodorsal vessels. However, the authors would recommend that a small cuff of muscle is left around...

  8. Deep circumflex iliac artery (DCIA) free flap without DCIA: report of a unique case.

    Science.gov (United States)

    Jairath, David; Hage, J Joris

    2004-10-01

    The iliac crest free flap is a reliable source of cancellous bone, muscle, and skin. The vascularization of this flap arises from the deep circumflex iliac artery (DCIA) which allegedly is always present. The authors report a unique case of successful microvascular transplantation of an iliac crest osteomyocutaneous free flap in a patient in whom the DCIA and DCIV were absent. PMID:15534778

  9. A propeller flap for single-stage nose reconstruction in selected patients: supratrochlear artery axial propeller flap.

    Science.gov (United States)

    Cordova, Adriana; D'Arpa, Salvatore; Massimiliano, Tripoli; Toia, Francesca; Moschella, Francesco

    2014-06-01

    The paramedian forehead flap is the gold standard technique for nose reconstruction. It requires two different surgical operations which prolonged the postoperative dressing and care. We present our 5-year experience with a propeller flap based on the supratrochlear artery, which allows one-stage transfer of the forehead skin to the nose without the need for pedicle division. This technique is indicated in a selected group of patients who are not suitable for multiple-stage reconstructions because they have concurrent medical conditions, reduced mobility, or live far away from specialized medical centers. We have renamed this procedure as supratrochlear artery axial propeller flap, from the acronym STAAP flap, to stress the axial, well known and constant, vascularization of the flap. In the past 5 years, we have been performing 25 STAAP flaps; full-thickness nasal reconstruction was performed in 11 cases. The patients were 16 males and 9 females, with a mean age of 79.5 years. All patients had multiple comorbidities. Complete flap survival was observed in 23 cases and healing was complete in 7 days. In two cases, there was a partial distal necrosis of the flap treated conservatively. Cosmetic results were good and the patient's satisfaction was significant. These results indicate that the STAAP flap is a reliable and useful technique in selected cases, as old or noncompliant patients who benefit from a one-stage technique of nose reconstruction. PMID:24918712

  10. Colgajo en hélice de perforante interósea posterior: Un nuevo procedimiento reconstructivo Propeller interoseous posterior perforator flap: A new reconstructive procedure

    Directory of Open Access Journals (Sweden)

    A. Fernández García

    2009-03-01

    reconstruction. This flap is based on the integrity of the dorsal carpal anastomosis between the anterior interosseous artery and the posterior interosseous artery. Hence, when the dorsal carpal anastomosis is not available, it is not possible to perform a distally-based posterior interosseous flap. We report a propeller perforator flap proximallybased, available without the dorsal carpal supply, and useful for the coverage of the distal third of the forearm, wrist and hand. We report the surgical technique, its applications, advantages and disadvantages and review the use o this flap in different clinical cases. A patient suffered a severe crush injury of their left upper limb. He presented osteosynthesis plate exposure in the radius and thrombosis of the revascularization anastomosis. The absence of reverse flow in the posterior interosseous artery was proven with Doppler Ultrasounds. A propeller interosseous posterior perforator flap was performed to cover a new by-pass and the osteosynthesis plate. Another patient suffered an automobile accident. He presented closed fractures of radius and ulna of their left upper limb. The radial column of carpus suffered a severe crush injury. After the osteosynthesis, a propeller interosseous posterior perforator flap was performed. The flap provided appropriate coverage of the dorso-radial aspect of the wrist and hand. In our clinical cases the propeller interosseous posterior perforator flap provided excellent coverage of the carpus and hand with low donor site morbidity. Propeller interosseous posterior perforator flap provide a versatile and reliable coverage option in upper limb reconstruction, available in absence of the dorsal carpal anastomosis and without sacrifice of the interosseous posterior artery.

  11. Persistent trigeminal artery: in situ thrombosis and associated perforating vessel infarction.

    Science.gov (United States)

    Gaughen, John R; Starke, Robert M; Durst, Christopher R; Evans, Avery J; Jensen, Mary E

    2014-06-01

    We report a patient with progressive brainstem infarction despite medical therapy. The patient was transferred to our institution for potential angioplasty of basilar stenosis. Imaging review demonstrated persistent trigeminal artery in situ thrombosis and associated perforating vessel infarction. Persistent trigeminal arteries are commonly associated with an atretic basilar artery and interventional treatment can result in significant morbidity and mortality. PMID:24351576

  12. A RARE CASE OF GALLBLADDER PERFORATION WITH CONCOMITANT SUPERIOR MESENTERIC ARTERY THROMBOSIS CAUSING BOWEL ISCHEMIA

    Directory of Open Access Journals (Sweden)

    Minakshi

    2014-01-01

    Full Text Available We are presenting a rare case of Gall Bladder Perforation with Superior Mesenteric Artery thrombosis causing mid gut gangrene. Gall bladder Perforation due to gallstones and Acute Mesenteric Ischemia are two different pathologies not associated with each other , occurring together in the same patient causing acute abdomen has not been reported in the literature till date.

  13. Reducing Radiation Dose Without Compromising Image Quality in Preoperative Perforator Flap Imaging With CTA Using ASIR Technology

    OpenAIRE

    Niumsawatt, Vachara; Debrotwir, Andrew N.; Rozen, Warren Matthew

    2014-01-01

    Computed tomographic angiography (CTA) has become a mainstay in preoperative perforator flap planning in the modern era of reconstructive surgery. However, the increased use of CTA does raise the concern of radiation exposure to patients. Several techniques have been developed to decrease radiation dosage without compromising image quality, with varying results. The most recent advance is in the improvement of image reconstruction using an adaptive statistical iterative reconstruction (ASIR) ...

  14. Complete lymph flow reconstruction: A free vascularized lymph node true perforator flap transfer with efferent lymphaticolymphatic anastomosis.

    Science.gov (United States)

    Yamamoto, Takumi; Yoshimatsu, Hidehiko; Yamamoto, Nana

    2016-09-01

    Treatment of primary lower extremity lymphedema (LEL) is challenging, and lymph node transfer (LNT) can be a choice of treatment for progressive LEL. However, LNT has a risk of donor site lymphedema and possible lymph node (LN) sclerosis due to efferent lymphatic vessel (ELV) obstruction. Here, we report the first case of complete lymph flow reconstruction with true perforator LNT with efferent lymphaticolymphatic anastomosis (ELLA) for a patient with primary LEL and severe lymphosclerosis. A 49-year-old female suffered from primary progressive unilateral left LEL refractory to conservative treatments with frequent episodes of cellulitis. A true perforator LN flap was selectively harvested from the left lateral thoracic region under indocyanine green (ICG) lymphography navigation and transferred to the left groin with perforator-to-perforator anastomosis. The ELV of the transplanted LN was supermicrosurgically anastomosed to the contralateral iliac lymphatic vessel that was subcutaneously transferred to the left groin. Postoperatively, the patient experienced no episode of cellulitis with reduced degree of compression treatment, and lymphedematous volume decreased from 306 to 264 in terms of LEL index. Postoperative ICG lymphography showed evidence of reconstructed lymph flow from the left foot to the left groin and to the right inguinal LN through the transplanted LN flap and the ELLA. There were no subjective or objective findings of donor site lymphedema of the left arm or the right back and the lower extremity. True perforator LN flap with ELLA is a safe and effective treatment and has the potential to be a useful therapeutic option for primary unilateral LEL. PMID:27449876

  15. Angiosome of the fibular artery as anatomic basis for free composite fibular flap

    OpenAIRE

    Manojlović Radovan; Milisavljević Milan; Tabaković Dejan; Ćetković Mila; Bumbaširević Marko

    2007-01-01

    Introduction. The free osteoseptocutaneus fibular flap is, anatomically, an angiosome of the fibular artery. Knowledge of detailed topography anatomy of the fibular artery and its branches is necessary for successful creation and elevation of the flap. Objective. The aim of the study was to determine topography of the tissue of the leg supplied only by the fibular artery, to describe topography relations of the branches of the fibular artery, their number, anastomoses, vascular plexus and the...

  16. Colgajo de perforantes de arteria epigrástica superior para cobertura de defecto cutáneo preesternal Covergae of a presternal skin defect with a superior epigastric perforator Flap

    Directory of Open Access Journals (Sweden)

    E. García Tutor

    2008-06-01

    Full Text Available Los colgajos basados en arterias perforantes representan hoy en día una muy buena alternativa para la reconstrucción y cobertura de defectos cutáneos. Sus numerosas ventajas tales como la mínima morbilidad de la zona donante, su fácil recuperación postquirúrgica, su gran versatilidad y la simplicidad que presentan tanto en su planteamiento prequirúrgico como en la técnica misma, han sido algunos de los motivos por los que durante la última década su uso ha tenido un desarrollo notable, siendo quizás el colgajo DIEP el mayor representante de este grupo. Recientemente se ha descrito un tipo de colgajo de similares características basado en arterias perforantes de la arteria epigástrica superior para la cobertura de defectos de la región preesternal baja. En el trabajo actual presentamos un caso clínico en el que una lesión en dicha zona previamente sometida a radioterapia es tratada con este colgajo, obteniendo una cobertura completa de la herida y un resultado estético aceptable.Perforator flaps nowadays represent a very good therapeutic alternative for reconstruction and coverage of skin defects. Their advantages such as the minimal morbidity of the donor site, their good and easy postsurgical recovery, great versatility and rather simple surgical approach and technique are some of the reasons why these flaps have been rapidly developed over the last decade, being the flap based on perforator from de deep inferior epigastric artery, DIEP flap, probably their main model. A flap of similar characteristics based on perforators coming from the superior epigastric artery has been recently described for the coverage of the lower sternum region. In this article we present a clinical case in which a wound in this area that had been previously exposed to radiotherapy is treated with a superiorepigastric perforator flap, achieving complete coverage of the defect and an acceptable aesthetic result.

  17. Chlorogenic Acid Enhances Abdominal Skin Flap Survival Based on Epigastric Artery in Nondiabetic and Diabetic Rats.

    Science.gov (United States)

    Bagdas, Deniz; Etoz, Betul Cam; Gul, Zulfiye; Ozyigit, Musa Ozgur; Cinkilic, Nilufer; Inan, Sevda; Buyukcoskun, Naciye Isbil; Ozluk, Kasim; Gurun, Mine Sibel

    2016-08-01

    Previous studies showed that chlorogenic acid (CGA) accelerates wound healing via its antioxidant activity. We aimed to investigate the effect of CGA in an experimental epigastric abdominal skin flap model in nondiabetic and diabetic rats. Rats were firstly divided into 2 groups: nondiabetic and diabetic. Diabetes was induced by streptozotocin. Then, 4 subgroups were created for each group: vehicle as well as 0.2 mg/0.5 mL, 1 mg/0.5 mL, and 5 mg/0.5 mL CGA treatments. Right epigastric artery-based abdominal skin flaps were elevated and sutured back into their original position. Chlorogenic acid or vehicle was injected once into the femoral arteries by leaving the epigastric artery as the single artery feeding the flaps during the injection. On postoperative day 7, flap survivals were evaluated, and the rats were killed. Distal flap tissues were collected for histopathological and biochemical assays. Chlorogenic acid showed greater flap survival in both nondiabetic and diabetic rats. Capillary density was increased, and necrosis was reduced in the CGA-treated rats. Chlorogenic acid decreased malondialdehyde levels as well as increased reduced glutathione and superoxide dismutase levels in the flap tissues. This study showed that CGA significantly improved flap survival by its antioxidant activities with intra-arterial local injections. PMID:25356637

  18. A Rare Case of an Artery Passing through the Median Perforating Canal of the Mandible

    Science.gov (United States)

    Iwanaga, Joe; Watanabe, Koichi; Saga, Tsuyoshi; Tabira, Yoko; Yamaki, Koh-ichi

    2016-01-01

    Along with the popularization of dental implant surgery, there has been considerable research on the lingual foramen using cone-beam computed tomography. Anatomical research has also revealed that the arteries entering the lingual foramina are branches of the submental and sublingual arteries. There have been no reports, however, of the submental or sublingual artery entering the mandible from the lingual foramen, perforating it, and then distributing to the inferior labial region. A 69-year-old man who donated his body to our department in 2015 was dissected. The mandible with overlying soft tissue of the mental region was resected and examined with microcomputed tomography, which showed that the canal perforated from the lingual foramen to the midline of the labial cortical plate. The canal was thus named the median perforating canal. To the best of our knowledge, there have been no other reports of a perforating artery of the mandible, so this case is thought to be rare. Hence, the existence of perforating arteries, such as in the present case, should be taken into consideration in preoperative diagnoses such as for dental implant surgery. Thus, the fusion of anatomical and radiological study is useful and necessary to understand surgical anatomy.

  19. Coronary artery perforation during percutaneous coronary intervention (PCI), successful management with covered stent

    International Nuclear Information System (INIS)

    Coronary artery perforation, (CP) is a rare and potentially life-threatening complication of percutaneous coronary intervention (PCI). CP has historically been reported to occur in 0.1-3.0% of PCI procedures. Although CP can be caused by coronary wires and balloon angioplasty, they are more frequently reported in PCI using atheroablative devices, stenting and excimer laser coronary angioplasty. We report a case of coronary perforation took place and was managed successfully. (author)

  20. A Case of Heel Reconstruction with a Reverse Sural Artery Flap in a Hemophilia B Patient

    OpenAIRE

    Byung Kwon Lee; Jeong Su Shim

    2012-01-01

    Hemophilia B is a rare blood coagulation disorder. Complications such as bleeding and hematoma can cause necrosis of flaps, wound disruption, and the disturbance of wound healing. In particular, guidelines for flap operations in hemophilia B patients have still not been defined, and case reports are rare. We reconstructed the heel of a 41-year-old male hemophilia B patient using a reverse sural artery flap operation. The patient presented with mild hemophilia, having 27% of the normal value o...

  1. CT-guided deep inferior epigastric perforator (DIEP) flap localization — Better for the patient, the surgeon, and the hospital

    International Nuclear Information System (INIS)

    Aims: To define the clinical benefits to the patient of preoperative imaging planning for deep inferior epigastric perforator (DIEP) flap reconstruction. Materials and methods: Since 2009 computed tomography angiography (CTA) has been provided for the preoperative planning of DIEP flap breast reconstruction in the largest plastic surgery unit in southeast England. In a retrospective, cohort–control study the outcomes of 100 consecutive patients who underwent preoperative CTA planning were compared with a closely-matched control group who underwent ultrasound planning only. The cohorts were evaluated for operative duration, mean operative blood loss and transfusion requirement, morbidity and flap or donor-site complications. Results: There were statistically significant improvements in mean operative duration (p < 0.05), intra-operative blood loss (p < 0.05), shorter mean inpatient stay (p < 0.05) for the CTA planning versus the ultrasound planning of DIEP flap reconstruction. Conclusion: Statistically significant benefits were demonstrated in key aspects of the surgical procedure following CTA-guided planning. The implications of these benefits are profound in terms of pure healthcare cost benefits.

  2. DELAY PROCEDURE IN THE PERFORASOME ERA: A CASE IN A DIEAP FLAP.

    Science.gov (United States)

    Hyza, P; Lombardo, G A G; Kubek, T; Jelinkova, Z; Vesely, J; Perrotta, R

    2015-01-01

    The deep inferior epigastric artery perforator (DIEAp) flap is becoming a widely used method of autologous breast reconstruction. Despite the huge use of the DIEAp flap in reconstructive field, an evidenced based approach in perforator selection has not yet been developed. Unfortunately there is no clear evidence about the relation between the number and dimension of the perforator vessel and the prediction of flap survival in a living model. An old technique like the vascular delay could be extremely useful as a lifeboat procedure when the vascularization of the flap after the dissection is inadequate. PMID:26650110

  3. Intraoperative hemodynamic evaluation of the radial and ulnar arteries during free radial forearm flap procedure.

    Science.gov (United States)

    Lorenzetti, Fulvio; Giordano, Salvatore; Suominen, Erkki; Asko-Seljavaara, Sirpa; Suominen, Sinikka

    2010-02-01

    The purpose of this prospective study was to assess the blood flow of the radial and ulnar arteries before and after radial forearm flap raising. Twenty-two patients underwent radial forearm microvascular reconstruction for leg soft tissue defects. Blood flow of the radial, ulnar, and recipient arteries was measured intraoperatively by transit-time and ultrasonic flowmeter. In the in situ radial artery, the mean blood flow was 60.5 +/- 47.7 mL/min before, 6.7 +/- 4.1 mL/min after raising the flap, and 5.8 +/- 2.0 mL/min after end-to-end anastomosis to the recipient artery. In the ulnar artery, the mean blood flow was 60.5 +/- 43.3 mL/min before harvesting the radial forearm flap and significantly increased to 85.7 +/- 57.9 mL/min after radial artery sacrifice. A significant difference was also found between this value and the value of blood flow in the ulnar and radial arteries pooled together ( P < 0.05). The vascular resistance in the ulnar artery decreased significantly after the radial artery flap raising (from 2.7 +/- 3.1 to 1.9 +/- 2.2 peripheral resistance units, P = 0.010). The forearm has a conspicuous arterial vascularization not only through the radial and ulnar arteries but also through the interosseous system. The raising of the radial forearm flap increases blood flow and decreases vascular resistance in the ulnar artery. PMID:19902406

  4. Colgajo bilateral de perforantes lumbares para la reconstrucción de un severo defecto tóracolumbar Bilateral lumbar perforator flap in reconstruction of a wide toracolumbar defect

    Directory of Open Access Journals (Sweden)

    P. Benito Duque

    2006-06-01

    Full Text Available En la reconstrucción de los defectos toracolumbares se han empleado numerosas técnicas quirúrgicas. Ocasionalmente se puede utilizar el cierre directo, injertos de piel, colgajos de dorsal ancho volteado y lumbosacro transverso, colgajos de transposición o de rotación tipo random, pero están limitados cuando los tejidos circundantes están radiados o presentan cicatrices por cirugías previas. Igualmente, la extensión del defecto puede hacerlos inviables. Los colgajos de perforantes están especialmente indicados en pacientes con deambulación conservada, haciendo posible el aporte de una gran superficie de piel y tejido subcutáneo bien vascularizado, basado en los vasos perforantes y evitando así el sacrificio de vasos principales o músculos. Presentamos el caso de una paciente con un defecto en la espalda de 17 cm. De diámetro secundario a la resección de un tumor espinocelular con exposición de cuerpos vertebrales, tratado mediante la transposición de dos colgajos basados en las arterias perforantes lumbares asociados a un colgajo de rotación de dorsal ancho miocutáneo.Thoracolumbar defects have been treated by a variety of surgical methods. Primary closure, skin grafting, reverse latissimus dorsi musculocutaneous flap, transverse lumbosacral back flap, local randomly designed rotation, or transposition flaps may be indicated in occasional cases, but there is limited indication for their use in some cases with a wide lesion or when the surrounding tissues have been compromised by previous surgery or irradiation. Perforator flaps are specially indicated for ambulatory patients, in which large amounts of well-vascularized skin and subcutaneous tissue are transfered easily based on one perforator vessel without sacrificing main vessels or muscles. The authors present a patient with a 17 cm wide defect in the midback region and exposed bone after excision of a squamous cell carcinoma, treated by two perforator flaps based on

  5. Incidentaloma at Radial Artery Forearm Free Flap Harvest: An Occult Volar Wrist Ganglion

    OpenAIRE

    Nambi, G.I.; M Dhiwakar

    2012-01-01

    Occult volar wrist ganglion originating from radioscaphoid interval and having adherence to flexor carpi radialis tendon [Fcr] and radial artery is an uncommon occurrence. We report such a case which was occult and asymptomatic during pre-operative assessment and presented as an incidentaloma during radial artery forearm free flap harvest for oral cancer reconstruction.

  6. Sealing of a dual feeding coronary artery perforation with homemade spring guidewire.

    Science.gov (United States)

    Hartono, Beny; Widito, Sasmojo; Munawar, Muhammad

    2015-10-01

    Coronary artery perforation (CAP) after percutaneous coronary intervention is a rare, but potentially life-threatening complication. The source of the bleeding is usually from one of the coronary arteries. In the era of chronic total occlusion technique, retrograde approach strategy sometimes is performed using collateral channels. When CAP occurs distal from the collateral channel, the source of bleeding can be from dual arteries, i.e., main and contra-lateral artery. Therefore, management of this bleeding should be intended to close the channel from both the arteries. We have successfully performed an emergent microcoil embolization in a patient with uncontrolled Ellis grade III perforation resulting cardiac tamponade which need pericardiocentesis. The perforation was sealed with the use of cutting the distal part of spring guidewire deployed at the septal collateral channel and fibered microcoil embolization deployed at the distal part of the other vessel. During 1 month follow-up, the patient was found to be well. In conclusion, CAP may result from two source of bleeding and should be kept into consideration. We successfully stopped the bleeding using the combination of fibered microcoil and tip of the spring guidewire. PMID:25301012

  7. Perforator Based Propeller Flaps in Limb Reconstructive Surgery: Clinical Application and Literature Review

    Directory of Open Access Journals (Sweden)

    Stefano Artiaco

    2014-01-01

    Full Text Available The reconstruction of loss of substance due to trauma or oncological excision may have relevant functional and aesthetic implications. We report our experience in twenty-one cases of propeller flaps for the treatment of loss of substance of the upper and lower limbs. The etiology of defect was tumor excision in nine cases, trauma in seven cases, surgical wound complications in four cases, and chronic osteomyelitis in one case. Clinical results were favorable in most cases and eighteen flaps survived. We observed an overall complication rate of 33% with four cases of superficial epidermolysis that spontaneously healed and three cases of partial flap loss ranging from 10 to 50% that required surgical revision by means of skin graft (two cases or ALT free flap (one case. Propeller flap harvesting requires great care and experience, and potential complications may occur even in expert hands. When indicated by the characteristic of the defect, these flaps can be a useful surgical option for the treatment of loss of substance of upper and lower limbs.

  8. Perforator Based Propeller Flaps in Limb Reconstructive Surgery: Clinical Application and Literature Review

    Science.gov (United States)

    Artiaco, Stefano; Bianchi, Pasquale; Boux, Elena; Tos, Pierluigi

    2014-01-01

    The reconstruction of loss of substance due to trauma or oncological excision may have relevant functional and aesthetic implications. We report our experience in twenty-one cases of propeller flaps for the treatment of loss of substance of the upper and lower limbs. The etiology of defect was tumor excision in nine cases, trauma in seven cases, surgical wound complications in four cases, and chronic osteomyelitis in one case. Clinical results were favorable in most cases and eighteen flaps survived. We observed an overall complication rate of 33% with four cases of superficial epidermolysis that spontaneously healed and three cases of partial flap loss ranging from 10 to 50% that required surgical revision by means of skin graft (two cases) or ALT free flap (one case). Propeller flap harvesting requires great care and experience, and potential complications may occur even in expert hands. When indicated by the characteristic of the defect, these flaps can be a useful surgical option for the treatment of loss of substance of upper and lower limbs. PMID:25250327

  9. 以腹壁下动脉穿支为蒂的血流桥接皮瓣修复肢体创面缺损%Flow-through deep inferior epigastric perforator flaps transplantation for reconstruction of large defects at the extremities

    Institute of Scientific and Technical Information of China (English)

    李涛; 陈振兵; 陈燕花; 丛晓斌; 艾方兴; 王锟; 洪光祥

    2014-01-01

    Objective To investigate the clinical application of flow-through deep inferior epigastric perforator flaps for reconstruction of large defects at the extremities.Methoths The deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery.Free deep inferior epigastric perforator flaps were harvested in flow-through manners to reconstruct associated arterial defect in the wound.The sensation assessment,Enneking score,and questionnaire of the flap aesthetic were all performed during follow-up period.Results From December 2011 to September 2012,5 patients with large defects at extremities were treated.The deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery.The wound defects ranged form 11 cm × 5 cm to 30 cm × 11 cm.And the flap size ranged from 13 cm ×7 cm to 33 cm × 13 cm.All flaps survived completely.The recipient arteries were all bypassed well documented by color Doppler examinations.All cases had 12-24 months' follow-up period.The flaps had good appearance and high aesthetic satisfactory(100%).12 months after operations,sensation assessment were all S3 +,and the Enneking score ratios were 82%-95%,with 87.2% in average.Conclusions Flow-through deep inferior epigastric perforator flaps are reliable and effective for reconstruction of large defects at the extremities with maintenance of the vascular status of the extremities.The flaps can also be designed in transverse or oblique mode for clinical application.%目的 探讨腹壁下动脉脐旁穿支血流桥接皮瓣修复四肢创面缺损的临床效果.方法 以腹壁下动脉-腹壁上动脉为轴心血管、脐旁穿支为皮瓣供血,形成血流桥接皮瓣术式移植,术后检测皮瓣感觉和神经功能,问卷调查患者对皮瓣外形满意度,对患肢功能行Enneking评分.结果 2011年12

  10. Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot.

    Science.gov (United States)

    Sato, Tomoya; Ichioka, Shigeru

    2016-01-01

    Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot. PMID:26190780

  11. Submental Artery Island Flap in Reconstruction of Harde Plate after wide Surgical Resection of Veruccous Carcinoma. Two case reports

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2013-06-01

    Full Text Available Introduction: Reconstruction of intraoral soft tissue defects is important in restoring function and esthetic. In large defects, there will be demand for regional pedicle flaps or free flaps. Hard palate separates nasal and oral cavities. Due to the small surface area between flap and remaining palate after surgical resections, optimal blood supply of the flaps for hard palate reconstructions are needed. This article demonstrates immediate reconstruction of two edentulous hemimaxillectomy patients with submental artery Island flap and brief review of this flap discussed. 

  12. Adipofascial sural artery flap for foot and ankle reconstruction in children: for better aesthetic outcome

    International Nuclear Information System (INIS)

    Wheel spoke injury of the ankle and foot is very common in children and its reconstruction is challenging. Reverse flow sural artery fasciocutaneous flap is versatile for this area but lead to significant donor site morbidity. Free tissue transfer is an option in children which needs a micro-vascular expertise, expensive equipment and long operating time. Method: Fifteen adipofascial flaps were done for foot and ankle coverage from June 2011 to June 2014 at CH and ICH Lahore. The efficacy of adipofascial sural artery flap for the coverage of these defects was evaluated. Results: Fifteen children presented with defects of foot and ankle, 11 (73%) were male and 4 (27%) were female. Their age ranged from 1 - 13 years. All patients had trauma to the foot due to wheel spoke injury. Flaps were used to cover tendoachilles and malleoli. In one patient there was flap tip necrosis with partial graft loss which healed with dressings. Donor site aesthetic outcome was satisfactory in all cases. Mean follow-up was I year. Conclusion: Adipofascial Sural artery flap is quick and safe with wide arc of rotation, minimal donor site morbidity and better aesthetic outcome and it does not sacrifice major extremity vessel. (author)

  13. Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

    Directory of Open Access Journals (Sweden)

    Dae-Sung Lee

    2013-05-01

    Full Text Available We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

  14. The vascularized sural nerve graft based on a peroneal artery perforator for reconstruction of the inferior alveolar nerve defect.

    Science.gov (United States)

    Hayashida, Kenji; Hiroto, Saijo; Morooka, Shin; Kuwabara, Kaoru; Fujioka, Masaki

    2015-03-01

    The sural nerve has been described for nerve reconstruction of the maxillofacial region since it provides many advantages. We report a case of a vascularized sural nerve graft based on a peroneal artery perforator for immediate reconstruction after the removal of intraosseous neuroma originating in the inferior alveolar nerve. The patient had a neuroma caused by iatrogenic injury to the inferior alveolar nerve. A 4-cm long neuroma existed in the inferior alveolar nerve and was resected. A peroneal perforator was chosen as the pedicle of the vascularized sural nerve graft for the nerve gap. The graft including the skin paddle for monitoring the perfusion supplied by this perforator was transferred to the lesion. The nerve gap between the two stumps of the inferior alveolar nerve was repaired using the 6-cm long vascularized sural nerve. The perforator of the peroneal artery was anastomosed to the branch of the facial artery in a perforator-to-perforator fashion. There was no need to sacrifice any main arteries. The skin paddle with 1 cm × 3 cm in size was inset into the incised medial neck. Perceptual function tests with a Semmes-Weinstein pressure esthesiometer and two-point discrimination in the lower lip and chin at 10 months after surgery showed recovery almost to the level of the normal side. This free vascularized sural nerve graft based on a peroneal artery perforator may be a good alternative for reconstruction of inferior alveolar nerve defects. PMID:25346479

  15. Predominant location of coronary artery atherosclerosis in the left anterior descending artery. The impact of septal perforators and the myocardial bridging effect

    OpenAIRE

    Wasilewski, Jarosław; Niedziela, Jacek; Osadnik, Tadeusz; Duszańska, Agata; Sraga, Wojciech; Desperak, Piotr; Myga-Porosiło, Jolanta; Jackowska, Zuzanna; Nowakowski, Andrzej; Głowacki, Jan

    2015-01-01

    Introduction Coronary artery atherosclerosis presents characteristic patterns of plaque distribution despite systemic exposure to risk factors. We hypothesized that local hemodynamic forces induced by the systolic compression of intramuscular septal perforators could be involved in atherosclerotic processes in the left anterior descending artery (LAD) adjacent to the septal perforators’ origin. Therefore we studied the spatial distribution of atherosclerosis in coronary arteries, especially i...

  16. Perforation of Transverse Colon: A Catastrophic Complication of Uterine Artery Embolization for Fibroids

    International Nuclear Information System (INIS)

    We report a case of a 43-year-old woman who underwent uterine artery embolization (UAE) for a symptomatic large fibroid uterus and had spontaneous perforation of the transverse colon 3 months after embolisation with near-fatal consequences. We believe this is the first reported case in the literature of this serious complication of UAE. We briefly review the literature on bowel complications after UAE and discuss lessons to be learned regarding patient selection and postprocedure follow-up.

  17. The use of propeller perforator flaps for diabetic limb salvage: a retrospective review of 25 cases

    OpenAIRE

    Georgescu, Alexandru V.; Ileana R. Matei; Irina M. Capota

    2012-01-01

    Background: Peripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG) with or without negative pressure wound therapy and local random flaps have been used wit...

  18. Reconstruction of maxillectomy defects using deep circumflex iliac artery-based composite free flap.

    Science.gov (United States)

    Baliarsing, Amresh S; Kumar, Vinay V; Malik, Neelima A; B, Dilip Kumar

    2010-03-01

    Reconstruction of maxillectomy defects is a challenging endeavor, and various methods have been described to rehabilitate these defects, out of which composite free tissue transfer has an established role in reconstruction of the maxillary defects. The deep circumflex iliac artery (DCIA) flap has distinct advantages regarding the volume and length of the bone in reconstruction. The contour of the iliac bone is similar to the maxilla and provides good esthetic result. Good volume of bone allows placement of osseointegrated implant for dental rehabilitation. We present 8 cases of maxilla reconstruction using DCIA flap (3 osteocutaneous and 5 osseous flaps) for benign and malignant pathologies of the maxilla. DCIA flap is difficult to harvest, has variable anatomy, and needs meticulous planning for optimum result. PMID:20219591

  19. Biphasic synovial sarcoma of the extremity : quadruple approach of isolated limb perfusion, surgical ablation, adipofascial perforator flap and radiation to avoid amputation

    OpenAIRE

    Steinsträßer, Lars; Agarwal, R.; Stricker, Ingo; Steinau, Hans-Ulrich; al- Benna, Sammy

    2011-01-01

    Synovial sarcoma is a rare type of soft tissue sarcoma that occurs mostly in young adults, and it is always regarded as a high-grade tumor. Here, we report the case of a 31-year-old German Caucasian male with synovial sarcoma of the wrist who was offered amputation at his local hospital. After referral to our Reference Centre for Soft Tissue Sarcoma, the quadruple approach of isolated limb perfusion, surgical ablation, adipofascial perforator flap and radiation avoided amputation and enabled ...

  20. Sural nerve preservation in reverse sural artery fasciocutaneous flap-a case report

    Directory of Open Access Journals (Sweden)

    Esezobor Emmanuel E

    2012-10-01

    Full Text Available Abstract Background The reverse sural artery flap is a generally accepted means of soft tissue reconstruction for defects of the distal third of the legs. The routine sacrifice of the sural nerve with its consequential temporary loss of sensation on the lateral aspect of the foot can be of concern to early rehabilitation of some patients. Method This is a case report of a 24 years old male who had Gustillo and Anderson type IIIB injury involving the upper part of the distal 3rd and the middle 3rd of tibia. A reverse sural artery flap was raised without transecting the sural nerve to cover the distal part of the defect. Result The distal part of the exposed bone was covered with the reverse sural artery flap without loss of sensation at anytime to the lateral part of the foot. Conclusion The reverse sural artery flap can be raised to cover the upper portion of the distal leg without severing the sural nerve.

  1. Acute iliac artery thrombosis and pyloric ulcer perforation - unique double emergency pathologies detected with MDCT

    International Nuclear Information System (INIS)

    Full text: Acute iliac artery thrombosis and pyloric ulcer perforation are both emergencies that require different surgical approach. Both conditions have serious consequences and high mortality rate. There are fewer reports on simultaneous cases of such surgical emergencies. We present a case of 67 years old man with abdominal pain with acute onset and paleness and pain in the left lower extremity. the patient was referred for a CT for assessment of acute limb ischaemia and also suspected mesenteric thrombosis. MDCT of abdomen and peripheral CT angiography of lower extremities was performed. The aim is to show the benefit of MDCT examination in depicting varieties of pathologies encountered in emergency patients. MDCT showed total occlusion of left iliac artery. No signs of mesenteric thrombosis were evident and the mesenteric arteries were patent. However there was free air in the peritoneal cavity suggestive of perforation. the patient was operated - arterial thrombectomy was performed together with pyloric ulcus excision. MDCT is an excellent non-invasive method that can give prompt answers to surgical emergencies

  2. The Retrograde Ulnar Dorsal Flap: Surgical Technique and Experience as Island Flap in Coverage of Hand Defects.

    Science.gov (United States)

    Vergara-Amador, Enrique

    2015-09-01

    Flaps from the forearm are often used to reconstruct soft-tissue defects in the hand. The retrograde ulnar dorsal flap has the advantage that it does not sacrifice a major vascular axis. The anatomic bases of this flap are the proximal and distal branch of the ulnar dorsal artery. The distal branch is partially accompanied with the dorsal branch of the ulnar nerve, and arrives under the abductor digiti quinti muscle making anastomoses with the deep branch of the ulnar artery. The proximal branch reaching the proximal third of the forearm, and anastomose with perforating branches of the ulnar artery. I used this island flap in 12 patients with coverage defects on the hand. The biggest flap was 13×6 cm. Only 1 flap had partial necrosis which did not lead to problems. The retrograde ulnar dorsal flap is a flap designed with reverse flow from the distal branch of the ulnar dorsal artery, and which does not sacrifice the ulnar artery. The donor defect on the forearm ulnar side had a greater esthetic acceptance. Knowing other distal anastomoses, described by other authors later, dorsal at the base of the fourth interdigital space grant greater security to the retrograde ulnar dorsal flap. It is worth highlighting the importance of preserving the adipofascial tissue around the pedicle. Experience with this flap permits us to state that it is a safe and reproducible flap to cover any defect on the dorsal of the hand as well as the first web space. PMID:26079665

  3. A clinical study on perforator stroke resulting from Wingspan stent angioplasty for symptomatic intracranial artery stenosis

    International Nuclear Information System (INIS)

    Objective: To evaluate the incidence, potential hazards and effective countermeasure for perforator stroke (PS) resulting from stent angioplasty of symptomatic intracranial artery stenosis. Methods: Peri-operation PS complications of 258 patients receiving Gateway balloon-Wingspan stenting for severe symptomatic intracranial stenosis were analyzed. The incidence, clinical course, and prognosis of PS resulting from stenting were recorded. Special attention was given to the anatomical features, clinical manifestation and video materials of patients with PS. χ2 test was used for statistics. Results: Two hundred and fifty-five patients received stent angioplasty successfully and 7 patients had PS (incidence rate 2.7%). The patients with basilar artery stenosis had a higher incidence of PS resulting from intracranial stenting (6.1%, 4/66) than patients with middle cerebral artery stenosis (2.5%, 3/118) (χ2=2.320, P= 0.025). The potential hazards for PS included preoperative perforator stroke adjacent to the stenotic segment and prominent dissection during operation. Six patients presented symptoms after awake from general anaesthesia and one had symptoms 3 hours after stenting. One deteriorated gradually and the others reached the maximum deficit almost at once. At the follow-up of 3 months, 3 patients were disabled and scored one, two, two by mRS respectively. Conclusion: The incidence of PS resulting from intracranial stenting was low and the prognosis was not disastrous. Stenosis at basilar artery and preoperative perforator stroke adjacent to the stenotic segment were potential risk factors for PS complication. Proper maneuver of angioplasty may decrease the incidence of PS and improve the prognosis. (authors)

  4. Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

    Energy Technology Data Exchange (ETDEWEB)

    Mehta, Vimal, E-mail: drvimalmehta@yahoo.co.in; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay [G.B. Pant Institute of Postgraduate Medical Education and Research (India)

    2016-01-15

    We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.

  5. Ruptured hepatic artery aneurysm precipitated by gangrenous perforated appendicitis: a case report.

    Science.gov (United States)

    Snow, Alec F; Vannahme, Milena; Kettley, Laura; Pullyblank, Anne

    2016-01-01

    Hepatic artery aneurysms are among the most common visceral artery aneurysms although still relatively rare. Repair of aneurysms >2 cm in diameter is important due to the high rate of rupture and associated mortality. Here, we present a case of a sudden rupture of a hepatic artery aneurysm after presentation with a perforated gangrenous appendicitis. There is increasing evidence that expansion and rupture of abdominal aortic aneurysm is related to degradation of elastin and collagen by matrix metalloproteinases (MMPs). Elastin degradation leads to expansion, while collagen degradation leads to rupture. The activity of MMPs has been shown to be upregulated by both sepsis and peritonitis. Here, we suggest that the inflammation from sepsis and peritonitis led to the activation and/or upregulation of MMPs, which precipitated aneurysm rupture via collagenase activity. PMID:27173883

  6. Ruptured hepatic artery aneurysm precipitated by gangrenous perforated appendicitis: a case report

    Science.gov (United States)

    Snow, Alec F.; Vannahme, Milena; Kettley, Laura; Pullyblank, Anne

    2016-01-01

    Hepatic artery aneurysms are among the most common visceral artery aneurysms although still relatively rare. Repair of aneurysms >2 cm in diameter is important due to the high rate of rupture and associated mortality. Here, we present a case of a sudden rupture of a hepatic artery aneurysm after presentation with a perforated gangrenous appendicitis. There is increasing evidence that expansion and rupture of abdominal aortic aneurysm is related to degradation of elastin and collagen by matrix metalloproteinases (MMPs). Elastin degradation leads to expansion, while collagen degradation leads to rupture. The activity of MMPs has been shown to be upregulated by both sepsis and peritonitis. Here, we suggest that the inflammation from sepsis and peritonitis led to the activation and/or upregulation of MMPs, which precipitated aneurysm rupture via collagenase activity. PMID:27173883

  7. Angiosome of the fibular artery as anatomic basis for free composite fibular flap

    Directory of Open Access Journals (Sweden)

    Manojlović Radovan

    2007-01-01

    Full Text Available Introduction. The free osteoseptocutaneus fibular flap is, anatomically, an angiosome of the fibular artery. Knowledge of detailed topography anatomy of the fibular artery and its branches is necessary for successful creation and elevation of the flap. Objective. The aim of the study was to determine topography of the tissue of the leg supplied only by the fibular artery, to describe topography relations of the branches of the fibular artery, their number, anastomoses, vascular plexus and the way of vascularization of the skin, muscle and bone tissue. Method. The popliteal artery was cannulated in 15 cadaveric legs, flushed with ink and then with 10% ink-gelatin. Fixation of tissue was performed with formalin and then micropreparation of the side branches of the fibular artery was performed. Also, two corrosive models were made. Localization of foramen nutrition was determined by measuring 50 fibulas. Results. The skin supplied by the fibular artery forms distal two thirds of the lateral-posterior aspect of the leg. Vascularization of the skin arises from the side branches of the fibular artery forming a rich fascia plexus at the deep fascia level. From 3 up to 7 side branches of the fibular artery are incorporated in the fascia arterial plexus and can be separated as septocutaneus and myocutaneus, according to topography relations. The nutritive artery enters the fibula cortex at a spot that, measured from the top of the fibula, lies in the area between 32% and 65% of the whole length of the fibula. Periosteal circulation of the fibula originates from the short side branches of the fibular artery that anastomoses at the periosteum level. Conclusion. The axial line of flap has to be marked 2 cm posterior to the line from caput fibulae to malleolus lateralis. Numerous anastomoses between the side branches of the fibular artery in the fascia plexus enable good circulation of the skin even when some of the branches are not included in the flap. The

  8. Discussing the model of cerebral watershed infarction and leukoaraiosis based on the perforating artery-neural tissue units

    Directory of Open Access Journals (Sweden)

    Yong-Peng Yu

    2015-01-01

    Full Text Available At present, there is still controversy in the etiology and pathogenesis of cerebral watershed infarction (CWI. The classification of watershed infarction is also confusing. Great changes have taken place in the knowledge of CWI with the development of the medical and imaging technology. Based on the concept of the perforating artery-neural tissue units, the innovative speculation on the relation among leukoaraiosis (LA (belong to white matter lesions, CWI and the mechanism of the perforating artery infarction formation was proposed in this paper. Based on the combination possibility of different perforating artery-neural tissue units,  the CWI was classified as lateral watershed infarction  (anterior cortical and posterior cortical watershed infarction, internal watershed infarction (anterior and interior type, posterior and interior type and interior type and deep watershed infarction (deep anterior type, deep posterior type and the various subtypes. This paper suggests that LA might be caused by chronic watershed cerebral ischemia change,  and perforating artery infarction and CWI are the same strain. This inference may help us to understand the relation among the mechanisms of the perforating artery infarction, CWI and LA.

  9. Coronary Artery Perforation Following Implantation of a Drug-Eluting Stent Rescued by Deployment of a Covered Stent in Symptomatic Myocardial Bridging

    OpenAIRE

    Zhang, Man; Kang, Woong Chol; Moon, Chan Il; Han, Seung Hwan; Ahn, Tae Hoon; Shin, Eak Kyun

    2010-01-01

    We successfully rescued a patient whose coronary artery perforated following implantation of a drug-eluting stent (DES), by deploying a stent-graft in symptomatic myocardial bridging. Our case demonstrated that coronary perforation could be handled without difficulty when perforated myocardial bridging is confined to the interventricular groove

  10. Coronary artery perforation: don't rush, IVUS may be useful.

    Science.gov (United States)

    Jurado-Román, Alfonso; García-Tejada, Julio; Hernández-Hernández, Felipe; Granda-Nistal, Carolina; Velázquez-Martín, María Teresa; González-Trevilla, Agustín Albarrán; Tascón-Pérez, Juan

    2015-10-01

    Coronary artery perforation (CAP) is a rare but potentially fatal complication of percutaneous coronary intervention. Polytetrafluoroethylene-covered stents prevent blood leakage between struts with a high rate of success. However, they lack elasticity and rapid and correct deployment is difficult. They have also a higher rate of stent restenosis and thrombosis. For these reasons, optimal deployment is essential. Although severe CAP needs an emergent solution, after stabilizing the patient, intracoronary imaging techniques may be useful to ensure correct expansion and reduce further adverse events. We present a case that shows the potential role of intravascular ultrasound in the resolution of a CAP. PMID:26437891

  11. Herniation after deep circumflex iliac artery flap: two cases of rare complication

    OpenAIRE

    Kim, Hee-Sung; Kim, Jae-Young; Hur, Hyuk; Nam, Woong

    2016-01-01

    Herniation after harvesting of deep circumflex iliac artery (DCIA) flap is a known but not a common complication. It occurs about 2.8 to 9 % according to the literatures and can proceed to a more severe complication such as bowel obstruction. There are several factors that exacerbate the risk: surgical factors, operator factor, and patient factors. Surgical factors include large anatomical defect and denervation of related muscles. Operator factor stands for unpunctual suture technique. Patie...

  12. Short and long term follow up results of (the versatile) reverse sural artery flap

    International Nuclear Information System (INIS)

    This study was designed to see the long and short term outcome of the reverse sural artery flap. Study Design: Case series. Patients and Methods: From January 2009 to December 2011, data was collected and analyzed for this study.Eighty nine patients with wounds on the ankle, heel, sole, distal leg, and foot were included in the study. They were followed up at 01 week, 02 weeks, and then 4 weekly for 06 months and at one year time from operation. They were examined for necrosis, congestion, surgical site infection, dehiscence of suture line, epidermolysis, donor site infection and functional outcome. Results: Most of the flaps healed nicely but two (2.25%) failed completely. Six flaps were delayed. However early follow up (within 04 weeks) revealed that there was partial loss of the distal 1-1.5 cm of flap in 04 patients (4.50%). Two patients (2.25%) developed superficial surgical site infection. Six patients (6.74%) developed venous congestion of the flaps which recovered within two weeks. Other minor complications included dehiscence of suture line in 3 patients (3.37%), and superficial Epidermolysis in four (4.50%) (Table-2). Twenty two patients (24.72%) returned to their work in 12-16 weeks, 31 (34.83%) in 16-20 weeks and 36 (40.45%) in 20-24 weeks. Long term follow-up to 06 months revealed hypertrophic scars at the donor site in three patients (4.91%) and recurrence of ulcer in 2 patients (3.27%). Conclusion: The sural fasciocutaneous flap provides reliable supple and durable most single-stage coverage of wounds of the distal third of the leg, heel, and foot with the results comparable to free-tissue transfer. (author)

  13. Predictive risk factors of free flap thrombosis in breast reconstruction surgery.

    Science.gov (United States)

    Masoomi, Hossein; Clark, Emily G; Paydar, Keyianoosh Z; Evans, Gregory R D; Nguyen, Audrey; Kobayashi, Mark R; Wirth, Garrett A

    2014-11-01

    Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication and whether patient characteristics play a role. Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent free flap breast reconstruction between 2009 and 2010 in the United States. Multivariate and univariate regression analyses were performed to identify independent risk factors of flap thrombosis. A total of 15,211 patients underwent free flap breast reconstruction surgery (immediate reconstruction: 43%). The most common flap was the free deep inferior epigastric perforator (DIEP) flap (53.6%), followed by free transverse rectus abdominis myocutaneous (TRAM) flap (43.1%), free superficial inferior epigastric artery (SIEA) flap (2%), and free gluteal artery perforator (GAP) flap (1.3%). The overall rate of flap thrombosis was 2.4 %, with the highest rate seen in the SIEA group (11.4%) and the lowest in the TRAM group (1.7%). Peripheral vascular disease (adjusted odds ration [AOR] 10.61), SIEA flap (AOR, 4.76) and delayed reconstruction (AOR, 1.42) were found to be statistically significant risk factors for flap thrombosis. Other comorbidities were not linked. While the overall rate of flap thrombosis in free flap breast reconstruction was relatively low (2.4%), Plastic Surgeons should be aware that patients with peripheral vascular disease and those undergoing free SIEA flap are at higher risk of flap thrombosis and they should closely monitor flaps to increase the chance for early salvage. PMID:24665051

  14. A study of the use of the supraclavicular artery flap for resurfacing of head, neck, and upper torso defects

    Directory of Open Access Journals (Sweden)

    Telang Parag

    2009-01-01

    Full Text Available The head and neck region is an aesthetically demanding area to resurface because of its high visibility. Tissue defects in this area often require distant flaps or free flaps to achieve an aesthetically acceptable result. The use of the Supraclavicular artery flap represents an extremely versatile and useful option for the resurfacing of head, neck and upper torso defects. Furthermore, islanding the flap gives it a wide arc of rotation and the color and texture match is superior to that of free flaps harvested from distant sites. In our study, we used the flap (both unexpanded and expanded predominantly for resurfacing neck defects resulting from the release of post-burn contractures. However, its applicability in other indications would also be similar. Except one, all our flaps survived almost completely and the post-operative morbidity was very low. We conclude that the supraclavicular artery flap not only provides a reasonably good color and texture match but also maintains the multi-directional activity in the neck region.

  15. Sectioned images and surface models of a cadaver for understanding the deep circumflex iliac artery flap.

    Science.gov (United States)

    Kim, Bong Chul; Chung, Min Suk; Kim, Hyung Jun; Park, Jin Seo; Shin, Dong Sun

    2014-03-01

    The aim of this study was to describe the deep circumflex iliac artery (DCIA) flap from sectioned images and stereoscopic anatomic models using Visible Korean, for the benefit of medical education and clinical training in the field of oromandibular reconstructive surgery. Serially sectioned images of the pelvic area were obtained from a cadaver. Outlines of significant structures in the sectioned images were drawn and stacked to build surface models. The PDF (portable document format) file (size, 30 MB) of the constructed models is available for free download on the Web site of the Department of Anatomy at Ajou University School of Medicine (http://anatomy.co.kr). In the PDF file, the relevant structures of the DCIA flap can be seen in the sectioned images. All surface models and stereoscopic structures associated with the DCIA flap are displayed in real time. We hope that these state-of-the-art sectioned images, outlined images, and surface models will help students and trainees better understand the anatomy associated with DCIA flap. PMID:24621709

  16. Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting

    Directory of Open Access Journals (Sweden)

    George S. Georgiadis

    2015-01-01

    Full Text Available Endovascular therapy for iliac artery chronic total occlusions is nowadays associated with low rates of procedure-related complications and improved clinical outcomes, and it is predominantly used as first-line therapy prior to aortobifemoral bypass grafting. Herein, we describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering complex aortoiliac lesions, who received common iliac arteries kissing stents, illustrating at final antegrade and retrograde angiograms the early recognition of a blood flow obstructing valve-like calcified intimal flap protruding through the stent struts, which was obstructing antegrade but not retrograde unilateral iliac arterial axis blood flow. The problem was resolved by reconstructing the aortic bifurcation at a more proximal level. Completion angiogram verified normal patency of aorta and iliac vessels. Additionally, a severe left femoral bifurcation stenosis was also corrected by endarterectomy-arterioplasty with a bovine patch. Postintervention ankle brachial pressure indices were significantly improved. At the 6-month and 2-year follow-up, normal peripheral pulses were still reported without intermittent claudication suggesting the durability of the procedure. Through stent-protruding calcified intimal flap, is a very rare, but existing source of antegrade blood flow obstruction after common iliac arteries kissing stents.

  17. Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting

    Science.gov (United States)

    Georgiadis, George S.; Georgakarakos, Efstratios I.; Schoretsanitis, Nikolaos; Argyriou, Christos C.; Antoniou, George A.; Lazarides, Miltos K.

    2015-01-01

    Endovascular therapy for iliac artery chronic total occlusions is nowadays associated with low rates of procedure-related complications and improved clinical outcomes, and it is predominantly used as first-line therapy prior to aortobifemoral bypass grafting. Herein, we describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering complex aortoiliac lesions, who received common iliac arteries kissing stents, illustrating at final antegrade and retrograde angiograms the early recognition of a blood flow obstructing valve-like calcified intimal flap protruding through the stent struts, which was obstructing antegrade but not retrograde unilateral iliac arterial axis blood flow. The problem was resolved by reconstructing the aortic bifurcation at a more proximal level. Completion angiogram verified normal patency of aorta and iliac vessels. Additionally, a severe left femoral bifurcation stenosis was also corrected by endarterectomy-arterioplasty with a bovine patch. Postintervention ankle brachial pressure indices were significantly improved. At the 6-month and 2-year follow-up, normal peripheral pulses were still reported without intermittent claudication suggesting the durability of the procedure. Through stent-protruding calcified intimal flap, is a very rare, but existing source of antegrade blood flow obstruction after common iliac arteries kissing stents. PMID:26783493

  18. Iatrogenic left common iliac artery and vein perforation during lumbar discectomy: a fatal case.

    Science.gov (United States)

    Busardò, Francesco Paolo; Frati, Paola; Carbone, Iacopo; Pugnetti, Paola; Fineschi, Vittorio

    2015-01-01

    Iatrogenic vascular injury during lumbar disk surgery, although rare, is a serious complication, and when it does occur, can be sudden and life-threatening. The risk of injury to the pelvic vessels intra-operatively can be explained by the close proximity of the retroperitoneal vessels to the vertebral column therefore causing injury to the anterior longitudinal ligament, which can give access to the retroperitoneal space. If signs of circulatory instability are noted during lumbar disk surgery, early diagnosis of vascular injury and urgent transperitoneal surgery or emergency stenting can save the patient's life. Here, is presented the case of a 52-year-old man who underwent an elective lumbar discectomy for a rightward disk herniation in the L4-L5 intervertebral space and died 12h after the operation for a hemorrhagic shock due to a severe intra-abdominal hemorrhage following iatrogenic left common iliac artery and vein perforation during lumbar discectomy. PMID:25467198

  19. 腹部穿支瓦合皮瓣修复手部大面积皮肤套脱伤%Repair of large-size degloving injury of the hand with epigastric perforator tile flap

    Institute of Scientific and Technical Information of China (English)

    谭琪; 刘光军; 杨磊; 王谦; 李振

    2014-01-01

    目的 探讨腹部带蒂穿支瓦合皮瓣修复手部大面积皮肤套脱伤的方法和临床效果.方法 以腹壁下动脉与腹壁上动脉和肋间动脉交通形成的轴型血管为解剖学基础,设计兔耳式腹部带蒂穿支瓦合皮瓣修复手部大面积皮肤套脱伤患者7例,均有手部掌侧和背侧的皮肤缺损.掌侧皮肤缺损大小为9 cm×8 cm~ 18 cm×9 cm,背侧皮肤缺损大小为8 cm×7 cm~ 14 cm×9 cm.皮瓣切取面积垂直向10 cm×6 cm~20 cm×9 cm,斜向9 cm×8 cm~22 cm×11 cm.供区均一期拉拢缝合.结果 7例患者术后随访5个月至2.5年,平均9个月.1例患者因掌侧皮瓣受压坏死.6例皮瓣均存活良好,外形、质地良好.基本恢复持物、抓握等功能,皮瓣感觉为S2~S3.结论 兔耳式腹部穿支瓦合皮瓣能够巧妙地覆盖手部掌侧、背侧大面积皮肤缺损,切取面积大,皮瓣血供来源可靠,能够最大程度地恢复患手功能,是一种实用、安全且简便的手术方式.%Objective To investigate the surgical methods and clinical results of repairing large-size degloving injury of the hand with epigastric perforator tile flap.Methods The rabbit ear-shaped abdominal tile flap was designed based on the axial vessel formed by communications among the inferior epigastric artery,superior epigastric artery and intercostal arteries.Such abdominal tile flaps were transferred to cover skin defects on both the palmar and dorsal aspects of the hand in 7 cases of large-size degloving injury of the hand.The size of the defect ranged from 9 cm × 8 cm to 18 cm × 9 cm on the palmar aspect and 8 cm × 7 cm to 14 cm × 9 cm on the dorsal aspect.The size of the flaps ranged from 10 cm × 6 cm to 20 cm × 9 cm in the vertical direction and from 9 cm × 8 cm to 22 cm × 11 cm in the oblique direction.Direct wound closure of the donor site was possible in all the cases.Results All 7 cases were follow-up for 5 to 30 months (average,9 months).Necrosis of the palmar flap

  20. [The treatment of a post-burn deformity and contracture of the neck, using extended flaps with axial type of blood supply].

    Science.gov (United States)

    Zhernov, A A; Zhernov, An A

    2012-03-01

    Experience of treatment of 24 patients, suffering neck deformity and contracture, using stretched flaps with axial type of blood circulation, was summarized. In total 43 expanders were implanted. The cutaneo-fascial flaps stretching was performed in the neck and thorax. In all the flaps a nutrition artery was included. The neck-brachial flaps, including supraclavicular artery, were applied in 25 (58.1%) patients, the neck-thoracic flaps, using superficial neck artery--in 12 (27.91%), the occipital-neck flaps on a musculocutaneous perforating vessels of occipital artery--in 6 (13.95%). The methods of the expander implantation, the stretching, transposition regimes of plastic material and its fixation were elaborated. The donor sites were closed using stretched tissues, left in place after formation of flaps. Flaps were fixed, using mechanical method of the tissues connection with duplicature formation from deepidermized portion of cicatrix or with polypropylene mesh, which played a role of a dense framework. Then a strong connective tissue bolt was formed, securely fixing transposedstretched tissues. While application of a complex-component vascularized flaps a suppuration have occurred in 3 (6.97%), partial necrosis--in 2 (4.64%) observations. Inclusion of nutritive vessels permit to form large size flaps with a small risk of necrosis occurrence. The stretched perforant flaps application permits to achieve positive result in 95.3% of observations--in immediate and in 81.82%--in far remote period. PMID:22702123

  1. Deep circumflex iliac artery flap combined with a costochondral graft for mandibular reconstruction.

    Science.gov (United States)

    Xingzhou, Qu; Chenping, Zhang; Laiping, Zhong; Min, Ruan; Shanghui, Zhou; Mingyi, Wang

    2011-12-01

    Our aim was to use the deep circumflex iliac artery (DCIA) flap together with a costochondral graft as a safe and reliable bone flap for routine reconstruction of the mandibular body and the temporomandibular joint (TMJ). Five patients with benign tumours of the mandible had segmental mandibulectomy including the condyle, and this was reconstructed in one stage using the DCIA combined with a constochondral graft. The rib was inserted into the iliac crest as a whole transplant, and fixed to the proximal stump of the mandible with a prebent reconstruction plate according to a computer-aided design. The grafts healed uneventfully, and dental implants were inserted in 4 cases. During the 2-year follow-up these patients had good mandibular function, including mouth opening, force of bite, and occlusion. The radiographs showed good bony consolidation between the graft and the stump of the mandible and function of the TMJ. A DCIA flap combined with a costochondral graft is a safe and reliable way to provide not only a large bulk of bone to suit the mandible, but also good function of the TMJ in the absence of radiotherapy. PMID:21144630

  2. A combined superficial inferior epigastric artery flap and vascularized iliac crest flap in the reconstruction of extended composite defects of the posterior mandible and adjacent soft tissue: first clinical results.

    Science.gov (United States)

    Gaggl, A J; Bürger, H; Chiari, F M

    2011-02-01

    The technique of posterior facial reconstruction using a combination of a superficial inferior epigastric artery (SIEA) flap and a microvascular iliac crest flap (deep circumflex iliac artery (DCIA) flap) is described. 12 cases are reported. The patients had unilateral squamous cell carcinoma of the posterior mandible affecting parts of the soft palate and tonsil region or the posterior cheek. In all patients unilateral neck dissection, resection of the posterior and lateral mandible, was performed. Reconstruction was carried out during primary surgical therapy, followed by postoperative radiotherapy. A flap combination of a SIEA and a DCIA flap was used. There were no problems with pedicle length or anastomoses. There was no flap loss or severe postoperative complications. All patients had good aesthetic and functional results. One patient had distant metastases 2 years postoperatively. All other patients were free of tumour relapse or metastases within 12-58 months of follow up. The SIEA flap and vascularized iliac bone flap combination is useful in reconstructing the posterior face. The iliac bone flap is well suited for posterior mandible reconstruction and the SIEA flap for reconstruction of the soft palate, lateral pharyngeal wall and cheek. Both flaps are harvested from the same donor site. PMID:21075599

  3. Salvage of a TRAM breast reconstruction flap using the retrograde internal mammary artery system

    Directory of Open Access Journals (Sweden)

    Sameena Hassan

    2014-01-01

    Full Text Available Background: Free tissue transfer provides an optimal means for breast reconstruction in creating an aesthetically natural appearance that is durable over time. The choice of donor vessels vary from surgeon to surgeon, but the internal mammary axis is one of the most popular choices together with the thoracodorsal vessels. Aims and Results: We present the case of a salvaged free transverse rectus abdominis myocutaneous breast reconstruction in which end-to-end antegrade anastomosis to the internal mammary artery (IMA was not possible due to frail vessel walls, but retrograde anastomosis to the IMA and antegrade anastomosis of internal mammary vessel resulted in a perfused and viable flap. Conclusion: We suggest the use of the retrograde internal mammary arterial system for microsurgical anastomosis when the anterograde flow is not adequate, the vessel wall is friable, and when other more common options are not available.

  4. CASE REPORT Superior Gluteal Artery Perforator Flap Breast Reconstruction Salvage Following Late Venous Congestion After Discharge

    OpenAIRE

    Chan, Rodney K.; Mathy, Jon A.; Przylecki, Wojitec; Guo, Lifei; Caterson, Stephanie A.

    2010-01-01

    Objective: Microvascular thrombosis is a dreaded complication of free tissue transfer, especially in breast reconstruction. Failure often leads to complete loss of the reconstruction and affects the patient both physically and psychologically. Fortunately, most vascular compromises occur early (within 24–36 hours) while the patient is still in the hospital and intervention takes place prior to irreversible thrombosis of the microvasculature. However, failures beyond 96 hours generally have di...

  5. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Medline Plus

    Full Text Available ... surgery each of them chose to undergo. The deep inferior epigastric perforator flap technique allows surgeons to rebuild breasts in the ... areolar-sparing mastectomy and immediate reconstruction using the deep inferior epigastric perforator flap, or the DIEP flap. I'm pleased to ...

  6. Distally based superficial sural artery flap for soft tissue coverage in the distal 2/3 of leg and foot

    Directory of Open Access Journals (Sweden)

    Kamath B

    2005-01-01

    Full Text Available Background: Skin coverage for defects in the lower 2/3 of leg, ankle region and posterior heel has always been a difficult challenge for reconstructive surgeon. Methods: We describe our experience with the distally based superficial sural artery flap coverage in 48 patients with moderate sized defects in these difficult areas. Results: One out of 48 flaps (in 48 patients was lost totally and 3 suffered marginal necrosis which did not require any secondary procedure. These complications could have been avoided by proper selection of cases and refining technical skills. Conclusion: This simple procedure could be an important and versatile tool for any reconstructive surgeon in providing skin coverage in the distal leg and proximal foot. Preservation of major arteries of the lower limb, minimal donor defect, relatively uninjured donor area in compound fracture or poly trauma involving distal leg are some of the advantages of the flap.

  7. Application of perforator flap for repair of finger soft tissue defect%穿支皮瓣移植在手指创面修复中的应用

    Institute of Scientific and Technical Information of China (English)

    周祥吉; 庞晖; 杨富强; 李东柱; 高学建; 范启申

    2009-01-01

    目的 探讨穿支皮瓣游离移植修复手指皮肤软组织缺损的设计和手术技巧.方法 切取小腿前外侧、小腿内侧下部、小腿外侧血管穿支皮瓣以及远段骨间背血管蒂穿支皮瓣,移植修复手指小创面13例.结果 13例皮瓣全部存活,受区与供区的功能、外观均良好.结论 在肢体部位以皮穿支或轴型血管为蒂设计穿支皮瓣,游离移植修复手指创面,患者痛苦小、损伤小,创面能获得满意覆盖.这为手外伤修复提供了一种新的选择,对术者也提出了更高的要求.%Objective To explore the surgical design and surgical techniques of perforator flap transfer for repairing soft tissue defects of the fingers. Methods Perforator flaps from anterolateral, inferomedial and lateral side of the lower leg and distal dorsal interosseous perforator mini flap were used to repair soft tissue defect of the fingers in 13 cases. Results All 13 flaps survived. The function and appearance of both the donor and recipient sites were good. Condusion Designing and harvesting a flap pedieled on a perforator or an axial vessel in the extremity for free transfer to cover soft tissue defects of the fingers offers a new surgical option for treating hand trauma, since it causes less pain and leas damage while providing satisfactory wound coverage. Meanwhile, however, it is technically more challenging to the surgeon.

  8. 颈横动脉颈段皮支皮瓣修复颈部瘢痕挛缩%Repair of cervical scar contracture with flaps containing cervical cutaneous branch of the transverse cervical artery

    Institute of Scientific and Technical Information of China (English)

    马显杰; 李杨; 王璐; 李威扬; 董立维

    2012-01-01

    Objective To observe the therapeutic effect of repairing cervical scar contracture using flaps carrying cervical cutaneous branch of the transverse cervical artery. Methods Sixty-six patients with scar contracture after burn in anterior region of neck hosptalized from 1988 to 2011.The scars were excised and repaired with flaps containing the cervical cutaneous branch of transverse cervical artery.They included 55 island flaps (with 9 flaps pre-expanded) and 11 non-island flaps (with 1 flap pre-expanded).After removing the scar and releasing the contracture,flaps with the cervical cutaneous branch of transverse cervical artery were designed and raised in the supraclavicular and infraclavicular regions and the anterior thoracic region.The axial vessel of the flap was the cutaneous artery,which perforated in the crossing area of sternocleidomastoid muscle and omohvoid muscle and originated from the transverse cervical artery.The posterior borderline of the flap reached the anterior border of the trapezius muscle.Its exterior borderline reached the middle part of deltoid muscle,and its interior borderline ended at the midsternal line.The lower borderline was located 3.0-4.0 cm below the nipple.The incisions at the interior,lower,and exterior borders of the flap were first made.Then after sharp dissection to the clavicle,blunt dissection was performed to the pedicle to allow the flaps to be able to cover the wound after rotation without undue tension.The pre-expanded donor sites were sutured directly,while the un-expanded ones were covered with skin graft. Results Out of the 66 flaps,64 flaps survived.Two flaps showed partial necrosis at the distal end due to sub-flap hematoma,and they healed after skin grafting. All the donor sites healed. The color and texture of all flaps matched well with the surrounding skin tissue.The flaps regained sensation pertaining to the chest in the early stage,and complete sensation pertaining to the neck appeared 6 months after surgery

  9. Technical refinements of composite thoracodorsal system free flaps for 1-stage lower extremity reconstruction resulting in reduced donor-site morbidity.

    Science.gov (United States)

    Bannasch, Holger; Strohm, Peter C; Al Awadi, Khalid; Stark, G Björn; Momeni, Arash

    2008-04-01

    A multitude of local flaps has been suggested for lower extremity reconstruction. However, the gold standard for defect coverage remains free tissue transfer. In this regard, the scapular vascular axis is a well-established source of expendable skin, fascia, muscle, and bone for use in free flap reconstruction of defects requiring bone and soft tissue in complex 3-dimensional relationships. Composite bone and soft-tissue flaps derived from the subscapular vascular axis include the osteocutaneous scapular flap, the "latissimus/bone flap," and the thoracodorsal artery perforator-scapular osteocutaneous flap.Patient outcome following reconstruction of lower extremity defects with composite free flaps from the thoracodorsal system were analyzed. Here, we demonstrate the execution of technical refinements on free composite flap transfers based on the thoracodorsal vascular axis, thus resulting in a stepwise reduction of donor-site morbidity. PMID:18362565

  10. Identification of independent risk factors for flap failure: A retrospective analysis of 1530 free flaps for breast, head and neck and extremity reconstruction.

    Science.gov (United States)

    Las, David E; de Jong, Tim; Zuidam, J Michiel; Verweij, Norbert M; Hovius, Steven E R; Mureau, Marc A M

    2016-07-01

    Reconstructive microsurgery is a powerful method of treating various complex defects. However, flap loss remains a possibility, leading to additional surgery, hospitalisation and costs. Consequently, it is important to know which factors lead to an increased risk of flap failure, so that measures can be undertaken to reduce this risk. Therefore, we analysed our results over a 20-year period to identify risk factors for flap failure after breast, head and neck and extremity reconstruction. The medical files of all patients treated between 1992 and 2012 were reviewed. Patient characteristics, surgical data and post-operative complications were scored, and independent risk factors for flap loss were identified. Reconstruction with a total of 1530 free flaps was performed in 1247 patients. Partial and total flap loss occurred in 5.5% and 4.4% of all free flaps, respectively. In all flaps, signs of compromised flap circulation were a risk factor for flap failure. More specifically, the risk factors for flap failure in breast reconstruction were previous radiotherapy, venous anastomosis revision, gluteal artery perforator (GAP) flap choice and post-operative bleeding. In head and neck reconstruction, pulmonary co-morbidity and anastomosis to the lingual vein or superficial temporal artery were risk factors, whereas a radial forearm flap reduced the risk. In extremity reconstruction, diabetes, prolonged anaesthesia time and post-operative wound infection were risk factors. Independent pre-, intra- and post-operative risk factors for flap failure after microvascular breast, head and neck and extremity reconstruction were identified. These results may be used to improve patient counselling and to adjust treatment algorithms to further reduce the chance of flap failure. PMID:26980600

  11. The Role of the Very Long Posterior Tibial Artery Flap following Severe Lower Limb Trauma: Case Series and Literature Review

    OpenAIRE

    Leela Sayed, MBChB; Noemi Kelemen, MD, MRCS; Stephen Williams, FRCS; Graham J. Offer, FRCS

    2013-01-01

    Summary: With advancing techniques, knowledge, and training, the decision to salvage a lower limb following severe trauma is becoming ever more popular and successful. However, in cases where amputation is inevitable due to extensive injury or infection, we encourage the use of the very long posterior tibial artery (VLPTA) flap when the sole of the foot and posterior tibial neurovasculature are intact. We report 3 patients who underwent below-knee amputation and reconstruction using the VLPTA...

  12. Analysis of deep inferior epigastric perforator (DIEP) arteries by using MDCTA: Comparison between 2 post-processing techniques

    International Nuclear Information System (INIS)

    Purpose: Our purpose was to compare two post-processing techniques, Maximum-Intensity-Projection (MIP) and Volume Rendering (VR) for the study of perforator arteries. Methods: Thirty patients who underwent Multi-Detector-Row CT Angiography (MDCTA) between February 2010 and May 2010 were retrospectively analyzed. For each patient and for each reconstruction method, the image quality was evaluated and the inter- and intra-observer agreement was calculated according to the Cohen statistics. The Hounsfield Unit (HU) value in the common femoral artery was quantified and the correlation (Pearson Statistic) between image quality and HU value was explored. Results: The Pearson r between the right and left common femoral artery was excellent (r = 0.955). The highest image quality score was obtained using MIP for both observers (total value 75, with a mean value 2.67 for observer 1 and total value of 79 and a mean value of 2.82 for observer 2). The highest agreement between the two observers was detected using the MIP protocol with a Cohen kappa value of 0.856. The ROC area under the curve (Az) for the VR is 0.786 (0.086 SD; p value = 0.0009) whereas the ROC area under the curve (Az) for the MIP is 0.0928 (0.051 SD; p value = 0.0001). Conclusion: MIP showed the optimal inter- and intra-observer agreement and the highest quality scores and therefore should be used as post-processing techniques in the analysis of perforating arteries.

  13. Analysis of deep inferior epigastric perforator (DIEP) arteries by using MDCTA: Comparison between 2 post-processing techniques

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca, E-mail: lucasaba@tiscali.it [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Atzeni, Matteo; Ribuffo, Diego [Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Mallarini, Giorgio [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Suri, Jasjit S. [Biomedical Technologies Inc., Denver, CO (United States); Idaho State University (Aff.), ID (United States)

    2012-08-15

    Purpose: Our purpose was to compare two post-processing techniques, Maximum-Intensity-Projection (MIP) and Volume Rendering (VR) for the study of perforator arteries. Methods: Thirty patients who underwent Multi-Detector-Row CT Angiography (MDCTA) between February 2010 and May 2010 were retrospectively analyzed. For each patient and for each reconstruction method, the image quality was evaluated and the inter- and intra-observer agreement was calculated according to the Cohen statistics. The Hounsfield Unit (HU) value in the common femoral artery was quantified and the correlation (Pearson Statistic) between image quality and HU value was explored. Results: The Pearson r between the right and left common femoral artery was excellent (r = 0.955). The highest image quality score was obtained using MIP for both observers (total value 75, with a mean value 2.67 for observer 1 and total value of 79 and a mean value of 2.82 for observer 2). The highest agreement between the two observers was detected using the MIP protocol with a Cohen kappa value of 0.856. The ROC area under the curve (Az) for the VR is 0.786 (0.086 SD; p value = 0.0009) whereas the ROC area under the curve (Az) for the MIP is 0.0928 (0.051 SD; p value = 0.0001). Conclusion: MIP showed the optimal inter- and intra-observer agreement and the highest quality scores and therefore should be used as post-processing techniques in the analysis of perforating arteries.

  14. Lateral Calcaneal Artery Flaps in Atherosclerosis: Cadaveric Study, Vascular Assessment and Clinical Applications

    Science.gov (United States)

    Tanthanatip, Pattaya; Kuhaphensaeng, Paiboon; Ruamthanthong, Anuchit; Pitiseree, Anont; Suwantemee, Chaichoompol

    2015-01-01

    Background: Soft tissue defects of the lateral malleolus (LM) and Achilles tendon pose difficult reconstructive problems due to the bony prominence and limited local tissue available. The objectives were to study the anatomical landmarks of the lateral calcaneal artery (LCA) and patency of LCA in atherosclerotic patients. Methods: Part I: Thirty-four cadaveric feet were dissected to identify the LCA. The distance between the LCA and the most prominent point of the LM was measured horizontally (LCAa-LM), obliquely (LCAb-LM), and vertically (LCAc-LM). Part II: Thirty-two patients were divided in 2 groups as nonatherosclerotic and atherosclerotic groups. The LCA was assessed by both Doppler ultrasonography and computed tomographic angiography (CTA). Part III: Clinical applications were demonstrated. Results: Part I: Mean distances of LCAa-LM, LCAb-LM, and LCAc-LM were 24.76, 33.68, and 35.03 mm, respectively. The LCA originated 94.12% from the peroneal artery. Part II: Doppler ultrasonography detected the LCA at 90.62% and 87.50% in nonatherosclerotic and atherosclerotic groups, respectively, whereas 100.00% and 93.75%, respectively, were detected by CTA. No statistically significant difference was found in the patency of the LCA between nonatherosclerotic and atherosclerotic patients. Part III: Clinical applications were performed in atherosclerotic patients. Conclusions: The LM is a reliable point to identify the LCA, and the LCA flap can be raised safely in atherosclerotic patients. Preoperative CTA should be performed in severely atherosclerotic patients or cases of major lower extremity vascular injuries. PMID:26495230

  15. Patient-Reported Assessment of Functional Gait Outcomes following Superior Gluteal Artery Perforator Reconstruction

    Directory of Open Access Journals (Sweden)

    Kevin Hur, BA

    2013-08-01

    Conclusions: SGAP flap surgery causes no statistically significant differences in overall LEFS. However, SGAP patients did report donor-site morbidity with decreased ability to perform certain activities and increased fatigue and pain in the longer follow-up period. We feel that patients should be educated regarding gait issues and undergo physical therapy during the early postoperative period.

  16. Free deep circumflex iliac artery vascularised bone flap for reconstruction of the distal radius: planning with CT angiography.

    Science.gov (United States)

    Ting, Jeannette W C; Rozen, Warren M; Leong, James; Crock, John

    2010-01-01

    Distal radius fractures in the younger population are often comminuted and intra-articular, which can increase the complexity of their management. In addition, these patients tend to place high demands on their wrists, and the prevention of functional arthritis necessitates excellent anatomical reduction. Complicated cases such as these are often limited in their management options. We present a complex case of distal radius fracture and bone loss in which initial therapy with nonvascularized bone graft failed, and osteomyelitis was a further complicating factor. With the aid of preoperative planning with computed tomographic angiography (CTA), a deep circumflex iliac artery (DCIA) bone flap was able to be assessed as a reconstructive option. The use of preoperative CTA, the first description of such imaging in this role, was able to delineate the bone to be harvested, confirm its vascular supply, and plan flap harvest. The use of a vascularized bone flap in this setting was thus undertaken and was able to provide an autologous anatomical support for the wrist while reducing the risk of recurrent infection and still preserving internal fixation. This unique application of the free DCIA bone flap was potentiated by CTA, achieving complete healing and good functional outcomes. PMID:20017201

  17. The pedicled thoraco-umbilical flap: A versatile technique for upper limb coverage

    Directory of Open Access Journals (Sweden)

    Mishra Sharad

    2009-01-01

    Full Text Available Injuries to upper limb has been on the increase and is invariably associated with significant soft tissue loss requiring a flap cover. Local tissue may not be available for cover in a majority of situations, necessitating import of tissue from a distant source. We have utilized the thoraco-umbilical flap taken from the trunk for this purpose. This flap is based on the perforators of the deep inferior epigastric artery that are maximally centred on the periumbilical region.This flap was used in 83 patients. The patients were observed for at least 3 weeks and any flap or donor site complications were recorded. The patients were again followed up at 3 months interval and the donor site scar was assessed. The flaps survived in 81 patients; there was marginal flap necrosis in five patients and partial flap necrosis in two patients. None of these patients required any additional procedure for coverage. The flap is technically easy to plan, almost effortless to drape around upper limb defects, with no significant donor site morbidity and also the post operative immobilization was fairly comfortable. The thoraco-umbilical flap thus is a very useful technique for coverage of the upper limb and is recommended as a first line flap for this purpose.

  18. Predominant location of coronary artery atherosclerosis in the left anterior descending artery. The impact of septal perforators and the myocardial bridging effect

    Science.gov (United States)

    Wasilewski, Jarosław; Niedziela, Jacek; Osadnik, Tadeusz; Duszańska, Agata; Sraga, Wojciech; Desperak, Piotr; Jackowska, Zuzanna; Nowakowski, Andrzej; Głowacki, Jan

    2015-01-01

    Introduction Coronary artery atherosclerosis presents characteristic patterns of plaque distribution despite systemic exposure to risk factors. We hypothesized that local hemodynamic forces induced by the systolic compression of intramuscular septal perforators could be involved in atherosclerotic processes in the left anterior descending artery (LAD) adjacent to the septal perforators’ origin. Therefore we studied the spatial distribution of atherosclerosis in coronary arteries, especially in relation to the septal perforators’ origin. Material and methods 64-slice computed tomography angiography was performed in 309 consecutive patients (92 male and 217 female) with a mean age of 59.9 years. Spatial plaque distribution in the LAD was analyzed in relation to the septal perforators’ origin. Additionally, plaque distribution throughout the coronary artery tree is discussed. Results The coronary calcium score (CCS) was positive in 164 patients (53.1%). In subjects with a CCS > 0, calcifications were more frequent in the LAD (n = 150, 91.5%) compared with the right coronary artery (RCA) (n = 94, 57.3%), circumflex branch (CX) (n = 76, 46.3%) or the left main stem (n = 42, 25.6%) (p < 0.001). Total CCS was higher in the LAD at 46.1 (IQR: 104.2) and RCA at 34.1 (IQR: 90.7) than in the CX at 16.8 (IQR: 61.3) (p = 0.007). In patients with calcifications restricted to a single vessel (n = 54), the most frequently affected artery was the LAD (n = 42, 77.8%). In patients with lesions limited to the LAD, the plaque was located mostly (n = 37, 88.1%) adjacent to the septal perforators’ origin. Conclusions We demonstrated that coronary calcifications are most frequently located in the LAD in proximity to the septal branch origin. A possible explanation for this phenomenon could be the dynamic compression of the tunneled septal branches, which may result in disturbed blood flow in the adjacent LAD segment (milking effect). PMID:26855661

  19. Posterior Thigh Flap Pedicled on the Cutaneous Vessels Arising From the Popliteo-posterior Intermediate Artery: A Report of 5 Cases.

    Science.gov (United States)

    Sun, Xi-Guang; Gong, Xu; Song, Liang-Song; Cui, Jian-Li; Yu, Xin; Liu, Bin; Lu, Lai-Jin

    2016-08-01

    Surgical repair of soft tissue defects of the knee and leg remains challenging. Using a case study approach, the anatomy of the popliteo-posterior intermediate cutaneous artery was examined, and a reverse island flap method was developed and implemented. After obtaining informed consent, 5 patients (1 woman, 4 men, age range 31 to 57 years) underwent the experimental use of a reverse island flap with a posterior thigh flap pedicled on the cutaneous vessels arising from the popliteo-posterior intermediate artery to repair soft-tissue defects of the knee and leg. The defects were caused by burned skin below the knee (n = 1), progressive skin necrosis in the knee after fracture surgery (n = 2), and skin infections associated with diabetes mellitus (n = 2). Skin defect sizes ranged from 15 cm x 5 cm to 30 cm x 12 cm. These large defects did not heal spontaneously; wound duration ranged from 1 week to 1 year, and all patients had refused defect repair with free flaps. Patients received posterior thigh flaps pedicled on the popliteo-posterior intermediate artery with areas ranging from 17 cm x 6 cm to 25 cm x 12 cm. All patients were treated with antibiotics and local dressings (iodoform and alcohol) changed daily post surgery, and blood supply was monitored by assessing the texture and color of the flap and venous regurgitation (ie, vein drainage disturbance). Four (4) of the five flaps survived completely. In 1 patient, partial survival of the flap, which had a good blood supply despite a venous circulation disorder, occurred: in this case, complete survival was achieved after treatment with a retrograde fascial flap and skin grafting. The appearance and texture of all flaps were satisfactory (ie, patients underwent only 1 operation, healing time was approximately 2 weeks, flap quality was close to normal skin, the donor site closed directly, and the shape and function of the knee and leg recovered well). No donor site abnormality was observed, and no postsurgical

  20. Reverse Sural Artery Island Flap With Skin Extension Along the Pedicle.

    Science.gov (United States)

    Lee, Hyun Il; Ha, Sung Han; Yu, Sun O; Park, Min Jong; Chae, Sang Hoon; Lee, Gi Jun

    2016-01-01

    The distally based sural flap is an efficient flap for reconstruction of soft tissues defects of lower limb. The unstable vascular pedicle, however, is prone to compression by the subcutaneous tunnel, especially when a long pedicle covers the distal area of the foot. The aim of the present study was to introduce a modified surgical technique that leaves the skin extension over the pedicle and to report the clinical results of this modification. A total of 25 consecutive patients with a mean age of 51.7 ± 14.7 years underwent surgery. We modified the conventional sural flap technique by leaving a skin extension over the entire length of the pedicle, creating a fasciocutaneous vascular pedicle. The postoperative flap survival rates, complications, and the characteristics of the flaps such as flap size, pedicle length, and the most distal area that could be covered with this modification, were reviewed. At the last clinical follow-up examination, all the flaps survived, although partial necrosis was observed in 2 (8%) cases. Four cases of venous congestion developed but healed without additional complications. The mean flap size was 5.9 ± 1.8 × 9.2 ± 2.7 cm. With this modification, the sural flap could cover the defect located in extreme distal areas, such as the medial forefoot and dorsum of the first metatarsophalangeal joint, with a longer pedicle (≤27 cm) in 7 patients (28%). A skin extension along the pedicle achieved the favorable survival rate of the sural flap and successfully extended the surgical indications to more distal areas. PMID:26810124

  1. Versatility of the Distally-Based Sural Artery Fasciocutaneous Flap on the Lower Leg and Foot in Patients with Chronic Disease

    Directory of Open Access Journals (Sweden)

    Jin-Su Park

    2013-05-01

    Full Text Available Background  A recent advancement in microsurgery, the free flap is widely used in the re­construction ofthe lowerleg and foot. The simple and effective methods oflocal flaps, inclu­ding transposition and advancement flaps, have been considered for patients with chronicdebilitationwho are unable to endure long surgical procedures or general anesthesia.However,the location and size of the wound may restrict the clinical application of a local flap. Underthese circumstances, a sural flap can be an excellent alternative, rendering satisfying clinicaloutcomesin chronically debilitated patients.Methods  Between 2008 and 2012, 39 patients underwent soft tissue defect treatment bysural artery flap as a final method. All ofthe patients had atleast one chronic disease or more(diabetes, hypertension, vascular disease, etc.. Also, all ofthe patients had a history of chroniclower extremity ulceration, which revealed no response to several months of conservativetreatment.Results  The results of the 39 cases had a successrate of 100% with 39 complete recoveries.Nine casessuffered complications: partial necrosis(n= 4,wound dehiscencewithout necrosis(n= 3, hematoma (n= 1, and infection (n= 1.Conclusions  The sural artery flap is not only usefulforthe lowerleg but also forthe heel, andother various parts. Furthermore, itis a relatively simple surgicaltechnique forreconstructingthe defect area for patients with various chronic conditions with a high surgical risk or con­traindicationsto surgery

  2. DIEP Flap Breast Reconstruction Using 3-dimensional Surface Imaging and a Printed Mold

    Directory of Open Access Journals (Sweden)

    Koichi Tomita, MD, PhD

    2015-03-01

    Full Text Available Summary: Recent advances in 3-dimensional (3D surface imaging technologies allow for digital quantification of complex breast tissue. We performed 11 unilateral breast reconstructions with deep inferior epigastric artery perforator (DIEP flaps (5 immediate, 6 delayed using 3D surface imaging for easier surgery planning and 3D-printed molds for shaping the breast neoparenchyma. A single- or double-pedicle flap was preoperatively planned according to the estimated tissue volume required and estimated total flap volume. The DIEP flap was then intraoperatively shaped with a 3D-printed mold that was based on a horizontally inverted shape of the contralateral breast. Cosmetic outcomes were assessed as satisfactory, as confirmed by the postoperative 3D measurements of bilateral breasts. We believe that DIEP flap reconstruction assisted with 3D surface imaging and a 3D-printed mold is a simple and quick method for rebuilding a symmetric breast.

  3. DIEP Flap Breast Reconstruction Using 3-dimensional Surface Imaging and a Printed Mold.

    Science.gov (United States)

    Tomita, Koichi; Yano, Kenji; Hata, Yuki; Nishibayashi, Akimitsu; Hosokawa, Ko

    2015-03-01

    Recent advances in 3-dimensional (3D) surface imaging technologies allow for digital quantification of complex breast tissue. We performed 11 unilateral breast reconstructions with deep inferior epigastric artery perforator (DIEP) flaps (5 immediate, 6 delayed) using 3D surface imaging for easier surgery planning and 3D-printed molds for shaping the breast neoparenchyma. A single- or double-pedicle flap was preoperatively planned according to the estimated tissue volume required and estimated total flap volume. The DIEP flap was then intraoperatively shaped with a 3D-printed mold that was based on a horizontally inverted shape of the contralateral breast. Cosmetic outcomes were assessed as satisfactory, as confirmed by the postoperative 3D measurements of bilateral breasts. We believe that DIEP flap reconstruction assisted with 3D surface imaging and a 3D-printed mold is a simple and quick method for rebuilding a symmetric breast. PMID:25878927

  4. CT angiographic evaluation of perforators in the lower limb and their reconstructive implication

    Directory of Open Access Journals (Sweden)

    Visweswar Bhattacharya

    2012-01-01

    Full Text Available Background: The perforator flaps evolved on the knowledge of the vascular tree from the main vascular trunk up to the subdermal plexus. Therefore, we thought that it′s necessary to map the whole vascular arcade by CT angiography. The aim of this study is to evaluate the perforators and the whole vascular tree of the lower limb by peripheral CT angiography with 3D reconstruction and intraoperative evaluation. This study helps in designing flaps of different constituents based on the selected perforators. Materials and Methods: Twenty patients having lower limb defects were selected. CT angiography was done using a non-ionic iodinated contrast media injected through the antecubital vein. The lower limbs were imaged using volume rendering CT scan machine. Three dimensional reconstructions were made. The whole arterial tree, along with the perforators, were mapped. Findings of the audio-Doppler were correlated with the CT angiographic observations. Further these evaluations were confirmed by intraoperative findings. Results: The three dimensional CT angiographic reconstruction with bone and soft tissue provided advanced knowledge of this vascular network. It delineated the main vessel, the perforators, their caliber, distance from fixed bony landmarks and course up to the subdermal plexus. These findings were confirmed during dissection of the proposed flap. The perforators were mainly musculocutaneous in the proximal leg and septocutaneous distally. Conclusions: The vascular details visualized by this technique made advancement over the existing methods namely color Doppler, audio Doppler, two dimensional angiography etc. It improved the understanding of perforator flaps and their successful clinical application.

  5. Superficial peroneal neurocutaneous vascular axial adipofascial-cutaneous flap pedicled with lateral supramalleolar perforator for coverage of donor site defects at foot dorsum%外踝上穿支蒂腓浅神经营养血管皮肤筋膜瓣修复足背皮瓣供区

    Institute of Scientific and Technical Information of China (English)

    陈雪松; 徐永清; 陈建明; 王元山; 管力; 余晓军; 许建明; 李彦林

    2013-01-01

    目的 探讨螺旋桨状腓浅神经营养血管皮肤筋膜瓣修复足背皮瓣供区的方法及效果.方法 对足背皮瓣切取后供区创面,设计以外踝上穿支为蒂,通过皮下筋膜层扩大切取的腓浅神经营养血管皮肤筋膜瓣(皮肤宽度4~6 cm)旋转180.修复;供区直接拉拢缝合,受区皮下筋膜层表面一期或二期移植皮片修复.结果 2007年5月至2011年10月临床应用7例,皮肤筋膜瓣最大切取面积30 cm×11 cm,最小19 cm×8 cm,皮瓣均全部成活.术后随访9~ 23个月,足踝外形及功能恢复满意,可正常穿鞋行走;修复手背皮肤肌腱联合缺损的足背趾长伸肌腱皮瓣全部成活,至少部分恢复主动伸指功能(2例进行了二期肌腱松解术).结论 该皮瓣血供确切,旋转修复距离足够,小腿供区仅留线状缝合瘢痕,适用于不同面积足背皮瓣切取后供区创面的修复.%Objective To report the operative techniques and clinical results of modified superficial peroneal neurocutaneous propeller adipofascial-cutaneous flap for reconstruction of donor site defects at foot dorsum.Methods A propeller adipofascial flap with a skin pedicle(4-6 cm in width) based on the lateral superamalleolar perforating artery which vascularized the flap through the nutrient vessel chain of the superficial peroneal nerve was designed to repair defects after harvesting of foot pedicled dorsal flap.The defects at donor site of the leg was closed directly and split-thickness skin grafting was performed on the adipofascial surface of the flap primarily or secondarily.Results From May 2007 to Oct.2011,7 cases were treated.All flaps were transplanted successfully with satisfactory cosmetic and functional results.The flaps size ranged from 19 cm × 8 cm to 30 cm × 11 cm.Conclusions The flap has reliable blood supply with a relatively large vascularized area,long rotation arc and minimum donor-site cosmetic morbidity.It' s a simple and safe procedure which is suitable

  6. Experience with peroneus brevis muscle flaps for reconstruction of distal leg and ankle defects

    Directory of Open Access Journals (Sweden)

    Babu Bajantri

    2013-01-01

    Full Text Available Objective: Peroneus brevis is a muscle in the leg which is expendable without much functional deficit. The objective of this study was to find out its usefulness in coverage of the defects of the lower leg and ankle. Patients and Methods: A retrospective analysis of the use of 39 pedicled peroneus brevis muscle flaps used for coverage of defects of the lower leg and ankle between November 2010 and December 2012 was carried out. The flaps were proximally based for defects of the lower third of the leg in 12 patients and distally based for reconstruction of defects of the ankle in 26 patients, with one patient having flaps on both ankles. Results: Partial flap loss in critical areas was found in four patients requiring further flap cover and in non-critical areas in two patients, which were managed with a skin graft. Three of the four critical losses occurred when we used it for covering defects over the medial malleolus. There was no complete flap loss in any of the patients. Conclusion: This flap has a unique vascular pattern and fails to fit into the classification of the vasculature of muscles by Mathes and Nahai. The unusual feature is an axial vessel system running down the deep aspect of the muscle and linking the perforators from the peroneal artery and anterior tibial artery, which allows it to be raised proximally or distally on a single perforator. The flap is simple to raise and safe for the reconstruction of small-to moderate-sized skin defects of the distal third of the tibia and all parts of the ankle except the medial malleolus, which is too far from the pedicle of the distally based flap. The donor site can be closed primarily to provide a linear scar. The muscle flap thins with time to provide a good result aesthetically at the primary defect.

  7. Propeller Flap Reconstruction in Post Oncological Thigh Defect: "The Move in Flap".

    Science.gov (United States)

    Nambi, G I; Salunke, Abhijeet Ashok

    2015-06-01

    Reconstruction of soft tissue defects of the limb after tumor resection is challenging question for oncosurgeons. The management differs from reconstruction of post traumatic defects due to the complexity of the primary surgery and subsequent radiation. The conventional propeller flap is based on a perforator which is located close to the defect; but in present case the perforator was located far away from the defect. So we describe it as "Move in flap" as the flap rotated a large volume of soft tissue lying between the defect and the perforator. We present a case of post oncological thigh defect with reconstruction using a propeller flap based on distal anteromedial perforator. PMID:26405422

  8. A conservative surgical approach for management of iatrogenic pulmonary artery perforation

    Directory of Open Access Journals (Sweden)

    Monodeep Biswas

    2012-01-01

    Full Text Available Accidental malposition of a chest tube in the pulmonary artery is a potentially fatal complication. Here we describe a 66 year-old obese woman with prior cardiac transplantation, intubated for respiratory failure and felt to have a large left pleural effusion. A chest tube was inserted using a trocar tube, and resulted in near-exsanguinating hemorrhage immediately, with development of hypovolemic shock. Prompt clamping of the tube proved life-saving, and CT scan confirmed placement of the tube in the main pulmonary artery. Initial stabilization, followed by a planned surgical approach, resulted in successful removal of the tube.

  9. Running barbed suture quilting reduces abdominal drainage in perforator-based breast reconstruction.

    Science.gov (United States)

    Liang, D G; Dusseldorp, J R; van Schalkwyk, C; Hariswamy, S; Wood, S; Rose, V; Moradi, P

    2016-01-01

    Prolonged abdominal drainage after perforator-based breast reconstruction is a common problem that can result in seroma formation, patient morbidity, and increased duration of hospital stay. Abdominal quilting with progressive tension sutures has been effective in reducing abdominal drainage in abdominoplasty patients prompting a change of practice in our unit. We studied consecutive unilateral mastectomy patients undergoing breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap. The initial 27 patients underwent breast reconstruction without any form of abdominal flap plication. The subsequent 26 patients underwent an identical DIEP flap raise procedure after which the abdominal flap was progressively tensioned using a running barbed suture quilting technique. All patients had closed suction drains inserted bilaterally until daily drain output was <40 ml in 2 consecutive days. Primary outcome measures were total volume of abdominal drainage and length of hospital stay. Independent statistical analyses were performed using Welch's t-test. There were no demographic differences between the two groups. A statistically significant decrease in the mean total abdominal drainage was found after quilting (238 ml vs. 528 ml; p = 0.0005). Patients in the quilting group also showed a reduction in mean duration of hospital stay. Quilting of the abdominal flap helps to reduce abdominal drainage not only in abdominoplasty patients but also in patients undergoing breast reconstruction with DIEP flap. PMID:26601878

  10. Peroneal island flap for wound coverage in complex injuries of the lower extremity

    OpenAIRE

    Fazal A; Rashid H; Cheema T

    2012-01-01

    Akil Fazal1, Haroon-ur-Rashid1, Tahseen Cheema21Section of Orthopedics, Department of Surgery, Aga Khan University, Karachi, Pakistan; 2Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USABackground: Complex injuries of the lower extremity pose a therapeutic challenge owing to limited availability of local soft tissue for coverage. One option in this region is the pedicled fasciocutaneous flap based on perforators of the peroneal artery. In this case se...

  11. Direct delayed breast reconstruction with TAP flap, implant and acellular dermal matrix (TAPIA)

    DEFF Research Database (Denmark)

    Børsen-Koch, Mikkel; Gunnarsson, Gudjon L; Udesen, Ann;

    2015-01-01

    combining the use of a propeller thoracodorsal artery perforator (TAP) flap with an acellular dermal matrix (ADM) and an implant. METHODS: The paper presents 43 delayed breast reconstructions in 38 women using a modified technique for harvesting the TAP flap in combination with an ADM and an implant for......BACKGROUND: The latissimus dorsi (LD) flap is considered one of the working horses within the field of breast reconstruction and it offers several advantages. However, donor-site morbidity may pose a problem. This article describes a new and modified technique for delayed breast reconstruction...... total breast reconstruction. The focus of this paper is the refinements of our technique and short-term outcome in complication rates. The data presented were collected retrospectively. RESULTS: Three patients experienced major complications including hematoma, partial flap necrosis, and venous...

  12. Decision making in double-pedicled DIEP and SIEA abdominal free flap breast reconstructions: An algorithmic approach and comprehensive classification.

    Directory of Open Access Journals (Sweden)

    Charles M Malata

    2015-10-01

    Full Text Available Introduction: The deep inferior epigastric artery perforator (DIEP free flap is the gold standard for autologous breast reconstruction. However, using a single vascular pedicle may not yield sufficient tissue in patients with midline scars or insufficient lower abdominal pannus. Double-pedicled free flaps overcome this problem using different vascular arrangements to harvest the entire lower abdominal flap. The literature is, however, sparse regarding technique selection. We therefore reviewed our experience in order to formulate an algorithm and comprehensive classification for this purpose. Methods: All patients undergoing unilateral double-pedicled abdominal perforator free flap breast reconstruction (AFFBR by a single surgeon (CMM over 40 months were reviewed from a prospectively collected database. Results: Of the 112 consecutive breast free flaps performed, 25 (22% utilised two vascular pedicles. The mean patient age was 45 years (range=27-54. All flaps but one (which used the thoracodorsal system were anastomosed to the internal mammary vessels using the rib-preservation technique. The surgical duration was 656 minutes (range=468-690 mins. The median flap weight was 618g (range=432-1275g and the mastectomy weight was 445g (range=220-896g. All flaps were successful and only three patients requested minor liposuction to reduce and reshape their reconstructed breasts.Conclusion: Bipedicled free abdominal perforator flaps, employed in a fifth of all our AFFBRs, are a reliable and safe option for unilateral breast reconstruction. They, however, necessitate clear indications to justify the additional technical complexity and surgical duration. Our algorithm and comprehensive classification facilitate technique selection for the anastomotic permutations and successful execution of these operations.

  13. Experience in Reconstruction for Small Digital Defects With Free Flaps.

    Science.gov (United States)

    Hung, Min-Hsiang; Huang, Kuo-Feng; Chiu, Haw-Yen; Chao, Wai-Nang

    2016-03-01

    Traumatic injuries to the digits resulting in soft tissue or bone loss require reconstruction. Traditionally, local flaps, such as homodigital flaps, heterodigital flaps, pedicled flaps, or distant flaps, are used for digital resurfacing. However, free tissue transfers can be used in selected patients. In this study, we present the use of different free flaps including groin skin flaps, groin osteocutaneous flaps, groin chimeric flaps, second dorsal metacarpal artery flaps, and partial toe flaps for digital reconstruction. A total of 19 digits were treated with 16 free flaps in our hospital. Of the flaps used, 5 were free groin skin flaps, 4 were free partial toe flaps, 3 were free groin chimeric flaps, 2 were free groin osteocutaneous flaps, and 2 were free second dorsal metacarpal artery flaps. The average flap size was 4.7 × 2.0 cm (range, 1.5 × 1 to 5 × 4 cm), and the average operative time was 6.0 hours (range, 4-9 hours). All flaps survived without partial or total necrosis. In conclusion, the free flap is a reliable and safe alternative for digital reconstruction. Moreover, the free groin flap provides not only a chimeric pattern for multiple fingers coverage but also an osteocutaneous pattern for thumb lengthening. The free second dorsal metacarpal artery flap provides a tenocutaneous pattern for tendon reconstruction and soft tissue coverage simultaneously, and the free partial toe flap is an excellent alternative for pulp reconstruction in terms of aesthetic appearance and functional outcome. PMID:26808771

  14. The possibility for use of venous flaps in plastic surgery

    International Nuclear Information System (INIS)

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required

  15. The possibility for use of venous flaps in plastic surgery

    Science.gov (United States)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  16. The possibility for use of venous flaps in plastic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Baytinger, V. F., E-mail: baitinger@mail.tomsknet.ru; Kurochkina, O. S., E-mail: kurochkinaos@yandex.ru; Selianinov, K. V.; Baytinger, A. V. [Research Institute of Microsurgery, Tomsk (Russian Federation); Dzyuman, A. N. [Siberian State Medical University, Tomsk (Russian Federation)

    2015-11-17

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  17. Flap raising on pulsatile perfused cadaveric tissue: a novel method for surgical teaching and exercise.

    Science.gov (United States)

    Wolff, Klaus-Dietrich; Fichter, Andreas; Braun, Christian; Bauer, Florian; Humbs, Martin

    2014-10-01

    Exercising flap raising procedures on cadavers is considered a prerequisite to prepare for clinical practise. To improve teaching and create conditions as realistic as possible, a perfusion device was developed providing pulsatile flow through the vessels of different donor sites. A plastic bag filled with red stained tab water was placed into a pump, which was driven by an electric motor. The bag was set under rhythmic compression with variable frequency and pressure. The pedicles of the radial forearm, anterolateral thigh, rectus abdominis, fibular and iliac crest flap were cannulated at the origin from their source arteries. Flap raising was performed under pulsatile perfusion in 15 fresh bodies and subsequently in 6 Thiel-embalmed cadavers during a flap raising course. We regularly observed staining of the skin and skin bleeding in fresh bodies and less reliable in embalmed cadavers. All flap pedicles showed pulsatile movements, and the radial pulse became palpable. Most perforators of the anterolateral thigh and osteocutaneous fibular flap could be identified by their pulse. Bleeding from bony tissue and venous return was seldom observed. We conclude that pulsatile perfusion of cadaveric tissue creates more realistic conditions for flap raising and improves teaching for beginners and advanced surgeons. PMID:24938642

  18. The Role of Septal Perforators and “Myocardial Bridging Effect” in Atherosclerotic Plaque Distribution in the Coronary Artery Disease

    OpenAIRE

    Wasilewski, Jarosław; Roleder, Marcin; Niedziela, Jacek; Nowakowski, Andrzej; Osadnik, Tadeusz; Głowacki, Jan; Mirota, Kryspin; Poloński, Lech

    2015-01-01

    Summary The distribution of atherosclerotic plaque burden in the human coronary arteries is not uniform. Plaques are located mostly in the left anterior descending artery (LAD), then in the right coronary artery (RCA), circumflex branch (LCx) and the left main coronary artery (LM) in a decreasing order of frequency. In the LAD and LCx, plaques tend to cluster within the proximal segment, while in the RCA their distribution is more uniform. Several factors have been involved in this phenomenon...

  19. Peroneal island flap for wound coverage in complex injuries of the lower extremity

    Directory of Open Access Journals (Sweden)

    Fazal A

    2012-01-01

    Full Text Available Akil Fazal1, Haroon-ur-Rashid1, Tahseen Cheema21Section of Orthopedics, Department of Surgery, Aga Khan University, Karachi, Pakistan; 2Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USABackground: Complex injuries of the lower extremity pose a therapeutic challenge owing to limited availability of local soft tissue for coverage. One option in this region is the pedicled fasciocutaneous flap based on perforators of the peroneal artery. In this case series, we present our experience of the peroneal island pedicled flap for reconstruction of lower extremity wounds.Methods: Records of 18 cases of peroneal island flap admitted consecutively to the Section of Orthopedics at Aga Khan University Hospital from January 1996 to December of 2009 were studied and their outcomes determined.Results: The most common indication for coverage was open wounds due to a road traffic accident (n = 10, followed by burns (n = 3. The most common area exposed was the lower third of the leg followed by the middle third. The tibia was exposed in 11 patients. The flaps ranged in size from 35 cm2 to over 200 cm2. In 13 patients, the flaps healed uneventfully, while in the remaining five there was partial flap necrosis. In four of the latter patients, the residual wound healed with conservative measures only, but the fifth patient required further surgery to achieve acceptable coverage.Conclusion: The peroneal artery flap appears to be a simple, useful, and reliable flap in the armamentarium of the surgeon when planning soft tissue coverage of the lower extremity.Keywords: leg injuries, surgical flaps, lower extremity

  20. The clinical application of anterolateral thigh flap.

    Science.gov (United States)

    Lee, Yao-Chou; Chiu, Haw-Yen; Shieh, Shyh-Jou

    2011-01-01

    The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by two-team work. Most importantly, the donor-site morbidity is minimal. However, the anatomic variations decreased its popularity. By adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator dissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe. PMID:22567234

  1. The retrograde limb of internal mammary vessels as reliable recipient vessels in DIEP flap breast reconstruction: a clinical and radiological study.

    Science.gov (United States)

    Salgarello, Marzia; Visconti, Giuseppe; Barone-Adesi, Liliana; Cina, Alessandro

    2015-04-01

    For many microsurgeons, antegrade internal mammary vessels (AIMVs) represent the recipients of choice in autogenous breast reconstruction. For the past few years, the retrograde internal mammary vessels (RIMVs) have been demonstrated to be a further reliable option when needed, according to many papers focusing more on the vein than on the artery. Besides the clinical evidence, the hemodynamic features of the retrograde system have been very seldom analyzed.In this article, we report our clinical experience with deep inferior epigastric perforator (DIEP) flaps anastomosed to RIMVs, along with a perioperative radiological follow-up to study RIMVs' hemodynamics and to further support the reliability of the retrograde system with particular focus on the retrograde internal mammary artery.Prospective, preoperative, and postoperative (3 days, 21 days, and 3 months, respectively) color Doppler sonographies of the internal mammary artery (IMA) and DIEPs have been performed to collect the velocity of flow (v) and resistive index (RI) data. Twenty-two patients agreed to undergo this protocol, of which 10 unipedicle flaps were anastomosed to AIMVs ("control" group), 10 bipedicle DIEPs to both AIMVs and RIMVs ("study" group), and 2 DIEPs anastomosed to retrograde internal mammary artery and antegrade internal mammary vein (not statistically analyzed for their paucity). Student t test was performed to compare the "control" and "study" groups.All the flaps survived, and no re-exploration was needed. Internal mammary artery and perforators v showed similar but speculate trend, whereas IMA and perforators RI looked stable during that time. Significant differences have been found in the "study" group for IMA v at 3-day period, for perforator v at 21- and 90-day periods, and for perforator RI at 90-day period, without any clinical implication for flap viability.Retrograde internal mammary vessels can be considered reliable vessels for both arterial flap input and venous flap

  2. Fasciocutaneous flaps of the lower leg: Anatomic study and clinical significance

    Directory of Open Access Journals (Sweden)

    Stevanović Goran

    2010-01-01

    Full Text Available Background/Aim. Soft tissue defects of the lower leg, especially in its distal third, still remain a challenging problem in reconstructive surgery. The aim of this study was to examine septocutaneous system of lower leg vascularization, quantitatively and qualitatively, which is the basis of fasciocutaneous and neurocutaneous flaps. Methods. Septocutaneous systems a. tibialis posterior and a. peroneae were examined by anatomical suprafascial lower leg microdissection of 40 fresh cadavers. Septocutaneous perforators located intermusculary, in deep crural fascia duplicature, were followed from its origin (at main arterial trunks of the lower leg till the point they reach the deep crural fascia. The number and localization of emergence of the septocutaneous perforators were examined for both above mentioned arterial trunks, and the obtained data were documented by photographs, tables and graphics. Statistical analysis (especially cluster analysis, was used for establishing reliable septocutaneous perforators levels. Results. Septocutaneous perforator systems of the lower leg have constant and reliable pattern of existance. Lower leg length was 36 cm in average, (between 33 and 43 cm. Lower leg was divided in 10 equal segments, 3.6 cm each. A. tibialis posterior and a. peronea had 5 septocutaneous perforators. Cluster analysis of a. tibialis posterior perforators (with diameter ≥ 0.5 mm, discovered 5 reliable levels of septocutaneous perforators. These levels are at 3.6-10.8 cm; 14.4-21.6 cm and 25.2-28.8 cm. For a. peronea reliable perforators were found at 3.6-10.8 cm, 14.4-18 cm and 21.6-25.2 cm. Posterior tibial artery perforators had the greatest diameter (from 0.5-1.8 mm; mean value 1.14 mm and SD = 0,26 mm. A mean diameter for peroneal artery perforators was 0.9 mm. Conclusion. Existance of reliable levels of septocutaneous perforators of the lower leg enables and makes reconstruction of the soft tissue defects of the lower leg, especially

  3. Achieving Symmetry in Unilateral DIEP Flap Breast Reconstruction: An Analysis of 126 Cases over 3 Years.

    Science.gov (United States)

    Wang, Tao; He, Jinguang; Xu, Hua; Ma, Sunxiang; Dong, Jiasheng

    2015-02-01

    Many patients who prefer breast reconstruction by a deep inferior epigastric artery perforator (DIEP) flap often lack skin laxity at the lower abdomen. Recreating a symmetrical breast with various degrees of ptosis is one of the most difficult procedures. In this report, varied DIEP flap shapes were precisely designed on the basis of normal breast ptosis. The reconstructive outcomes were quantitatively evaluated for asymmetry of footprint, volume, breast projection, and nipple position by a 3-dimensional scanning system. One hundred twenty-six cases of unilateral DIEP flap breast reconstruction were successfully performed from January 2009 to July 2012. The maximal flap width ranged from 7.5 to 10.5 cm (mean, 9.0 cm), and the flap length ranged from 28 to 38 cm (mean, 32.5 cm). The discrepancy of the footprint and nipple position did not differ significantly between the reconstructed and normal breasts. However, the reconstructed side had significantly higher breast volume and projection. For patients with a relatively tight abdomen, the flap design and shaping approach we propose achieves a maximal symmetrical outcome and should be considered as a good and reliable option. PMID:25409622

  4. Freestyle-Like V-Y Flaps of the Eyebrow: A New Outlook and Indication of an Historical Technique

    Directory of Open Access Journals (Sweden)

    Angelo Alberto Leto Barone

    2013-01-01

    Full Text Available The eyebrow region is of utmost importance for facial movement, symmetry, and the overall cosmetic appearance of the face. Trauma or tumor resection often leave scars that may dislocate the eyebrow producing an alteration both in static symmetry of the face and in the dynamic expressivity. The authors present a technique for eyebrow’s defects repair using the remaining eyebrow advancement by means of a “freestyle-like” V-Y flap. In the past two years a total of eight consecutive patients underwent excision of skin lesions in the superciliary region and immediate reconstruction with this technique. On histology, six patients were affected from basal cell carcinomas, one from squamous cell carcinoma, and one from congenital intradermal melanocytic nevus. The pedicle of the flap included perforators from the supratrochlear, supraorbital, or superficial temporalis artery. Advancement of the entire aesthetic subunit that includes the eyebrow using a V-Y perforator flap was performed successfully in all cases achieving full, tension-free closure of defects up to 3.0 cm. “Freestyle-like” V-Y flaps should be considered as a first-line choice for partial defects of the eyebrow. The greater mobility compared to random subcutaneous flaps allows to reconstruct large defects providing an excellent cosmetic result.

  5. Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects

    Directory of Open Access Journals (Sweden)

    QU Zhi-gang

    2012-12-01

    Full Text Available 【Abstract】 Objective: To report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocu-taneous flaps. Methods: Six patients with large skin and soft tissue defects were included in this report. There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar. All wounds were in the upper extremity. The sizes of defects ranged from 15 cm×6 cm to 30 cm×18 cm. Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissi-mus dorsi. The thoracodorsal artery and its perforators were carefully protected during surgery. Results: All flaps healed primarily without flap congestion, margin necrosis or infection. The skin donor sites either received split-thickness skin graft (3 cases, mostly from the anterior thigh or was closed primarily (3 cases and had minimal morbidity. Follow-up of 6-12 months showed that the contour of flap was aesthetic and the func-tion of limb was excellent. Conclusion: Our experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for recon-struction of large skin and soft tissue defects in the upper extremity. Key words: Surgical flaps; Upper extremity; Soft tissue injuries; Reconstructive surgical procedures

  6. Posteromedial thigh (PMT) propeller flap for perineoscrotal reconstruction: A case report.

    Science.gov (United States)

    Scaglioni, Mario F; Chen, Yen-Chou; Yang, Johnson Chia-Shen

    2015-10-01

    Fournier's gangrene can lead to extensive defects of the perineoscrotal area with exposure of the testes. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Due to its proximity, medial thigh skin appeared to be the most versatile donor site for perineoscrotal reconstruction. In this report, we present a case of reconstruction of a large perineoscrotal defect because of Fournier's gangrene using a posteromedial thigh (PMT) perforator propeller flap. A 58 year-old male who suffered from Fournier's gangrene resulted in a scrotal defect of 10 × 12 cm(2) with a large dead space. A pedicled PMT propeller flap measuring 9 × 23 cm(2) with two perforators that originated from the profunda femoris artery (PFA) was harvested for scrotal defect reconstruction and dead space obliteration. The flap survived completely, with no recipient or donor site morbidity. The length of followup was 3 months and was uneventful. The pedicled PMT propeller flap may be considered as a valid option for perineoscrotal reconstruction. PMID:26314393

  7. Thoraco-epigastric flap for breast reconstruction in cancer

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhayev,

    2015-01-01

    Full Text Available Reconstructive surgery for breast cancer are an integral method of rehabilitation of cancer patients. Breast reconstruction may be delayed and instantaneous. The article presents a description of the thoraco-epigastric flap for breast reconstruction in cancer. The operation involves the replacement of the remote volume (after radical resection of the breast and the breast skin adjacent tissues adjacent to the inframammary crease from the side of the anterior abdominal wall. Surgery is indicated when the tumor in the lower parts of the breast, closest to the skin, in combination with small size breast cancer. The article presents a clinical example of this operation. Described in detail the operation, received a good cosmetic result. The advantage of the application of thoraco-epigastric flap is in the simplicity of the technique of its execution, good blood supply, donor wound is easily sutured due to the possible wide separating cellular adjacent skin and subcutaneous tissue. The disadvantage of this method is limited and the need for careful monitoring of perforating branches of the upper epigastric artery. Thus, thoraco-epigastric flap, can be applicable when performing reconstructive operations for breast cancer in compliance with the necessary requirements for the formation of the flap and the correct attitude to feeding the flap vessels, and virtually eliminates possible complications with the healing of the flap. Undoubtedly, reconstructive plastic surgery for breast cancer, during the testimony and technical capabilities, are an essential component of surgical treatment.

  8. Combining rhinoplasty with septal perforation repair.

    Science.gov (United States)

    Foda, Hossam M T; Magdy, Emad A

    2006-11-01

    A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting with septal perforations (size 1 to 5 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. Complete closure of the perforation was achieved in 90% of perforations of size up to 3.5 cm and in only 70% of perforations that were larger than 3.5 cm. Cosmetically, 95% were very satisfied with their aesthetic result. The external rhinoplasty approach proved to be very helpful in the process of septal perforation repair especially in large and posteriorly located perforations and in cases where the caudal septal cartilage was previously resected. Our results show that septal perforation repair can be safely combined with rhinoplasty and that some of the routine rhinoplasty maneuvers, such as medial osteotomies and dorsal lowering, could even facilitate the process of septal perforation repair. PMID:17131270

  9. Modified osteomyocutaneous iliac crest flaps transplantation.

    Science.gov (United States)

    Liu, Jun; Song, Dajiang; Li, Jinsong; Xu, Jian; Lv, Hongbin

    2015-04-01

    The paper aims to improve the operative technique of osteomyocutaneous iliac crest flap harvesting, further minimise morbidity of donor site, and improve the effect of recipient site reconstruction. From March 2005 to March 2011, 55 cases of osteomyocutaneous iliac crest flap harvested by different methods were performed to reconstruct the defects of the extremities. Twenty-nine cases were reconstructed with a traditional deep circumflex iliac artery osteomusculocutaneous flap. Twenty-six cases were repaired with modified osteomyocutaneous iliac crest flaps. In 29 cases with a traditional DCIA osteomusculocutaneous flap, two cases showed the injured lateral femoral cutaneous nerve. Flapnecrosis was significant in two cases. Arterial compromise occurred in one case 5 days after operation completion and led to flap failure. Three flaps developed postoperative venous congestion, but only one flap received re-exploration. In the other two cases, some stitches were removed for decompression. All three flaps survived. In two cases, marginal flap necrosis occurred, but no secondary skin grafting was required. In 26 cases with modified flap transplantation, one case showed the injured lateral femoral cutaneous nerve. All flaps survived totally. Osseous integration was achieved in all 55 cases in 3 ∼ 9 months after operation. The modified osteomyocutaneous iliac crest flap technique enhances flap safety, provides the additional advantages of reducing donor-site morbidity, and improves the recipient-site contour. PMID:25001367

  10. Variabilidad en el diseño y composición del colgajo de perforante de tibial posterior para la reconstrucción de defectos en la pierna Versatility on design and composition of the tibial posterior perforator flap for reconstruction of leg defects

    Directory of Open Access Journals (Sweden)

    C. Laredo Ortiz

    2011-03-01

    perforators allows the use of muscular and tendinous cuffs in the same flap to solve more complex defects, becoming something more than a free flap alternative. We present a serie of 43 patients to describe the reconstructive possibilities of the tibialis posterior perforator flap in its propeller form, as for design variability and composed flap use, with the aim of minimizing donor site morbility even more without the use of grafts.

  11. Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects

    Institute of Scientific and Technical Information of China (English)

    QU Zhi-gang; LIU Yu-jie; HE Xu; DING Xiao-hen; FANG Guan-grong

    2012-01-01

    Objective:To report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocutaneous flaps.Methods:Six patients with large skin and soft tissue defects were included in this report.There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar.All wounds were in the upper extremity.The sizes of defects ranged from 15 cm×6 cm to 30 cm× 18 cm.Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissimus dorsi.The thoracodorsal artery and its perforators were carefully protected during surgery.Results:All flaps healed primarily without flap congestion,margin necrosis or infection.The skin donor sites either received split-thickness skin graft (3 cases,mostly from the anterior thigh) or was closed primarily (3 cases)and had minimal morbidity.Follow-up of 6-12 months showed that the contour of flap was aesthetic and the function of limb was excellent.Conclusion:Our experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for reconstruction of large skin and soft tissue defects in the upper extremity.

  12. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Medline Plus

    Full Text Available ... tough decisions these and other women made after learning they had breast cancer. You will also see the breast reconstruction surgery each of them chose to undergo. The deep inferior epigastric perforator flap technique allows surgeons to rebuild breasts in the most ...

  13. Titanium plate reconstruction of the osseous defect after harvest of a composite free flap using the deep circumflex iliac artery.

    Science.gov (United States)

    Halsnad, S M; Dhariwal, D K; Bocca, A P; Evans, P L; Hodder, S C

    2004-06-01

    Hernia formation following harvest of bicortical iliac crest bone occurs infrequently as a late complication and may lead to chronic pain at the donor site and rarely to obstruction and strangulation of bowel. We describe the use of a custom-made titanium plate used to reconstruct the iliac donor site following harvest of a DCIA composite free flap. A pre-operative 3D CT and stereolithography model of the ilium are used to fabricate a titanium plate of the desired shape and size. This plate is used to reconstruct the donor site defect at the time of primary surgery. This technique may reduce late complications following DCIA composite free flap harvest. PMID:15121274

  14. Colgajo de avance en V-Y de gastrocnemio medial basado en perforante para cierre de defectos del tercio medio de la pierna V-Y advancement gastrocnemius perforant based flap for closure of defects of the medial third of the leg

    Directory of Open Access Journals (Sweden)

    V. Spröhnle

    2010-06-01

    Full Text Available Los colgajos de avance en V-Y han sido una alternativa popular para el cierre de heridas profundas, pero su movilidad es limitada. Los colgajos basados en perforantes son especialmente útiles cuando se necesita un mayor avance y cobertura. Diseñamos un colgajo de gastrocnemio que utiliza ambas técnicas para cubrir los defectos del tercio medio y superior de la pierna en sus caras lateral y posterolateral. Evaluamos en forma retrospectiva 5 pacientes con heridas en el tercio medio y superior de la pierna, tratados entre enero de 2005 y septiembre de 2007 en un solo centro y por un mismo cirujano. Todos fueron varones, con un promedio de edad de 48 años y la etiología fue traumática en todos los casos. El vaso perforante se evaluó preoperatoriamente por medio de doppler color en todos los casos. Valoramos telefónicamente la satisfacción del paciente en el postoperatorio tardío. En todos los casos, encontramos los vasos perforantes identificados en el preoperatorio; el tiempo operatorio promedio fue de 1.8 horas. No hubo complicaciones; la cobertura fue exitosa en todos los casos y los pacientes se mostraron satisfechos en la encuesta realizada. El tiempo medio de seguimiento postoperatorio fue de 19 meses. En conclusión, creemos que el colgajo de avance en V-Y de gastrocnemio basado en perforante se presenta como una alternativa segura para el cierre de defectos del tercio medial y superior de la pierna, en un sólo tiempo quirúrgico y con buenos resultados estéticos y funcionales a largo plazo.Advancement V-Y flaps have been a popular choice for closure of deep wounds but their mobility is limited. Perforant based flaps are specially useful when greater advancement and bigger coverage are needed. We designed a gastrocnemius based flap that uses both techniques for covering the defects of the medial third of the leg. We follow a retrospective evaluation of 5 patients that had their wounds in the medial and superior third of the leg

  15. One-stage total repair of anomalous origin of right pulmonary artery from aorta by the double-flap technique, followed by coarctation repair using extended end-to-end arch reconstruction

    International Nuclear Information System (INIS)

    The anomalous origin of the right pulmonary artery from the ascending aorta combined with coarctation of aorta is a rare congenital malformation. The method chosen for performing a prompt surgery to correct the multiple disease lesions is important. Here we report one-stage surgical strategy which involved a double-flap technique alongside an extended end-to-end arch reconstruction in a newborn baby

  16. 大鼠腹壁浅动脉岛状皮瓣防护的研究%Research on a new method for protecting superficial epigastric artery island skin flaps in rats

    Institute of Scientific and Technical Information of China (English)

    张栋益; 康深松; 张正文; 吴蕊

    2015-01-01

    Objective To observe the protective effects of a protective clothing on rats' ischemia-reperfusion superficial epigastric artery (SIEA) flaps, which made of medical imaging film;explore new methods for fixing and protecting flaps.Methods Sixteen adult SD rats were randomly divided into 2 groups : control group (n =8), experimental group (n =8).A left low abdominal island flap which sized 6.0 cm × 3.0 cm and fed by the superficial epigastric artery was created in rats of all the 2 groups.Blocked the arterial blood flow by vascular clamps for 10 hours to establish Ischemia-reperfusion model of flaps.Rats in experimental group were fixed with a protective clothing but rats in control group not.The activities of rats, integrity and retraction degree of the flaps in each group were observed daily for 5 days.Results Observed flaps after 2, 3 and 5 days of the operation respectively, we found that the protective clothing was benefit to prevent rats bite flaps themselves and retraction of flaps without impacting basic activities of rats.Conclusion It is quite necessary for us to fix and protect SIEA flaps of rats when the ischemia-reperfusion models were made.The protective clothing made of medical imaging film effect significantly for preventing rats bite flaps themselves and retraction of flaps, and with simple fabrication process, which can be used as a new method to promote in animal experiments.%目的 观察医学影像胶片制作的一种防护罩对大鼠缺血再灌注腹壁浅动脉岛状皮瓣的防护作用.方法 将16只成年SD大鼠随机分成对照组、实验组,每组8只.各组大鼠于左侧腹部制备6cm×3cm腹壁浅动脉为蒂的岛状皮瓣,血管夹阻断皮瓣动脉血流10 h后恢复灌注制备皮瓣缺血再灌注动物模型,实验组大鼠以防护罩固定,对照组大鼠造模后不做外固定,模型制备完成后的5d内每天观察各组大鼠的活动、皮瓣的完整性及回缩程度.结果 各组

  17. Clinical application of island skin flap of pollical dorsal digital arteries in repairing defect of soft tissue%拇指背动脉岛状皮瓣的临床应用及血供障碍处理

    Institute of Scientific and Technical Information of China (English)

    蒋良福; 周飞亚; 李志杰; 杨景全; 褚庭纲; 池征璘; 高伟阳

    2011-01-01

    Objective:To introduce clinical experience of repairing defect of pollical soft tissue with island skin flap of pollical dorsal digital arteries,and explore the reasons of disturbance of blood supply and its therapeutic method. Methods: From July 2005 to December 2008,21 thumbs in 21 patients with defect of soft tissue were treated with surgery. There were 16 males and 5 females,ranging in age from 16 to 55 years with an average of 39 years. Defects of extremity-radialis soft tissues of thumb in 4 cases were repair with island skin flap of dorsal-radial pollical arterial;and defects of ulnaris ,finger pulp, hyponychium of thumb in 17 cases were repair with island skin flap of dorsal-ulnar pollical arterial. The pivoting point of flap was 0.5 cm proximal to interphalangeal joint. The size of flap was from 2 cm×1.5 cm to 4 cm×2.5 cm. Results:Blood articulo was found in 6 cases during operation and after operation and the flaps survived after corresponding treatment. The patients were follow-up from 3 months to 2 years. The texture and shap of flap was good, only had slightly pigmentation. Range of motion was normal in metacarpophalangeal joints and interphalangeal joint. All the flaps of prothetic finger pulp had sensory recovery with two point discrimination for 4-10 mm. Conclusion:It is easy and effective in repairing defect of pollical soft tissue with island skin flap of pollical dorsal digital arteries. The treatment of pedicle is key to success,the length,width and compression of pedicle can effect on blood supply of flap.%目的:介绍拇指背动脉岛状皮瓣修复拇指软组织缺损的临床经验,并探讨血供障碍的因为及处理方法.方法:自2005年7月至2008年12月,外科治疗21例21指拇指软组织缺损,男16例,女5例:年龄16~55岁,平均39岁.应用拇指背桡侧动脉岛状皮瓣修复拇指远节桡侧软组织缺损(4例),拇指背尺侧动脉岛状皮瓣修复拇指尺侧、指腹及甲床缺损(17例),皮

  18. MORPHOLOGICAL STUDY OF MEDIAL CIRCUMFLEX FEMORAL ARTERY IN HUMAN CADAVERS

    Directory of Open Access Journals (Sweden)

    Brijesh R. Aghera

    2014-10-01

    Full Text Available Background: Medial circumflex femoral artery is an important branch of Profunda femoris artery. It is an important artery in supplying blood to the head and neck of the femur, the adductor muscles and form anastomosis around head of femur. So study of variation of medial circumflex femoral artery great value for surgeon and orthopaedic surgeries. Materials and Methods: The present study includes 102 lower limbs of adult formalin fixed human cadavers used for the routine dissection procedure for under graduate and post graduate students in the department of Anatomy, M.R. Medical College, KBN Medical college and H K E Homeopathic College, Gulbarga (India during 2011-2014.The study was done by dissection method as per Cunningham’s manual of practical Anatomy. Result: In present study, we found that 25 extremities (25.49% medial circumflex femoral artery was originated directly from femoral artery. In 10 extremities (9.80% a common trunk was observed form medial circumflex femoral with femoral artery. Normal study was observed in 66 extremities (64.70%. Conclusion: In present study and other past studies we conclude that knowledge of variation in this artery is very important to preventing injury to vessels during surgical procedures around hip joint and also has important value in plastic surgery operations as the vascular pedicle of grafts such as the transverse upper gracilis (TUG flap, medial thigh flap and medial circumflex femoral (gracilis perforator free flap. During case of selective arteriography in ischaemic necrosis of the femoral head to know the arterial supply of the femoral head it is used.

  19. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Medline Plus

    Full Text Available ... that the lower blood supply, which is the deep inferior epigastric artery and vein, comes up from underneath the muscle ... the vein but there isn't an adequate artery, so usually in that setting, we'll proceed as planned ... perforator technique. 00:18:40 WILLIAM SAMSON, MD: ...

  20. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle.

    Science.gov (United States)

    Koshima, I; Yamamoto, H; Hosoda, M; Moriguchi, T; Orita, Y; Nagayama, H

    1993-09-01

    Chimeric composite flaps combined using microanastomoses consist of two or more flaps or tissues, each with an isolated pedicle and a single vascular source. Free combined chimeric flaps using the lateral circumflex femoral system were used to treat massive composite defects of the head and neck in 10 cases. A combined anterolateral thigh flap and vascularized iliac bone graft based on the lateral circumflex femoral system and the deep circumflex iliac system was the most commonly used combination. An anteromedial thigh flap and a paraumbilical perforator-based flap were also combined with this principal combination. The advantages of this chimeric flap over other osteocutaneous flaps are: (1) The flap is relatively thin and the pedicle vessels are up to 10 cm longer and are wider than those of other flaps for easier harvesting of the flap. (2) It is unnecessary to reposition the patient. (3) The vascular pedicle to the skin can be separated from that of the bone. (4) The donor site is not close to the recipient site. (5) The donor scar is in an unexposed area. (6) The skin territory of this flap is extremely wide. (7) A combined anterolateral and anteromedial thigh flap and vascularized iliac bone graft can be easily obtained as an extended combined osteocutaneous flap. (8) Other neighboring skin flaps, such as a groin flap, a paraumbilical perforator-based flap, or a medial thigh flap, can be combined with this chimeric flap because several major muscle branches to be anastomosed derive from the lateral circumflex femoral system. Chimeric composite flaps using the lateral circumflex femoral system are considered suitable for the repair of massive composite defects of the head and neck. PMID:8341739

  1. Lower Extremity Reconstruction Using Vastus Lateralis Myocutaneous Flap versus Anterolateral Thigh Fasciocutaneous Flap

    Directory of Open Access Journals (Sweden)

    Min Jae Lee

    2012-07-01

    Full Text Available Background The anterolateral thigh (ALT perforator flap has become a popular option fortreating soft tissue defects of lower extremity reconstruction and can be combined witha segment of the vastus lateralis muscle. We present a comparison of the use of the ALTfasciocutaneous (ALT-FC and myocutaneous flaps.Methods We retrospectively reviewed patients in whom free-tissue transfer was performedbetween 2005 and 2011 for the reconstruction of lower extremity soft-tissue defects. Twentyfourpatients were divided into two groups: reconstruction using an ALT-FC flap (12 cases andreconstruction using a vastus lateralis myocutaneous (VL-MC flap (12 cases. Postoperativecomplications, functional results, cosmetic results, and donor-site morbidities were studied.Results Complete flap survival was 100% in both groups. A flap complication was noted inone case (marginal dehiscence of the ALT-FC group, and no complications were noted in theVL-MC group. In both groups, one case of partial skin graft loss occurred at the donor site,and debulking surgeries were needed for two cases. There were no significant differences inthe mean scores for either functional or cosmetic outcomes in either group.Conclusions The VL-MC flap is able to fill occasional dead space and has comparable survivalrates to ALT-FC with minimal donor-site morbidity. Additionally, the VL-MC flap is easily elevatedwithout myocutaneous perforator injury.

  2. 胫后动脉穿支皮瓣修复下肢软组织缺损%Repair of the soft tissue defect in the lower extremities by posterior tibial artery flap

    Institute of Scientific and Technical Information of China (English)

    刘绍江; 钟凤林; 兰玉平; 赵晨阳; 徐兵; 肖衡; 童伟

    2011-01-01

    目的 总结胫后动脉穿支皮瓣修复下肢软组织缺损的临床疗效.方法 2003年1月~2009年6月,应用胫后动脉穿支皮瓣修复下肢软组织缺损42例.结果 42例患者均获得随访,随访8个月~6年,平均1年6个月.40例术后全部成活,1例皮缘2cm坏死,经换药自行愈合,1例皮瓣远端直径约5cm坏死,经换药新鲜后行植皮术后顺利愈合.肢体功能不同程度恢复,供区无明显功能障碍.结论 胫后动脉穿支皮瓣解剖恒定,便于转移,切取面积大,切取方便,供区影响小,是修复下肢软组织缺损的一种有效方法.%Objective To summarize the clinical results of repairing the soft tissue defect in the lower extremities by posterior tibial artery flap.Methods Form Jan.2003 to June 2009,42 cases were adopted with posterior tibial artery flap to repair the soft tissue defect in the lower extremities.Results All patients were followed up from 8 to 72 months, with the average 18 months.Flaps survived well in 40 cases, A 2cm necrosis at the borderline of the flap was observed in 1 case which was healed by changing dressing.A 5cm necrosis at the end of the flap was observed in 1 case which was healed by skin graft.The function of the extremities recovered to some extend.No obvious dysfunction occurred in the donor region.Conclusion Due to its constant location, easy transferring and sufficient donor resources, the posterior tibial artery flap is an effective method to repair the soft tissue defect of the extremities

  3. Prefabricated supraclavicular flap as a salvage procedure for a failed microvascular hypopharyngeal defect closure in a tetraplegic patient.

    Science.gov (United States)

    Fischborn, G Till; Schmidt, Andreas B; Giessler, Goetz A

    2011-09-01

    Delayed hypopharyngeal perforations in tetraplegics are a rare but potentially life-threatening complication of anterior cervical spine instrumentation. To date, no established treatment regimen exists for these situations. A patient with traumatic tetraplegia sub-C4 was admitted to the hospital 14 days after anterior spinal fusion with an infected hypopharyngeal perforation. After hardware removal, the spine was restabilized with a composite free osteomusculocutaneous fibula with the flexor hallucis longus muscle closing the mucosal defect. However, it was lost because of external venous compression. After 54 days, definitive reconstruction was achieved with a delayed supraclavicular artery flap. Follow-up endoscopy showed a closed and mucosalized defect. Composite free flaps are intriguing for complex hypopharyngeal and spine defects; however, they can undergo fatal external compression due to postoperative swelling in this area. Supraclavicular flaps might serve as a rescue alternative, offering unimpaired neck mobility that is crucial for tetraplegics, adequate tenuity for the hypopharynx, and reliable blood supply without large vessels in the field. PMID:21508817

  4. Application of superiorgluteal artery island myocutaneous flap for treatment of sacroiliac ducubital necrosis in clinical research%应用臀上动脉岛状肌皮瓣治疗骶尾部压疮的临床研究

    Institute of Scientific and Technical Information of China (English)

    何青峰; 陈瑛; 万睿; 毛文; 欧阳山蓓

    2012-01-01

    目的:探讨应用臀上动脉岛状肌皮瓣治疗骶尾部压疮的临床效果.方法:201 0年1月~ 2012年5月,收治11例骶尾部褥疮患者.男7例,女4例;年龄52~73岁.褥疮范围6cm× 5cm~ 11cm× 8cm.根据缺损部位及大小设计以臀上动脉为血管蒂的轴型岛状肌皮瓣移位修复骶尾部压疮.结果:术后肌皮瓣全部成活,1 0例伤口Ⅰ期愈合,1例出现切口缘2cm长度的感染,经换药后愈合.随访3个月,移植肌皮瓣未见破溃,皮肤颜色及弹性均恢复较好,压疮无复发.结论:臀上动脉岛状肌皮瓣供血动脉恒定,切取方便,质地较厚耐磨,供区无需植皮,在臀骶部压疮的治疗效果较为理想.%Objective To investigate the superiorgluteal artery island musculocutaneous flap in the sacroiliac decubital necrosis treatment in the clinical effect. Methods January 2010-May 2012, treated 11 cases of patients with the sacroiliac decubital necrosis. 7 males and 4 females; aged 52 to 73 years. Sacroiliac decubital necrosis range 6cm x 5cm ~11cm x 8cm. According to defect location and size of design to the superior gluteal artery pedicled axial musculocutaneous flap repair thesacroiliac decubital necrosis. Results Musculocutaneous flap after all survived the 10 cases of wound Phase I of healing, one cases of infection of the incision margin of 2cm length, healed after changing dressing. Followed up for three months, the transplanted muscle flap was no ulceration, skin color and elasticity recovered well, pressure ulcer recurrence. Conclusion The superior gluteal artery musculocutaneous flap in the feeding artery of a constant, easy to cut, wear thick texture, the donor site without skin grafting, more desirable buttocks sacroiliac decubital necrosis treatment.

  5. Repair of a canine forelimb skin deficit by microvascular transfer of a caudal superficial epigastric flap.

    Science.gov (United States)

    Lewin, G A; Smith, J H

    2010-02-01

    Extensive skin loss from the forelimb of a Border collie was repaired by a microvascular caudal superficial epigastric flap, with secondary meshing of the flap to increase coverage. The caudal superficial epigastric artery and vein were anastomosed to the brachial artery and vein. End-to-end anastomosis to the brachial artery and vein did not compromise peripheral blood flow, and no flap necrosis was observed after subsequent limited meshing of the flap. PMID:20070493

  6. Perforated monolayers

    Energy Technology Data Exchange (ETDEWEB)

    Regen, S.L.

    1992-12-01

    Goal of this research program is to create ultrathin organic membranes that possess uniform and adjustable pores ( < 7[angstrom] diameter). Such membranes are expected to possess high permeation selectivity (permselectivity) and high permeability, and to provide the basis for energy-efficient methods of molecular separation. Work carried out has demonstrated feasibility of using perforated monolayer''-based composites as molecular sieve membranes. Specifically, composite membranes derived from Langmuir-Blodgett multilayers of the calix[6]arene-based surfactant shown below plus poly[l-(trimethylsilyl)-l-propyne] (PTMSP) were found to exhibit sieving behavior towards He, N[sub 2] and SF[sub 6]. Results of derivative studies that have also been completed are also described in this report.

  7. Dorsal hand coverage with free serratus fascia flap

    DEFF Research Database (Denmark)

    Fotopoulos, Peter; Holmer, Per; Leicht, Pernille;

    2003-01-01

    serratus fascia flap, the connective tissue over the serratus muscle, for dorsal hand coverage. The flap consists of thin and well-vascularized pliable tissue, with gliding properties excellent for covering exposed tendons. It is based on the branches of the thoracodorsal artery, which are raised in the...... flap, leaving the long thoracic nerve intact on the serratus muscle. Coverage of the flap with split-thickness skin graft is done immediately. The free serratus fascia flap is an ideal flap for dorsal hand coverage when the extensor tendons are exposed, especially because of low donor-site morbidity....

  8. The Use of the Juri Temporo-Parieto-Occipital Flap

    OpenAIRE

    Juri, Jose; Valotta, Marìa Fernanda

    2005-01-01

    The temporo-parieto-occipital flap, introduced in 1969, was the first large monopedicled flap performed in the scalp for reconstructive and aesthetic purposes. Its versatility for correction of many areas of the scalp relies on its wide arch of rotation, based in the flap's pedicle, which is the superficial temporal artery and vein. The axial pattern of the flap is explained by the unique kind of vascularization present in the scalp, based on a profuse intraparietal blood flow with multiple a...

  9. Peroperative evaluation of vascularity of various flaps by fluorescein technique

    Directory of Open Access Journals (Sweden)

    Bhattacharya V

    2006-01-01

    Full Text Available Background: The viability of any pedicled flap depends upon its vascularity. When a flap is dissected it becomes relatively ischaemic. Ultimately, the viability of the flap depends on the vessels incorporated in the pedicle and their perfusion capacity. There are different techniques to evaluate the blood supply of a flap. Aims: This study deals with experimental and clinical efficiency of fluorescein dye technique to evaluate the vascularity of flaps of various compositions. Materials and Methods: The experimental study was conducted on rats to standardize the technique. Thereafter clinical evaluation was conducted for different flaps namely fasciocutaneous, skeletonized perforator based fasciocutaneous, adipofascial, fasciocutaneous flap with adipofascial extension, fasciocutaneous flap with fascial extension and fasciocutaneous flap with split fascial extension. Conclusions: The paper deals in detail with the technique and method of documentation of a fluorescein study on flaps both experimentally and clinically. The appearance of fluorescein on both the surfaces and distal margin of the flap confirmed the adequacy of vascularity soon after dissection of the flaps. It was found to be an easy, safe and reliable objective method.

  10. Clinical application of first dorsal metacarpal artery radial cutaneous branch and superficial radial nerve flap%第一掌骨背动脉桡侧皮支蒂桡神经浅支皮瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    沈小芳; 芮永军; 许亚军; 糜菁熠; 赵刚

    2012-01-01

    目的 介绍应用第一掌骨背动脉桡侧皮支蒂桡神经浅支皮瓣修复拇指软组织缺损的体会.方法 2006年6月至2009年8月,对9例拇指桡侧软组织缺损患者,应用以第一掌骨背动脉桡侧皮支为轴心血管并携带桡神经浅支皮瓣进行修复,切取面积4.0 cm×2.0cm~7.0 cm× 3.5 cm.结果 术后9例皮瓣全部存活,6例获得随访,3例失访,随访时间为11~34个月.皮瓣质地良好,感觉恢复至S2~S3+,供区植皮愈合良好,轻度色素沉着,无痛性神经瘤发生.结论 第一掌骨背动脉桡侧皮支蒂桡神经浅支皮瓣血供可靠,成活率高,方法简单,可修复拇指全指腹缺损,是修复拇指软组织缺损的方法之一.%Objective To explore the clinical outcomes of applying first dorsal metacarpal artery radial cutaneous branch and superficial radial nerve flap to repair soft tissue defects of the thumb. Methods Nine cases of soft tissue defects in the thumb were treated from June 2006 to August 2009 with a flap using the first dorsal metacarpal artery radial cutaneous branch as the axial vessel and including the superficial radial nerve.The size of the raised flaps ranged from 4.0 cm× 2.0 cm to 7.0 cm× 3.5 cm. Results All the flaps survived after the surgery.Follow-up time ranged from 11 to 34 months in 6 cases.Three cases were lost to follow-up.The flaps had good texture.Protective sensation was restored from S2 to S3 +.The donor site skin graft healed well with slight pigmentation.There were on painful neuroma in these 6 cases. Conclusion First dorsal metacarpal artery radial cutaneous branch and superficial radial nerve flap has a high survival rate and reliable blood supply.It is easy to operate and can cover large defects.This flap is an ideal flap for repair of soft tissue defects in the thumb.

  11. Blood flow autoregulation in pedicled flaps

    DEFF Research Database (Denmark)

    Bonde, Christian T; Holstein-Rathlou, Niels-Henrik; Elberg, Jens J

    2009-01-01

    INTRODUCTION: Clinical work on the blood perfusion in skin and muscle flaps has suggested that some degree of blood flow autoregulation exists in such flaps. An autoregulatory mechanism would enable the flap to protect itself from changes in the perfusion pressure. The purpose of the present study...... was to evaluate if, and to what extent, a tissue flap could compensate a reduction in blood flow due to an acute constriction of the feed artery. Further, we wanted to examine the possible role of smooth muscle L-type calcium channels in the autoregulatory mechanism by pharmacological intervention...... with the L-type calcium channel blocker nimodipine and the vasodilator papaverine. MATERIAL AND METHODS: Pedicled flaps were raised in pigs. Flow in the pedicle was reduced by constriction of the feed artery (n=34). A transit time flow probe measured the effect on blood flow continuously. Following...

  12. Segmental embolization of the gastroduodenal artery in a case of a perforated pseudoaneurysm and gastrointestinal bleeding; Segmentembolisation der Arteria gastroduodenalis bei perforiertem Pseudoaneurysma und gastrointestinaler Massivblutung

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R. [Inst. fuer Diagnostische Radiologie der Friedrich-Alexander-Univ. Nuernberg-Erlangen (Germany); Inst. fuer Diagnostische und Interventionelle Radiologie der Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany); Cavallaro, A.; Bautz, W. [Inst. fuer Diagnostische Radiologie der Friedrich-Alexander-Univ. Nuernberg-Erlangen (Germany)

    2004-07-01

    We present the history of a woman suffering from an extensive gastrointestinal bleeding due to liver cirrhosis and chronic pancreatitis. Selective angiogram of the celiac artery revealed a pseudoaneurysm of the gastroduodenal artery caused by inflammatory wall penetration. The life-threatening hemorrhage was completely stopped by embolization with three stainless steel coils after microcatheter engagement of the gastroduodenal artery. The particularity of this case is the restricted embolization of the aneurysm vessel segment, so the collateral circulation of the gastroduodenal and pancreaticoduodenal artery could be preserved. (orig.)

  13. Use of groin flap in the closure of through and through defect of a forearm: A case report

    OpenAIRE

    Balakrishnan, Chenicheri; Pane, Thomas A; Khalil, Abdullah J

    2004-01-01

    The groin flap is a vascularized axial flap based on the superficial circumflex iliac artery arising from the femoral artery just below the inguinal ligament. It is used regularly by many reconstructive surgeons for covering soft tissue defects of the hand. Although the development of various fasciocutaneous free flaps during the 1980s decreased the attractiveness of the groin flap, these flaps can be used in reconstructing significant defects of the forearm and hand where free tissue transfe...

  14. Neural Anatomy of the Anterolateral Thigh Flap.

    Science.gov (United States)

    Luenam, Suriya; Prugsawan, Krit; Kosiyatrakul, Arkaphat; Chotanaphuti, Thanainit; Sriya, Piyanee

    2015-06-01

    The anterolateral thigh (ALT) flap is one of the commonly used sensate flaps for intra-oral, hand, and foot reconstruction. The objective of this study was to describe the anatomic location of the sensory nerves supplying the ALT flap in relation to the surface landmarks and with the vascular pedicles. The dissections were carried out in 28 embalmed specimens. An axial line from the anterior superior iliac spine to the superolateral border of the patella and two circles with radii of 5 and 10 cm centered on the midpoint of the former line were used for the surface landmarks. At the intersection point of the axial line and the 10-cm circle, the main lateral femoral cutaneous nerve (LFCN) and its anterior branch were located within 1 and 2.4 cm, respectively. At the intersection point of the axial line and the 5-cm circle, the anterior branch of the LFCN was located within 2.8 cm. The anterior branch of the LFCN can be detected within 3 cm from the central perforator pedicle in all specimens. The posterior branch of the LFCN, superior perforator nerve, and median perforator nerve were found in more variable locations. The findings from our study provide additional information for clinical use in the planning of sensate ALT flap harvest. PMID:26078503

  15. Use of bilateral groin flaps in the closure of defects of the perineum: A case report

    OpenAIRE

    Balakrishnan, Chenicheri; Klein, Justin D; Vashi, Christopher

    2006-01-01

    Reconstruction of perineal and groin defects is a challenging problem. Commonly used methods of reconstruction include skin grafts and local flaps. The groin flap is a vascularized axial flap based on the superficial circumflex iliac artery arising from the femoral artery just below the inguinal ligament. Due to the location, the donor defect can usually be closed primarily, leaving an acceptable scar. The use of bilateral groin flaps for coverage of defects of the anterior perineum following...

  16. Thumb Reconstruction Using Foucher’s Flap

    Science.gov (United States)

    Kola, Nardi

    2016-01-01

    BACKGROUND: Extensive pulp defects of the thumb, with the exposure of tendon or bone, are challenging reconstructive problems. Surgical treatment includes the use of local, regional, and free flaps. AIM: This paper is focused in Foucher’s neuro vascular flap. First DMCA or Foucher’s pedicle flap is a successful thumb reconstruction method, especially in patients not disturbed by its cosmetic appearance. MATERIAL AND METHODS: The first dorsal metacarpal artery (FDMCA) arises from the radial artery in the first intermetacarpal space, just distal to the tendon of the extensor pollicis longus. Pulp area of the thumb is the area where Foucher’s flap is more utilizable. This technique has other applications such as first web reconstruction, thumb lengthening, and following resection of tumors on the dorsum of the hand. RESULTS: We have in study 7 cases with work related trauma in two years period of time, between 2012 and 2014. We had only one partial flap survival and all the other flaps survived entirely. We have also taken in consideration subjective satisfaction with a range score from 4 to 10, cold intolerance, flap area and donor site sensibility with a range score from low to medium to normal. CONCLUSION: Careful pedicle discovery, secured elevation, pedicle strangulation prevention are very important for flap survival.

  17. Reactive perforating collagenosis

    Directory of Open Access Journals (Sweden)

    Yadav Mukesh

    2009-01-01

    Full Text Available Reactive perforating collagenosis is a rare cutaneous disorder of unknown etiology. We hereby describe a case of acquired reactive perforating collagenosis in a patient of diabetes and chronic renal failure.

  18. Reactive perforating collagenosis

    OpenAIRE

    Yadav Mukesh; Sangal B; Bhargav Puneet; Jai P; Goyal Mukul

    2009-01-01

    Reactive perforating collagenosis is a rare cutaneous disorder of unknown etiology. We hereby describe a case of acquired reactive perforating collagenosis in a patient of diabetes and chronic renal failure.

  19. Groin reconstruction by anterolateral thigh flap: A review of 16 cases

    Directory of Open Access Journals (Sweden)

    Ahmad Quazi

    2004-01-01

    Full Text Available We present our experience of pedicled Anterolateral thigh flap for reconstruction of groin defects in cancer patients. Total of 17 flaps in 16 patients were performed between January 2001 to May 2003. 15 flaps were used for groin defects after node dissection for carcinoma of Penis (bilateral groin defects in one patient, 1 case of Squamous Cell Carcinoma of groin and 1 case of Soft Tissue Sarcoma of groin. All patients were male. 16 were myocutaneous variety and 1 was fasciocutaneous flap based on the septocutaneous perforator. Complications were few and all patients achieved durable long-term coverage. We found the flap to be technically easy and reliable.

  20. Patient Satisfaction and Quality of Life in DIEAP Flap versus Implant Breast Reconstruction.

    Science.gov (United States)

    Sgarzani, Rossella; Negosanti, Luca; Morselli, Paolo Giovanni; Vietti Michelina, Veronica; Lapalorcia, Luigi Maria; Cipriani, Riccardo

    2015-01-01

    The psychological impact of breast reconstruction has widely been described, and multiple studies show that reconstruction improves the well-being and quality of life of patients. In breast reconstruction, the goal is not only the morphological result, but mainly the patient's perception of it. The objective of our study is to compare the physical and psychosocial well-being and satisfaction concerning the body image of patients who had reconstruction with breast implants to those of patients who had reconstruction with deep inferior epigastric artery perforator flaps. Our results demonstrated a similar quality of life between the two groups, but the satisfaction level was significantly higher in patients who had reconstruction with autologous tissue. Feedback from patients who have already received breast reconstruction may be useful in the decision-making process for future patients and plastic surgeons, enabling both to choose the reconstructive technique with the best long-term satisfaction. PMID:26649331

  1. A Case of Urethral Reconstruction Using a Superficial Circumflex Iliac Artery

    Directory of Open Access Journals (Sweden)

    Kun-Woon Yoo

    2012-05-01

    Full Text Available A radial forearm free flap has been conventionally used for urethral reconstruction. However,aesthetic and functional complications occur frequently at the donor site. The use of asuperficial circumflex iliac artery perforator (SCIP flap can resolve these disadvantages.Here, we report our case with a review of literature. A 69-year-old man visited our hospitalwith multiple contusions of the abdomen and genital amputation. After necrotic tissuedebridement, the length of the residual corpus carvernosum was 1.5 cm and that of thecorpus spongiosum and urethra was 1 cm. For the reconstruction of the penis, a SCIP flap andanterolateral thigh free flap was performed. The primary closure was performed at the donorsite. Three weeks postoperatively, the patient had a urethral foley catheter removed. Theneourethra was functioning well without stricture. Four months postoperatively, the patienthad no complications such as urethral stricture. A good recovery was also achieved withno aesthetic deficits at the donor site. SCIP flap is appropriate for urethral reconstruction.Because of its proximity to the recipient sites, it makes surgical preparation easier and theprimary closure at the donor site available. It is also advantageous in that its location isalmost unnoticeable.

  2. The median forehead flap reviewed: a histologic study on vascular anatomy.

    Science.gov (United States)

    Skaria, A M

    2015-05-01

    Local skin flaps can be divided into two types: random flaps and axial flaps. An axial flap is defined as a flap containing a named artery in its pedicle. For the paramedian forehead flap (PMFF) a lot of surgeons insist on the point that the pedicle must contain the supratrochlear artery. To demonstrate that median forehead flaps (MFF) need not contain a named artery, we selected first 8 patients with a PMFF and further 12 patients who had undergone reconstructive surgery using a MFF. After division, we analysed the pedicle of the flap histologically and measured the diameter of the arteries or arterioles and compared them to anatomical descriptions of the frontal arteries. In none of the 12 cases could we find a functional artery of approximately 1 mm in diameter that could correspond to the supratrochlear artery. The MFF is an axial flap but not in accordance with the current definition of this term. In contrast to published literature, we show that only in a part of cases a named artery was present in the pedicle. Despite this fact, the MFF is a secure flap for full thickness defect repair on the nose. PMID:24756613

  3. Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects.

    Science.gov (United States)

    Safavi-Abbasi, Sam; Komune, Noritaka; Archer, Jacob B; Sun, Hai; Theodore, Nicholas; James, Jeffrey; Little, Andrew S; Nakaji, Peter; Sughrue, Michael E; Rhoton, Albert L; Spetzler, Robert F

    2016-08-01

    OBJECT The objective of this study was to describe the surgical anatomy and technical nuances of various vascularized tissue flaps. METHODS The surgical anatomy of various tissue flaps and their vascular pedicles was studied in 5 colored silicone-injected anatomical specimens. Medical records were reviewed of 11 consecutive patients who underwent repair of extensive skull base defects with a combination of various vascularized flaps. RESULTS The supraorbital, supratrochlear, superficial temporal, greater auricular, and occipital arteries contribute to the vascular supply of the pericranium. The pericranial flap can be designed based on an axial blood supply. Laterally, various flaps are supplied by the deep or superficial temporal arteries. The nasoseptal flap is a vascular pedicled flap based on the nasoseptal artery. Patients with extensive skull base defects can undergo effective repair with dual flaps or triple flaps using these pedicled vascularized flaps. CONCLUSIONS Multiple pedicled flaps are available for reconstitution of the skull base. Knowledge of the surgical anatomy of these flaps is crucial for the skull base surgeon. These vascularized tissue flaps can be used effectively as single or combination flaps. Multilayered closure of cranial base defects with vascularized tissue can be used safely and may lead to excellent repair outcomes. PMID:26613175

  4. Multiple bowel perforation and necrotising fasciitis secondary to abdominal liposuction in a patient with bilateral lumbar hernia

    OpenAIRE

    Vincent Delliere; Bertheuil, N.; Harnois, Y.; S Thienot; Gerard, M.; Robert, M; Watier, E.

    2014-01-01

    We present a rare complication of abdominal liposuction: bowel perforation and necrotizing fasciitis. Because of bilateral lumbar hernia, a 56-year-old woman had caecum and descending colon perforation during lipoplasty. She had septic shock syndrome at her admission. The authors treated this complex wound with several debridement, omental flap, NPWT and split-thickness skin graft. The incidence of abdominal wall perforation with visceral injury is 14 in 100,000 liposuctions performed. There ...

  5. The iliac bone or osteocutaneous transplant pedicled to the deep circumflex iliac artery. I. Anatomical and technical considerations.

    Science.gov (United States)

    Bitter, K; Danai, T

    1983-10-01

    The technique of microsurgical vessel anastomosis has brought about many new ideas in reconstructive surgery. Many bone sites have been examined for their suitability as donor areas. For reconstructive purposes in the maxillo-facial region, the iliac bone has proven to be the best because of its shape and bulk. A large part of this bone is nourished by the deep circumflex iliac artery (DCIA). Branches of this vessel surround the iliac crest, perforate the flat abdominal muscles, and supply blood to the overlying skin. The anatomical properties of this region present the possibility of raising a large osteomyocutaneous flap. PMID:6226758

  6. Preliminary results using a newly developed projection method to visualize vascular anatomy prior to DIEP flap breast reconstruction

    NARCIS (Netherlands)

    Hummelink, S.; Hameeteman, M.; Hoogeveen, Y.; Slump, C.H.; Ulrich, D.J.O.; Schultze Kool, L.J.; Hofer, S.

    2014-01-01

    Introduction: In a deep inferior epigastric perforator (DIEP) flap breast reconstruction, computed tomography angiography (CTA) is currently considered as the gold standard in preoperative imaging for this procedure. Unidirectional Doppler ultrasound (US) is frequently used; however, this method doe

  7. Preliminary results using a newly developed projection method to visualize vascular anatomy prior to DIEP flap breast reconstruction

    NARCIS (Netherlands)

    Hummelink, S.L.; Hameeteman, M.; Hoogeveen, Y.L.; Slump, C.H.; Ulrich, D.J.O.; Schultze Kool, L.J.

    2015-01-01

    INTRODUCTION: In a deep inferior epigastric perforator (DIEP) flap breast reconstruction, computed tomography angiography (CTA) is currently considered as the gold standard in preoperative imaging for this procedure. Unidirectional Doppler ultrasound (US) is frequently used; however, this method doe

  8. Prospective evaluation of outcome measures in free-flap surgery.

    LENUS (Irish Health Repository)

    Kelly, John L

    2004-08-01

    Free-flap failure is usually caused by venous or arterial thrombosis. In many cases, lack of experience and surgical delay also contribute to flap loss. The authors prospectively analyzed the outcome of 57 free flaps over a 28-month period (January, 1999 to April, 2001). The setting was a university hospital tertiary referral center. Anastomotic technique, ischemia time, choice of anticoagulant, and the grade of surgeon were recorded. The type of flap, medications, and co-morbidities, including preoperative radiotherapy, were also documented. Ten flaps were re-explored (17 percent). There were four cases of complete flap failure (6.7 percent) and five cases of partial failure (8.5 percent). In patients who received perioperative systemic heparin or dextran, there was no evidence of flap failure (p = .08). The mean ischemia time was similar in flaps that failed (95 +\\/- 29 min) and in those that survived (92 +\\/- 34 min). Also, the number of anastomoses performed by trainees in flaps that failed (22 percent), was similar to the number in flaps that survived (28 percent). Nine patients received preoperative radiotherapy, and there was complete flap survival in each case. This study reveals that closely supervised anastomoses performed by trainees may have a similar outcome to those performed by more senior surgeons. There was no adverse effect from radiotherapy or increased ischemia time on flap survival.

  9. 包膜对猪扩张后动脉筋膜皮瓣血供影响的研究%Study on effect of the capsular tissue on the blood supply of expanded artery-pedicled fasciocutaneous flaps in the pig

    Institute of Scientific and Technical Information of China (English)

    张志宏; 王佳琦; 李文志

    2011-01-01

    目的:探讨包膜切除与包膜保留,对猪扩张后超长动脉筋膜皮瓣血流动力学、氧代谢及皮瓣活力的影响,为临床处理皮瓣包膜提供参考.方法:9~12个月龄成年小型香猪8只,每只猪对称各设计1个以胸背动脉穿支血管为蒂、面积为5cm×20cm的扩张后动脉筋膜皮瓣.实验组扩张后动脉筋膜皮瓣包膜切除,对照组皮瓣包膜保留.比较二组皮瓣的血氧饱和度、MDA含量和成活长度的变化.结果:实验组扩张后动脉筋膜皮瓣的血氧饱和度低于对照组;MDA含量高于对照组;成活长度小于对照组.结论:包膜增加了扩张后动脉筋膜皮瓣的血供,应该予以保留.%Objective To discuss the effect of capsulectomy on the hemodynamics, oxygen metabolism and viability of the expanded artery-pedicled fasciocutaneous flaps in the pig. It provides references of clinical management for the capsular tissue. Methods 20 cephalicly based expanded fasciocutaneous flaps with axial-pattern blood flow, 5cm ×20cm, were designed on each back skin, using piglets aged 9~12 months as an experimental model. Group C was expanded flap with capsulectomy. Group D was expanded flap with intact capsular tissue. The expanded skin flaps with capsulectomy at the time of flap elevation were in experimental group, and flaps with intact underlying capsular tissue were in control group. Compare the changes of tissue oxygen saturation, malondialdehyde content and the length of flap viability in two groups. Results Tissue oxygen saturation values in control group were lower than that in experimental group, the MDA content in control group was higher than that in experimental group, and the length of flap viability in control group was shorter than that in experimental group. Conclusions The capsular tissue adds blood supply to the expanded artery-pedicled fasciocutaneous flaps,and it should be retained.

  10. Antenatal appendicular perforation.

    OpenAIRE

    Narasimharao, K. L.; Mitra, S. K.; Pathak, I. C.

    1987-01-01

    Antenatal appendicular perforation leading to localized meconium peritonitis and intestinal obstruction is reported in a premature neonate. The baby was successfully treated by a limited ileocaecal resection.

  11. Skin paddle vascularity of free fibula flap – A study of 386 cases and a classification based on contribution from axial vessels of the leg

    OpenAIRE

    Prabha S Yadav; Ahmad, Quazi G.; Shankhdhar, Vinay K.; Nambi, G I

    2012-01-01

    Objective: The skin paddle of the free fibula flap receives its vascular supply from septocutaneous perforators, musculocutaneous perforators or from both, and these perforators might originate from the peroneal or posterior tibial vessels or from both. The objective of this study was to classify the skin paddles based on the dominance of vascular contribution by these axial vessels through their different perforator systems. Materials and Methods: A retrospective analysis of 5-year data of 3...

  12. 不同带蒂皮瓣修复拇指软组织缺损的临床研究%Repair of thumb soft tissue defects with different pedicle flaps

    Institute of Scientific and Technical Information of China (English)

    胡稷杰; 金丹; 魏宽海; 林昂如; 王钢

    2009-01-01

    Objective To discuss the clinical outcomes of different pedicle flaps used for thumb soft tissue defects. Methods Between August 2006 and March 2008, we repaired 37 cases of soft tissue defects and bone exposure of the thumb. Of them, 15 were repaired with the dorsoradial arterial retrograde flap, 5 with the pulp advancement flap, 6 with the dorsal aspect of the index finger flap, 2 with the radial artery retrograde flap, and 9 with the dorsoulnar arterial retrograde flap. The surface projective line of the dorsoulnar or dorsoradial artery of the thumb was made the axial line of the dorsoulnar or dorsoradial arterial retrograde flap, and the vertical line across the perforating branch of dorsal artery 2. 2±0. 2 cm from the nail groove was made the rotation point. The area of the flap was as large as 3.5 cm×4. 5 cm. Results All the 37 flaps survived. They were followed up for 3 to 12 (average, 5. 0±0. 8) months postoperatively. The appearance of the thumb was satisfactory. The pulp two-point discrimination was 5 to 10 mm and the range of motion at the interphalangeal joints of the thumb was 0 to 70° Conclusion The dorsoradial arterial retrograde flap of the thumb is a good choice for the thumb soft tissue defects, and the radial artery retrograde flap can be used for degloving injury of the thumb.%目的 探讨修复拇指软组织缺损的最佳手术方式. 方法 自2006年8月至2008年3月对37例拇指软组织缺损伴骨外露或Ⅰ类拇指缺损者进行手术修复.37例患者中,以拇指桡背侧动脉为蒂的皮瓣修复15例,指腹推进皮瓣修复5例,示指背侧皮瓣修复6例,桡动脉皮瓣修复2例,以拇指尺背侧动脉为蒂皮瓣修复9例.其中拇指尺、桡背侧动脉皮瓣的设计以拇指尺、桡背侧动脉体表投影线为轴心线,拇指桡、尺侧纵轴线上距甲沟(2.2±0.2)cm处为旋转点,皮瓣面积最大可达3.5 cm×4.5cm.结果 术后37例皮瓣全部成活.术后随访3~12个月,平均(5.0±0.8)个月.

  13. Robot-Assisted Free Flap in Head and Neck Reconstruction

    Directory of Open Access Journals (Sweden)

    Han Gyeol Song

    2013-07-01

    Full Text Available Background  Robots have allowed head and neck surgeons to extirpate oropharyngealtumors safely without the need for lip-split incision or mandibulotomy. Using robots inoropharyngealreconstruction is newbut essentialfor oropharyngeal defectsthatresultfromrobotic tumor excision. We report our experience with robotic free-flap reconstruction ofhead and neck defectsto exemplify the necessity forrobotic reconstruction.Methods  We investigated head and neck cancer patients who underwent ablation surgeryand free-flap reconstruction by robot. Between July 1, 2011 andMarch 31, 2012, 5 caseswereperformed and patient demographics, location of tumor, pathologic stage, reconstructionmethods, flap size, recipient vessel, necessary pedicle length, and operation time wereinvestigated.Results  Among five free-flap reconstructions, four were radial forearm free flaps and onewas an anterolateral thigh free-flap. Four flaps used the superior thyroid artery and oneflap used a facial artery as the recipient vessel. The average pedicle length was 8.8 cm. Flapinsetting and microanastomosis were achieved using a specially manufactured roboticinstrument. The total operation timewas 1,041.0 minutes(range, 814 to 1,132 minutes, andcomplicationsincluding flap necrosis, hematoma, andwound dehiscence did not occur.Conclusions  Thisstudy demonstratesthe clinically applicable use ofrobotsin oropharyngealreconstruction, especially using a free flap. A robot can assist the operator in insettingthe flap at a deep portion of the oropharynx without the need to perform a traditionalmandibulotomy. Robot-assisted reconstruction may substitute for existing surgical methodsand is accepted asthemost up-to-datemethod.

  14. Análisis de perforantes de la epigástrica inferior profunda con Angio TC 3D, Eco Doppler color y Doppler simple de ultrasonidos en colgajo DIEP: resultados preliminares Analysis of deep inferior epigastric perforating vessels with 3D CT angiography, color Doppler ultrasonography and Doppler in diep flaps: preliminary results

    Directory of Open Access Journals (Sweden)

    J. Castro García

    2008-09-01

    Doppler ultrasound, Colour-Duplex and Angio-CT with three-dimentional reconstruction. Surgical procedure findings were considered as the reference value. The evaluation procedure included the election of the most suitable perforator vessels, taking account of the location, caliber and anatomical relationships with the muscle. The Angio-CT with three-dimentional reconstruction showed 100% specificity (CI 95% 75.3-100, and very high positive predictive value. In this way, this technique could be considered as an excellent tool for preoperative evaluation of perforators flaps. Color-Duplex showed that in 46,1% of the patients (CI 95% 19,2-74% the selected perforator matched with the intraoperatively selected. Using Doppler ultrasound only in 30,8% of the cases (IC 95% 9,1-61,4% this result was observed. In this report, Angio-CT with three-dimentional reconstruction has revealed as a very high specificity technique, that allows a great account of important information, only comparable with anatomical dissection and ahead from Doppler ultrasound and color-Dupplex.

  15. Retrograde vascularisation of fibula free flap in composite oro-mandibular reconstruction

    Directory of Open Access Journals (Sweden)

    G I Nambi

    2013-01-01

    Full Text Available We present a case of composite oromandibular reconstruction with fibula free flap in which the vascularity to the flap was established in a retrograde direction through the distal end of the peroneal pedicle vessels. The flap was initially designed in such a way so as to anastomose with superior thyroid artery. However after initial good flow, the superior thyroid artery flow became insufficient. Therefore, an attempt was made to vascularise the flap by anastomosing the distal end of peroneal vessels with the facial artery and a tributary of the internal jugular vein so that the flap was perfused in a retrograde direction. This was successful and the retrograde flow was adequate to ensure flap survival. We believe this to be the first successful case of reverse vascular flow reported for composite oromandibular reconstruction with the fibula free flap.

  16. Iatrogenic neonatal bladder perforation

    Directory of Open Access Journals (Sweden)

    Lilia Trigui

    2011-01-01

    Full Text Available Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic causes. The present study describes the case of a 3-day-old infant with ascites due to bladder perforation secondary probably to manual decompression of the bladder. The infant underwent successful surgical repair of the perforation.

  17. Strategies in Perforated Diverticulitis

    NARCIS (Netherlands)

    J. Vermeulen (Jefrey)

    2010-01-01

    textabstractAlthough diverticulitis is a common disease affecting the gastrointestinal tract, few is known about the optimal surgical treatment of its most severe form: perforated diverticulitis. Regardless of the selected operation, perforated diverticulitis is associated with mortality rates up to

  18. Repair of Head and Face Defects with the Use of Pericranial Flap

    OpenAIRE

    Mohammad Naeimi; Saeed Hosseini

    2011-01-01

    Introduction: The pericranial flaps' benefits have been described in many otolaryngologic, maxillofacial and plastic surgery literature. The benefits ar e due to the pericranial flaps unique characteristics including good flexibility and mobility, very rich blood supply from several arterial sources and access to sufficient bulk of the flap without any need for distant surgical sites. Using pericranial flaps to repair the local defects of the head and face region in several cases has been ...

  19. Postirradiation flap infection about the oral cavity

    International Nuclear Information System (INIS)

    Postirradiation alteration of oral flora is well documented in the literature. Infection as a complication leading to partial or complete loss of a flap used to reconstruct a defect in the oral cavity is a worrisome outcome. We describe how a flap that was judged clinically to be viable became overwhelmingly infected with the Klebsiella oxytoca, an oral cavity pathogen encountered in this patient following irradiation. Local and systemic changes led to detachment of the flap. This complication may be explained, in view of the absence of venous congestion or arterial ischemia both clinically and pathologically, by the proven contamination of the flap by the Klebsiella pathogen. Local factors resulted in lower resistance and subsequent overwhelming infection. Discussion of the case, review of pertinent literature, and proposed solutions are presented

  20. Perforation of the Right Ventricle Induced by Pulmonary Artery Catheter at Induction of Anesthesia for the Surgery for Liver Transplantation: A Case Report and Reviewed of Literature

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora-Martins

    2009-01-01

    Full Text Available We report a case of a 45-year-old male patient diagnosed with liver cirrhosis by hepatitis C and alcohol, with a Child-Pugh score C and a model for end-stage liver disease (MELD score of 27, and submitted to liver transplantation. The subject underwent insertion of the pulmonary artery catheter (PAC in the right internal jugular vein, with technical difficulty concerning catheter advance. There was sudden hypotension, increase in central venous pressure (CVP, and decrease in SvO2 15 minutes after the PAC had been inserted, followed by cardiorespiratory arrest in pulseless electrical activity (PEA, which was promptly assisted with resuscitation. Pericardiocentesis was performed without success, so the individual was subjected to a subxiphoid pericardial window, which led to output of large amounts of blood as well as PEA reversal to sinus rhythm. Sternotomy was performed; rupture of the apex of the right ventricle (RV was detected, and suture of the site was accomplished. After hemodynamic stabilization, the patient was transferred to the ICU, where he developed septic shock and, despite adequate therapy, died on the eighteenth day after ICU admission.

  1. Perforation of the Right Ventricle Induced by Pulmonary Artery Catheter at Induction of Anesthesia for the Surgery for Liver Transplantation: A Case Report and Reviewed of Literature

    Science.gov (United States)

    Auxiliadora-Martins, Maria; Apinagés dos Santos, Erick; Adans Wenzinger, Daniel; Alkmim-Teixeira, Gil Cezar; Neto, Gerardo Cristino de M.; Sankarankutty, Ajith Kumar; de Castro e Silva, Orlando; Martins-Filho, Olindo Assis; Basile-Filho, Anibal

    2009-01-01

    We report a case of a 45-year-old male patient diagnosed with liver cirrhosis by hepatitis C and alcohol, with a Child-Pugh score C and a model for end-stage liver disease (MELD) score of 27, and submitted to liver transplantation. The subject underwent insertion of the pulmonary artery catheter (PAC) in the right internal jugular vein, with technical difficulty concerning catheter advance. There was sudden hypotension, increase in central venous pressure (CVP), and decrease in SvO2 15 minutes after the PAC had been inserted, followed by cardiorespiratory arrest in pulseless electrical activity (PEA), which was promptly assisted with resuscitation. Pericardiocentesis was performed without success, so the individual was subjected to a subxiphoid pericardial window, which led to output of large amounts of blood as well as PEA reversal to sinus rhythm. Sternotomy was performed; rupture of the apex of the right ventricle (RV) was detected, and suture of the site was accomplished. After hemodynamic stabilization, the patient was transferred to the ICU, where he developed septic shock and, despite adequate therapy, died on the eighteenth day after ICU admission. PMID:20066172

  2. The distally based superficial sural flap for reconstruction of the lower leg and foot.

    Science.gov (United States)

    Rajacic, N; Darweesh, M; Jayakrishnan, K; Gang, R K; Jojic, S

    1996-09-01

    We describe our experience with the use of distally based superficial sural flaps for coverage of defects in the lower leg and foot in 21 patients. In 18 patients the flap was successfully transferred, in 2 cases partial necrosis of the flap occurred and 1 flap failed completely. In 18 cases the flap was used as a fasciocutaneous flap and in 3 cases as a fascial flap only. The advantages of this flap are: easy and quick dissection, hence saving operating time, minimal morbidity of donor site and preservation of major arteries of the leg. Although the flap was described as reliable for covering defects around the ankle joint, we have been able to cover defects of the dorsum of the foot distally and up to the mid-third of the tibia proximally. PMID:8881785

  3. Perforating Thin Metal Sheets

    Science.gov (United States)

    Davidson, M. E.

    1985-01-01

    Sheets only few mils thick bonded together, punched, then debonded. Three-step process yields perforated sheets of metal. (1): Individual sheets bonded together to form laminate. (2): laminate perforated in desired geometric pattern. (3): After baking, laminate separates into individual sheets. Developed for fabricating conductive layer on blankets that collect and remove ions; however, perforated foils have other applications - as conductive surfaces on insulating materials; stiffeners and conductors in plastic laminates; reflectors in antenna dishes; supports for thermal blankets; lightweight grille cover materials; and material for mockup of components.

  4. Increasing options in autologous microsurgical breast reconstruction: four free flaps for 'stacked' bilateral breast reconstruction.

    Science.gov (United States)

    Rozen, Warren Matthew; Patel, Nakul Gamanlal; Ramakrishnan, Venkat V

    2016-04-01

    For autologous breast reconstruction, there are cases where one free flap cannot provide the volume of tissue required, and the concept of 'stacked' bilateral deep inferior epigastric artery (DIEP) flaps was developed, in which hemi-abdominal flaps are raised on each deep inferior epigastric artery (DIEA), and both flaps transferred to the chest. In cases of bilateral breast reconstruction, stacked flaps may be required to achieve volume replacement, however options are not described. We demonstrate the use of stacked free flaps for bilateral breast reconstruction, using one DIEP flap stacked with one transverse upper gracilis (TUG) flap for each side. A 49-year-old woman, with BRCA1 mutation, presented for risk reduction mastectomies. Flap design was planned to achieve maximal projection and primary nipple reconstruction. This was able to be achieved by using the DIEP flap de-epithelialised and completely buried, with the flap orientated with the pedicle on its superficial surface, and the TUG flap lying superficially with its skin paddle used for nipple reconstruction and able to be monitored clinically. There were no flap or donor related complications and good aesthetic outcomes were achieved. This technique offers a further option in microsurgical breast reconstruction for patients in whom there is a paucity of abdominal tissue for reconstruction. PMID:27047791

  5. Breast reconstruction using a latissimus dorsi flap after mastectomy

    DEFF Research Database (Denmark)

    Højvig, Jens B; Bonde, Christian T

    2015-01-01

    INTRODUCTION: The latissimus dorsi (LD) myocutaneous flap has long been regarded as the second choice flap for autologous breast reconstruction following a mastectomy in our department. Despite uncertainty about donor-site morbidity, it is regarded as a relatively safe procedure; moreover, in...... contrast to our first choice, the deep inferior epigastric perforator flap, no microsurgical expertise is needed. METHODS: This is a systematic review of patient files for all LD breast reconstructions performed in the 2004-2013 period, at Rigshospitalet, Copenhagen, Denmark. RESULTS: A total of 135...... 13 patients (10%) had local complications and were re-operated within the first 30 days. We observed one flap loss and only one systemic complication; a urinary tract infection. In all, 38 patients (28%) received antibiotic treatment after the operations and 27 (20%) developed a seroma at the donor...

  6. Pectoralis myocutaneous flap for salvage of necrotic wounds

    Energy Technology Data Exchange (ETDEWEB)

    Price, J.C.; Davis, R.K.; Koltai, P.J.

    1985-02-01

    The authors have utilized six pectoralis major myocutaneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull-up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis. These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means. This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. The authors conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosis.

  7. Pectoralis myocutaneous flap for salvage of necrotic wounds

    International Nuclear Information System (INIS)

    The authors have utilized six pectoralis major myocutaneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull-up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis. These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means. This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. The authors conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosis

  8. [Coverage of anterior knee defect by reverse flow anterolateral thigh flap: About two cases].

    Science.gov (United States)

    Montoya-Faivre, D; Pineau, V; Colson, T; Brix, M; Simon, E

    2016-08-01

    The coverage of soft-tissue defects concerning the front of the knee and the proximal lower leg is a complex procedure. The reverse flow anterolateral thigh flap represents a good solution for this defects, especially when the coverage surface is large-sized and a free flap is not appropriate regarding the difficulty of the process. Flap retrograde vascularization is based on the anastomosis between the descending branch of the circumflex femoral artery and lateral superior genicular artery. It is an easy solution with low morbidity. The authors have chosen this flap to cover soft-tissue defect of anterior knee from two patients with total knee prothesis. PMID:26169962

  9. Spontaneous Perforation of Pyometra.

    Science.gov (United States)

    Sharma, Nalini; Singh, Ahanthem Santa; Bhaphiralyne, Wankhar

    2016-04-01

    Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted. PMID:27152313

  10. Repairing facial defect with a reversal flow axial retroauricular island flap based on the superficial temporal artery%应用颞浅动脉跨区供血的反流轴型耳后岛状皮瓣修复面部缺损

    Institute of Scientific and Technical Information of China (English)

    邱柏程; 于海生

    2014-01-01

    目的:探讨颞浅动脉跨区供血的反流轴型耳后岛状皮瓣在修复面部缺损中的应用。方法:根据颞浅动脉的解剖分布及其与耳后动脉的吻合特点,制备以颞浅动脉供血的耳后岛状皮瓣,经皮下隧道转移至受区,修复面部缺损。结果:本组19例患者,17例全部存活,皮瓣的形态、色泽及功能良好。2例早期出现静脉回流障碍,积极处理后,皮瓣远端仅有小部分表皮坏死。结论:颞浅动脉跨区供血的反流轴型耳后岛状皮瓣修复面部缺损,是比较理想的修复方式。%Objective To investigate the application of reversal flow axial retroauricular island flap based on the superficial temporal artery for facial defect. Methods According to the anatomical distribution of the superficial temporal artery and the anastomosis characteristics between posterior auricular artery and superficial temporal artery,we manufactured retroauricular island flap nourished by superficial temporal artery to repair facial defect via a subcutaneous tunnel. Results Among seventeen out of nineteen patients in this group,the transplanted skin flap survived and their shape、color and function were well.Two cases with venous reflux disorders in early stage was treated actively,only a small portion of the distal skin necrosised. Conclusion Reversal flow axial retroauricular island flap based on the superficial temporal artery is an ideal repairing way for facial defect.

  11. Oropharyngeal reconstruction with a pedicled submandibular gland flap.

    Science.gov (United States)

    Mashrah, Mubarak A; Zhou, Shang-Hui; Abdelrehem, Ahmed; Ma, Chunyue; Xu, Liqun; He, Yue; Zhang, Chen-Ping

    2016-05-01

    Locoregional flaps are widely used for reconstruction of small and medium defects in the oral cavity. The submandibular gland flap is a pedicled flap, which derives its blood supply from the facial artery, based on the submandibular gland. We describe the use of the flap in 20 patients who required oropharyngeal reconstruction with a pedicled submandibular gland flap after resection of a tumour between July 2012 and October 2014. Patients with squamous cell carcinoma were excluded. All flaps were pedicled on the facial vessels (inferiorly in 17 patients and superiorly in 3). The indications were: reconstruction of intraoral mucosal defects (n=13), filling the parapharyngeal dead space (n=6), and obliteration of the mastoid (n=1). All the flaps atrophied, but with no clinical effect. One patient developed partial loss of the flap, and one early leakage. There were no cases of xerostomia, and no signs of recurrence during the postoperative follow-up period of 3-26 months. The flap is useful, as it is simple and reliable for reconstruction of small to medium oropharyngeal defects in carefully selected cases, and gives good cosmetic and functional results. PMID:26388070

  12. Posterior neurocutaneous vascular axial flap pedicled with distal segment of the posterior interosseous artery in the forearm for repairing defects of the hand%以骨间后血管为蒂的前臂后侧皮神经营养血管皮瓣在手部创伤修复中的应用

    Institute of Scientific and Technical Information of China (English)

    陈雪松; 肖茂明; 王元山; 黄敢; 管力; 张黎明; 周晨

    2009-01-01

    Objective To report the surgical techniques and clinical results of modified posterior neurocutaneous vascular axial flap in the forearm.Methods A reversed posterior neurocutaneous vascular flap in the forearm pedicled with distal segment of the posterior interosseous artery was designed to repair skin defects in the hand caused by hish energy injuries.Tweney-two patients with skin defect distal to the dorsal wrist were treated with this flap.The distal-most defect was at the proximal interphalangeal joint.The largest flap measured 14 cm×10 cm.The longest pedicle was 12 cm.Results All flaps were transferred successfully without necrosis.There was no vascular crisis.Postoperative follow up ranged from 6 to 12 months.The flaps had good texture and consistency.Hand function and appearance Were satisfactory.Conclusion Modified reverse posterior neurocutaneous vascular flap in the forearm can overcome limimtions in harvest area and rotation distance by the conventional flap,making it suitable for repairing large skin and soft tissue defects in the hand.%目的 报告应用改进前臂后侧皮神经营养血管逆行皮瓣的手术方法及临床效果.方法 设计以骨间背侧血管下段为蒂的前臂后侧皮神经营养血管皮瓣逆向转位修复手腕背以远的皮肤缺损创面.临床应用22例,皮瓣最远修复至近侧指间关节,皮瓣最大切取面积为14cm×10 cm,蒂部最长12 cm.结果 术后22例皮瓣全部存活,未发生血管危象.随访时间为6~12个月,皮瓣质地优良,外形与功能恢复满意.结论 经改进后的前臂后侧皮神经营养血管皮瓣可用于修复手部较大面积的皮肤软组织缺损.

  13. Skin paddle vascularity of free fibula flap - A study of 386 cases and a classification based on contribution from axial vessels of the leg

    Directory of Open Access Journals (Sweden)

    Prabha S Yadav

    2012-01-01

    Full Text Available Objective: The skin paddle of the free fibula flap receives its vascular supply from septocutaneous perforators, musculocutaneous perforators or from both, and these perforators might originate from the peroneal or posterior tibial vessels or from both. The objective of this study was to classify the skin paddles based on the dominance of vascular contribution by these axial vessels through their different perforator systems. Materials and Methods: A retrospective analysis of 5-year data of 386 free fibula flaps used in oro-mandibular reconstruction was done and the skin paddle vascularity was studied. While majority of the skin paddles received their blood supply from the peroneal septocutaneous perforators, a few had their dominant supply from the soleus musculocutaneous perforators in addition to peroneal septocutaneous perforators. In few cases, the soleus musculocutaneous perforators were the sole source of blood supply to the skin paddle. The limitation in this study was the inability to augment the clinical observation with cadaveric study. Results: The skin paddle of the free fibula flap was classified into four different types (a-d based on the dominance of vascular contribution by axial vessels of the leg. Conclusion: The skin paddle of the free fibula flap has reliable blood supply, but a thorough knowledge of the variations in vascular pattern of the skin paddle is required especially to salvage the larger paddles used in the reconstruction complex oro-mandibular defects.

  14. Postpartum spontaneous colonic perforation due to antiphospholipid syndrome

    OpenAIRE

    Ahmed, Kamran; Darakhshan, Amir; Au, Eleanor; Khamashta, Munther A; Katsoulis, Iraklis E

    2009-01-01

    The antiphospholipid syndrome (APS) is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosis, fetal loss, thrombocytopenia, leg ulcers, livedo reticularis, chorea, and migraine. We document a previously unreported case of a 37-year-old female in whom APS was first manifested by infarction and cecal perforation following cesarean section. At laparotomy the underlying ...

  15. Safely Combining Abdominoplasty with Aggressive Abdominal Liposuction Based on Perforator Vessels: Technique and a Review of 300 Consecutive Cases

    OpenAIRE

    Smith, Lane F.

    2015-01-01

    Background: There continues to be controversy about performing abdominoplasty concurrently with abdominal liposuction. The concern is that liposuction on the already vascularly compromised abdominal flap will lead to increased complications and flap necrosis. The central abdomen is supplied by the epigastric system. If perforator vessels from this system are spared, the blood supply to the abdomen can be spared and liposuction should be able to be safely performed on the elevated abdominal fl...

  16. Spontaneous corneal perforation in an eye with Peters' anomaly

    Directory of Open Access Journals (Sweden)

    Kim M

    2013-07-01

    Full Text Available Moosang Kim, Seung-Chan Lee, Seung-Jun Lee Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, South Korea Abstract: A premature female infant underwent her first ophthalmologic examination at the age of 4 weeks. The initial examination of the baby was requested for evaluation of a ‘white spot’ on the surface of her right eye. She had been hospitalized in the neonatal intensive care unit because of systemic abnormalities, such as a right clavicle fracture and microcephaly. Slit-lamp examination of the right eye showed a central corneal opacity, corneal thinning, and an iridocorneal adhesion. The lens and fundus of the right eye could not be observed. We observed no pathologic findings in the left eye. The baby's parents were informed of the high risk for spontaneous corneal perforation without external pressure. At 42 days of age, an ophthalmologic examination of the infant was again requested for evaluation of ‘tears’ from her right eye 3 hours previously. Examination revealed corneal perforation, iris protrusion, and a flat anterior chamber. We performed emergent conjunctival flap surgery. Three months following surgery, the patient's right eye was successfully preserved with no sign of inflammation or leakage. Keywords: conjunctival flap, corneal perforation, Peters' anomaly

  17. Adipofascial Anterolateral Thigh Flap Safety: Applications and Complications

    Directory of Open Access Journals (Sweden)

    Tommaso Agostini

    2013-03-01

    Full Text Available Background A thinned anterolateral thigh (ALT flap is often harvested to achieve optimalskin resurfacing. Several techniques have been described to thin an ALT flap including anadipocutaneous flap, an adipofascial flap and delayed debulking.Methods By systematically reviewing all of the available literature in English and French, thepresent manuscript attempts to identify the common surgical indications, complications anddonor site morbidity of the adipofascial variant of the ALT flap. The studies were identifiedby performing a systematic search on Medline, Ovid, EMBASE, the Cochrane Database ofSystematic Reviews, Current Contents, PubMed, Google, and Google Scholar.Results The study selection process was adapted from the Preferred Reporting Items forSystematic Reviews and Meta-Analyses statement, and 15 articles were identified usingthe study inclusion criteria. These articles were then reviewed for author name(s, year ofpublication, flap dimensions and thickness following defatting, perforator type, type of transfer,complications, thinning technique, number of cases with a particular area of application anddonor site morbidity.Conclusions The adipofascial variant of the ALT flap provides tissue to fill large defects andimprove pliability. Its strong and safe blood supply permits adequate immediate or delayeddebulking without vascular complications. The presence of the deep fascia makes it possibleto prevent sagging by suspending and fixing the flap for functional reconstructive purposes(e.g., the intraoral cavity. Donor site morbidity is minimal, and thigh deformities can bereduced through immediate direct closure or liposuction and direct closure. A safe bloodsupply was confirmed by the rate of secondary flap debulking.

  18. AN ANATOMIC STUDY OF ADIPOFASCIAL FLAP OF THE LEG

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To investigate the vascular anatomy of the subcutaneous tissues and fascias of the leg. Methods Four fresh cadaver legs which had been injected with colored latex were dissected under magnification to identify the origin, course an distribution of vessels from the subfascial level to the skin. The adipofascial flap was harvested from the whole medial side of the leg and fascial flap from other leg of the same cadaver. The posterior tibial artery and its first and second supra-malleolus septal arteries were retained in these flaps. Selective injection of China ink through posterior tibial artery was carried out, and dimension of ink- stained areas was recorded. Results Three main trunk vessels of the leg gave off branches to deep fascia and subcutaneous tissues, forming a large vascular plexus in the subcutaneous tissues on the deep fascia and a deli- cate, but dense and well anastomosed vascular plexus beneath the deep fascia. The vascular plexus in the subcu- taneous tissues ran deeper than the superficial venous system. The areas stained by selective injection in adipo- fascial flaps were larger than those in the fascial flaps. Conclusion Subcutaneous tissues and deep fascia can be considered as an anatomic entity nourished by two very well developed vascular networks which lie on both sides of deep fascia. Incorporation of the deep fascia can not only protect the subcutaneous tissue from being lacerated during raising of the flap, but also enhance vascularity of the adipofascial flap. Leaving superficial veins intact while raising the skin flap does not jeopardize the vascular plexus in the subcutaneous tissues and can preserve the superficial lymnphatic vessels, so that postoperative edema of the flap or the leg could be avoided.

  19. Rat Endovascular Perforation Model

    OpenAIRE

    Sehba, Fatima A.

    2014-01-01

    Experimental animal models of aneurysmal subarachnoid hemorrhage (SAH) have provided a wealth of information on the mechanisms of brain injury. The Rat endovascular perforation model (EVP) replicates the early pathophysiology of SAH and hence is frequently used to study early brain injury following SAH.

  20. Anatomía arterial de los colgajos musculares de extensor carpi radialis longus y extensor carpi radialis brevis para su uso en transferencia muscular funcional libre Arterial anatomy of the extensor carpi radialis longus and extensor carpi radialis brevis muscle flaps related to its use in free functioning muscle transfer

    Directory of Open Access Journals (Sweden)

    A. Rodríguez Lorenzo

    2008-09-01

    ón anatómica del nervio radial con el pedículo del ECRL hace que no sea posible su transferencia como colgajo libre sin sacrificar la rama motora del nervio radial en la mayor parte de los casos.The arterial anatomy of the Extensor Carpi Radialis Longus and Brevis (ECRL, ECRB flaps is herein described in order to provide the vascular basis to be used as free muscle transfer for facial reanimation. We used 29 fresh above-elbow human arms injected by means of two diferent techniques.Latex-injection was performed in 18 arms and the modified lead oxide-gelatine injection technique was performed in 11 arms. The ECRL and ECRB with their pedicles were dissected, photodocumented and radiographied.The number, length and calibers of the muscle pedicles were recorded. The intramuscular vascular pattern and the relations of the main pedicles of the muscles with the radial nerve were also noted. Two vascular patterns were found following the Mathes and Nahai Classification of the Vascular Anatomy of the Muscles (number of pedicles and its dominance: Type I (37,9% of ECRL and 20,7% of ECRB dissections and Type II (62,1% of ECRL and 79,3% of ECRB dissections. The dominant pedicle for the ECRL (with an average caliber of 1,73 mm and an average length of pedicle of 32,32 mm is a branch of the radial recurrent artery in 100% of the dissections and the dominant pedicle for the ECRB (with an average caliber of 1,11 mm and an average length of pedicle of 27,77 mm a branch of the radial artery in 68,9% of the dissections and a branch of radial recurrent artery in 31,1% of the cases. As a conclusion, ECRL and ECRB muscle flaps present two types of vascular patterns: type I and type II.Type II pattern is the most common in our study. The anatomical features of both muscles (vascular basis,presence of an important fascial layer, contour and length of the muscle, make them reliable as free muscles flaps for facial reanimation, however, the relation between the dominant pedicle for the ECRL

  1. Free Radial Forearm “Bunting” Flap for Reconstructing Soft-tissue Defects Involving Multiple Fingers

    Directory of Open Access Journals (Sweden)

    Ataru Sunaga, MD

    2013-08-01

    Full Text Available Summary: Reconstruction of soft-tissue defects on multiple fingers is challenging because the number of recipient vessels for free flaps is limited. We report the use of a free radial forearm flap with multiple perforator-based skin islands for the reconstruction of complex soft-tissue defects involving multiple fingers. The injuries were caused by a heat press. The flap was transferred, like “bunting,” to the injured hand with an exteriorized pedicle. The technique presented here is advantageous because it simultaneously covers multiple defects and allows immediate hand therapy after the operation.

  2. Increasing options in autologous microsurgical breast reconstruction: four free flaps for ‘stacked’ bilateral breast reconstruction

    Science.gov (United States)

    Patel, Nakul Gamanlal; Ramakrishnan, Venkat V.

    2016-01-01

    For autologous breast reconstruction, there are cases where one free flap cannot provide the volume of tissue required, and the concept of ‘stacked’ bilateral deep inferior epigastric artery (DIEP) flaps was developed, in which hemi-abdominal flaps are raised on each deep inferior epigastric artery (DIEA), and both flaps transferred to the chest. In cases of bilateral breast reconstruction, stacked flaps may be required to achieve volume replacement, however options are not described. We demonstrate the use of stacked free flaps for bilateral breast reconstruction, using one DIEP flap stacked with one transverse upper gracilis (TUG) flap for each side. A 49-year-old woman, with BRCA1 mutation, presented for risk reduction mastectomies. Flap design was planned to achieve maximal projection and primary nipple reconstruction. This was able to be achieved by using the DIEP flap de-epithelialised and completely buried, with the flap orientated with the pedicle on its superficial surface, and the TUG flap lying superficially with its skin paddle used for nipple reconstruction and able to be monitored clinically. There were no flap or donor related complications and good aesthetic outcomes were achieved. This technique offers a further option in microsurgical breast reconstruction for patients in whom there is a paucity of abdominal tissue for reconstruction. PMID:27047791

  3. The platysma myocutaneous flap.

    Science.gov (United States)

    Baur, Dale A; Williams, Jonathan; Alakaily, Xena

    2014-08-01

    Reconstructing defects of the oral mucosa or skin of the lower one-third of the face can be accomplished by a variety of techniques. This article presents two versions of the platysma myocutaneous flap, which is a reliable, axial pattern, pedicled flap capable of providing excellent one-stage reconstruction of such defects. As discussed herein, the superiorly based and posteriorly based versions of the flap have wide application in the oral and facial region. Also provided is a review of other uses of this flap in head and neck surgery. PMID:24958382

  4. Use of a Galeopericranial Flap for the Reconstruction of Anterior Cranial Base Defects

    OpenAIRE

    Chia-Hsiang Fu; Sheng-Po Hao; Yung-Shin Hsu

    2005-01-01

    Background: To evaluate the efficacy of using a galeopericranial flap for reconstruction ofanterior cranial base defects.Methods: In Linkou Chang Gung Memorial Hospital from February 1994 to November2003, 25 patients who had tumors of the skull base underwent craniofacialresection, and a galeopericranial flap was used to reconstruct the anterior cranialbase defect. The galeopericranial flap was developed and based on atleast 1 side of the supraorbital or supratrochlear arteries and veins; it ...

  5. Ophthalmic Artery Embolization as Pretreatment of Orbital Exenteration for Conjunctival Squamous Cell Carcinoma

    International Nuclear Information System (INIS)

    The aim of this study is to describe the effect of transarterial embolization from the ophthalmic artery as a pretreatment for orbital exenteration. A 75-year-old Chinese man with a 7-year history of gradual increase of the left eye swelling showed a massive conjunctival tumor growing outwardly from the interpalpebral fissure and had no light perception in the left eye. Magnetic resonance imaging showed orbital invasion of the tumor around the left eyeglobe. The initial surgery for the planned orbital exenteration was discontinued after skin incision around the orbital margin due to massive hemorrhage. The patient underwent transarterial embolization with gelatin sponge (Spongel) of the feeding arteries from the left ophthalmic artery and, the next day, had orbital exenteration with well-controllable bleeding and reconstruction with free vascularized anterolateral thigh cutaneous flap transfer. Pathologically, well-differentiated squamous cell carcinoma proliferated in exophytic, papillary, and nested fashions, arising from the bulbar conjunctiva. Tumor cells were also found in the conjunctival stroma around the vessels. The sclera at the equator had a perforated site with tumor cell invasion, but no intraocular invasion was found. Hematoxylin-positive gelatin sponges were found inside the orbital vessels and large choroidal vessels. In conclusion, transarterial embolization of feeding arteries arising from the ophthalmic artery is a useful pretreatment to control bleeding at orbital exenteration for malignancy.

  6. The effects of epinephrine and dobutamine on skin flap viability in rats

    DEFF Research Database (Denmark)

    Krammer, Caspar W; Ibrahim, Rami Mossad; Hansen, Tom G;

    2015-01-01

    to evaluate the effects of the intraoperative administration of epinephrine and dobutamine on axial-pattern skin flap survival in rats. METHODS: Fifty-four Sprague Dawley rats were randomized into three groups (n = 18). A tubed axial-pattern skin flap was performed. Animals were randomized to receive......BACKGROUND: Intraoperative reduction in arterial pressure may cause hypoperfusion of skin flaps, which may increase the risk of flap failure. There is no international consensus regarding the use of vasoactive or inotropic agents to restore or maintain flap perfusion. The purpose of this study was...... an intraperitoneal injection of epinephrine 0.1 mg/kg, dobutamine 0.3 mg/kg, or saline (0.5 ml). The rats were euthanized after 7 days and the viable area of the flap was compared between the groups using a digital imaging and computer software. RESULTS: Seven rats/flaps were excluded from the study...

  7. Medical image of the week: eosphageal perforation

    Directory of Open Access Journals (Sweden)

    Bilal J

    2015-04-01

    Full Text Available No abstract available. Article truncated after 150 words. A 74 year old man with a past medical history of esophageal strictures status post dilatation, coronary artery disease status post CABG, and atrial fibrillation presented to hospital with complaints of severe chest pain that began after the consumption of tortilla chips one hour prior to presentation. Electrocardiogram and cardiac enzymes were not consistent with acute coronary syndrome. Chest X-ray was consistent with a widened mediastinal silhouette. Contrast esophogram was negative for extra luminal extravasation. CT scan of the chest with oral contrast demonstrated thickening of the mid-thoracic esophagus with an extra-luminal focus of gas in the mediastinum along with fluid along the inferior aspect of the esophagus (Figures 1 and 2. These findings were concerning for esophageal perforation. The patient was taken to the operating room for endoscopy which showed micro perforation in mid-esophagus. Esophageal perforation remains a highly morbid condition. Mortality rates are based predominantly on time of ...

  8. Spontaneous Perforation of Pyometra

    OpenAIRE

    Sharma, Nalini; Singh, Ahanthem Santa; Bhaphiralyne, Wankhar

    2016-01-01

    Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perfor...

  9. Biomineralization in perforate foraminifera

    OpenAIRE

    L. J. de Nooijer; H. J. Spero; Erez, J.; Bijma, J.; Reichart, G. J.

    2014-01-01

    In this paper, we review the current understanding of biomineralization in perforate foraminifera. Ideas on the mechanisms responsible for the flux of Ca2 + and inorganic carbon from seawater into the test were originally based on light and electron microscopic observations of calcifying foraminifera. From the 1980s onward, tracer experiments, fluorescent microscopy and high-resolution test geochemical analysis have added to existing calcification models. Despite recent insights, no general c...

  10. Predicting venous insufficiency in flaps raised on the deep inferior epigastric system using computed tomography (CT) angiography.

    Science.gov (United States)

    Wagels, M; Pillay, R; Saylor, A; Vrtik, L; Senewiratne, S

    2015-12-01

    Computed Tomography Angiogram (CTA) has become a routine part of pre-operative assessment of vascular anatomy and design in perforator flaps. We conducted a retrospective cohort study of flap raised on the deep inferior epigastric system (DIES) at our institution in order to identify CTA signs that might predict venous congestion in these flaps. 98 consecutive patients who had 124 DIES flaps raised from 2008 to 2012 were studied. Of these 124 flaps, four (3.2%) developed venous congestion. Our results showed that a Superficial Inferior Epigastric Vein (SIEV) that is larger than the DIEV at origin is highly predictive of congestion (5.2 vs 3.5 mm, p = 0.007). The findings of an axial non-arborising superficial system (96.7% vs 0, p flap failure with patients, and contingency planning to augment venous drainage with the superficial system if required. PMID:26375461

  11. The rhombic bilobed flap, a simple, geometrically designed flap

    Directory of Open Access Journals (Sweden)

    Yoshiaki Sakamoto

    2014-01-01

    Full Text Available We describe a combination of the common rhomboid flap and bilobed flap and provide an example of its use. The rhombic bilobed flap is simple to use and is associated with fewer complications, such as pin-cushioning and standing cone deformities, while minimizing the risk of skin necrosis and tension on the flap.

  12. Knee and Ankle Reconstruction With Reverse Anterolateral Thigh and Free Anterolateral Thigh Flap From One Donor Site.

    Science.gov (United States)

    Choi, KyeongBeom; Cho, JaeHo; Park, MyongChul; Park, Dong Ha; Lee, Il Jae

    2016-09-01

    Traditionally, the anterolateral thigh (ALT) free flap is used in distal lower extremity reconstruction. Reverse ALT flap has become one of the most popular choices for knee joint soft tissue defects. A 53-year-old man sustained a degloving injury in the right lateral side of the lower extremity from the lateral malleolar area to the knee joint area. The contamination was severe, necessitating serial debridement and negative pressure wound therapy. After 4 weeks, no more soft tissue necrosis was evident. No more microorganism growth was confirmed by swab culture. ALT free flap using proximal perforator was planned for lateral malleolar area reconstruction and reverse ALT flap using distal perforator was planned to cover knee joint after confirming the pedicle length was sufficient for simultaneous knee and lateral malleolar area reconstruction. PMID:27317019

  13. Oesophageal perforation in extreme prematurity

    OpenAIRE

    Jones, Katherine Elizabeth; Wagener, Silke; Willetts, Ian Edward; Lakhoo, Kokila

    2012-01-01

    Management of oesophageal perforation in extremely premature babies is a challenge and carries a high morbidity. The authors report their experience of three separate cases of oesophageal perforation they encountered over the last 18 months in extremely premature neonates. In the first case, the diagnosis of oesophageal perforation was known in an otherwise stable baby who was treated conservatively with a good outcome. In the second and third cases, the patients proceeded to thoracotomy befo...

  14. Rare cause of oesophagus perforation

    OpenAIRE

    Sabuncuoglu, Mehmet Zafer; Benzin, Mehmet Fatih; Dandin, Ozgur; Cakir, Tugrul; Sozen, Isa; Sabuncuoglu, Aylin; Teomete, Uygar

    2014-01-01

    INTRODUCTION Oesophagus perforations, which are generally caused by iatrogenic injuries, are a serious clinical event. There are still high rates of mortality and morbidity and there is no gold standard of surgical treatment. PRESENTATION OF CASE The case is here presented of a 54-year old female with complaints of dysphagia after having swallowed a bone in food, who was determined with oesophagus perforation on CT examination. DISCUSSION Oesophagus perforation generally occurs secondary to i...

  15. Treatment of kid foot soft tissue defect with reverse flap with cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial%腓动脉皮支与腓肠神经联合远端蒂皮瓣修复小儿足踝部皮肤缺损

    Institute of Scientific and Technical Information of China (English)

    喻伟光; 邵新中; 吕莉; 苏晓清; 石硕

    2010-01-01

    Objective To investigate the clinical efficiency of kid foot soft tissue defect with reverse flap with cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial. Methods From Feb. 2006 to Feb. 2009, according to the position and size of the soft tissue defects, the sural nerve nutritional vessel flap combine with the cutaneous branch of the peroneal artery were desingned and obtained to repair the 5 cases soft tissue defects of the foot. The flap size ranged from 8 cm × 7 cm to 18 cm × 10 cm. The vessel pedicle of cutaneous branches ranged from 1.7 cm to 3.0 cm. The distribution of the vessel pedicle of cutaneous branches ranged from 4.5 cm to 8.0 cm on the lateral malleolus. Results All flaps survived completely in 6 cases. The outline and function were satisfactory during 6-18 months follow-up. Among of 6 cases, the sural nerve were anastomosed with the acceptor sensory nerve in all cases. The skin sense were sat-isfactory after 1 year of operation and 2-point discrimination was 10-13 mm. Conclusion The blood supply of this flap is reliable without sacrifice of major arteries. Flap elevation is easy. It can reverse to a long dis-tance and can repair large skin defects. Especially this flap could have some sensory nerve. It is very useful in repairing kid foot large soft tissue defect.%目的 探讨腓动脉皮支与腓肠神经营养血管联合远端蒂皮瓣逆行修复小儿足踝部皮肤缺损的临床应用效果.方法 根据缺损部位及大小设计以腓动脉下段皮支与腓肠神经营养血管的联合远端蒂及旋转点,沿腓肠神经营养血管轴线切取皮瓣,逆行移位修复小儿足踝部皮肤软组织缺损6例.皮瓣切取范围8.0 cm × 7.0 cm~18.0 cm×10.0 cm,联合血管蒂长1.7~3.0 cm,血管蒂发出部位位于外踝上4.0~8.0 cm.结果 术后6例皮瓣其中5例完全成活,创面Ⅰ期愈合.1例远端1.0 cm发生干性坏死,面积约2.0 cm×1.0 cm,经换药后愈合.随访6~18个月,

  16. 应用枕动脉跨区供血头皮瓣修复头皮肿瘤术后大面积复杂头皮缺损%Reconstruction of large and complex defects secondary to scalp tumor resection by reverse flow axial flap nourished by the artery acrossing area supply

    Institute of Scientific and Technical Information of China (English)

    李荷欢; 贺佳妮; 韩思源; 唐明睿; 刘晓颖

    2011-01-01

    目的 探讨头皮肿瘤切除术后大面积、复杂头皮缺损的修复方法.方法 应用枕动脉跨区供血的头皮瓣,修复伴有骨膜、颅骨缺失的占头皮1/3~1/2(8cm×6cm~14cm×13cm)的大面积头皮缺损者9例.结果 9例患者的枕动脉跨区供血反流轴型皮瓣全部成活,创面均Ⅰ期修复,术后随访3~42个月,头皮肿瘤未见复发,效果满意.结论 枕动脉与头皮其他血管之间存在广泛、稳定的吻合支,血运丰富,以枕动脉为供血动脉,跨区切取大面积的头皮瓣,一次修复头部肿瘤切除术后大面积复杂头皮缺损,是一种安全、可靠、有效的方法.%Objective To investigate the reconstruction method of large and complex scalp defects after scalp resection. Methods Nine reverse flow axial flaps nourished by the occipital artery acrossing area supply were designed to reconstruct the scalp defects ( range from 8 cm ×6 cm to 14 cm × 13 cm . about 1/3 to 1/2 ofthe scalp) with deficiency of periosteum and cranial bones. Results All 9 flaps survived completely and the defects were reconstructed primarily postoperatively. Satisfactory results were received in all cases after 3 to 42 months follow-up without tumor recurrence m any case. Conclusion The scalp is well vascularized and has abundant anastomoses between the occipital artery and other arteries of scalp. After the resection of scalp tumor,reverse flow axial flap nourished by the artery acrossing area supply based on the occipital artery is a relatively simple and reliable procedure for the reconstruction of large and complex scalp defect.

  17. A bilobed thoracoabdominal myocutaneous flap for large thoracic defects.

    Science.gov (United States)

    Charanek, Ali M

    2014-04-01

    The author presents a surgical procedure for chest-wall soft tissue reconstruction due to large losses based on a modified thoracoabdominal myocutaneous flap. Designed in a bilobed shape, it rests on the superior epigastric vessels and may include the cranial one fourth of the rectus abdominis muscle and the premuscular fascia of external oblique muscle and constitutes one of the largest flaps based on a single minor artery. Local recurrent breast tumors and adjuvant therapy associated to obesity, high blood pressure, type II diabetes, and tobacco abuse on previously debilitated patients render the usual reconstructive procedure difficulties. These become indications for this flap, whose safety is improved by maintaining the deep fascia of the external oblique muscle attached to the flap to preserve the network of the arteries close to the fascia and a wide-ranging interarterial choke anastomosis alongside the lateral projection of the flap on the thorax. Thus, a wide range of angles allows us to reach even the opposite site of the thorax over the sterna area with an easy closure of the donor site facilitated by the vertical portion of the abdominal donor site. The flap was used in 55 patients, and no serious complications, including necrosis, notable dehiscence, hematoma, seroma, or abdominal wall weakness, were observed. The overall aspect is acceptable with the visible scars over the upper part of the abdomen. PMID:23503434

  18. Ipsilateral fasciocutaneous flaps for leg and foot defects

    Directory of Open Access Journals (Sweden)

    Bhattacharya V

    2003-01-01

    Full Text Available It was a revolutionary enhancement for lower limb reconstruction when fasciocutaneous flaps were first described and used in clinical practice in 1981. Subsequently persistent studies were made to emphasize and confirm the rich vascular network associated with deep fascia. Thereafter studies were directed to identify the various types of perforators supplying the deep fascia and the overlying subcutaneous tissue and skin. Accordingly the scientists classified these flaps keeping in mind their clinical applications. The authors of this article have also performed extensive research on various aspects. This has led to better understanding about the finer details of vascularity. Based on this various modifications have been made for safe application of reconstruction for defects extending from knee to sole. To avoid complications the clinician should be able to select the proper procedure as regards the donor site and the possible preoperative and postoperative technical faults. A well-designed and meticulously executed flap usually has smooth recovery. Both Colour Doppler and Audio Doppler are useful tools in planning a safe flap. Now these flaps have proved to be standard technique without requiring a special set up extensive training.

  19. Post Stamp Perforation Recognition

    OpenAIRE

    Koníček, Vladimír

    2008-01-01

    Rozpoznávání zoubkování poštovních známek je důležitým faktorem při posuzování pravosti poštovní známky. Typ a rozměr zoubkování mají výrazný vliv na cenu poštovní známky. Tato práce se zabývá navrhem detektoru zoubkování poštovních známek. Cílem práce je vytvořit aplikaci, která z fotografie určí zoubkování zobrazené poštovní známky. Aplikace pro práci s obrazy využívá knihovnu OpenCV. Post stamp perforation recognition is important factor in authentication of post stamps. Type and perfor...

  20. Estudio preoperatorio de vasos receptores en reconstrucción mamaria con colgajo DIEP Preoperative planning of receiver vessels in breast reconstruction with DIEP flap

    Directory of Open Access Journals (Sweden)

    C. Tejerina Botella

    2011-09-01

    Full Text Available El estudio preoperatorio vascular de cualquier colgajo microquirúrgico es esencial para el buen desarrollo del mismo. En el colgajo DIEP (colgajo de perforante de arteria epigástrica inferior profunda aplicado a la reconstrucción mamaria, se han establecido durante los últimos años diferentes técnicas para la planificación preoperatoria de la anatomía de los vasos perforantes de la arteria epigástrica inferior. Sin embargo, pensamos, que también es muy importante la planificación anatómica preoperatoria de los vasos receptores, que en la mayoría de los casos son la arteria y vena mamarias internas. Estos vasos sufren en ocasiones variaciones anatómicas, llegando incluso a no existir en algunos pacientes. El conocimiento exacto de la localización, permeabilidad y calibre de estos vasos receptores hará que la intervención sea mas rápida y sencilla.An accurate preoperative vascular evaluation of microsurgical flaps is essential for a good procedure. In DIEP (deep inferior epigastric perforator flap, in breast reconstruction, have been described different preoperative techniques to study the anatomy of the deep inferior epigastric perforators. We think that preoperative planning of the receiver vessels, (internal mammary artery and vein, in most of cases is very important too. These vessels have anatomic changes in some patients. To know the exact location, permeability, and calibre of these vessels will help us to have a more easy and quick operation.

  1. Clinical anatomy of the donor zone of venous flaps of forearm

    Directory of Open Access Journals (Sweden)

    O. S. Kurochkina

    2012-01-01

    Full Text Available The variant anatomy of saphenous veins of forearm in the zones of venous flap rising remains unstudied yet, as well as the influence of the valve apparatus of saphenous veins on the arterial perfusion of venous flaps. The paper studies the variant anatomy of saphenous veins of the upper third of the volar surface of forearm. Two versions of saphenous veins are revealed: major (axial and retiform. It is found experimentally that the valve apparatus of saphenous veins does not influence considerably the arterial perfusion of venous flaps of forearm.

  2. Flapping of Insectile Wings

    Science.gov (United States)

    Huang, Yangyang; Kanso, Eva

    2015-11-01

    Insects use flight muscles attached at the base of the wings to produce impressive wing flapping frequencies. Yet the effects of muscle stiffness on the performance of insect wings remain unclear. Here, we construct an insectile wing model, consisting of two rigid wings connected at their base by an elastic torsional spring and submerged in an oscillatory flow. The wing system is free to rotate and flap. We first explore the extent to which the flyer can withstand roll perturbations, then study its flapping behavior and performance as a function of spring stiffness. We find an optimal range of spring stiffness that results in large flapping amplitudes, high force generation and good storage of elastic energy. We conclude by conjecturing that insects may select and adjust the muscle spring stiffness to achieve desired movement. These findings may have significant implications on the design principles of wings in micro air-vehicles.

  3. 腓肠神经营养血管皮瓣修复足踝部皮肤缺损%Clinical Application of Flap Pedicled with Sural Nerve Nutrient Vessel in Repairing Soft Tissue Defect of the Ankle and Foot

    Institute of Scientific and Technical Information of China (English)

    彭德飞; 程代薇; 李自力; 朱文; 杜娇

    2011-01-01

    Objective To explore the application of flap pedicled with sural nerve nutritional vessel axial in repairing soft tissue defect of the ankle and foot. Methods From January 2003 to January 2011, according to the position and size of the soft tissue defects, the modified flaps were applied in 13 cases with soft tissue defects of the ankle and foot on the anatomical basis of the inter-musclar septum perforating branches of peroneal artery and the sural nerve nutrient vessel. The flap size ranged from 9 cm x 8.5 cm to 28 cm x 13 cm. The vessel pedicle of perforating branches ranged from 1.7 cm to 3.3 cm. Results Among the 13 cases, 11 flaps survived completely, 2 patients suffered from distal edge necrosis and healed after dressing change. The outline and function were satisfactory during 6-12 months follow-up. Conclusion This flap is easy, reliable and large enough to repair skin defect of the ankle and foot.%目的 探讨改进腓肠神经营养血管皮瓣修复足踝部皮肤软组织缺损的方法及效果.方法 2003年1月至2011年1月,在腓动脉穿支与腓肠神经营养血供的解剖基础上,根据足踝部皮肤缺损大小,设计腓肠神经营养血管皮瓣,逆行移位修复足踝部皮肤软组织缺损13例.切取皮瓣而积9 cm×8.5 cm~ 28 cm×13 cm,穿支血管蒂长1.7~3.3 cm.结果 本组中11例皮瓣全部存活,2例皮瓣远端边缘坏死,经换药治愈.全部患者随访6~12个月,皮瓣外形及功能满意.结论 腓动脉穿支蒂腓肠神经营养血管皮瓣手术操作简便,血供可靠,切取面积大,适用于修复足踝部大面积皮肤软组织缺损.

  4. Deep plantar arteries of some mammals, with special reference to the plantar metatarsal arteries.

    OpenAIRE

    Horie,Masashi; Murakami,Takuro; Kikuta,Akio

    1988-01-01

    The plantar metatarsal arteries of some mammals were studied. In the dog, raccoon dog and cat, the second proximal perforating branch was fully developed and produced the plantar metatarsal arteries. These plantar metatarsal arteries ran on the plantar surfaces of the interosseous muscles along the metatarsal bones or intermetatarsal spaces, and gave rise to the digital arteries of the second to fifth toes. In the rabbit, a branch of the medial plantar artery ran transversely on the plantar s...

  5. Repair of finger soft tissue defects using axial pattern flaps%轴型皮瓣修复手指软组织缺损

    Institute of Scientific and Technical Information of China (English)

    梁钢; 徐宝成; 李大为

    2012-01-01

    目的 观察应用不同轴型皮瓣修复手指软组织缺损的临床效果并探讨其可行性.方法 2005-2010年,对浙江绍兴第二医院收治的30例手指软组织缺损患者,分别应用5种轴型皮瓣进行修复,其中拇指背侧皮神经营养血管远端蒂皮瓣4例、游离足拇趾腓侧皮瓣6例、改良掌背动脉逆行皮瓣8例、游离骨间后动脉桡背侧肌间隔穿支皮瓣6例以及携带长段骨间后动脉的游离骨间后动脉皮瓣6例.皮瓣切取面积2.5 cm ×2.0 cm ~8.0 cm×3.0 cm.供瓣区创面直接缝合或移植皮片修复.观察患者术后皮瓣成活情况,随访患手局部感觉、功能及外形变化. 结果 本组患者中27例术后切口无感染、皮瓣成活良好;2例皮瓣远端部分坏死、1例发生静脉危象,经处理创面愈合.18例患者获得1 ~12个月的随访,皮瓣色泽、质地较好,厚薄适中.大多数患者受区拇指或掌指的外形及功能恢复达预期目的,两点辨别觉为5 ~9 mm;供瓣区外形和功能基本不受影响. 结论 根据手指软组织缺损的具体情况,结合不同轴型皮瓣特点进行优化选择,多能获得预期效果.%Objective To investigate the feasibility and effect of different types of axial pattern flaps in repairing soft tissue defects of the fingers. Methods Five types of axial pattern flaps were used to repair soft tissue defects of the fingers of 30 patients admitted to the Second Hospital of Shaoxing Municipality from 2005 to 2010,including distally-based dorsal thumb neurocutaneous vascular flaps in 4 cases,free flaps from the fibular side of the great toe in 6 cases,modified retrograde dorsal metacarpal artery flaps in 8 cases,free flaps based on the radiodorsal septomuscular perforator of the posterior interosseous artery in 6 cases,and free posterior interosseous artery flaps carrying a long segment of the posterior interosseous artery in 6 cases.The flap size ranged from 2.5 cm × 2.0 cm to 8.0 cm × 3.0 cm

  6. Control of Flap Vortices

    Science.gov (United States)

    Greenblatt, David

    2005-01-01

    A wind tunnel investigation was carried out on a semi-span wing model to assess the feasibility of controlling vortices emanating from outboard flaps and tip-flaps by actively varying the degree of boundary layer separation. Separation was varied by means of perturbations produced from segmented zero-efflux oscillatory blowing slots, while estimates of span loadings and vortex sheet strengths were obtained by integrating wing surface pressures. These estimates were used as input to inviscid rollup relations as a means of predicting changes to the vortex characteristics resulting from the perturbations. Surveys of flow in the wake of the outboard and tip-flaps were made using a seven-hole probe, from which the vortex characteristics were directly deduced. Varying the degree of separation had a marked effect on vortex location, strength, tangential velocity, axial velocity and size for both outboard and tip-flaps. Qualitative changes in vortex characteristics were well predicted by the inviscid rollup relations, while the failure to account for viscosity was presumed to be the main reason for observed discrepancies. Introducing perturbations near the outboard flap-edges or on the tip-flap exerted significant control over vortices while producing negligible lift excursions.

  7. Microsurgical medial plantar flap banking: a method of choice for digital tip injury?

    Science.gov (United States)

    Nagase, T; Ohmori, K

    1998-11-01

    A tip injury of the left thumb was repaired via microsurgical medial plantar flap banking. The medial plantar flap was transferred temporarily to the lower abdominal wall and was anastomosed microsurgically to the deep inferior epigastric artery and vein as a banked flap. It was later grafted to the thumb in a manner similar to a pedicled flap. The flap was transferred successfully, and the tissue texture and bulk was sufficient, with considerable sensory recovery and minimal donor site deformity. This method may be worthwhile to consider as one of the options of digital tip reconstruction, and the concept of microsurgical flap banking may be promising in the field of reconstructive microsurgery. PMID:9827959

  8. High-resolution postcontrast time-of-flight MR angiography of intracranial perforators at 7.0 Tesla.

    Directory of Open Access Journals (Sweden)

    Anita A Harteveld

    Full Text Available BACKGROUND AND PURPOSE: Different studies already demonstrated the benefits of 7T for precontrast TOF-MRA in the visualization of intracranial small vessels. The aim of this study was to assess the performance of high-resolution 7T TOF-MRA after the administration of a gadolinium-based contrast agent in visualizing intracranial perforating arteries. MATERIALS AND METHODS: Ten consecutive patients (7 male; mean age, 50.4 ± 9.9 years who received TOF-MRA at 7T after contrast administration were retrospectively included in this study. Intracranial perforating arteries, branching from the parent arteries of the circle of Willis, were identified on all TOF-MRA images. Provided a TOF-MRA before contrast administration was present, a direct comparison between pre- and postcontrast TOF-MRA was made. RESULTS: It was possible to visualize intracranial perforating arteries branching off from the entire circle of Willis, and their proximal branches. The posterior cerebral artery (P1 and proximal segment of P2 appeared to have the largest number of visible perforating branches (mean of 5.1 in each patient, with a range of 2-7. The basilar artery and middle cerebral artery (M1 and proximal segment M2 followed with a mean number of 5.0 and 3.5 visible perforating branches (range of 1-9 and 1-8, respectively. Venous contamination in the postcontrast scans sometimes made it difficult to discern the arterial or venous nature of a vessel. CONCLUSION: High-resolution postcontrast TOF-MRA at 7T was able to visualize multiple intracranial perforators branching off from various parts of the circle of Willis and proximal intracranial arteries. Although confirmation in a larger study is needed, the administration of a contrast agent for high-resolution TOF-MRA at 7T seems to enable a better visualization of the distal segment of certain intracranial perforators.

  9. High-Resolution Postcontrast Time-of-Flight MR Angiography of Intracranial Perforators at 7.0 Tesla

    Science.gov (United States)

    Harteveld, Anita A.; De Cocker, Laurens J. L.; Dieleman, Nikki; van der Kolk, Anja G.; Zwanenburg, Jaco J. M.; Robe, Pierre A.; Luijten, Peter R.; Hendrikse, Jeroen

    2015-01-01

    Background and Purpose Different studies already demonstrated the benefits of 7T for precontrast TOF-MRA in the visualization of intracranial small vessels. The aim of this study was to assess the performance of high-resolution 7T TOF-MRA after the administration of a gadolinium-based contrast agent in visualizing intracranial perforating arteries. Materials and Methods Ten consecutive patients (7 male; mean age, 50.4 ± 9.9 years) who received TOF-MRA at 7T after contrast administration were retrospectively included in this study. Intracranial perforating arteries, branching from the parent arteries of the circle of Willis, were identified on all TOF-MRA images. Provided a TOF-MRA before contrast administration was present, a direct comparison between pre- and postcontrast TOF-MRA was made. Results It was possible to visualize intracranial perforating arteries branching off from the entire circle of Willis, and their proximal branches. The posterior cerebral artery (P1 and proximal segment of P2) appeared to have the largest number of visible perforating branches (mean of 5.1 in each patient, with a range of 2–7). The basilar artery and middle cerebral artery (M1 and proximal segment M2) followed with a mean number of 5.0 and 3.5 visible perforating branches (range of 1–9 and 1–8, respectively). Venous contamination in the postcontrast scans sometimes made it difficult to discern the arterial or venous nature of a vessel. Conclusion High-resolution postcontrast TOF-MRA at 7T was able to visualize multiple intracranial perforators branching off from various parts of the circle of Willis and proximal intracranial arteries. Although confirmation in a larger study is needed, the administration of a contrast agent for high-resolution TOF-MRA at 7T seems to enable a better visualization of the distal segment of certain intracranial perforators. PMID:25774881

  10. Spontaneous Perforation of Pyometra

    Directory of Open Access Journals (Sweden)

    Begüm Yildizhan

    2006-01-01

    Full Text Available Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01–0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6% [3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy. Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture.

  11. CT findings of exophageal perforation

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Jeong Nam; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Hahm, Chang Kok [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2002-09-01

    To determine which CT findings are useful for the early disgnosis of esophageal perforation, and on the basis of these findings, to assess the accuracy of prediction of the perforation site. A review of medical records indicated that between January 1995 and December 2001, 36 patients with esophageal perforation were admitted to our hospital. Thirteen of these [M:F=8:5, age; 28-69 (mean, 52.4) years], who had undergone CT chest scanning, were included in this study. The causes of esophageal perforation were trauma (n=5), infectious diseases (n=4), Boerhaave syndrome (n=1), lung cancer (n=1), esophageal cancer (n=1), and idiopathic. Two chest radiologists unaware of the clinical findings reviewed the CT scans and predicted whether the upper or lower esophagus was perforated. The most common CT finding was extraluminal air at the posterior mediastinum (n=11), while other findings included pulmonary consolidation (n=10), pleural effusion (n=7), discontinuity of the esophageal wall (n=6) and subcutaneous emphysema (n=4), fluid collection around the esophagus (n-4), esophageal wall thickening (n=4), pneumothorax (n=2), and lung abscess (n=2). The perforation site was accurately predicted in 76.9% of cases (10/13). The CT findings which help the diagnosis of esophageal perforation, and prediction of the sites at which it occurs, are extraluminal air of fluid collection, focal defect of the esophageal wall, and esophageal wall thickening.

  12. Vascularized iliac osteocutaneous flap based on the deep circumflex iliac vessels: experience in 13 cases.

    Science.gov (United States)

    Minami, A; Ogino, T; Itoga, H

    1989-01-01

    We have carried out 13 vascularized iliac osteocutaneous flaps (VIOF) based on the deep circumflex artery (DCIA) and accompanying veins for cases with compound skin and bone defects. Ten of 13 cases obtained bony union at both ends of the iliac crest with only VIOF. Two of the remaining 3 cases obtained bony union at one end only with the VIOF but united at another end with an additional conventional bone grafting procedure. The final case, a traumatic bone defect of the tibia, failed to obtain bony union at either end of the iliac segment. In 5 of 11 patients in which an osteocutaneous flap was used, complete skin flap survival occurred. Of the remaining 6, one flap went on to complete necrosis, and five flaps were complicated by superficial or partial necrosis. The incidence of flap complications was analysed according to the size of flap. Five flaps with complete survival averaged 6.8 x 10.6 cm in size; however, five flaps with superficial or partial necrosis averaged 10.0 x 15.8 cm. These results suggest that the maximal safe skin flap dimension from the DCIA supply alone is probably 10 x 15 cm. PMID:2671586

  13. Combination of microvascular medial femoral condyle and iliac crest flap for hemi-midface reconstruction.

    Science.gov (United States)

    Brandtner, C; Hachleitner, J; Buerger, H; Gaggl, A

    2015-06-01

    In midface defects including the orbit (Brown class III and IV), no single flap can provide adequate reconstruction. In this technical note, the combination of vascularized iliac crest flap and vascularized medial femoral condyle flap (MFC) is described. The vascularized iliac crest flap is reported to be the gold standard for maxilla reconstruction. There is, however, no consensus on the best method for orbital and nasal wall reconstruction. The MFC flap can be harvested as a thin corticoperiosteal flap or as an osteomyocutaneous flap. Due to the periosteal blood supply, this flap can be customized for an individual defect of the upper hemi-midface. It is therefore of great benefit in orbital and nasal wall reconstruction. By combining the deep circumflex iliac artery (DCIA) bone flap and the MFC flap, the best standard reconstruction technique of the hemi-maxilla can be combined with a new anatomical precise microvascular reconstruction technique of the orbit. A nearly symmetric midface appearance can be achieved. PMID:25835757

  14. Redefining the vascular anatomy of the peroneus brevis muscle flap.

    Science.gov (United States)

    Ensat, Florian; Weitgasser, Laurenz; Hladik, Michaela; Larcher, Lorenz; Heinrich, Klemens; Skreiner, Anna; Russe, Elisabeth; Fuerntrath, Frank; Kamp, Jonas; Cotofana, Sebastian; Wechselberger, Gottfried

    2015-01-01

    The peroneus brevis flap can be used as either proximally or distally based flap for coverage of small to medium-sized defects in the lower leg. The purpose of this study was to clarify the vascular anatomy of the peroneus brevis muscle. An anatomical dissection was performed on 17 fixed adult cadaver lower legs. Altogether, 87 segmental branches (mean 5.1 ± 1.6 per leg) either from the fibular or anterior tibial artery to the muscle were identified. Sixty-two were branches from the fibular artery (mean 3.4 ± 1.1 per fibular artery), whereas 25 (mean 1.4 ± 0.9 per anterior tibial artery) originated from the anterior tibial artery. The distance between the most distal vascular branch and the malleolar tip averaged 4.3 ± 0.6 cm. An axial vascular bundle to the muscle could be identified in all cadavers; in one leg two axial supplying vessels were found. Their average length was 5.5 ± 2.4 cm and the average arterial diameter was 1.1 ± 0.5 mm, the average venous diameter was 1.54 ± 0.7 mm. The constant blood supply to the peroneus brevis muscle by segmental branches from the fibular and tibial artery make this muscle a viable option for proximally or distally pedicled flap transfer. The location of the most proximal and distal branches to the muscle and conclusively the pivot points for flap transfer could be determined. Furthermore, a constant proximal axial vascular pedicle to the muscle may enlarge the clinical applications. Perfusion studies should be conducted to confirm these findings. PMID:25046821

  15. Treatment of oesophageal perforation by intubation.

    OpenAIRE

    Quayle, A R; Moore, P. J.; Jacob, G.; Griffith, C D; Rogers, K

    1985-01-01

    The mortality following oesophageal perforation ranges from 25% to 100% depending on the delay in diagnosis and treatment. Although the treatment recommended for thoracic perforations is emergency thoracotomy and suture of the perforation, the avoidance of this approach in elderly patients is desirable. We therefore describe 6 cases of oesophageal perforation which were treated by insertion of a Celestin tube at laparotomy.

  16. Thoracic Esophageal Perforation After Blunt Trauma in a Child: A Delayed Diagnosis and Surgical Management.

    Directory of Open Access Journals (Sweden)

    Alper Avci

    2010-09-01

    Full Text Available Esophageal rupture due to external blunt trauma is extremely rare in children. A-13-year old boy was admitted to emergency room with shortness of breath and abdominal pain. His history revealed fall down from 3 metres height, falling of a wooden block over chest, 4 hours before at home. Thoracic esophageal perforation was diagnosed at the 6th day of hospital stay. Surgical management was planned and right-sided  thoracotomy was performed at the 7th day after admission. The esophageal layers were closed primarily and separately after muscular and mucosal debridement. Reinforcement of the primary repair was done with pleural and intercostal muscle flaps. The esophagus was tied with absorbable sutures at proximal and distal parts of the perforation to block the esophageal passage. Gastrostomy and jejunostomy were performed for nutrition. We report here a successful management with primary repair of this esophageal perforation of late diagnosis.

  17. Reconstruction of an emergency thoracotomy wound with free rectus abdominis flap: Anatomic and radiologic basis for the surgical technique

    Directory of Open Access Journals (Sweden)

    Barnett Carlton

    2010-05-01

    Full Text Available Abstract An alcoholic 50-year-old male patient with a history of schizophrenia sustained stab wounds into both ventricles and left lung, and survived following an emergency department thoracotomy. The EDT wound, however became infected requiring serial debridements of soft tissue, rib cartilage and sternum. Regional flap options such as pectoralis major and latissimus dorsi muscle flaps could not be employed due to inadequate reach of these flaps. Additionally, bilateral transection of the internal mammary arteries during emergency thoracotomy eliminated the use of rectus abdominis muscles as pedicled flaps based on the superior epigastric vasculature. Therefore, the EDT wound was reconstructed by using the right rectus abdominis muscle as a free flap. The deep inferior epigastric vessels of the flap were anastomosed to the right internal mammary vessels proximal to their transection level in the third-forth intercostal space. The flap healed with no further wound complications.

  18. Perforated midgut diverticulitis: Revisited

    Directory of Open Access Journals (Sweden)

    Milan Spasojevic

    2012-01-01

    Full Text Available AIM: To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis. METHODS: Three data sources were used: the Medline and Google search engines were searched for case reports on one or more patients treated for perforated midgut diverticulitis (Meckel’s diverticulitis excluded that were published after 1995. The inclusion criterion was sufficient individual patient data in the article. Both indexed and non-indexed journals were used. Patients treated for perforated midgut diverticulitis at Vestfold Hospital were included in this group. Data on symptoms, laboratory and radiology results, treatment modalities, surgical access, procedures, complications and outcomes were collected. The Norwegian patient registry was searched to find patients operated upon for midgut diverticulitis from 1999 to 2007. The data collected were age, sex, mode of access, surgical procedure performed and number of patients per year. Historical controls were retrieved from an article published in 1995 containing pertinent individual patient data. Statistical analysis was done with SPSS software. RESULTS: Group I: 106 patients (48 men were found. Mean age was 72.2 ± 13.1 years (mean ± SD. Age or sex had no impact on outcomes (P = 0.057 and P = 0.771, respectively. Preoperative assessment was plain radiography in 53.3% or computed tomography (CT in 76.1%. Correct diagnosis was made in 77.1% with CT, 5.6% without (P = 0.001. Duration of symptoms before hospitalization was 3.6 d (range: 1-35 d, but longer duration was not associated with poor outcome (P = 0.748. Eighty-six point eight percent of patients underwent surgery, 92.4% of these through open access where 90.1% had bowel resection. Complications occurred in 19.2% of patients and 16.3% underwent reoperation. Distance from perforation to Treitz ligament was 41.7 ± 28.1 cm. At surgery, no peritonitis was found in 29.7% of patients, local

  19. Multiple bowel perforation and necrotising fasciitis secondary to abdominal liposuction in a patient with bilateral lumbar hernia

    Directory of Open Access Journals (Sweden)

    Vincent Delliere

    2014-01-01

    Full Text Available We present a rare complication of abdominal liposuction: bowel perforation and necrotizing fasciitis. Because of bilateral lumbar hernia, a 56-year-old woman had caecum and descending colon perforation during lipoplasty. She had septic shock syndrome at her admission. The authors treated this complex wound with several debridement, omental flap, NPWT and split-thickness skin graft. The incidence of abdominal wall perforation with visceral injury is 14 in 100,000 liposuctions performed. There are only 12 cases of bowel perforation in literature but this complication is probably underestimated. Prompt surgical debridement is absolutely mandatory in this life threatening scenario. Lumbar hernia is very rare and should be ruled out before every abdominal liposuction clinically or with imaging modalities.

  20. Clinical application of branch artery of the sural medial gastrocnemius muscle flap combine with sural nerve nutritional vessel axial%腓肠肌内侧头穿支动脉与腓肠神经营养血管联合蒂肌皮瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    邵新中; 喻伟光; 王巧君; 王英彩; 吕莉; 王立; 孙建涛

    2011-01-01

    Objective To investigate the clinical efficiency of branch artery of the sural medial gastrocnemius muscle flap combine with sural nerve nutritional vessel axial.Methods From February 2006to March 2010,according to the position and size of the soft tissue defects,the muscle flap combined with branch artery of the sural medial gastrocnemius and sural nerve nutritional vessel axial were desingned and obtained to repair 7 cases of sofi tissue defects of the upper-region of the tibial.The flap size ranged from 8.0 cm × 8.0 cm to 12.0 cm × 10.0 cm.The vessel pedicle of branches ranged from 1.8-3.0 cm.The distribution of the vessel pedicle of branches ranged from 10.0-17.0 cm on the distant popliteal fossa,and ranged from 2.0-5.0 cm on the back of medial line.Results The outline and function were satisfactory during 6-15 months follow-up.Conclusion The blood supply of this flap is reliable without sacrifice of major arteries.Flap elevation is easy.It can transfer to a long distance and can repair large skin defects.It is very useful in repairing upper-region of the tibial large soft tissue defect.%目的 探讨腓肠肌内侧头穿支动脉与腓肠神经营养血管联合蒂肌皮瓣的临床应用效果.方法 自2006年2月至2010年3月,根据缺损部位及大小设计以腓肠肌内侧头穿支动脉与腓肠神经营养血管轴的联合蒂,沿腓肠肌内侧头血管轴切取皮瓣,顺行移位修复膑前及胫骨上段皮肤及软组织缺损7例.皮瓣切取范围8.0 cm×8.0 cm~12.0 cm×10.0 cm,联合血管蒂长1.8~3.0 cm,联合血管蒂发出位于腘褶皱以远10.0 ~ 17.0 cm,距后正中线2.0~5.0 cm的范围内.结果 6例伤口一期愈合.1例发生皮瓣远端表浅干性坏死,面积约1 cm×2 cm,经换药后逐渐愈合.随访6~ 15个月,无任何并发症,肌皮瓣质地优良,外观满意.结论 腓肠肌内侧头穿支动脉与腓肠神经营养血管联合蒂肌皮瓣手术操作简便,血供可靠且不牺牲主要动脉,切取面

  1. [PELVIC FLOOR RECONSTRUCTION AFTER PELVIC EVISCERATION USING GRACILIS MUSCULOCUTANEOUS FLAP].

    Science.gov (United States)

    Pavlov, V N; Bakirov, A A; Kabirov, I R; Izmajlov, A A; Kutlijarov, L M; Safiullin, R L; Urmancev, M F; Sultanov, I M; Abdrahimov, R V

    2015-01-01

    Evisceration of the pelvic organs (EPO) is a fairly uncommon surgical treatment that removes all organs from a patient's pelvic cavity. We use gracilis musculocutaneous flap to repair pelvic floor after EPO. Over the period from November 2013 to December 2014 we carried out EPO with reconstructive repair of the pelvic floor with gracilis musculocutaneous flap in 10 patients with locally advanced pelvic tumors. We describe the surgical procedure and surgical outcomes in these patients. Mean age of the patients was 55 years. Mean duration of EPO with the pelvic floor repair was 285 min., mean blood loss--595 mL and the average length of hospital stay--19 days. Gracilis musculocutaneous flap has a sufficient arterial supply and mobility for pelvic floor reconstruction. Necrosis of flap's distal edge occurred in one of the 10 clinical cases, while the remaining flaps were fully preserved. Complete healing of wounds with no signs of weakening of the pelvic floor muscles was observed in all cases. Pelvic floor reconstruction is an essential procedure in order to reduce complications associated with the evisceration of the pelvic organs. The Gracilis musculocutaneous flap is the logical alternative to repair pelvic floor defect. It does not contribute to complications like functional deficiency of the lower limbs, complications of stoma formation or weakening of the muscles of the anterior abdominal wall. PMID:26390558

  2. Early Mobilization after Free-flap Transfer to the Lower Extremities: Preferential Use of Flow-through Anastomosis

    Directory of Open Access Journals (Sweden)

    Shimpei Miyamoto, MD

    2014-03-01

    Conclusions: This study demonstrates that early mobilization after free-flap transfer to the lower extremity is made possible by flow-through anastomosis for both arteries and veins. Flow-through flaps have stable circulation from the acute phase and can tolerate early dangling and ambulation.

  3. Spontaneous Intestinal Perforation in Neonates

    Directory of Open Access Journals (Sweden)

    Charu Tiwari

    2015-03-01

    Full Text Available Background: The term Spontaneous Intestinal Perforation (SIP suggests a perforation in the gastrointestinal tract of a newborn with no demonstrable cause.Methods: Four neonates presenting with spontaneous bowel perforation were analyzed with respect to clinical presentation, management and outcome.Results: The mean age at presentation was 11.4 days. There were three males and one female. One of the neonates was preterm, very low birth weight and the other three were full term. Two neonates underwent emergency exploratory laparotomy and two were initially managed by peritoneal drainage in view of poor general condition; one of them improved and did not require further operative intervention. The preterm very low birth weight neonate was stabilized and explored after 48 hours. Intra-operatively, two of them had two ileal perforations each which required ileostomy; one had single perforation in the transverse colon which was primarily repaired. All four had an uneventful recovery.Conclusion: SIP is a distinct clinical entity and has better outcome than neonates with intestinal perforation secondary to Necrotizing Enterocolitis (NEC.

  4. Propeller Flaps and Its Outcomes - A Prospective Study of 15 Cases Over Two-years

    Science.gov (United States)

    K.T., Ramesha; J., Vijay; M., Shankarappa

    2014-01-01

    Introduction: Cover flaps are needed in management of any bodily defect involving bone, tendon, nerve & vessels. The major objective of a plastic surgeon, facing a complex soft-tissue defect, is to replace “like with like” tissues at minimal donor site “cost” and with maximal accuracy & efficacy. Aims: To study the “Propeller Flaps” utility in reconstructive surgeries, evaluate its planning and complications involving donor site morbidity. Methodology: The prospective study was conducted on 15 cases (11 males/4 females) of propeller flaps during the period of two years (2010-12) in Department of Plastic Surgery and Burns, Bangalore Medical College and Research Institute (BMCRI), Karnataka, India. The propeller flaps were performed in cases with defects due to any cause. Exclusion criteria: Cases with Peripheral Vascular Disease (PVD). Flaps were performed and details recorded. Results: Overall results revealed problem resolution in 87% cases (13 cases). Comprehensive description of each flap type and its related cases are given in the table. It has been categorically found that there were 2 flap partial losses. Partial necrosis has been reported in heavy-smoker patients. Conclusion: This current study clearly justifies that careful application, optimal designing & judicious scientific application of local perforator flaps for lower-limb wounds including rest of the body is successful in many aspects providing high-quality reconstruction ensuring minimal morbidity. It is cost-effective as well as time-saving. PMID:24596732

  5. Angular vessels as a new vascular pedicle of an island nasal chondromucosal flap: Anatomical study and clinical application

    OpenAIRE

    HOU, DIANJU; Fang, Lin; Zhao, Zhenmin; ZHOU, CHUANDE; YANG, MINGYONG

    2012-01-01

    Successful eyelid reconstructions have been reported when using an axial nasal chondromucosal flap based on the dorsal nasal artery. The present study aimed to present a detailed anatomical description of the blood supply of the lateral nasal region and the angular artery, in order to propose the angular vessels as a new vascular pedicle for the island nasal chondromucosal flap. A total of 11 cadavers (22 hemi-faces) were examined. Observations with regard to the origin, course and distributi...

  6. CLINICAL STUDY OF DUODENAL PERFORATION

    Directory of Open Access Journals (Sweden)

    Sambasiva Rao

    2016-04-01

    Full Text Available BACKGROUND The duodenal injury can pose a formidable challenge to the surgeon and failure to manage it properly may have devastating results. Over the centuries, there was little to offer the patient of acute abdomen beyond cupping, purgation and enemas, all of which did more harm than good. It was not until 1884 that Mikulicz made an attempt to repair a perforation. Recent statistics indicate roughly 10% of population develop gastric or duodenal ulcer in life time. Roughly 1-3% of population above the age of 20 years have some degree of peptic ulcer activity during any annual period. A detailed history with regards to the signs and symptoms of the patient, a meticulous examination, radiological and biochemical investigations help to arrive at a correct preoperative diagnosis. In this study, a sincere effort has been put to understand the demographic patterns, to understand the underlying aetiology and to understand the effectiveness of the standard methods of investigation and treatment in use today. METHODS This is a 24 months prospective study i.e., from September 2011 to September 2013 carried out at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation. The study included the patients presenting to Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation to emergency ward with signs and symptoms of hollow viscus perforation. The sample size included 30 cases of duodenal perforation. RESULTS Duodenal ulcer perforation commonly occurs in the age group of 30-60 years, but it can occur in any age group. Majority of the patients were male. Smoking and alcohol consumption were risk factors in most cases (53.3% for the causation of duodenal ulcer perforation. Sudden onset of abdominal pain, situated at epigastrium and right hypochondrium was a constant symptom (100%. Vomiting, constipation and fever were not so common. CONCLUSION The emergency surgical management for perforated duodenal ulcer is by

  7. Development of radiation injury model in musculocutaneous flaps used for breast reconstruction

    International Nuclear Information System (INIS)

    Purpose/Objective: Occasionally it becomes necessary to treat women who have undergone a mastectomy and immediate musculocutaneous flap breast reconstruction with radiation therapy for microscopically positive margins. Radiation therapy is known to have a wide range of deleterious effects on living tissue and, specifically composite flaps. Small vessel thrombosis, necrosis, lymphedema, fibroblast dysfunction, and severe contracture are just a few of these effects that may lead to flap compromise. An animal model of the TRAM flap has been described: however, a thorough review of the literature finds a few experimental studies on the effects of radiation on musculocutaneous flaps. This study is designed to produce a reproducible and quantitative model of radiation injury that can service as a basis for further investigation. Materials and Methods: Eleven adult male Sprague-Dawley rats underwent a standardized rectus abdominis musculocutaneous flap based on the superior epigastric artery. Two control rats had flaps raised but did not receive radiation. The flaps were allowed to heal six weeks and the remaining rats were randomized to three groups of three rats each. The first group received 2000 rads in five fractions, the second 3000 rads in ten fractions, and the third 3000 rads in 15 fractions. Radiation was delivered via a dual energy clinical linear accelerator centered over the flap. The rats were sacrificed at eight weeks from the last dose of radiation. The flaps were subjected to elasticity measuring by standard Instron tensiometer, total surface area measurements and standard histology stains, as well as elastin stains and Masson Trichrome stains. Results: The total area of the flap measured by Mocha analysis decreased in all rats from the initial 30 cm2. However, the decrease in irradiated flaps was greater when compared to non-irradiated controls and the degree of contracture increased as the amount of radiation increased. Control flaps averaged 16.27 cm2

  8. Posterior repair with perforated porcine dermal graft

    Directory of Open Access Journals (Sweden)

    G. Bernard Taylor

    2008-02-01

    Full Text Available OBJECTIVE: To compare postoperative vaginal incision separation and healing in patients undergoing posterior repair with perforated porcine dermal grafts with those that received grafts without perforations. Secondarily, the tensile properties of the perforated and non-perforated grafts were measured and compared. MATERIALS AND METHODS: This was a non-randomized retrospective cohort analysis of women with stage II or greater rectoceles who underwent posterior repair with perforated and non-perforated porcine dermal grafts (PelvicolTM CR Bard Covington, GA USA. The incidence of postoperative vaginal incision separation (dehiscence was compared. A secondary analysis to assess graft tensile strength, suture pull out strength, and flexibility after perforation was performed using standard test method TM 0133 and ASTM bending and resistance protocols. RESULTS: Seventeen percent of patients (21/127 who received grafts without perforations developed vaginal incision dehiscence compared to 7% (5/71 of patients who received perforated grafts (p = 0.078. Four patients with vaginal incision dehiscence with non-perforated grafts required surgical revision to facilitate healing. Neither tensile strength or suture pull out strength were significantly different between perforated and non-perforated grafts (p = 0.81, p = 0.29, respectively. There was no difference in the flexibility of the two grafts (p = 0.20. CONCLUSION: Perforated porcine dermal grafts retain their tensile properties and are associated with fewer vaginal incision dehiscences.

  9. Indications and long-term assessment of 10 cases of cross-leg free DCIA flaps.

    Science.gov (United States)

    Townsend, P L

    1987-09-01

    Compound fractures of the lower limb with skin and bone loss are difficult repair problems, especially in multiple level injuries. With bone loss between 6 and 12 cms, the deep circumflex iliac artery (DCIA) flap is usually the flap of choice in reconstruction; the aim is to carry out microvascular anastomosis of the flap vessels to vessels on the damaged leg. However, this may be difficult or even impossible. Experience of 10 cross-leg DCIA flaps is outlined, with indications and surgical technique. The long-term bone healing is compared with 13 cases with anastomosis based on the same leg. There appears to be no difference in callus formation and remodelling of bone, indicating that despite subsequently dividing the original main vascular supply the bone in the DCIA flap remains vascularized and behaves as such. PMID:3310809

  10. Diagnosis and management of coronary dissection and perforation in percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    TAN Ning; HE Peng-cheng

    2010-01-01

    @@ With 20 years of instrumental progress and technical creativity,percutaneous coronary intervention(PCI)has become one of the most important treatments for coronary artery disease.As PCI depends either on the mechanical dilatation of the artery or on the ablation of atherosclerotic plaque,and because most procedures are carried out in impaired coronary arteries,including the passage of the guidewire,balloon inflation,and stent implantation,PCI may result in life-threatening complications,such as dissection and perforation.These complications should be treated correctively and promptly.The purpose of this paper was to review the incidence,pathogenesis and management of coronary artery dissection and perforation arising from the use of PCI.

  11. Clinical anatomy of the donor zone of venous flaps of forearm

    OpenAIRE

    O. S. Kurochkina

    2012-01-01

    The variant anatomy of saphenous veins of forearm in the zones of venous flap rising remains unstudied yet, as well as the influence of the valve apparatus of saphenous veins on the arterial perfusion of venous flaps. The paper studies the variant anatomy of saphenous veins of the upper third of the volar surface of forearm. Two versions of saphenous veins are revealed: major (axial) and retiform. It is found experimentally that the valve apparatus of saphenous veins does not influence consid...

  12. Critical Appraisal of Nasolabial Flap for Reconstruction of Oral Cavity Defects in Cancer Patients

    International Nuclear Information System (INIS)

    Purpose: Re-evaluation of nasolabial flap in lip and oral cavity reconstruction and role of each of its variants in reconstructing various intermediate size defects was addressed. Patients and Methods: Case-series study was con-ducted in National Cancer Institute, Cairo University over the period from July 2005 - January 2009 which included 23 patients with clinically T-l N0, T-2 N0 invasive squamous cell carcinoma of buccal mucosa and the vermilion border of the lower lip. Immediately after surgical excision, one stage reconstruction of the defect was done using a type of nasolabial flap. All patients were followed and the median follow-up period was 7.5 month. Results: Twelve patients with the lower lip carcinoma and 11 patients with the carcinoma of buccal mucosa underwent surgical excision under frozen section control. 19 fasciocutaneous nasolabial flap and 4 facial artery musculomucosal flaps were used for reconstruction. Minor wound complications occurred in 2 flaps and one patient required secondary suture. Flap viability was reliable and was not affected by performance of a synchronous neck dissection. Functional results were satisfactory, cosmetic results were good in most of the patients and excellent when facial artery musculomucosal flap was used. Conclusion: The nasolabial flap is a reliable and minimally traumatic local flap for one stage reconstruction of medium size defects in the oral cavity. The abundant blood supply allowed its modification in order to cover larger defects or to obtain better cosmetic results. This versatility makes it more widely used thus minimizing the use of local tongue flaps and split thickness grafts for covering these medium size defects in cases of buccal mucosa cancer or affecting the other lip or commissure in cases of lip cancer. It has a high viability rate, low complication rate; it is quick and easy to perform in addition to its satisfactory functional and cosmetic results.

  13. Papilla Preservation Flap as Aesthetic Consideration in Periodontal Flap Surgery

    OpenAIRE

    Sandra Olivia; Natalina Natalina; Felix Hartono

    2013-01-01

    Flap surgery is treatment for periodontal disease with alveolar bone destruction. Surgical periodontal flap with conventional incision will result in gingival recession and loss of interdental papillae after treatment. Dilemma arises in areas required high aesthetic value or regions with a fixed denture. It is challenging to perform periodontal flap with good aesthetic results and minimal gingival recession. This case report aimed to inform and to explain the work procedures, clinical and rad...

  14. Perforation of aluminium alloy thin plates

    OpenAIRE

    ANTOINAT, Léonard; Kubler, Régis; BAROU, Jean Luc; VIOT, Philippe; BARRALLIER, Laurent

    2015-01-01

    Low velocity perforation of aeronautical aluminium alloy sheets 2024 T3 is studied in this paper. After a literature review on recent experiments and models of plate’s perforation, experimental results for 2 thicknesses (2 mm and 4 mm) of plates are presented. Perforation tests are performed with an instrumented drop test. The striker has a large diameter and a conical shape nose. Two models for perforation are presented and calibrated to bring a better understanding of the experiments. The f...

  15. Repair of scars in submaxillary region using expanded forehead axial flaps with fascia pedicles carrying bilateral frontal branches of superficial temporal artery and vein%带双侧颞浅动静脉额支筋膜蒂的额部轴型扩张皮瓣修复下颌部瘢痕

    Institute of Scientific and Technical Information of China (English)

    黄永新; 詹新华; 范金财; 郑静伟; 吴祖煌; 陈建崇; 刘世康

    2010-01-01

    applying expanded forehead axial flaps with fascia pedicles carrying bilateral frontal branches of superficial temporal artery and vein(expanded forehead axial flap with double pedicels in brief, EFAF-DP) in repairing scars in submaxillary region. Methods Sixteen patients with mandibular scars hospitalized in Department of Burns and Plastic Surgery of the First Hospital Affiliated to Fuzhou General Hospital in Nanjing Military Area Command from July 2005 to December 2009 were repaired with EFAF-DP. The operation consisted of 3 stages. Before operation, the location and course of superficial temporal arteries and veins (STAV) and their frontal and parietal branches were identified with Ultrasonic Doppler blood flow detector. In stage Ⅰ , STAV were dissected from the frontalis muscle as a pedicle to form a skin soft tissue space to hold the dilator of a proper size. In stage Ⅱ , after gradual dilation by repeated filling with saline, the dilator was removed. EFAF-DP was dissected to repair mandibular scar. Donor site was closed with sutures. In stage Ⅲ , flap pedicles were divided and pruned. Results Flap sizes ranged from 25 cm ×6 cm to 33 cm × 16 cm. The duration of dilation was 3-5 months, with 3.6 months in average. Ten patients underwent the operation of EFAF-DP transplantation and cervical skin dilatation. All flaps survived with healing of wounds. Disorder of venous return at the distal end of one flap was seen after second stage surgery, and it was corrected after comprehensive treatment including relieving spasm and improving venous return. Donor site wounds healed with normally grown hair without cicatricial alopecia along the hairline. Few hairs grew around mandible in one female patient out of the three(no hair grew on flaps of other two patients). This female patient and two male patients requesting for beard plasty received laser depilation treatment 1 to 3 months after discharge, with good result. Other male patients received no special treatment for

  16. 51例乳腺癌患者术后游离腹壁皮瓣乳房重建的临床分析%A retrospective study of 51 cases with abdominal based free flap breast reconstruction after mastectomy for breast cancer

    Institute of Scientific and Technical Information of China (English)

    陈嘉莹; 沈镇宙; 邵志敏; YU Pei-rong; 吴炅; 陈嘉健; 曹阿勇; 薛静彦; 陈灿铭; 柳光宇; 胡震; 狄根红; 韩企夏

    2012-01-01

    breast reconstruction after mastectomy for breast cancer. Methods: A review of 52 abdominal based free flap breast reconstructions (51 patients) from Jun. 2006 to Nov. 2011 was undertaken, comprising 1 free transverse rectus abdomenis myocutaneous (F-TRAM) flap, 32 deep inferior epigastric artery perforator (DIEP) flaps and 19 muscle sparing F-TRAM flaps. The follow-up data were assessed. Results: Forty-nine among 51 patients were successfully received the abdominal based free flap breast reconstruction. The overall success rate was 96.1%. Four patients had further procedures for either vessels re-anastomosis or flap excisions. Internal thoracic vessels were used as recipient vessels in 42 flaps (80.1%) while subscapular vessels in 9 flaps (17.3%) and lateral thoracic vessels in 1 flap (1.9%). The mean number of perforator vessel was 2.31, ranging from 1 to 4. Mean duration of hospitalization was 20 days, ranging from 10 to 39 days. Mean post-operation duration of hospitalization was 11 days, ranging from 4 to 22 days. Twenty-three patients (57.5%) received chemotherapy after immediate breast reconstruction. Time of the first chemotherapy was 15.6 days after operations. Thirteen patients (25.5%) had nipple reconstruction after breast reconstruction. Median follow-up time was 7.5 months, ranging from 1.2 to 38.5 months. Two patients (3.92%) had total flap loss, 1 (1.96%) had flap infection, 1 (1.96%) had hematoma, 8 (15.69) had partial fat necrosis, 3 (5.88%) had abdominal wall complications. The overall aesthetic satisfaction was 8.5. Conclusion: The abdominal based free flap reconstruction can be used for breast cancer patients with satisfactory aesthetic results and low complication rates. In practice, DIEP flap reconstruction involves a more technically challenging operation skills and a learning curve associated with perforator selection.

  17. Aesthetic Total Reconstruction of Lower Eyelid Using Scapha Cartilage Graft on a Vascularized Propeller Flap

    Science.gov (United States)

    Watanabe, Hidekata; Masumoto, Kazuyuki; Kikuchi, Mamoru; Satake, Yoshiyasu; Yanai, Tetsu; Harada, Yoshimi; Ishihara, Yasuhiro; Yasuta, Masato

    2016-01-01

    Background: The aim of this study was to review the results of a cohort of patients based on our experience with a new technique for total lower eyelid reconstruction after a large defect caused by malignant tumor and trauma. A scapha cartilage graft with small skin on a vascularized propeller flap was used for 16 cases requiring lower eyelid reconstruction. Methods: Patients were identified from a database, and a retrospective case note review was conducted. The scapha cartilage graft was sutured to the margin of the defect of the palpebral conjunctiva and tarsus. The propeller flap, rotated by a perforator-based lateral orbital flap or a subcutaneous-based nasolabial flap, was vascularized on the scapha cartilage graft as anterior lining of the lower eyelid. The follow-up, including results of slit-lamp examination, lasted for varying periods, but often it was for 12 months. Results: The scapha cartilage graft with small skin on a vascularized propeller flap was viable in all cases. Slit-lamp examination detected no irritation or injury of the conjunctiva and cornea, and visual acuity was maintained in all cases. A deformity in the donor helix by this technique was also improved by getting a smaller skin harvested from the scapha. Conclusion: Use of the scapha cartilage graft with small skin on a vascularized propeller flap allows for a good fit to the orbit, short operative time under local anesthesia, good graft viability, and a good esthetic result with minimal donor site morbidity. PMID:27200258

  18. Early Management Experience of Perforation after ERCP

    Directory of Open Access Journals (Sweden)

    Guohua Li

    2012-01-01

    Full Text Available Background and Aim. Perforation after endoscopic retrograde cholangiopancreatography (ERCP is a rare complication, but it is associated with significant mortality. This study evaluated the early management experience of these perforations. Patients and Methods. Between November 2003 and December 2011, a total of 8504 ERCPs were performed at our regional endoscopy center. Sixteen perforations (0.45% were identified and retrospectively reviewed. Results. Nine of these 16 patients with perforations were periampullary, 3 duodenal, 1 gastric fundus, and 3 patients had a perforation of an afferent limb of a Billroth II anastomosis. All patients with perforations were recognized during ERCP by X-ray and managed immediately. One patient with duodenal perforation and three patients with afferent limb perforation received surgery, others received medical conservative treatment which included suturing lesion, endoscopic nasobiliary drainage (ENBD, endoscopic retrograde pancreatic duct drainage (ERPD, gastrointestinal decompression, fasting, broad-spectrum antibiotics, and so on. All patients with perforation recovered successfully. Conclusions. We found that: (1 the diagnosis of perforation during ERCP may be easy, but you must pay attention to it. (2 Most retroperitoneal perforations can recover with only medical conservative treatment in early phase. (3 Most peritoneal perforations need surgery unless you can close the lesion up under endoscopy in early phase.

  19. Intraoperative hemodynamic evaluation of the latissimus dorsi muscle flap: a prospective study.

    Science.gov (United States)

    Lorenzetti, Fulvio; Giordano, Salvatore; Tukiainen, Erkki

    2012-05-01

    The aim of this study was to assess intraoperatively the hemodynamic changes in the donor vessel of free latissimus dorsi (LD) flap before and after denervation and to analyze flow changes after flap transfer. Twenty-seven patients underwent LD muscle microvascular reconstruction for lower-limb soft tissue defects. Measurements of blood flow were performed intraoperatively by using a 2- to 5-mm probe ultrasonic transit-time flowmeter around the dissected vessels. Registrations were made in the thoracodorsal artery before and after harvesting the flap, after compressing and cutting the motor nerve, and after anastomosis. Mean blood flow of in situ harvested thoracodorsal artery as measured intraoperatively by transit-time flowmeter was (mean ± standard deviation) 16.6 ± 11 mL/min and was significantly increased after raising the flap to 24.0 ± 22 mL/min (p <0.05); it was 25.6 ± 23 mL/min after compressing the motor nerve and was significantly increased after cutting the motor nerve to 32.5 ± 26 mL/min (p <0.05). A significant increase of blood flow to 28.1 ± 19 mL/min was also detected in the thoracodorsal artery after flap transplantation with end-to-side anastomosis (p <0.05). Vascular resistance in the thoracodorsal artery significantly decreased after flap raising and anastomosis (from 7.5 ± 3.4 to 4.0 ± 1.9 and to 4.5 ± 2.4, respectively, p <0.05). LD flap harvesting increases blood flow and decreases resistance in the thoracodorsal artery, especially after denervation. PMID:22492006

  20. Differential imaging features of pulmonary artery dissection from other intraluminal diseases of pulmonary artery: Two cases report

    International Nuclear Information System (INIS)

    Pulmonary artery dissection is rarer than other intraluminal diseases of pulmonary artery such as pulmonary thromboembolism or pulmonary artery sarcoma. We report two cases of pulmonary artery dissection mimicking pulmonary artery sarcoma. Computed tomography (CT) showed no enhancement of intrapulmonary arterial lesion or expansion of involved pulmonary artery. Magnetic resonance imaging (MRI) showed low-signal intensity intimal flap on T1- and T2-weighted images. There was no fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)-CT. In this case report, we describe the imaging features of pulmonary artery dissection on CT, MRI, and PET-CT.

  1. Differential imaging features of pulmonary artery dissection from other intraluminal diseases of pulmonary artery: Two cases report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Joo Ho; Shin, Hyun Woong; Sohn, Kung Rak; Lee, Yil Gi [Daegu Fatima Hospital, Daegu(Korea, Republic of)

    2015-03-15

    Pulmonary artery dissection is rarer than other intraluminal diseases of pulmonary artery such as pulmonary thromboembolism or pulmonary artery sarcoma. We report two cases of pulmonary artery dissection mimicking pulmonary artery sarcoma. Computed tomography (CT) showed no enhancement of intrapulmonary arterial lesion or expansion of involved pulmonary artery. Magnetic resonance imaging (MRI) showed low-signal intensity intimal flap on T1- and T2-weighted images. There was no fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)-CT. In this case report, we describe the imaging features of pulmonary artery dissection on CT, MRI, and PET-CT.

  2. Perforated Peptic Ulcer: new insights

    NARCIS (Netherlands)

    M.J.O.E. Bertleff (Marietta)

    2011-01-01

    textabstractMuch has been written on perforated peptic ulcer (PPU) during the last hundred years. In 1500, when necropsies were first allowed, often a small hole was found in the anterior wall of the stomach, giving an explanation for symptoms of acute abdominal pain, nausea, vomiting which often le

  3. Flag flapping in a channel

    Science.gov (United States)

    Alben, Silas; Shoele, Kourosh; Mittal, Rajat; Jha, Sourabh; Glezer, Ari

    2015-11-01

    We study the flapping of a flag in an inviscid channel flow. We focus especially on how quantities vary with channel spacing. As the channel walls move inwards towards the flag, heavier flags become more unstable, while light flags' stability is less affected. We use a vortex sheet model to compute large-amplitude flapping, and find that the flag undergoes a series of jumps to higher flapping modes as the channel walls are moved towards the flag. Meanwhile, the drag on the flag and the energy lost to the wake first rise as the walls become closer, then drop sharply as the flag moves to a higher flapping mode.

  4. Multidisciplinary management of a mandibular buccal plate perforation

    Directory of Open Access Journals (Sweden)

    Yuli Nugraeni

    2010-12-01

    Full Text Available Background: Endodontists often have difficulty in the management of endo-perio cases, because they cannot visually detect the condition of outer root surfaces, especially in bucco-lateral roots. The bone defect is rare and its treatment needs collaboration of endodontists and periodontists. An endodontist treats cases based on dental history, radiograph of root canals to measure root canals, to uncover abnormalities and to diagnose, but as the endodontists cannot directly see the affected parts, the unseen portion of the tooth could only be seen after flap surgery. Purpose: This case presents the importance of multidisciplinary approach by the endodontist and periodontitis to treat bucal plate perforations in endo-perio cases. Case: The first patient, a 47-year-old female had endodontic treatment and a porcelain crown restoration; however, after several months she felt pain. The second patient, a 45 year-old female had endodontic treatment and after six months she feel painful. Case management: The first patient, was referred to a periodontist. The opening flap surgery has been done, a bone defect was found in tooth 45. Subsequently, the exposed crater was filled with a bone graft and the pain disappeared. The second patient, with improper endodontic treatment. The flap surgery was conducted, there was found a bone defect in tooth 36. The last treatment, a bone graft has been covered and then the pain was not present. Conclusion: Proper diagnosis and treatment of perforations on the buccal aspect of a root was able to eliminate pain and avoid tooth extraction.Latar belakang: Endodontis sering mengalami kesulitan dalam menangani kasus endo-perio karena secara visual kondisi ini tidak tampak diluar permukaan akar, khususnya pada akar bukolateral. Defek tulang sangatlah jarang dan perawatannya membutuhkan kolaborasi endodotis dan periodontis. Seorang endodontis merawat kasus-kasus berdasarkan riwayat gigi, radiografis saluran akar untuk melihat

  5. Postpartum spontaneous colonic perforation due to antiphospholipid syndrome

    Institute of Scientific and Technical Information of China (English)

    Kamran Ahmed; Amir Darakhshan; Eleanor Au; Munther A Khamashta; Iraklis E Katsoulis

    2009-01-01

    The antiphospholipid syndrome (APS) is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosis, fetal loss, thrombocytopenia, leg ulcers, livedo reticularis, chorea,and migraine. We document a previously unreported case of a 37-year-old female in whom APS was first manifested by infarction and cecal perforation following cesarean section. At laparotomy the underlying cause of colonic perforation was not clear and after resection of the affected bowel an ileo-colostomy was performed. The diagnosis of APS was established during post-operative hospital stay and the patient was commenced on warfarin.Eventually, she made a full recovery and had her stoma reversed after 4 mo. Pregnancy poses an increased risk of complications in women with APS and requires a more aggressive approach to the obstetric care. This should include full anticoagulation in the puerperium and frequent doppler ultrasound monitoring of uterine and umbilical arteries to detect complications such as preeclampsia and placental insufficiency.

  6. Keystone flaps in coloured skin: Flap technology for the masses?

    Directory of Open Access Journals (Sweden)

    Satish P Bhat

    2013-01-01

    Full Text Available Introduction: Viscoelastic properties of skin in coloured ethnic groups are less favourable compared to Caucasians for executing Keystone flaps. Keystone flaps have so far been evaluated and reported only in Caucasians. The potential of Keystone flaps in a coloured ethnic group is yet unknown. Aim: This article reviews the experience to reconstruct skin defects presenting in a coloured ethnic group, by using Keystone flaps, with a review of existing literature. Design: Uncontrolled case series. Materials and Methods: This retrospective review involves 55 consecutive Keystone flaps used from 2009 to 2012, for skin defects in various locations. Patient demographic data, medical history, co-morbidity, surgical indication, defect features, complications, and clinical outcomes are evaluated and presented. Results: In this population group with Fitzpatrick type 4 and 5 skin, the average patient age was 35.73. Though 60% of flaps (33/55 in the series involved specific risk factors, only two flaps failed. Though seven flaps had complications, sound healing was achieved by suitable intervention giving a success rate of 96.36%. Skin grafts were needed in only four cases. Conclusions: Keystone flaps achieve primary wound healing for a wide spectrum of defects with an acceptable success rate in a coloured skin population with unfavorable biophysical properties. By avoiding conventional local flaps and at times even microsurgical flaps, good aesthetic outcome is achieved without additional skin grafts or extensive operative time. All advantages seen in previous studies were verified. These benefits can be most appreciated in coloured populations, with limited resources and higher proportion of younger patients and unfavorable defects.

  7. Effects of hyperbaric oxygen preconditioning on ischemia-reperfusion inflammation and skin flap survival

    Institute of Scientific and Technical Information of China (English)

    QI Zheng; GAO Chun-jin; WANG You-bin; MA Xue-mei; ZHAO Ling; LIU Fu-jia; LIU Xue-hua

    2013-01-01

    Background Hyperbaric oxygen preconditioning (HBO) is a new method of ischemia preconditioning.In this study,we examined its effects on skin flap survival and the mechanisms involved.Methods Thirty-six rats were divided into three groups:HBO preconditioning,control,and sham groups.An extended epigastric adipocutaneous flap based on the right superficial epigastric artery and vein was raised.A 3-hour period of flap ischemia was induced by clamping the pedicle vessels with a microvascular clamp.At the end of ischemia induction,the clamp was removed and the flap was resutured.Rats in the HBO preconditioning group were treated with HBO four times before surgery.Microcirculation in the skin flap was measured on postoperative days 1,3 and 5.The size of the flap was measured on postoperative day 5,before the animals were sacrificed.Samples of the skin flap were prepared and stained with hematoxylin and eosin.The levels of tumor necrosis factor (TNF)-o,interleukin (IL)-1β,and IL-6 in the flap samples were measured.Results Surviving flap size was significantly higher in the HBO preconditioning group compared with controls,with a reduced inflammatory response and increased perfusion.IL-1,TNF-α,and IL-6 levels in the HBO preconditioning group were lower than in controls.Conclusions HBO preconditioning improved flap survival in this ischemia-reperfusion rat model.The mechanisms responsible for this effect may relate to attenuation of the inflammatory response and increased flap perfusion following HBO preconditioning.

  8. Facial contour deformity correction with microvascular flaps based on the 3-dimentional template and facial moulage

    Directory of Open Access Journals (Sweden)

    Dinesh Kadam

    2013-01-01

    Full Text Available Introduction: Facial contour deformities presents with varied aetiology and degrees severity. Accurate assessment, selecting a suitable tissue and sculpturing it to fill the defect is challenging and largely subjective. Objective assessment with imaging and software is not always feasible and preparing a template is complicated. A three-dimensional (3D wax template pre-fabricated over the facial moulage aids surgeons to fulfil these tasks. Severe deformities demand a stable vascular tissue for an acceptable outcome. Materials and Methods: We present review of eight consecutive patients who underwent augmentation of facial contour defects with free flaps between June 2005 and January 2011. De-epithelialised free anterolateral thigh (ALT flap in three, radial artery forearm flap and fibula osteocutaneous flap in two each and groin flap was used in one patient. A 3D wax template was fabricated by augmenting the deformity on facial moulage. It was utilised to select the flap, to determine the exact dimensions and to sculpture intraoperatively. Ancillary procedures such as genioplasty, rhinoplasty and coloboma correction were performed. Results: The average age at the presentation was 25 years and average disease free interval was 5.5 years and all flaps survived. Mean follow-up period was 21.75 months. The correction was aesthetically acceptable and was maintained without any recurrence or atrophy. Conclusion: The 3D wax template on facial moulage is simple, inexpensive and precise objective tool. It provides accurate guide for the planning and execution of the flap reconstruction. The selection of the flap is based on the type and extent of the defect. Superiority of vascularised free tissue is well-known and the ALT flap offers a versatile option for correcting varying degrees of the deformities. Ancillary procedures improve the overall aesthetic outcomes and minor flap touch-up procedures are generally required.

  9. The figure-of-eight radix nasi flap for medial canthal defects.

    Science.gov (United States)

    Seyhan, Tamer

    2010-09-01

    Basal cell carcinomas commonly involve the medial canthal region and reconstruction of medial canthal defects is a challenging problem in reconstructive surgery. A new axial pattern flap raised from radix nasi region has been successfully used for the medial canthal defects in eight patients in figure-of-eight manner. One of the ellipses of the figure of eight is the defect, the other is the radix nasi flap. The radix nasi flap with a dimension up to 25 mm is transposed to the defect based either on ipsilateral anastomosis of the dorsal nasal artery with angular artery (AA) or with the connection of its source artery (i.e. ophthalmic artery) if the AA is damaged. All flaps survived and no tumour recurrence was observed. The donor sites were closed primarily and hidden at the radix nasi crease in all cases. The radix nasi flap in figure-of-eight fashion is good alternative for defects of the medial canthal area in terms of attaining a suitable colour and texture and minimal surgical scars. PMID:20079658

  10. Bilateral popliteal arterial dissection.

    Science.gov (United States)

    Chen, Po-Liang; Ko, Shih-Yu; Tan, Ken-Hing

    2012-01-01

    A clinical feature of bilateral popliteal arterial dissection without involving the descending aorta, bilateral iliac, as well as femoral arteries has never been reported in the past literature. We report a 56-year-old man with hypertension and coronary artery disease who presented to our emergency department with complaints of bilateral knee pain after long-distance walking. Physical examination was notable for elevated blood pressure, but there was no palpable pulsation over dorsalis pedis arteries on his feet. Laboratory evaluation revealed a d-dimer level of 35.2 mg/L (FEU) on the day of the test and 1.2 mg/L one and a half months ago (normal level, <0.55). These findings were suggestive of a recent-onset peripheral arterial occlusive disorder. Computed tomography of the aorta showed bilateral popliteal arterial dissection with arterial intimal flap. Abdominal aorta, bilateral iliac, and femoral arteries remained intact with only arteriosclerotic change. Minimally invasive endovascular stent grafting was then performed. The patient had an uneventful recovery. PMID:21106320

  11. The effects of perforation sizes on laminar heat transfer characteristics of an array of perforated fins

    International Nuclear Information System (INIS)

    Highlights: ► Thermal effects of perforation sizes and numbers are studied in perforated fins. ► Flow is laminar and perforations are along the length of fins. ► Porosity is defined as volume of perforations divided by volume of a solid fin. ► At a constant porosity, fins with fewer perforations have higher heat transfer rates. ► At a constant porosity, perforated fins do not affect total drag. - Abstract: Shaeri and Yaghoubi [25] reported the highest heat transfer rate in a laminar flow for a perforated fin with the most perforations (porosity), regardless of investigation on the effects of perforation sizes. In this study, the effects of size and number of perforations on laminar heat transfer characteristics of an array of perforated fins at the highest porosity of the study of Shaeri and Yaghoubi [25] have been numerically investigated. The Navier–Stokes and energy equations are solved by the finite volume procedure using the SIMPLE algorithm. Results show that at a specific porosity, the thermal entrance length of each perforation of a fin with a lower number of perforations is larger than that of each perforation of a fin with a higher number of perforations. Therefore, in a laminar flow and at a constant porosity, a fin with fewer perforations is more efficient to enhance the heat transfer rate compared with a fin with more perforations. Although perforated fins have higher friction drag and lower pressure drag with respect to solid fins, perforated fins do not affect total drag.

  12. Maxillary sinus perforation by orthodontic anchor screws.

    Science.gov (United States)

    Motoyoshi, Mitsuru; Sanuki-Suzuki, Rina; Uchida, Yasuki; Saiki, Akari; Shimizu, Noriyoshi

    2015-06-01

    To facilitate safe placement of orthodontic anchor screws (miniscrews), we investigated the frequency of maxillary sinus perforation after screw placement and the effect of sinus perforation on screw stability. Maxillary sinus perforations involving 82 miniscrews (diameter, 1.6 mm; length, 8 mm) were evaluated using cone-beam computed tomography. All miniscrews were placed in maxillary alveolar bone between the second premolar and first molar for anchorage for anterior retraction in patients undergoing first premolar extraction. The placement torque and screw mobility of each implant were determined using a torque tester and a Periotest device, and variability in these values in relation to sinus perforation was evaluated. Eight of the 82 miniscrews perforated the maxillary sinus. There was no case of sinusitis in patients with miniscrew perforation and no significant difference in screw mobility or placement torque between perforating and non-perforating miniscrews. The sinus floor was significantly thinner in perforated cases than in non-perforated cases. A sinus floor thickness of 6.0 mm or more is recommended in order to avoid miniscrew perforation of the maxillary sinus. PMID:26062857

  13. A CLINICAL STUDY ON ILEAL PERFORATION

    Directory of Open Access Journals (Sweden)

    Kishore Babu

    2016-03-01

    Full Text Available INTRODUCTION Ileal perforation is a common problem seen in tropical countries, the commonest cause being typhoid fever. In western countries the causes are malignancy, trauma and mechanical aetiology, in the order of frequency.1,2,3 Over the years a definite changing trend has been observed in ileal perforations both in terms of causes, treatment and prognosis. Better antibiotics, aggressive surgery and the elimination of conservative treatment, better preoperative and postoperative care have all significantly contributed to the improvement in patient outcome.4,5 But still cases of ileal perforation cause a significant morbidity and mortality that persists despite the significant changes in health care over the years. AIMS AND OBJECTIVES To study the aetiology, presentation, management outcome and the factors influencing prognosis and outcome in ileal perforations. MATERIAL & METHODS Study Setting S. V. Medical College, Department of General Surgery, Tirupati. Study Period Patients attending S. V. Medical College, Department of General Surgery with perforation during the period from November 2012 to October 2015. Inclusion Criteria Patients between age group of more than 14 years presenting with pain abdomen and who are diagnosed to have ileal perforation in the intra operative period are selected. Exclusion Criteria Patients with peritonitis due to other causes like gastric, duodenum or large bowel perforation are excluded. Study Method The present study is a prospective study done on 28 patients of ileal perforation due to typhoid complication, nonspecific and traumatic perforations. History, clinical examination, investigations, operative findings, post-operative complications were recorded. In patients with non-traumatic perforations Widal test was done. CONCLUSION Typhoid fever and traumatic aetiology are the most common cause of Ileal perforation, followed by TB. Patients are more of male gender and are in reproductive age group. Widal

  14. Versatality of supraclavicular flap in neck, face, and upper chest region coverage

    International Nuclear Information System (INIS)

    The objective is to analyze the utility of the island supraclavicular flap in a region where skin graft cannot be used and free flap is not feasible. We assessed complications and functional outcomes. Study Design: Prospective descriptive study. Place and Duration of Study: The study was done at plastic and reconstructive surgery department CMH Rawalpindi during the period of 03 year from October 2011 to October 2014. Material and Patients: An island supraclavicular artery flap was used to reconstruct oncologic, and post burn neck contractures release defects. 30 patients were included in the study. Doppler probe was used to help with localization of vascular pedicle. All the patients with scarring in both shoulder regions, history of radiation to neck and undergoing radical neck dissection were excluded. Results: A total of 30 patients were included 20 (66.6%) male and 10 (33.3%) were female. Oncologicre section was followed by immediate reconstruction with island supraclavicular artery flap. Post burn contractures were released and covered by a pedicled supraclavicular artery flap. The recipient sites were neck, face, oral and upper chest region. The average harvest time was 1 and half hour. Donor site was closed primarily in 22 (73.3%) while 8 (26.6%) require skin grafting. Post burn contractures needed scar management with intralesional steroid, pressure garments and scar revision with Z-plasty in 4(13.3%) cases. 1 (3.3%) flap failed completely and the defect was covered with a skin graft. We had 01 (3.3%) mortality due to respiratory obstruction, despite adequate flap perfusion for 24 hours. Minor complications included, partial flap loss, seroma, and haematoma formation. In addition hypertrophied scar, spreading scar and keloid formation occurred at the donor site 18 (60%). Conclusion: Island supraclavicular artery flap with an easy learning curve is a reliable flap. It has a good colour and texture match with minimal donor site morbidity. It is an excellent

  15. Colonic perforation in Behcet's syndrome

    Institute of Scientific and Technical Information of China (English)

    Catherine M Dowling; Arnold DK Hill; Carmel Malone; John J Sheehan; Shona Tormey; Kieran Sheahan; Enda McDermott; Niall J O'Higgins

    2008-01-01

    A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet's syndrome (BS). He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases.

  16. CT in acute perforated sigmoid diverticulitis

    Energy Technology Data Exchange (ETDEWEB)

    Lohrmann, Christian [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany)]. E-mail: lohrmann@mrs1.ukl.uni-freiburg.de; Ghanem, Nadir [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Pache, Gregor [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Makowiec, Frank [Department of Surgery, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Kotter, Elmar [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Langer, Mathias [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany)

    2005-10-01

    Background: To assess the value of computed tomography (CT) in patients with acute perforated sigmoid diverticulitis in correlation with the Hinchey classification of perforated diverticular disease. Methods: Thirty patients with acute perforated sigmoid diverticulitis underwent computed tomography prior to surgery. Computed tomography scans were compared with the surgical and histopathological reports, utilizing the Hinchey classification. Results: In 28 of the 30 (93%) patients examined, the Hinchey stage was correctly determined by means of computed tomography. One patient with Hinchey stage IV was falsely classified as Hinchey stage III, and one patient with Hinchey stage III as Hinchey stage II. Computed tomography revealed 12 out of 14 (86%) patients with perforation sites and 3 out of 3 (100%) patients with contained perforation. In one of 17 (6%) patients with surgically or histopathologically proven perforation or contained perforation, a bowel wall discontinuity was revealed by computed tomography. In 6 of the 17 (35%) patients with surgical or histopathological perforation or contained perforation, extraluminal contrast material was detected by computed tomography. Conclusions: Computed tomography is a valuable imaging tool for determining the degree of acute perforated sigmoid diverticulitis, by means of which patients can be stratified according to the severity of the disease; furthermore, this tool is of assistance in surgical planning.

  17. CT in acute perforated sigmoid diverticulitis

    International Nuclear Information System (INIS)

    Background: To assess the value of computed tomography (CT) in patients with acute perforated sigmoid diverticulitis in correlation with the Hinchey classification of perforated diverticular disease. Methods: Thirty patients with acute perforated sigmoid diverticulitis underwent computed tomography prior to surgery. Computed tomography scans were compared with the surgical and histopathological reports, utilizing the Hinchey classification. Results: In 28 of the 30 (93%) patients examined, the Hinchey stage was correctly determined by means of computed tomography. One patient with Hinchey stage IV was falsely classified as Hinchey stage III, and one patient with Hinchey stage III as Hinchey stage II. Computed tomography revealed 12 out of 14 (86%) patients with perforation sites and 3 out of 3 (100%) patients with contained perforation. In one of 17 (6%) patients with surgically or histopathologically proven perforation or contained perforation, a bowel wall discontinuity was revealed by computed tomography. In 6 of the 17 (35%) patients with surgical or histopathological perforation or contained perforation, extraluminal contrast material was detected by computed tomography. Conclusions: Computed tomography is a valuable imaging tool for determining the degree of acute perforated sigmoid diverticulitis, by means of which patients can be stratified according to the severity of the disease; furthermore, this tool is of assistance in surgical planning

  18. Saphenous Vein Graft Perforation During Percutaneous Coronary Intervention - A Nightmare to be Avoided

    Directory of Open Access Journals (Sweden)

    Surender Deora

    2015-01-01

    Full Text Available Percutaneous coronary interventions (PCIs of saphenous vein grafts (SVGs is challenging and is associated with adverse short- and long-term clinical outcome as compared to native coronary arteries. SVG perforation is rare but catastrophic and needs immediate attention. Various factors predisposing for SVG perforation are old degenerated graft, ulcerated plaque, severe fibrotic, or calcified lesion necessitating high pressure balloon or stent inflation, use of intravascular ultrasound (IVUS or other atheroablative devices. Management includes prolonged balloon occlusion, reversal of anticoagulation, use of covered stent, and emergency pericadiocentesis if required.

  19. The revascularization of pedicle skin flaps in pigs: a functional and morphologic study

    International Nuclear Information System (INIS)

    Functional and morphologic changes occurring during the revascularization of pedicle flaps have been investigated in the skin of pigs. The skin flaps, 16 cm long by 4 cm wide, were based on a row of segmental vessels arising from the internal mammary artery. Comparative measurements were made in flapped and normal skin. The inherent blood supply in the pedicle of the flap was unable to maintain the whole of the flap in a viable state. Flap viability was ascertained at surgery by the use of the intravital dye Disulphine blue. Injections of the dye after surgery gave a less accurate prediction of viability than when dye was injected prior to surgery. Revascularization between the flap and surrounding skin was evident 3 to 4 days postoperatively at the distal, most hypoxic part of the viable flap. The whole flap had a collateral vascular supply 7 to 10 days after surgery. Isotope clearance studies showed that the greatest functional changes occurred in the distal third of the viable flap, where, after initially slowing, the clearance rate became faster than in normal skin (day 5). Potassium extraction studies indicated similar changes. However, an increase in the red-cell volume on day 1 suggested that vascular shunting was occurring. The results of the morphologic studies indicated a correlation between the number of blood vessels per unit area, the thickness of the dermis, and the recorded functional changes. Seven days after surgery, when isotope clearance rates were very rapid, there was a significant increase in the vascular density and dermal thickness

  20. Active Control of Long Bridges Using Flaps

    DEFF Research Database (Denmark)

    Hansen, H. I.; Thoft-Christensen, Palle

    The main problem in designing ultra-long span suspension bridges is flutter. A solution to this problem might be to introduce an active flap control system to increase the flutter wind velocity. The investigated flap control system consists of flaps integrated in the bridge girder so each flap is...... different flap configurations for a bridge section model by using aerodynamic derivatives for a flat plate. The example shows that different flap configurations can either increase or decrease the flutter wind velocity. for optimal flap configurations flutter will not occur....

  1. Effects of some pharmacological agents on the survival of unipedicled venous flaps: an experimental study.

    Science.gov (United States)

    Askar, I; Saray, A; Gurlek, A; Sevin, K; Sabuncuoglu, B T

    2001-01-01

    Clinical and experimental studies have been conducted to improve the survival of venous flaps. As a result of these studies, although various survival mechanisms were raised, none obtained satisfactory information. Venous stasis, and the resultant venous thrombosis, is a factor that decreases the survival of venous flaps. In this study, we evaluated the effects of two antiinflammatory agents, etodolac and etofenamate, on the survival of unipedicled venous flaps. In this study, 35 male New Zealand white rabbits (3,500-4,000 g) (70 ears) were used. Perichondrocutaneous flaps, 3 x 4.5 cm in size, were designed and raised, keeping the central veins intact in the middle of venous flap. Central arteries and nerves were ligated and transected both proximally and distally, to prepare unipedicled venous flaps. A silicone sheet was placed between the cartilage tissue and flap, to prevent blood flow and revascularization beneath. The subjects were divided into seven groups, consisting of five rabbits (10 ears). In the negative control group (group I), the single vascular pedicle of venous flaps, central veins were ligated and flaps sutured into their own place as the composite graft. In the positive control group (group II), after venous flaps were prepared, normal saline, 0.2 mL, was given subcutaneously. In the first of five experimental groups (group III), unfractionated heparin (100 U/day) was given subcutaneously. In the second experimental group (group IV), etodolac (5 mg/kg/day) was given subcutaneously. In the third experimental group (group V), etophenamate (5 mg/kg/day) was given orally through a feeding tube. In the fourth experimental group (group VI), parnaparin (5 anti-Xa U/kg/day) was given subcutaneously. In the fifth experimental group (group VII), nadroparin (5 anti-Xa U/kg/day) was given subcutaneously, about 7 days postoperatively. At the eighth postoperative day, surviving areas of venous flaps were measured, and the results were evaluated by Kruskal

  2. A CALCULUS CHOLECYSTITIS PERFORATING AT THE NECK

    Directory of Open Access Journals (Sweden)

    Jayashri

    2014-08-01

    Full Text Available Gallbladder perforation is a rare complication of cholecystitis and cholelithiasis. The high morbidity and mortality rates associated with this condition are due to delays in diagnosis and treatment since signs and symptoms of perforation do not differ significantly from those of uncomplicated cholecystitis. We report a case of 17 year old boy who presented with perforation at the neck of gall bladder with extrusion of a stone. It was associated with bile infected with S. typhi.

  3. LAPAROSCOPIC REPAIR OF PERFORATED PEPTIC ULCER

    OpenAIRE

    S. Lunca; N.S. Romedea; C. Moroşanu

    2007-01-01

    Since 1990 when Mouret reported the first laparoscopic sutureless repair for a perforated duodenal ulcer and Nathanson the first successful laparoscopic suture repair for perforated peptic ulcer, laparoscopic approach became a widespread procedure. Treatment for perforated ulcer can be performed laparoscopically in 85% of cases, making it possible to avoid a median laparotomy which can lead to wound infection and late eventration. Laparoscopic approach is indicated in any case of suspected ga...

  4. Spontaneous ileal perforation complicating low anorectal malformation

    Directory of Open Access Journals (Sweden)

    TiJesuni Olatunji

    2015-01-01

    Full Text Available Anorectal malformation is a common anomaly in neonates. Although colorectal perforations have been reported as a complication, ileal perforation is rarely encountered. This is a report of a 2-day-old boy presenting with a low anorectal malformation, complicated with ileal perforation, necessitating laparotomy and ileal repair. Anoplasty was done for the low anomaly. Early presentation and prompt treatment of anorectal malformations is important to prevent such potential life threatening complication.

  5. Flap Edge Noise Reduction Fins

    Science.gov (United States)

    Khorrami, Mehdi R. (Inventor); Choudhan, Meelan M. (Inventor)

    2015-01-01

    A flap of the type that is movably connected to an aircraft wing to provide control of an aircraft in flight includes opposite ends, wherein at least a first opposite end includes a plurality of substantially rigid, laterally extending protrusions that are spaced apart to form a plurality of fluidly interconnected passageways. The passageways have openings adjacent to upper and lower sides of the flap, and the passageways include a plurality of bends such that high pressure fluid flows from a high pressure region to a low pressure region to provide a boundary condition that inhibits noise resulting from airflow around the end of the flap.

  6. Perforation Peritonitis: A Two Year Experience

    Directory of Open Access Journals (Sweden)

    Shyam Kumar Gupta, Rajan Gupta, Gurdev Singh, Sunil Gupta

    2010-07-01

    Full Text Available Four hundred patients who presented in the emergency of GMC Jammu as a case of perforation peritonitisover a period of two years were studied. In most of the cases diagnosis was made by clinical examinationsupplemented by investigations in the form of standing X-ray chest PA view with domes of diaphragm,Ultrasound abdomen and abdominal paracentesis. Contrast enhanced CT scans of abdomen wereconducted on patients where the diagnosis of perforation peritonitis was doubtful. After resuscitation,Laparotomy was done in all the patients and thorough peritoneal lavage was done. A note of the site,size, type, number of perforations was made and biopsy was taken from the edge of the perforationwhenever indicated. The most common cause of gastrointestinal perforation in our study was duodenalulcer perforation, followed by appendicitis, typhoid perforation, blunt/penetrating trauma, gastric perforation,obstruction, iatrogenic, malignancy, and recurrent perforation. Primary closure of the perforation wasmost commonly done procedure, followed by appendectomy, resection anastomosis of the gut andexteriorization of the gut. The overall mortality was 6 % and morbidity in the form of wound infection,fever, respiratory complications, residual abscess, dyselectrolytemia, burst abdomen, jaundice, sepsis,cardiac complications, anastomotic disruption was present

  7. The effect of recombinant hirudin on rabbit ear flaps with venous insufficiency

    Directory of Open Access Journals (Sweden)

    Serdar Duzgun

    2014-01-01

    Full Text Available The effect of recombinant hirudin, which is the most powerful antithrombotic agent, on flaps with venous insufficiency was investigated. Oedema and congestion are frequent on flaps, causing necrosis unpredictably. Venous insufficiency and thrombosis are experimentally and clinically more frequent than arterial occlusion. Twenty-one adult New Zealand rabbits were used in this study. Skin flaps (3 × 6 cm were elevated on a 1-cm-wide pedicle on rabbit ears. The artery, nerve, and vein were exposed and examined with the aid of a surgical microscope. Venous insufficiency was established by cutting the vein and nerve. In the control group, no additional surgical or medical procedures were performed and the ear flap was inset to its original location. Subcutaneous low molecular weight heparin (LMWH; 320 IU/kg was administered to a second group of rabbits after the same surgery, and recombinant hirudin (2 μg was administered via the pedicle artery 5 minutes after the vein and nerve were bound and cut in a third group of rabbits. Compared with control and LMWH groups on day 3 and 7, the hirudin-treated group had less hair loss, lower oedema scores and less haematoma formation. Furthermore, a lower size of necrotic areas and an increase in the circulating area on day 7 was found in the hirudin-treated group. In addition, angiography revealed new vessel development (neovascularisation only in the hirudin group. On histologic sections, hirudin-treated animals had lower oedema, inflammation and congestion scores than animals in the other two groups. Thus, when administered into the ear flap through the pedicle as a pure recombinant preparation, hirudin increased flap survival by its antithrombotic effects and by accelerating neoangiogenesis. Recombinant hirudin may be used in clinical practice to treat flaps with venous problems and to increase survival rates.

  8. Success of free flap anastomoses performed within the zone of trauma in acute lower limb reconstruction.

    Science.gov (United States)

    Bendon, Charlotte L; Giele, Henk P

    2016-07-01

    Traditionally, in free flap cover of lower limb injuries, every attempt is made to perform anastomoses proximal to the zone of injury. We report on the success of anastomoses within the zone of trauma, at the level of the fracture, avoiding further dissection and exposure. The records of free flap reconstructions for fractures of the lower extremity at a tertiary trauma centre between 2004 and 2010 were retrospectively reviewed. A total of 48 lower limb fractures required free flap reconstruction, performed at 28 days post injury (0-275 days). Anastomoses were proximal (21), distal (5) or within the zone of trauma (22). There was no significant difference (p > 0.05) in return to theatre, revision of anastomosis or flap survival between groups. Of the 22 performed within the zone of injury, five returned to theatre but only two for revision of anastomosis and 20 (91%) of these flaps survived. Of the 48 free flaps, arterial anastomoses were end to end in 34 (71%) and end to side in 14 (30%). There was no significant difference (p > 0.05) in return to theatre, revision of anastomosis or flap survival between the end-to-end and end-to-side groups. There was a tendency for arterial anastomoses to be performed end to end outside the zone of trauma (23/26) compared to within the zone of trauma (11/22). Our data suggest that free flap anastomoses can be performed safely in the zone of trauma in lower limb injuries. PMID:27108076

  9. Bilateral Distraction Osteogenesis of Vascularized Iliac Crest Free Flaps Used in Mandibular Reconstruction

    Science.gov (United States)

    Subramaniam, Shiva S.; Vujcich, Nathan J.; Nastri, Alf L.

    2016-01-01

    Summary: Vascularized free flaps have become the gold standard in reconstructing large segmental mandibular defects; however, even when bony union and soft-tissue coverage is achieved, insufficient bone stock and altered facial contour can create functional and cosmetic problems for the patient. There have been limited case reports on the use of secondary distraction osteogenesis to address these issues. The authors report a case of bilateral mandibular distraction of deep circumflex iliac artery free flaps, used for mandibular reconstruction after total mandibulectomy for treatment of osteosarcoma. Performed for reasons of retrognathia and facilitation of dental prosthetic rehabilitation, this is the first case of bilateral horizontal distraction osteogenesis of deep circumflex iliac artery free flaps reported in the literature.

  10. [Surgical treatment of duodenal perforation].

    Science.gov (United States)

    Csáky, G; Bezsilla, J; Sikorszki, L; Tóth, D

    2000-04-01

    Duodenal ulcer can be cured successfully by the eradication of Helicobacter pylori (H. p.) and administration of anti-acid secretory drugs, however, from among the complications of duodenal ulcer, perforation with unchanged incidence continues to need an urgent operation. The authors examined the case histories, results of preoperative examinations, data of operations, and postoperative events of 175 patients hospitalized for perforation of duodenal ulcer in the past five years. The average age of the 38 women was more than 20 years greater than that of the 137 men. The time between the appearance of the serious symptoms and the operation exceeds 24 hours in 31 patients. There was serious preoperative general condition (ASA IV. and V.) in 13.7% of the cases. In the last year infection with H. p. was proved with Pylori Screen II (Orion Diagnostica) serological examination in 22 patients. Closure of the perforation was made in open fashion in 155 (average operative time: 54.1 min.), laparoscopically in 7 (average operative time: 117.9 min.) and gastric resection was necessary in 12 patients (average operative time: 154.6 min.). In 20.4% of the survivors a complication was observed. All of the 18 non-survivors (10.3%) were operated on in poor condition and beyond recovery. Seven patients operated on laparoscopically experienced undisturbed recovery, and stayed in the hospital the shortest time (average: 5.4 days). In the authors opinion the preoperative knowledge of H. p. infection influences the method of the operation of choice, and they recommend the laparoscopic access in elected cases. PMID:11299619

  11. Simultaneous expander and deep inferior epigastric perforator reconstruction: indications and alloderm sling technique for protecting the anastomosis

    Directory of Open Access Journals (Sweden)

    Elizabeth Stirling Craig

    2015-04-01

    Full Text Available Aim: Autologous tissue is considered the "gold standard" for breast reconstruction today. However, little is known about deep inferior epigastric perforator (DIEP flap reconstruction in combination with tissue expander (TE/implant. The authors describe a series of combined DIEP flap/TE reconstruction, including its indications and technique to ensure protection of the pedicle during the expansion process. Methods: Between January 2009 and December 2012, patients undergoing immediate DIEP with TE reconstruction were retrospectively reviewed. Oncologic, comorbid conditions, intraoperative, postoperative expansion, complications, and technique data points were collected. Photographs were taken postoperatively and patient's satisfaction surveys were obtained to assess overall satisfaction. Results: Five patients underwent immediate DIEP flap/TE reconstruction utilizing our alloderm sling technique. There were no complications to the pedicle, flap, expander, or mastectomy skin perioperatively or postoperatively. All patients describe being very satisfied, often with improved breast volume and projection as compared to their preoperative appearance. Conclusion: The results of this study suggest that DIEP flap/TE reconstruction is safe, in particular when utilizing the alloderm sling technique, and should be considered in patients who lack sufficient abdominal tissue, have existing breast asymmetries, or do not desire the scar deformity of latissimus dorsi.

  12. Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature.

    Science.gov (United States)

    Halani, Sameer H; Baum, Griffin R; Riley, Jonathan P; Pradilla, Gustavo; Refai, Daniel; Rodts, Gerald E; Ahmad, Faiz U

    2016-09-01

    OBJECTIVE Esophageal perforation is a rare but well-known complication of anterior cervical spine surgery. The authors performed a systematic review of the literature to evaluate symptomatology, direct causes, repair methods, and associated complications of esophageal injury. METHODS A PubMed search that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included relevant clinical studies and case reports (articles written in the English language that included humans as subjects) that reported patients who underwent anterior spinal surgery and sustained some form of esophageal perforation. Available data on clinical presentation, the surgical procedure performed, outcome measures, and other individual variables were abstracted from 1980 through 2015. RESULTS The PubMed search yielded 65 articles with 153 patients (mean age 44.7 years; range 14-85 years) who underwent anterior spinal surgery and sustained esophageal perforation, either during surgery or in a delayed fashion. The most common indications for initial anterior cervical spine surgery in these cases were vertebral fracture/dislocation (n = 77), spondylotic myelopathy (n = 15), and nucleus pulposus herniation (n = 10). The most commonly involved spinal levels were C5-6 (n = 51) and C6-7 (n = 39). The most common presenting symptoms included dysphagia (n =63), fever (n = 24), neck swelling (n = 23), and wound leakage (n = 18). The etiology of esophageal perforation included hardware failure (n = 31), hardware erosion (n = 23), and intraoperative injury (n = 14). The imaging modalities used to identify the esophageal perforations included modified contrast dye swallow studies, CT, endoscopy, plain radiography, and MRI. Esophageal repair was most commonly achieved using a modified muscle flap, as well as with primary closure. Outcomes measured in the literature were often defined by the time to oral intake following esophageal repair. Complications included

  13. Unusual Anatomic Variations Associated With Bilateral Ulnar Artery Hypoplasia.

    Science.gov (United States)

    Ro, Hyung-Suk; Roh, Si-Gyun; Shin, Jin Yong; Lee, Nae-Ho; Yang, Kyung-Moo

    2016-05-01

    Variations and anomalies of upper extremities have been commonly reported in routine dissection, clinical practices, and cadaver studies. Despite ongoing research on arterial variations of upper extremities, the absence of bilateral ulnar artery is extremely rare with only 3 patients reported. As the authors are presenting a successfully treated patient, initially prepped for radial forearm osteocutaneous free flap for treatment on oromandibular defect after a wide resection of head and neck cancer lesion, being confirmed to have bilateral ulnar artery hypoplasia and due to this, the patient had to change her surgical plan to fibular osteocutaneous free flap. PMID:27100648

  14. Hyperbilirubinemia as a predictor for appendiceal perforation

    DEFF Research Database (Denmark)

    Burcharth, J; Pommergaard, H C; Rosenberg, J; Gögenur, I

    2013-01-01

    Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum bilirubin may be a useful marker for appendiceal perforation. The purpose of this systematic review was to evaluate studies investigating elevated serum...

  15. Barrett's ulcer: cause of spontaneous oesophageal perforation.

    OpenAIRE

    Limburg, A. J.; Hesselink, E. J.; Kleibeuker, J H

    1989-01-01

    We report two patients, who presented within six months with the classic clinical picture of 'spontaneous' oesophageal perforation, which was caused by a perforated Barrett's ulcer. These two cases underline the importance of postoperative endoscopy in ruling out intrinsic oesophageal disease as the cause of the rupture in every patient, who survives this life threatening condition.

  16. Bowel perforation detection using metabolic fluorescent chlorophylls

    Science.gov (United States)

    Han, Jung Hyun; Jo, Young Goun; Kim, Jung Chul; Choi, Sujeong; Kang, Hoonsoo; Kim, Yong-Chul; Hwang, In-Wook

    2016-03-01

    Thus far, there have been tries of detection of disease using fluorescent materials. We introduce the chlorophyll derivatives from food plants, which have longer-wavelength emissions (at >650 nm) than those of fluorescence of tissues and organs, for detection of bowel perforation. To figure out the possibility of fluorescence spectroscopy as a monitoring sensor of bowel perforation, fluorescence from organs of rodent models, intestinal and peritoneal fluids of rodent models and human were analyzed. In IVIS fluorescence image of rodent abdominal organ, visualization of perforated area only was possible when threshold of image is extremely finely controlled. Generally, both perforated area of bowel and normal bowel which filled with large amount of chlorophyll derivatives were visualized with fluorescence. The fluorescence from chlorophyll derivatives penetrated through the normal bowel wall makes difficult to distinguish perforation area from normal bowel with direct visualization of fluorescence. However, intestinal fluids containing chlorophyll derivatives from food contents can leak from perforation sites in situation of bowel perforation. It may show brighter and longer-wavelength regime emissions of chlorophyll derivatives than those of pure peritoneal fluid or bioorgans. Peritoneal fluid mixed with intestinal fluids show much brighter emissions in longer wavelength (at>650 nm) than those of pure peritoneal fluid. In addition, irrigation fluid, which is used for the cleansing of organ and peritoneal cavity, made of mixed intestinal and peritoneal fluid diluted with physiologic saline also can be monitored bowel perforation during surgery.

  17. High power laser perforating tools and systems

    Science.gov (United States)

    Zediker, Mark S; Rinzler, Charles C; Faircloth, Brian O; Koblick, Yeshaya; Moxley, Joel F

    2014-04-22

    ystems devices and methods for the transmission of 1 kW or more of laser energy deep into the earth and for the suppression of associated nonlinear phenomena. Systems, devices and methods for the laser perforation of a borehole in the earth. These systems can deliver high power laser energy down a deep borehole, while maintaining the high power to perforate such boreholes.

  18. Analysis of bowel perforation in necrotizing enterocolitis

    Energy Technology Data Exchange (ETDEWEB)

    Frey, E.E.; Smith, W.; Franken, E.A. Jr.; Wintermeyer, K.A.

    1987-07-01

    The most severe complication of necrotizing enterocolitis (NEC) is bowel perforation. Identification of neonates at high risk for perforation and optimization of radiologic imaging to identify bowel perforation are necessary to reduce the high mortality rate associated with this catastrophic event. One hundred 55 cases of NEC were seen at our institution during a 5.5 year period. Nineteen (12%) progressed to perforation. A review of surgical findings, autopsy results and radiographs from these patients shows only 63% had radiographic evidence of free air in the peritoneal cavity at the time of perforation. Twenty-one percent had radiographic evidence of ascites but no pneumoperitoneum, and 16 percent had neither free air nor ascites. Thus purely radiographic criteria for bowel perforation in NEC are imprecise, and paracentesis is mandatory in NEC patients with ascites or clinical findings indicative of peritonitis. Timing of radiographic studies and site of bowel involvement are also important. Seventy-nine percent of perforations occurred by 30 h from confirmation of diagnosis (by clinical or radiographic criteria). Surgery or autopsy revealed involvement of the ileo-cecal region in 89% of cases with the actual site of perforation occurring in this area in 58% of patients.

  19. LAPAROSCOPIC REPAIR OF PERFORATED PEPTIC ULCER

    Directory of Open Access Journals (Sweden)

    S. Lunca

    2007-04-01

    Full Text Available Since 1990 when Mouret reported the first laparoscopic sutureless repair for a perforated duodenal ulcer and Nathanson the first successful laparoscopic suture repair for perforated peptic ulcer, laparoscopic approach became a widespread procedure. Treatment for perforated ulcer can be performed laparoscopically in 85% of cases, making it possible to avoid a median laparotomy which can lead to wound infection and late eventration. Laparoscopic approach is indicated in any case of suspected gastroduodenal perforation and seems to offer the same advantages as for the vast majority of laparoscopic procedures. Nowadays laparoscopic repair of duodenal perforation seems to be a useful method for reducing hospital stay, complications and return to normal activity if carried on in proper manner. With better training in minimal access surgery and better ergonomics now available the time has arrived for it to take its place in the surgeon’s repertoire.

  20. SPONTANEOUS ESOPHAGEAL PERFORATION: WHEN NOT TO OPERATE

    Directory of Open Access Journals (Sweden)

    Shenthil Prabhu

    2015-10-01

    Full Text Available Spontaneous Oesophageal perforation is lethal unless managed appropriately. Oesophageal perforation can be spontaneous (Boerhaeve, post traumatic, malignant or foreign body induced. Appropriate treatment depends on the size of perforation, time of presentation between rupture and diagnosis and general condition of the patient. Not all patients need surgical management and when carefully selected there are subset of patients who can be managed medically. CASE REPORT: A case of spontaneous oesophageal perforation due to intense retching following alcohol intake in a 35year old male is described here with a review of pertinent literature. The patient had presented with intense retching followed by vomiting which contained undigested food particles initially only to be followed by hematemesis, chest pain, fever with left sided pleural effusion. Computed tomographic scan demonstrated a pneumomediastinum, and left sided pleural effusion. The patient was managed successfully by conservative treatment. CONCLUSION:Spontaneous oesophageal perforation can be managed conservatively in a selected set of patients .

  1. CHEMICAL CAUTERISATION OF TYMPANIC MEMBRANE PERFORATIONS

    Directory of Open Access Journals (Sweden)

    Vikramjit Singh

    2015-04-01

    Full Text Available Cauterisation of 144 ear perforations ( R ight and L eft with 20 percent TCA ( T richloracetic acid was tried in patients having 2 to 6mm perforations . Per forations were dry for 3 weeks - 3 months or more. 30 patients were having traumatic perforations such as slap on face, blast injuries or associated with head injuries. Most of the patients were having perforations due to inflammation. Few of them had recent attack of otitis media which were effectively treated by suitable antibiotics, anti - histamines and subs equently taken for cauterization of perforation. Site of perforation was mostly on the anteroinferior quadrant, next the inferior quadrants. Still less number in the entire four quadrant, least no. in P. S. quadrant. Traumatic perforations were irr egular i n shape varying from 2 - 6 mm in size and were elliptical in shape. Hearing loss ranged from 15dB - 45dB ( D epending upon size and site of perforation. Main presenting symptoms in inflammation cases were intermittent discharge as well as deafness. In traumatic case history of pain and deafness was the main symptom. We did wait for 1 month in traumatic cases to achieve spontaneous closure. In inflammatory cases cautery was considered first line of treatment. It has to be done several times at 10 days interval. Mo st of the times closure of perforation was achieved with 3 attempts, inflammatory cases 5 th or 6 th attempt. In one case as many as 23 attempts. In 6 cases of perforation after partial take of graft in myringoplasty occurred after 3 months cauterization was attempted and we got closure in 5 of them. In one case re myringoplasty had to be done.

  2. Optimization of geometrical characteristics of perforated plates

    International Nuclear Information System (INIS)

    Highlights: ► Perforated plate are tested against 12.7 mm API projectile. ► Perforations similar to the projectile diameter offer more efficient core fracture. ► Larger perforations gave a more efficient core fragmentation. ► SEM microscopy analysis has shown a ductile fracture mode at impact point. - Abstract: In this paper, an attempt was made to design effective non-homogenous armor in form of perforated plate mounted at close distance from basic armor plate. Perforated plate with three perforation diameters: 9, 10 and 11 mm, two ligaments length: 3.5 and 4.5 mm ligaments, set at 0° and 28° angles, were combined to 13 mm basic plate and tested against 12.7 mm API ammunition. It has been shown that larger perforations gave a more efficient core fragmentation, while angled specimens were the only ones that offer full protection against five API shots when the perforated plate was placed at 100 mm from the basic plate. Perforations that are similar in size to the penetrating core diameter offer a more efficient core fracture, leading to a faster fragment separation. This may enable a smaller distance between the add-on perforated and basic plate to be used. Scanning electron microscopy analysis has shown a ductile fracture mode at impact point, with hardness values on plate basic level. On the other hand, a brittle fracture mode with a rise in local hardness measured near impact point is a result of intensive high speed plastic deformation produced by bending stresses. A drop in local hardness measured near impact point, may be the result of intensive cracking that occur due to repeated projectile impact

  3. 颈肩峰区跨区供血轴型皮瓣的应用解剖%Applied anatomy of cervico-acromial crossing skin flap

    Institute of Scientific and Technical Information of China (English)

    胡春梅; 王乃利; 杨喆; 李养群; 唐勇; 赵穆欣

    2012-01-01

    目的 探讨颈肩峰区跨区供血轴型皮瓣的解剖学基础及临床应用可行性.方法 在北京协和医学院基础研究所解剖形态实验室提供的5具(10侧)新鲜成人尸体及10具(20侧)防腐成人标本上,应用医用红色乳胶灌注动脉,蓝色乳胶灌注静脉,在直视或手术显微镜下,解剖颈肩峰区动静脉、皮动脉以及真皮下血管网、深筋膜浅层血管网,对前界为锁骨、后界为肩胛冈、外侧界为肩峰、内侧为颈根部的颈肩峰区主要血供进行巨微解剖学观察.结果 ①皮动脉穿出点集中在斜方肌前缘及其延伸线的区域,宽度约4 cm的范围;②斜方肌前缘及其延伸线为轴心的中间部位,吻合支最为丰富,血管吻合多为网状,其次是肩胛冈上区.在众多的吻合支中可观察到每侧颈肩峰区均有2~3支明显的贯穿颈根至肩峰全长的吻合支,多位于中轴位置及后侧,在深筋膜浅层至真皮下血管网之间有丰富的交通支相连.结论 颈肩峰区皮动脉穿出点位置恒定,深筋膜浅层血管吻合支丰富,可形成颈肩峰区跨区供血轴型皮瓣.%Objective To investigate the applied anatomy of the blood supply of the cervicoacromial crossing flap and its feasibility in clinical application.Methods 5 fresh adult and 10 forman fixed adult cadaver specimens were used.The arteries,veins,cutaneous arteries,subdermal vascular network,and vascular network of the superficial layer of deep fascia in the cervico-acromial area were observed and studied under the microscope.The frontier border of the cervico-acromial area is clavicle,the posterior border is the spine of scapula,the outer border is acromion and the inner border is cervical base.Results ① The perforator branches concentrate at the front edge of trapezius muscle; ②The vessel network around the front edge of trapezius muscle is abundant.Among the anastomosis,two or three anastomosis which across the area from the base of the neck to

  4. Experimental Study of Wake / Flap Interaction Noise and the Reduction of Flap Side Edge Noise

    Science.gov (United States)

    Hutcheson, Florence V.; Stead, Daniel J.; Plassman, Gerald E.

    2016-01-01

    The effects of the interaction of a wake with a half-span flap on radiated noise are examined. The incident wake is generated by bars of various widths and lengths or by a simplified landing gear model. Single microphone and phased array measurements are used to isolate the effects of the wake interaction on the noise radiating from the flap side edge and flap cove regions. The effects on noise of the wake generator's geometry and relative placement with respect to the flap are assessed. Placement of the wake generators upstream of the flap side edge is shown to lead to the reduction of flap side edge noise by introducing a velocity deficit and likely altering the instabilities in the flap side edge vortex system. Significant reduction in flap side edge noise is achieved with a bar positioned directly upstream of the flap side edge. The noise reduction benefit is seen to improve with increased bar width, length and proximity to the flap edge. Positioning of the landing gear model upstream of the flap side edge also leads to decreased flap side edge noise. In addition, flap cove noise levels are significantly lower than when the landing gear is positioned upstream of the flap mid-span. The impact of the local flow velocity on the noise radiating directly from the landing gear is discussed. The effects of the landing gear side-braces on flap side edge, flap cove and landing gear noise are shown.

  5. Arterial Catheterization

    Science.gov (United States)

    ... version AMERICAN THORACIC SOCIETY Patient Information Series Arterial Catheterization An arterial catheter is a thin, hollow tube ... PHYSICIANS: AND COPY Why Do I Need Arterial Catheterization? Common reasons an arterial catheterization is done include: ■ ...

  6. THORACO - ABDOMINAL FLAP FOR RESURFACING LARGE POST MASTECTOMY DEFECTS IN LOCALLY ADVANCED CA. BREAST

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao

    2015-02-01

    Full Text Available Covering of large wounds after mastectomy in locally advanced Ca breast with skin that can withstand radiotherapy is a challenge to the surgeon. Here this study we used a local advancement flap from the adjacent area called Thoraco - A bdominal F la p (TA flap for such giant defects. This is based on superficial and lumbar arteries and is thick to with stand consequent RT . MATERIALS AND METHODS: Of the total 107 cases of LABC 32 had post mastectomy defects of larger than 12 cm and could not be closed by simple approximation. Among the 32 cases 17 cases are covered by split thickness skin grafting. 15 cases are covered by TA flap. These cases are assessed for mean operating time, mean blood loss, post - operative stay, flap necrosis and viability of the f lap after radiotherapy. RESULTS: There is minimal extra time or blood loss in these cases . All the flaps healed well except for small edge necrosis in 4 cases. In all the patients we could start radiotherapy in the fourth week of surgery and all the flaps withstood RT well. After further evaluation probably this can be recommended as procedure for giant post mastectomy defects particularly for those who require RT early

  7. Repair of Head and Face Defects with the Use of Pericranial Flap

    Directory of Open Access Journals (Sweden)

    Mohammad Naeimi

    2011-01-01

    Full Text Available Introduction: The pericranial flaps' benefits have been described in many otolaryngologic, maxillofacial and plastic surgery literature. The benefits ar e due to the pericranial flaps unique characteristics including good flexibility and mobility, very rich blood supply from several arterial sources and access to sufficient bulk of the flap without any need for distant surgical sites. Using pericranial flaps to repair the local defects of the head and face region in several cases has been reported in this study. Materials and Methods: A follow up study was carried out on 12 patients who had undergone frontal sinus obliteration; auriculoplasty and repair of the orbital walls and scalp’s defects. Pericranial flap had been used for all these patients. Demographic specifications, surgical indications, imaging evaluations and early and late complications were recorded as well. The functional and cosmetic results and also the satisfaction level of patients were also assessed. Results: According to the average follow up period which lasted about 4 years, none of the patients suffered early or late significant complications. No disease relapse or need for revision surgery was reported. Almost all patients were completely satisfied with the procedure and its cosmetic results. Conclusion: The use of a pericranial flap is a simple, quick, cost-effective and safe method for repair of head and face defects. Although, a longer follow up time is required, but this uncomplicated method has been considered as an ideal method to repair sinonasal, ear and scalp defects.

  8. Early Venous Occlusion Detection in a Free Flap Using Real-time Laser Doppler Imaging

    Directory of Open Access Journals (Sweden)

    Héba Alkhashnam, MD

    2013-04-01

    Full Text Available Summary: Early detection of venous occlusion in free flaps is particularly difficult to identify, and its duration is known to be directly proportional to flap mortality. Here, we report a case of deep inferior epigastric perforator based breast reconstruction in which the intraoperative use of a perfusion camera enabled identifying a venous occlusion based on microcirculatory pulsation dynamics in real time. The sensitivity of our proposed method suggests that in certain cases in which the onset of venous occlusion begins in the operating room we can detect and treat occlusion before sending the patient to recovery. Further development of this technique will allow for earlier and more objective decision making with regard to venous occlusion detection in free tissue transfer.

  9. Daqing Perforation Charges Enjoy Good Market Reputation

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    @@ Founded in 1965, Daqing Perforation Charge Plant is the earliest oil perforation charge factory in China. The products,which are branded as "Qingmao" and enjoy good market reputation, are now sold to more than 20 domestic oil fields and 11 countries in the world. To meet the different demands by customers, the plant has developed some new products for market expansion with the penetration capability boosted 1130mm from 700mm five years ago. The large-calibration perforation charge filled a blank in the country.

  10. Septum nasal perforation: treatments and literature' review

    Directory of Open Access Journals (Sweden)

    Martinez Neto, Eulógio Emílio

    2010-03-01

    Full Text Available Introduction: The present study consists in a bibliographical' review concerning the articles related to the different manifestations and forms of the septum nasal perforation, with a main emphasis in the description of its techniques of surgical correction. As the etiology, that is fundamentally iatrogenic, accordingly surgical trauma. Other causes include exhibition to chemical industrial reagents, cocaine use, intranasal steroidal therapeutic, neoplasia and, infectious conditions. There is a few data concerning the prevalence of septum perforation in the general population. The decision making about surgical correction or medical treatment depend on the anatomic characteristics and of the pathogenesis of the septal perforation.

  11. Traumatic prenatal sigmoid perforation due to amniocentesis

    Energy Technology Data Exchange (ETDEWEB)

    Fines, B.; Ben-Ami, T.E.; Yousefzadeh, D.K. [Dept. of Radiology, Univ. of Chicago, IL (United States)

    2001-06-01

    A variety of fetal injuries, including those inflicted to the gastrointestinal tract by amniocentesis, have been reported before. This brief report describes the first documented case of sigmoid perforation owing to the common procedure of amniocentesis that manifested as abdominal distention at birth. A potential link between this complication and a recent increased incidence of ''intrauterine spontaneous perforation'' of the gastrointestinal tract has been mentioned. Practicing radiologists are encouraged to inquire directly about the history of amniocentesis in unexplained cases of intrauterine intestinal perforation. (orig.)

  12. Perforation of the gallbladder diagnosed preoperatively

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, D.G.; Lieberman, L.M.

    1983-04-01

    A 69-year-old white male was admitted to the hospital for right upper quadrant pain, fever, and vomiting. Acute cholecystitis was not thought to be present because of a negative ultrasonogram and oral cholecystogram. A sup(99m)Tc-PIPIDA hepatobiliary study showed definite evidence of gallbladder perforation, with pockets of radiolabeled bile in the abdomen. Immediate surgery confirmed the scan diagnosis. In patients who are at high risk for gallbladder perforation the technetium-99m-labeled iminodiacetic acid hepatobiliary scan should be considered as a first procedure to rule out acute cholecystitis and possible gallbladder perforation.

  13. Perforation of the Gallbladder diagnosed preoperatively

    International Nuclear Information System (INIS)

    A 69-year-old white male was admitted to the hospital for right upper quadrant pain, fever, and vomiting. Acute cholecystitis was not thought to be present because of a negative ultrasonogram and oral cholecystogram. A sup(99m)Tc-PIPIDA hepatobiliary study showed definite evidence of gallbladder perforation, with pockets of radiolabeled bile in the abdomen. Immediate surgery confirmed the scan diagnosis. In patients who are at high risk for gallbladder perforation the technetium-99m-labeled iminodiacetic acid hepatobiliary scan should be considered as a first procedure to rule out acute cholecystitis and possible gallbladder perforation. (orig.)

  14. The reverse sural fasciocutaneous flap for the treatment of traumatic, infectious or diabetic foot and ankle wounds: A retrospective review of 16 patients

    Directory of Open Access Journals (Sweden)

    Ioannis A. Ignatiadis

    2011-01-01

    Full Text Available The authors present their experience with the use of sural fasciocutaneous flaps for the treatment of various soft tissue defects in the lower limb. This paper is a review of these flaps carried out between 2003 and 2008. The series consists of 16 patients, 11 men and 5 women with an average age of 41 years (17-81 and with a follow-up period between 2 and 7 years. The etiology was major velocity accident in six cases, diabetes mellitus with osteomyelitis after ORIF for fractures (2, work accident in five, and another two cases with complications of lower limb injuries. The defect areas were located on calcaneus, malleolar area, tarsal area and lower tibia. Associated risk factors in the patients for the flap performance were diabetes (five patients and cigarette smoking (ten patients.The technique is based on the use of a reverse-flow island sural flap combined with other flaps in three cases (cross-leg, peroneal, gastrocnemius. The anatomical structures which constituted the pedicle were the superficial and deep fascia, the sural nerve, the lesser saphenous vein and skin.The flap was viable in all 15 patients. On 8 cases was achieved direct closure, on three cases occurred a superficial necrosis and was skin grafted, on one case was observed partial necrosis which was treated with a second flap (posterior tibial perforator flap and another one occurred delayed skin healing.The sural fasciocutaneous flap is useful for the treatment of severe and complex injuries and their complications in diabetic and non diabetic lower limbs. Its technical advantages are easy dissection, preservation of more important vascular structures in the limb and complete coverage of the soft tissue defects in just one operation without the need of microsurgical anastomosis. Thus this flap offers excellent donor sites for repairing soft tissue defects in foot and ankle.

  15. Retrocardiac pneumomediastinum in association with tracheal and esophageal perforations

    International Nuclear Information System (INIS)

    Retrocardiac pneumomediastinum was encountered in two premature infants; one had a tracheal perforation and one an esophageal perforation. Contrast studies showed communication between the sites of perforation and the retrocardiac air. Clinical signs suggestive of such perforation include abnormal course of tubes on plain chest films and bloody aspirates. (orig.)

  16. Efficient flapping flight of pterosaurs

    Science.gov (United States)

    Strang, Karl Axel

    In the late eighteenth century, humans discovered the first pterosaur fossil remains and have been fascinated by their existence ever since. Pterosaurs exploited their membrane wings in a sophisticated manner for flight control and propulsion, and were likely the most efficient and effective flyers ever to inhabit our planet. The flapping gait is a complex combination of motions that sustains and propels an animal in the air. Because pterosaurs were so large with wingspans up to eleven meters, if they could have sustained flapping flight, they would have had to achieve high propulsive efficiencies. Identifying the wing motions that contribute the most to propulsive efficiency is key to understanding pterosaur flight, and therefore to shedding light on flapping flight in general and the design of efficient ornithopters. This study is based on published results for a very well-preserved specimen of Coloborhynchus robustus, for which the joints are well-known and thoroughly described in the literature. Simplifying assumptions are made to estimate the characteristics that can not be inferred directly from the fossil remains. For a given animal, maximizing efficiency is equivalent to minimizing power at a given thrust and speed. We therefore aim at finding the flapping gait, that is the joint motions, that minimize the required flapping power. The power is computed from the aerodynamic forces created during a given wing motion. We develop an unsteady three-dimensional code based on the vortex-lattice method, which correlates well with published results for unsteady motions of rectangular wings. In the aerodynamic model, the rigid pterosaur wing is defined by the position of the bones. In the aeroelastic model, we add the flexibility of the bones and of the wing membrane. The nonlinear structural behavior of the membrane is reduced to a linear modal decomposition, assuming small deflections about the reference wing geometry. The reference wing geometry is computed for

  17. Effect of Perforation Area and Arrangement Pattern on Structural Behaviour of Nature Inspired Perforated Hollow Structure

    Directory of Open Access Journals (Sweden)

    Woo Yian Peen

    2013-01-01

    Full Text Available The Cholla cactus skeleton has been the inspiration source for this study, in our effort to search forlight and more structural effective structures. This woody skeleton of Cholla with oval shaped perforationsarranged in spiral pattern is found strong enough to support the cactus self weight. This research has beencarried out to investigate the effects of percentage of perforations and perforations arrangements on structuralbehaviour of cylindrical hollow section. A total of eleven models consisting of one cylindrical hollow sectionwithout perforation as the control model and ten simplified perforated cylindrical hollow sections have beenconstructed using a finite element method software. The perforated models have been assigned with 10 to 50percent of perforations area by fixing the number of perforations to twenty and altering the perforation size toachieve the percentage variable. Computational analyses have been carried out for three loading conditions:compressive, flexural and torsional. Findings have shown that the increment in percentage of perforationsproduces higher stresses to the cylindrical hollow section. This has effects on the structural capacity of thecylindrical hollow section. Array arrangement of the perforations shows better structural performance incompression and flexural loading conditions while spiral arrangement exhibits better structural performanceunder torsional loading condition.

  18. Stercoral perforation in a 17-year old.

    LENUS (Irish Health Repository)

    McHugh, S

    2012-02-01

    INTRODUCTION: Stercoral perforation is a rare cause of perforation. This is the first reported case where a partial eating disorder (ED) is the primary causative differential. CASE PRESENTATION: We present the case of a 17-year-old girl who presented to her local Emergency Department with a 24-h history of left-sided abdominal pain. She subsequently deteriorated and a computed tomography scan of her abdomen showed gross distension of the large bowel with a sigmoid perforation. She underwent total colectomy with end ileostomy. Histology reported stercoral perforation but normal bowel ganglia. While an inpatient she was reviewed by the Psychiatric team who were concerned she was suffering from a partial ED. CONCLUSION: This case highlights the importance of a multidisciplinary approach in optimally treating patients such as these. Aggressive medical management with involvement of a psychiatric team and dietetics addresses any underlying causative psychiatric issues and helps prevent recurrence.

  19. Stercoral perforation in a 17-year old.

    LENUS (Irish Health Repository)

    McHugh, S

    2009-04-02

    INTRODUCTION: Stercoral perforation is a rare cause of perforation. This is the first reported case where a partial eating disorder (ED) is the primary causative differential. CASE PRESENTATION: We present the case of a 17-year-old girl who presented to her local Emergency Department with a 24-h history of left-sided abdominal pain. She subsequently deteriorated and a computed tomography scan of her abdomen showed gross distension of the large bowel with a sigmoid perforation. She underwent total colectomy with end ileostomy. Histology reported stercoral perforation but normal bowel ganglia. While an inpatient she was reviewed by the Psychiatric team who were concerned she was suffering from a partial ED. CONCLUSION: This case highlights the importance of a multidisciplinary approach in optimally treating patients such as these. Aggressive medical management with involvement of a psychiatric team and dietetics addresses any underlying causative psychiatric issues and helps prevent recurrence.

  20. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Medline Plus

    Full Text Available ... usually in that setting, we'll proceed as planned with the deep inferior epigastric perforator technique. 00: ... revision of the reconstruction. So it's almost a planned two-stage process. We like to do as ...

  1. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Medline Plus

    Full Text Available ... think it's important for us to acknowledge the impact of a breast cancer diagnosis on patients. We' ... So even if you use several perforators, the impact on the abdominal wall musculature is still minimal. ...

  2. Laparoscopic Repair for Perforated Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    A. Cotirleţ

    2015-01-01

    Full Text Available Perforated peptic ulcer (PPU, despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. However we can say that laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered with the necessary expertise available.

  3. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Medline Plus

    Full Text Available ... And I'm going to -- Shelly, could you hold that for me? 00:06:55 SHELDON MARC ... mastectomies while Dr. Smith is already beginning to harvest the flap. This was actually a patient with ...

  4. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Medline Plus

    Full Text Available ... recurrence after mastectomy is small, it's probably under 5%. Those recurrences that develop almost always develop in ... had the back flap, or latissimus reconstruction, approximately five years ago, and she wants to know if ...

  5. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Medline Plus

    Full Text Available ... mastectomies while Dr. Smith is already beginning to harvest the flap. This was actually a patient with ... And at this point, you're beginning to harvest the abdominal tissue that will be ultimately used ...

  6. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Medline Plus

    Full Text Available ... flap doesn't require the removal of abdominal muscle. That allows for a less painful and faster ... older techniques that required sacrifice of the abdominal muscle, this technique does not. And it certainly is ...

  7. Current management of peptic ulcer perforations

    International Nuclear Information System (INIS)

    Perforation is a life-threatening complication of peptic ulcer disease. Smoking and use of non-steroidal anti-inflammatory drugs are important risk factors for perforation. Diagnosis is made clinically and confirmed by the presence of pneumoperitoneum on radiographs. Nonoperative management is successful in patients identified to have a spontaneously sealed perforation proven by water-soluble contrast gastroduodenogram. Operative management consists of the time-honoured practice of mental patch closure, but now this can be done by laparoscopic methods. The practice of addition of acid-reducing procedures is currently being debated though it continues to be recommended in good-risk patients. Laparoscopic approaches to closure of duodenal perforation are now being applied widely and may become the gold standard in the future especially in patients with < 10 mm perforation size presenting within the first 24 hours of onset of pain. The role of Helicobacter pylori in duodenal ulcer perforation is controversial and more studies are needed to answer this question though recent indirect evidence suggests that eradicating H pylori may reduce the necessity for adding acid reducing procedures and the associated morbidity. Perforation is a life-threatening complication of peptic ulcer disease. The management of peptic ulcer disease has evolved over the decades, due to advances in operative techniques, bacteriology and pharmacology. While the recognition of the role of Helicobacter pylori (H. pylori) in peptic ulceration has resulted in a paradigm shift in the management of uncomplicated peptic ulcers, debate continues about the appropriate management of perforated duodenal bulb and prepyloric ulcers. A new dimension has been added to this controversy by the advent of laparoscopic techniques for closing the perforation. A Medline search of all articles dealing with the management of peptic ulcer perforation published after 1985 was undertaken. The short listed articles were

  8. Perforated fairings for landing gear noise control

    OpenAIRE

    Boorsma, K.; Zhang, X; Molin, N.

    2008-01-01

    Landing gears of commercial aircraft make an important contribution to total aircraft noise in the approach configuration. Using fairings to shield components from high speed impingement reduces noise. Furthermore, perforating these fairings has been confirmed by flight tests to further enable noise reduction. Following a more fundamental study on the application of perforated fairings, a study has been performed to investigate and optimize the benefits of bleeding air through landing gear fa...

  9. Traumatic oesophageal perforation due to haematoma

    DEFF Research Database (Denmark)

    Grønhøj Larsen, Christian; Brandt, Bodil

    2014-01-01

    thoracic trauma leading to perforation on the 18th day. DISCUSSION: In treatment of oesophageal haematoma in patients on vitamin-K antagonists, strict control of the International Normalized Ratio (INR) is essential along with total parenteral nutrition therapy and refrainment through nasogastric tubes...... intramural hematoma gradually lysed and causing late perforation. CONCLUSION: Although extremely rare, an oesophageal haematoma and late complications must be considered in patients on anti-coagulant therapy following blunt thoracic trauma and complaining only of chest pain....

  10. Delayed bowel perforation following suprapubic catheter insertion

    OpenAIRE

    Mehta Ajay; Ahmed Shwan J; Rimington Peter

    2004-01-01

    Abstract Background Complications of suprapubic catheter insertion are rare but can be significant. We describe an unusual complication of a delayed bowel perforation following suprapubic catheter insertion. Case presentation A gentleman presented with features of peritonitis and feculent discharge along a suprapubic catheter two months after insertion of the catheter. Conclusion Bowel perforation is the most feared complication of suprapubic catheter insertion especially in patients with low...

  11. Evaluation of urgent esophagectomy in esophageal perforation

    OpenAIRE

    de Aquino, José Luis Braga; de CAMARGO, José Gonzaga Teixeira; Cecchino, Gustavo Nardini; PEREIRA, Douglas Alexandre Rizzanti; Bento, Caroline Agnelli; LEANDRO-MERHI, Vânia Aparecida

    2014-01-01

    Background Esophageal trauma is considered one of the most severe lesions of the digestive tract. There is still much controversy in choosing the best treatment for cases of esophageal perforation since that decision involves many variables. The readiness of medical care, the patient's clinical status, the local conditions of the perforated segment, and the severity of the associated injuries must be considered for the most adequate therapeutic choice. Aim To demonstrate and to analyze the re...

  12. Delayed Esophageal Perforation after Cervical Spine Plating

    OpenAIRE

    Kim, Seong Jung; Ju, Chang Il; Kim, Dong Min; Kim, Seok Won

    2013-01-01

    Although anterior approaches to the cervical spine are popular and safe, they cause some of complications. Esophageal perforation after anterior spinal fusion is a rare but potentially life-threatening complication. We present a rare case of delayed esophageal perforation caused by a cervical screw placed via the anterior approach. A 43-year-old man, who had undergone surgery for complete cord injury at another orthopedic department 8 years previously, was admitted to our institute due to pai...

  13. Non-occlusive mesenteric ischaemia of a free jejunal flap.

    Science.gov (United States)

    Onoda, Satoshi; Kimata, Yoshihiro; Yamada, Kiyoshi; Koshimune, Seijiro; Onoda, Tomoo; Shirakawa, Yasuhiro

    2013-05-01

    Free jejunal transfer using microsurgery after oesophageal or pharyngeal cancer resection is a useful operative approach. However, the disadvantage of free tissue transfer is the risk of necrosis of the transferred tissue due to impaired blood supply. In addition, jejunal flaps are more prone to blood-flow disorders such as ischaemia and congestion compared with other types of flaps. The causes of local blood supply disorders after microsurgery are divided broadly into two classes: one is thrombosis of an artery and/or vein in the anastomotic region and the other consists of local physical factors such as compressive pressure derived from haematoma formation and the effect of infection of the vascular pedicle. In this report, two rare cases of blood-flow disorder of the transferred free jejunum are described. In both cases, no signs of significant infection or occlusion of the vascular pedicles were present and late necrosis progressed gradually. The patients showed remarkable weight loss and a poor nutritional state due to inadequate preoperative nutritional intake. The necrosis was considered to be a result of non-occlusive mesenteric ischaemia of a free jejunal flap, and the factors contributing to free jejunal necrosis were reviewed. PMID:23395151

  14. Surgical treatment of perforated gastric ulcer

    Directory of Open Access Journals (Sweden)

    Korica Milan

    2002-01-01

    Full Text Available Introduction Peptic ulcer perforation is a complication of ulcer disease which requires urgent surgical treatment. The aim of this paper was to point out our experience in surgical treatment of perforated peptic ulcer. Material and methods This retrospective study analyzes results of surgical treatment in 365 patients with perforated peptic ulcer during the period January 1996 to December 2000. Results During the last 5-year period 365 patients were treated following peptic ulcer perforation. The average age was 43.53±8.26, with the span from 18 to 86. The most frequent surgical procedures in treatment of peptic ulcer perforation were: simple closure with biopsy (55.88%, excision of the ulcer with a pyloroplasty and vagotomy (35.29% as nonresection surgical procedures and stomach resection after Billroth II (8.83%. The postoperative mortality was 4.41%. Conclusions The methods of choice in surgical treatment of gastric ulcer perforation are nonresection surgical procedures with drug therapy and eradication of Helicobacter pylori, if present.

  15. Treatment of osteomyelitis and soft tissue defects at distal region of leg and foot by pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels%腓骨短肌肌瓣联合腓肠神经营养血管逆行岛状皮瓣治疗患者小腿远端及足部骨髓炎伴软组织缺损

    Institute of Scientific and Technical Information of China (English)

    胡骁骅; 陈忠; 黎明; 杜伟力; 王成; 沈余明

    2013-01-01

    lateral aspect of calcaneus.After debridement,soft tissue defect sizes ranged from 4 cm× 2 cm to 13 cm × 9 cm,and bone defect sizes ranged from 3.0 cm×3.0 cm×3.0 cm to 6.0 cm×3.0 cm×4.0 cm.The distally pedicled peroneus brevis muscle flaps with size ranging from 11 cm ×3 cm to 16 cm ×4 cm were used to fill the wound cavities of bone defects,and reverse island flaps with sural nerve and blood supplying vessels with size ranging from 5 cm × 3 cm to 14 cm × 10 cm were used for the repair of soft tissue defects.Flap donor sites were closed by direct suture or skin grafting.Results Muscle flaps and flaps survived in 11 cases,and the wounds healed well.Necrosis appeared in flap and muscle flap at the distal end in one patient,which was repaired with posterior tibial artery perforator myocutaneous flap.Patients were followed up for 6 to 24 months.Osteomyelitis did not recur,and both the texture and shape of flaps were satisfactory.Conclusions The distally pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels are suitable for the repair of osteomyelitis and soft tissue defects at distal region of leg and foot.The operation is simple,safe,reliable,and easy to perform.

  16. Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

    International Nuclear Information System (INIS)

    To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis. The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

  17. Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Gyu Chang [Dept. of Radiology, Gumi Hospital, Soonchunhyang University College of Medicine, Gumi (Korea, Republic of)

    2011-07-15

    To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis. The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p < 0.001). The sensitivity of circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

  18. Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time

    International Nuclear Information System (INIS)

    To evaluate mutidetector computed tomography (MDCT) for the prediction of perforation site according to each gastrointestinal (GI) tract site and elapsed time. One hundred and sixty-eight patients who underwent MDCT before laparotomy for GI tract perforation were enrolled and allocated to an early or late lapse group based on an elapsed time of 7 h. Two reviewers independently evaluated the perforation site and assessed the following CT findings: free air location, mottled extraluminal air bubbles, focal bowel wall discontinuity, segmental bowel wall thickening, perivisceral fat stranding and localised fluid collection. The overall diagnostic accuracy was 91.07 % and 91.67 % for reviewers 1 and 2, respectively, with excellent agreement (kappa 0.86). Accuracies (98.97 % and 97.94 %) and agreements (kappa 0.894) for stomach and duodenum perforation were higher than for other perforation sites. Strong predictors of perforation at each site were: focal bowel wall discontinuity for stomach, duodenal bulb and left colon, mottled extraluminal air bubbles for retroperitoneal duodenum and right colon, and segmental bowel wall thickening for small bowel. The diagnostic accuracy was not different between the early- and late-lapse groups. MDCT can accurately predict upper GI tract perforation with high reliability. Elapsed time did not affect the accuracy of perforation site prediction. (orig.)

  19. Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Cheol; Yang, Dal Mo; Kim, Sang Won [Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of); Park, Seong Jin [Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of)

    2014-06-15

    To evaluate mutidetector computed tomography (MDCT) for the prediction of perforation site according to each gastrointestinal (GI) tract site and elapsed time. One hundred and sixty-eight patients who underwent MDCT before laparotomy for GI tract perforation were enrolled and allocated to an early or late lapse group based on an elapsed time of 7 h. Two reviewers independently evaluated the perforation site and assessed the following CT findings: free air location, mottled extraluminal air bubbles, focal bowel wall discontinuity, segmental bowel wall thickening, perivisceral fat stranding and localised fluid collection. The overall diagnostic accuracy was 91.07 % and 91.67 % for reviewers 1 and 2, respectively, with excellent agreement (kappa 0.86). Accuracies (98.97 % and 97.94 %) and agreements (kappa 0.894) for stomach and duodenum perforation were higher than for other perforation sites. Strong predictors of perforation at each site were: focal bowel wall discontinuity for stomach, duodenal bulb and left colon, mottled extraluminal air bubbles for retroperitoneal duodenum and right colon, and segmental bowel wall thickening for small bowel. The diagnostic accuracy was not different between the early- and late-lapse groups. MDCT can accurately predict upper GI tract perforation with high reliability. Elapsed time did not affect the accuracy of perforation site prediction. (orig.)

  20. Pedicle Anterolateral Thigh Flap Reconstruction after Pelvic Tumor Resection: A Case Report

    Directory of Open Access Journals (Sweden)

    Robert M. Whitfield

    2010-01-01

    Full Text Available A 47-year-old female with a locally advanced urologic malignancy previously managed with resection, diversion, and postoperative radiation therapy presented for management of her recurrent cancer that had eroded through the soft tissues of the left inner thigh and vulva. On all staging studies the tumor involved the left common femoral artery, and vein, both above and below the inguinal ligament. The difficulty with such tumors is the availability of tissue to reconstruct the defect. The patient had a history of deep venous thrombosis in the femoral venous system. A local flap was the most logical type of reconstruction. The patient had a right lower quadrant ureterostomy with a large parastomal hernia which further limited the local flap options. An anterolateral thigh flap from the opposite thigh was used to reconstruct the soft tissue deficit in this patient. This resurfaced the defect and provided coverage for the vascular reconstruction.

  1. Tissue perforation of vessel substitutes using a femtosecond Ti:sapphire laser system

    Science.gov (United States)

    Schmidt, Volker; Husinsky, Wolfgang; Graf, R.; Fitzal, F.; Grabenwoeger, M.

    2000-06-01

    Previous investigations of transmural capillary ingrowth into the inner surface of biosynthetic vascular prostheses through perforations created by an excimer laser have shown that spontaneous endothelialization of the protheses can be achieved. Disadvantages of the excimer laser are a large and non-circular beam profile and an inconvenient handling of the UV-radiation for medical applications. Therefore, a new commercial laser system, consisting of a mirror-dispersion- controlled Ti:S oscillator and a femtosecond multipass amplifier, which avoids these disadvantages was sued to perforate grafts made of a new biomedical. The laser-tissue interaction is based ona different mechanism due to the short pulsewidth high peak intensity and near IR wavelength. The very short pulsewidth reduces thermal damage of the tissue. The basic mechanism of the laser tissue interaction is not yet fully understood and still subject of investigations. Several biografts with 1 mm wall thickness have been used. The hole diameter could be varied between 50 and 200 micrometers and the distance between the holes was 4 mm. At laser intensities of approximately 20-30 TW/cm2 and a repetition rate of 1 kHz it took less than a second to drill a single hole. Subsequently to the perforation procedure, one perforated and one untreated biograft were implanted into the carotid arteries of several test sheep. It can be concluded that very intense near IR laser radiation is an ideal means for structuring biological tissue.

  2. STUDY OF MEDIAL CIRCUMFLEX ARTERY

    Directory of Open Access Journals (Sweden)

    Pavan P Havaldar

    2014-06-01

    Full Text Available Background: The proper knowledge of the course and ramification of blood vessels of lower limbs is very important for surgeons and interventional radiologist. Medial circumflex femoral artery usually originates from posteromedial aspect of the profunda femoris, but often originates from femoral artery itself. It has an important role in supplying blood to femoral neck and head, fatty tissue in acetabular fossa and used in flaps reconstructive surgery. Methods: 50 adult lowerlimbs were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Dissection of femoral triangle was carried out according to Cunningham’s manual. Site and mode of origin of the branches of femoral artery were studied, configuration of the femoral origins of medial and lateral circumflex femoral artery and their prevalence were studied. Results: Out of 50 extremities, Medial circumflex femoral artery took origin from profunda femoris in 41 specimens and from femoral artery in 9 specimens. Conclusion: The knowledge of normal origin and variation of medial circumflex femoral artery is very valuable in preventing iatrogenic injury to these vessels during surgical procedures of femoral triangle.

  3. Nursing Care in Repair of Defect of Soft Tissue in Hand and Foot with Modified Free Groin Flap%改良游离腹股沟皮瓣修复手及足部皮肤软组织缺损患者的护理

    Institute of Scientific and Technical Information of China (English)

    朱丽萍; 傅育红; 朱雪君

    2011-01-01

    Objective:To investigate the strategy of nursing care in repair of defect of soft tissue in hand and foot with modified free groin flap.Methods:In 12 patients suffered from defect of soft tissue in hand and foot repaired applying modified free groin flap which blood supply were deep iliac circunfiex artery and it's myocutaneous perforating branch, preoperative preparation were done well, cutaneous condition in groin area were assessed completely, preoperative instruction were aimed directly, skin and vessel in recipient site were protected,respiratory passage were prepaied well; In postoperative stage, special nursing of microsurgery were strengthened in emphasis, main points to observe modified free groin flap were mastered, Atv articulo were adjusted correctly, nursing care in donor site were completed well, inguinal hernia were prevented, body position were resettled and nursing care in deainage were done according to the operative characteristics, basic nursing were strengthened, and health instruction were fulfiled to prevent injury again.Results:All flaps survived, partial necrosis in a flap happened, and wound healing was gained by change dressings and skin grafting.Primary healing was gained in wound of abdomen, and no nursing compliation happened.With following-up for (3~12) months, the appearance of flap were satisfactory, and the texture of flap were soft.Conclusion:Scientific nursing care in peri-operation made an important role in raising survival rate of flap.%目的:探讨改良游离腹股沟皮瓣移植修复手及足部软组织缺损患者围手术期的护理对策.方法:对12例手及足部软组织缺损患者行以旋髂深动脉为主干血管及以肌皮穿支为供血的游离腹股沟皮瓣移植术的患者完善术前准备,充分评估腹股沟区域皮肤情况,针对性做好术前指导,保护供受区皮肤血管,做好呼吸道准备:术后重点加强显微外科专科护理,掌握改良游离腹股沟

  4. Repair of a wide lower extremity defect with cross-leg free transfer of latissimus dorsi and serratus anterior combined flap: a case report

    OpenAIRE

    Turgut, Gursel; Kayalı, Mahmut Ulvi; Köse, Özkan; Baş, Lütfü

    2010-01-01

    Composite tissue loss in extremities involving neurovascular structures has been a major challenge for reconstructive surgeons. Reconstruction of large defects can only be achieved with microsurgical procedures. The success of free flap operations depends on the presence of healthy recipient vessels. In cases with no suitable donor artery and vein or in which even the use of vein grafts would not be feasible, the lower limb can be salvaged with a cross-leg free flap procedure. We present a ca...

  5. Comparing the donor-site morbidity using DIEP, SIEA or MS-TRAM flaps for breast reconstructive surgery

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Rasmussen, Mads Kløvgaard; Sørensen, Jens Ahm

    2012-01-01

    Countless studies have compared the use of autologous tissue for breast reconstruction; however, rates of donor-site morbidity differ greatly. This study examined the donor-site morbidity of superficial inferior epigastric artery (SIEA), deep inferior epigastric perforator (DIEP) and muscle-spari...

  6. Arterial stick

    Science.gov (United States)

    ... the main arteries in the forearm (radial and ulnar arteries). The procedure is done as follows: The ... Arteries also have thicker walls and have more nerves. When the needle is inserted, there may be ...

  7. Surgical Treatment of Perforation Esophageal Carcinoma

    Institute of Scientific and Technical Information of China (English)

    Depu Duan; Jihua Zou; Zhigang Cai; Shengyong Wu; Haibo Xiao; Yiyong Zhou; Xiang Liang; Dekui Sun; Songchang Wu

    2006-01-01

    OBJECTIVE To determine the ideal method of surgical preoperative treatment for perforation with esophageal carcinoma.METHODS 36 cases of perforation with esophageal carcinoma were treated surgically in this series.Perforations occurred into the right lung in14 cases ,the mediastinum in 17 cases and trachea in 5 cases.Open thoracic surgery was performed in 34 cases,in which the right thoracic approach using a 3-incision method was applied in 16 cases,and operation by stages in 15 cases.Of the 34 cases,retrosternal substitution of the esophagus with stomach or colon was performed in 26 cases.RESULTS Surgery was successful in 31 cases and operative death occurred in 3 cases.The postoperative follow up study was from 3~72months.Of these cases 15 wree alive at 7~12 months, 2 at 24 months,and 1 at 72 months. The results can be considered satisfactory.CONCLUSION The therapeutic results of surgical treatment of perforation with esophageal carcinoma were markedly superior to that of conventional conservative treatment. The authors suggest that surgical intervention without delay should be undertaken for patients having a perforation with carcinoma of the esophagus. A right thoracic approach with a 3-incision method (retrosternal replacement of esophagus with stomach or colon) or operation by stages is preferable.

  8. [Scapular/parascapular double skin-paddle free flap for transfixing blast injuries of the hand. A case report].

    Science.gov (United States)

    Colson, T; Pozetto, M; Gibert, N; Dautel, G

    2014-06-01

    Balistic transfixing hand traumas require a complex reconstruction management. Stabilization and reconstruction of the injuried tissues need a double skin-paddle coverage. We present an original case report of a double skin-paddle scapular/parascapular free flap used to cover a through and through gunshot injury of the right hand. A 14-years-old patient presents a severe and extensive wound with full-thickness palmar and dorsal skin defects, dislocation of the carpal bones, median nerve and flexor tendons losses. Distal vascularization is maintained by the deep palmar arch system supplied by the ulnar artery. The radial artery is severed at the level of the first dorsal interosseous space. The measured defect of the dorsal skin was 12×7cm and the palmar one was 6×3cm. After skeletal stabilization, tendinous and nerve preparation, the hand coverage was performed using a double skin-paddle scapular/parascapular free flap. The vascular anastomoses include an end-to-side arterial suture between the circumflex scapular and the radial arteries, and an end-to-end venous suture between the circumflex scapular and the dorsal radial veins. The scapular/parascapular double skin-paddle free flap is a safe and reliable technique to achieve a dorsal and palmar hand coverage in lack of local flaps alternatives. It can be used as a good option prior to bone graft, tendinous and nervous reconstruction. PMID:24268067

  9. Adjoint-based optimization of flapping plates hinged with a trailing-edge flap

    Directory of Open Access Journals (Sweden)

    Min Xu

    2015-01-01

    Full Text Available It is important to understand the impact of wing-morphing on aerodynamic performance in the study of flapping-wing flight of birds and insects. We use a flapping plate hinged with a trailing-edge flap as a simplified model for flexible/morphing wings in hovering. The trailing-edge flapping motion is optimized by an adjoint-based approach. The optimized configuration suggests that the trailing-edge flap can substantially enhance the overall lift. Further analysis indicates that the lift enhancement by the trailing-edge flapping is from the change of circulation in two ways: the local circulation change by the rotational motion of the flap, and the modification of vortex shedding process by the relative location between the trailing-edge flap and leading-edge main plate.

  10. Bi-pedicled V-Y gastrocnemius myocutaneous flap for repairing Achilles tendon and overlying skin defect: the anatomic basis and clinical application

    Institute of Scientific and Technical Information of China (English)

    XU Yong-qing; ZHU Yue-liang; YANG Jun; LI Jun; DING Jing; LU Sheng

    2007-01-01

    Objective: To study the anatomic basis of the bi-pedicled V-Y gastrocnemius myocutaneous flap for repairing the composite Achilles tendon defect. Methods: The pedicle anatomy of the bi-pedicled V-Y gastrocnemius myocutaneous flap was examined on 30 cadaver specimens. The sliding distances of the flap were measured at different knee flexion degrees. The bi-pedicled V-Y gastrocnemius myocutaneous flap was applied in 12 cases of Achilles tendon defect with simultaneous skin and soft tissue defect. Results: The sural arteries could be classified into four types. After cutting off the gastrocnemius origin with a "Z-shaped" incision, the sliding distance of the flap reached (3.7±0.5)cm when the knee flexed 0°,(4.9±0.7)cm when the knee flexed 30°,(6.7±0.7)cm when the knee flexed 60°and (9.2±0.9)cm when the knee flexed 90°. All the defects healed. The patients recovered ambulation with satisfactory knee and ankle function.The follow-up was 4 months -12 years. Conclusions: Different sural artery types should be noticed during the harvest of the bi-pedicled V-Y gastrocnemius myocutaneous flap. With 90°knee flexion,this flap is suitable for one-stage repair of composite Achilles tendon defect within 9.2 cm±0.9 cm.

  11. Analysis of 120 Pectoralis Major Flaps for Head and Neck Reconstruction

    Directory of Open Access Journals (Sweden)

    Young Sun You

    2012-09-01

    Full Text Available Background A pectoralis major flap is one of the standard tools for the reconstruction ofdefects of the head and neck. Despite the technical advancement in free tissue transfer inhead and neck reconstruction, the benefits of a pectoralis major flap should not be overlooked.The purpose of this study is to evaluate our 17 years of experience in reconstructing defectsof the head and neck region using the pectoralis major flap.Methods We retrospectively reviewed the medical records of 112 patients (120 cases whounderwent pectoralis major flap operations for head and neck reconstruction during a periodranging from 1994 to 2010.Results In our series, no total necrosis of the flap occurred. Of the total cases, 30.8% presentedwith flap-related complications. Major complications occurred in 20% of all of the casesbut were then all successfully treated. The male sex was correlated with the occurrence ofoverall complications (P=0.020 and major complications (P=0.007. Preoperative albuminlevels of <3.8 g/dL were correlated with the formation of fistula (P=0.030. Defects of thehypopharynx were correlated with the occurrence of major complications (P=0.019 and theformation of fistula (P=0.012. Secondary reconstructions were correlated with the occurrenceof overall complications (P=0.013 and the formation of fistula (P=0.030.Conclusions A pectoralis major flap is still considered to be a safe, versatile one-stagereconstruction procedure in the management of the defects of head and neck and theprotection of the carotid artery.

  12. Diagnostic and prognostic value of {sup 99m}Tc-tetrofosmin scintigraphy in maxillofacial flaps

    Energy Technology Data Exchange (ETDEWEB)

    Aigner, Reingard M.; Sorantin, Erich [Department of Radiology, Division of Nuclear Medicine, Karl-Franzens University Graz, Auenbruggerplatz 9, 8036 Graz (Austria); Schultes, Guenter [Department of Oral and Maxillofacial Surgery, Karl-Franzens University Graz (Austria)

    2003-02-01

    In oro-maxillofacial malignancies, new therapeutic approaches are placing changing demands on the diverse diagnostic modalities. In contradistinction to mandibular reconstruction of former years, the transplants (microvascular anastomosed pedicled flaps, ''flaps'') now consist of one or more arteries feeding a soft tissue component attached to a piece of bone suitably fitted to fill the defect. We addressed the diagnostic value of technetium-99m tetrofosmin scintigraphy in differentiating between viability and non-viability of the soft tissue portion of flaps in the immediate postoperative assessment. A total of 60 patients who had received flaps for reconstruction of the mandible after partial resection were investigated with {sup 99m}Tc-tetrofosmin 3-5 days after surgery. Scintigraphy consisted of (a) radionuclide angiography, (b) static planar imaging in four projections starting at 10 min post injection, and (c) single-photon emission tomography (SPET) performed immediately after the planar imaging. Normal perfusion associated with no defects throughout the soft tissue portion of the transplant was observed in 46/60 patients. This scintigraphic pattern was identical to viability and normal postoperative follow-up. Hypoperfusion and small defects on planar and SPET images indicated viability and uncomplicated postoperative healing in 6/60 patients, but non-viability/inadequate healing of the flap in 4/60 patients. Absence of perfusion combined with a large defect on static planar and SPET images definitively showed the non-viability of the flap (4/60 patients). It is concluded that {sup 99m}Tc-tetrofosmin scintigraphy is a sensitive diagnostic tool for the immediate postoperative assessment of the viability and the adequacy of implantation of the soft tissue portion of flaps. Therefore tetrofosmin scintigraphy is an important modality in order (a) to define the optimal therapeutic regimen in the immediate postoperative period and (b) to

  13. Diagnostic and prognostic value of 99mTc-tetrofosmin scintigraphy in maxillofacial flaps.

    Science.gov (United States)

    Aigner, Reingard M; Schultes, Guenter; Sorantin, Erich

    2003-02-01

    In oro-maxillofacial malignancies, new therapeutic approaches are placing changing demands on the diverse diagnostic modalities. In contradistinction to mandibular reconstruction of former years, the transplants (microvascular anastomosed pedicled flaps, "flaps") now consist of one or more arteries feeding a soft tissue component attached to a piece of bone suitably fitted to fill the defect. We addressed the diagnostic value of technetium-99m tetrofosmin scintigraphy in differentiating between viability and non-viability of the soft tissue portion of flaps in the immediate postoperative assessment. A total of 60 patients who had received flaps for reconstruction of the mandible after partial resection were investigated with (99m)Tc-tetrofosmin 3-5 days after surgery. Scintigraphy consisted of (a) radionuclide angiography, (b) static planar imaging in four projections starting at 10 min post injection, and (c) single-photon emission tomography (SPET) performed immediately after the planar imaging. Normal perfusion associated with no defects throughout the soft tissue portion of the transplant was observed in 46/60 patients. This scintigraphic pattern was identical to viability and normal postoperative follow-up. Hypoperfusion and small defects on planar and SPET images indicated viability and uncomplicated postoperative healing in 6/60 patients, but non-viability/inadequate healing of the flap in 4/60 patients. Absence of perfusion combined with a large defect on static planar and SPET images definitively showed the non-viability of the flap (4/60 patients). It is concluded that (99m)Tc-tetrofosmin scintigraphy is a sensitive diagnostic tool for the immediate postoperative assessment of the viability and the adequacy of implantation of the soft tissue portion of flaps. Therefore tetrofosmin scintigraphy is an important modality in order (a) to define the optimal therapeutic regimen in the immediate postoperative period and (b) to provide better prognosis. PMID

  14. Diagnostic and prognostic value of 99mTc-tetrofosmin scintigraphy in maxillofacial flaps

    International Nuclear Information System (INIS)

    In oro-maxillofacial malignancies, new therapeutic approaches are placing changing demands on the diverse diagnostic modalities. In contradistinction to mandibular reconstruction of former years, the transplants (microvascular anastomosed pedicled flaps, ''flaps'') now consist of one or more arteries feeding a soft tissue component attached to a piece of bone suitably fitted to fill the defect. We addressed the diagnostic value of technetium-99m tetrofosmin scintigraphy in differentiating between viability and non-viability of the soft tissue portion of flaps in the immediate postoperative assessment. A total of 60 patients who had received flaps for reconstruction of the mandible after partial resection were investigated with 99mTc-tetrofosmin 3-5 days after surgery. Scintigraphy consisted of (a) radionuclide angiography, (b) static planar imaging in four projections starting at 10 min post injection, and (c) single-photon emission tomography (SPET) performed immediately after the planar imaging. Normal perfusion associated with no defects throughout the soft tissue portion of the transplant was observed in 46/60 patients. This scintigraphic pattern was identical to viability and normal postoperative follow-up. Hypoperfusion and small defects on planar and SPET images indicated viability and uncomplicated postoperative healing in 6/60 patients, but non-viability/inadequate healing of the flap in 4/60 patients. Absence of perfusion combined with a large defect on static planar and SPET images definitively showed the non-viability of the flap (4/60 patients). It is concluded that 99mTc-tetrofosmin scintigraphy is a sensitive diagnostic tool for the immediate postoperative assessment of the viability and the adequacy of implantation of the soft tissue portion of flaps. Therefore tetrofosmin scintigraphy is an important modality in order (a) to define the optimal therapeutic regimen in the immediate postoperative period and (b) to provide better prognosis. (orig.)

  15. Use of the Vascularized Iliac-Crest Flap in Musculoskeletal Lesions

    Directory of Open Access Journals (Sweden)

    Cristiane Tonoli

    2013-01-01

    Full Text Available Bone loss was in the past treated by several methods, such as bone distraction and the use of nonvascularized or tissue-bank bone grafts. With the advent of modern microsurgical techniques, the vascularized bone flap has been used with good results; it resolves local nutritional problems, repairs soft tissue that is often damaged by severe trauma, and treats bone loss due to tumors, pseudarthroses, and osteomyelitis. This paper reports the authors’ experience with the use of vascularized iliac-crest flaps to treat orthopedic pathologies in five patients with traumatic bone loss (<10 cm, three with osteomyelitis, and three with atrophic nonunion. In all cases, the same surgeon obtained a vascularized iliac-crest flap with a pedicle based on the deep iliac circumflex artery. All flaps consolidated within a mean period of 3 months. These findings demonstrate that the use of an iliac-crest flap is a treatment option in cases of bone loss and that it is associated with good functional results and minimal donor-site morbidity.

  16. Davis flap: the glory still present

    Science.gov (United States)

    El-Sabbagh, Ahmed Hassan

    2016-01-01

    Background: Upper third defects of the ear are too large to be closed primarily without distorting the auricle. Full thickness defects can be reconstructed with local flaps. In this article, Davis flap was used to fill the upper third defects of the ear with some modifications. Patients and methods: Eight patients underwent reconstruction of full thickness auricular defects with Davis flaps from July 2012 to December 2014. The posterior surface of the flap and the raw area of conchal area were covered by full thickness graft taken from posterior surface of ear. Results: All flaps survived. No congestion was noted. The donor sites and skin grafts healed uneventfully. Conclusion: Davis flap is a simple and reproducible tool for reconstruction of upper third of ear. PMID:27274439

  17. Pedal arteries of monkeys, with special reference to the plantar metatarsal arteries.

    Directory of Open Access Journals (Sweden)

    Hinenoya,Hitoshi

    1987-12-01

    Full Text Available In the Japanese, Formosan and crab-eating monkeys, the dorsal metatarsal arteries and their lateral distal perforating branches were well developed and supplied, directly or via the catella plantaris distalis, the plantar digital arteries. In the black ape, the plantar digital arteries arose from the medial plantar artery. The plantar metatarsal arteries of these monkeys, including the black ape, arose from the catella plantaris proximalis or deep plantar arch and were classified into the superficial plantar metatarsal (sM, superficial plantar intermetatarsal (sI, deep plantar metatarsal (dM and deep plantar intermetatarsal (dI arteries in relation to the interosseous muscles and metatarsal bones. This classification largely coincides with that of the human hand and foot (Murakami, 1969, 1971 and the monkey hand (Nakai et al., 1987.

  18. WAVE INTERACTION WITH PERFORATED CAISSON BREAKWATERS

    Institute of Scientific and Technical Information of China (English)

    Chen Xue-feng

    2003-01-01

    The reflection coefficient of perforated caissons and the total horizontal forces acting on them were experimentally and numerically analyzed and discussed when wave propagates normally. To consider the viscosity effect of fluid and nonlinear action of waves on structures, the VOF (Volume Of Fluid) method combined with the k-ε turbulence model was used to simulate the interaction between waves and structures. Governing equations were solved with the finite difference method. Through 2D experimental study in the wave flume, the empirical relationship between the reflection coefficient of perforated caissons and the main affecting factors were obtained from the experimental data using the least square method. Also the correlation between the ratio of the total horizontal force acting on perforated caisson and the force acting on solid caisson and the main affecting factors were regressed from the experimental data.

  19. Experimental skin flaps and nitric oxide

    OpenAIRE

    Gribbe, Örjan

    2006-01-01

    Abstract. Surgical flaps are used in plastic surgery to reconstruct tissue defects due to trauma or cancer removal. Occasionally flaps are subjected to ischemia and reperfusion injury leading to flap failure. Nitric oxide (NO), a small gaseous molecule, has vast physiological importance as it participates in the regulation of blood pressure, blood flow, neurotransmission and immune response. NO is synthesized by the enzyme NO synthase (NOS), which exists in both constitutiv...

  20. Wing flapping with minimum energy

    Science.gov (United States)

    Jones, R. T.

    1980-01-01

    A technique employed by Prandtl and Munk is adapted for the case of a wing in flapping motion to determine its lift distribution. The problem may be reduced to one of minimizing induced drag for a specified and periodically varying bending moment at the wing root. It is concluded that two wings in close tandem arrangement, moving in opposite phase, would eliminate the induced aerodynamic losses calculated

  1. Evaluation of urgent esophagectomy in esophageal perforation

    Science.gov (United States)

    de AQUINO, José Luis Braga; de CAMARGO, José Gonzaga Teixeira; CECCHINO, Gustavo Nardini; PEREIRA, Douglas Alexandre Rizzanti; BENTO, Caroline Agnelli; LEANDRO-MERHI, Vânia Aparecida

    2014-01-01

    Background Esophageal trauma is considered one of the most severe lesions of the digestive tract. There is still much controversy in choosing the best treatment for cases of esophageal perforation since that decision involves many variables. The readiness of medical care, the patient's clinical status, the local conditions of the perforated segment, and the severity of the associated injuries must be considered for the most adequate therapeutic choice. Aim To demonstrate and to analyze the results of urgent esophagectomy in a series of patients with esophageal perforation. Methods A retrospective study of 31 patients with confirmed esophageal perforation. Most injuries were due to endoscopic dilatation of benign esophageal disorders, which had evolved with stenosis. The diagnosis of perforation was based on clinical parameters, laboratory tests, and endoscopic images. ‪The main surgical technique used was transmediastinal esophagectomy followed by reconstruction of the digestive tract in a second surgical procedure. Patients were evaluated for the development of systemic and local complications, especially for the dehiscence or stricture of the anastomosis of the cervical esophagus with either the stomach or the transposed colon. Results Early postoperative evaluation showed a survival rate of 77.1% in relation to the proposed surgery, and 45% of these patients presented no further complications. The other patients had one or more complications, being pulmonary infection and anastomotic fistula the most frequent. The seven patients (22.9%) who underwent esophageal resection 48 hours after the diagnosis died of sepsis. At medium and long-term assessments, most patients reported a good quality of life and full satisfaction regarding the surgery outcomes. Conclusions Despite the morbidity, emergency esophagectomy has its validity, especially in well indicated cases of esophageal perforation subsequent to endoscopic dilation for benign strictures. PMID:25626932

  2. Intestinal perforation as an early complication in Wegener’s granulomatosis

    Directory of Open Access Journals (Sweden)

    Morsal Samim

    2010-05-01

    Full Text Available We present the case of a young man with involvement of the gastrointestinal tract in the early phase of Wegener’s granulomatosis. The patient presented at the emergency department with sudden onset of abdominal pain, nausea and vomiting. Radiography work up was negative for free air although ultrasound examination showed extraluminal intra-abdominal fluid. Exploratory laparotomy showed perforation of the jejunum. The bowel was vital except for this small segment of jejunum. A 5-cm long segment of jejunum was resected which revealed ulcerative inflammation accompanied by occluded arteries of the small intestine. Although intestinal perforation in Wegener’s granulomatosis is uncommon, several cases have been previously reported. Intestinal involvement in the early phase of the disease is even more uncommon. This case combined with previously reported cases emphasizes the possibility of gastrointestinal manifestation early in Wegener’s disease.

  3. Optimal propulsive flapping in Stokes flows

    International Nuclear Information System (INIS)

    Swimming fish and flying insects use the flapping of fins and wings to generate thrust. In contrast, microscopic organisms typically deform their appendages in a wavelike fashion. Since a flapping motion with two degrees of freedom is able, in theory, to produce net forces from a time-periodic actuation at all Reynolds numbers, we compute in this paper the optimal flapping kinematics of a rigid spheroid in a Stokes flow. The hydrodynamics for the force generation and energetics of the flapping motion is solved exactly. We then compute analytically the gradient of a flapping efficiency in the space of all flapping gaits and employ it to derive numerically the optimal flapping kinematics as a function of the shape of the flapper and the amplitude of the motion. The kinematics of optimal flapping are observed to depend weakly on the flapper shape and are very similar to the figure-eight motion observed in the motion of insect wings. Our results suggest that flapping could be a exploited experimentally as a propulsion mechanism valid across the whole range of Reynolds numbers. (paper)

  4. Optimal propulsive flapping in Stokes flows

    CERN Document Server

    Was, Loic

    2014-01-01

    Swimming fish and flying insects use the flapping of fins and wings to generate thrust. In contrast, microscopic organisms typically deform their appendages in a wavelike fashion. Since a flapping motion with two degrees of freedom is able, in theory, to produce net forces from a time-periodic actuation at all Reynolds number, we compute in this paper the optimal flapping kinematics of a rigid spheroid in a Stokes flow. The hydrodynamics for the force generation and energetics of the flapping motion is solved exactly. We then compute analytically the gradient of a flapping efficiency in the space of all flapping gaits and employ it to derive numerically the optimal flapping kinematics as a function of the shape of the flapper and the amplitude of the motion. The kinematics of optimal flapping are observed to depend weakly on the flapper shape and are very similar to the figure-eight motion observed in the motion of insect wings. Our results suggest that flapping could be a exploited experimentally as a propul...

  5. Optimal propulsive flapping in Stokes flows.

    Science.gov (United States)

    Was, Loïc; Lauga, Eric

    2014-03-01

    Swimming fish and flying insects use the flapping of fins and wings to generate thrust. In contrast, microscopic organisms typically deform their appendages in a wavelike fashion. Since a flapping motion with two degrees of freedom is able, in theory, to produce net forces from a time-periodic actuation at all Reynolds numbers, we compute in this paper the optimal flapping kinematics of a rigid spheroid in a Stokes flow. The hydrodynamics for the force generation and energetics of the flapping motion is solved exactly. We then compute analytically the gradient of a flapping efficiency in the space of all flapping gaits and employ it to derive numerically the optimal flapping kinematics as a function of the shape of the flapper and the amplitude of the motion. The kinematics of optimal flapping are observed to depend weakly on the flapper shape and are very similar to the figure-eight motion observed in the motion of insect wings. Our results suggest that flapping could be a exploited experimentally as a propulsion mechanism valid across the whole range of Reynolds numbers. PMID:24343130

  6. Anatomía arterial de los colgajos musculares de extensor carpi radialis longus y extensor carpi radialis brevis para su uso en transferencia muscular funcional libre Arterial anatomy of the extensor carpi radialis longus and extensor carpi radialis brevis muscle flaps related to its use in free functioning muscle transfer

    OpenAIRE

    A. Rodríguez Lorenzo; S.F. Morris; Carrera Burgaya, A.; Martelo Villar, F.

    2008-01-01

    El objetivo de este trabajo es documentar el aporte arterial y el patrón vascular intramuscular de los músculos Extensor Carpi Radialis Longus (ECRL) y Extensor Carpi Radialis Brevis (ECRB) para analizar su utilización como colgajos libres en transferencia muscular funcional para reanimación facial. Realizamos un estudio anatómico en 29 brazos humanos en fresco. Las técnicas de inyección utilizadas fueron la modificada de oxido de plomo y gelatina en 11 cadáveres y la de inyección pulsátil de...

  7. Delayed bowel perforation following suprapubic catheter insertion

    Directory of Open Access Journals (Sweden)

    Mehta Ajay

    2004-12-01

    Full Text Available Abstract Background Complications of suprapubic catheter insertion are rare but can be significant. We describe an unusual complication of a delayed bowel perforation following suprapubic catheter insertion. Case presentation A gentleman presented with features of peritonitis and feculent discharge along a suprapubic catheter two months after insertion of the catheter. Conclusion Bowel perforation is the most feared complication of suprapubic catheter insertion especially in patients with lower abdominal scar. The risk may be reduced with the use of ultrasound scan guidance.

  8. Duodenal perforation precipitated by scrub typhus

    Directory of Open Access Journals (Sweden)

    Raghunath Rajat

    2015-01-01

    Full Text Available Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  9. Duodenal Perforation Precipitated by Scrub Typhus.

    Science.gov (United States)

    Rajat, Raghunath; Deepu, David; Jonathan, Arul Jeevan; Prabhakar, Abhilash Kundavaram Paul

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection. PMID:26069430

  10. Perforated Plates as Passive Mitigation Systems

    Directory of Open Access Journals (Sweden)

    G.S. Langdon

    2008-03-01

    Full Text Available This paper presents the results of tests on fully-clamped circular plates subjected to blastloading directed down a tube. Four series of tests were performed. In one set of experiments,the blast wave was allowed to progress unhindered down the tube to impinge upon the plate,and in the other tests, perforated plates were placed in the path of the blast wave to hinderprogression down the tube, disrupting the blast and absorbing some of the kinetic energy.Results of the tests indicate that the perforated plates can be used as a form of passive mitigation.

  11. Microsurgical anatomy of the middle cerebral artery

    Directory of Open Access Journals (Sweden)

    Pai S

    2005-01-01

    Full Text Available Background: The microsurgical anatomy of the middle cerebral artery (MCA is of particular interest to the cerebrovascular surgeon. The purpose of this study was to define the microsurgical anatomy of the MCA and its various branches in the Indian population. Methods: Ten MCAs were studied from five cadaveric brain specimens. The authors studied the outer diameter, length, branches, perforators and site of these on the main trunk (M1, the division of the main trunk, the secondary trunks and their various cortical branches using the operating microscope under 5-20x magnification. Results: The outer diameter of the MCA main trunk ranges from 2.5 to 4 mm with a mean of 3.35 mm. The superolateral branches consisted of polar temporal artery and anterior temporal artery that had a common origin and sometimes the uncal artery or the accessory uncal artery. Perforators or lenticulostriate arteries were seen in the inferomedial surface all along the length of M1. Eight bifurcations and two trifurcations were noted. Cortical branches and their origin are discussed. Conclusion: Although the microsurgical anatomy of the MCA in Indian population correlated with the findings in the western literature, some structural and statistical variations were noted.

  12. Clinical application of reversed saphenous neurocutaneous vascular flap pedicle with the perforating branches of the tibialis posterior artery%胫后动脉穿支蒂隐神经营养血管逆行皮瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    柴益民; 邱勋永; 林崇正; 马心赤; 陈彦堃

    2004-01-01

    目的报道改进手术方法的隐神经营养血管逆行皮瓣临床应用的效果.方法在多普勒血流仪引导下设计以胫后动脉发出的筋膜皮穿支为血管蒂及旋转点,沿隐神经营养血管轴线切取皮瓣逆向转位修复小腿中下段及足踝部皮肤缺损创面.结果临床应用7例,皮瓣全部成活,皮瓣面积为15 cm×8 cm~5 cm×4 cm,穿支血管蒂位于内踝上方8~20 cm处.随访6~18个月,皮瓣质地优良,外形与功能恢复满意.结论该皮瓣设计灵活,切取方便,血供可靠,适于修复小腿中下段及足踝部的皮肤软组织缺损创面,为一种皮神经营养血管皮瓣与穿支蒂皮瓣相结合的新型皮瓣.

  13. Duodenal perforation associated with norovirus and rotavirus gastroenteritis

    OpenAIRE

    Ueda, Norishi; Shimotake, Takashi; Ohama, Kazunori

    2013-01-01

    Key Clinical Message Norovirus (NoV) and rotavirus (RV) gastroenteritis are usually self-limiting. However, few pediatric cases of bowel perforation and no duodenal perforation with NoV gastroenteritis were reported. We describe two children with duodenal perforation due to NoV or RV gastroenteritis. Suspicion for this association enables prompt intervention, preventing lethal outcomes of these common infections.

  14. Perforated duodenal ulcer: an unusual complication of gastroenteritis.

    OpenAIRE

    Wilson, J. M.; Darby, C. R.

    1990-01-01

    A 7 year old boy was admitted to hospital with gastroenteritis, which was complicated by an acute perforated duodenal ulcer. After oversewing of the perforation he made an uncomplicated recovery. Peptic ulceration is under-diagnosed in childhood and this leads to delay in diagnosis and appropriate management. Ulceration is associated with severe illness and viral infections, but perforation is rare.

  15. Spontaneous perforation of a pyometra presenting as generalized peritonitis.

    OpenAIRE

    Hosking, S. W.

    1985-01-01

    Eleven cases of spontaneous perforation of a pyometra have previously been reported. All were associated with, and probably secondary to, cervical occlusion. A further case is described, but differs in that the cervical canal was patent. In the absence of other possible causes of uterine perforation, the aetiology of the perforation in this case remains uncertain.

  16. Reconstruction of the columella and the tip of the nose with an island-shaped forehead flap

    Directory of Open Access Journals (Sweden)

    Vulović Dejan

    2011-01-01

    Full Text Available Background. Posttraumatic and postoperative defects of columella and the tip of the nose are difficult to reconstruct. There are several operative methods described in the literature, and many of them are step-by-step procedures with long duration. The aim of this study was to present one-step procedure for reconstruction of the columella and the tip of the nose with island-shaped arterial forehead flap. Case report. A 45-year old man was submitted to surgical excision of basocellular skin cancer. After the excision, a defect of the columella and tip of the nose the remained, 3 × 2.5 cm in dimensions, with exposed alar cartilages. During the same operation, the defect was covered with an island-shaped arterial forehead flap. Postoperative one-year course was uneventful, without signs of tumor recurrence after one year, and further surgical corrections were unnecessary. Conclusion. Considering the results of our operative technique, we believe that middle island-shaped forehead flap is suitable for reconstruction of the columella and the tip of the nose, due to the following reasons: safe vascularization of flap, similarity of the transferred tissue with the excised one, the procedure is completed in one step, simple surgical technique and uncomplicated healing of a flap-harvesting site.

  17. Scanning electron microscopy of irradiated recipient blood vessels in head and neck free flaps

    International Nuclear Information System (INIS)

    Irradiated and control recipient blood vessels in a similar patient population were studied with scanning electron microscopy. The vessels that were biopsied were then anastomosed to a free flap. Irradiated arteries display a significantly greater wall thickness and higher incidence of intimal dehiscence compared with control arteries. Fibrin deposition, microthrombi, and endothelium cell dehiscence are present more frequently in irradiated vessels than in control vessels. Details of the preparation and anastomotic technique for irradiated blood vessels are discussed. Microvascular surgery in irradiated human blood vessels carries with it a higher risk of thrombosis due to preexisting vessel wall damage. This risk can be minimized by experience and attention to detail

  18. Role of Subfascial Endoscopic Perforator Surgery (SEPS) in Management of Perforator Incompetence in Varicose Veins : A Prospective Randomised Study

    OpenAIRE

    Vashist, M. G.; Malik, Vijay; Singhal, Nitin

    2012-01-01

    The study was carried out to compare the efficacy of subfascial endoscopic perforator surgery (SEPS) and open subfascial ligation of perforators in varicose veins. This study was conducted on 100 patients of varicose veins from January 2006 to December 2010. Clinical scoring and color Doppler were performed in all the patients before surgery. Patients were divided into two groups: Group A and Group B alternately. Management of the perforators was done by subfascial endoscopic perforator surge...

  19. Infantile perforated appendicitis: A forgotten diagnosis

    Directory of Open Access Journals (Sweden)

    Katherine W. Gonzalez

    2015-04-01

    Full Text Available Acute appendicitis in the infant is a rare surgical diagnosis despite its frequency in older patients. The clinical presentation is often vague and can be misleading. We present the successful diagnosis and treatment of a 3 month old female with perforated appendicitis.

  20. Intestinal perforation caused by multiple magnet ingestion

    Directory of Open Access Journals (Sweden)

    Nergul Corduk

    2014-01-01

    Full Text Available Multiple magnet ingestion is rare, but can cause serious gastrointestinal complications. We report a case of 7-year-old girl with multiple intestinal perforations caused by multiple magnet ingestion. The aim of this report is to draw attention to magnetic toys, results of magnet ingestion and the importance of timing of operation.

  1. Concrete wall perforation by rigid missile

    International Nuclear Information System (INIS)

    Tests were performed to study the perforation risk of reinforced concrete by industrial accidental missile. An empiric formula is established from shots of cylindrical missile with flat nose and its validity range is set. Some shots with different missile shape have given correction to introduce then in the formula. Calculation with finite elements are compared with tests results

  2. Diagnosis and management of iatrogenic endoscopic perforations

    DEFF Research Database (Denmark)

    Paspatis, Gregorios A; Dumonceau, Jean-Marc; Barthet, Marc;

    2014-01-01

    expertise available at the center. A switch to carbon dioxide insufflation, the diversion of luminal content, and decompression of tension pneumoperitoneum or tension pneumothorax should also be done. 5 After closure of an iatrogenic perforation using an endoscopic method, ESGE recommends that further...

  3. Stercoral Perforation of the Colon in Pregnancy

    OpenAIRE

    Atkinson AL; Pepe A

    2010-01-01

    We report a 37 year old multi-parous lady, who in her third trimester of pregnancy, presented to the emergency room with acute diffuse abdominal pain and involuntary guarding. Findings on physical examination were consistent with peritonitis and a decision was made by the admitting team to perform an urgent laparotomy which surprisingly showed a stercoral perforation of the colon.

  4. Concrete wall perforation by rigid missile

    International Nuclear Information System (INIS)

    Tests were performed to study the perforation risk of reinforced concrete by industrial accidental missile. An empiric formula is established from shots of cylindrical missile with flat nose and its validity range is set. Some shots with different missile shape have given correction to introduce then in the formula. Calculation with finite elements are compared with test results. (orig.)

  5. [The super extended sub-mental flap or combo sub-mental flap].

    Science.gov (United States)

    Martin, D

    2014-08-01

    The author presents a technical variation of the sub-mental flap including in a conventional pedicled flap both sub-mental axes and their anastomoses on the midline. The assessment of the first flaps raised according to this method confirms the improvement of the distal blood supply. It allows the possibility to harvest "super extended" flaps reaching the contralateral auricular lobula. This variation can be considered as an axial flap which only the tip, located beyond the mandibular angle, is at random. The evolution of the sub-mental flap from its original description to this variation called "combo sub-mental flap" is then presented. Its reliability and the technical simplification it provides will have to be assessed in the future. PMID:24840945

  6. Secondary onlay free flap reconstruction of glossectomy defects following initial successful flap restoration.

    Science.gov (United States)

    Rihani, Jordan; Lee, Thomas; Ducic, Yadranko

    2013-08-01

    Patients who undergo tongue reconstruction over time may develop gradual worsening of dysarthria and dysphagia secondary to flap atrophy. At our institution, these patients undergo a secondary flap onlay procedure for augmentation of the neotongue. We review a total of 11 patients with total glossectomy defect who underwent secondary tongue augmentation with secondary onlay free flap consisting of radial forearm free flap (n = 6) and rectus free flap (n = 5). There was improvement in swallowing in 7 of 11 patients. Five (45.4%) patients achieved gastric tube independence. Seven (63.6%) patients achieved a varying degree of oral intake. All patients achieved tracheostomy independence. Dysarthria was improved in all patients. There were no flap failures. Therefore, a secondary onlay flap technique is feasible and may improve dysphagia and dysarthria to achieve gastric tube and tracheostomy independence in total glossectomy patients with delayed tongue atrophy. PMID:23625797

  7. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Medline Plus

    Full Text Available ... Dr. Mark Smith, who's the associate chief of plastic surgery here at Beth Israel. 00:01:55 MARK ... informative and educational. From Beth Israel New York, good night. 01:07:41 ANNOUNCER: This has been an in-depth look at DIEP flap reconstruction surgery at Beth Israel Medical Center in New York ...

  8. Analysis of tail effects in flapping flight

    NARCIS (Netherlands)

    Tay, W.B.; Bijl, H.; Van Oudheusden, B.W.

    2011-01-01

    Numerical simulations have been performed to examine the interference effects between an upstream flapping airfoil and a downstream stationary airfoil in a tandem configuration at a Reynolds number of 1000, which is around the regime of small flapping micro aerial vehicles. The object

  9. 逆行岛状皮瓣联合局部皮瓣修复示指软组织缺损%Combining reversed island flap with local flap in treatment of the index finger soft tissue defect

    Institute of Scientific and Technical Information of China (English)

    吴玉家; 曹令; 张亚洁; 杨芬; 常娜; 贾赤宇

    2013-01-01

    目的:评价利用指动脉或第一掌背动脉为轴型血管的逆行岛状皮瓣修复示指软组织缺损,并利用局部皮瓣修复次生创面的术式特点.方法:根据示指创面位置,近侧指间关节以远创面利用以指动脉为轴型血管的逆行岛状皮瓣修复,近侧指间关节(含关节)以近者利用第一掌背动脉,供瓣区利用局部易位皮瓣修复.结果:临床应用15例,利用指动脉者7例,利用掌背动脉者8例,除1例轴型皮瓣术后部分坏死再次清创缝合外,余皮瓣均一期愈合.结论:灵活应用指动脉或第一掌背动脉为轴型血管的逆行岛状皮瓣修复示指软组织缺损,并利用局部皮瓣修复次生创面,这一术式有效果可靠、操作方便、手术次数少等特点.%Objective To introduce a method of repairing index finger soft tissue defect by reversed island flap and local flap. Methods According to proximal interphalangeal joints.the distal wound was repaired by reversed island flap using digital artery as axial vascular,the proximal one using dorsal metacarpal artery, the donor area of island flap was repaired by local translocation flap. Results Fifteen ere treated by this method,using digital artery in seven cases,using dorsal metacarpal artery in eight,the flap had partial necrosis in one case,the others healed by first intention. Conclusion The technique of repairing index finger soft tissue defect by reversed island flap and local flap has more advantages,such as effective,reliable and easy to operate, fewer surgical and so on.

  10. Clinical study of reconstructing the medial malleolus with free grafting of fibular head composite tendon bone flap

    Institute of Scientific and Technical Information of China (English)

    WU Shui-pei

    2008-01-01

    Objective: To explore new surgical procedure for repairing and reconstructing medial malleolus and soft tissue defect.Methods: According to the size of medial malleolus and composite soft tissue defect, vascular fibular head composite tendon bone flap free grafting using anterior tibial recurrent vessel as the perforating branch was designed to reconstruct the medial malleolar saddle and triangular ligament, and composite back broadest muscle flap free grafting was designed to repair the medical malleolar wound surface. From January 2000 to December 2006, the technique was used in 5 male patients who were injured by machine or in traffic accidents, causing bone and soft tissue defect. The size of wound surface ranged from 19 cm×12 cm to 24 cm×12 cm.Results: The wound surface was healed at the first stage in 4 cases, and the other case had infection and was cured in 6 months with anti infection therapy. Postoperative follow-ups from 6 months to 6 years showed that grafted bones and free cutaneous flaps were healed well, malleolar joints were stable, joint movement was normal, and the appearance was satisfactory. The overall outcome was good.Conclusion: Fibular head composite tendon bone flap free grafting is effective for repairing medical malleolar defect.

  11. Load-bearing capacity of perforated trapezoidal sheeting

    OpenAIRE

    Misiek, Thomas; Saal, Helmut

    2010-01-01

    Thin-walled perforated sheeting is used for sound absorption in buildings. The perforation may extend over the whole surface or only parts of the sheeting, e.g. webs. So far only reduction factors for the in-plane stiffness and the bending stiffness of fully perforated sheets with an equilateral triangular perforation pattern are included in EN 1993-1-3 and EN 1999-1-4. These factors only apply to perforation patterns in form of equilateral triangles, because of the isotropy assumed during de...

  12. Use of pulsed neutron logging to evaluate perforation washing

    International Nuclear Information System (INIS)

    This invention relates to the use of pulsed neutron logging techniques before and after perforation washing operations are performed to evaluate the degree of success of the perforation washing operations. Well logging operations of a type designed to respond to the difference between a formation immediately behind the well sheath and voids in the formation are performed both before and after the perforation washing operation. differences between the two resulting logs are then indicative of voids created by perforation washing. In a preferred embodiment, pulsed neutron logging is used as the logging technique, while a weighted brine having a high absorption cross section to pulsed neutrons is used as the perforation washing fluid

  13. Fasciocutaneous flap for vaginal and perineal reconstruction

    International Nuclear Information System (INIS)

    A skin and fascia flap from the medial thigh is proposed for vaginal and perineal reconstruction. Dissection, vascular injection, and radiographs of 20 fresh cadaver limbs uniformly demonstrated the presence of a communicating suprafascial vascular plexus in the medial thigh. Three to four nonaxial vessels were consistently found to enter the proximal plexus from within 5 cm of the perineum. Preservation of these vessels permitted reliable elevation of a 9 X 20 cm fasciocutaneous flap without using the gracilis muscle as a vascular carrier. Fifteen flaps in 13 patients were used for vaginal replacement and coverage of vulvectomy, groin, and ischial defects. Depending on the magnitude of the defect, simultaneous and independent elevation of the gracilis muscle provided additional vascularized coverage as needed. Our experience indicates that the medial thigh fasciocutaneous flap is a durable, less bulky, and potentially sensate alternative to the gracilis musculocutaneous flap for vaginal and perineal reconstruction

  14. Fasciocutaneous flap for vaginal and perineal reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Wang, T.N.; Whetzel, T.; Mathes, S.J.; Vasconez, L.O.

    1987-07-01

    A skin and fascia flap from the medial thigh is proposed for vaginal and perineal reconstruction. Dissection, vascular injection, and radiographs of 20 fresh cadaver limbs uniformly demonstrated the presence of a communicating suprafascial vascular plexus in the medial thigh. Three to four nonaxial vessels were consistently found to enter the proximal plexus from within 5 cm of the perineum. Preservation of these vessels permitted reliable elevation of a 9 X 20 cm fasciocutaneous flap without using the gracilis muscle as a vascular carrier. Fifteen flaps in 13 patients were used for vaginal replacement and coverage of vulvectomy, groin, and ischial defects. Depending on the magnitude of the defect, simultaneous and independent elevation of the gracilis muscle provided additional vascularized coverage as needed. Our experience indicates that the medial thigh fasciocutaneous flap is a durable, less bulky, and potentially sensate alternative to the gracilis musculocutaneous flap for vaginal and perineal reconstruction.

  15. Exotic wakes of flapping fins

    DEFF Research Database (Denmark)

    Schnipper, Teis

    downstream neighbour. When this neighbour is a second flag close by, they synchronise in frequency and the leader experiences a reduced drag compared to that on the lone flag. In case the follower is replaced by a flapping plate, upstream synchronisation and drag reduction is again found over a wide range of...... frequencies. Drag reductions up to a factor 3 are measured. Many results presented are obtained through flow visualisations. A great effort is made to produce visualisations of primarily high scientific quality, but often also with a certain aesthetic appeal....

  16. CLINICAL STUDY OF ABDOMINAL HOLLOW VISCERAL PERFORATION-NON TRAUMATIC

    Directory of Open Access Journals (Sweden)

    Vinod Kumar

    2014-07-01

    Full Text Available : INTRODUCTION: Perforation of any part of gastrointestinal track usually gives rise to a life threatening emergency. A high index of suspicion is essential to diagnose visceral perforation early as significant morbidity and mortality results from diagnostic delay. This study was undertaken to analyse regarding sex incidence, seasonal factors, etiological factors, clinical features, investigations, treatment, complications of hollow perforation and results were compared with results of previous similar studies. METHODS: The total number 31 cases of hollow visceral perforation in abdomen have been studied prospectively in detail during the period from October 2009 to September 2011. RESULTS: Among the 31cases of gastrointestinal perforation, perforation of duodenal ulcer 9 cases (29.3% was the commonest, there was male predominance constituting 21(67.7%, peptic ulcer perforation maximum is seen between June and September. The most common complication recorded was wound infection 5 cases (16.1%, death 4 cases (12.9%.Median length of the stay was 13days (2-44days. CONCLUSION: From our study of 31 cases of hollow viscous perforation the following can be concluded most common age group affected is 40-60 years, more commonly seen in males. Duodenum is the most common site perforation. In general peptic ulcer perforation maximum is seen between June and September, in rainy season. Most presented with hollow viscous perforation after 24 hours to the hospital. Wound infection, septicemia was, most common cause of morbidity and mortality respectively.

  17. Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis

    Science.gov (United States)

    Masood, Irfan; Majid, Zain; Rafiq, Ali; Rind, Waqas; Zia, Aisha; Raza, Sajjad

    2015-01-01

    Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. Herein, we describe a case of a 25-year-old male who presented with generalized peritonitis requiring an emergency exploratory laparotomy, which revealed pan-enteric perforation characterized by multiple perforations of the small bowel extending 10–15 cm from the DJ flexure up to the terminal ileum. The perforations were primarily closed, while 6–8 cm of the diseased terminal ileum was resected and the two ends were brought out as double-barreled ostomy. To the best of our knowledge, such an extensive tuberculous perforation of the small bowel has not been previously reported in the literature before. PMID:26798540

  18. Laser resurfacing of skin flaps: an experimental comparison

    Directory of Open Access Journals (Sweden)

    Srdan Babovic

    2011-05-01

    Full Text Available Objective. The influence of Coherent Ultrapulse, TruPulse and Erbium: YAG laser skin resurfacing on survival of the skin flaps when performed simultaneously was evaluated. Material and methods. We used twelve female Yucatan minipigs in the study. Skin flaps including paniculus carnosus were raised on the animals’ back. The flaps were sutured into the defect under tension. We designed 4 experimental groups: Control-Flaps only, Group 2-Flaps + 4 immediate TruPulse laser passes, Group 3-Flaps + 2 immediate Coherent UltraPulse laser passes, Group 4-Flaps – immediate 50J/cm2 total fluence with Erbium: YAG laser. Results. Flap survival in Control group was 98.8%. There was no flap in Group 2 with complete survival. Survival of the flaps in Group 2 (Tru-Pulse ranged from 75-90%, with average flap survival area of 85.2%. In Group 3 (UltraPulse all 24 flaps had some area of necrosis. Flap survival in Group 3 ranged from 75-95%, with an average of 85.6%. In Group 4 (Erbium: YAG flap survival area ranged from 70-95%, with all 24 flaps with some area of necrosis, with average flap survival area of 87.3%. There is a significant statistical difference in flap survival area between groups 2, 3 and 4 versus Control (p<0.001. Conclusion. The results of our study suggest that laser resurfacing of skin flaps sutured under tension in the same operative session is detrimental for skin flap survival. We also found no significant difference in flap survival area between TruPulse, Coherent UltraPulse and Erbium: YAG laser treated flaps.

  19. The management of large perforations of duodenal ulcers

    Directory of Open Access Journals (Sweden)

    Sharma Rajeev

    2005-06-01

    Full Text Available Abstract Background Duodenal ulcer perforations are a common surgical emergency, but literature is silent on the exact definition, incidence, management and complications of large perforations of duodenal ulcers. Methods The case files of 162 patients who underwent emergency laparotomy for duodenal ulcer perforations over a period of three years (2001 – 2003 were retrospectively reviewed and sorted into groups based on the size of the perforations – one group was defined as 'small 'perforations (less than 1 cm in diameter, another 'large' (when the perforation was more than 1 cm but less than 3 cms, and the third, 'giant'(when the perforation exceeded 3 cm. These groups of patients were then compared with each other in regard to the patient particulars, duration of symptoms, surgery performed and the outcome. Results A total of 40 patients were identified to have duodenal ulcer perforations more than 1 cm in size, thus accounting for nearly 25 % of all duodenal ulcer perforations operated during this period. These patients had a significantly higher incidence of leak, morbidity and mortality when compared to those with smaller perforations. Conclusion There are three distinct types of perforations of duodenal ulcers that are encountered in clinical practice. The first, are the 'small' perforations that are easy to manage and have low morbidity and mortality. The second are the 'large' perforations, that are also not uncommon, and omental patch closure gives the best results even in this subset of patients. The word 'giant' should be reserved for perforations that exceed 3 cms in diameter, and these are extremely uncommon.

  20. Pudendal thigh flap for repair of rectovaginal fistula.

    Science.gov (United States)

    Sathappan, S; Rica, M A I

    2006-08-01

    The pudendal thigh flap or the Singapore flap is a versatile flap that can be used in the repair of recto-vaginal fistulae. Apart from the potential problem of hair growth, this neurovascular flap proves to be surprisingly simple in technique, robust and has a high potential for normal or near-normal function. PMID:17240589