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Sample records for artery perforator flap

  1. Internal Mammary Artery Perforator flap

    NARCIS (Netherlands)

    Schellekens, P.P.A.

    2012-01-01

    Reconstructive surgery evolved as a result of the enormous numbers of World War I and II victims, long before profound knowledge of the vascularity of flaps was present. Sophisticated imaging techniques have given us at present a thorough understanding of the vascularity of tissues so that randomly

  2. 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)

  3. 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

  4. Quadrilobed superior gluteal artery perforator flap for sacrococcygeal defects

    Institute of Scientific and Technical Information of China (English)

    HAI Heng-lin; SHEN Chuan-an; CHAI Jia-ke; LI Hua-tao; YU Yong-ming; LI Da-wei

    2013-01-01

    Background Perforator flaps are used extensively in repairing soft tissue defects.Superior gluteal artery perforatorflaps are used for repairing sacral defects,but the tension required for direct closure of the donor area after harvesting ofrelatively large flaps carries a risk of postoperative dehiscence.This research was to investigate a modified superiorgluteal artery perforator flap for repairing sacrococcygeal soft tissue defects.Methods From June 2003 to April 2010,we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients (study group).The wound and donor areas were measured,and the flaps were designed accordingly.Wound healing was assessed over a follow-up period of 6-38 months.From January 1998 to February 2003,twelve patients with sacrococcygeal pressure sores were treated with traditional methods,VY advancement flaps or oblong flaps,as control group.Results After debridement,the soft tissue defects ranged from 12 cm × 10 cm to 26 cm × 22 cm (mean 16.3 cm x 13.5cm).Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm (mean 18.2 cm × 14cm).Four patients were treated using left-sided flaps,and two were treated using both right-and left-sided flaps.Suction drains were removed on postoperative Days 3-21 (mean 5.9) and sutures were removed on postoperative Days 12-14.Each flap included 1-2 perforators for each of the donor and recipient sites.Donor sites were closed directly.All flaps survived.In eight patients,the wounds healed after single-stage surgery.After further debridement,the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33,respectively.The rate of first intention in the study group (80%,8/10) significantly increased than that of control group ((25%,3/12),X2=4.583,P=-0.032).Follow-up examinations found that the flaps had a soft texture without ulceration.In the two patients without

  5. 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

  6. Thoraco dorsal artery perforator flap for trismus release in a young girl.

    Science.gov (United States)

    Deneuve, Sophie; Qassemyar, Quentin; Blancal, Jean-Philippe; Couloignier, Vincent; Sainte-Rose, Christian; Janot, François; Kolb, Frederic

    2015-11-01

    Trismus is a frequent complication occurring after treatment of tumors of the pterygomaxillary fossa. Local flaps and full-thickness skin grafts fail to release it because they usually lead to scar contracture in previously irradiated tissues. We propose to release it with a thoracodorsal artery perforator flap, which is feasible in children like other perforator flaps. It is interesting because it is thinner than the anterolateral thigh flap and its scar may be less disgraceful and easier to hide.

  7. Island medial plantar artery perforator flap for reconstruction of plantar defects.

    Science.gov (United States)

    Koshima, Isao; Narushima, Mitsunaga; Mihara, Mokoto; Nakai, Ikuo; Akazawa, Satoshi; Fukuda, Norio; Watanabe, Yorikatsu; Nakagawa, Masahiro

    2007-11-01

    Three cases in which island medial plantar artery perforator flaps were successfully transferred for coverage of the plantar defects are described. This perforator flap is different from the medial plantar flap based on the medial plantar artery. The flap has no fascial component and is nourished only with the perforator of the medial plantar vessel. Therefore, transection of the medial plantar artery is usually unnecessary. This flap can cover defects on the forefoot and heel without transaction of the medial plantar system. The advantages of this flap are no need for deep or long dissection for the medial plantar vessel, no exposure of the plantar sensory nerve, a short time for flap elevation, minimal donor-site morbidity, relatively large flap survival, and no damage of both the posterior tibial and medial plantar neurovascular systems. PMID:17992152

  8. 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.

  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 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.

  15. The Development of the Medial Circumflex Femoral Artery Perforator (MCFAP) Flap

    OpenAIRE

    Hallock, Geoffrey G

    2006-01-01

    In the quixotic quest for the “ideal” flap, the major attribute of the medial circumflex femoral artery perforator flap is its minimal donor-site deformity even if primary closure is not possible and a skin graft must be used. This source vessel captures the medial groin skin territory, and therefore sometimes has been referred to as the “medial groin” flap. This flap can be moderately large, the donor site easily hidden by clothing, the flap almost always has at least a single relatively lar...

  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. 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...

  1. Reconstruction after Anterior Chest Wall Keloid Resection Using Internal Mammary Artery Perforator Propeller Flaps

    Science.gov (United States)

    Ogawa, Rei; Ono, Shimpei; Akaishi, Satoshi; Dohi, Teruyuki; Iimura, Takeshi; Nakao, Junichi

    2016-01-01

    Background: It is difficult to completely resect huge anterior chest wall keloids and then close the wound directly. We report here our retrospective analysis of our case series of patients with such keloids who underwent reconstruction with internal mammary artery perforator (IMAP) pedicled propeller flaps and then received postoperative high-dose-rate superficial brachytherapy. Methods: All consecutive patients with large/severe keloids on the anterior chest wall who underwent keloid resection followed by reconstruction with IMAP-pedicled propeller flaps and then high-dose-rate superficial brachytherapy in our academic hospital were identified. All cases were followed for >18 months. Donor site position, perforator pedicle, flap size, angle of flap rotation, complications, and recurrence were documented. Results: There were nine men and one woman. The average age was 37.9 years. The average follow-up duration was 28.7 months. The largest flap was 16 × 4 cm. The dominant perforators of the internal mammary artery were located in the sixth (n = 2), seventh (n = 5), eighth (n = 1), and ninth (n = 2) intercostal spaces. Twelve months after surgery, patients reported marked relief from keloid-associated pain and itching, except in two patients who underwent partial keloid resection; their remaining keloids were still troublesome but after conservative therapies, including steroid ointments/plasters, the keloids gradually ameliorated. Eighteen months after surgery, there was no keloid recurrence or new development of keloids on the donor site. Conclusions: IMAP-pedicled propeller flaps transfer skin tension from the anterior chest wall to the abdomen. Our series suggests that this approach combined with radiation therapy can control keloid recurrence.

  2. 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.

  3. Pedicled perforator flaps

    DEFF Research Database (Denmark)

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

    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 recon......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...... more practical and creative to use a free-style manner during pedicled perforator flap surgery, instead of being obliged to predefined templates for this type of procedure....

  4. Reconstruction of the postauricular defects using retroauricular artery perforator-based island flaps: Anatomical study and clinical report.

    Science.gov (United States)

    Zhang, Yuan Zheng; Li, Ying Li; Yang, Chao; Fang, Shuo; Fan, Hao; Xing, Xin

    2016-09-01

    The objectives of the study were to introduce and investigate the reliability of a new flap for postauricular defects using the retroauricular artery perforator.Twenty auricles from 10 Asian human cadavers were dissected to examine the retroauricular perforator distribution and diameter. Fourteen patients with postauricular defects underwent reconstruction using the retroauricular artery perforator from 2013 to 2015. After locating the position of the perforator by ultrasound Doppler blood flow detection, a suitable flap was designed according to the defect's size, condition, and distance from the pedicle. The flap was meticulously elevated, rotated appropriately, and sutured to the defect. The donor site was then closed.Cadaver dissection showed that the posterior auricular artery produces at least 2 constant branches with an external diameter of 0.84 ± 0.25 mm at the origin. These branches proceed toward the mastoid process at the height of the auriculocephalic angle to nourish the skin and fascia. A total of 14 clinical cases were available for 3 to 12 months postoperative follow-up. All flaps survived completely, maintaining good skin color, perfect outer contour, and complete patient satisfaction with the aesthetic results after initial treatment.Retroauricular artery perforator-based island flaps appear to be ideal for 1-stage reconstruction of postauricular skin defects. PMID:27631246

  5. 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

  6. 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...

  7. The Versatile Modiolus Perforator Flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo

    2016-01-01

    BACKGROUND: Perforator flaps are well established, and their usefulness as freestyle island flaps is recognized. The whereabouts of vascular perforators and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our...

  8. 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.

  9. 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

  10. 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

  11. 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...

  12. 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.

  13. 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

  14. 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

  15. 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.

  16. Use of Thoracodorsal Artery Perforator Flaps to Enhance Outcomes in Alloplastic Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Jonathan Bank, MD

    2014-05-01

    Conclusions: Patients who underwent irradiation before TDAP flap did not have a higher complication rate when compared with patients who had a full LD flap following radiation. By integrating well-vascularized, nonradiated tissue of a TDAP flap in reconstruction, overall complication rate may be minimized and the results are comparable to the generally accepted method of utilizing the entire latissimus dorsi muscle.

  17. 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.

  18. 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

  19. [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.

  20. [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

  1. 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

  2. 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

  3. Immediate Bilateral Breast Reconstruction with Unilateral Deep Superior Epigastric Artery and Superficial Circumflex Iliac Artery Flaps.

    Science.gov (United States)

    Hansen, Keith S; Gutwein, Luke G; Hartman, Brett C; Sood, Rajiv; Socas, Juan

    2016-09-01

    Autologous breast reconstruction utilizing a perforator flap is an increasingly popular method for reducing donor site morbidity and implant-related complications. However, aberrant anatomy not readily visible on computed tomography angiography is a rare albeit real risk when undergoing perforator flap reconstruction. We present an operative case of a patient who successfully underwent a bilateral breast reconstruction sourced from a unilateral abdominal flap divided into deep superior epigastric artery and superficial circumflex iliac artery flap segments. PMID:27689054

  4. REPAIR OF SOFT TISSUE DEFECTS OF LOWER EXTREMITY BY USING CROSS-BRIDGE CONTRALATERAL DISTALLY BASED POSTERIOR TIBIAL ARTERY PERFORATOR FLAPS OR PERONEAL ARTERY PERFORATOR FLAPS%桥式交叉胫后动脉或腓动脉穿支皮瓣修复对侧下肢软组织缺损

    Institute of Scientific and Technical Information of China (English)

    范存义; 阮洪江; 蔡培华; 刘坤; 黎逢峰; 曾炳芳

    2011-01-01

    目的 探讨采用健侧逆行胫后动脉或腓动脉穿支皮瓣桥式交叉修复下肢软组织缺损的可行性.方法 2007年8月-2010年2月,收治15例下肢软组织缺损患者.男14例,女1例;年龄25~48岁,平均33.9岁.交通事故伤8例,机器伤4例,重物砸伤3例.1例踝部植皮后遗留22 cm×8 cm大小的瘢痕(伤后35个月);余14例软组织缺损位于踝部1例,小腿中下1/3处12例,小腿中上1/3处1例;创面范围8cm×6 cm~26 cm×15 cm;受伤至入院时间为4~28 d,平均14.8 d.采用逆行胫后动脉穿支皮瓣(9例)或腓动脉穿支皮瓣(6例)桥式交叉修复,皮瓣切取范围为10 cm×8 cm~28 cm×17cm.供区创面两端直接缝合,中部残留创面取游离皮片植皮修复.术后5~6周行皮瓣断蒂.结果 术后2例腓动脉穿支皮瓣分别出现远端轻度淤血及边缘部分坏死,经换药后均成活;其余皮瓣断蒂后均顺利成活,受区创面Ⅰ期愈合.供区切口Ⅰ期愈合,植皮均成活.15例均获随访,随访时间7~35个月,平均19.5个月.皮瓣质地、色泽与受区相近,外形较满意.末次随访时根据美国矫形足踝协会(AOFAS)踝与后足功能评分标准,评分为81~92分,平均87.3分.结论 健侧逆行胫后动脉或腓动脉穿支皮瓣桥式交叉可较好修复对侧小腿或足部大面积皮肤软组织缺损,术中无需吻合血管,血管危象发生率低,手术成功率高.%Objective To discuss the feasibility of repairing soft tissue defects of lower extremity with a distally based posterior tibial artery perforator cross-bridge flap or a distally based peroneal artery perforator cross-bridge flap. Methods Between August 2007 and February 2010, 15 patients with soft tissue defect of the legs or feet were treated. There were 14 males and 1 female with a mean age of 33.9 years (range, 25-48 years). The injury causes included traffic accident in 8 cases, crush injury by machine in 4 cases, and crush injury by heavy weights in 3 cases. There was

  5. 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

  6. 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

  7. 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.

  8. Direct popliteal artery perforator flap: anatomical study and clinical application%腘窝直接动脉穿支皮瓣的解剖学基础与临床应用

    Institute of Scientific and Technical Information of China (English)

    林涧; 陆骅; 郑和平; 林加福

    2014-01-01

    Objective To investigate and evaluate the clinical effect of the direct popliteal artery perforator flap.Methods Thirty embalmed lower limbs of adult cadavers which perfused with red latex were used to dissection,major observations were the origin,perforators and anastomoses regulations of the direct popliteal artery.Based on the anatomical study,direct popliteal artery perforator flaps were designed and used clinically to 7 patients who had soft tissue defects in popliteal fossa.Results The direct popliteal artery perforator was direct started from lateral wall of the superior segment of popliteal artery,and about 7-11 cm above knee joint.Then it goes up along the middle line of posterior region of thigh,and pierced from the carvity between semitendinosus and biceps femoris and gave off several branches in superficial fascia.Finally,these branches anastomoses with many perforating branches which were gave off form deep femoral artery (the 1st to 3rd perforator artery),obturator artery and lateral circumflex femoral artery.Clinically,all flaps were survived eventually,and 6 of them were healed quickly,only 1 case needed to change dressings to healed its partial necrosis for the pedicle had too much soft tissues and too swelling to block its blood supply.After 2-12 months of following-up,the colors and appearances of these flaps were excellent,and the function of knees were nearly normal.Conclusion Direct popliteal artery perforator flap has relatively constant location and sufficient blood supply to use in clinical application,it is safe and easy to use for recovering soft tissue defects in popliteal fossa.%目的 探讨与评价胭窝直接动脉穿支皮瓣的临床应用效果. 方法 在30侧动脉内灌注红色乳胶的成人下肢标本上,解剖观测腘窝直接动脉穿支的起源、分支与吻合规律;设计腘窝直接动脉穿支皮瓣,并转位修复腘窝部软组织缺损7例. 结果 胭窝直接动脉穿支于膝关节平面上7~11 cm处起

  9. Flow-through ulnar artery proximal perforator flaps for wound coverage of palm defects%尺动脉近段血流桥接穿支皮瓣修复手掌部创面缺损

    Institute of Scientific and Technical Information of China (English)

    李涛; 陈振兵; 艾方兴; 丛晓斌; 田甲; 洪光祥

    2014-01-01

    目的 探讨尺动脉近段血流桥接穿支皮瓣修复手掌部创面缺损的临床应用.方法 本组5例均为外伤导致手掌部皮肤、软组织缺损、血管损伤合并手指血运不良.2012年2月至10月我们应用尺动脉近段血流桥接穿支皮瓣修复创面,桥接了手掌部血管.术后超声检测桥接血管通畅情况,问卷调查患者对皮瓣外形的满意度,检测皮瓣触痛觉、温度觉、两点分辨觉,检查患指的关节活动度.结果 5例皮瓣均存活良好.随访时间为12~ 18个月,皮瓣较薄、外形良好,桥接血管血流均通畅,供区伤口均Ⅰ期愈合.患者对皮瓣外形满意度高(100%),术后12个月皮瓣两点分辨觉恢复至7.3~ 12.1 mm,平均7.8mm,皮瓣感觉恢复至S3+.结论 尺动脉近段血流桥接穿支皮瓣在修复手掌部创面的同时能重建断指血运,这是对细小穿支皮瓣的较好改进方法,具有特殊的适应证和应用价值.%Objective To investigate the clinical application of flow-through ulnar artery proximal perforator flaps for wound coverage of palm defects.Methods From February 2012 to October 2012,flowthrough ulnar artery proximal perforator flap was used to treat 5 cases of traumatic skin and soft tissue defects of the palm along with metacarpal artery injury and compromised finger perfusion.The vessel of the flap was inset between the ends of the injured metacarpal artery to repair the metacarpal artery so both the flap and the fingers were perfused.Postoperatively patency of the vessel was monitored by ultrasound.Patients' satsfaction of flap aesthetics was assessed by a questionnaire.Pain,touch and temperature sensations,two-point discrimination and finger movement were tested.Results All five flaps survived well.The patients were follow-up for 12 to 18 months.The flaps were thin and had good appearance.The flow through vessel was patent in all the cases.Primary healing was achieved in the donor sites.The patients were highly

  10. 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

  11. Preoperative CT angiography reduces surgery time in perforator flap reconstruction

    NARCIS (Netherlands)

    Smit, Jeroen M.; Dimopoulou, Angeliki; Liss, Anders G.; Zeebregts, Clark J.; Kildal, Morten; Whitaker, Iain S.; Magnusson, Anders; Acosta, Rafael

    2009-01-01

    The use of perforator flaps in breast reconstructions has increased considerably in the past decade. A disadvantage of the perforator flap is difficult dissection, which results in a longer procedure. During spring 2006, we introduced CT angiography (CTA) as part of the diagnostic work-up in perfora

  12. 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

  13. 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

  14. Reconstruction of the soft-tissue defects of the hand with free medial sural artery perforator flap%游离腓肠内侧动脉穿支皮瓣修复手部创面

    Institute of Scientific and Technical Information of China (English)

    张龙春; 陈莹; 王鹏; 丁晟; 马亮; 姚建民

    2015-01-01

    目的 探讨腓肠内侧动脉穿支皮瓣修复手部皮肤软组织缺损的临床疗效.方法 自2010年1月至2013年6月收治手部皮肤软组织缺损患者12例,采用游离腓肠内侧动脉穿支皮瓣移植修复.其中感染创面8例,清洁创面4例,创面面积为5cm×4cm~13cm×8cm;切取皮瓣面积为6 cm×4 cm~ 14 cm×9 cm.皮瓣的动脉与鼻烟窝处的桡动脉或分支吻合,静脉和桡动脉的伴行静脉或头静脉吻合.2例皮瓣通过缝合皮神经重建感觉.结果 术后10例皮瓣顺利存活;1例皮瓣边缘出现水泡,经拆线处理后存活;1例皮瓣下积血出现静脉危象,经清除积血引流处理后危象解除,皮瓣存活.受区和供区创面均Ⅰ期愈合,随访3~ 12个月,皮瓣色泽与受区相似,无明显臃肿,质地柔软,无一例发生溃疡,2例缝合皮神经的皮瓣感觉恢复到S3.9例皮瓣供区遗留线性瘢痕,3例遗留植皮瘢痕,肢体活动无影响.结论 腓肠内侧动脉穿支皮瓣的血管解剖较恒定,分离鳃剖皮瓣相对简单,皮瓣薄而柔软,受区外形较美观,供区创伤小,不损伤小腿主要血管和腓肠肌,是修复手部中小创面的良好选择.%Objective To evaluate the clinical results of soft tissue coverage of the hand using free medial sural artery perforator flap.Methods From January 2010 to June 2013,12 cases of soft tissue defects of the hand with bone and tendon exposure were treated with medial sural artery perforator flap transfer.Of these defects,4 were clean wounds while the other 8 had infections.The sizes of the defect ranged from 5 cm × 4 cm to 13 cm× 8 cm.The sizes of the flaps ranged from 6 cm× 4 cm to 14 cm × 9 cm.The feeding artery of the flap was anastomosed with the radial artery or its branch in the anatomical snuff box.The flap vein was anastomosed with the radial concomitant vein or the cephalic vein.Sensation of the flap was restored in 2 cases with cutaneous nerve coaptation.Results Postoperatively 10 flaps

  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. Clinical application of free KISS lateral femoral circumflex artery perforator flap in repairing defects of limbs%游离旋股外侧动脉穿支KISS皮瓣修复四肢创面的临床应用

    Institute of Scientific and Technical Information of China (English)

    唐修俊; 魏在荣; 王波; 王达利; 孙广峰; 金文虎; 李海

    2015-01-01

    Objective To summarize the clinical efficacy of free KISS lateral femoral circumflex artery perforator flap in repairing defects of limbs.Methods Twelve cases were suffered wound surface defects on hands and feet.And the defects were repaired by flap construction from October,2010 to May,2013,based on the characteristics of the defects combined with anatomical features of the free lateral femoral circumflex artery perforator flap.Length of flap was adopted as the width for direct suture in the flap donor.Results Postoperative flap and donor area preliminarily healed.There was no vascular crisis.Twelve cases received 6-18 months followed-up (averaged of 12 months).The skin flap was good in color and texture.The dorsal flap was a bit bloated.Linear scar was remained in distal flap donor area.The quadriceps muscle power level 5,knee flexion,extension 10°-180°.Quadriceps strength,knee flexion and stretch activities were all normal.The flaps recovered protective sense.Four cases had tendon adhesion after hand tendon transplantation.The finger function was well recovered after release.At the last followup,the functions of the upper limbs were evaluated according to the trial evaluation standard of the Hand Surgery Association of Chinese Medical Association:6 cases were excellent,1 case was good,and 1 case was qualified.Conclusion The design of the lobulated tissue flap of the lateral femoral circumflex artery descending branch is flexible.Large area of the surface defect can be repaired.The flap donor area is directly sutured.It is an ideal method to repair the wound tissue defect.%目的 总结游离旋股外侧动脉穿支KISS皮瓣在修复四肢创面中的临床疗效. 方法 2010年10月-2013年5月,根据手足部创面的特点,结合旋股外侧动脉穿支解剖特点设计分叶皮瓣,通过皮瓣重组(KISS)修复手足部创面缺损12例,将皮瓣的长度变成宽度使皮瓣供区直接缝合. 结果 术后皮瓣及供区Ⅰ

  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. The anatomical characteristics and clinical application of the lateral superior genicular artery perforator iliotibial band flap%膝上外侧动脉穿支髂胫束皮瓣的解剖特点与临床应用

    Institute of Scientific and Technical Information of China (English)

    高建明; 徐达传; 储旭东; 郭峰; 卢绪; 骆宇春; 刘云鹏

    2010-01-01

    Objective To discuss anatomical characteristics and clinical results of the lateral superior genicular artery perforator iliotibial band flap. Methods From September 1999 to July 2009, the origin,course, branches and distribution of the lateral superior genicular artery and blood supply of iliotibial band were observed on 40 sides adult lower limbs perfused with red latax. Five perforator iliotibial band and 4 perforator iliotibial band flaps of 9 cases were treated with anastomosis of lateral superior genicular artery perforating rami. Results The lateral superior genicular artery of 35 cases (80%) originates from the popliteal artery. Its originated external diameter was (1.8 ± 0.4) mm. It divides into ascending branch and descending branch, and they gives off septofascio-cutaneous perforator, or anatomoses the lateral uppermost genicular artery in the vastus lateralis muscle, and then formes the musculocutaneous perforator of iliotibial band. The originated external diameter of the larger perforator of iliotibial bands was ( 1.0 ± 0.2) mm and they provides for the skin and iliotibial band of lateral superior genicular area. Nine cases, including 5 cases of simple Achilles tendon defects, two cases of achilles tendon defects with skin defects, and 2 cases of lower extremity and foot soft tissue defects were treated with transplantation of the vascularized iliotibial band (flap) with perforator vascular anastomoses. All cases were followed up 6 - 92 months. The results showed significant improvement in "heel test" and Thompson sign in the rerupture of the Achilles tendon occurred. Four perforator iliotibial band flaps survived well. Conclusion The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and new donor in the reconstruction of soft tissue and composite defects.%目的 探讨膝上外侧动脉穿支髂胫束皮瓣的解剖学基础与临床应用效果.方法 自1999年9月至2009年7月,在40侧经动脉灌注红

  1. 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

  2. Anatomical study and clinical application of the medial sural artery perforator flap%吻合腓肠内侧血管穿支皮瓣的应用解剖和临床应用

    Institute of Scientific and Technical Information of China (English)

    程天庆; 柴益民; 曾炳芳

    2008-01-01

    目的 报道腓肠内侧血管穿支皮瓣的解剖学研究与游离移植的临床效果.方法 用明胶-氧化铅液灌注12侧标本的胭动脉,观测腓肠内侧血管及其穿支的分支、蒂长、管径等;取下标本皮肤软组织拍摄X线片,利用Photoshop与Scion Image分析穿支分布的趋向性和供血面积.临床上吻合腓肠内侧血管穿支皮瓣修复5例手部软组织缺损,皮瓣面积为7 cm×4 cm~12 cm×8 cm. 结果 所有标本的腓肠内侧血管至少存在1支穿支,平均2.1支;位于距横纹9~18 cm、距后中线1~5 cm的范围内;其深筋膜处的外径为(1.03±0.22)mm;穿支供血的总面积为(107.5±23.9)cm2,单穿支的供血面积为(58.3±17.0)cm2.5例移植皮瓣全部成活,随访6~12个月,手部修复后外形与功能恢复满意.结论 明胶-氧化铅液灌注造影是皮瓣血管解剖学研究的可靠方法;腓肠内侧血管恒定存在的穿支,可作为腓肠内侧血管穿支皮瓣的血供来源;该皮瓣外形美观,是修复手部中、小面积皮肤软组织缺损的良好选择.%Objective To report the anatomical study and clinical application of the medial sural artery pertorator flaps. Methods The anatomical study involved 12 fresh adult cadaver lower legs, the arteries of which were perfused with suspensions of lead oxide and gelatine. The bifurcation, location, length, diameter and blood territories of the medial sural artery and its perforating vessels were recorded by dissection, angiography and photography. The integument of the leg was dissected and ridiographed. The tendency of the vessels was analyzed, the surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image. With the aid of anatomic study, a series of five clinical cases was reported, including five free medial sural flaps for ipsilateral hand reconstruction. Results There was at least one perforating vessel in the medial sural areas of the specimen. A mean

  3. The middle-forearm flap based on perforator of ulnar artery for electrical burn wound on the wrist%前臂中段尺动脉穿支皮瓣修复腕部电击伤创面

    Institute of Scientific and Technical Information of China (English)

    储国平; 杨敏烈; 俞舜; 秦宏波; 赵庆国; 苏青和; 吕国忠

    2014-01-01

    Objective To dicuss the application and therapeutic effect of middle-forearm flap based on perforator of ulnar artery for electrical burn wound on the wrist.Methods From Oct.2009 to Oct.2012,10 cases of electrical burn wounds on the wrist were treated.A line from radialis medial epicondyle of humerus to the interior radialis pisiform bone was connected as flap axis.At the midpoint of the line,Doppler flow imaging meter was used to detect the emerging point of perforator vessel.The flap was designed and harvested.The flap was transferred reversely,with superficial vein retaining which was anastomosed with vein at recipient sites in 3 cases.The wounds in the donor sites were closed directly in 2 cases,and with skin graft in 8 cases.Results All the 10 flaps survived completely.7 cases without vein anastomosis underwent obvious flap edema during 2-4 days postoperatively,which resovled 1 week later.Sub-flap tissue necrosis and infection happened in 2 cases,which healed after dressing and drainage.Patients were followed up for 3-36 months with satisfactory results.Conclusions The middle-forearm flap based on perforator of ulnar artery has a stable and reliable blood supply.It offers a new choice for the electric burn wound on the wrist,especially at the ulnar side.%目的 探讨前臂中段尺动脉穿支皮瓣修复腕部电击伤创面的临床效果及应用体会.方法 2009年10月至2012年10月,对10例腕部电击伤患者,在前臂内侧近中段,以肱骨内上髁桡侧至豌豆骨桡侧略偏内的连线为皮瓣的轴心线,在轴线中点处,以多普勒血流探测仪探及穿支血管穿皮点为皮瓣旋转点,设计并切取皮瓣逆行转移修复创面,其中保留皮瓣浅静脉并与受区静脉吻合3例;供瓣区直接拉拢缝合2例,移植皮片修复8例.结果 术后10例皮瓣全部成活,但7例未吻合静脉的皮瓣术后2—4d肿胀较明显,1周后均恢复正常;2例皮瓣下组织继发坏死并感染,经换

  4. [Intraoperative verification of a perforator flap vascularization by indocyanine green angiography].

    Science.gov (United States)

    Royer, E; Rausky, J; Binder, J-P; May, P; Virzi, D; Revol, M

    2014-02-01

    After Koshima and Soeda first described perforator flaps in 1988, Wei has improved the technique by describing the "free style perforator flap". These flaps have the advantage of being performed on all skin perforators and in reducing donor site morbidity. The disadvantage, however is that the size of their angiosome is not defined and the evaluation of their relay on the experience of the surgeon. An evaluation of the size of an angiosome by conducting intraoperative angiography is proposed. Intraoperative angiography is performed after injection of indocyanine green. Stimulation of the indocyanine green by infrared causes the emission of fluorescent radiation. This fluorescence is then detected by a specific camera that displays real-time visualization of the skin's perfusion. We present the case of a 39-year-old patient who had an open tibial pilon fracture, for which we performed a pedicled propeller flap based on a posterior tibial perforator. Angiography was used to determine accurately the optimal skin perfusion of the propeller flap, which was based on a perforator from the posterior tibial artery. Angiography identified several levels of skin perfusion with a high fluorescence, intermediate and absent. The non-vascularized part of the skin paddle was resected. Given the unreliability of this technique, hypoperfused area was retained. Debridment of this area, however was necessary at day 5 postoperative with repositionning of the flap. Indocyanine green angiography may be a useful decision-making tool for intraoperative surgeon. It allows to adjust the size of the propeller flap's skin paddle to it angiosome. However, this evaluation method needs to be improved with the introduction of a quantitative threshold.

  5. 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...

  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. 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.

  9. 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.

  10. 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

  11. 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,...

  12. Multidetector-row computed tomography in the planning of abdominal perforator flaps.

    Science.gov (United States)

    Masia, J; Clavero, J A; Larrañaga, J R; Alomar, X; Pons, G; Serret, P

    2006-01-01

    An accurate preoperative evaluation of the vascular anatomy of the abdominal wall is extremely valuable in improving the surgical strategy in abdominal perforator flaps. The multidetector-row computer tomography offers thin slice coverage of extended volumes with an extremely high spatial resolution. From October 2003 to December 2004, 66 female patients had breast reconstruction surgery in our department using the deep inferior epigastric artery perforator flap. Our multidetector-row computer tomography studies were performed using a 16-detector-row computer tomography scanner. The image assessment was carried out using the following protocol: we first identified the best three perforators from each side of the abdomen. Then we conducted a three-dimensional reconstruction of the abdomen by identifying exactly where the three best perforators emerged from the rectus abdominis fascia. We then transferred the data obtained from the image to the patient using a coordinate system. In addition, we also placed the dominant perforators in the patient by using a conventional hand-held Doppler. During the operation we compared intra-operative findings, Doppler results and computer tomography outcomes. Neither false positive nor false negative results were found in the computer tomography outcome. Multidetector-row computer tomography provides us with an easy method of interpreting the virtual anatomic dissection in three dimensions. It has high sensitivity and specificity and provides a good quality evaluation of the perforator vessels. This information allows reduction of operating time and safer performance of surgery. The multidetector-row computer tomography is a highly effective tool in the preoperative study of abdominal perforator flaps. PMID:16716952

  13. 封闭负压引流结合掌背动脉穿支皮瓣、掌长肌腱移植修复手背复合组织缺损%Vacuum sealing drainage combined dorsal metacarpal artery perforator flap and palmaris longus tendon transplantation to repair complex tissue defect of dorsum of hand

    Institute of Scientific and Technical Information of China (English)

    张友; 周宏斌; 成杰

    2016-01-01

    Objective To investigate the therapeutic effect of vacuum sealing drainage ( VSD) combined with retro-grade dorsal metacarpal artery perforator flap and palmaris longus tendon transplantation to repair complex tissue de-fect of dorsum of hand. Methods 11 cases of complex tissue defect in the back of hand were treated by VSD com-bined with retrograde dorsal metacarpal artery perforator based island flap, palm long tendon transplantation. The tis-sue defect size was 1. 8 cm × 2. 0 cm~3. 0 cm × 6. 0 cm and the cutting flap size was 2. 0 cm × 2. 5 cm~3. 5 cm × 7. 0 cm. Results 7 flaps were based on the second dorsal metacarpal artery perforator, 2 flaps were based on the third dorsal metacarpal artery perforator, and 2 flaps were based on the fourth dorsal metacarpal artery perforator. All patients received follow-up for 7 ~25 months. All the flaps were survived with wonderful appearance and satisfied function of fingers. There was no infective case. According to the Total Active Motion ( TAM) criteria to evaluate the function of injury finger at the final follow-up,6 cases were graded as excellent,3 as good, 2 as fair. Conclusions VSD can valid control wound inflammation. The dorsal metacarpal artery perforator flap has good function,acceptable forma, and reliably blood supply. It is a good choice to use VSD combined with retrograde dorsal metacarpal artery perforator flap and palmaris longus tendon transplantation for resurfacing complex tissue defect of dorsum of hand.%目的:探讨封闭负压引流( VSD)技术结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复手背复合组织缺损的临床疗效。方法应用VSD技术结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复11例手背复合组织缺损患者。组织缺损面积1.8 cm ×2.0 cm ~3.0 cm ×6.0 cm,切取皮瓣面积2.0 cm ×2.5 cm ~3.5 cm ×7.0 cm。结果切取第2掌背动脉穿支岛状皮瓣7例,第3掌背动脉穿支岛状皮瓣2例,第4掌

  14. Anatomic basis of the proximal ulnar artery perforator neurocutaneous flap%尺动脉近段穿支蒂皮神经营养血管皮瓣的解剖基础

    Institute of Scientific and Technical Information of China (English)

    陈超勇; 岳素琴; 魏在荣; 林加福; 郑和平; 张发惠

    2011-01-01

    目的 为尺动脉近段穿支蒂前臂内侧皮神经营养血管皮瓣提供解剖学基础.方法 在30侧动脉内灌注红色乳胶的成人上肢标本上解剖观测:①前臂内侧皮神经的走行与分布;②尺动脉近段穿支与前臂内侧皮神经营养血管间吻合关系.另在1侧新鲜标本上进行摹拟手术设计.结果 ①前臂内侧皮神经前支较粗长,与贵要静脉伴行,在前臂沿尺侧腕屈肌内侧缘或尺侧腕屈肌与掌长肌肌腱之间的浅筋膜中下行,分布于前臂掌面尺侧,远侧可达腕横纹;②营养血管为多节段、多源性,其中尺动脉近段穿支的位置相对恒定,自尺动脉起始后,先经指浅、深屈肌之间,后沿指浅屈肌与尺侧腕屈肌之间下行,在肱骨内上髁下8.7 cm处穿过深筋膜浅出至皮下组织中,并分出众多的细小血管与前臂内侧皮神经的神经旁和神经干血管链的分支密切吻合,在指浅屈肌与尺侧腕屈肌之间形成顺沿肌间隙和前臂内侧皮神经纵轴的血管丛.穿支蒂干长(2.0±0.2)cm,外径(0.9±0.2)mm.结论 可形成尺动脉近段穿支蒂前臂内侧皮神经营养血管皮瓣转位修复肘部软组织缺损.%Objective To provide anatomic basis for clinical application of the neurocutaneous flap pedicled with proximal ulnar artery perforator.Methods 30 embalmed upper limbs from adult cadavers perfused with red latex were used for this anatomic study, and the followings were observed: ①The course and distribution of the medial forearm cutaneous nerve.② Aanastomoses between the proximal ulnar artery perforator and nutrient vessels of medial forearm cutaneous nerve.③Mimic operation was performed on one fresh specimen.Results ① Anterior branch of the medial forearm cutaneous nerve (MFCN), with the relative large diameter, companied with basilic vein and coursed through superficial fascia located in flexor carpi ulnaris and palmaris longus.The MFCN distributed on medial forearm and distally

  15. 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

  16. 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

  17. Inferior Flap Tympanoplasty: A Novel Technique for Anterior Perforation Closure

    Directory of Open Access Journals (Sweden)

    Haim Gavriel

    2013-01-01

    Full Text Available Objective. To report a novel tympanoplasty modification for anterior tympanic membrane perforation closure. Materials and Methods. A prospective study on 13 patients who underwent inferior tympanoplasty between December 2008 and May 2011 was carried out. In our technique, an inferior rather than a posterior flap is raised and the graft is laid from the inferior direction to obtain better access to the anterior part of the tympanic membrane perforation and provide better support. Results. A total of 13 patients underwent the novel inferior tympanoplasty technique with a mean age of 33 years. Six patients had undergone tympanoplasties and/or mastoidectomies in the past, 3 in the contralateral ear. A marginal perforation was observed in 3 cases, total perforation in 2 and subtotal in 1 case. The mean preoperative pure-tone average was 40.4 dB (10 to 90 dB, compared to 26.5 dB (10 to 55 dB postoperatively. All perforations were found to be closed but one (92.3% success rate. Conclusions. The inferior tympanoplasty technique provides a favorable outcome in terms of tympanic membrane closure and hearing improvement for anterior perforations, even in difficult and complex cases. It is based on a well-known technique and is easy to implement.

  18. 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...

  19. 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.

  20. 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

  1. 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.

  2. Repairing the wrap-around flap donor skin defect by perforator flap%穿支皮瓣修复(坶)甲瓣供区皮肤缺损

    Institute of Scientific and Technical Information of China (English)

    魏义涛; 钟桂午; 吕廷斌; 黄家文; 范钊文; 颜世猛

    2013-01-01

    目的 报道胫前、后动脉穿支皮瓣修复(坶)甲瓣供区的临床效果.方法 对25例(坶)甲瓣供区皮肤缺损患者,设计并切取游离胫前、后动脉穿支皮瓣进行修复,皮瓣切取面积为8 cm×3 cm~10 cm×5 cm.结果 应用胫前、后动脉穿支皮瓣修复(坶)甲瓣供区创面25例,均顺利成活.随访6~24个月,皮瓣质地柔软,弹性及耐磨性好,色泽接近正常,供受区功能与外观良好.结论 胫前、后动脉穿支皮瓣是精细化修复(坶)甲瓣供区创面的一种有效方法.%Objective To report the clinical application of repairing the wrap -around flap donor skin defect with perforator flap of anterior and posterior tibial. Methods We designed and cut the perforator flap of anterior and posterior tibial artery to repair 25 patients with the skin defect of the wrap -around flap donor, the area of cutting flap was 8 cm×3 cm~10 cm ×5 cmo Results All 25 cases survived. Followed-up from 6 months to 24 months, the flaps were soft, elastic, wearable, and the color approached normal. The function and appearance were excellent. Conclusion Perforator flap of anterior and posterior tibial is an effective method of repairing the wrap-around flap donor skin wound.

  3. Posterior tibial artery above the medial malleolus in blood supplying by mesh link-pattern perforator flaps in repairing defect in heel region%胫后动脉内踝上链型穿支蒂网状供血皮瓣修复跟后组织缺损

    Institute of Scientific and Technical Information of China (English)

    卢帆; 钟雷; 蔡震; 杜丽平

    2011-01-01

    目的 总结胫后动脉内踝上链型穿支蒂网状供血皮瓣修复跟后组织的方法和效果.方法 2007年5月~2011年5月采用胫后动脉内踝上链型穿支蒂网状供血皮瓣修复跟后组织缺损16例.皮肤缺损范围4cm×4cm~6cm×9cm.皮瓣切取范围5cm ×5cm ~7cm×10cm.供区游离植皮.结果 术后皮瓣、植皮均成活良好,创面Ⅰ期愈合.10例随访,平均随访11个月.皮瓣质地色泽好,无破溃.正常穿鞋行走.结论 胫后动脉内踝上链型穿支蒂网状供血皮瓣是修复跟后组织缺损的一种有效、简便、可靠的方法.%Objective To investigate the method and effect of Posterior tibial artery above the medial malleolus in blood supplying by mesh link-pattern perforator flaps in repairing defect in heel region. Methods May 2007 to may 2011, 16 patients with defect in heel region were treated by Posterior tibial artery above the medial malleolus in blood supplying by mesh link-pattem perforator flaps. The size of defects ranged from 4. 0cm x 6. 0cm to 6. 0cm x 6. 0cm. The size of flaps ranged from 5. 0cm x 5. Ocm to 7. Ocm x 10. Ocm. Skin grafting to close secondary wound in donor region. Results After operation, 16 patients healed by first intention. Flaps and tree skins were survived. And 10 cases were followed up for 11 months. Color and quality of flaps were good, and no ulcer. The functions of walking and wearing shoes were normal. Conclusion Posterior tibial artery above the medial malleolus in blood supplying by mesh link-pattem perforator flaps can effectively repaire defects in heel region, and it is a convenient and optimal method.

  4. 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.

  5. 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

  6. 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.

  7. 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

  8. 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

  9. 胫后动脉穿支皮瓣修复足背足跟部软组织缺损的临床应用%Application of posterior tibial artery perforator-based flap for repairing skin soft tissue defect in dorsal pedis and sufficient root with bone and tendon eaplosure

    Institute of Scientific and Technical Information of China (English)

    李振科; 杨健胜; 姜凯; 吴焯鹏

    2011-01-01

    目的 研究利用胫后动脉穿支皮瓣修复足背足跟部软组织缺损的临床效果.方法 2007年8月~2010年8月利用胫后动脉穿支皮瓣修复足背软组织缺损12例,足跟部皮肤缺损6例,共18例.结果 18例皮瓣均成活,创面愈合良好,创面缺损修复满意.结论 利用胫后动脉穿支皮瓣修复足背足跟部软组织缺损操作简单、皮瓣面积大、质地柔软、成功率高、创伤小、且不损伤小腿主要血管,是修复足背足跟部软组织缺损的理想方法和选择.%Objective To explore the effects of posterior tibial artery perforator-based flap in reconstruction of skin soft tissue defect in dorsal pedis and sufficient root. Methods The 12 cases with skin soft tissue defect in dorsal pedis and 6 cases with skin soft tissue defect in sufficient root total 18 cases were treated with local transfer of posterior tibial artery perforator-based flap form Aug 2007 to Aug 2010. Results 18 cases the flap were all alive, the wounds were better healed and the repairtion of the wounds were satisfactory.Conclusion Use the posterior tibial artery perforator-based flap to reconstruct the skin soft tissue defect in dorsal pedis and sufficient root is an simple operation ,and the flap may be make so large and soft,and it did not hert the main vesssl of the shank,and it is an ideal method and choice for repairing skin soft tissue defect in dorsal pedis and sufficient root with bone and tendon explosure .

  10. Microdissection of distal artery perforator of the medial leg and design of skin flap pedicled with nutrient vessels of the saphenous nerve%小腿内侧远端动脉穿支显微解剖与隐神经营养血管皮瓣设计

    Institute of Scientific and Technical Information of China (English)

    张发惠; 郑和平; 张国栋

    2007-01-01

    以胫后动脉肌间隙支、内踝前动脉穿支和以踝管区动脉穿支血管蒂的3种隐神经-大隐静脉营养血管远端蒂皮瓣或复合瓣,旋转轴点在内踝平面,适宜小腿远段、踝足部及其远侧的组织缺损修复.%BACKGROUND: The distally based skin flap pedicled with nutrient vessels of saphenous nerve has provided a method with higher achievement ratio to repair the tissue defect of ankle and foot, due to its high rotation point, lacking of distributive characteristics of distally pedicled vessels description for the specific operations, so it is still difficult in clinical application.OBJECTIVE: To investigate the distal artery perforators of medial leg, so as to suggest an anatomical theory for the reasonable design of the distally based compound flap pedicled with nutrient vessels of saphenous nerve-great saphenous vein.DESIGN: A single sample experiment.SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out in the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from May to October, 2004.Thirty-four adult specimens perfused with red emulsion at lateral arteries of upper lower limbs were provided by the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.METHODS: Specimens of the distal medial legs were dissected with microscope taking the most prominent point of medial malleolus as the pivot point.MAIN OUTCOME MEASURES: ① Distal artery perforators of medial leg; ② Distal nutrient vessels of saphenous nerve-great saphenous vein; ③ Blood supply correlation of nutrient vessel with neighboring muscle, bone and skin.RESULTS: ① The distal artery perforators of medial leg derived from 9 main

  11. 足底内侧动脉穿支蒂足背内侧皮神经逆行皮瓣的应用%The clinical application of plantar medial perforator artery based reverse island medial dorsal pedal neurocutaneous vascular flaps

    Institute of Scientific and Technical Information of China (English)

    崔立群; 陈金钢; 张明; 赵万超; 马睿

    2009-01-01

    目的 探讨足底内侧动脉穿支蒂足背内侧皮神经营养血管逆行岛状皮瓣的临床应用效果.方法 2005年6月至2008年3月;应用以足底内侧动脉穿支为蒂的足背内侧皮神经营养血管逆行岛状皮瓣修复足前端软组织缺损12例,皮瓣切取面积3.0 cm×3.5 cm~5.5 cm×8.5 cm.结果 12例皮瓣全部成活,供区创面也愈合顺利.经随访6~24个月,皮瓣质地、弹性均正常,无溃疡发生,感觉获得一定恢复,两点辨别觉为7~10 mm,外观及功能满意.供区创面也顺利愈合.结论 该皮瓣扩大了切取面积和修复范围,具有手术操作相对简单、安全,不损伤主要血管,皮瓣厚薄适中,弹性好,耐磨,色泽与受区一致的优点.%Objective To explore the clinical effect of plantar medial perforator artery based reverse island medial dorsal pedal neuroutaneous vascular flaps. Methods 12 cases with soft tissue defects of forefeet were treated by plantar medial perforator artery based reverse island medial dorsal pedal neurocutaneous vascular flaps. The flap size ranged from 3.0cm×3.5 cm to 5.5 cm×8.5cm. Result All flaps survived completely. The patients were followed up for 6 ~ 24 months. The texture and flexibility of the flaps were normal with no ulcer. The sensation improved with the two-point discrimination of 7 ~ 10 mm. The cosmetic and functional results were satisfactory. The wounds at donor site healed primarily. Conclusions The flaps have expanded size for large defects with good flexibility, thickness and texture. It is easily performed with less morbidity to main artery.

  12. 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.

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

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    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.

  14. Free deep inferior epigastric perforator flap used for management of post-pneumonectomy space empyema.

    Science.gov (United States)

    Manley, Kate; Gelvez, Sandra; Meldon, Charlotte J; Levai, Irisz; Malata, Charles M; Coonar, Aman S

    2013-04-01

    Various solutions exist for management of post-pneumonectomy space empyema. We describe the use of a free deep inferior epigastric perforator (DIEP) flap to fill the space and close a pleural window. Previously, flaps involving abdominal muscle or omentum have been used for this purpose. Abdominal surgery to harvest such flaps can impair ventilatory mechanics. The DIEP flap--harvested from the abdomen, and composed primarily of skin and muscle avoids this problem, thus is a desirable technique in patients with impaired lung function. We believe this is the first report of the DIEP flap to close a postpneumonectomy empyema space.

  15. Perforator-based chimaeric thoracodorsal flap for foot reconstruction.

    Science.gov (United States)

    Rausky, Jonathan; Binder, Jean-Philippe; Mazouz-Dorval, Sarra; Hamou, Cynthia; Revol, Marc

    2013-12-01

    The reconstruction of severe defects of the ankle and foot is a challenge. The ideal solution should combine a thin skin flap on the dorsum to allow shoe fitting and a muscle flap with a split-thickness skin graft on the weight-bearing area. Perforator-based thoracodorsal chimaeric flaps allow us to achieve these two goals with minimal donor-site morbidity. We present a reconstruction of an extended circumferential defect of the ankle with an exposed heel using a chimaeric thoracodorsal perforator flap with a serratus muscle flap. The skin flap was transferred on the dorsal foot, whereas the serratus anterior muscle was transferred on the exposed heel. Postoperative recovery was uneventful and the patient began full weight bearing after 3 months. Twelve months after reconstruction, natural shape and walking function were successfully achieved.

  16. Double-pedicle abdominal perforator free flaps for unilateral breast reconstruction: new horizons in microsurgical tissue transfer to the breast.

    Science.gov (United States)

    Hamdi, Moustapha; Khuthaila, Dana K; Van Landuyt, Koenraad; Roche, Nathalie; Monstrey, Stan

    2007-01-01

    The DIEAP (deep inferior epigastric artery perforator) flap is a suitable option for breast reconstruction resulting in excellent aesthetic outcome, and minimal donor site morbidity. Contraindications for use of the DIEAP flap may include previous abdominal liposuction and/or surgery, or lack of abdominal tissue. The purpose of this paper is to describe options of using abdominal perforator flaps, based on double-pedicle techniques, despite these contraindications. A retrospective evaluation was carried out on a series of 16 patients who required abdominal double-pedicle free perforator flaps for unilateral breast reconstruction since June 2002. The indications were multiple abdominal scars, previous abdominal liposuction and thin patients in five, three and eight cases, respectively. Preoperative mapping of the vascular network was done using Duplex and/or multi-detector CT scan imaging. Clinical evaluation of medical charts was done regarding patients' characteristics, surgical techniques, ischaemia/total operative time and complications. A clinical evaluation was done on all patients with average follow up of 15 months. Fat necrosis was investigated clinically and by mammogram examination. Different microsurgical techniques were performed to provide enough blood supply to the requested flaps: Perforator (P) to contralateral Deep Inferior Epigastric (DIE) anastomosis (P/DIEAP), in two patients; bilateral DIE vessels (DIEAP/DIEAP) in seven patients; and DIE with SIE (superficial inferior epigastric) vessels in seven patients (DIEAP/SIEA). One pedicle was always anastomosed to the internal mammary vessels. The second pedicle was anastomosed end-to-end to a side branch of the DIE or end-to-side with the DIE pedicle in 13 cases. The thoracodorsal vessels were used as recipient vessels for the second pedicle in three cases. Average operative time was 6h 30min (range 5h 30min-8h). All 16 flaps survived and fat necrosis occurred in one case. The harvesting of perforator

  17. 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

  18. 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

  19. The lateral superior genicular artery perforator iliotibial band flap for the treatment of scar contraction of popliteal fossa%膝上外侧动脉穿支髂胫束皮瓣修复腘窝部瘢痕挛缩

    Institute of Scientific and Technical Information of China (English)

    郑鑫; 安洪宾; 陈滔; 王海宝

    2013-01-01

    Objective:To discuss clinical results of the lateral superior genicular artery perforator iliotibial band flap for the treatment of scar contracture of popliteal fossa. Methods: Form January 1999 to December 2011,11 patients with scar contraction of popliteal fossa were treated with the lateral superior genicular artery perforator iliotibial band flap. Among the patients , 7 patients were male and 4 patients were female, ranging in age from 24 to 58 years old, with an average of 33 years old. The operation time ranged from 3 months to 1 year after trauma. Eight patients had injuries in the right side and 3 patients had the injuries in the left. Five patients had the injuries caused by traffic, 3 patients had the injuries caused by hot compression and other 3 patients suffered from burns. The flap area ranged from 7.0 cm×4.0 cm to 20.0 cm×8.0 cm. Results:AH the flaps survived. Three patients had epidermis necrosis. After 5 months to 2 years follow-up period,the knee function recovered,the flap shape was favorable and the skin firmness was moderated. Conclusion: The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and an ideal donor in the reconstruction of popliteal fossa scar contracture.%目的:探讨膝上外侧动脉穿支髂胫束皮瓣治疗腘窝部瘢痕挛缩的临床疗效,为腘窝区瘢痕挛缩寻找最佳的手术方式.方法:自2009年1月至2011年12月,应用膝上外侧动脉穿支髂胫束动脉皮瓣修复腘窝瘢痕挛缩11例,男7例,女4例;年龄24~58岁,平均33岁;病程3个月~1年,平均6.5个月;右膝关节8例,左膝关节3例;交通伤5例,热压伤3例,烧伤3例.采用膝上外侧动脉穿支髂胫束皮瓣局部转移修复创面,切取皮瓣面积最大20.0 cm×8.0 cm,最小7.0 cm×4.0 cm.结果:术后皮瓣全部成活,3例远端血运差,局部色素沉着,表皮坏死脱痂.术后随访5个月~2年,膝关节活动均恢复正常,皮瓣外形良好,皮肤松紧度适中.

  20. 胫前动脉内踝前穿支蒂足内侧岛状皮瓣修复踝周较小创面%Repairing small wounds around ankle by medial planta island flaps pedicled with anterior tibial artery perforator infront of inner malleolus

    Institute of Scientific and Technical Information of China (English)

    魏在荣; 邵星; 帅霞; 孙广峰; 韩文杰; 金文虎; 王达利

    2010-01-01

    Objective To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle.Methods From Jan. 2005 to Jun. 2009, 10 cases with small wounds around ankle were treated with medial planta island flaps pedicled with anterior tibial artery perforator. The flap size ranged from 7.5 cm×2.8 cm to 13.0 cm × 5.0 cm. The wounds at the donor sites were covered with skin grafts. Results All the 10 flaps and skin grafts were survived with primary healing. The patients were followed up for 6-12 months with satisfactory cosmetic results. The 2-point discrimination was 4-6 mm when the proximal end of saphenous nerve was not injured, and it was 9-10 mm when the nerve was injuried or cut off. The patients could walk with no occurrence of ulcer in flaps or donor site. Conclusions The medial planta island flaps pedicled with anterior tibial artery perforator can effectively repair the small wounds around ankle with reliable blood supply.%目的 探讨胫前动脉内踝前穿支蒂足内侧岛状皮瓣修复踝周较小创面的可行性.方法 采用胫前动脉内踝前穿支蒂足内侧岛状皮瓣修复踝周较小创面,皮瓣面积:7.5 cm×2.8 cm~13.0 cm×5.0 cm.供区移植皮片覆盖.结果 2005年1月至2009年6月于临床应用10例,术后皮瓣及供区所植皮片均顺利成活,供、受区切口均一期愈合.术后随访6~12个月,皮瓣外形良好,隐神经近端未受伤者皮瓣两点辨别觉4~6 mm,隐神经近端受伤、中断者皮瓣两点辨别觉9~10mm.皮瓣供区周围感觉未见异常.患足可负重行走,皮瓣及供区无溃疡.结论 胫前动脉内踝前穿支蒂足内侧岛状皮瓣可修复踝周较小创面,皮瓣血供可靠,操作简单.

  1. Radial artery perforator flap for repair of soft tissue defect after palm postoperative scar contracture%桡动脉穿支皮瓣逆行转移修复手掌瘢痕挛缩术后软组织缺损

    Institute of Scientific and Technical Information of China (English)

    王刚; 姚有榕; 邓盼; 张一智; 徐云钦; 申屠刚

    2016-01-01

    Objective To explore the clinical effect of the radial artery perforator flap on repairing soft tissue defect after palm postoperative scar contracture. Methods Eighteen patients with palm scar contracture were selected. The palm soft tissue defect was repaired by radial artery perforator flap after the operation of scar removal and soft tissue release. The areas of soft tissue ranged from 5 cm × 3 cm to 8 cm × 5 cm. The area of donor flap exceeds 20%of the wounds area, and wounds were repaired by free skin grafting. Six months after operation, the hand function was compared with that before operation. Results All the patients were followed up for 6-15 months (mean 10.8 months), all flaps survived with good shape, and flap donor site wounds were healed by skin grafting. The patients were evaluated 6 months after operation according to the Chinese Medical Hand Surgery Society of upper part of functional assessment criteria: excellent in 11 cases, good in 5 cases and general in 2 cases, but preoperative functional evaluation was excellent 0 case, good in 3 cases, general in 7 cases and poor in 8 cases. Compared with that before operation, the postoperative function was significantly improved. Conclusions It is a commendable approach of repairing soft tissue defect after postoperative palm scar contracture by radial artery perforator flap, because it can provide reliable blood supply, and significantly improve hand function with exactly clinical effect.%目的 探讨桡动脉穿支皮瓣逆行转移修复手掌瘢痕挛缩术后软组织缺损的临床疗效.方法 选取手掌瘢痕挛缩患者18例,均行瘢痕切除、软组织松解,缺损创面予以桡动脉穿支皮瓣逆行转移修复,缺损创面面积5cm×3cm~8cm×5cm,皮瓣供区创面放大20%切取,创面均予以游离植皮修复.术后6个月随访比较术前、术后手功能变化.结果 所有患者均获得随访,随访时间为6~15个月(平均10.8个月),所有皮瓣均完全成活,皮瓣供

  2. 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.

  3. 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

  4. 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

  5. The reverse extended peroneal artery perforator flap for soft tissue defects of the ankle and fool%腓动脉及穿支血管蒂皮瓣逆行转移修复足踝部软组织缺损

    Institute of Scientific and Technical Information of China (English)

    阮洪江; 蔡培华; 柴益民; 范存义

    2009-01-01

    目的 探讨应用腓动脉及穿支血管蒂皮瓣逆行转移修复足踝部软组织缺损的手术方法 和临床效果.方法 2007年4月至2008年2月,收治10例足踝部软组织缺损患者.男7例,女3例;年龄8~52岁,平均34.2岁.致伤原因:车祸伤6例,坠落伤2例,慢性溃疡1例,烫伤1例.在患肢小腿外侧区沿腓动脉轴线设计皮瓣,术中游离包含于皮瓣内的1~3支腓动脉穿支,于腓动脉穿支近端结扎切断腓动脉及静脉,向远端游离至外踝尖上约5 cm并以此为旋转点,连同皮瓣向远端逆行转移覆盖足踝软组织缺损区.切取皮瓣范围为10 cm×5 cm~25 cm×15 cm,血管蒂长6~17 cm.结果术后10例皮瓣全部成活.仅1例皮瓣远端局部回流不畅、浅表坏死,经换药及抗感染治疗后愈合.供区均Ⅰ期愈合.全部病例获5~14个月(平均9.5个月)随访,所有患者皮瓣外形及功能满意,行走正常.结论 腓动脉及穿支血管蒂营养皮瓣血管蒂长,蒂部细小易转移而不易受压,血供可靠,切取范围大,皮肤质地良好,用于足踝部皮肤软组织缺损的修复效果满意.%Objective To investigate the operative technique and clinical results of repairing soft tissue defects of the ankle and foot with reverse extended peroneal artery perforator flap. Methods From April 2007 to February 2008, 10 patients, 7 men and 3 women, were treated with this technique, with an av-erage age of 34.2 years (ranged from 8 to 52 years). The initial wounds were caused by trauma, burn injury and chronic ulcer, with bone and/or tendon exposure. The flap was designed overlying the course of the per-oneal artery, which corresponds to the palpable posterior border of the fibula when mapped to the surface.The flap was raised by dividing the peroneal artery and veins proximally and elevating them distally, which covered for the defects of the ankle and foot. The pivot point was placed at the level of the ankle joint dis-tally. Thus the flap was

  6. 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.

  7. 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

  8. 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...

  9. 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

  10. Repair of soft tissue defect at finger tip with square island flap pedicled with skin perforator of digital artery on the distal interphalangeal joint%指动脉远侧指间关节皮支蒂指侧方岛状皮瓣修复指端软组织缺损

    Institute of Scientific and Technical Information of China (English)

    周晓; 许亚军; 芮永军; 寿奎水; 姚群

    2011-01-01

    目的 探讨以指动脉远侧指间关节皮支为蒂指侧方岛状皮瓣修复同指指端软组织缺损的临床效果.方法 2009年6月至2010年3月,对15例15指手指远侧指间以远的指端缺损的患者,采用以指动脉远侧指间关节皮支为蒂指侧方岛状皮瓣转移修复,术中切取皮瓣范围1.2 cm×0.8 cm~2.0 cm × 3.0 cm,供区取前臂全厚皮片移植修复.结果 15例15指术后获得随访10例10指,时间为6~12个月,皮瓣和移植皮片全部顺利成活,皮瓣质地柔软,外观满意,颜色与周围皮肤接近,顺行推进岛状皮瓣的两点辨距觉为5~6 mm,逆行岛状皮瓣的两点辨距觉为7~10 mm,远侧指间关节屈伸活动无明显障碍.手功能ATM法评定,优8指,良1指,可1指.结论 应用该皮瓣修复指端软组织缺损,不损伤指动脉和指神经,简化了传统的指根部岛状皮瓣的手术,是一种较好的方法.%Objective To investigate the repair of soft tissue defect at finger tip with square island flap pedicled with skin perforator of digital artery on the distal interphalangeal joint( DIP). Methods From Jun. 2009 to Mar. 2010, 15 cases with soft tissue defects at 15 fingers tip were treated with this island flaps. The flap size ranged from 1. 2 cm × 0. 8 cm to 2. 0 cm × 3. 0 cm. The defects at donor sites were covered with skin grafts from forearm. Results All the flaps and skin grafts survived. 10 fingers in 10 cases were followed up for 6-12 months. The color, texture and contour of the flaps were good. The twopoint discrimination distance was 5-6 mm on the directed island flaps, and 7-10 mm on the reverse island flaps. No obvious functional problem was found in DIP motion. The hand function was assessed as excellent in 8 fingers, good in 1 finger and medium in 1 finger. Conclusions The main artery and nerve will not be sacrified when the island flap is used. The operative procedures are easily performed for the treatment of fingertip skin defect.

  11. 腓浅动脉单一穿支微型皮瓣游离移植修复手足部皮肤缺损%Superficial peroneal artery's singleness perforator flaps transfer to repair skin and soft defect of hands and feet

    Institute of Scientific and Technical Information of China (English)

    江长青; 孟繁斌; 张建; 邱健钊; 桂先革; 徐贵升

    2012-01-01

    目的 探讨腓浅动脉单一穿支微型皮瓣的临床疗效,并对手足部较小面积的皮肤软组织缺损进行定点修复. 方法 自2009年11月至2011年1月,共对8例(左足1例,右足1例,左手3例,右手3例)皮肤软组织缺损面积为(1.3 cm×5.0 cm~2.5 cm×6.0 cm)的患者进行腓浅动脉单一穿支微型皮瓣游离移植手术;依据术前查阅相关解剖文献,在小腿外侧中部,以腓骨小头与外踝连线为轴线,该轴线中点为腓浅动脉穿支部位,依据皮肤缺损区大小及形状设计皮瓣,并对皮瓣的设计、切取、皮瓣与受区的血管吻合、成活特点及治疗效果进行分析. 结果 8例手足部皮肤软组织缺损应用面积为1.5 cm× 5.2 cm~2.8 cm×6.2 cm的腓浅动脉单一穿支微型皮瓣进行修复后均成活,外形、质地均满意,术后功能恢复效果良好;1例术后出现水疱、暗紫、脱痂后成活;1例术后皮瓣存活顺利,但出现指骨骨髓炎,经治疗愈合. 结论 腓浅动脉单一穿支微型皮瓣游离移植可对手足部较小的皮肤软组织缺损进行精确的定点修复,临床效果满意.%Objective To explore the clinical efficacy of minitype vascularized superficial peroneal artery's singleness perforator flap,and then to accurately repair skin and soft tissue defects of hands and foots. Methods From November 2009 to January 2011,eight cases(one case of left foot,one case of right foot,three cases of left hand and 3 cases of right band,1.3 cm × 5.0 cm - 2.5 cm× 6.0 cm of skin and soft tissue defects)were treated by minitype vascularized superficial peroneal artery's singleness perforator flap.Based on preoperative applied anatomy papers, it was the superficial peroneal artery's perforator position in the middle of the lateral lower leg to the fibula head; We designed the flap based on the size and shape of skin defect,and then to analysize the flap design,lap cut,he vascular anastomosis of flap and recipient,effect and

  12. STUDY OF VARIOUS MODIFICATIONS OF REVERSE SURAL ARTERY FLAP

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    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

  13. 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、

  14. Medial circumflex femoral artery flap for ischial pressure sore

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    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.

  15. 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.

  16. Perforator flap transplantation assisted by the multislice spiral computed tomographic angiography: the clincal report%MSCTA辅助穿支皮瓣移植的初步报告

    Institute of Scientific and Technical Information of China (English)

    高建明; 薛峰; 夏云宝; 储旭东; 华国军; 李坤; 骆宇春; 潘功茂

    2011-01-01

    目的 探讨MSCTA在穿支皮瓣移植中应用的可行性.方法 自2009年5月~2010年9月,我们对6例小腿、足踝软组织缺损病人拟行穿支皮瓣移植修复术,术前行MSCTA检查,下肢血管三维成像,术中根据穿支皮瓣的穿支血管的位置、直径、分布情况,设计穿支皮瓣的血管蒂,皮瓣轴心线,以及皮瓣的大小,行穿支皮瓣移植手术.结果 MSCTA图像显示:2例膝上外侧动脉穿支、4例胫后动脉穿支图像清晰,而且与皮瓣移植手术中解剖穿支血管情况完全一致.2例穿支皮瓣行吻合血管游离移植,4例穿支皮瓣带蒂转移,手术顺利完成.5例皮瓣完全成活,1例皮瓣边缘坏死,1个月后皮瓣整形后愈合良好.结论 MSCTA图像在穿支皮瓣移植手术中提供有价值的解剖路径,对穿支血管显影有良好的敏感性,缩短了手术时间,明显提高手术的准确性.因此,MSCTA在穿支皮瓣移植中的应用具有良好的可行性.%Objective To investigate the potentiality of multislice spiral computed tomographic angiography(MSCTA) on preoperative planning of the perforator flap transplantation. Methods From May 2009 to September 2010, 6 cases with soft tissue defects of lower extremity, ankle and foot were treated in our department using perforator flaps. MSCTA was performed preoperatively in all patients scheduled for tissue transfer. MSCTA showed three dimensional images of blood vessels of the lower extremities and perforators. During perforator surgery, MSCTA image assessment allowed us to plan the axis, size and shape of perforator flaps according to the position, calibre and course of pedicled vessels. Results MSCTA images showed perforator vessels clearly, including lateral superior genicular artery perforating rami and posterior tibial artery perforating rami in 2 and 4 cases respectively, which was consistant to the course of perforator vessels observed during the operation. 2 cases were treated with the vascularized

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

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    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.

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

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    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.

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

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    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.

  20. Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus

    Science.gov (United States)

    Miyagi, Kana; Forouhi, Parto

    2016-01-01

    Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer. PMID:27651974

  1. Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus

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    Joseph W. Duncumb

    2016-01-01

    Full Text Available Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™ used for administering primary chemotherapy in breast cancer.

  2. Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus.

    Science.gov (United States)

    Duncumb, Joseph W; Miyagi, Kana; Forouhi, Parto; Malata, Charles M

    2016-01-01

    Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer. PMID:27651974

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

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    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.

  4. 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

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

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    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.

  6. A Renal Perforating Artery Mistaken for Arterial Bleeding after Percutaneous Renal Biopsy: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ye Lim; Lee, Chang Hee; Kim, Kyeong Ah; Park, Cheol Min [Korea University College of Medicine, Seoul (Korea, Republic of)

    2009-12-15

    Perirenal hematoma after a renal biopsy is a common complication that usually resolves spontaneously, but this rarely requires transfusions or surgical/radiological intervention. We report here on a case of a renal perforating artery that was mistaken for renal arterial bleeding in a 53-year-old woman who was complicated with perirenal hematoma after undergoing a percutaneous renal biopsy. On the color and pulsed wave Doppler ultrasonography, linear blood flow was seen in the perirenal hematoma, which extended perpendicularly from the renal parenchyma into the perirenal space, and this linear blood flow exhibited an arterial pulse wave. On CT angiography, the renal perforating artery was demonstrated as a curvilinear vessel coursing tangentially to the renal margin and we decided that it was a pseudolesion caused by the renal perforating artery. A renal perforating artery may be mistaken for renal arterial bleeding after a percutaneous renal biopsy. A renal perforating artery and arterial bleeding can be differentiated by the location and shape seen on a color Doppler examination and the pulse waves characteristics

  7. Repair of a Perforated Sinus Membrane with a Subepithelial Palatal Conjunctive Flap: Technique Report and Evaluation

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    S. A. Gehrke

    2012-01-01

    Full Text Available The maxillary sinus grafting procedure has proven to be an acceptable modality for bone augmentation to provide a base for endosseous implants, routinely used for the rehabilitation of posterior maxilla. Perforation of the membrane is the most common complication in this type of procedure. This paper presents a technique for repairing a perforated Schneiderian membrane with a conjunctive connective tissue graft harvested from the palate and shows the histological and radiographic evaluation of the results. Ten consecutives cases with the occurrence of membrane perforation were included in this study. All were repaired with a flap of tissue removed from the palatine portion near to the surgical site. The technique is demonstrated through a clinical case. The results showed successful integration of 88.8% of the implants after 12 months from prosthesis installation. Histological evaluation of the samples showed that the use of nanocrystalized hydroxyapatite showed an adequate stimulation of boné neoformation within 6 months. Radiographic evaluation revealed a small apical implant bone loss, not compromising their anchorages and proservation. Thus, it can be concluded that the use of conjunctive technique with collected palate flap for sealing the perforation of the membrane of the sinus may have predictable result.

  8. 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

  9. 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: ...

  10. Scalp Free Flap Reconstruction Using Anterolateral Thigh Flap Pedicle for Interposition Artery and Vein Grafts

    OpenAIRE

    Chin Whan Kim; Sung Hee Hong; Jong Hoon Lee; Suk Chan Eun; Kyung Hee Min; Jun Hyung Park

    2012-01-01

    We experienced satisfactory outcomes by synchronously transplanting an artery and vein using an anterolateral thigh flap pedicle between the vascular pedicle and recipient vessel of a flap for scalp reconstruction. A 45-year-old man developed a subdural hemorrhage due to a fall injury. In this patient, the right temporal cranium was missing and the patient had 4×3 cm and 6×5 cm scalp defects. We planned a scalp reconstruction using a latissimus dorsi free flap. Intraoperatively, there was a s...

  11. 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...

  12. The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature

    Directory of Open Access Journals (Sweden)

    Fok Margaret

    2008-04-01

    Full Text Available Abstract Background Reverse flow sural neurocutaneous flap has been utilized more frequently during the past decade to cover vital structures around the foot and ankle area. The potential advantages are the relatively constant blood supply, ease of elevation and preservation of major vascular trunks in the leg. The potential disadvantages remain venous congestion, donor site morbidity and lack of sensation. Methods This descriptive case series was conducted at Queen Mary Hospital, Hong Kong, from 1997 to 2003. Ten patients having undergone reverse flow sural neurocutaneous flap were identified through medical records. There were six females (60% and four males (40%, with an average age of 59.8 years. The defects occurred as a result of trauma in five patients (50%, diabetic ulcers in four (40% and decubitus ulcer in one (10% paraplegic patient. The defect site included non weight bearing heel in four (40%, tendo Achilles in two (20%, distal tibia in two (20%, lateral malleolus in one (10% and medial aspect of the midfoot in one patient (10%. The maximum flap size harvested was 14 × 6 cm. Preoperative doppler evaluation was performed in all patients to identify perforators and modified plaster of paris boot was used in the post operative period. A detailed questionnaire was developed addressing variables of interest. Results There was no flap failure. Venous congestion was encountered in one case. The donor site was relatively unsightly but acceptable to all patients. The loss of sensation in the sural nerve distribution was transient in all patients. Conclusion Reverse sural artery flap remains to be the workhorse flap to resurface the soft tissue defects of the foot and ankle. Anastomosis of the sural nerve to the digital plantar nerve can potentially solve the issue of lack of sensation in the flap especially when used for weight bearing heel.

  13. Automatic 3D vascular tree construction of perforator flaps for plastic surgery planning.

    Science.gov (United States)

    Gao, Jean; Wen, Quan

    2004-01-01

    Perforator flaps have been increasingly used in the past few years for trauma and reconstructive surgical cases. With the thinned flap design, greater survivability and a 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. In this paper, we will propose a computational framework for the automatic 3D vascular tree construction. The computational framework begins with an image segmentation algorithm, spedge-and-medge, which is an integration of Canny edge detector, edge-linking, and split-and-merge to initially segment out the vessels from the background. To deal with the possible broken vessels, a vascular cross-sectional tree repairing and interpolation algorithm is then developed based on the 3D connectivity and root-converging properties of the tree branches. Furthermore, to extract the essential characteristics of the vascular structure, 3D thinning algorithms are used to build up the skeletons of the tree. At each stage of the framework, 3D rendering results are provided for the visualization of the computed results. The proposed method achieves good performance and has been used for the 3D vascular tree construction and surgical danger zone measurements on 39 harvested cadaver perforator flaps with the types of ALTP, GAP, and TAP. PMID:17271020

  14. Relationship and flap design on the perforators of the posterior leg%小腿后部各区穿支间的关系与皮瓣设计

    Institute of Scientific and Technical Information of China (English)

    徐象党; 戴开宇; 周鹏; 杨新东; 唐茂林

    2009-01-01

    Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.%目的 研究小腿后部各区穿支间的关系,为穿支皮瓣的临床应用提供解剖学依据.方法 选择6具动脉灌注明胶-氧化铅混悬液的新鲜成人整尸标本,将小腿后部分为上、中、下三等份,层次解剖观测各区穿支的分布状况,拍摄X

  15. 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

  16. 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。

  17. 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.

  18. Combined vascular reconstruction and free flap transfer in diabetic arterial disease.

    Science.gov (United States)

    Vermassen, F E; van Landuyt, K

    2000-01-01

    Gangrenous lesions of the foot or lower leg due to severe diabetic arterial disease resulting in extensive soft tissue defects with exposed bones or tendons often result, even after successful revascularisation, in staged or primary amputation. We present our experience with 45 such patients treated with combined arterial reconstruction and free tissue transfer for limb-salvage. All presented with peripheral vascular disease of diabetic origin, and extensive gangrenous lesions that could not be treated by simple wound closure or skin-grafting without major amputation. A total of 53 arterial reconstructions and 47 free-flap transfers were performed. In the majority of patients, the distal anastomosis was on a pedal or tibial vessel. These bypass grafts or a native revascularized artery served as the inflow tract for the free flap which was anastomosed using microsurgical techniques. Venous anastomoses were preferentially performed on the deep venous system. Donor muscles were Musculus rectus abdominis (n=37), Musculus latissimus dorsi (n=5), Musculus serratus anterior (n=3), and a perforator flap (n=2) tailored to the size of the defect and covered with a split thickness graft (STG). The operation was set up as a combined procedure in 39/45 patients, two teams working simultaneously, limiting the mean operative time to 6 h. Early reinterventions had to be performed in 14 patients resulting in five flap losses of which two could be treated with a new free flap transfer and three were amputated. Three other patients died in the postoperative period, leaving us with a total of 39/45 patients leaving the hospital with a full-length limb. Independent ambulation was achieved in 32 of these 39 patients. During late follow-up (mean 26 months) eight bypasses occluded resulting in two amputations and two new vascular reconstructions. Combined survival and limb-salvage rate was 84% after 1 year, 77% after 2 years and 65% after 3 years. The advantages of this combined technique

  19. 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...... 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...

  20. 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

  1. Rare occurrence of simultaneous coronary artery perforation and intracoronary thrombus formation following angioplasty

    Institute of Scientific and Technical Information of China (English)

    Su-Yan Bian; Liu-Fa Duan

    2013-01-01

    Both coronary artery perforation and intracoronary thrombus formation are life-threatening complications of percutaneous coronary interventions, which rarely occur simultaneously during angioplasty. We herein report a case of stent-related, left circumflex artery perforation, and subsequently acute left main artery thrombosis after the leakage was embolized with 7 microcoils. Intracoronary thromboectomy and systemic anticoagulant therapy were carefully used with good results. This case also represents some of our uncertainties regarding the best management of the patient.

  2. 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

  3. 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.

  4. 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) ...

  5. Anatomic basis of posterolateral midforearm perforator flap%前臂后外侧中段穿支皮瓣的解剖学基础

    Institute of Scientific and Technical Information of China (English)

    郑和平; 林涧; 张志宏; 陈超勇; 张发惠

    2011-01-01

    Objective To observe the anatomy of the perforator flap of the posterolateral midforearm. Methods Lateral condyle of the humems wag taken as the observation mark on 30 specimens of adult upper limb perfused with red latex.The surgical magnifier Wag used to obse~e the origin,branches and distribution of the perforating branches of the posterolateral midforearm as well as alanagtomosis between perforating branches and peripheral vessels.Mimic operation WaS performed on the two sides of the fresh specimen.Results The perforating branches of the posterolateral midforearm originated from the radial musculoculancous branches of the posterior interosseous artery,the intermuscular branches of the radial artery and the direct periosteal branch of the radial artery had relatively stable location of piercing the deep fascia.Then,the perforating branches of the posterolateral midforearm pagsed through the deep fascia to the subcutaneous part among the spatium intermusculare of extensor digitorum and extensor carpi radialis brevis,supinator and abductor pollicis longus(within 12.5-15.8 cm below the lateral condyle of the humerus).Large number of small blood Vessels were also separated and closely aligned with the musculoculancous branches vascular,perineural and neural stem vascular chain of lateral branches of posterior antebrachial cutaneous nerve.Then,the vascular plexus was formed along the spatium intermusculare and lateral branches of posterior antebrachial cutaneous nerve longitudinal axis between extensor digitorum and extensor carpi radialis brevis. Conclusion The axial pattern flaps or cross-regional blood supply skin flap pedicled with the perforating branches of the posterolateral midforearm Can be formed to repair the soft tissue defect of tlle forearm and wrist.%目的 观察前臂后外侧中段穿支皮瓣的解剖学.方法 在30侧动脉内灌注红色乳胶的成人上肢标本上,以肱骨外上髁为观测标志点,手术放大镜下重点解剖观测:(1)

  6. 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...

  7. 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

  8. 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.

  9. 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

  10. Bases anatómicas vasculares de los colgajos perforantes cutáneos Vascular anatomical basis of perforator skin flaps

    Directory of Open Access Journals (Sweden)

    S. Morris

    2006-12-01

    ía vascular clínicamente relacionada de los colgajos perforantes.Over the past 2 decades the use of musculocutaneous perforator flaps has increased worldwide as microsurgeons have become more comfortable with the technique. Perforator flaps have now become well established as a part of the evolution of microsurgery. Since perforator flaps are based on individual musculocutaneous or septocutaneous perforators, it is imperative that the reconstructive microsurgeon has the detailed anatomical information necessary to plan perforator flap transfers. The goal of this paper is to review the various angiographic techniques which are available to study the vascular anatomy of the human body and to present our current vascular injection technique. We will show illustrative examples using the lead oxide gelatin injection technique to elucidate the relevant anatomy of perforator flap donor sites. The lead oxide gelatin injection technique has been previously reported by Salmon and Rees and Taylor. The injection technique may be used for arterial or venous injections but we have primarily used it for arterial injections. The injection steps are detailed in the paper. Over the past five years we have dissected a total of 21 human fresh cadavers after lead oxide gelatin arterial injection studies. A total of over 7000 radiographs have been reviewed and summarized. We present summarized results of the anatomical research in the areas of head and neck, upper limb, torso and lower limb regions. The lead oxide gelatin injection technique is simple and inexpensive and the computer analysis technique is straight forward and provides excellent visualization of the architecture of the human skin. The fine details identified using this injection technique provides useful information to surgeons planning transfers of skin, muscle, bone and nerve and therefore our understandingly of clinically related vascular anatomy of perforator flaps can be improved.

  11. 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

  12. 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.

  13. Arterial blood flow and microcirculatory changes in a rat groin flap after thrombosis induced by electrical stimulation of the artery.

    Science.gov (United States)

    Qi, Y; Gazelius, B; Linderoth, B; Lundeberg, T

    2002-03-01

    An experimental model of acute arterial thrombosis was developed in a rat groin flap model. Electrical stimulation was delivered to the flap artery while measuring blood flow in the artery and in the flap microcirculation using a laser Doppler system. Electrical stimulation produced an occlusive thrombosis in 10 rats within 68.1 +/- 19.26 (mean +/- SE) min. Thrombosis formation produced a rapid decrease of the LDF readings in the artery (90%) and in the flap (70%), the decrease being fairly parallel. Following the spontaneous thrombolysis, the artery perfusion recovered to baseline level but the flap blood flow only recovered by 10-20%. During electrical stimulation there was no change of the systemic blood pressure. The dynamic course of thrombus formation was documented on a videotape recorder through a microscope-mounted video camera and monitored on a television screen. Segments of the artery were obtained during and at the end of the experiments. The histological examination revealed arterial thrombosis composed of red blood cells, fibrin, and white blood cells, without any significant architectural and endothelial changes in the vessel walls. The study suggests that this model using electric vessel stimulation is effective for inducing arterial thrombosis and provides a simple method for recording the dynamic course of thrombus formation. PMID:11866541

  14. 预扩张的脐旁穿支皮瓣修复肘关节瘢痕挛缩畸形%Reconstruction of elbow scar contracture using pre-expanded perforator-based paraumbilical flaps

    Institute of Scientific and Technical Information of China (English)

    李广学; 穆籣; 刘岩; 臧梦青; 刘元波

    2016-01-01

    .Therefore,a distant flap sometimes is needed to reconstruct the extensive defect of the elbow.The anterior truck provide abundant well-pefused flap, such as superficial inferior epigastric artery (SIEA ) flap, intercostal artery flap and perforator-based paraumbilical flaps.However,the usage of these flaps was limited because of insufficient soft tissue when dealing with large defect,thick abdominal portion and limited pedicle length. The pre-expanded perforator-based paraumbilical flaps overcome these limitations and provide thin,reliable coverage with the best functional and aesthetic results.We present our experience in reconstructing elbow scar contracture using pre-expanded perforator-based paraumbilical flaps.Methods The elbow scar contracture was corrected in 1 8 cases with pre-expanded perforator-based paraumbilical flaps,with 8 cases in the left side and 10 cases in the right side including 11 male cases and 7 female cases.Aged 4 years to 46 years with an average age of 18.8 years.Burn inj ury causes:1 3 cases were inj uried with hot liquid and 5 case were flame burns,the median time was 18 months from 6 months to 6 years after burn.Elbow joint movement was obviously limited preoperatively,and there were no abundant skin surrounding the elbow to repair the defect after the scar contracture release.Operative method:During the first-stage procedure,the expander was implanted into the ispilateral normal abdominal subcutaneous tissues.First of all,the elbow scar and contracture deformity was marked,and the extent of the defect after scar contracture release was estimated according to the contralateral elbow joint and the extent of the ispilateral side. The flap for reconstruction was slightly larger than the defect.Then two large perforators were detected in the ipsilateral paraumbilical area with hand-held ultrasound Doppler,the axis of the flap was oriented along the axis between the umbilicus and the ipsilateral inferior angle of scapula.The incision was made at the superior

  15. Omentum Free Flap Anastomosed to Arterial Bypass in Open Knee Dislocation: Case Report and Discussion

    OpenAIRE

    Pauchot, Julien; Ducroux, Emilie; Leclerc, Grégoire; Obert, Laurent; Sergent, Anne Pauline

    2015-01-01

    Objective: To report on the original surgical management of a patient with severe trauma of both legs involving anastomosis of an omentum free flap with an emergency vascular bypass. Methods: After stabilization of the knee with an external fixator, a femoral-tibial bypass graft was performed to revascularize the leg with the contralateral great saphenous vein. Ten days later, an omentum free flap was used with an end-to-side arterial anastomosis between the right gastroepiploic artery and by...

  16. 小腿穿支皮瓣修复踝周皮肤软组织缺损%Using lower leg perforator flaps to repair soft tissue defect on ankle

    Institute of Scientific and Technical Information of China (English)

    丰波; 张志; 呼和; 庞有明; 张澜; 王永军; 牛克成

    2014-01-01

    flaps of lower legs,with 10 cases of posterior tibial artery perforator flaps on the medial malleolus,12 cases of front top flaps of com peroneal artery on external ankle,40 cases of back top flaps of peroneal artery on external ankle.The sizes of the flap ranged from 4.0 cm ×5.5 cm to 9.0 cm × 15.0 cm.Ten cases were applied direct suturing in donor site,and other cases were applied skin grafts to repair the defect.Results Flaps in 56 cases completely survived.Partial necrosis appeared in 3 cases of front top flaps of peroneal artery on external ankle,one perforator flap of posterior tibial artery on the medial malleolus and 2 cases of back top flaps of peroneal artery on external ankle.All these cases recovered after careful dressing changes.Sixty two cases were followed up for 3-12 months.Texture of flaps was soft with good elasticity.All of the donor skin grafts in patients survived.Conclusion Perforator flaps have the advantage of easy operation,little damage to the main blood vessels,high reliability in flap survival,less destroy to donor site.It is important that individualized flap is selected given different position of defect.

  17. Perforator-based chimeric anterolateral thigh flap for head and neck reconstruction after en bloc resection%股前外侧穿支嵌合皮瓣修复头颈肿瘤根治术后缺损

    Institute of Scientific and Technical Information of China (English)

    徐中飞; 代炜; 张恩礁; 段维轶; 刘法昱; 谭学新; 黄绍辉; 秦兴军; 孙长伏

    2012-01-01

    PURPOSE; To discuss and report the operative techniques for harvesting perforator-based chimeric flap in anterolateral thigh region and the advantages for head and neck reconstruction after en bloc resection. METHODS: A retrospective review was performed of perforator -based chimeric anterolateral thigh (ALT)flap for head and neck reconstruction since December of 2007 to March of 2011. 66 perforator-based chimeric flaps were harvested including a skin paddle and a muscular flap supplied by one mother pedicle-descending branch of lateral circumflex femoral artery(d- LCFA). 32 flaps were used for the mobile tongue and floor of mouth reconstruction, 30 flaps for base of the tongue and parapharyngeal walls, two for the buccal skin, one for hemimandible and one for parotid. The muscular flap were used to eliminate the dead space of submandibular area. Flaps size ranged from 7cmx4cm to 16cmx7cm and muscular flap was 3cm x4cm approximately. The complications and functions of both donor and recipient sites were recorded and the operative techniques of perforator-based chimeric flap elevation were generalized. RESULTS: All 65 flaps survived completely and the total survival percentage was 98.5%. Only one flap failed and was removed 5 days postoperatively. No complications (fistula, infection, hematoma, seroma et al) were observed in recipient and donor sites. Two anteromedial thigh flaps (AMT) were used for reconstruction due to no sizable perforators in the ALT region. All cases were followed up for 0.5-3 years. The flaps didn't atrophy after six months and the contour was satisfactory. The functions of speech and swallow were recovered well. All the donor sites were closed primarily and the scar was not obvious. The leg's function recovered well. CONCLUSIONS: Using a combination of retrograde and antegrade dissection is a safe and versatile method for harvesting a perforator-based chimeric flap. A chimeric flap including multiple components can meet therequirements of

  18. 腹壁下动脉穿支皮瓣在乳房再造和胸壁溃疡修复中的应用%Deep inferior epigastric perforator flaps in breast reconstruction and chest wall ulcer repair

    Institute of Scientific and Technical Information of China (English)

    徐军; 穆兰花; 刘元波; 朱晓峰; 李森恺

    2001-01-01

    目的 在解剖学研究基础上,对以腹壁下动静脉为蒂的横行腹直肌(TRAM)肌皮瓣的切取进行完善和改进,将其精确为腹壁下动脉穿支(DIEP)皮瓣,从而提供一种更为理想的乳腺癌术后乳房再造和胸壁创面修复的皮瓣。 方法切取DIEP皮瓣,移植至胸壁受区,腹壁下动静脉分别与胸廓内动静脉相吻合,用于乳腺癌术后乳房再造和胸壁放射性溃疡的修复。 结果 解剖学研究和临床观察发现自腹壁下动脉有粗大的肌皮穿支或皮支自血管主干发出,穿过腹直肌纤维直接进入皮瓣,因此,术中只剪开腹直肌前鞘,钝性分离腹壁下动静脉及其穿支周围的腹直肌纤维,无须离断腹直肌纤维,临床应用DIEP皮瓣再造乳房4例,修复胸壁缺损2例,皮瓣面积(10cm×12cm)~(12cm×35cm),全部成活,效果满意。 结论 DIEP皮瓣是对传统的TRAM皮瓣的一种技术改良,既保留了TRAM皮瓣血运丰富、组织量大、易于塑形的优点,尚可保持腹直肌的完整性,同期进行腹壁整形。%Objectives To modifiy the techniques of harvesting the freeinferior epigastric artery transverse rectus abdominis myocutaneous flap as deep inferior epigastric perforator (DIEP) flap based on the anatomic study and to provide ideal methods for breast reconstruction after operation of mastocarcinoma and repair of chest wall ulcer after radiotherapy. Methods DIEP flaps were elevated and transferred to recipient sites in the chest walls. The inferior epigastric artery and vein were anastomosed to the internal thoracic artery and vein. Results During flap dissection, large perforators were found to enter the flap across the fibers of the rectus muscle. So DIEP flaps were elevated with preservation of the continuity of the rectus muscle′s fibers. Four DIEP flaps were used for breast reconstruction and two for repair of chest wall ulcer. The size of the flaps ranged from (10

  19. 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

  20. Application of Orthodromic Island Flap Prosthetics of Homo-Digital Artery in Finger-Tip Defect

    Directory of Open Access Journals (Sweden)

    Daming Lu

    2014-03-01

    Full Text Available Objective: To investigate the clinical efficacy of orthodromic island flap prosthetics of homodigital artery on finger-tip defect. Methods: A total of 21 patients with finger-tip defect from December, 2010 to April, 2013 were given orthodromic island flap prosthetics of homo-digital artery, with the maximum and minimum sizes of flaps being 20 mm×22 mm and 10 mm×15 mm, respectively. Results: All patients with finger-tip defect survived from the flap surgery and the wounds were favorably healed. 3 - 12 months follow-up after operation, the flaps were observed with approving appearance, soft texture and favorable elasticity, with two-point discrimination being 6 - 8 mm. According to TAM detection of hand functions, flaps were excellent healed in 19 cases, good and fairish in 1 case respectively, with effective rate being 95.2%. Conclusion: Orthodromic island flap prosthetics of homo-digital artery is simple and safe in operation with satisfactory effcacy, being the most ideal method for the repair of finger-tip defect.

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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. 

  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. 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)

  8. Arterial supply of the olfactory trigone and the anterior perforated substance in macrosmatic and microsmatic animals.

    Science.gov (United States)

    Nachman, Ewa; Topol, Mirosław

    2002-01-01

    An investigation was conducted into the differences between macrosmatic and microsmatic animals of arterial supply in the area of the olfactory trigone and the anterior perforated substance. A brain of domestic cat was taken as an example of a macrosmatic animal and a brain of baboon as an example of a microsmatic animal. The cerebral blood vessels of the cadavers of 30 cats and 11 baboons were filled with latex and, after fixation in acid alcohol by means of microscopic operation, the cortical and deep branches of the anterior and middle cerebral arteries were dissected. We discovered that there were differences between these two groups of animals in the places of arising of deep branches and in their course. In the cat the deep branches running through the area of the olfactory trigone arose from the beginning part of the middle cerebral artery in numbers 5-10 and entered the brain in the olfactory tubercle. In the baboon the deep branches arose from two sources: the middle cerebral artery and the anterior cerebral artery. The branches of the middle cerebral artery went through the anterior perforated substance, forming two groups of branches: lateral and medial. PMID:12725495

  9. 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

  10. 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...

  11. 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

  12. 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.

  13. A radioanatomic study of the internal mammary artery and its perforators using multidetector computed tomography angiography.

    Science.gov (United States)

    Tan, Onder; Yuce, Ihsan; Aydin, Osman Enver; Kantarci, Mecit

    2014-05-01

    The Internal Mammary Artery (IMA) and its perforators play an important role in coronary bypass grafting and reconstructive breast, head, and neck surgery. This study aimed to obtain anatomic data pertaining to these vessels using Multi Detector Computed Tomography Angiography (MDCTA) and to demonstrate that the MDCTA could be a considerable assessment tool prior to surgery. In 50 outpatients (27 males and 23 females), the above-mentioned arteries were bilaterally evaluated with a 16-detector spiral computed tomography scanner. Based on the obtained images, diameters of the bilateral IMAs were separately measured in each intercostal spaces from 1 to 5 through their traces. IMAPs greater than 0.5 mm in diameter were bilaterally evaluated in terms of distance from the sternal border to the ramification point under the muscular layer, maximal external diameter at ramification from the IMA, and the length between the ramification point from the IMA and enter point to the subcutaneous fat tissue. Mean diameters of the left and right IMAs were 2.05 ± 0.50 mm and 2.20 ± 0.57 mm, respectively. Mean diameters, distances, and lengths of the perforators were 1.30 ± 0.30 mm, 6.80 ± 3.40 mm, 17.05 ± 6.07 mm on the left side and 1.32 ± 0.25 mm, 6.71 ± 3.43 mm, 17.35 ± 3.48 mm on the right side, respectively. No statistically difference was found between the sides (P > 0.05). About 20 of 36 perforators appeared in the second intercostal space, whereas there were eight in the first and eight in the third intercostal space. MDCTA, as a non-invasive vascular imaging method, can be a valuable tool for investigating the anatomic characteristics of the IMA and its perforators before planning an operation. PMID:24105707

  14. 前臂后外侧中段穿支皮瓣的解剖与临床研究%Anatomical Study and Clinical Application of the Perforator Flap in the Posterolateral Mid-forearm

    Institute of Scientific and Technical Information of China (English)

    岳素琴; 林涧; 郑和平; 林加福; 张发惠

    2011-01-01

    Objective: To investigate and evaluate the clinical application of the posterolateral aspect of the mid - forearm ( PLMF ). Methods:30 embalmed upper limbs of adult cadavers perfused with red latex were used for this study, the origin, branches, and distribution of the perforating arteries at posterolateral aspect of the mid - forearm were observed through meticulous dissection on one fresh cadaver, HAES - steril and ink compound was perfused through the brachial artery, after which the staining area of the skin isolated on the perforating arteries was measured. Based on the anatomical study, 11 cases of perforator flaps at the posterolateral aspect of the mid - forearm were harvested to repair soft tissue defects in the forearm and wrist. Results: Perforating branches of posterolateral midforearm originated from the radial musculoculancous branches of the posterior interosseous artery, the intermuscular branch and direct periosteal branch of the radial artery traveled through the space between extensor digitorum and extensor carpi radialis brevis supinator and abductor pollicis longus, supi-nator and abductor pollicis longus, emerging from the deep fascia subcutaneously at 12.5~15.8 cm below the lateral condyle of humerus. Several minute branches were emitted from these perforating branches to participate in the formation of the paraneural and intraneural vascular plexuses of the posterior antebrachial cutaneous nerve. The diameter of the perforating arteries after piercing the deep fascia was ( 1.0±0. 3 )cm,( 0. 9 ±0. 2 ) cm and ( 0. 6 ±0. 2 )cm, respectively. The ink staining area was 13 cm x7 cm. Clinically, all flaps in 13 cases survived uneventfully without cyanose, swelling or blister. After 3 ~ 15 months of following - up, the colors and appearances of these flaps were excellent. Conclusions: The anatomy of the perforating arteries at the posterolateral aspect of the mid - forearm are relatively constant; and the flap based on them are profuse in blood

  15. 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)

  16. The clinical analysis of sacral pressure ulcers utilizing perforator flaps%臀部穿支皮瓣治疗骶尾部褥疮100例临床分析

    Institute of Scientific and Technical Information of China (English)

    杜丽平; 傅荣; 游晓波

    2012-01-01

    Objective To explore the clinical effects of various types Perforator Flap in the Reconstruction of Sacral Pressure Ulcers. Complications were analyzed. Methods A retrospective study from 100 operated cases using the superior gluteal artery perforator (SGAP) for sacral pressure ulcer is reported. According to defect parts and size, the patients are divided into two groups, which were designed with pure pedicle or island flaps respectively. Results The defect areas ranged from 4cmX5cm-10cmX12cm and 84 cases of 100 were healed primarily. We analyze two group's Complications and assess their risk factors. There is a statistical difference between the two groups. Conclusion The perforator flaps is an ideal method for the treatment of Ischia-sacral pressure ulcer. The pure pedicle flap operation is simple with low risk, but has low mobility, which is applicable to smaller defects. The island flap is a relatively complicated operation and has high mobility! The operation is applicable to ulcer bigger defect.%目的 探讨应用各种类型臀部穿支动脉皮瓣修复骶尾部褥疮的手术方法及临床效果.方法 对应用穿支皮瓣修复治疗骶尾部褥疮的100例病例按皮瓣类别分组进行分析.根据缺损部位及大小分为两组,分别设计单纯带蒂穿支皮瓣(旋转或移位皮瓣)、岛状穿支皮辨(推进或移位)修复骶尾部褥疮,并对其治愈率、并发症发生率和复发率等进行分析.结果 100例病例中84例皮瓣全部成活,伤口均一期愈合.随访1~7年,皮瓣质地优良,外形满意,溃疡无复发.结论 穿支蒂皮辩设计灵活,切取方便,血供可靠,不损伤臀部肌肉,供区无需植皮,是修复臀骶部褥疮的理想方法;旋转或移位皮瓣手术操作较简单,成功率高,但移动性差,仅适用于皮肤缺损小的褥疮;岛状皮瓣移动性高,操作相对复杂,手术风险大,适用于皮肤缺损较大或周围瘢痕较多的褥疮.

  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. 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

  19. 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.

  20. Lateral Genicular Artery Flap for Reconstruction of a Large Knee Defect, Following Oncological Resection - Case Report.

    Science.gov (United States)

    Zbuchea, Andrei

    2016-01-01

    This article presents the case of a 53 years old patient, with ulcerated and infected dermatofibrosarcoma, extended on the anterolateral side of the left knee. The postexcisional defect, exposing patella, was covered through a regional cutaneous flap of the distal third of the thigh, upper lateral genicular artery-based, measuring 20/10 cm, together with expanded free skin split grafts, applied in proximal third of the leg and distal third of the left thigh. Surgical stages and favorable postoperative evolution are exposed. Selection of a particular surgical procedure, depending on the extent and location of the postexcisional defect, as well as therapeutic alternatives according to the literature data, are also discussed. In conclusion, the lateral genicular artery flap represents a useful surgical procedure for covering anterolateral extended defects of the knee, by bringing pliable, supple and flexible cutaneous tissue, similar to original skin, without bulk or irregularities. Moreover, this flap dissection and transposition to the defect does not involve making microsurgical vascular anastomosis. PMID:27604676

  1. 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

  2. CT and MRI findings of cerebral ischemic lesions in the cortical and perforating arterial system

    Energy Technology Data Exchange (ETDEWEB)

    Kameyama, Masakuni; Udaka, Fukashi; Nishinaka, Kazuto; Kodama, Mitsuo; Urushidani, Makoto; Kawamura, Kazuyuki; Inoue, Haruhisa; Kageyama, Taku [Sumitomo Hospital, Osaka (Japan)

    1995-07-01

    It is clinically useful to divide the location of infarction into the cortical and perforating arterial system. Computerized tomography (CT) and magnetic resonance imaging (MRI) now make the point of infarction a simple and useful task in daily practice. The diagnostic modality has also demonstrated that risk factors and clinical manifestations are different for infarction in the cortical as opposed to the perforating system. In this paper, we present various aspects of images of cerebral ischemia according to CT and/or MRI findings. With the advance of imaging mechanics, diagnostic capability of CT or/and MRI for cerebral infarction has markedly been improved. We must consider these points on evaluating the previously reported results. In addition, we always consider the pathological background of these image-findings for the precise interpretation of their clinical significance. In some instances, dynamic study such as PET or SPECT is needed for real interpretations of CT and/or MRI images. We paid special reference to lacunar stroke and striatocapsular infarct. In addition, `branch atheromatous disease (Caplan)` was considered, in particular, for their specific clinical significances. Large striatocapsular infarcts frequently show cortical signs and symptoms such as aphasia or agnosia in spite of their subcortical localization. These facts, although have previously been known, should be re-considered for their pathoanatomical mechanism. (author).

  3. 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

  4. Application of Orthodromic Island Flap Prosthetics of Homo-Digital Artery in Finger-Tip Defect

    Institute of Scientific and Technical Information of China (English)

    Lu Daming; Lu Xiangrong; Lu Zehnliang; Zhu Jinhong

    2014-01-01

    Objective:To investigate the clinical efficacy of orthodromic island flap prosthetics of homo-digital artery on ifnger-tip defect. Methods: A total of 21 patients with ifnger-tip defect from December, 2010 to April, 2013 were given orthodromic island lfap prosthetics of homo-digital artery, with the maximum and minimum sizes of lfaps being 20 mm×22 mm and 10 mm×15 mm, respectively. Results: All patients with ifnger-tip defect survived from the lfap surgery and the wounds were favorably healed. 3~12 months follow-up after operation, the lfaps were observed with approving appearance, soft texture and favorable elasticity, with two-point discrimination being 6~8 mm. According to TAM detection of hand functions, lfaps were excellent healed in 19 cases, good and fairish in 1 case respectively, with effective rate being 95.2%. Conclusion:Orthodromic island flap prosthetics of homo-digital artery is simple and safe in operation with satisfactory effcacy, being the most ideal method for the repair of ifnger-tip defect.

  5. The infrahyoid flap: a comprehensive review of an often overlooked reconstructive method.

    Science.gov (United States)

    Deganello, Alberto; Leemans, C René

    2014-08-01

    The infrahyoid flap is a myocutaneous pedicled flap mainly nourished by the superior thyroid vessels through the perforators of the infrahyoid muscles. This thin and pliable flap provides a skin island of about 7 by 4 cm from the central part of the anterior neck. The flap can be transferred on its pedicle of superior thyroid artery and vein to reconstruct medium sized head and neck defects created after cancer ablation. We have successfully used this flap in a series of 40 cases with no total flap loss and with 1 case of superficial skin necrosis. The aim of this review is to highlight the clinical usefulness of this pedicled flap even in the microvascular free flap era. A comprehensive review of the available literature reporting on the infrahyoid flap has been carried out using a web search. The history of the infrahyoid flap, the surgical technique with technical innovations, the clinical utility and limitations of this flap, are reported and discussed. Among the 7 larger series (cohort larger than 50 cases) a total of 956 flaps were performed, and the global success rate was 91.7%, with failures being mainly related to partial skin necrosis, as the rate of total (skin and muscle) flap necrosis was only 1%. This flap is reliable, easy to harvest during neck dissection, oncologically safe, it does carry a negligible donor site morbidity. This paper highlights how the infrahyoid flap can represent an excellent reconstructive solution in selected patients and head and neck sites. PMID:24856306

  6. 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 abdominoplasty patients but also in patients undergoing breast reconstruction with DIEP flap. PMID:26601878

  7. 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.

  8. 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...

  9. Estudo anatômico das artérias perfurantes do músculo gastrocnêmio medial Anatomical study of perforator arteries of the medial gastrocnemius muscle

    Directory of Open Access Journals (Sweden)

    Diogo Mesquita Rebouças

    2008-04-01

    distance of 14.0 cm from the popliteal fold and between 16.5 cm and 34.0 cm from the medial malleolus. CONCLUSION: MGM irrigation by ASM and its perforating arteries is adequate for the use of the muscle as a myocutaneous flap of in the lower limb.

  10. 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.

  11. Application of anterolateral thigh perforator flap for repair of soft tissue defect of the hand%股前外侧穿支皮瓣修复手部软组织缺损

    Institute of Scientific and Technical Information of China (English)

    张兴奎; 李虎; 夏勇; 王彬; 张桂红; 唐阳平; 苗峰; 丁桂友; 张亮; 董中洋; 郭彬; 马晓辉

    2012-01-01

    目的 探讨应用游离修薄股前外侧穿支皮瓣修复手部软组织缺损的临床效果.方法 对28例手部软组织缺损创面,采用股前外侧皮瓣游离移植修复.术中切取游离皮瓣至仅剩血管蒂相连时,修薄皮瓣,从外周至血管皮支穿出点附近按次序阶梯样修剪,保留穿出点周围1.5~2.0cm组织不予修剪,同时观察皮瓣血供,防止穿支损伤,皮瓣修薄后游离移植修复手部创面.结果 28例皮瓣全部存活.25例获得3~ 12个月的随访,3例失访.术后皮瓣质地柔软,弹性好,无臃肿,肤色接近正常皮肤,恢复部分感觉功能,手功能及外形恢复良好.结论 修薄股前外侧穿支皮瓣是股前外侧皮瓣的改进,皮瓣存活后疗效满意,是修复手部创面的理想方法之一.%Objective To explore the application of free anterohteral thigh perforator flap in repairing soft tissue defects of the hand and evaluate the clinical results.Methods Free anterolateral thigh perforator flap was transferred to repair soft tissue defects of the hand in 28 cases.During flap harvesting trimming of the flap was carried out when the flap was freed and only connected with its vascular pedicle.A step-wise defatting was done from the periphery of the flap towards the vascular pedicle with 1.5 to 2.0 cm tissue around the perforator preserved.Flap circulation was carefully observed to prevent damage to the perforators.The vascular pedicle was then disconnected and the flap transferred to the hand to cover the defect.Results All the 28 flaps survived.Twenty-five cases were follow-up for 3 to 12 months,while 3 cases were lost to follow-up.The flaps were supple and elastic with near normal color.There was no bulkiness.Partial sensation was restored.The function and appearance of the hand were good.Conclusion The thin anterolateral thigh perforator flap is an improvement of the traditional anterolateral thigh flap.The survived flaps are ideal in terms of covering hand defects and

  12. 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

  13. 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

  14. 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

  15. 拱顶石穿支岛状皮瓣在皮肤软组织缺损修复中的应用%The keystone design perforator island flap in reconstructive surgery

    Institute of Scientific and Technical Information of China (English)

    杨超; 邢新; 徐建国; 徐苗; 方硕; 孙肇晟

    2014-01-01

    Objective To introduce the experience in skin defects reconstruction using keystone design perforator island flap.Methods Since June 2012 to June 2013,the flaps have been used in 14 patients.The size of defects ranged from 1 cm × 1 cm to 5 cm × 9cm at the extremities,trunk and facial region.The trapezoidal shaped flap has the same width as the defect.The flap is designed along the edge of the defect with 90° angle at the ends of the island flap.This curvilinear-and trapezoidal-shaped flap essentially consists of two conjoined V-Y advancement flaps at the proximal and distal end.The vascular supply is supported by the subcutaneous vascular network and fascial/muscular perforators.Perforators should be detected by Doppler techniques when large size flaps are used.Results Primary wound healing and satisfactory result was achieved in 13 patients except for one with partial flap necrosis.Conclusion The technique offers a simple and effective method of wound closure in situations that would otherwise have required complex flap closure or skin grafting.%目的 探讨拱顶石穿支岛状皮瓣修复皮肤软组织缺损的临床效果.方法 2012年6月至2013年6月,设计应用拱顶石穿支岛状皮瓣(keystone design perforator island flap,KDPIF)修复四肢、躯干及面部皮肤软组织缺损14例,缺损面积为1 cm×1 cm~5 cm×9 cm.术中于缺损旁设计拱形皮瓣,皮瓣宽度与缺损宽度一致,皮瓣紧邻创缘的两侧顶角呈90°,在该皮瓣的头尾两端包含2个V-Y推进皮瓣.皮瓣血供主要来自皮下血管网和来自筋膜及肌肉的穿支血管,对于一些面积较大的皮瓣,术前可通过多普勒确定皮瓣基底穿支血管的位置.结果 本组13例患者创面一期愈合,仅1例出现皮瓣部分坏死,经换药后二期愈合.术后随访3~6个月,患者对形态和功能均感满意.结论 拱顶石穿支岛状皮瓣为皮肤软组织缺损创面的修复提供了一种简单、有效的方法,对于一些可能

  16. The modified keystone perforator island flap for reconstruction of skin defects at head and face%改良拱顶石穿支岛状皮瓣修复头面部皮肤软组织缺损

    Institute of Scientific and Technical Information of China (English)

    刘忠山; 赵天兰; 何志旭; 余道江; 刘宁; 陈祥军; 莫骁群

    2016-01-01

    目的 探讨改良拱顶石穿支岛状皮瓣修复头面部皮肤软组织缺损的临床效果.方法 2013年1月至2014年9月,应用改良拱顶石穿支岛状皮瓣修复头面部皮肤软组织缺损创面13例,缺损面积为0.8 cm×1.0 cm~20.0 cm×10.0 cm,皮瓣切取面积1.5 cm×1.0 cm ~22.0 cm×12.0 cm.以头面部穿支血管为蒂,于创面旁设计拱顶石形状皮瓣,以既能减轻切口张力义能有好的美容效果为原则,尽量减少辅助切口,面部切口线选择与皮纹方向一致或隐蔽的部位或面部美容单元旁;发际内切口应注意减少对毛囊的损伤,注意皮瓣转移对头发生长方向的影响.结果 术后12例伤口愈合良好,1例皮瓣部分坏死,经植皮后愈合.患者均获1 ~12个月随访,对术后功能、皮肤感觉及外观均满意.结论 改良拱顶石穿支岛状皮瓣修复头面部皮肤软组织缺损,可取得较好的效果.%Objective To investigate the clinical application of the modified keystone perforator island flap for reconstruction of skin defects at head and face.Methods From January 2013 to September 2014,13 cases with skin defects at head and face were repaired by modified keystone perforator island flap.The skin defects ranged from 0.8 cm× 1.0 cm to 20.0 cm × 10.0 cm.And the flap size ranged from 1.5 cm × 1.0 cm to 22.0 cm × 12.0 cm.The flap was designed along the edge of the defect,the vascular supply was supported by muscular perforators.In order to relieve suture tension and have a good cosmetic effect,auxiliary incisions should be as less as possible.Flap should be designed to hide parts of facial incision or surgical margins within the natural borders of each facial unit,or along the direction of striae.Incision within the hairline should be taken to minimize damage to the hair follicles.The direction of hair growth shouldn't be changed after the flap transfer.Results All cases had 1-12 months' follow-up period.12 flaps survived completely,with one partial

  17. Supercharging and Augmenting Venous Drainage of an Anterolateral Thigh Free Flap: Options and Indications

    Directory of Open Access Journals (Sweden)

    Frederic W.-B. Deleyiannis, MD, MPhil, MPH

    2014-04-01

    Full Text Available Summary: This study introduces the options for supercharging and augmenting venous drainage of an anterolateral thigh free flap. Clinical indications and options for additional microvascular anastomoses are reviewed in 5 consecutive patients. The indications were simultaneous mucosal and cutaneous defects, divergent mucosal defects, and extensively wide and long cutaneous defects. Three additional vascular pedicles were anastomosed: the transverse branch of the lateral circumflex (n = 3, a perforator coming directly off the superficial femoral artery (n = 1, and a posterior perforator from the profundus femoral artery (n = 1. The anastomosis of a separate pedicle from the superior, medial, and/or posterior-lateral thigh may be a useful technique when confronted with an extensive defect that may not reliably be reconstructed with a routine anterolateral thigh flap based on a single perforator.

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

    Directory of Open Access Journals (Sweden)

    Joseph Richard Dusseldorp, BCom, MBBS(Hons

    2014-10-01

    Conclusions: This study confirms that 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.

  19. 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.

  20. 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

  1. Flow-through posterior interrosseous artery flaps for repair of digital wounds combined with artery injury%游离骨间后动脉血流桥接皮瓣修复伴指动脉缺损的手指创面

    Institute of Scientific and Technical Information of China (English)

    李涛; 陈振兵; 丛晓斌; 艾方兴; 周攀; 洪光祥

    2014-01-01

    .Conclusions Flow-through posterior interrosseous artery flaps are safe and effective to cover digital wounds and restore blood circulation.The technique improves the clinical application of perforator flaps.

  2. Clinic application of micro-dissected perforator flap technique for defatting bulky flap at the second stage%显微削薄穿支皮瓣技术在臃肿皮瓣二期削薄中的应用

    Institute of Scientific and Technical Information of China (English)

    唐举玉; 周征兵; 吴攀峰; 俞芳; 肖勇兵; 潘丁; 庞晓阳; 曾磊; 卿黎明

    2016-01-01

    Objective To explore the feasibility and clinic effect of the micro-dissected perforator flap technique for defatting bulky flap at the second stage.Methods From October, 2013 to June, 2014, 9 patients had been performed to preserve 3-5 mm thickness of fascia-fatty tissue on the recipient site, remove the subcutaneous tissue uniformly around the perforator under microscope and protect the vascular pedicle and perforator vessel carefully.Results The 9 bulky flap which were taken defatting procedure survived and the wounds got healed primarily.All the patients were followed up for 3-12 months (average 6 months), the flap bulky appearance significantly reduced, and the function were improved obviously.Conclusion The micro-dissected perforator flap technique is an ideal method for defatting the bulky flap at the second stage as it can keep reliable blood supply, get good appearance and the procedure can be finished at one time.%目的 探讨显微削薄穿支皮瓣技术应用于臃肿皮瓣二期削薄的可行性与临床疗效.方法 从2013年10月至2014年6月,应用显微削薄穿支皮瓣技术治疗皮瓣移植术后臃肿畸形9例,手术显微镜下分离并保护好穿支血管,保留真皮下脂肪3~5mm,去除多余脂肪组织.结果 9例术后皮瓣无1例坏死,创口均一期愈合.术后随访3~12个月,平均6个月.皮瓣色泽正常,质地良好,受区外形及功能明显改善.结论 应用显微削薄穿支皮瓣技术对臃肿皮瓣二期削薄能一次完成手术,术后皮瓣血供可靠,外形良好,是一种理想的皮瓣削薄新方法.

  3. Detection on distribution and flowing dynamics of cutaneous perforators of tibial anterior arteries with col-or Doppler flow imaging%彩色多普勒超声对胫前动脉穿支皮瓣血管的研究

    Institute of Scientific and Technical Information of China (English)

    高慧; 胡建群

    2015-01-01

    ).In the distal segment, we found relatively few perforators.The perforating points of cutaneous branches mostly (55.5%case) ap-peared within 15-27 cm length above the lateral maleollus of fibula.There were no significant differences in the peak systolic velocity between left and right cutaneous perforators.Conclusion The color Doppler ultrasonography with high resolution could show the distri-bution and location clearly, assess the quality of the blood flow of perforators artery, and provide scientific basis for planning skin flap.

  4. 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

  5. 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.

  6. Evaluation of lower-limb arteries with multidetector computed tomography angiography prior to free flap surgery: a radioanatomic study.

    Science.gov (United States)

    Tan, Onder; Yuce, Ihsan; Kantarci, Mecit; Algan, Said

    2011-03-01

    In this study, we aimed to evaluate the vascular structures of the lower limb with multidetector computed tomography (CT) angiography and to reveal the importance of this method in preoperative planning of microsurgical transplantation. In 24 patients, lower-limb arteries were bilaterally evaluated with 16-detector spiral CT scanner in terms of patency, stenosis, or occlusion; maximal and minimal external diameters through their traces; and variations as well as length of the peroneal artery. The peroneal artery was absent unilaterally in two patients (4.3%). The mean maximal and minimal diameters were as 2.77 and 1.63, 2.92 and 1.75, and 2.72 and 1.50 mm for anterior and posterior tibial and peroneal arteries, respectively. The ranges of lengths of peroneal arteries were 50 to 117 mm. This valuable tool can provide detailed information about vascular and the remaining anatomic structures by means of its high-resolution characteristics before planning free flap surgery. PMID:21181625

  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. Use of preoperative ultrasound in designing the true pectoralis major myocutaneous island flap

    Institute of Scientific and Technical Information of China (English)

    CHEN Xiao-hong; ZHAO Han-xue; FANG Ju-gao; YU Zhen-kun; HUANG Zhi-gang

    2012-01-01

    Background Traditional techniques used for harvesting the pectoralis major myocutaneous (PMMC) flap have accompanying disadvantages,such as the necessity for an upper chest skin incision,the bulkiness of myocutaneous tissue at the pedicle of the flap,and the risk of total or partial necrosis of flap tissue.The aim of this study was to develop a safe and fast method for preparing PMMC island flaps using preoperative ultrasonography for vessel detection.Methods Forty-one PMMC island flaps were used for one-stage reconstruction of head and neck defects,including 21 cases in the treatment group and 20 cases in the control group.In the treatment group,ultrasonography was used to mark out the course of the thoracic branches of the thoracoacromial artery and the lower end of this artery perforating from the fascia into the muscles,as well as the largest perforating branch of the fourth or fifth internal mammary artery entering the PMMC flap.A line,from the lower end of the thoracic branch to the largest perforating branch of the fourth or fifth internal mammary artery,was drawn to determine the axis of the PMMC flap.In the control group,PMMC island flaps were designed according to conventional methods without using ultrasonography.Results According to the ultrasonic marks,the distance from lower end of thoracic branch to the midpoint of the margin of the inferior clavicular was (5.1±1.2) cm.The time from designing to transferring the island flap was significantly shorter in the treatment group ((51.0±10.5) minutes) compared with the control group ((78.0±13.9) minutes,P <0.01).The rate of partial necrosis was 4.7% (1/21) in the treatment group and 35.0% (7/20) in the control group.There was one case of flap failure in the control group due to vascular injury during vascular pedicle dissection.Conclusion Preoperative vessel detection by ultrasonography facilitates easy and safe harvesting of the true PMMC island flap.

  9. 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.

  10. Repair of perforating skin and soft tissue defects of the palms with dorsalis pedis parallel flaps%足背并联皮瓣修复手掌贯穿性皮肤软组织缺损

    Institute of Scientific and Technical Information of China (English)

    冯仕明; 王爱国; 高顺红

    2015-01-01

    Objective To explore the effect of dorsalis pedis parallel flaps in repairing perforating skin and soft tissue defects of the palms.Methods Eighteen patients with perforating skin and soft tissue defects of the palms were hospitalized from July 2008 to November 2010.The area of skin defect ranged from 2.0 cm × 1.5 cm to 5.0 cm ×2.5 cm.The dorsalis pedis parallel flaps were used to repair these defects,with the area ranging from 2.0 cm × 2.0 cm to 5.5 cm × 3.0 cm.The donor sites were covered with autologous full-thickness skin from inner thigh.Results All the 18 flaps and skin grafts of donor sites survived completely.Seventeen patients were followed up for 6 to 23 months,with mean time of 10 months,and one patient was lost to follow-up.The texture,elasticity,and appearance of all the 17 flaps were satisfactory,with no obvious pigmentation or cicatricial contracture.At the last follow-up,the distance of two-point discrimination of flaps ranged from 6 to 9 mm,with mean distance of 7.4 mm,and the sensation of flaps reached S3 in 13 patients who had nerve anastomosis.Conclusions The dorsalis pedis parallel flap,with reliable blood supply and flexible design,is a good choice for repairing perforating skin and soft tissue defects of the palms.%目的 探讨采用足背并联皮瓣修复手掌贯穿性皮肤软组织缺损的疗效. 方法 2008年7月-2010年11月,笔者单位收治18例手掌贯穿性皮肤软组织缺损患者.单处皮肤软组织缺损面积为2.0 cm×l.5 cm~5.0 cm ×2.5 cm.应用足背并联皮瓣治疗,单处皮瓣切取面积为2.0 cm×2.0 cm~5.5 cm ×3.0 cm.供瓣区创面采用自体大腿内侧全厚皮片修复. 结果 术后18例患者皮瓣全部成活,所有足部供区植皮均成活.本组17例患者术后随访6~23个月,平均10个月;l例患者失访.17例皮瓣外观恢复较好,皮瓣质地柔软、弹性好,无臃肿,未见明显色素沉着以及瘢痕挛缩.行神经吻合的13例患者,末次随访时皮

  11. 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.

  12. [Fasciocutaneous flap of the posterior surface of the thigh with distal pedicle. Anatomical study and surgical value. A propos of 3 cases].

    Science.gov (United States)

    Lambert, F; Cariou, J L; Couturaud, B; Bellavoir, A

    1996-04-01

    In the light of previous studies, the authors conducted an anatomical study on 21 cadaveric dissections with injection in order to define the characteristics of the distally based fasciocutaneous flap of the posterior surface of the thigh, described for the first time in 1988 by Maruyama. This leaf-shaped flap extends from the popliteal region to the gluteal sulcus. It possesses an axial arterial network derived from the popliteal artery, reinforced by the perforating arteries derived from the vessel or the profunda femoris artery. The venous return is ensured by venae comitantes and the communicating saphenous vein. The flap raising technique is described. From 1991 to 1994, 3 patients were operated in order to cover a defect of the knee (1 case) and amputation stumps (2 cases). The postoperative course was uneventful and the results were considered to be stable and of excellent quality with a follow-up of 2 to 4 years.

  13. Ⅰ期移植复合股前外侧穿支皮瓣治疗ⅢC型开放性损伤%Primary composite anterolateral thigh perforator flap transfer for treatment of Gustilo type Ⅲ C open fracture

    Institute of Scientific and Technical Information of China (English)

    王欣; 潘佳栋; 黄耀鹏; 周丹亚; 胡瑞斌; 杨科跃; 陈宏; 章伟文

    2014-01-01

    Objective To investigate the procedure techniques and clinical effects for treatment of cases on the brink of amputation with composite anterolateral thigh perforator flap (ALTP) in primary surgery.Methods From July 2008 to December 2012,9 cases on the verge of amputation received primary composite ALTP transfer to perform limb salvage surgery.All cases were Gustilo type Ⅲ C open injuries resulted from traffic accidents which involved upper extremities in 3 cases and lower extremities in 6 cases.Emergent fracture fixation was done for 5 cases; primary external fixation followed by definitive bone grafting was done for 4 cases combined with bone defects.Types of flaps consisted of flow-through ALTPs in 4 cases,chimeric ALTPs in 2 cases,flow-through + chimeric ALTPs in 2 cases,flow-through + chimeric + polyfoliate ALTP in 1 case.Size of flaps ranged from 10 cm × 6 cm-22 cm × 9 cm.Donor sites were closed primarily.Results Limb salvage succeeded for all the 9 cases.Six flaps survived uneventfully,but another 3 flaps developed tension blisters and survived eventually after stitches removing and blood-letting.Postoperative follow-up was 5-36 months.All cases achieved bone union in 4.5-8 months (mean,6.3 months).Conclusion Emergent composite ALTP transfer can not only save the limb,but also reduce the recovery time and complications and contribute to the early recovery of limb function.%目的 探讨急诊Ⅰ期移植复合股前外侧穿支皮瓣(anterolateral thigh perforator flap,ALTP)挽救濒临截肢患者肢体的手术方法与临床疗效. 方法 2008年7月-2012年12月对9例濒临截肢的患者采用Ⅰ期移植复合ALTP进行保肢手术.所有患者均为交通伤所致的GustiloⅢC型开放性损伤.上肢3例,下肢6例,其中急诊行骨折内固定5例,伴骨缺损Ⅰ期予外固定、Ⅱ期行植骨内固定4例.移植单纯桥接动脉型ALTP 4例,单纯嵌合型AL-TP 2例,桥接动脉+嵌合型ALTP 2例,桥接动脉+嵌合+分叶型ALTP 1

  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. 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

  18. [Oroantral perforations

    NARCIS (Netherlands)

    Stoelinga, P.J.W.

    2004-01-01

    Some risk factors in relation to the occurrence of an oroantral perforation are discussed in the light of the existing literature. Factors relevant for the diagnosis and the treatment of an oroantral perforation, are discussed. Small perforations probably heal without problems, provided that the alv

  19. 三种修复手部创面皮瓣的临床疗效评价%Three different flaps for coverage of soft tissue defects in the hand:a clinical evaluation

    Institute of Scientific and Technical Information of China (English)

    谢仁国; 汤锦波; 茅天; 徐静; 王古衡; 刘国峰

    2009-01-01

    Objective To evaulate the clinical results of posterior interosseous artery flap, anterolateral thigh flap and medial sural artery perforator flap for coverage of soft tissue defects in the hand and to provide useful guidance on clinical selection of flaps. Methods Twenty-three cases with soft tissue defects of the hand repaired with these three different flaps were followed up and evaluated. DASH scores, touch and pressure (Semmes-Weinstein monofllament test), 2-point discrimination (motion 2PD and static 2PD), thermal sensation, flap bulkiness and donor site contracture were recorded and analyzed statistically. Results There were no significant differences in all detected data among these three different flaps, except for flap bulkiness. The transplanted anterolateral thigh flap was much bulkier than the other two flaps. Concldusion The posterior interesseous artery flap, anterolateral thigh flap and medial sural artery perforator flap have their own characteristics. Flap selection should be evideuce-based to suit individual case and clinical requirement.%目的 比较骨间背侧动脉皮瓣、股前外侧皮瓣和腓肠内侧动脉穿支皮瓣的临床疗效,为临床的皮瓣选用提供参考.方法 对应用骨间背侧动脉皮瓣、股前外侧皮瓣和腓肠内侧动脉穿支皮瓣修复手部创面的23例患者进行随访,比较分析DASH(disability of the arm,shoulder and hand)分数、损伤的部位、触觉压觉(Senunes-Weinstein单丝法)、两点分辨觉(动、静态,m2PD、s2PD)、温度觉、臃肿程度和供区瘢痕挛缩程度.结果 三种皮瓣的DASH评分、瘢痕挛缩程度、皮瓣的臃肿程度、触觉压觉、两点分辨觉和温度觉的结果 ,差异均没有统计学意义;股前外侧皮瓣的臃肿程度高于其他两种皮瓣,差异具有统计学意义.结论 三种皮瓣各有特点,临床选择应该根据各种客观要求,不要主观臆测.

  20. 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

  1. Repair of upper lip defect with inferior labial artery island flap%下唇动脉岛状皮瓣修复上唇缺损

    Institute of Scientific and Technical Information of China (English)

    刘杨; 王绍峰; 何晓宁; 刘强

    2012-01-01

    目的 探讨下唇动脉岛状皮瓣修复上唇缺损的可行性及效果.方法 采用单侧下唇动脉岛状皮瓣修复上唇唇红及白唇局部缺损,皮瓣蒂部包括1条下唇动脉和2条下唇静脉.自2005年7月至2011年5月,共修复上唇缺损患者7例.结果 本组7例患者,术后随访3~6个月,皮瓣全部成活,颜色、质地与周围皮肤相近,无明显的挛缩,皮瓣感觉功能良好,水从口中漏出明显改善,无口轮匝肌功能障碍,患者对上唇功能及外观都满意.其中,3例患者于术后3个月行唇弓、唇珠、人中成形术.结论 应用单侧下唇动脉岛状皮瓣修复上唇唇红联合白唇局部缺损是一种比较理想的方法.%Objective To explore the feasibility and effect of inferior labial artery island flap for the repair of upper lip defect. Methods The inferior labial artery island flap which was designed on the lower lip with a vascular pedicle including one inferior labial artery and two veins, was used to repair the defects of the ipsilateral upper lip on totally 7 patients received from July 2005 to May 2011. Results After 3 to 6 months follow-up in all 7 cases, all flaps survived completely and had not visible contraction. The coloration and texture were closed to surrounding, and liquid leakage from the lip and the appearance of the injured area were clearly improved. Dysfunction of the orbicularis oris muscle was not observed, and sensory function was recovered within 6 months. The patient was satisfied not only with the function but also with the appearance of his lip. Conclusion The inferior labial artery island flap is an optimal method for the repair of ipsilateral upper lip defect.

  2. EFFECTIVENESS OF PERFORATOR FLAPS FOR ELDERLY PATIENTS WITH ISCHIA-SACRAL ULCERS%臀部穿支皮瓣治疗老年患者骶尾部褥疮的疗效

    Institute of Scientific and Technical Information of China (English)

    傅荣; 杜丽平; 游晓波

    2011-01-01

    Objective To investigate the operative technique and the effectiveness of perforator flaps for the treatment of elderly patients with ischia-sacral ulcers. Methods Between January 2005 and June 2010, 29 elderly patients with ischia-sacral ulcers were treated. There were 16 males and 13 females, aged from 61 to 75 years (mean, 68 years), including 11 cases of degree Ⅲ and 18 cases of degree Ⅳ according to the standard of the National Pressure Ulcer Advisory Panel (NPUAP). The disease duration was from 5 months to 10 years (median, 5.5 years). The size of ulcers ranged from 7 cm ×6 cm to 12 cm × 10 cm. Of them, 8 cases were companied by cerebral vascular disorders, 6 cases by Alzheimer disease, 11 cases by paraplegia, and 4 cases by others. The flap size ranged from 8 cm × 6 cm to 14 cm × 12 cm. The donor sites were sutured directly. Results Distal flap necrosis occurred in 3 cases (10.3%) 2 days after operation and healed after symptomatic treatment, and the remaining flaps survived and wound healed by first intention with first intention rate of 89.7%. The incisions of donor sites healed primarily. Two cases (6.9%) had infection 1 week after operation and 1 case (3.4%) had wound dehiscence 10 days after operation. Twenty-seven patients were followed up 6 months to 5 years (mean, 3 years). Two cases recurred at 1 and 3 years after operation, respectively. One died of infection, and the other healed by debridement and suture. The flaps of other patients had good texture, color, and elasticity. Conclusion As long as the indications are controlled strictly, good effectiveness can be achieved in the treatment of elderly patients with ischia-sacral ulcers by using perforator flaps.%目的 探讨应用臀部穿支皮瓣治疗老年患者骶尾部褥疮的临床效果.方法 2005年1月-2010年6月,收治29例老年骶尾部褥疮患者.男16例,女13例;年龄61~75岁,平均68岁.病程5个月~10年,中位病程5.5年.根据美国国家褥疮顾问小

  3. Clinical application of prefabricated super-thin perforator flaps after expansion in the reconstruction of facial and cervical scar%扩张预制超薄穿支皮瓣在面颈部瘢痕修复中的研究及应用

    Institute of Scientific and Technical Information of China (English)

    王春梅; 杨思奋; 范金财; 任家骠; 徐伟; 许开元; 郭静苹; 梅劲; 高建华

    2015-01-01

    Objective To explore a combined application of tissue expansion,perforator flaps and super-thin flaps in reconstruction of extensive face and neck scars.Methods In the first stage,the position and course of the perforators were confirmed with the multi-detector computed tomography (MDCT) and color Doppler ultrasound.The expanders were implanted between subdermal vascular plexus and superficial fascia.In the second stage,the expanded super-thin perforator flaps were transferred to resurface the extensive defects and deformities in the face and neck.Results 26 cases with extensive facial and cervical scars were included in this study.Except for one case with necrosis at the distal end,the other 25 flaps survived completely.The maximum flap size was 35 cm × 10 cm with a pedicle of 8 cm × 4 cm.Long-term follow-up showed that this combined application provided thinner flap than the conventional pre-expanded flap,thus avoiding secondary flap debulking and revisions.All the patients got improvement in contours,facial features and emotional expression.Conclusions The combined application of tissue expansion,perforator flaps and super-thin flaps is a practical method which has advantages in feature recontouring and recovery of delicate emotions in reconstruction of extensive face and neck scars.%目的 探讨一种将扩张皮瓣、穿支皮瓣与超薄皮瓣技术相结合的扩张预制超薄穿支皮瓣,在面颈部广泛性瘢痕治疗中的效果.方法 一期术前应用多排螺旋CT(MDCT)、多普勒超声血流探测仪定位穿支血管的部位及走行,于真皮下血管网以下为分离层次埋置扩张器,二期以穿支血管为蒂,设计扩张超薄穿支皮瓣,修复面颈部大面积瘢痕畸形及皮肤缺损.结果2005至2013年对26例面颈部广泛性瘢痕患者以扩张超薄穿支皮瓣修复,包括颈肩背皮瓣9例、颈胸皮瓣5例、面颈部皮瓣12例,结果 仅1例皮瓣远端坏死,余25例皮瓣均成活良好.其中颈肩背跨区

  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. 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

  6. Tertiary resurfacing after one of the first free flaps in Europe, a reflection on 30 years of microsurgical progress.

    Science.gov (United States)

    Hart, A M; Tollan, C J; Dabernig, J; Acland, R; Taggart, I

    2007-01-01

    Free flaps have been used for over 30 years. During this period, improved anatomical understanding has increased donor options and available pedicle lengths, permitting safer, single-stage reconstructions with simpler anastomoses. Refinements, such as perforator flaps in particular, have greatly improved donor morbidity, recipient site cosmesis, and the ability to replace 'like with like' while retaining options for innervation. This case highlights the evolution from one of Europe's first free tissue transfers, effectively a perforator flap, through the advent of free muscle flaps to the current generation of contourable perforator flaps. Free flap transfer has become increasingly sophisticated, safer, and more predictable, yet the potential quality of reconstructive outcome has changed little.

  7. Free superficial iliac circumflex artery skin flap : the clinical application and management of donor site defects%旋髂浅动脉游离皮瓣的临床应用及供瓣区处理

    Institute of Scientific and Technical Information of China (English)

    韩军涛; 谢松涛; 陶克; 张万福; 计鹏; 胡大海

    2013-01-01

    Objective To investigate the clinical application of free superficial iliac circumflex artery skin flaps,as well as the management of donor site defects.Methods 17 free superficial iliac circumflex artery skin flaps were applied for the traumatic defects or deformities on face,neck,foot,hand,ankle and lower leg,respectively.The donor site defects were closed directly or covered by paraumbilical island flaps.Results The 17 flap size ranged from 5 cm× 3 cm to 19 cm × 14 cm.16 flaps survived completely except 1 flap with partial necrosis,which was closed by free skin graft.The donor site defects were closed directly in 10 cases,and covered by paraumbilical island flaps in 7 flaps without no flap necrosis.The abdomen had a good appearance.Conclusions Good appearance can be achieved with free superficial iliac circumflex artery skin flaps for the dcfects on face,neck,foot,hand,ankle and lower leg.Paraumbilical island flap can be used for the donor site defects.%目的 探讨旋髂浅动脉皮瓣游离移植的临床适应证及供瓣区的修复方法.方法 根据创面大小设计旋髂浅动脉皮瓣,并分别游离移植修复17例面颈部、足踝部及小腿等处创伤及畸形,对供瓣区无法直接拉拢缝合者,设计同侧脐旁岛状皮瓣转移进行修复.结果 17例旋髂浅动脉游离皮瓣,最大面积19 cm×14 cm,最小5 cm×3 cm,16例术后成活良好,1例皮瓣部分坏死,术后2周移植皮片修复.10例供瓣区直接缝合,7例行脐旁岛状皮瓣转移修复,皮瓣全部成活,术后经3个月至2年随访,腹部外形良好.结论 旋髂浅动脉皮瓣游离移植,对于面颈部及手足等处具有良好的修复效果,而同侧脐旁岛状皮瓣亦可使供瓣区得到良好的修复.

  8. 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.

  9. 指动脉逆行岛状皮瓣改良重建回流的临床应用%Improved Finger Artery Retrograde Island Flap Reconstruction Backflow Effect

    Institute of Scientific and Technical Information of China (English)

    孙中建; 王智慧; 徐鹏

    2014-01-01

    目的:分析吻合静脉重建回流在指动脉逆行岛状皮瓣中的应用。方法:在指动脉逆行岛状皮瓣移植手术中改良应用静脉吻合重建回流的方式,将包含在皮瓣内的指侧方静脉与手指远端伤口的静脉断端端端吻合重建皮瓣的回流。结果:36例36指皮瓣全部成活,无回流障碍,皮瓣质地良好,无需二期整形。结论:指动脉逆行岛状皮瓣移植手术改良应用静脉吻合重建回流的术式具备临床应用价值。%Objective :To analyze anastomosis venous reconstruction reflux in the application of the finger artery retro-grade island flap .Methods :In finger artery retrograde island flap transplantation surgery improved venous anastomosis for reconstructing the reflux way ,when will be included in the flap of lateral veins and distal finger wound end end to end anastomosis to reconstruct venous flaps backflow .Results:Already all 36 cases of 36 refers to flap survival ,as a re-sult ,no reflux obstacle ,flap texture is good ,without phaseⅡ plastic .Conclusion:Finger artery retrograde island flap transplantation improved venous anastomosis for reconstructing the reflux operation has clinical value in practice .

  10. 指固有动脉终末背侧支皮瓣修复指端缺损的疗效观察%Repair of fingertip defect with double flaps based on the end dorsal branches of the digital artery and dorsal metacarpal artery

    Institute of Scientific and Technical Information of China (English)

    于吉文; 霍永峰; 顾光学; 厉雷明; 王彤; 盛路新

    2015-01-01

    目的 探讨应用指固有动脉终末背侧支皮瓣修复指端组织缺损的临床疗效. 方法 2007年3月—2011年10月,应用指固有动脉终末背侧支岛状皮瓣修复指端组织缺损6例. 结果 术后6例皮瓣全部成活,随访1~12个月,平均7.3个月,皮瓣血运良好,色泽及弹性与受区周围皮肤基本一致. 皮瓣无明确皮神经支配,感觉恢复较差,术后6~12个月,皮瓣两点辨别觉为6~8 mm,对冷热觉不敏感,对针刺等疼痛刺激有感觉. 结论 指固有动脉终末背侧支岛状皮瓣修复指端组织缺损是一种可行手术方法.%Objective To study the effect of flap based on the end dorsal branches of the digital artery on repairing of fingertip soft tissue loss. Methods From March 2007 to October 2008, the reverse flap of the end dorsal branches of digital artery was harvested for coverage of fingertip soft tissue loss for 6 cases, at the same time the reverse flap of dorsal metacarpal artery to repair dorsal donor site. Among the 6 patients, 2 cases were index fingers, 1 case was middle finger, 3 cases were ring fingers. Results All flaps survived completely. Follow-up of 1~12 months in the 6 cases, averaged 7.3 months. The blood supply and texture of the flaps was fine, and the color and elasticity was of little difference to the ambient. The skin nerves of the double flaps were not connected, and the sensibility of the flaps was poorly recovered, and the two-point discrimination was 6~8 mm in sensate flap which based on the end dorsal branches of digital artery, while it was 8-10 mm in sensate flap which based on the dorsal metacarpal artery during 6-12 months postoperative. Conclusion Double flaps based on the end dorsal branches of the digital artery and dorsal metacarpal artery is a realistic and effective method to repair fingertip defect.

  11. 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

  12. 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.

  13. 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.

  14. The reverse digital artery island flap for coverage of 63 cases 69 fingertip defects%指动脉逆行岛状皮瓣修复63例69指指端缺损

    Institute of Scientific and Technical Information of China (English)

    宋震坤; 姚建民; 吴守成; 沈向前; 李建兵; 宋春轶; 宋建良; 孙豪

    2001-01-01

    Objective To study and analyze clinical effects of the reverse digital artery island flap for fingertip defects. Methods From 1990 to 1999, 69 fingertip defects (63 cases) were repaired by the reverse digital artery island flaps. Results All flaps survived except one necrosis. Follow-up of 1 to 28 months showed satisfactory results functionally and cosmetically. Conclusion The reverse digital artery island flap is a safe and effective procedure with a high survival rate and therefore is a feasible choice for coverage of fingertip defects.%目的分析、探讨指动脉逆行岛状皮瓣修复指端缺损的临床效果。方法 1990~1999年应用指动脉逆行岛状皮瓣治疗63例69指指端缺损。结果除1例皮瓣坏死外,其余均存活。术后经1~28个月随访,外形满意,效果良好。结论指动脉逆行岛状瓣是一种修复指端缺损的可行方法。

  15. Clinical Application of Skin Flap Pedicled with Dorsal Carpal Branch of Ulnar Artery%尺动脉腕上支皮瓣在手部皮肤缺损中的应用

    Institute of Scientific and Technical Information of China (English)

    任静; 张金鹏; 范永红; 宋家祥; 张勇; 刘峰; 吕晓峰; 李智; 赵爱彬; 朱明雨; 朱庭标; 顾浩

    2013-01-01

      目的:总结应用尺动脉腕上支皮瓣修复手、腕部软组织缺损。方法:对11例手、腕部软组织缺损应用尺动脉腕上支皮瓣修复的治疗进行回顾性分析。结果:除2例皮瓣边缘部分坏死,其余皮瓣全部成活,术后稍显臃肿,功能恢复满意。结论:尺动脉腕上支皮瓣具有取材方便、血供可靠、不牺牲主干血管等优点,是修复手、腕部软组织缺损的理想皮瓣。%Objective:To summary clinical application of skin flap pedicled with dorsal carpal branch of ulnar artery to reconstruct soft tissue defects of hand or wrist.Methods: Surgical outcome of 11 cases of soft tissue defects of hands or wrists which were reconstructed by skin flap pedicled with dorsal carpal branch of ulnar artery were retrospectively analyzed. Results: Good coverage of the defects has been achieved except partial necrosis of flap edge in two cases. The limbs seem to be slightly Bulging after surgery but function well. Conclusion:The major advantage of skin flap pedicled with dorsal carpal branch of ulnar artery should be it’ s easy dissection and reliable blood supply. In the same time, major vascular do not need to be sacrificed. Skin flap pedicled with dorsal carpal branch of ulnar artery might be an ideal choice to reconstruct soft tissue defect of hand or wrist.

  16. 颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损%Clinical application of superficial temporal artery island flap in the reconstruction of eyelid and periorbital defect

    Institute of Scientific and Technical Information of China (English)

    李政康; 范先群

    2010-01-01

    目的 探讨颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损的适应证、安全性和有效性.方法 根据颞浅血管的解剖分布,制备以颞浅动脉为蒂形成的顺行岛状皮瓣,通过皮下隧道移转至缺损区,修复各种原因所致的重度眼睑及眶周组织缺损患者18例(18眼).术后随访6个月,观察皮瓣存活、眼睑功能恢复情况和手术效果.结果 16例皮瓣完全存活,皮瓣颜色与受区皮肤相近,质地柔软,皮瓣感觉功能良好,睑裂闭合良好,外观满意.1例术后早期出现静脉回流障碍,经积极处理,皮瓣远端有小片表皮坏死.1例皮瓣因严重静脉淤滞坏死,术后3个月行游离植皮术,植皮存活.6例患者因皮瓣肿胀,行Ⅱ期修整术.结论 颞浅动脉顺行岛状皮瓣具有血供丰富、色泽质地与受区相近等优点,是修复重度眼睑及眶周组织缺损并重建眼睑功能和外观理想的皮瓣.%Serious defect of eyelid and periorbital tissue affects the appearance of patients and closure-eye function.Application of superficial temporal artery island flap to repair the defected tissue is considered to be an available method to reconstruct eyelid and periorbital tissue.ObjectiveThis study aims to investigate the indication,safety and effectivity of reconstructing the serious defect of eyelid and periorbital tissue by forward flow flap.MethodsEighteen eyes of 18 cases with serious eyelid and periorbital tissue defect were reconstructed by covering the defect zone with superficial temporal artery to form forward flow flap.The flap was made along the distribution of superficial temporal artery with the size over the tissue detect area and transferred to lesion via subcutaneous tunnel.The follow-up time was 6 months.Survival status of flap,plastic condition of lesion and surgical treatment were discussed.ResultsAmong 18 cases with eyelid and periorbital defect,the flaps were survived in 16 cases with the satisfactory repairing

  17. 足跗外侧动脉岛状皮瓣修复足前部皮肤缺损%Reconstruction of forefoot skin defect with island flap pedicled with lateral tarsal artery

    Institute of Scientific and Technical Information of China (English)

    张继春; 张伟; 夏晓明; 张亮; 韩金豹

    2012-01-01

    目的 探讨足跗外侧动脉岛状皮瓣修复足前部皮肤缺损的临床疗效.方法 2007年3月至2009年1月,应用足跗外侧动脉逆行岛状皮瓣修复足前部皮肤缺损患者12例.结果 12例皮瓣均完全成活.随访8 ~ 22个月,平均13个月.皮瓣及皮片质地柔软,色泽与周围正常皮肤相似,外观无臃肿,无需二期皮瓣修整.受区皮瓣感觉以深痛觉为主,皮瓣边缘1 ~2 cm范围有浅触觉和痛觉恢复,即皮瓣边缘感觉为S1 ~S2级.供区皮片有浅触觉和痛觉恢复,未发现皮瓣磨损及破溃,穿鞋无影响,患者步态正常.结论 跗外侧动脉岛状皮瓣对足部的影响较小,是修复足前部软组织缺损的良好选择.%Objective To investigate the therapeutic effect of island flap pedicled with lateral tarsal artery for forefoot skin defect.Methods From March 2007 to January 2009,12 cases with forefoot skin defects were treated by reversed island flap pedicled with lateral tarsal artery.Results All the flaps survived completely with a followed-up period of 8-22 months,13 months in average.The flaps and skin grafts had soft texture and a similar color as the surrounding skin.The flaps had a suitable thickness with deep pain sensation.Shallow touch and pain sensation recovered in the skin graft and within 1-2 cm of the flap edge,which was graded as S1-S2.There was no problem in shoes-wearing and walking.No flap ulcer happened.Conclusion Island flap pedicled with lateral tarsal artery is suitable for forefoot skin defect,leaving less morbidity to donor site.

  18. 带神经削薄的游离股前外侧穿支分叶皮瓣修复足踝部软组织缺损%Clinical application of free super-thin anterolateral femoral perforator lobulated skin flap with nerve for repair of tissue defect of the foot and ankle

    Institute of Scientific and Technical Information of China (English)

    董玉金; 张铁慧; 钟声; 任远飞

    2016-01-01

    Objective To explore the clinical outcome of free super⁃thin anterolateral femoral perforator lobulated skin flap with nerve for repairing the tissue defect of the foot and ankle. Methods Free super⁃thin anterolateral femoral perforator lob⁃ulated skin flap with nerve was transferred to repair soft tissue defects of the foot and ankle in 32 cases. There were 20 males and 12 females with an average age of 35.5 years (range, 21-50 years). The wounds located in dorsal and plantar ankle skin with ten⁃don, bone and/or internal fixation exposed. The defect area was from 12 cm×10 cm to 20 cm×15 cm. At first the site of perforator vessels were determined by Doppler, according to the wound shape and size, the flaps were designed and harvested with the site as center;the femoral lateral cutaneous nerve was carried and most tensor fascia was reserved. During flap harvesting trimming of the flap was carried out, the flap was freed and only connected with its vascular pedicle. A step⁃wise defatting was done from the pe⁃riphery of the flap towards the vascular pedicle with 1.0 to 2.0 cm tissue around the perforator preserved. Flap circulation was care⁃fully observed to prevent damage to the perforators. The vascular pedicle was disconnected and formed a split leaf skin flap, and then the flap was transferred to the foot and ankle to cover the defect. Results All the 32 flaps were survived. No vascular crisis happened and all skin grafts were survived in donor sites. Necrosis of 1.5 cm×1.0 cm of the distal flap occurred in 1 case five days after surgery and it was healed by dress changing. All the 32 cases were followed⁃up for 6 to 24 months (average, 13 months). The flaps were supple and elastic with near normal color. There was no bulkiness. Sensory function was recovered well and two point discrimination (2⁃PD) was about 3.0-5.0 mm. The function and appearance of the foot and ankle were good. According to the Chi⁃nese Medical Association of hand surgery

  19. Retrospective study of reverse dorsal metacarpal flap and compound flap: a review of 122 cases

    Institute of Scientific and Technical Information of China (English)

    LU Lai-jin; GONG Xu; LIU Zhi-gang; ZHANG Zhi-xin

    2006-01-01

    Objective:To evaluate the clinical application and discuss the operative indication of the reverse dorsal metacarpal flap and its compound flap on the skin defects of hand.Methods: From 1990 to 2003, we applied the reverse dorsal metacarpal flap and its compound flap to repair soft tissue defects of fingers in 122 cases, which included 90cases of the reverse metacarpal flap and 32 cases of its compound flaps with tendon grafts, nerve grafts or bone grafts. Based on the follow-up observations, we analyzed the indications of the reverse metacarpal flap and its compound flaps, the postoperative contours, flap colors and textures in comparison to contralateral fingers retrospectively.Results: In the series of 122 cases, flaps survived and the donor site defects were closed directly. The follow-up period ranged from 1-12 years. The postoperative contours,colors and textures of the flaps and its compound flaps were similar to those of normal fingers, although linear scar remained. According to standards of sense recovery(British Medical Research Council, BMRC ), the sense function of the flaps resumed S3 after operation for 1 year.In 10 cases with the tendon defects treated by the flap with tendon grafts, function of flexion-extension of fingers resumed 50%-75% in comparison to the contralateral fingers using the method of measurement of total active motion. In 7 cases with the phalangeal nonunion or bone defects treated by the flap with bone grafts, union occurred after operation for 3 months.Conclusions: To soft tissue defects on fingers with bone or tendon exposure, the reverse metacarpal flap and its compound flap are a better choice for repairing. The range of repairing is up to the distal interphalangeal joint of fingers. The second dorsal metacarpal artery is more consistent and larger as the choice of vascular pedicle, in comparison with other dorsal metacarpal arteries.Postoperative flap color and texture are similar to normal fingers.

  20. Colgajo sural medial: un nuevo colgajo de perforantes para la reconstrucción del territorio maxilofacial Medial sural flap: a new flap for maxillofacial reconstruction

    Directory of Open Access Journals (Sweden)

    Ignacio Arribas-García

    2012-12-01

    Full Text Available Introducción: La reconstrucción microquirúrgica de defectos mucocutáneos craneofaciales se realiza con técnicas descritas desde hace muchos años y se basan fundamentalmente en el colgajo radial, el anterolateral de muslo y el lateral de brazo, entre otros. Se presenta un nuevo colgajo microvascularizado fasciocutáneo para la reconstrucción de defectos en el territorio de cabeza y cuello, el colgajo de perforantes dependiente de la arteria sural medial. Material y métodos: Se presentan 4 pacientes con carcinoma epidermoide de cavidad oral, donde se realizaron 4 colgajos dependientes de la arteria sural medial para la reconstrucción de sus defectos tras la cirugía ablativa de la lesión tumoral. Resultados: El colgajo sural medial presentó una excelente adaptabilidad y una adecuada viabilidad en todos los casos, con unos buenos resultados funcionales, estéticos y con escasa morbilidad de la zona donante. Conclusión: Se presenta una nueva técnica reconstructiva en defectos de cabeza y cuello.Introduction: Microsurgical reconstruction of craniofacial mucocutaneous defects have been performed for many years using well-known techniques, that are mainly based on flaps from the radial forearm, the anterolateral thigh and lateral arm, among others. We present the medial sural artery perforator flap, a new vascularized fasciocutaneous flap for head and neck reconstruction. Material and methods: We present four patients with oral squamous cell carcinoma. A medial sural artery flap was performed for the oral reconstruction after tumour ablation surgery. Results: The medial sural flap showed excellent adaptability and adequate viability in all cases, with good functional and aesthetic results and low donor site morbidity. Conclusion: We present a new reconstructive technique in head and neck defects.

  1. 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

  2. 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

  3. 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

  4. 颞浅动脉顶支扩张岛状皮瓣在修复头皮缺损中的应用%Application of the parietal branches of superficial temporal artery island flap in complex scalp defects

    Institute of Scientific and Technical Information of China (English)

    王楷; 李爱林; 赵月强; 余墨声; 罗定安; 吴晓蔚

    2013-01-01

    Objective To investigate the application of the parietal branches of superficial temporal artery island flap in the complex scalp defects.Methods A parietal branches of superficial temporal artery island flap on the ectatic scalp flap was designed to repair the complex scalp defects in 25cases and the repairing effect was observed.Results The island flaps were survived completely in 24patients,in which 1 patient had partial necrosis because of the flap tension was too large,but healed after local dressing and debridement.After followed up 6~ 12 months,the color and texture of the flap were the same to the surrounding normal scalp,and the shape was satisfactory.The flap donor site of hair growth was good,with well healing and no obvious complications.Conclusions The parietal branches of superficial temporal artery island flap can repair the complex scalp defects with the flexible flap design and movement.The flap survives well and the repair area is large.The flap and the surrounding scalp connects good.Therefore,it is a good method strongly recommended for small area complex scalp defects repair in clinics.%目的 探讨颞浅动脉顶支扩张岛状皮瓣在修复复杂头皮缺损中的应用.方法 通过在扩张头皮瓣上设计以颞浅动脉顶支为蒂的岛状皮瓣,转移修复复杂头皮缺损25例,并观察其愈合和修复效果.结果 25例患者,24例皮瓣完全存活,1例患者因皮瓣张力过大出现部分坏死,但通过清创及换药后愈合.术后随访6~12个月,头皮缺损修复部位与周围皮肤色泽、质地相似,外形恢复满意,皮瓣供受区毛发生长良好,创面愈合良好,无并发症发生.结论 应用颞浅动脉顶支为蒂的岛状扩张皮瓣修复复杂头皮缺损,皮瓣存活良好,皮瓣设计、转移灵活,修复范围较大,皮瓣与周边头皮衔接良好,是修复复杂头皮缺损的一种良好方法,值得应用和推广.

  5. 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

  6. Repairing of fingertip defect with topographical anterograde flap pedicled with digital artery trunk or branch%带指掌侧固有动脉或其分支局部顺行皮瓣修复指端缺损

    Institute of Scientific and Technical Information of China (English)

    林宏伟; 吴杰; 江标; 连素文; 邹育才; 肖瑛; 赵资坚; 林丽贤

    2015-01-01

    目的:探讨带指掌侧固有动脉或其分支局部顺行皮瓣修复指端缺损的临床效果。方法总结2011年6月至2014年6月期间,采用带指掌侧固有动脉或其分支局部顺行皮瓣转移修复的83例118个指端缺损的临床资料。结果92个皮瓣顺利成活。7个背侧旋转皮瓣、5个V-Y推进皮瓣在术后24 h内出现动脉危象,9个背侧旋转皮瓣、5个掌侧旋转皮瓣在术后24 h内出现静脉危象。视循环危象具体情况分别采用拆除皮瓣周边、蒂部部分缝线,皮瓣小切口放血,皮瓣按摩,改变手指体位,患指制动等方法处理。动脉危象皮瓣4个存活,8个部分坏死。静脉危象皮瓣8个存活,6个部分坏死。皮瓣供区植皮57/62例(91.9%)全部成活。67例99指获得3~12个月、平均5.5个月的随访。皮瓣色泽红润、质地柔软、外观自然、不臃肿,与周围皮肤接近。皮瓣蒂部不臃肿。指端饱满,外形良好。两点辨别觉8~12 mm,无痛性瘢痕形成,无严重触痛。患指各关节活动基本正常,无关节坚硬。患者能适应正常工作与生活,对指端感觉及伤指外形均较满意。按中华医学会手外科学会上肢部分功能评定试用标准评定,优63指,良20指,可16指,优良率83.8%。结论带指掌侧固有动脉或其分支局部顺行皮瓣修复指端缺损,方法简便,无需复杂显微外科技术,效果满意,对供区影响小,成功率高,值得临床推广应用。%Objective To investigate the clinical outcomes of repairing fingertip defects by transferring topographical anterograde flaps pedicled with digital artery trunk or branch. Methods From Jun. 2011 to Jun. 2014, 118 fingers in 83 cases with fingertip defects were treated with topographical anterograde flaps pedicled with digital artery trunk or branch. We recorded and generalized the clinical materials. Results 92 flaps survived uneventfully. 7 digital artery dorsal

  7. 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.

  8. Preparation method and application value of anterolateral thigh free-style perforator flap on reconstruction of oral and maxillofacial defects%股前外侧free-style穿支皮瓣的制备方法及其在口腔颌面部缺损修复重建中的应用价值

    Institute of Scientific and Technical Information of China (English)

    黄磊; 白植宝; 吴晓琴

    2015-01-01

    ObjectiveTo study the preparation method and application value of anterolateral thigh free-style perforator flap on reconstruction of oral and maxillofacial defects.Methods 86 patients with oral and maxillofacial defects, who were diagnosed and treated in our hospital, were selected and were divided into two groups according to random number table. To compare the treatment effect between control group of 43 patients who were treated with anterolateral thigh flap preparation technology, and observation group of 43 patients who were treated with anterolateral thigh free-style perforator flap preparation technology. Results The operation time and donor site healing time in observation group were obviously shorter than which in control group, the incision length in observation group was obviously less than which in control group, the transplantation effect in observation group was obviously better than which in control group, the incidence of flap greyish white, increased tension, local edema, donor site pain, muscle herniation, wound dehiscent, long dated lower-limb muscular strength weakness were obviously lower in observation group than which in control group, the good recovery rate of shape, speech, swallowing function were obviously higher than which in control group, the differences were statically significant(P<0.05).Conclusion Anterolateral thigh free-style perforator flap preparation technology applied on reconstruction of oral and maxillofacial defects has better treatment effect and higher safety, is worthy of clinical popularization and application.%目的:探讨股前外侧free-style穿支皮瓣的制备方法及其在口腔颌面部缺损修复重建中的应用价值。方法选取本院2008年5月~2014年10月诊治的口腔颌面部缺损患者86例,采用随机数字表法分为两组,43例患者采用传统股前外侧皮瓣制备术治疗为对照组,43例患者采用股前外侧free-style穿支皮瓣制备术治疗为观察组,比较

  9. 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

  10. 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

  11. 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.

  12. REVERSED FASCIA PEDICLED PERONEAL PERFORATING BRANCH SURAL NEUROFASCIOCUTANEOUS FLAP FOR REPAIRING SOFT TISSUE DEFECT IN DORSAL PEDIS%腓动脉穿支筋膜蒂腓肠神经营养血管皮瓣修复足背皮肤软组织缺损

    Institute of Scientific and Technical Information of China (English)

    郑磊; 董忠根; 郑稼; 肖海滨; 刘立宏

    2011-01-01

    Objective To summarize the clinical experience of repairing soft tissue defect in dorsal pedis with reversed fascia pedicled peroneal perforating branch sural neurofasciocutaneous flap, and to explore surgery matters needing attention and measures to prevent flap necrosis. Methods Between August 2000 and April 2009, 31 patients with soft tissue defects in dorsal pedis were treated with reversed fascia pedicled peroneal perforating branch sural neurofasciocutaneous flaps.There were 23 males and 8 females with a median age of 34 years (range, 3-65 years). Defects were caused by traffic accident in 20 cases, by machine in 2 cases, and by crush in 2 cases. The time from injury to admission was 1-32 days (mean, 15 days).And 6 cases had chronic ulcer or unstable scar excision with disease duration of 6 months to 10 years, and 1 case had squamous carcinoma with disease duration of 5 months. The wounds were located in medial dorsal pedis in 12 cases and lateral dorsal pedis in 19 cases; including 14 wounds near the middle metatarsal and 17 wounds beyond the middle metatarsal (up to the metatarsophalangeal joint in 10 cases). All cases accompanied with bone or tendon exposure. Five cases accompanied with long extensor muscle digits tendon rupture and defect, 1 case accompanied with talus fracture, 1 case accompanied with talus fracture and third metatarsal fracture. The size of the wounds ranged from 6.0 cm × 4.5 cm to 17.0 cm x 10.0 cm. The size of the flaps ranged from 8.0 cm × 5.5 cm to 20.0 cm × 12.0 cm. The donor sites were resurfaced by skin graft. Results Seventeen flaps survived uneventfully, wounds healed by first intention. Distal epidermal or superficial necrosis occurred in 6 flaps at 5-12 days after operation, wounds healed by dressing change or skin graft. Distal partial necrosis occurred in 8 flaps (7 in medial dorsal pedis and 1 in lateral dorsal pedis) at 7-14 days after operation, wounds healed by skin graft in 3 cases, by secondary suture in 3 cases

  13. Coverage of donor site defects on dorsum of the foot after dorsalis pedis flap transfer with pedicled lateral supramalleolar artery flaps%外踝上动脉皮瓣修复足背组织移植供区缺损的临床研究

    Institute of Scientific and Technical Information of China (English)

    李涛; 陈振兵; 翁雨雄; 丛晓斌; 艾方兴; 周攀; 洪光祥

    2014-01-01

    Objective To investigate the clinical application of pedicled for coverage of donor site defects resulted from dorsalis pedis flap transfer.Methods From October 2008 to September 2012,the flap pedicled on the lateral supramalleolar artery was reverse transferred to cover the defect on the dorsum of the foot resulted from dorsalis pedis flap harvest in 11 cases.Among these cases 6 had second toe combined with dorsalis pedis flap transfer and 5 had dorsalis pedis flap transfer.Postoperatively the appearance of the flaps,pain and touch sensation,temperature perception and two-point discrimination were evaluated.AOFAS assessment of donor foot function was performed.Results Flaps of the 11 cases all completely survived.Primary wound healing was achieved at the flap donor site.Nine cases were follow-up for 12 to 24 months while 2 were lost to follow-up.The flaps had good appearance.There were no excessive scar,pain or ulcer.The patients were satisfied with the aesthetic results.Perception of pain,temperature and touch was restored.At 12 months postoperatively,twopoint discrimination was (10.1 ± 2.2) mm on average.Sensory recovery was S3+,while the mean foot and ankle AOFAS score was 90.7.Conclusion Reverse transfer of pedicled lateral supramalleolar artery flap is a good option for coverage of dorsum foot soft tissue defect.It reduces donor site morbidity and restores good appearance and function of the donor foot.%目的 探讨外踝上动脉皮瓣带蒂逆行转移修复足背组织移植供区缺损的临床效果.方法 2008年10月至2012年9月,对11例手外伤其中6例行第二足趾加足背皮瓣游离移植,5例足背皮瓣移植的患者采用外踝上动脉皮瓣带蒂逆行转移,修复足背组织移植后供区缺损创面.术后对皮瓣外形满意度,痛触觉、温度觉、两点分辨觉及对患足功能行AOFAS评分.结果 术后11例皮瓣全部顺利存活,供区伤口均Ⅰ期愈合.9例获得12~ 24个月的随访,2例失访.皮瓣具有

  14. 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....

  15. Design and application of tension skin flap of the pedicle of distally based skin flap or reverse-flow island flap%远端蒂皮瓣或逆行岛状皮瓣转移术蒂部减张皮瓣的设计与应用

    Institute of Scientific and Technical Information of China (English)

    王培吉; 秦建忠; 董启榕

    2008-01-01

    目的 探讨在远端蒂皮瓣或逆行岛状皮瓣蒂部设计减张皮瓣的可行性和临床应用效果.方法 临床应用胫后动脉内踝上皮支逆行岛状皮瓣修复9例,胫后动脉小腿内侧穿支远端蒂皮瓣修复2例,腓动脉外踝上皮穿支逆行岛状皮瓣修复8例,腓浅神经营养血管逆行岛状皮瓣修复4例,远端蒂腓肠神经营养血管皮瓣修复3例,掌背筋膜蒂逆行岛状皮瓣修复2例.蒂部减张瓣呈梭形或圆形,面积为1.0 am×1.0 cm~5.0 cm×3.5 cm.结果 28例皮瓣术后血运良好,无肿胀、淤血,全部成活,随访皮瓣质地良好,外形美观,供区均一期愈合,疗效满意.结论 在远端蒂皮瓣或逆行岛状皮瓣蒂部设计减张皮瓣是可行的.可有效地防止蒂部血管受压或血管网破坏而影响皮瓣的血运,是一种可靠的预防远端蒂皮瓣或逆行岛状皮瓣血供障碍的新方法.%Objective To explore the feasibility and clinical resuhs of the tension skin flap of the pedicle of distally based skin flap or reverse-flow island flap. Methods Nine cases were repaired using reversed island flap pedicled with cutaneous branches of medial supramalleolar of posterior tibial artery in clinic,2 cases using distally based skin flap pedicled with the medial perforator of the posterior tibial artery,8 cases using reversalisland flap of peroneal artery lateral mulleolus skin perfarator 4 cases using reversed island flap pedicled with superficial peroneal nerve and its nutrient vessels. 3 cases using distally based sural neurocutaneous flap,and 2 cases using reversed island flap pedicled with dorsal fascia of hand.The area of the tension flap was 1.0 cm×1.0 cm to 5.0 am×3.5 cm. Results All the flaps completely survived.On the postoperative years follow-up,the texture of the flap was excellent,and primary healing was obtained at the donor site. Conclusion It's effective to design at the pedicle of the distally based flap or reversed island flap a tension skin

  16. 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...

  17. 股前外侧free-style穿支皮瓣在口腔颌面部缺损修复重建中的应用%Application of vascularized anterolateral thigh perforator flap harvested with free-style approach in oral and maxillofacial reconstruction

    Institute of Scientific and Technical Information of China (English)

    陈洁; 蒋灿华; 尹乒; 杨龙; 吴晓珊; 黄龙; 翦新春

    2015-01-01

    目的 探讨股前外侧free-style穿支皮瓣的制备方法及其在口腔颌面部缺损修复重建中的应用价值. 方法 2013年8月-2014年5月,采用free-style手术方式制备股前外侧穿支皮瓣一期修复53例口腔颌面部肿瘤根治术后缺损.术前应用手持式声学多普勒标记股前外侧供区皮肤血管穿支,并以此为中心根据受区缺损的大小和范围设计相应形状的皮瓣.术中先通过内侧的皮瓣边缘切口于阔筋膜上暴露穿支,然后逆行解剖出足够长度的血管蒂,部分病例根据受区需要于显微镜下对皮瓣进行修薄处理. 结果 53例皮瓣均移植成功,5例因修薄出现表皮剥脱,4例边缘部分坏死经清创换药后愈合.术后随访5~ 14个月,受区外形及语音、吞咽功能恢复较好.供区均一期关闭且无伤口裂开、切口瘢痕增生及远期下肢肌力下降等并发症发生. 结论 股前外侧free-style穿支皮瓣制备方法通过术前精确定位血管穿支能在最大限度保存供区美观、减少功能损害的同时达到理想的修复效果,符合现代修复重建外科微创、精细及个体化的理念.%Objective To assess the harvest method and application value of free-style anterolateral thigh perforator flap (ALTPF) in oral-maxillofacial reconstruction.Methods Fifty-three patients who suffered from oral and maxillofacial tumor underwent simultaneous reconstruction using free-style ALTPFs after radical resection from August,2013 to May,2014.Perforators of the ALTPF region were marked through hand-held Doppler probe preoperatively.Flaps were designed centered on perforators according to the defect size of the accepting site.Incisions were first made at the inner border of the designed flap.Perforators were exposed above the fascia lata femoris and then dissected retrogradely through the vastus lateralis muscle to harvest a vascular pedicle with desired caliber and length.Flap thinning was applied under microscope in

  18. Reverse second dorsal metatarsal artery island flap for repairing the soft tissue defect at toes%第2跖背动脉逆行筋膜岛状皮瓣修复足趾软组织缺损

    Institute of Scientific and Technical Information of China (English)

    焦玉峰; 王海全; 李耀胜

    2009-01-01

    Objective To report the application of reverse second dorsal metatarsal artery island flap for repairing the soft tissue defect at toes. Methods From May 2005 to Septemper 2008,5 cases with soft tissue defects at toes were treated with reverse second dorsal metatarsal artery island flaps. The flaps size ranged from 2 cm ×3 cm to 5 cm×6 cm. Results All the 5 flaps survived completely. The patients could walk 1~2 months after operation. The patients were followed up for 5~7 months with good appearance, texture and sensation of toes. Conclusion The reverse second dorsal metatarsal artery island flap has a reliable blood supply and good tissue texture. It is a practical method for repairing the soft tissue defect at toes.%目的 介绍应用第2跖背动脉逆行筋膜岛状皮瓣修复足趾软组织缺损的手术方法.方法 2005年5月至2008年9月,对5例患者应用第2跖背动脉逆行筋膜岛状皮瓣修复足趾软组织缺损.皮瓣切取面积为2 cm×3 cm~5 cm×6 cm.结果 5例皮瓣全部成活,术后1~2个月恢复正常行走.随访5~7个月趾外形饱满,皮瓣质地良好,感觉基本恢复.结论 以第2跖背动脉为血管蒂的逆行筋膜岛状皮瓣具有血供可靠,切取方便,质地优良等优点,是修复足趾软组织缺损的较好方法.

  19. 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 this, three different...

  20. 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.

  1. 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.

  2. 趾动脉终末支岛状皮瓣重塑再造指外形%Toe artery terminal branch island flap for finger reconstruction and remodeling

    Institute of Scientific and Technical Information of China (English)

    巨积辉; 侯瑞兴; 李雷; 李建宁; 刘新益; 周荣; 李祥军; 熊胜; 李秀平; 王盛福

    2011-01-01

    目的 研究趾动脉终末支岛状皮瓣重塑再造指外形的可行性.方法 2008年3月至2009年12月,对17例(19指)手指缺损游离足趾移植再造的患者,术中同时采用足趾趾动脉终末支岛状皮瓣转移嵌入第二趾颈部,消除因该部位狭窄导致的再造指外形的缺陷.结果 术后再造19指及嵌入趾颈部狭窄处皮瓣全部存活,供受区伤口Ⅰ期愈合.随访时间为6~17个月,平均8个月.再造指外形得到明显改善,指腹感觉恢复良好,两点分辨觉为8~12 mm.结论 应用趾动脉终末支岛状皮瓣重塑再造手指外形,解决了再造指指腹膨大和掌侧颈部狭窄的外形缺陷,临床疗效较好.%Objective To study the feasibility of using toe artery terminal branch island flap for remodeling and reconstruction of finger shape. Methods From March 2008 to December 2009,19 fingers of 17 cases that were reconstructed by toe transfer had the toe artery terminal branch island flap inserted in the neck of the second toe during the toe transfer surgery to correct the appearance deficit caused by the narrow area. Results All 19 reconstructed fingers and the inserted toe artery terminal branch island flaps survived after the surgery. Donor site wound had primary healing. Postoperative follow-up lasted 6 to 17 months,with an average of 8 months. The appearance of reconstructed fingers was greatly improved. There was good recovery of pulp sensation,with two-point discrimination being 8 to 12 mm. Patients feel quite satisfied. Conclusion Toe artery terminal branch island flap corrects the deficit in appearance of fingers the palm side of the finger.

  3. 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...

  4. 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

  5. 颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损%Repairing alar defects by using a retro-grade island auricle composite tissue flap based on the interconnection of superficial temporal artery and posterior auricular artery

    Institute of Scientific and Technical Information of China (English)

    陈石海; 韦强; 廖明德; 刘庆丰; 于海生

    2009-01-01

    Objective To investigate the application of reverse island auricular composite tissue flap based on the superficial temporal artery for alar defects. Methods 16 cases with alar defects were treated with reverse island auricular composite tissue flap based on the superficial temporal artery. Results All the composite auricular flaps survived with primary heMing. The patients were followed up for half a year to four years. The survived composite flaps had a similar color, texture and appearance as normal alar. The cosmetic result was satisfactory. Conclusions Reverse island auricular composite tissue tlap based on the superficial temporal artery is very suitable for alar defects.%目的 探讨应用颢浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损的方法.方法 对16例鼻翼缺损患者,应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣移植修复.结果 全部病例移植的带蒂耳廓复合组织瓣完全成活,伤口一期愈合.最长随访4年,最短半年,移植的耳廓复合组织瓣的形态、颜色和质地与正常鼻翼相似,效果满意.结论 应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损,是一种理想的修复方法.

  6. Clinical application of reverse island flap based on tibial plantar digital artery%(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    王天桢; 辛献珍; 朱天杰; 杨占彪

    2009-01-01

    Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ~ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.%目的 探讨采用各级政(足母)趾胫侧趾底动脉逆行岛状皮瓣修复(足母)趾远端软组织缺损的临床效果.方法 2003至2008年,根据(足母)趾远端软组织缺损的情况,对18例患者采用(足母)趾胫侧趾底动脉逆行岛状皮瓣修复.通过随访观察(足母)趾外形、功能恢复情况,了解临床疗效,总结优缺点.结果 术后随访6~12个月,18例皮瓣全部成活,修复后(足母)趾远端外观尚好,趾端无明显触痛,功能恢复满意.结论 躅趾胫侧趾底动脉逆行岛状皮瓣血管走行相对较为恒定,皮瓣供、受区距离较近,转移方便,手术操作容易,是修复(足母)趾远端软组织缺损的较好方法.

  7. 颞浅动脉岛状皮瓣修复重度感染性义眼座暴露%The repair surgery of severe infectious orbital implants exposure with superficial temporal artery island flaps

    Institute of Scientific and Technical Information of China (English)

    杨鸿斌; 刘素芝; 包俊辉; 刘萍

    2013-01-01

    Objective To discuss the method and efficacy of repairment of large severely infectious orbital implants exposure with superficial temporal artery island flaps.Methods To analyse retrospectively the clinical data in ophthalmology department of Xinjiang Hospital of Occupational Disease:6 eyes from 6 cases,with exposure of diameters over 10 mm or concurrent infections in orbital implants.Results After partial penetration and flush for infection control,the patient' s ipsilateral superficial temporal artery island flaps were implanted into the ocular prosthesis to repair the large defect of the conjunctiva sac all at once.All the flaps of 6 cases survived,with stable blood supply,good wear resistance and smooth union with the conjunctiva sac tissues.The ocular prosthesis moved smoothly in all quadrants.Except for the long hair after surgery in 2 cases,no other postoperative complications appeared in the follow-up of 1 to 5 years,with good effect of the treatment.Conclusion The effective partial anti-inflammatory therapy,combined with the superficial temporal artery island flap,is a feasible and effective surgery procedure to repair severe ocular prosthesis exposure and the co-infection.%目的 探讨颞浅动脉岛状皮瓣一次性修复感染性义眼座大面积暴露的方法和效果.方法 新疆职业病医院眼科6例(6眼)义眼座暴露直径>10 mm或合并感染的回顾性分析.结果 经过局部贯穿并冲洗控制感染,取同侧颞浅动脉岛状皮瓣,植入义眼一次性修复大面积结膜囊缺损,6例全部成活,皮瓣血供稳定,耐磨性良好,与结膜囊内组织愈合平整.安装义眼各象限活动自如.术后2例出现毛发过长,需修剪,未见其它术后并发症,随访1~5年,手术效果良好.结论 局部有效抗炎结合颞浅动脉岛状皮瓣,一次性修复严重义眼座暴露合并感染,是可行有效的手术方式.

  8. 指动脉中段背侧支岛状皮瓣的设计与应用%Application of the island flap at the dorsum of the middle phalange with the pedicel of the digital proper artery

    Institute of Scientific and Technical Information of China (English)

    李启朝; 张双喜; 陈振喜; 朱广明; 崔浩杰; 顾方瑞; 卢俊岳

    2011-01-01

    Objective To explore a method for the treatment of the skin defects at the distal phalanges of 2-5th fingers. Methods The island flap at the dorsum of the middle phalange was designed with the pedicle of dorsal branches from the digital proper artery. When the flap was used to repair defect at finger pulp, the dorsal branch of the digital proper nerve in the flap was kept to be anastomosed to the digital proper nerve at the recipient finger. From Feb. 2005 to May. 2010, 54 cases with skin defects at the distal phalanges of 61 fingers were treated with the flap, including 35 defects at finger pulp and 26 defects at finger tip. Results The maximum size of defects and flaps was 2. 2 cm× 2. 5 cm and 2.4 cm ×2. 7 cm, respectively. 61 flaps survived completely. Blister was happened in 3 flaps 2 days after operation,which healed spontaneously without necrosis. 54 cases were followed up for 5 to 22 months ( average, 11 months). The flaps had good texture and color match with normal sensation (grade S4). The 2-point discrimination distance was 6-9 mm. The interphalangeal joint had normal movement. Conclusions The island flap at the dorsum of the middle phalange is an ideal method for the skin defect at the distal phalange of finger.%目的 探索一种修复第2~5指远节皮肤缺损的方法。方法 以指固有动脉中段背侧支为蒂,设计手指中节指背岛状皮瓣。如需重建指腹感觉,在切取皮瓣时,则应于皮瓣近端保留适当长度的指固有神经背侧支(小指为指背神经),以便与伤指指固有神经断端吻合。2005年2月至2010年5月,应用此方法修复54例手指远节皮肤缺损,共61指,其中指腹缺损35指,指端缺损26指。结果 皮肤缺损最大面积2.2 cm ×2.5 cm,皮瓣切取最大面积2.4 cm ×2.7 cm。61指皮瓣全部成活,3指术后2天皮瓣远端出现水泡,未予以处理。术后7d水泡开始萎缩吸收,术后14 d水泡消退,皮瓣成活。54例

  9. 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...

  10. The application of three dimensional psychological nursing for Deep Inferior Epigastric Perforator flap breast reconstruction patients%三维心理护理在腹壁下动脉穿支皮瓣乳房再造患者治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    周蓓; 梅文星; 李俊

    2012-01-01

    目的:探讨三维心理护理在腹壁下动脉穿支(Deep Inferior Epigastric Perforator,DIEP)皮瓣乳房再造治疗中的应用.方法:乳腺癌术后希望进行乳房再造就诊患者为主要人群,通过在术前、术后及随访中,与其本人及家属,以医生和护士为沟通主体对其进行心理疏导.结果:本组患者32例,接受DIEP乳房再造者26例,手术效果满意,心理状态良好.结论:三维心理护理在DIEP皮瓣乳房再造治疗中起着辅助作用,对于患者的生活状态及术后康复有巨大影响,值得临床推广应用.%Objective To explore the application of three dimensional psychological nursing for Deep Inferior Epigastric Perforator flap breast reconstruction. Methods We performed the psychological guidance to the women who would like to take breast reconstruction operation because of absence of breast due to breast cancer during preoperative period, postoperative period and follow-up period. And their family members received the psychological guidance as well. Results There are 32 women got the three dimensional psychological nursing, 26 patients were willing to accept the surgery, all of them were satisfied with the effects with psychological well -being. Conclusion The dimensional psychological nursing produces positive effects on the DIEP breast reconstruction, plays an important role in the patients' quality of life and postoperative rehabilitation, and is well worth clinical application.

  11. Engineered Vascularized Muscle Flap.

    Science.gov (United States)

    Egozi, Dana; Shandalov, Yulia; Freiman, Alina; Rosenfeld, Dekel; Ben-Shimol, David; Levenberg, Shulamit

    2016-01-01

    One of the main factors limiting the thickness of a tissue construct and its consequential viability and applicability in vivo, is the control of oxygen supply to the cell microenvironment, as passive diffusion is limited to a very thin layer. Although various materials have been described to restore the integrity of full-thickness defects of the abdominal wall, no material has yet proved to be optimal, due to low graft vascularization, tissue rejection, infection, or inadequate mechanical properties. This protocol describes a means of engineering a fully vascularized flap, with a thickness relevant for muscle tissue reconstruction. Cell-embedded poly L-lactic acid/poly lactic-co-glycolic acid constructs are implanted around the mouse femoral artery and vein and maintained in vivo for a period of one or two weeks. The vascularized graft is then transferred as a flap towards a full thickness defect made in the abdomen. This technique replaces the need for autologous tissue sacrifications and may enable the use of in vitro engineered vascularized flaps in many surgical applications. PMID:26779840

  12. 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.

  13. Fasciocutaneous flaps

    NARCIS (Netherlands)

    D.E. Tolhurst (David)

    1988-01-01

    textabstractAbout that time the concept of independent myocutaneous vascular territories (Me Craw and Dibbell, 1977) was beginning to take hold but the deep fascia, sandwiched between muscles and the skin, was largely regarded as an isolating layer of dense, avascular fibrous tissue from which flaps

  14. 鼻烟窝皮瓣在手部皮肤缺损中的应用%Application of snuff-box flap in repairing skin defects of the hand

    Institute of Scientific and Technical Information of China (English)

    陶水良; 曾林如; 汤样华

    2010-01-01

    目的 探讨应用带蒂鼻烟窝皮瓣修复手部中小面积软组织缺损的方法和临床效果.方法 2005年7月至2009年5月,对22例手部软组织缺损的患者,应用鼻烟窝皮瓣进行修复.结果 术后1例皮瓣远端部分坏死,经换药后愈合;余皮瓣全部存活.术后随访6~24个月,皮瓣质地、色泽及外观良好,皮瓣无臃肿及萎缩,感觉良好.结论 以桡动脉皮支为蒂的鼻烟窝皮瓣血管解剖恒定,是修复手部中小面积软组织缺损的有效方法.%Objective To explore the surgical technique and clinical outcomes of pedicled snuff-box flap to repair skin defects in the hand of small to medium sizes. Methods From July 2005 to May 2009 , the snuff-box flap was used to repair soft tissue defects of the hand in 22 cases. The survival rate, texture, colour and sensation of the flaps were evaluated. Results All 22 flaps survived except the partial distal necrosis in 1 case. Postoperative follow-up period ranged from 6 to 24 months. The texture, colour and appearance of the flaps were good. There was no bulkiness and atrophy of the flap. Flap sensation was good. Conclusion The snuffbox flap based on perforator of the radial artery has constant vascular anatomy. It is an effective procedure to repair small to medium size defects of the hand.

  15. 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.

  16. 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.

  17. Application of metatarsal artery flap for repairing polysyndactyly and syndactyly of toes%趾动脉皮瓣在足部多趾并趾畸形修复中的应用

    Institute of Scientific and Technical Information of China (English)

    汪洋; 张宁; 胡勇; 连晓杰; 程瑞林; 徐文鹏

    2016-01-01

    Objective To design a pedicled island flap with metatarsal artery for repairing skin defect after separating polysyndactyly and syndactyly.Methods Among 49 cases,28 of them were followed up from January 2010 to January 2013.There were polysyndactyly (n =7) and syndactyly (n =21).And the latter involved first & second toes (n=5),second & third toes (n=3),third & fourth toes (n =4) and fourth & fifth toes (n =9).Pedicled island flap with metatarsal artery was used for repairing skin defect after separating polysyndactyly and syndactyly without skin grafts.Results All cases were corrected successfully with deep toe-webs and natural expansion between toes.During a median follow up period of 8 months,excellent appearance and texture appeared without local pain.The color of flap was similar to that of adjacent skin.And static two-point discrimination was 4 to 10 mm.Conclusions Pedicled island flap with metatarsal artery may repair left skin defect fully after separating polysyndactyly and syndactyly without skin grafting.And donor site may be readily sutured.Thus metatarsal artery flap transplantation is reliable,safe and efficient for repairing polysyndactyly and syndactyly of toes.%目的 设计以同趾或邻趾的趾动脉为蒂的岛状皮瓣来修复分趾后趾蹼区的皮肤缺损.方法 2010年1月至2013年1月间共收治并趾多趾畸形49例,28例获得随访.其中,男19例,女9例;年龄13~44个月,平均27.1个月.其中踇多趾畸形7例;并趾畸形21例,包括:第1、2趾并趾畸形5例,第2、3趾并趾畸形3例,第3、4趾并趾畸形4例,第4、5趾并趾畸形9例.所有患儿分趾后均采用趾动脉皮瓣修复趾蹼部皮肤缺损.供区趾体损伤面积较小,可直接缝合,无需植皮.结果 术后所有并趾畸形均得到了矫正,趾间获得很深的趾蹼和自然张开的弧度.出院后28例获得随访,平均随访时间8个月.随访期间发现皮瓣质地柔软,外形满意,无色差,伤指无疼痛,两点分辨率在4

  18. 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

  19. 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

  20. Application of popliteal intermediate cutaneous artery descending branch island flap for treatment of knee joint scar%腘窝中间皮动脉下行支岛状皮瓣治疗膝关节瘢痕

    Institute of Scientific and Technical Information of China (English)

    孙广峰; 金文虎; 魏在荣; 聂开瑜; 祁建平; 邓呈亮; 王达利; 张子阳; 李书俊

    2016-01-01

    Objective To investigate the effect with the popliteal intermediate cutaneous artery descending branch island flap repair the wound in the knee joint after resection of scar.Methods From January 2006 to December 2014,A total of 12 cases of knee joint contracture patients,8 cases were male,4 were female;the age ranged from 4 to 58 years old;8 cases of hot water scald,electric injury in 2 cases,2 cases of scar radioactive contracture,3 cases with ulcer.The knee extension 10 degrees to 30 degrees.For scar excision of knee joint loosening,the scar excision wound size (3-5) cm × (10-14) cm,popliteal intermediate cutaneous wounds with artery descending branch island flap,The flap size (4-6) cm × (11-15) cm.Donor sites were closed directly in 2 cases,10 cases of skin graft.Results The all were followed up after operation.Follow-up 6 to 24 months,the 12 cases survived completely,and the skin graft donor site homogeneity of survival,the skin color and similar to the surrounding mucosa,soft texture,shape is not bloated,the knee extension of up to 0 degree,and the walking without a limp.Conclusions The popliteal intermediate cutaneous artery descending branch island flap blood supply is reliable,donor and recipient adjacent region,which has the advantages of simple operation,is one of the ideal flap for repairing the knee joint wound.%目的 探讨腘窝中间皮动脉下行支岛状皮瓣在膝关节瘢痕挛缩修复中的应用.方法 2006年1月至2014年12月,共收治膝关节瘢痕挛缩患者12例,膝关节完全伸展后呈10°~30°(以解剖位为0°),行瘢痕切除膝关节松解术,创面大小(3~5) cm×(10~14) cm,应用腘窝中间皮动脉下行支岛状皮瓣转移修复创面,皮瓣大小(4~6) cm×(11~15) cm.供瓣区直接缝合2例,游离植皮10例.结果 12例均获随访,时间为6~ 24个月,皮瓣完全成活,供区植皮均一期成活,皮瓣色泽与周围组织相近,质地柔软,外形不臃肿,膝关节伸展可达0

  1. The first dorsal metacarpal artery flap combined with thenar flap to repair thumb degloving inju-ry%第一掌背动脉皮瓣联合大鱼际皮瓣修复拇指末节皮肤脱套伤

    Institute of Scientific and Technical Information of China (English)

    曾广军; 余爱军; 熊文; 郭孝军

    2015-01-01

    目的 探讨第一掌背动脉皮瓣联合大鱼际皮瓣修复拇指末节皮肤脱套伤的疗效. 方法2009年1月至2014 年7 月,我院收治拇指末节皮肤脱套伤19 例,创面缺损面积2 cm ×5 cm~3 cm ×6 cm,其中13例合并甲床缺如,6例伴甲床残留,均采用第一掌背动脉皮瓣联合大鱼际皮瓣进行修复.观察记录患者术后拇指的外形、感觉及手指总主动活动度( total active motion, TAM) ,采用中华医学会手外科学会上肢部分功能评定试用标准评价手指功能,Michigan手外科问卷评定患者对拇指外观的满意度. 结果 本组12例皮瓣术后完全存活;5例术后2~4 d皮瓣表面出现水疱,颜色暗红,拆除蒂部旋转点缝线后,皮瓣血运逐渐好转,最终存活良好;2例第一掌背动脉皮瓣尖端皮缘坏死,换药后痂下愈合,无骨外露. 所有供区切口均一期愈合. 术后3个月随访时,手指皮瓣外形良好,指腹皮瓣感觉可,两点辨别觉6~9 mm,指背皮瓣无感觉恢复;手指功能评定结果:优17指,良2指,优良率为100%;Michigan手外科问卷评定结果:非常满意15例,满意4例. 结论 该术式疗效满意,是治疗拇指末节皮肤脱套伤的一种可行性方法.%Objective To investigate the curative effect of the first dorsal metacarpal artery flap com-bined with thenar flap to repair thumb degloving injuries. Methods From Jan. 2009 to Jul. 2014, 19 cases of distal thumb degloving injury in our hospital were collected and the defect area was between 2 cm ×5 cm-3 cm×6 cm, including 13 cases of nail bed defect, and 6 cases of nail bed residual. The first dorsal metacarpal artery skin flap and thenar flap were used to repair the skin. The shape, feel and the total active motion ( TAM) of the thumbs were observed. Finger function was assessed according to the trial criteria of upper limb functional evaluation developed by the Chinese Medical Society of Hand Surgery. The Michigan hand surgery questionnaire was used to

  2. 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.

  3. Application of a new laser Doppler imaging system in planning and monitoring of surgical flaps

    Science.gov (United States)

    Schlosser, Stefan; Wirth, Raphael; Plock, Jan A.; Serov, Alexandre; Banic, Andrej; Erni, Dominique

    2010-05-01

    There is a demand for technologies able to assess the perfusion of surgical flaps quantitatively and reliably to avoid ischemic complications. The aim of this study is to test a new high-speed high-definition laser Doppler imaging (LDI) system (FluxEXPLORER, Microvascular Imaging, Lausanne, Switzerland) in terms of preoperative mapping of the vascular supply (perforator vessels) and postoperative flow monitoring. The FluxEXPLORER performs perfusion mapping of an area 9×9 cm with a resolution of 256×256 pixels within 6 s in high-definition imaging mode. The sensitivity and predictability to localize perforators is expressed by the coincidence of preoperatively assessed LDI high flow spots with intraoperatively verified perforators in nine patients. 18 free flaps are monitored before, during, and after total ischemia. 63% of all verified perforators correspond to a high flow spot, and 38% of all high flow spots correspond to a verified perforator (positive predictive value). All perfused flaps reveal a value of above 221 perfusion units (PUs), and all values obtained in the ischemic flaps are beneath 187 PU. In summary, we conclude that the present LDI system can serve as a reliable, fast, and easy-to-handle tool to detect ischemia in free flaps, whereas perforator vessels cannot be detected appropriately.

  4. 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

  5. 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

  6. 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 ...

  7. 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.

  8. 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.

  9. 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.

  10. 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...

  11. The digital artery series and parallel of island flap for repairing degloving injury of the fingertip%指动脉串或并联岛状皮瓣修复指端脱套伤

    Institute of Scientific and Technical Information of China (English)

    刘刚义; 付清海; 朱修文; 荣向科; 刘宗义; 王春旭; 苟军全

    2014-01-01

    瓣修复患者的需求.%Objective To investigate the method and effectiveness of the digital artery series and parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger Methods Between September 2008 and July 2012,the finger artery series retrograde island flaps tiled in the repair of finger degloving injury in 13 cases,repair of adjacent finger tip degloving injury in 11 cases; 8 cases of degloved injuries of the fingertip were tiled with the digital artery parallel island flap from ulnaris middle finger and radialis ring finger of arteria digitalis communis pedicled which were from the same palm side.The size of skin and soft tissue defect ranged from 2.0 cm × 1.8 cm-7.2 cm ×5.5 cm,gutted flap minimum ranged from 1.1 cm × 1.0cm-1.5 cm × 1.3cm,and the maximum ranged from 3.0 cm × 2.2 cm-5.5 cm × 4.5 cm.The donor sites were repaired with the intermediate split thickness free skin grafts and performed with pressure dressing.Results The group of 32 cases,in 1 case the flap vasospasm occurred in operation of free process,the symptoms disappeared after local application of papaverine and hot compress ; 1 case of flap occurred disturbance of blood circulation after operation because of tight suturing for pedicle,the symptoms relieved after removing the stitches at intervals; 2 cases blisters appeared after operation,disappeared after a week.All skin flaps were survived,incision and skin graft donor sites healed by first intention.Twenty patients were followed-up from 6 to 12 months after operation.All flaps presented the satisfactory appearance and texture,recovered protective feeling.At last follow-up,the two-point discrimination was 7 to 10mm,and the flexion and extension function of wounded fingers recovered to normal.According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association,there were excellent in 19 cases,good in 10 cases,and moderate in 3 cases.No significant loss to the donor

  12. 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.

  13. Repair of electrical burns in the limbs with flap%四肢电烧伤创面的皮瓣修复

    Institute of Scientific and Technical Information of China (English)

    金秀; 王涛; 蒋子平; 于家傲; 路来金

    2015-01-01

    artery flap,1 case was treated by free latissimus dorsi flap,3 cases were treated by free anterolateral thigh flaps;1 case was treated by reverse island forearm posterior interosseous flap,2 cases were treated by posterior perforator reversed island flaps of the lower leg,1 case was treated by anterolateral perforator reversed island flaps of the lower leg.The area of flap was from 42.0 cm × 13.0 cm to 6.0 cm × 3.0 cm.The survival rate of the flap,the appearance and function of limb were observed.Results All these patients were followed up from 4 months to 3 years 6 months,the mean time was 6 months and 20 days.Thirty-five flaps survived completely,accounting for 92.1%,and 3 cases suffered partial necrosis at the distal end,accounting for 7.9%.Secondary healing was achieved by dress changing.The appearance of the limbs was satisfactory.Among the 28 cases whose bums were on the hands,the total number of excellent and good was 15,medium was 8,and 5 poor cases.The excellent and good rate was 57.1%.Conclusion Early repairing of the electrical burns with flaps is the effective method for protecting the deep structures of the limb,preventing and control the secondary infections and preserve the function of the limbs.

  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. 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

  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. Vaginal reconstruction using perineal-thigh flaps with subcutaneous pedicle.

    Science.gov (United States)

    Chen, Z; Chen, C; Chen, M; Zhang, J; Wu, N; Wang, J

    1991-03-01

    A technique of vaginal reconstruction using bilateral, perineal-thigh flaps with subcutaneous pedicle is described. In this procedure, the flaps were raised bilaterally and introduced into an artificial space between the urinary bladder and rectum. The blood supply for the flaps flows from the perineal artery through anastomotic branches to the external pudendal artery. The authors used the technique on four patients, and all the flaps survived entirely. There was no complication. According to a more than two-year follow-up survey, the reconstructed vaginas are expansible and contract little. No stent is needed. There is good sensitivity in the wall of the artificial vagina because sensory nerves run through the flaps.

  18. 指固有动脉皮支血管链逆行侧方皮瓣修复手指软组织缺损%Flap Pedicled with Lateral Vascular Chain of Cutaneous Branch of Digital Artery to Repair the Soft Tissue Defect of the Distal Finger

    Institute of Scientific and Technical Information of China (English)

    李超; 王浩; 潘朝晖

    2014-01-01

    目的:探讨指固有动脉皮支血管链逆行侧方皮瓣修复手指远端软组织缺损的效果。方法以指固有动脉背侧皮支上行支、下行支形成的链式吻合供血,在手指近节侧方切取皮瓣。皮瓣的轴线是手指侧方中线,皮瓣旋转点为中节指体中远端,皮瓣的蒂部宽度为0.5~1.0cm。皮瓣携带指背神经与创面指神经断端进行缝合修复,重建手指感觉。逆行移位皮瓣修复指端创面32例。结果32例皮瓣全部成活。术后随访6个月~1年,皮瓣外形与正常相近,弹性、色泽良好。缺损饱满而不臃肿,质地柔软,有排汗功能,两点辨别觉达5~9 mm。结论采用指固有动脉皮支血管链逆行侧方皮瓣一期修复指端缺损,疗程短,效果好,操作简单,血供可靠,不牺牲指固有动脉、神经,供区损伤小,术后并发症少,并且能重建皮瓣感觉,是一种理想的手术修复方法。%Objective To explore the effect of flap pedicled with lateral vascular chain of cutaneous branch of digital artery to re -pair the soft tissue defect of the distal finger .Methods The flap based on the dorsal cutaneous branch of digital artery ,the ascending branch and the descending branch formation of supply vascular chain in the finger's lateral.The axis of the flap was finger lateral midline , the rotation point of flap was the middle finger of the distal , and the pedicle width of flap was 0.5~1.0cm.Flap repaird dorsal nerve and stump nerve , reconstructed of the finger's feeling.Retrograde transposition of flap in 32 cases to repair finger end .Results All flaps survived in 32 cases. After followed up for 6 months~1 years,flap had the normal close,elastic,good colour.Defect was full and not bloated , and soft texture,had the function that discharge sweat ,two-point discrimination Jueda 5~9mm.Conclusion Flap pedicled with lateral vascular chain of cutane-ous branch of digital artery to repair the

  19. Clinical application of the reverse dorsal metacarpal and digital fasciocutaneous flaps based on the dorsal cutaneous branches of the proper digital artery%指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    谢松林; 唐举玉; 陶克奇; 吴攀峰; 夏小丹; 刘昌雄; 黄雄杰

    2010-01-01

    目的 探讨以指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣修复手指中、远节皮肤软组织缺损的效果.方法 从2007年6月至2009年6月,应用以指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣修复25例手指中、远节皮肤软组织缺损,皮瓣旋转点位于手指近节中点或近节远段.结果 24例皮瓣完全成活,1例皮瓣远端少部分表皮层坏死.随访病例20例,随访12~18个月.6例皮瓣蒂部局部臃肿需要二期修薄,其余皮瓣血运良好,耐寒,皮瓣薄而质地柔软,外观色泽良好,皮瓣供区无伸肌腱粘连和指蹼挛缩.5例吻合神经的皮瓣两点分辨觉6~10 mm,15例未吻合神经的皮瓣两点分辨觉8~14 mm.结论 以指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣血运可靠,旋转弧长,操作简单,皮瓣更接近创面,对皮瓣供区损伤更小,可以吻合皮神经重建皮瓣感觉,是一种修复手指中、远节软组织缺损的理想方法.%Objective To investigate the effect of repairing soft tissue defects in the middle and distal phalanx with the reverse dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery. Methods Twenty-five fingers with soft tissue defects in the middle and distal phalanx were repaired by the reverse dorsal metacarpal and digital fasciocutaneous flaps based on the dorsal cutaneous branches of the proper digital artery from June 2007 to June 2009. Their pivot points were located at the midpoint or distal segment of proximal phalanx. Results Among 25 flaps, 24 survived completely, but cuticular layer in the distal part of one flap was partially necrotic. Twenty flaps were followed up from 12 to 18 months after operation. All flaps were characterized by rich blood supply, cold-resistance, suitable thickness, soft texture and good colour, except that 6 flaps required a secondary operation because of their fat and clumsy pedicel. There was no

  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. 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.

  3. Interosseous dorsal artery retrograde island flap to repair hand machine and nursing care of skin defect%骨间背动脉逆行岛状皮瓣修复手部机器绞伤皮肤缺损的护理

    Institute of Scientific and Technical Information of China (English)

    韦亚红; 姜傲; 倪晓威; 孟宜

    2016-01-01

    Objective In order to summarize the nursing experiences and improve nursing quality,we explore the perioperative nursing methods in patients reconstructing skin defects with posterior interosseous artery flaps. Methods The 13 patients with skin defects were treated with debridements and vacuum sealing drainage system,and then the skin defects were covered with posterior interosseous artery flaps. In the perioperative period,we give united nursing interven-tion to the patients,including basic nursing,psychological nursing,controlling infection,carefully observing the vascular crisis,instructing exercise,and discharge guidance. Results All the 13 flaps survive well. Conclusion The effects of posterior interosseous artery flaps covering skin defects of hand is well. Based on the characteristics of the blood supply of this flap,we carry out comprehensive perioperative nursing,and can judge the occurance of vascular crisis effectively. United nursing intervention is effective in improving the surviving rate of the posterior interosseous artery flap.%目的:探讨骨间背侧动脉逆行岛状皮瓣修复手外伤皮肤缺损围手术期的护理方法,总结护理经验,提高护理质量。方法对13例机器绞伤先期行清创、VSD负压吸引术,后期行骨间背动脉逆行岛状皮瓣的患者进行综合护理干预,包括注重心理护理、加强基础护理、术后控制感染、严密观察血管危象、指导功能训练、重视出院指导等。结果13例患者皮瓣血运良好,全部成活。结论骨间背侧动脉逆行岛状皮瓣修复手外伤皮肤缺损疗效满意,根据皮瓣血运的特点开展全面的围术期护理,可有效判断血管危象的实际发生情况,进而提高皮瓣移植成活率。

  4. 以上唇动脉为蒂的逆行鼻唇沟瓣修复鼻眶下区缺损的临床研究%The clinical effect of reversed nasolabial flap pedicled with superior labial artery for the reconstruction of nasal and infraorbital defects

    Institute of Scientific and Technical Information of China (English)

    刘平; 李勇; 郑田; 季平; 邱丽华; 李颖; 张碧; 鲁琦; 赵洪伟

    2014-01-01

    Objective To evaluate the clinical effect of reversed nasolabial flap pedicled with superior labial artery for the recon-struction of nasal and infraorbital defects .Methods From September 2006 to May 2013 ,13 cases with large nasal and infraorbital defects were reconstructed by the reversed nasolabial flap pedicled with superior labial artery .In all patients these defects were re-sulted by the excision of carcinomas .The disease course ranged from 2 months to 28 years .The size of nasal and infraorbital defects was from 2 .0 cm × 1 .2 cm to 4 .0 cm × 3 .6 cm .All defects were restored by the reversed nasolabial flap pedicled with superior labial artery in 10 cases and by the island flap in 3 cases .The size of flap was similar to that of defects .The donor areas were sutured di-rectly .Results All flaps were completely survived .The incision at the donor and accepted sites healed in the first stage .In 4 pa-tients flap revision was performed after 6-12 months because of mild swelling at the pedicles of skin flaps .Patients were followed up for 4-60 months (the mean was 28 .4 months) .All patients were satisfied with the nasal ventilatory function and appearance , flap texture and color .No obvious scars were found at donor sites .Conclusion Reversed nasolabial flap pedicled with superior labial artery is a better choice to repair the nasal and infraorbital defect after excision of carcinomas .%目的:探讨以上唇动脉为蒂的逆行鼻唇沟瓣修复鼻眶下区缺损的手术方法和疗效。方法2006年9月至2013年5月,收治鼻眶下缺损患者13例。所有患者为肿瘤切除术鼻眶下区缺损,病程为2个月至28年。缺损范围为2.0cm×1.2cm~4.0 cm ×3.6 cm。术中采用同侧上唇动脉为蒂的逆行鼻唇沟瓣修复缺损,其中10例为带蒂皮瓣,3例为轴型岛状皮瓣;皮瓣切取范围与缺损大小相近。供区直接对位缝合。结果所有皮瓣全部成活,供、受区切口全

  5. 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.

  6. 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

  7. Doppler-assisted vascular pedicle flaps in eyelid and periorbital reconstruction.

    Science.gov (United States)

    Yeatts, R P; Newsom, R W; Matthews, B L

    1996-09-01

    The use of a transcutaneous ultrasonic Doppler flow detector to identify the supratrochlear and superficial temporal arteries permits the design of narrow-based, thin-tipped forehead flaps for use in medial canthal and eyelid reconstruction. In the 13 cases described, the axial, vascular supply of a proposed myocutaneous forehead flap was determined with a transcutaneous ultrasonic Doppler flow detector permitting narrow-based pedicle widths of 0.8 to 1.2 cm. The design of the distal portion of the flap was determined by the primary defect. The width of the flap varied from 1.5 to 4.0 cm, with the flap's axial length limited only by the hairline. This use of the ultrasonic Doppler flow detector, permitting narrow-based, thin-tipped vascular pedicle flaps, has assisted in refining the concept of forehead flaps and has made these flaps an acceptable primary reconstructive technique in the periorbital region. PMID:8790111

  8. Breast reconstruction using a latissimus dorsi flap after mastectomy

    DEFF Research Database (Denmark)

    Højvig, Jens B; Bonde, Christian Torsten

    2015-01-01

    , 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...... of 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...

  9. 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

  10. [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

  11. Fibula free flap for mandible reconstruction: analysis of 30 consecutive cases and quality of life evaluation.

    Science.gov (United States)

    Maciejewski, Adam; Szymczyk, Cezary

    2007-01-01

    The objectives of this study were to evaluate the use of fibula free flaps (FFF) for mandible reconstruction in patients with oral cavity cancer and to assess the quality of life (QOL) of the patients who underwent reconstructive surgery. Thirty patients with T(3), T(4) oral cavity carcinoma underwent surgical resection of the primary tumor infiltrating the mandible or primarily originating from the mandible. According to the length (less or more than 8 cm) and localization (anterior or posterior) of the mandibular defect, patients were subdivided into four groups. In all cases an osseoseptocutaneous FFF was chosen for postresective defect reconstruction. To reconstruct anterior mandibular defects, two osteotomies were needed to give the fibula a proper shape. For extended defects, the fibula usually required more than one osteotomy. Skin islands were designed based on Doppler cutaneous perforator findings. The fibular free skin islands remained viable in all patients and no partial or total skin loss was observed. In the majority of patients (87 percent) the facial artery was used for arterial anastomosis. In 6 month follow-ups, the QOL was evaluated as very good except for socioeconomic items. Pain was mild and incidental. Appearance and subjective feeling scores were excellent in two groups with mandibular defects smaller than 8 cm, although in patients with larger defects, they were still very good. Functional effects remained good, and they correlated with the size of defects. In contrast, social activities, recreation, and employment were below patients' expectations and generally reflected the current situation in Poland, but no correlation with the results of reconstruction was found. The present results show that osseocutaneous fibula free flap used in reconstructive surgery for cancer of the oral cavity allows more radical and aggressive resection with very good or excellent functional and aesthetic outcome. Estimated QOL seems an important part of

  12. An ideal and versatile material for soft-tissue coverage: experiences with most modifications of the anterolateral thigh flap.

    Science.gov (United States)

    Ozkan, Omer; Coşkunfirat, O Koray; Ozgentaş, H Ege

    2004-07-01

    Free anterolateral thigh flaps are a popular flap used for the reconstruction of various soft-tissue defects. From April, 2002 to June, 2003, 32 free anterolateral thigh flaps were used to reconstruct soft-tissue defects. Twenty-three of these flaps were used for lower extremity reconstruction, and nine were used for head and neck reconstruction. There were 24 male and eight female patients, with ages between nine and 82 years. The size of the flaps ranged from 11 to 32 cm in length and 6 to 18 cm in width. Five flaps required reoperation for vascular compromise in four patients and for twisting of the pedicle in another patient. While four of these were salvaged, one flap was lost due to recipient vessel problems. Musculocutaneous perforators were found in 23 cases, and septocutaneous perforators were found in nine cases. In four cases, thinning of the flap was performed. The flap was used as a flow-through type for lower extremity reconstruction in three patients. In two patients, the flap was used as a neurosensory type for foot reconstruction. Eighteen cases underwent split-thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed primarily. In three patients, the donor areas required a partial skin regrafting procedure. No infections or hematomas were observed. Despite some variations in its vascular anatomy, the anterolateral thigh flap offers the following advantages: 1) it has a long and large-caliber vascular pedicle; 2) it has a wide, reliable skin paddle; 3) it may be harvested as a neurosensory flap; 4) it can be harvested whether its pedicle is septocutaneous or musculocutaneous; 5) it can be designed as a flow-through flap; 6) it can be elevated as a thin or musculocutaneous flap; and 7) the procedure can be performed by two teams working simultaneously, and no positional changes are required.

  13. 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.

  14. 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.

  15. [Pedicled versus free TRAM flap for breast reconstruction].

    Science.gov (United States)

    Galla, T J; Lukas, B; Feller, A M

    1999-03-01

    In breast reconstruction, the free TRAM-flap offers many advantages over the pedicled TRAM-flap. Due to its superior perfusion, the free flap rarely develops necrosis. Shaping of the flap is easier due to the lack of the thick muscle pedicle. Because the rectus muscle is spared, there is minimal donor site morbidity. However, the necessary microvascular anastomoses reduced the acceptance of the free TRAM-flap. During a 13-months period, 51 breast reconstructions were performed in 41 patients, 31 unilateral and ten bilateral. 45 flaps served for delayed reconstruction and six flaps for immediate reconstruction. The operations were performed by two teams working simultaneously. The average operating time was 3.9 hours for unilateral and 6.9 hours for bilateral delayed reconstruction. For immediate reconstruction, 6.2 and 6.3 hours were required for uni- and bilateral procedures, respectively. In 38 flaps, the thoracodorsal vessels served as recipient vessels; 13 flaps were anastomosed to the internal mammary artery and vein. Postoperative complications were observed in 13 patients. Three vessel anastomoses had to be revised. In one flap, a partial necrosis occurred; in two flaps hematoma evacuation was necessary. Two patients suffered from fat necroses at the abdomen and one umbilicus was lost. Skin irritations and seromas at the abdomen occurred in five patients. Pulmonary embolism was diagnosed in one patient three weeks postoperatively. Abdominal hernias or bulging in the epigastric area were not observed up to 15 months after reconstruction. These results reveal a low complication rate for breast reconstruction with the free TRAM-flap. The advantages of this technique as compared to the pedicled technique are discussed.

  16. 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.

  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. 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

  20. Perforated peptic ulcer

    DEFF Research Database (Denmark)

    Søreide, Kjetil; Thorsen, Kenneth; Harrison, Ewen M;

    2015-01-01

    Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacter...... pylori and use of non-steroidal anti-inflammatory drugs are common causes, demographic differences in age, sex, perforation location, and underlying causes exist between countries, and mortality rates also vary. Clinical prediction rules are used, but accuracy varies with study population. Early surgery...... need further assessment. Adequate trials with low risk of bias are urgently needed to provide better evidence. We summarise the evidence for perforated peptic ulcer management and identify directions for future clinical research....

  1. 缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损%Repair of fingertip defect with proper digital artery lateral cutaneous branch-chain flap accompanied with dorsal digital nerve or dorsal branch of proper digital nerve coaptation

    Institute of Scientific and Technical Information of China (English)

    孙涛; 魏鹏; 周丹亚; 胡瑞斌; 滕晓峰; 陈宏

    2011-01-01

    Objective To explore the effect of using proper digital artery lateral cutaneous branch-chain flap with dorsal digital nerves or dorsal branch of proper digital nerye for repairing of fingertip defect.Methods From December 2008 to November 2009, 24 cases (26 digits) of fingertip defect were treated with proper digital artery lateral cutaneous branch-chain flap.The flap was designed on the lateral side of the proximal phalanx of the injured finger with its long axis running on the lateral midline of the finger.The vascular pedicle was 0.8 to 1.0 cm wide.The pivot point was at the distal 1/3 of the middle phalanx upon which the flap was reversed to repair the defect of the fingertip.The dorsal digital nerve or dorsal branch of proper digital nerve was included in the flap and coapted with the nerve in the wound to reconstruct sensation of the injured finger.Results All 26 flaps survived.Postoperative follow-up period was 6 to 8 months.All these flaps recovered with satisfying and quality, excellent sensation with 4 to 8 mm two-point discrimination.ROM of the interphalangeal joint of the injured finger was good.Conclusion Proper digital artery lateral cutaneous branchchain flap transfer with nerve coaptation is an ideal method for repairing fingertip defect.The surgery is simple.Reliable blood supply can be achieved without sacrificing the proper digital artery.Coaptation of the nerve restores sensation at the fingertip.There is minor donor site damage and very few complications.%目的 探讨缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损的疗效.方法 2008年12月至2009年11月,对24例26指指远端皮肤缺损患者,以指固有动脉背侧支形成的血管链为血供,于近节指体侧方设计皮瓣,皮瓣轴线为指体侧方中线,皮瓣蒂宽0.8~1.0cm,皮瓣转折点为中节指体中远端,逆行转移修复指远端皮肤缺损,皮瓣携带指固有神经背侧支或指背神经与创面指神经断端进行缝合

  2. 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...

  3. 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.

  4. Angio computed tomography preoperative evaluation for anterolateral thigh flap harvesting.

    Science.gov (United States)

    Ribuffo, Diego; Atzeni, Matteo; Saba, Luca; Milia, Arianna; Guerra, Maristella; Mallarini, Giorgio

    2009-04-01

    The vascular anatomy of the anterolateral thigh flap (ALTF) has many possible variations, and none of the currently used mapping techniques (eg, Echo Color Doppler) gives a thorough knowledge of all details. Among the last generation of angiographic diagnostic techniques, multi detector computed tomography, popularly known as Angio CT, has emerged as an outstanding noninvasive operator independent option, and has been described for deep inferior epigastric perforator and pedicled transverse rectus abdominis muscle planning. This study was conducted to evaluate its usefulness prior to ALTF harvesting.Nine consecutive patients were considered for oral or lower extremity reconstruction with the ALTF. After written informed consent was obtained from all patients, a preoperative Angio-CT study was performed for surgical planning. Accurate identification of septocutaneous or musculocutaneous perforator vessels was achieved and their location, course, and anatomic variations were reported and influenced surgery. Angio CT allows a complete vascular study of the donor area of the ALTF and evaluation of the best perforator vessels before surgery allows surgeons to get an ideal planning of the flap. This imaging method is currently proposed to every patient undergoing ALT flap reconstruction. PMID:19325338

  5. Repairing of Defect on Middle-distal Finger with Reverse Fascial Redicle Island Flap of Dorsal Branche of Digital Artery%指动脉背侧支逆行筋膜皮瓣修复手指中末节缺损的临床应用

    Institute of Scientific and Technical Information of China (English)

    吴毓强; 赵科; 闫庆军; 张良舟

    2013-01-01

    目的 分析手指近节筋膜皮瓣逆行转移修复手指中末节组织缺损的临床效果.方法 回顾性分析2008年3月至2012年3月期间在我院接受治疗的60例手指中末节组织缺损患者的临床资料,60例患者取近节指背设计皮瓣比创面大约20%,并标明受区及供区切口线,自皮瓣近侧切口,寻找位于手指侧方中线偏掌侧的固有血管.结果 术后皮瓣全部成活,手功能及外形均满意.结论 此皮瓣不牺牲手指指动脉,手术简便,是修复手指中末节软组织缺损及骨外露的一种有效可行的手术方法.%Objective To introduce the surgical procedure and indication of the reverse fascial pedicle island flap of the digital artery dorsal branches in repairing middle-distal finger defect. Methods By retrospective analysising 60 examples' clinical date whose middle-distal finger soft tissue defect were cured in our hospital from March, 2008 to March,2012. Proximal back flap was taken. The flaps were twenty percent more than the wound area. We marked the recipient area and incision line of donor area,cut incision from the proximal side of flap and found the inherent blood vessels that locate in palm side neutral partial side. Results After the operation,all the flaps survived. The appearance and function of the finger were all satisfactory. Conclusion The flap don't sacrifice finger artery. The operation is easy. And it's a effective way to repair middle-distal finger defect and bone exposure.

  6. 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

  7. 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 ...

  8. 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

  9. 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

  10. 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.

  11. 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 ...

  12. [Antecubital flap: advantages in elbow coverage. An anatomical study and experience of five clinical cases].

    Science.gov (United States)

    Duteille, F; Rocchi, L; Dautel, G; Merle, M

    2001-02-01

    The antecubital flap is a fasciocutaneous strip that has its blood supply provided by the first proximal collateral of the radial artery. This flap was described for the first time in 1983 by Lamberty and Cormack, but it has not been widely used and there have been only a few reports in the literature concerning this procedure. The aim of the present investigation was to demonstrate via an anatomical study and a report on five cases the viability of the various anatomical features of this cutaneous flap, and also its positive contribution to elbow reconstruction. The anatomical study involved eight fresh cadavers (eight upper limbs). An injection of colored prevulcanized latex was made in the humeral artery in the lower third of the arm. The aim was to determine which artery provided blood supply to the flap, its anatomical location, and also to look for possible distal anastomoses which would permit a distal pedicled flap to be removed. Contrary to the findings of other authors, in the present study it was found that the vessel providing blood to the antecubital flap always branched off from the radial artery. However, no anastomoses with distal vascularization were detected, which would have permitted a distal pedicled flap to be obtained. The use of the antecubital flap for elbow coverage was then illustrated by five clinical cases of soft tissue defects of the elbow. This method was found to be reliable, practical, and the flap could be rapidly dissected. Moreover, this particular technique is sensitive, and has an interesting rotational arc. The distal cutaneous island flap has the advantage of limiting scar tissue. A comparison between the antecubital flap and other pedicled flaps has then been made. In conclusion, it appears that this little-known procedure has definite advantages, and that it should be included in the range of surgical techniques that are available for soft tissue reconstruction in the case of elbow defects.

  13. 鼻烟窝皮瓣修复拇指大面积皮肤缺损的临床应用%Snuff-box Flap for Treatment of Thumb Large Area Skin Defects

    Institute of Scientific and Technical Information of China (English)

    张扬; 林平; 高峰

    2014-01-01

    探讨鼻烟窝皮瓣在修复拇指大面积皮肤缺损中的方法和治疗效果。从2008年1月~2013年10月间应用桡动脉在解剖鼻烟窝穿支为血管蒂的鼻烟窝皮瓣,逆行修复拇指大面积皮肤缺损26例,年龄17岁~55岁。术后平均随访时间25个月,皮瓣全部成活。皮瓣色泽及质地与健侧拇指背侧皮肤相近,拇指活动度基本正常。因此,鼻烟窝皮瓣是一种简便经济、效果理想、患者易于接受的术式,适合应用于拇指大面积皮肤缺损的治疗。%To explore the surgical technique and clinical outcomes of snuff-box flap to repair large area skin defects in thumbs ,26 patients ,age 17 to 55 years old ,had the snuff-box flap ,which used the perforator vessel of radial artery in snuff-box as pedicle vascular to repair large area skin defects in the thumb from January 2008 to October 2013 were included .All the flaps are alive .The patients were followed up with an average of 25 months .The color and texture of the flaps are similar to that of the contralateral thumb .The sphere of thumb movement is relatively normal .The operation of using snuff-box flap to repair large area skin defects in thumbs has economic material benefit ,ideal effect and be accepted .

  14. 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

  15. 皮瓣延迟术对大鼠三血管体穿支皮瓣成活的影响及其机制%Effects of surgical delay procedure on the survival of perforator flap with three angiosomes in rat and its mechanism

    Institute of Scientific and Technical Information of China (English)

    李俊杰; 高自勉; 高伟阳; 李浙峰

    2014-01-01

    8)、(63±13)、(69 ±9)、(67±8)、(64±13) μm]及单纯延迟组术后3、7d闭塞区域2Ⅱ血管外径显著高于常规皮瓣组相应时相点血管外径水平[术后0、1、2、3、7d分别为(46±10)、(40 ±9)、(43±13)、(46±12)、(47±11)μm],q值为7.29~10.79,P值均小于0.05.常规皮瓣组、单纯延迟组大鼠术后3、7d以及延迟皮瓣组大鼠术后0、1、2d组内闭塞区域1与闭塞区域2间血管外径比较,差别明显(q值为5.32~9.56,P值均小于0.05).术后3、7d,常规皮瓣组及延迟皮瓣组大鼠闭塞区域1、单纯延迟组大鼠闭塞区域2血管外径显著高于组内术后0d(q值为6.12~8.13,P值均小于0.05).(2)术后7d内,常规皮瓣组、延迟皮瓣组大鼠皮瓣内来自蒂部的血液都顺利通过闭塞区域1覆盖血流动力学供区.术后0d,2组大鼠皮瓣内的血液越过闭塞区域1后均发生持续约3 min的血流阻塞现象,常规皮瓣组出现在闭塞区域2附近,延迟皮瓣组出现在闭塞区域2远端约1 cm处.(3)术后7d,延迟皮瓣组大鼠皮瓣成活率为(95±12)%,显著高于常规皮瓣组的(80±9)%(t=2.91,P <0.01),皮瓣部分坏死仅出现在潜在供区.(4)术后7d,与未行手术的左侧皮肤血管相比,常规皮瓣组大鼠皮瓣内闭塞区域1的血管扩张明显,相邻血管树间界限模糊,而闭塞区域2的血管变化轻微;延迟皮瓣组大鼠皮瓣内2个闭塞区域的血管均明显扩张. 结论 本实验的延迟方法可促进大鼠三血管体穿支皮瓣潜在供区的成活,其主要是通过皮瓣术前扩张闭塞区域2的闭塞血管实现的.%Objective To observe the effects of surgical delay procedure on the survival of perforator flap with three angiosomes in rat,and to explore its possible mechanism.Methods The flap model was a perforator flap with three angiosomes which located on the right dorsal side of a rat based on thc right deep circumflex iliac vessel.The two connection areas between the three angiosomes were

  16. Cervicofacial flap revisited

    Directory of Open Access Journals (Sweden)

    Dhananjay V. Nakade

    2016-11-01

    Conclusions: Cervicofacial flap is simple, easy to operate, consume less operating time as compared to microvascular flap. It is less complicated and especially useful in diabetic, hypertensives and old debilitated patients with high risk of anaesthesia. [Int J Res Med Sci 2016; 4(11.000: 4669-4674

  17. 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.

  18. 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

  19. 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 ...

  20. 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...

  1. 指固有动脉不同节段背侧皮支为蒂的岛状皮瓣修复同指皮肤缺损%Application of island flap pedicled with dorsal cutaneous branches of digital internal artery for skin defect at the same finger

    Institute of Scientific and Technical Information of China (English)

    阚利民; 陈超; 张会文; 刘建华

    2010-01-01

    目的 探讨以指固有动脉不同节段背侧皮支为蒂的岛状皮瓣修复同指皮肤及软组织缺损的临床效果.方法 2005年6月至2008年6月,对45例52指手指皮肤缺损的患者,采用以指固有动脉背侧皮支为蒂的岛状皮瓣转移修复.结果 45例中除4指皮瓣远端部分坏死外,其余皮瓣全部成活,经4~8个月随访,功能及外观良好.吻合神经皮瓣的两点辨别觉为6.0~9.0 mm,平均7.4 mm.未吻合神经的皮瓣的两点辨别觉为8~10 mm,平均9 mm.植皮区无明显凹陷,5指轻度色素沉着,4指出现植皮边缘瘢痕挛缩,其中1指远侧指间关节约10°伸直受限,经理疗后未见缓解.2指出现供区瘢痕触痛,经理疗后部分缓解.在常温下和冰水中均未出现苍白、发凉.供指指腹感觉均为S_4.手功能按ATM法,优42指,良7指,可3指,优良率达92%.结论 该术式不损伤手指的主要动脉,是治疗手指皮肤缺损的一种可行的手术方法.%Objective To investigate the therapeutic effect of island flap pedicled with dorsal cutaneous branches of digital internal artery for skin defect at the same finger. Methods From June 2005 to June 2008, 52 fingers in 45 cases with skin defects were treated with island flap pedicled with dorsal cutaneous branches of digital internal artery for skin defect at the same finger. Results Partial necrosis happened at the distal end of 4 island flaps. All the other flaps survived completely. The patients were followed up for 4-8 months with satisfactory cosmetic and functional results. The two-points discrimination distance was 6. 0-9.0mm ( average, 7.4 mm) in flaps with nerve anastomosis, and 8-10 mm (average, 9mm) in flaps without nerve anastomosis. Minor pigmentation occurred in 5 fingers, cicatricial contracture around the skin graft in 4 fingers, and pain in donor site scar in 2 fingers. The hand function was assessed as excellent in 42 fingers, as good in 7 fingers and medium in 3 fingers. Conclusions The

  2. 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,

  3. Gastric conduit perforation.

    Science.gov (United States)

    Patil, Nilesh; Kaushal, Arvind; Jain, Amit; Saluja, Sundeep Singh; Mishra, Pramod Kumar

    2014-08-16

    As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized.

  4. 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.

  5. 逆行第1跖底动脉岛状皮瓣修复第1、2趾底创面%Reversed plantar metatarsal artery island flap for coverage of the plantar defects at the first and second toes

    Institute of Scientific and Technical Information of China (English)

    徐一波; 刘亚臣

    2012-01-01

    Objective To investigate the clinical effect of reversed plantar metatarsal artery island flap in repairing the plantar soft tissue defects at the first and second toes.Methods 12 cases with plantar soft tissue defects at the first and second toes were repaired by reversed plantar metatarsal artery island flap which size ranged from 2 cm ×3 cm to 4 cm ×6 cm,including 5 cases at emergency,5 cases with the donor site defects at great toes after free lateral pulp flap transfer,and 2 cases with the donor site defects at second toes after free medial pulp flap transfer.Results All the reversed plantar metatarsal artery island flaps at the first and second toes survived uneventfully with desirable appearance and sensation over a 3-35 month follow-up.No complication happened at the donor sites.Conclusions It is an reliable method to adopt the reversed plantar metatarsal artery island flap for the plantar soft tissue defects at the first and second toes,with the advantages of stable blood vessels,high survival rate,good skin texture and few complications.%目的 探讨逆行第1跖底动脉逆行岛状皮瓣修复第1、2趾底创面的方法和临床效果.方法 采用逆行第1跖底动脉岛状皮瓣修复第1趾趾腹(腓侧)及第2趾胫侧创面皮肤软组织缺损创面,临床应用12例,皮瓣面积为2 cm×3 cm~4cm×6 cm,其中急诊修复外伤性创面5例,修复游离足拇趾腓侧皮瓣供区5例,游离第2趾胫侧皮瓣供区创面2例.结果 术后皮瓣全部成活,随访3 ~35个月,皮瓣质地良好,外形不臃肿,供区愈合良好,且无明显并发症,耐磨性良好,患者满意.结论 逆行第1跖底动脉岛状皮瓣皮瓣血运可靠,皮肤质地良好,手术切取安全,是修复第1趾趾腹(腓侧)及第2趾胫侧创面的较理想方法,值得临床广泛应用.

  6. The role of temporalis fascia for free mucosal graft survival in small nasal septal perforation repair.

    Science.gov (United States)

    Jeon, Eun-Ju; Choi, Jin; Lee, Joo-Hyung; Kim, Sung-Won; Nam, In-Chul; Park, Yong-Su; Jin, Sang-Gyun; Cheon, Byung-Jun

    2014-01-01

    Temporalis fascia has been used widely as a interposition graft for mucosal rotation flap in nasal septal perforation repair. However, the exact role of temporalis fascia in healing process has not yet been clarified. For the pedicle of rotation flap has been considered as a major vehicle for nutrition distribution, the role of temporalis fascia has been devaluated. In this study, we experienced small nasal septal perforation repairs using free mucosal graft not having pedicles but covered by temporalis fascia. Three patients with small nasal septal perforations not larger than 1 × 1 cm were included. In 2 patients, the perforations were repaired using free composite grafts from the inferior turbinate mucosa covered by continuous temporalis fascia not divided, and the surgical results were successful with complete healings. In 1 patient, however, the temporalis fascia was divided into 2 parts to better fit the shape of the perforation, and the graft failed to survive. These surgical results suggest that the temporalis fascia might have an important role in healing process of nasal septal defect and could be used as a beneficial options for small mucosal defect repair surgeries using free mucosal grafts.

  7. 中节指动脉及其背侧支为蒂逆行岛状皮瓣修复指端缺损%Repair of fingertip defect with reverse island flap based on middle phalange of digital artery and its dorsal branches

    Institute of Scientific and Technical Information of China (English)

    陈乐锋; 柯于海; 周望高; 熊懿; 张振伟; 游楚红

    2015-01-01

    目的:介绍一种对手指供区损伤较小的皮瓣修复手指指端缺损的方法。方法对15例手指指端缺损患者,以指固有动脉中段及其背侧支为蒂,设计手指中节指背岛状皮瓣进行修复。若需重建皮瓣感觉,则在切取皮瓣时,于皮瓣近端切取适当长度的指固有神经背侧支,与伤指指固有神经缝合。结果15指皮瓣及植皮全部成活,5指术后2 d皮瓣远端出现水疱,未予处理,术后7 d水疱开始萎缩吸收,术后2周水疱消失。术后随访3~9个月,皮瓣成活好,质地柔软,外形满意,颜色与患指周围皮肤相近,两点辨别觉6~9 mm,远指间关节屈伸功能无明显障碍。手功能根据ATM法评定:优10例,良5例。结论中节指动脉及其背侧支为蒂逆行岛状皮瓣是修复指端缺损较理想的方法之一。%Objective To introduce a flap which injured slightly on the donor sites, in repairing the fingertip defect. Methods 15 cases with defect on 15 fingers tip were treated with this island flaps. When the flap was used to repair defect at finger pulp, the dorsal branch of the digital proper nerve in the flap was kept to be anastomosed to the digital proper nerve at the recipient finger. Results All the flaps and skin grafts survived. Blister happened in 5 flaps 2 days after operation, which healed spontaneously without necrosis. The blister begin to shrink and be obsorption 7 days after operation, and disappear 2 weeks after operation. All cases were followed up for 3~9 months. The color, texture and contour of the flaps were good. The two-point discrimination distance was 6~9 mm on the flaps. No obvious functional problem was found in DIP motion. The hand function was assessed as excellent in 10 fingers, good in 5 fingers. Conclusion The reverse island flap based on middle phalange of digital artery and its dorsal branches is an ideal method to repair the fingertip defect.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. [Harvesting technique of chimeric multiple paddles fibular flap for wide oromandibular defects].

    Science.gov (United States)

    Foy, J-P; Qassemyar, Q; Assouly, N; Temam, S; Kolb, F

    2016-08-01

    Carcinological head and neck reconstruction still remains a challenge due to the volume and varied tissues needed. Large and wide oromandibular defects require, not just the bone but also soft tissues for the pelvilingual reconstruction and therefore, a second free flap may become necessary in addition to a fibular flap. The option of an unique chimeric flap based on the fibular artery and its branches is less known whereas it offers the advantage of a unique flap with bone, muscle and multiple skin paddles, independent of each other. The aim of this technical note is to present step by step the surgical procedure of this chimeric flap and share this method that avoids a second free flap.

  13. 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.

  14. 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

  15. Dynamic underbalance perforating with the PURE technique

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Andy

    2004-07-01

    Canadian Natural Resources International (CNR) recently performed successful completions on two wells in the Ninian field of the United Kingdom North Sea using the PURE (Mark of Schlumberger) perforating system for clean perforations. PURE perforating is a patented method developed by Schlumberger employing a dynamic underbalance to remove perforating debris, minimise crushed zone damage within the perforations and enhance well performance. Both of these jobs at Ninian employed tubing-conveyed perforating (TCP). (author)

  16. 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...

  17. Versatility of free SCIA/SIEA flaps in head and neck defects.

    Science.gov (United States)

    Nasir, Serdar; Aydin, Mustafa Asim

    2010-07-01

    Reconstruction of head and neck defects may require replacement of the bony structures, external soft tissue, and intraoral mucosa. Most cases, including maxillary defects, often require repair using only soft tissue flaps. Recently, the authors used free superficial circumflex iliac artery/superficial inferior epigastric (SCIA/SIEA) flaps for head and neck reconstruction. This was their first choice over other free flaps due to its versatile advantages. Fifteen patients underwent head and neck reconstruction with free SCIA/SIEA flaps (n = 16). No flap loss was observed; however, emergency vascular reanastomosis was performed in 3 cases to restore the blood supply in compromised flaps. Flap thinning and secondary debulking procedures were performed in 4 cases. The functional and aesthetic results were deemed as acceptable in all patients. Based on our results, we believe that the free SCIA/SIEA flap is useful for soft tissue defect reconstruction in the head and neck. It has the following advantages: (1) Large flap elevation is possible for reaching distant recipient vessels, (2) Two surgical teams may work at the same time preparing the donor and recipient regions, and (3) The flap design uses an abdominoplasty incision, which has minimal donor site morbidity.

  18. Blowing Flap Experiment: PIV Measurements

    Science.gov (United States)

    Hutcheson, Florence V.; Stead, Daniel J.; Bremmer, David M.

    2004-01-01

    PIV measurements of the flow in the region of a flap side edge are presented for several flap configurations. The test model is a NACA 63(sub 2)-215 Hicks Mod-B main element airfoil with a half-span Fowler flap. Air is blown from small slots located along the flap side edge on either the top, bottom or side surfaces. The test set up is described and flow measurements for a baseline and three blowing flap configurations are presented. The effects that the flap tip jets have on the structure of the flap side edge flow are discussed for each of the flap configurations tested. The results indicate that blowing air from a slot located along the top surface of the flap greatly weakened the top vortex system and pushed it further off the top surface. Blowing from the bottom flap surface kept the strong side vortex further outboard while blowing from the side surface only strengthened the flap vortex system. It is concluded that blowing from the top or bottom surfaces of the flap may lead to a reduction of flap side edge noise.

  19. Primary appendiceal adenocarcinoma of colonic type with perforating peritonitis.

    Directory of Open Access Journals (Sweden)

    Noguch H

    2001-10-01

    Full Text Available Primary adenocarcinoma of the appendix is rare, especially the colonic type. We report a case of appendiceal adenocarcinoma of colonic type associated with perforating peritonitis after aorto-femoral artery bypass surgery. A 79-year-old woman presented with fever and pain in the right lower abdomen. She had undergone aorto-femoral artery bypass surgery due to arteriosclerosis obliterans 6 months earlier. Abdominal ultrasonography and computed tomography showed a suspected pool of fluid surrounding the artificial vessel and a mass lesion in the upper end of the fluid collection. These findings suggested localized peritonitis due to appendiceal perforation. Emergency laparotomy showed a pool of pus around the artificial vessel and inflamed appendix, which adhered to the surrounding tissue. The mass was excised in combination with an ileocaecal resection, followed by an ileocolic anastomosis. The histological diagnosis was moderately differentiated adenocarcinoma of the appendix, colonic type. The tumour had infiltrated and obstructed the lumen of the orifice of the appendix, which may have caused perforation of the appendix. She was examined at regular periodic follow-ups and no evidence of recurrence or metastasis was noted in the 12-month postoperative period. These findings indicate that, in cases of acute appendicitis, especially with perforation, the possibility of appendiceal adenocarcinoma should be considered.

  20. 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.

  1. 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

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 第四跖背动脉逆行岛状皮瓣在第二足趾再造手指供区趾蹼皮肤缺损中的临床应用%Clinical Analysis of Fourth Dorsal Metatarsal Artery Retrograde Island Flap is Applied to the Second Toe and Finger Reconstruction for the District of Toe Web Skin Defect

    Institute of Scientific and Technical Information of China (English)

    钱吹; 王金昌; 郑存汪

    2014-01-01

    Objective To investigate the clinical application of fourth dorsal metatarsal artery retrograde island flap of second toe and finger reconstruction after donor toe web skin defect. Methods In 2007 January 2009 December, the clinical data were cut from the second toe and finger reconstruction with dorsal metatarsal flap area ranging from 13 patients were analysed. Results 13 cases were al flaps survived, and fol ow-up time ranged from 3 months to 16 months, the skin texture, feel good, toe web satisfactory appearance, for walking foot function satisfied. Conclusion Maximize the protection of the donor foot function, reducing the complications after skin grafting, is the ideal operation method.%目的探讨第四跖背动脉逆行岛状皮瓣修复第二足趾再造手指后供区趾蹼皮肤缺损的临床应用效果。方法2007年1月~2009年12月,均为切取第二足趾再造手指时携带面积不等的跖背皮瓣13例患者的临床资料进行分析。结果术后13例转移皮瓣全部存活,术后随访时间为3~16个月,皮瓣质地、感觉良好,趾蹼外形满意,供足行走功能满意。结论最大限度地保护了供足的功能,减少了植皮后并发症,是较为理想的手术方式。

  7. 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

  8. 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.

  9. 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

  10. Soft tissue augmentation for restoration of facial contour deformities using the free SCIA/SIEA flap.

    Science.gov (United States)

    Nasir, Serdar; Aydin, Mustafa Asim; Altuntaş, Selman; Sönmez, Erhan; Safak, Tunç

    2008-01-01

    Reconstruction for facial contour deformities is still a challenging process and treatment for most cases is achieved only by soft tissue augmentation. The use of free tissue transfer offers the advantage of one step vascularized soft tissue augmentation. This article summarized the authors' use of de-epithelialized free superficial circumflex iliac artery/superficial inferior epigastric artery flap for facial contour deformities. Of these patients, two had hemifacial microsomia, one depressed scar, and one had hemifacial progressive atrophy. Stable restoration of the facial contour was achieved in all patients. The advantages of this flap are numerous. Two surgical teams may work at the same time for flap harvesting and recipient area preparation. A wide flap may be planned for large contour deformity to achieve one single stage augmentation. Pedicle course of this flap allows primary de-fating without disturbing distal flap circulation when in need of a thin flap for mild contour deformity. Donor site may be closed with bikini (abdominoplasty) incision, which has excellent esthetic outcome compared to other flaps.

  11. 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.

  12. 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...

  13. 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

  14. 掌背动脉皮支皮瓣修复多个手指软组织缺损%Repair of multi-fingers soft tissue defects with flaps based on cutaneous branches of dorsal metacarpal artery

    Institute of Scientific and Technical Information of China (English)

    刘宇舟; 芮永军; 糜菁熠; 邱扬; 华雍

    2015-01-01

    Objective To investigate the method and result of repairing multi-fingers soft tissue defects using the dorsal metacarpal flaps with cutaneous branches as pedicle.Methods From February,2010 to January,2013,9 patients with multi-fingers tissue defects were treated with the 2nd,3rd,4th dorsal metacarpal flaps with cutaneous branches as pedicles.The area of flaps ranged from 1.2 cm × 2.5 cm to 2.5 cm × 5.0 cm.The donor sites were sutured with full thick skin graft.Results All flaps survived.After a followed-up of 8 months to 24 months(average 12 months),the texture and shape of the flaps were good and non-bloated.The flap sensibility as sessment were S3-S3+.The two-point discrimination testing were 10 to 13 mm (average 11.6 mm).The TAM score of range of motion was 60% to 75% of the healthy side.The skin graft of donor site were soft.Conclusion Procedure of dorsal metacarpal flaps with cutaneous branches as pedicles easy is a good method to repaire the soft tissue defects of muhi-fingers.%目的 探讨应用掌背动脉皮支皮瓣修复多个手指软组织缺损的方法和效果. 方法 自2010年2月至2013年1月,对9例多个手指软组织缺损,采用第2、3、4掌背动脉皮支皮瓣修复,皮瓣切取面积为1.2cm×2.5cm~2.5 cm×5.0cm,供区全厚皮片植皮. 结果 术后皮瓣全部成活.术后随访8~24个月,平均12个月,皮瓣外形满意,质地优良,不臃肿,感觉恢复至S3~S3+,两点辨别觉10 ~ 13mm(平均11.6 mm),手指屈伸功能按TAM法评价,达健侧手指的60%~ 75%.供区植皮质地柔软. 结论 掌背动脉皮支皮瓣切取方便,血供可靠,不牺牲主干血管,是修复多个手指软组织缺损的良好方法.

  15. 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...

  16. 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.

  17. 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...

  18. CLINICAL STUDY OF DUODENAL PERFORATION

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    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

  19. Distally Based Iliotibial Band Flap: Anatomic Study with Surgical Considerations.

    Science.gov (United States)

    Wong, Victor W; Higgins, James P

    2016-09-01

    Background Reconstruction of high-risk fascia, tendon, or ligament defects may benefit from vascularized tissue. The iliotibial band (ITB), a thick fibrous tract of connective tissue, serves as a potential donor site for free tissue transfer but its blood supply has not been thoroughly investigated. The aim of this anatomical study was to investigate the vascular supply to the distal ITB and its role as a free fascial flap. Methods We dissected 16 fresh-frozen cadaveric legs and injected latex into the superolateral geniculate artery (SLGA). A distal ITB fascial flap was designed and measurements were taken for flap dimensions, pedicle length and size, and SLGA perfusion territory. Results The SLGA perfused 11.5 ± 2.3 cm of distal ITB (proximal to the lateral femoral epicondyle) and provided 6.4 ± 0.7cm of pedicle length to the ITB flap. Conclusions Chimeric options to include bone (from the lateral femoral condyle), cartilage (from the lateral femoral trochlea), muscle (from vastus lateralis or biceps femoris), and skin are possible. Surgical harvest techniques are proposed, including preservation of ITB insertions to minimize lateral knee instability. Clinical validation is needed to determine the role of the distal ITB free fascial flap in reconstructive microsurgery.

  20. MYOCUTANEOUS FLAPS IN RECONSTRUCTION OF ORTHOPAEDIC DEFECTS : RURAL EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Bakane

    2015-09-01

    Full Text Available Post traumatic and post excisional full thickness tissue defects as well as exposed implants and bones after surgery are challenging to orthopedic surgeons. Management of these complex injuries become difficult if the wound closure cannot be brought primarily. A flap is a unit of tissue that may be transferred from donor to a recipient site while maintaining its blood supply. Many such type of flaps are used to cover the defects and the donor site is either closed primarily or covered by skin graft. We present our experie nce of managing post traumatic , post excisional defect at Acharya Vinoba Bhave Rural Hospital by various types of flaps such as reverse sural artery flap, gastrocnemius and anterolateral thigh flaps which have significantly reduced the morbidity and long t erm complications of the open wounds. The non - availability of expertise, experience of surgeon in the field of reconstruction and poverty are the major constraints in rural India. Our experience of three cases is discussed.

  1. Distally Based Iliotibial Band Flap: Anatomic Study with Surgical Considerations.

    Science.gov (United States)

    Wong, Victor W; Higgins, James P

    2016-09-01

    Background Reconstruction of high-risk fascia, tendon, or ligament defects may benefit from vascularized tissue. The iliotibial band (ITB), a thick fibrous tract of connective tissue, serves as a potential donor site for free tissue transfer but its blood supply has not been thoroughly investigated. The aim of this anatomical study was to investigate the vascular supply to the distal ITB and its role as a free fascial flap. Methods We dissected 16 fresh-frozen cadaveric legs and injected latex into the superolateral geniculate artery (SLGA). A distal ITB fascial flap was designed and measurements were taken for flap dimensions, pedicle length and size, and SLGA perfusion territory. Results The SLGA perfused 11.5 ± 2.3 cm of distal ITB (proximal to the lateral femoral epicondyle) and provided 6.4 ± 0.7cm of pedicle length to the ITB flap. Conclusions Chimeric options to include bone (from the lateral femoral condyle), cartilage (from the lateral femoral trochlea), muscle (from vastus lateralis or biceps femoris), and skin are possible. Surgical harvest techniques are proposed, including preservation of ITB insertions to minimize lateral knee instability. Clinical validation is needed to determine the role of the distal ITB free fascial flap in reconstructive microsurgery. PMID:27135145

  2. 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.

  3. 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

  4. REPAIR OF FINGER SOFT TISSUE DEFECT WITH ISLAND FLAP BASED ON VASCULAR CHAIN OF CUTANEOUS BRANCH OF DORSAL METACARPAL ARTERY%指蹼动脉分支蒂掌背链状血管皮瓣修复手指软组织缺损

    Institute of Scientific and Technical Information of China (English)

    张文静; 张文龙; 焦成; 刘亚静

    2013-01-01

    Objective To investigate the operative procedure and the clinical results of the island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery for repairing finger soft tissue defect. Methods Between January 2008 and March 2012, 28 cases of tissue defect of fingers (32 fingers) were repaired with the island flaps based on the vascular chain of the cutaneous branch of dorsal metacarpal artery. There were 20 males (23 fingers) and 8 females (9 fingers), with an average age of 29.5 years (range, 14-67 years). The injury causes included 14 cases of crush injury, 6 cases of pressing injury, 5 cases of cutting injury, and 3 cases of avulsion injury. The locations included 10 index fingers, 13 long fingers, 6 ring fingers, and 3 little fingers. There were 9 defects of proximal segment, 12 defects of middle segment, and 11 defects of distal segment. The area of defect ranged from 1.0 cm x 0.8 cm to 5.2 cm x 3.5 cm. The disease duration was 1 hour to 15 days. The area of flaps ranged from 1.2 cm × 1.0 cm to 5.5 cm × 3.8 cm. The donors were closed by suture or were repaired with skin graft. Results Tense blister occurred in 3 cases, which was cured after dressing change; the other flaps survived. Wound obtained primary healing. Twenty-five patients (27 fingers) were followed up 6-25 months (mean, 16.8 months). The flaps had soft texture and satisfactory appearance. Two point discrimination was 6-9 mm (mean, 7.7 mm) at 6 months after operation. The total active movement of fingers was 105-230° (mean, 204.6°). The results were excellent in 17 fingers, good in 8 fingers, and fair in 2 fingers with an excellent and good rate of 92.6%. Conclusion The island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery has the advantages of the deverting point from the dorsal point to the palm, the extended vessel pedicle, and expanded operation indications, so it is not necessary to cut the dorsal metacarpal artery. It can

  5. 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.

  6. 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

  7. 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.

  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. 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.

  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. Triple gastric peptic ulcer perforation.

    Science.gov (United States)

    Radojkovic, Milan; Mihajlovic, Suncica; Stojanovic, Miroslav; Stanojevic, Goran; Damnjanovic, Zoran

    2016-03-01

    Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Nevertheless, little is known about gastroduodenal perforation in cancer patients. Described in the present report is the case of a 41-year old woman with stage IV recurrent laryngeal cancer, who used homeopathic anticancer therapy and who had triple peptic ulcer perforation (PUP) that required surgical repair. Triple gastric PUP is a rare complication. Self-administration of homeopathic anticancer medication should be strongly discouraged when evidence-based data regarding efficacy and toxicity is lacking.

  12. 扩张的颈肩峰区锁骨上皮瓣修复面颈部软组织缺损%Pre-expanded cervico-acromial flap based on the supraclavicular artery for resurfacing soft tissue defects of head and neck

    Institute of Scientific and Technical Information of China (English)

    杨喆; 刘伟; 李养群; 王乃利; 唐勇; 赵穆欣; 马宁; 王维新

    2015-01-01

    Objective To investigate the therapeutic effect of pre-expanded cervico-acromial flap based on the supraclavicular artery for resurfacing soft tissue defects of head and neck. Methods In this series,from Jan 2008 to Jan 2014,24 patients with ages between 5 and 42 years suffering from facial and cervical scar or nevis or port-wine stain were treated.In the first stage,the tissue expander (600ml to 800ml in volume) was implanted on the deep fascia layer of the cervicoacromial region;600 to 800ml saline were injected during a 10 to 16 weeks period.In the second stage after expansion, sufficient skin and tissue was obtained to resurface the defects of head and neck. Results All 24 flaps healed primarily with good functional and cosmetic results.The maximum size of the flap was 23cm × 16cm,whereas the minimum size was 20cm × 8cm.After an average follow-up time of 12 months, significant improvement in function with good esthetic outcomes were achieved,and the donor sites scar seemed acceptable.There were no significant complications. Conclusion The pre-expandedcervico-acromialfasciocutaneous flap based on the supraclavicularartery can provide a large amount of thin tissue with both good color and texture,and without the need for microsurgery, and avoid the disadvantages of donor-site morbidity.This flap is reliable and safe for resurfacing large skindefects of the head and neck.%目的:探讨扩张的颈肩峰区锁骨上皮瓣修复面颈部较大面积软组织缺损的临床治疗效果。方法:2008年1月至2014年1月对24例面颈部软组织缺损患者,年龄5~42岁,采用以锁骨上动脉为蒂的预扩张的颈肩峰区筋膜皮瓣修复。一期在颈肩峰区域深筋膜浅层埋置1~2枚扩张器(600~800ml),定期注水,二期切除面颈部瘢痕或色素病变,以扩张皮瓣带蒂转移修复组织缺损,供区多可直接缝合。结果:本组24例患者扩张皮瓣切取面积为20cm×8cm~23cm×16cm,皮瓣均成活

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

    Directory of Open Access Journals (Sweden)

    Sandra Olivia

    2013-07-01

    Full Text Available 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 radiographic outcomes of surgical papilla preservation flap in the area that requires aesthetic. Case 1 was a surgical incision flap with preservation of papillae on the anterior region of teeth 11 and 12, with a full veneer crown on tooth 12. Case 2 was a surgical incision flap with preservation of papillae on the posterior region of tooth 46 with inlay restoration. Evaluation for both cases were obtained by incision papilla preservation of primary closure was perfect, good aesthetic results, minimal gingival recession and the interdental papillae can be maintained properly. In conclusion, periodontal flap surgery on the anterior region or regions that require high aesthetic value could be addressed with papilla preservation incision. Incision papilla preservation should be the primary consideration in periodontal flap surgery if possible.DOI: 10.14693/jdi.v19i3.144

  14. 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.

  15. 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.

  16. 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.

  17. A perforated diverticulum in Cushing's disease

    OpenAIRE

    de Havenon, Adam; Ehrenkranz, Joel

    2011-01-01

    We report a case of perforated colonic diverticulum in Cushing's disease. Although perforated diverticuli have been described in patients with Cushing's syndrome secondary to exogenous glucocorticoids, this complication has not been described in patients with Cushing's disease. Patients with hypercortisolism, from either exogenous or endogenous sources, should be monitored for diverticular perforation.

  18. Hyperbilirubinemia as a predictor for appendiceal perforation

    DEFF Research Database (Denmark)

    Burcharth, J; Pommergaard, H C; Rosenberg, J;

    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...... bilirubin as a predictor for appendiceal perforation....

  19. 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

  20. Dissecting Sub-epicardial Hematoma Due to Coronary Perforation and Non-developing Stent

    Institute of Scientific and Technical Information of China (English)

    Guo Hangyuan; Xing Yangbo; Lee JongDae

    2007-01-01

    We report a 65-year-old man who presented with anastomotic perforation of the distal right coronary artery due to stent deployment, complicated by a small and stable dissecting sub-epicardial hematoma,and non-developing stent. The cause was unknown.

  1. 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

  2. Application of reversed island flaps based on the superficial palmar branch of the radial artery to reconstruct the first web%桡动脉掌浅支腕横纹皮瓣在虎口修复中的应用

    Institute of Scientific and Technical Information of China (English)

    郑大伟; 黎章灿; 许立; 张旭阳; 石荣剑; 孙峰; 寿奎水

    2015-01-01

    目的:总结桡动脉掌浅支( SPBRA)腕横纹部逆行岛状皮瓣在虎口软组织缺损修复中的应用及疗效。方法回顾性分析2012年1月—2013年3月徐州仁慈医院手足显微外科收治的8例虎口软组织缺损患者的临床资料。其中男5例、女3例,年龄15~63岁。开放伤5例,虎口挛缩松解术后创面3例。创面范围2.5 cm ×3 cm~3.5 cm ×7 cm,平均3.1 cm ×4.8 cm。开放伤均在一期创面彻底清创止血后行负压封闭引流(VSD),二期行创面修复。8例患者均采用大小为3.0 cm ×3.5 cm~4.0 cm ×7.5 cm的SPBRA腕横纹岛状皮瓣带蒂逆行转移修复虎口软组织缺损;供区直接缝合。术后观察皮瓣成活、伤口愈合情况,随访观察皮瓣质地、虎口功能及供区功能情况。结果本组8例,术中1例因血管变异改行其他术式,其余7例均顺利完成手术。7例患者术后皮瓣均完全成活,供、受区创面均Ⅰ期愈合;术后随访6~13个月,平均9.5个月,皮瓣颜色及质地与周围皮肤相似,外形满意,皮瓣恢复部分浅感觉,拇指可完成外展及对掌功能,供区瘢痕轻微,无功能影响。术后6个月7例患者虎口宽度距离为5.2~6.1 cm,平均5.8 cm,虎口宽度为健侧的72%~96%(平均87%),拇指可完成外展及对掌功能。重建虎口功能评定:优5例,良1例,中1例。腕部供区功能评定:优6例,良1例。结论 SPBRA腕横纹部逆行岛状皮瓣带蒂转移修复虎口软组织缺损,具有手术简便、血运可靠、术后功能、外观恢复好等优点,是修复虎口创面的理想方法之一。%Objective To discuss the clinical results of the island flaps based on the superficial palmar branch of the radial artery ( SPBRA ) in repairing the first web. Methods The clinical data of 8 hospitalized patients with soft tissue defect of the first web treated in Xuzhou Renci Hospital from 2012 January to 2013 March were analyzed retrospectively. There were 5

  3. Flap-Edge Blowing Experiments

    Science.gov (United States)

    Gaeta, R. J.; Englar, R. J.; Ahuja, K. K.

    2003-01-01

    This Appendix documents the salient results from an effort to mitigate the so-called flap-edge noise generated at the split between a flap edge that is deployed and the undeployed flap. Utilizing a Coanda surface installed at the flap edge, steady blowing was used in an attempt to diminish the vortex strength resulting from the uneven lift distribution. The strength of this lifting vortex was augmented by steady blowing over the deployed flap. The test article for this study was the same 2D airfoil used in the steady blowing program reported earlier (also used in pulsed blowing tests, see Appendix G), however its trailing edge geometry was modified. An exact duplicate of the airfoil shape was made out of fiberglass with no flap, and in the clean configuration. It was attached to the existing airfoil to make an airfoil that has half of its flap deployed and half un-deployed. Figure 1 shows a schematic of the planform showing the two areas where steady blowing was introduced. The flap-edge blowing or the auxiliary blowing was in the direction normal to the freestream velocity vector. Slot heights for the blowing chambers were on the order of 0.0 14 inches.

  4. 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

  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. 14 CFR 23.701 - Flap interconnection.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Flap interconnection. 23.701 Section 23.701... Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a system must— (1) Be synchronized by a mechanical interconnection between the movable flap surfaces that...

  7. Radiated noise from an externally blown flap

    Science.gov (United States)

    Reddy, N. N.; Yu, J. C.

    1975-01-01

    The far field noise from subsonic jet impingement on a wing-flap with a 45 deg bend was experimentally investigated. The test parameters are jet Mach number and flap length. For long flaps, the primary source mechanisms are found to be turbulent mixing and flow impingement. For short flaps, the interaction of turbulent flow with the flap trailing edge appears to strongly influence the radiated noise.

  8. Blood flow dynamics and sensitivity in breasts after reconstruction with DIEP-flap.

    Science.gov (United States)

    Klasson, Stina; Svensson, Karin; Wollmer, Per; Velander, Patrik; Svensson, Henry

    2014-12-01

    A method of breast reconstruction is based on the Deep Inferior Epigastric Perforator (DIEP) technique. Skin and fat are transplanted from the abdomen to the chest; blood vessels are reconnected through microsurgery. Nerves are, however, left unconnected. This study aims to evaluate the blood flow and reinnervation of blood vessels and skin in breasts reconstructed by DIEP flaps without neural repair. In all, DIEP flaps of 10 patients were tested at an average of 16.3 months postoperatively. Blood flow was assessed by PeriScan PIM II System, both before and after indirect heating. Tactile perception threshold was assessed by Semmes-Weinstein monofilament and thermal sensibility by SENSELab MSA Thermotest. The patients' contralateral breasts were used as controls. The blood flow of the flaps was statistically significantly lower than in the control breasts, both before and after indirect heating. The change in blood flow after indirect heating did, however, not significantly differ when comparing the breasts. All flaps regained deep pressure sensibility in all four quadrants. Five patients regained even better sensibility in one of their quadrants. Seven patients regained perception of cold stimuli, five perceived warmth. This study has shown that skin blood flow regulation is present in DIEP flaps 1 year after reconstruction. Blood flow dynamics are very similar to those in the normal breast. There is also a recovery of tactile and thermal sensibility, but this study has not shown any clear parallels between recovery blood flow, tactile sensibility and thermal sensibility.

  9. [Cocaine-related gastric perforation].

    Science.gov (United States)

    Ring, A; Stein, E; Stern, J

    2010-06-01

    Since the 1980s the abuse of cocaine has been -associated with gastroduodenal perforations in the United States. Here, we report the case of a 28-year-old man who came to our hospital with severe abdominal pain after smoking cocaine. Physical examination revealed generalised abdominal guarding. His X-ray did not show any free intraperitoneal air. However, there was a slightly elevated white blood cell count. Upon laparoscopic exploration of the abdomen, the -patient was found to have a generalised peritonitis secondary to a perforation of the prepyloric anterior wall. The operative procedure consisted of ulcer excision and primary closure with a pyloroplasty as well as an extensive abdominal irrigation after laparotomy.

  10. 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.

  11. 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.

  12. 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

  13. Disc replacement with temporalis myofascial flap pedlcled on the middle temporal artery and vein%应用颞中动静脉为蒂的颞肌筋膜瓣置换颞下颌关节盘

    Institute of Scientific and Technical Information of China (English)

    姜滨; 陈敏洁; 张善勇; 杨驰

    2009-01-01

    目的:介绍一种治疗中晚期颞下颌关节(temporomandibularjoint,TMJ)结构紊乱(internal derangement,ID)的手术方法,即以颞中动静脉为蒂的颞肌筋膜瓣(temporalis myofascial flap,TMF)置换关节盘.方法:对48例TMJ ID患者(52侧)进行颞中动静脉为蒂的颞肌筋膜瓣关节盘置换术.颞肌筋膜瓣血管蒂采用颞浅动静脉的分支一颞中动静脉,在关节盘切除后转移入关节间隙内.结果:所有手术均顺利完成.术后MRI显示,髁突与关节窝之间均由混合信号物质充填,两者完全隔开.结论:颞中动静脉为蒂的颞肌筋膜瓣是关节盘的良好替代物.

  14. 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.

  15. Diagnosis of perforated gastric ulcers by ultrasound.

    Science.gov (United States)

    Wallstabe, L; Veitt, R; Körner, T

    2002-10-01

    Patients with a perforation of the gastrointestinal tract need fast confirmation of diagnosis and early treatment to improve outcome. Plain abdominal x-ray does not always prove the perforation particularly at early stage. We report about a 62 year-old woman complaining of consistent abdominal pain with sudden onset. Ultrasound was taken as first diagnostic measure, revealing a perforation. The leakage was located in the stomach. Radiography confirmed the pneumoperitoneum without indicating the perforated location. During operation the perforated gastric ulcer was found and sutured. This case report points out the reliability of ultrasound in diagnosing a pneumoperitoneum. Additionally it provides a summary of ultrasound signs seen in perforated gastric and duodenal ulcers and a review of literature.

  16. Stercoral colonic diverticulum perforation with jejunal diverticulitis mimicking upper gastrointestinal perforation

    Institute of Scientific and Technical Information of China (English)

    BI Jing-tao; GUO Yan-tong; ZHAO Jing-ming; ZHANG Zhong-tao

    2012-01-01

    Stercoral perforation of the colon is an unusual pathological condition with fewer than 150 cases reported in the literature to date.We present a case of stercoral colonic perforation mimicking upper gastrointestinal perforation,which was diagnosed by computed tomography preoperatively.However,at laparotomy,stercoral colonic diverticulum perforation with jejunal diverticulitis became the most appropriate diagnosis.Colonic perforation is a severe complication in surgery.It is a rather uncommon event usually caused by malignancy,diverticular disease,trauma or ulcerative colitis.Stercoral perforation of the colon was reported by Berry1 in 1894.Fewer than 150 cases have been reported in the literature to date.2,3 We present a rare case of stercoral diverticulum colonic perforation with jejunal diverticulitis mimicking upper gastrointestinal (GI) perforation,which was correctly diagnosed at laparotomy.

  17. 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.

  18. Management of biliary perforation in children

    Directory of Open Access Journals (Sweden)

    Mirza Bilal

    2010-01-01

    Full Text Available Background: To study the aetiology, management and outcome of biliary perforations in paediatric age group. Patients and Methods: In a retrospective study, the records of patients presented with biliary peritonitis due to biliary perforations, managed from March 2006 to July 2009, are reviewed. Results: Eight male patients with biliary peritonitis due to biliary perforation were managed. These patients were divided in two groups, A and B. Group A, (n = 3 patients, had common bile duct (CBD perforation, and Group B (n=5 patients had gallbladder perforation. The presenting features were abdominal pain, fever, abdominal distension, vomiting, constipation, jaundice and signs of peritonism. The management of CBD perforations in Group A was by draining the site of perforation and biliary diversion (tube cholecystostomy. In Group B, the gallbladder perforations were managed by tube cholecystostomy in four patients and cholecystectomy in one patient, however, one patient had to be re-explored and cholecystectomy performed due to complete necrosis of gall bladder. There was no mortality in our series. All patients were asymptomatic on regular follow-up. Conclusion: Early optimal management of biliary perforations remarkably improved the very high mortality and morbidity that characterised this condition in the past.

  19. 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

  20. 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.

  1. 空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折%Cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures

    Institute of Scientific and Technical Information of China (English)

    周炎; 刘世清; 瞿新丛; 廖琦; 余铃; 黄涛

    2014-01-01

    目的 探讨空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折的手术方法及临床疗效. 方法 2008年3月至2011年6月,对收治的12例距骨颈骨折采用空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗.术后非负重功能位外固定12~14周,并根据X线片显示骨折愈合情况确定负重时间.末次随访时根据美国足与踝关节外科协会踝与后足功能评分系统评价术后功能. 结果 12例术后随访12 ~ 48个月,平均24个月.1例出现切口皮缘坏死,经换药处理后愈合.距骨颈骨折均获愈合,愈合时间为16~ 24周,平均20周.末次随访时AOFAS踝与后足功能评分为55~ 96分,平均82.5分,其中优4例,良5例,可3例.2例发生距下关节轻度创伤性关节炎,口服消炎镇痛药后疼痛缓解;1例发生距骨体缺血性坏死,X线片显示距骨体骨质硬化,但未塌陷,嘱患者减少负重并定期随访观察. 结论 应用空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折,能改善距骨体血供,降低距骨缺血性坏死的发生,是有效的治疗手段.%Objective To investigate the surgical techniques and clinical efficacy of cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures.Methods From March 2008 to June 2011,12 cases with talus neck fractures were treated with cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery.External fixation in functional position for 12-14 weeks,and the load time was determined by X-ray fracture healing.Functional results were assessed according to AOFAS (American Orthopaedic Foot and Ankle Society) score at last follow-up.Results Twelve cases were followed up for an average of 24 months (12 to 48 months).One case of skin flap necrosis healed by dressing.All the fractures healed

  2. Reconstruction of Complex Shoulder Defect in a Case of Subclavian Artery Thrombosis

    OpenAIRE

    Satish, Chetan

    2012-01-01

    We report a case of a 24-year-old man with complex shoulder defect on the right side following a road traffic accident. The patient was found to have a subclavian artery thrombosis in its second part with good collaterals ensuring limb viability. Free-flap reconstruction was not possible because of lack of recipient vascular pedicle nearby. Pedicled flaps routinely used for this area such as pectoralis major and latissimus dorsi myocutaneous flaps could not be used as their vascular pedicles ...

  3. 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

  4. 高频彩色多普勒超声在游离股前外侧穿支皮瓣中血管皮支定位的应用研究%Study of the application of high frequency color Doppler in skin branch blood vessel positioning in dissociative anterolateral thigh flap

    Institute of Scientific and Technical Information of China (English)

    丰波; 呼和; 王永军; 张澜; 庞有明; 牛克成

    2013-01-01

    Objective To study the distribution pattern of the perforating blood vessels, body surface positioning and haemodynamics in dissociative anterolateral thigh flap (ALTF) by making use of high frequency color Doppler technology, which will provide the reference evidence in selecting the advantage side between the two donor sides prior to surgery. Methods To test the number, caliber, starting point, traveling course, location passing through the deep fascia, mean flow rate of two-side ALFT perforating blood vessels on 30 healthy volunteers and 13 cases of surgical patients by high frequency color Doppler, and by making the comparison of the observation of perforating blood vessels during the surgery with that detected by color Doppler, statistic analysis had been conducted. Results All together 192 perforating arteries had been detected among 30 healthy people and 13 cases of patients, and among which 79.3% were myocutaneous perforator, 18.6% were septocutaneous perforator and 2.1% were direct cutaneous perforator. Perforating caliber was (1.02±0.41)mm;There was no statistic significance between left side and right side in mean flow rate of blood(P>0.05), but there was statistic significance between males and females, with higher mean flow rate among males than females(P0.05). Frequency spectrum demonstration:forward wave in contraction period, extreme slow flow rate or without blood flow in diastole period with low speed and high resistance one-way spectrum. Conclusions High frequency color Doppler can directly observe lateral femoral circumflex artery, the descending branch of the lateral circumflex femoral artery, as well as the characters of bigger perforating blood vessels in terms of number, caliber, structure of blood vessel wall, extending direction, distribution area, haemodynamics, blood vessel quality evaluation and body surface positioning. The perforating results in 13 cases of patients observed during surgeries are consistent with the detection by

  5. PIV Measurements on a Blowing Flap

    Science.gov (United States)

    Hutcheson, Florence V.; Stead, Daniel J.

    2004-01-01

    PIV measurements of the flow in the region of a flap side edge are presented for several blowing flap configurations. The test model is a NACA 63(sub 2)-215 Hicks Mod-B main-element airfoil with a half-span Fowler flap. Air is blown from small slots located along the flap side edge on either the top, bottom or side surfaces. The test set up is described and flow measurements for a baseline and three blowing flap configurations are presented. The effects that the flap tip jets have on the structure of the flap side edge flow are discussed for each of the flap configurations tested. The results indicate that blowing air from a slot located along the top surface of the flap greatly weakened the top vortex system and pushed it further off the top surface. Blowing from the bottom flap surface kept the strong side vortex further outboard while blowing from the side surface only strengthened the vortex system or accelerated the merging of the side vortex to the flap top surface. It is concluded that blowing from the top or bottom surfaces of the flap may lead to a reduction of flap side edge noise.

  6. 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.

  7. 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

  8. 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.

  9. Jejunal atresia associated with idiopathic ileal perforation

    Directory of Open Access Journals (Sweden)

    Das P

    2008-01-01

    Full Text Available Jejunoileal atresia is one of the common causes of neonatal intestinal obstruction. Intestinal perforation with meconium peritonitis in the neonatal period, which carries a high mortality rate, is also common. The association of jejunal atresia with idiopathic ileal perforation is very rare.

  10. 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.

  11. Iatrogenic esophageal perforation in a newborn

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Mi; Yeon, Kyung Mo; Park, Won Soon; Choi, Jung Hwan [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1990-07-15

    Esophagus and pharyngeal structures of newborn are very week and so vulnerable. When a parallel longitudinal tubular structure around (especially behind) the esophagus is seen, traumatic esophageal perforation must be differentiated. We report a case of esophageal perforation in a premature twin baby by nasogastric tube insertion.

  12. 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.

  13. 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.

  14. Intestinal perforation secondary to metastasic lung carcinoma

    Directory of Open Access Journals (Sweden)

    M. C. Álvarez Sánchez

    2014-11-01

    Full Text Available Secondary symptomatic gastrointestinal metastases from lung primary tumor are rare. They can cause a variety of clinical conditions such as perforation, obstruction and bleeding. Intestinal perforations of intestinal metastases have a very poor prognosis. We present a case of a patient with metastatic lung cancer who presents with intestinal perforation and pneumoperitoneum. A 67 year old male, immunosuppressed and smoker is diagnosed with acute abdomen secondary to perforation of a tumor of the terminal ileum, as well as three other similar injuries. Resection and anastomosis. The patient died two months after surgery. The final pathological diagnosis supports epidermoidide poorly differentiated lung carcinoma. It was concluded that given an intestinal perforation in a patient diagnosed with lung carcinoma, it shouldn´t be excluded the metastases origen . Surgery is a purely palliative procedure.

  15. 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 .

  16. [Gastric perforation associated with Candida infection].

    Science.gov (United States)

    Bollo, Jesús; Carrilo, Elena; Lupu, Ion; Caballero, Ferran; Trias, Manel

    2009-01-01

    Notable causes of gastroduodenal ulcer are Helicobacter pylori infection, intake of non-steroidal anti-inflammatory agents, neoplastic disease, acid hypersecretory states and secondary peptic ulcer disease. There are case reports of healthy patients or those with risk factors for fungal infection who develop gastroduodenal ulcer perforation associated with the presence of fungi in ascitic fluid or gastroduodenal ulcer tissue but without the above-mentioned etiological factors. Thus, other factors and pathogens may be involved in the pathogenesis of perforation. The use of antifungal agents in patients following surgery for a perforated gastroduodenal ulcer is controversial. We report two cases of healthy patients who underwent surgery for perforated gastroduodenal ulcer, in whom the most frequent causes of perforation were excluded. Only the presence of Candida in the ulcer was found.

  17. 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

  18. 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.

  19. 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

  20. 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.

  1. Continuous tissue oxygen tension measurement as a monitor of free-flap viability.

    Science.gov (United States)

    Hirigoyen, M B; Blackwell, K E; Zhang, W X; Silver, L; Weinberg, H; Urken, M L

    1997-03-01

    Early recognition of vascular compromise within microvascular free-tissue transfers is essential if reexploration is to prove successful. Tissue oxygen tension is increasingly recognized to be a sensitive and reliable index of tissue perfusion, and preliminary studies suggest that it may be of value in the assessment of free-flap viability. We describe our investigation into the application of an implantable microcatheter oxygen sensor in the monitoring of free flaps used in head and neck and extremity reconstruction. In a preliminary study using the rabbit model, we sought to evaluate the response of oxygen tension as an index of tissue perfusion in myocutaneous (n = 20) and osteomyocutaneous flaps (n = 5) under conditions of arterial and venous occlusion. A clinical study was then undertaken to evaluate the role of this method in the monitoring of surface and buried free flaps. In 30 heterogeneous free-tissue transfers, sensors placed intraoperatively were used to provide continuous information about flap oxygen tension (mean monitoring period 3.2 +/- 0.8 days). The data generated were correlated with changes in clinical parameters and routine flap observations. Results for experimental and clinical data have confirmed the efficacy of continuous tissue oxygen measurements using this device as a method that provides an objective, recordable index of free-tissue transfer viability in a variety of circumstances and vascular events. Tissue oxygen tension is a suitable index by which to evaluate flap viability with the probe placed in muscle or bone but is unreliable when used for the monitoring of revascularized cutaneous flaps. PMID:9047197

  2. Diagnosis and treatment of gallbladder perforation

    Institute of Scientific and Technical Information of China (English)

    Hayrullah Derici; Cemal Kara; Ali Dogan Bozdag; Okay Nazli; Tugrul Tansug; Esra Akca

    2006-01-01

    AIM: To present our clinical experience with gallbladder perforation cases.METHODS: Records of 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis in our clinic between 1997 and 2006 were reviewed retrospectively. Sixteen (4.8%) of those patients had gallbladder perforation. The parameters including age, gender, time from the onset of symptoms to the time of surgery, diagnostic procedures, surgical treatment, morbidity, and mortality were evaluated.RESULTS: Seven patients had type Ⅰ gallbladder perforation, 7 type Ⅱ gallbladder perforation, and 2 type Ⅲ gallbladder perforation according to Niemeier's classification. The patients underwent surgery after administration of intravenous electrolyte solutions, and were treated with analgesics and antibiotics within the first 36 h (mean 9 h) after admission. Two patients died of sepsis and multiple organ failure in the early postoperative period. Subhepatic abscess, pelvic abscess,pneumonia, pancreatitis, and acute renal failure were found in 6 patients.CONCLUSION: Early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance. Upper abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation.

  3. 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.

  4. Modelling of acoustic transmission through perforated layer

    Directory of Open Access Journals (Sweden)

    Lukeš V.

    2007-10-01

    Full Text Available The paper deals with modeling the acoustic transmission through a perforated interface plane separating two halfspaces occupied by the acoustic medium. We considered the two-scale homogenization limit of the standard acoustic problem imposed in the layer with the perforated periodic structure embedded inside. The homogenized transmission conditions govern the interface discontinuity of the acoustic pressure associated with the two halfspaces and the magnitude of the fictitious transversal acoustic velocity. By numerical examples we illustrate this novel approach of modeling the acoustic impedance of perforated interfaces.

  5. Nasal Septum Perforation due to Methamphetamine abuse

    Directory of Open Access Journals (Sweden)

    Mehdi Bakhshaee

    2012-07-01

    Full Text Available Introduction: Spontaneous Perforation of the nasal septum is an uncommon condition. Nasal inhalation of substances such as cocaine has long been linked to this Perforation. Case Report: This report describes the case of a 46-year-old woman who was addicted to methamphetamine and who presented with perforation of the nasal septum.This is the first reported case of nasal septal necrosis linked to nasal inhalation of methamphetamine. Conclusions: Patient history and assurance regardingillegal drug consumption and abuse is a key point for fast and accurate diagnosis. The pathophysiology of drug-induced sinunasal disease and a review of the literature are also presented.

  6. 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.

  7. Reconstruction with a 180-degree Rotationally Divided Latissimus-dorsi-musculocutaneous Flap after the Removal of Locally Advanced Breast Cancer

    Directory of Open Access Journals (Sweden)

    Hajime Matsumine, MD, PhD

    2014-09-01

    Full Text Available Summary: This study described a technique for reconstruction of a large lateral thoracic region defect after locally advanced breast cancer resection that allows for full coverage of the defect and primary closure of the flap donor site. The authors performed reconstruction using the newly designed 180-degree rotationally-divided latissimus-dorsi-musculocutaneous flap in a 42-year-old woman for coverage of a large skin defect (18 × 15 cm following extensive tissue resection for locally advanced breast cancer. The latissimus-dorsi-musculocutaneous flap, consisting of two rotated skin islands (18 × 7.5 cm each that were sutured to form a large skin island, was used for coverage of the defect. The flap was sutured without causing excessive tension in the recipient region and the donor site was closed with simple reefing. No skin grafting was necessary. The flap survived completely, shoulder joint function was intact, and esthetic outcome was satisfactory. Quick wound closure allowed postoperative irradiation to be started 1 month after surgery. The technique offered advantages over the conventional pedicled latissimus-dorsi-musculocutaneous flap, but the flap was unable to be used, when the thoracodorsal artery and vein were damaged during extensive tissue removal. Detailed planning before surgery with breast surgeons would be essential.

  8. 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.

  9. Formation of a reliable capsular flap in a rat model.

    NARCIS (Netherlands)

    Schuringa, M.C.; Hartman, E.H.M.; Ruhe, P.Q.; Jansen, J.A.; Spauwen, P.H.M.

    2007-01-01

    Prefabrication can be used to produce capsular flaps; other researchers have confirmed the feasibility of such flaps. Before the possibilities of capsular flaps can be explored, a reliable method to create these flaps has to be established first. METHODS: To produce capsular flaps in a rat model, th

  10. 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.

  11. 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.

  12. Perforated peptic ulcer: How to improve outcome?

    DEFF Research Database (Denmark)

    Møller, Morten Hylander; Adamsen, Sven; Wøjdemann, Morten;

    2008-01-01

    Despite the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased...... with an emphasis on risks that are preventable. A systematic review including randomized studies was carried out. There are a limited number of studies of patients with peptic ulcer perforation. Most of these studies are of low evidential status. Only a few randomized, controlled trials have been published...... to improve the outcome of patients with peptic ulcer perforation, sepsis needs to be factored into the existing knowledge and treatment Udgivelsesdato: 2008/8/27...

  13. 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.

  14. 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</