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Sample records for island skin flap

  1. Dermatosurgery Rounds - The Island SKIN Infraorbital Flap

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    Georgi Tchernev

    2017-07-01

    Full Text Available The main objective in dermatologic surgery is complete excision of the tumour while achieving the best possible functional and cosmetic outcome. Also we must take into account age, sex, and tumour size and site. We should also consider the patient's expectations, the preservation of the different cosmetic units, and the final cosmetic outcome. Various reconstructive methods ranging from secondary healing to free flap applications are usedfor the reconstruction of perinasal or facial defects caused by trauma or tumour surgery. Herein, we describe the nasal infraorbital island skin flap for the reconstruction in a patient with basal cell carcinoma. No complications were observed in operation field. The infraorbital island skin flap which we describe for the perinasal area reconstruction is a safe, easily performed and versatile flap. The multidimensional use of this flap together with a relatively easy reconstruction plan and surgical procedure would be effective in flap choice.

  2. Tadalafil significantly reduces ischemia reperfusion injury in skin island flaps

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    Oguz Kayiran

    2013-01-01

    Full Text Available Introduction: Numerous pharmacological agents have been used to enhance the viability of flaps. Ischemia reperfusion (I/R injury is an unwanted, sometimes devastating complication in reconstructive microsurgery. Tadalafil, a specific inhibitor of phosphodiesterase type 5 is mainly used for erectile dysfunction, and acts on vascular smooth muscles, platelets and leukocytes. Herein, the protective and therapeutical effect of tadalafil in I/R injury in rat skin flap model is evaluated. Materials and Methods: Sixty epigastric island flaps were used to create I/R model in 60 Wistar rats (non-ischemic group, ischemic group, medication group. Biochemical markers including total nitrite, malondialdehyde (MDA and myeloperoxidase (MPO were analysed. Necrosis rates were calculated and histopathologic evaluation was carried out. Results: MDA, MPO and total nitrite values were found elevated in the ischemic group, however there was an evident drop in the medication group. Histological results revealed that early inflammatory findings (oedema, neutrophil infiltration, necrosis rate were observed lower with tadalafil administration. Moreover, statistical significance (P < 0.05 was recorded. Conclusions: We conclude that tadalafil has beneficial effects on epigastric island flaps against I/R injury.

  3. The submental island flap.

    Science.gov (United States)

    Sterne, G D; Januszkiewicz, J S; Hall, P N; Bardsley, A F

    1996-03-01

    The submental island flap is a reliable source of skin of excellent colour, contour and texture match for facial resurfacing and leaves a well hidden donor site. The flap is safe, rapid and simple to raise. We report on its use in 12 cases of facial or intraoral reconstruction. Complications were few. However, there was one case of complete flap loss following its use in a reverse flow manner, due to the presence of an unreported, but constant, valve in the venous system of the face. We believe this flap to be a worthwhile addition to the existing surgical armamentarium.

  4. 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

  5. Haemodynamics and viability of skin and muscle flaps

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    Clarke, H.M.

    1985-01-01

    In reconstructive surgery, occasional free flap failures occur despite the clinical and technical advances in microsurgery of the past few years. To minimize these losses a better understanding of basic flap physiology must be achieved. The objectives of this work were the investigation of the haemodynamic characteristics of skin and muscle flaps in normal and compromised circumstances, the viability of skin and muscle flaps after pedicle ligation or ischaemia, and the possible interrelationship of haemodynamics and viability. A Wistar rat groin island skin flap model was used to assess flap survival following vascular compromise produced by vessel ligation. Survival was seen earliest following loss of the artery and was not dependent on circulation through the vascular pedicle after 5 days. A study using free groin flaps in rats gave similar results. Normal free groin flaps were then transferred to irradiated Fischer F344 rats. Delayed neovascularization was shown at a time corresponding to the onset of the late phase of the response to skin radiation. A canine inferior epigastric free skin flap model was established to determine the normal haemodynamic parameters during free flap transfer. A canine gracilis free muscle flap model was developed. Normal haemodynamic parameters are given. These parameters were examined after ischaemia. Survival of the muscle followed ischaemia of 4 hours or less. Flap survival is not dependent solely on arterial input or venous drainage. More complex phenomena such as the reactive hyperaemia following ischaemia are implicated in survival.

  6. Skin flaps and grafts - self-care

    Science.gov (United States)

    ... Regional flaps - self-care; Distant flaps - self-care; Free flap - self-care; Skin autografting - self-care; Pressure ulcer ... your wound To care for the graft or flap site: You may need to rest ... around it clean and free from dirt or sweat. DO NOT let the ...

  7. Mannitol in reperfusion skin island flaps injury Manitol na reperfusão de retalhos cutâneos em ilha

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    Alberto Schanaider

    1999-09-01

    Full Text Available In the skin, the concept of reperfusion injury is well established. The application of this knowledge to deal with skin flap surgery problems, has a great prophylactic potential. This experimental study was performed to evaluate the action of mannitol as a scavenger of oxygen-free radicals, after an ischemia-reperfusion injury on skin island flaps. Thirty six male Wistar rats were divided into three test groups (n = 12: a non-ischemic group (group I, and two others (groups II and III which were subjected to nine hours of ischemia following by 30 minutes of reperfusion. After seven days, all animals of group II, treated with saline, showed full skin flap necrosis. The assessment of group III, that received a 20% solution of mannitol prior to the onset of reperfusion, revealed 75% (9/12 of flap viability. These results suggest that pre-treatment with mannitol is able to enhance flaps survival with significantly less tissue necrosis (p O conhecimento acerca da lesão decorrente da reperfusão na pele, já encontra-se consolidado. A aplicação destes conceitos revela uma perspectiva muito promissora na profilaxia de problemas cirúrgicos resultantes do manuseio de retalhos cutâneos em ilha. Este estudo experimental foi realizado com o objetivo de avaliar a ação do manitol, na qualidade de inativador dos radicais oxigênio livres, após isquemia e reperfusão sobre retalhos cutâneos em ilha. Trinta e seis ratos machos, do tipo Wistar, foram divididos em três grupos (n =12, cada com a seguinte distribuição: Grupo I - sem isquemia, grupos II e III - submetidos durante nove horas a isquemia seguida por 30 minutos de reperfusão. Após sete dias, todos os animais do grupo II, tratados com solução salina, apresentaram necrose e em toda extensão dos retalhos. Na análise do grupo III, que recebeu solução de manitol a 20% previamente ao inicio da reperfusão, verificou-se viabilidade de 75% (9/12 dos retalhos. Estes resultados sugerem que o pr

  8. Subcutaneous island pedicle flap for aesthetic reconstruction of the face

    Institute of Scientific and Technical Information of China (English)

    LI Jun-hui; XING Xin; OUYANG Tian-xiang; LI Ping; XU Jie; GUO En-tan

    2006-01-01

    Objective:To investigate the outcomes of subcutaneous island pedicle flap for reconstruction of the medium-sized facial skin defects. Methods: Eighty nine cases of facial defects within one cosmetic unit following removal of skin tumors or scars were reconstructed with advancement or transposition island pedicle flaps. Patient records and postoperative photographs were reviewed retrospectively. Both patients and other surgeons were asked to assess outcome variables. Results: All flaps survived with primary healing postoperatively. Patients and surgeons judged excellent or good overall outcomes in 95.5% and 92.7%of all evaluated cases, respectively. Conclusion: The subcutaneous island pedicle flap may be an extremely versatile and reliable method for aesthetic reconstruction of medium-sized facial defects in the patients of all time of life.

  9. Keystone flaps in coloured skin: Flap technology for the masses?

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    Satish P Bhat

    2013-01-01

    Full Text Available Introduction: Viscoelastic properties of skin in coloured ethnic groups are less favourable compared to Caucasians for executing Keystone flaps. Keystone flaps have so far been evaluated and reported only in Caucasians. The potential of Keystone flaps in a coloured ethnic group is yet unknown. Aim: This article reviews the experience to reconstruct skin defects presenting in a coloured ethnic group, by using Keystone flaps, with a review of existing literature. Design: Uncontrolled case series. Materials and Methods: This retrospective review involves 55 consecutive Keystone flaps used from 2009 to 2012, for skin defects in various locations. Patient demographic data, medical history, co-morbidity, surgical indication, defect features, complications, and clinical outcomes are evaluated and presented. Results: In this population group with Fitzpatrick type 4 and 5 skin, the average patient age was 35.73. Though 60% of flaps (33/55 in the series involved specific risk factors, only two flaps failed. Though seven flaps had complications, sound healing was achieved by suitable intervention giving a success rate of 96.36%. Skin grafts were needed in only four cases. Conclusions: Keystone flaps achieve primary wound healing for a wide spectrum of defects with an acceptable success rate in a coloured skin population with unfavorable biophysical properties. By avoiding conventional local flaps and at times even microsurgical flaps, good aesthetic outcome is achieved without additional skin grafts or extensive operative time. All advantages seen in previous studies were verified. These benefits can be most appreciated in coloured populations, with limited resources and higher proportion of younger patients and unfavorable defects.

  10. 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.

  11. 指侧方岛状皮瓣和微型静脉皮瓣的局部解剖及在皮肤缺损型断指再植中的应用%Anatomy and Clinical Application of Finger Side Quadrate Island Flap and Miniature Vein Skin Flap in Replantation of Severed finger with Skin Defect

    Institute of Scientific and Technical Information of China (English)

    胡洪涌; 刘国龙; 王威; 黄桂桃; 赵小伟

    2011-01-01

    目的 研究指侧方岛状皮瓣和微型静脉皮瓣的局部解剖及在皮肤缺损型断指再植修复中的临床应用.方法 分别利用上肢血管铸形标本、前臂取皮手术标本、新鲜废弃手部标本及活体手部体表测量标本等进行应用解剖研究,并在此基础上,按掌侧、背侧及环状缺损3种类型选取皮肤缺损型断指病例18例19指,分别设计指侧方岛状皮瓣、前臂微型游离静脉皮瓣及前2种皮瓣之联合皮瓣3种术式进行再植修复.结果 19指及皮瓣均成活;患指长度无明显短缩,外观良好,移植皮瓣质地良好;患指功能TAM评分:优7指,良9指,差3指,优良率为84.21%.结论 指侧方岛状皮瓣和微型静脉皮瓣可灵活应用于各种类型的皮肤缺损型断指的再植修复.%Objective To research the regional anatomy and the clinical application of finger side quadrate island flap and miniature vein skin flap in replantation of severed finger with skin defect. Methods The applied anatomy was studied by using upper limb vessel casting specimens,forearm skin surgical specimens, fresh abandoned hand specimens and in vivo surface hand measurement specimens. According to different defect location (palmar defect, dorsal defect and ring defect), 19 fingers of 18 patients with finger amputation were selected and repaired using finger side quadrate island flap, forearm miniature free vein skin flap and the combined flaps for replanlation of amputated fingers,respectively. Results Skin flaps survived in all cases and the length of repaired fingers did not shortened. The repaired fingers had good appearance and high-quailty skin flaps. TAM showed excellent in 7 fingers,good in 9 and bad in 3. The excellent and good rate was 84.21%. Conclusion Finger side quadrate island flap and miniature vein skin flap can be extensively used in different types of replanlation of amputated finger with skin defect.

  12. DIEP flap sentinel skin paddle positioning algorithm.

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    Laporta, Rosaria; Longo, Benedetto; Sorotos, Michail; Pagnoni, Marco; Santanelli Di Pompeo, Fabio

    2015-02-01

    Although clinical examination alone or in combination with other techniques is the only ubiquitous method for flap monitoring, it becomes problematic with buried free-tissue transfer. We present a DIEP flap sentinel skin paddle (SSP) positioning algorithm and its reliability is also investigated using a standardized monitoring protocol. All DIEP flaps were monitored with hand-held Doppler examination and clinical observation beginning immediately after surgery in recovery room and continued postoperatively at the ward. Skin paddle (SP) position was preoperatively drawn following mastectomy type incisions; in skin-sparing mastectomies types I-III a small SP (sSP) replaces nipple-areola complex; in skin-sparing mastectomy type IV, SSP is positioned between wise-pattern branches while in type V between medial/lateral branches. In case of nipple-sparing mastectomy SSP is positioned at inframammary fold or in lateral/medial branches of omega/inverted omega incision if used. Three hundred forty-seven DIEP flap breast reconstructions were reviewed and stratified according to SP type into group A including 216 flaps with large SP and group B including 131 flaps with SSP and sSP. Sixteen flaps (4.6%) were taken back for pedicle compromise, 13 of which were salvaged (81.25%), 11 among 13 from group A and 2 among 3 from group B. There was no statistical difference between the groups concerning microvascular complication rate (P = 0.108), and time until take-back (P = 0.521) and flap salvage rate (P = 0.473) resulted independent of SP type. Our results suggest that early detection of perfusion impairment and successful flaps salvage could be achieved using SSP for buried DIEP flap monitoring, without adjunctive expensive monitoring tests.

  13. 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

  14. RECONSTRUCTION OF SOFT TISSUE OF HAND USING ISLAND AND PERFORATOR FLAPS

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    V. S. Mel'nikov

    2014-01-01

    Full Text Available Objective: to determine the capabilities and perspectives of island and perforator flaps for soft tissue reconstruction of the hand. Material and methods. Results of treatment of 41 patients with defects of the soft tissue of the hand, treated at the in the period from 2010 to 2013 and operated using the island flaps and perforator flaps (DAP flap. Results and conclusion. In all cases the authors have received positive functional and cosmetic results, which were evaluated using a questionnaire DASH, the average score was 12.3. Digital artery perforator flaps allow close defect covering tissue any surface fingers. The use of perforator flaps allows reconstructing soft tissue defect with the skin of the same anatomical region as identical morphologically lost. The second important advantage is that the DAP flap is not included in the magisterial arteries, allows its use as a recipient for subsequent microsurgical reconstructions.

  15. Anterior Palatal Island Advancement Flap for Bone Graft Coverage ...

    African Journals Online (AJOL)

    2015 Journal of Surgical Technique and Case Report | Published by Wolters Kluwer - Medknow. 42. Anterior Palatal Island ... prosthodontic treatments should have ideal characteristics, as .... are rotated palatal flap and palatal advanced flap.

  16. Effect of Systemic Antioxidant Allopurinol Therapy on Skin Flap Survival

    Science.gov (United States)

    Rasti Ardakani, Mehdi; Al-Dam, Ahmed; Rashad, Ashkan; Shayesteh Moghadam, Ali

    2017-01-01

    BACKGROUND It has been reported that systemic administration of allopurinol improves cell survival. This study was aimed to evaluate effects of allopurinol on skin flaps in dogs. METHODS Twenty dogs underwent one skin flap surgery with a 2-week interval. The first procedure was performed according to the standard protocols. The second phase was started by a 1-week pretreatment with allopurinol. Length of the necrotic zone was measured and recorded daily. At each phase, flaps were removed and sent for histopathological study after 1 week observation. RESULTS Mean length of the necrotic zone in allopurinol treated skin flaps has been significantly less than normal flaps over all 7 days of observation (p<0.0001). Histopathology study showed less inflammation and more normal tissue structure in the allopurinol treated skin flaps. CONCLUSION It was demonstrated that systemic administration of allopurinol significantly improved skin flap survival. PMID:28289614

  17. 不同形状蒂部减张瓣在逆行皮神经营养血管皮瓣中的应用%Application of the tension skin flap with different shapes in the pedicle of the reverse neurocutaneous island flap

    Institute of Scientific and Technical Information of China (English)

    厉孟; 蓝旭; 甄平; 刘兴炎; 高秋明; 宋明甲

    2013-01-01

    Objective:To investigate the effects of the tension skin flap with different shapes on the transplantation of the reverse neurocutaneous island flap. Methods:From January 2006 to January 2012,there were 21 patients in the study (in-cluding 15 males and 6 females),and aged from 14 to 58 years old (35 years old on average). Tension skin flaps with different shapes (triangle,round and ellipse) were used to improve the blood supply of the reverse neurocutaneous island flap. The ten-sion skin flaps in the pedicle were designed triangularly (10 patients),spherically (8 patients) or elliptically (3 patients). There were 5 patients with defects in the hand (the size from 5.0 cm×2.0 cm to 8.0 cm×5.0 cm),and 16 patients with defects in the foot and inferior segment of leg,or around the ankle (the size from 6.0 cm×4.0 cm to 13.0 cm×7.0 cm). And all the patients were with the tendon and bone exposed. All the flaps were reversal transplanted ,including 5 dorsal neurocutaneous flaps of foot,4 superficial peroneal neurocutaneous flaps,4 saphenous neurocutaneous flaps,3 sural neurocutaneous flaps,2 superficial radial neurocutaneous flaps,3 lateral neurocutaneous flaps of forearm. And the survival rate,appearance and sensory recovery of the flaps were analyzed. Results:The distant part of the reversed sural neurocutaneous island flap in 1 case necrosized and healed after dressing change. The other flaps survived entirely ,and the donor site all healed primarily. The follow up time was from 3 months to 2 years (averaged 7 months),and all the flaps had recovered pain and warm sensation with perfect appear-ance. Conclusion:The tension skin flap in the pedicle can enhance the blood supply and promote survival rate of the reverse neurocutaneous island flap,and can also improve its appearance.%目的:探讨3种不同形状蒂部减张瓣在皮神经营养皮瓣逆行转移术中的应用及其疗效。方法:自2006年1月至2012年1月,皮瓣坏死患者21例,男15例,女6

  18. Mastectomy skin flap necrosis: challenges and solutions

    Science.gov (United States)

    Robertson, Stuart A; Jeevaratnam, Johann A; Agrawal, Avi; Cutress, Ramsey I

    2017-01-01

    Introduction Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions. Methods A MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance. Results MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited. Conclusion MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem. PMID:28331365

  19. Mastectomy skin flap necrosis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Robertson SA

    2017-03-01

    Full Text Available Stuart A Robertson,1 Johann A Jeevaratnam,2 Avi Agrawal,2 Ramsey I Cutress,3,4 1Department of Surgery, University Hospital Coventry and Warwickshire NHS Trust, Coventry, 2Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, 3Department of Breast Surgery, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, 4Somers Cancer Research UK Centre, Southampton General Hospital Southampton, UK Introduction: Mastectomy skin flap necrosis (MSFN has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions. Methods: A MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance. Results: MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited. Conclusion: MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem. Keywords: mastectomy, flap, necrosis, complication, breast surgery

  20. The application of island myocutaneous flap for challenging wounds on cervico-thoracic region

    Institute of Scientific and Technical Information of China (English)

    XING Xin; XUE Chun-yu; LI Li; HUAN Jing-ning; GUO En-tan

    2006-01-01

    Objective:To introduce the experiences in the application of island myocutaneous flap for challenging wound on cervico-thoracic region. Methods: Different myocutaneous flaps were selected according to the location, peculiarity and etiological factor of wound. There were 28 cases of island pectoralis major island myocutanuous flaps, 34 cases of latissimus dorsi island myocutaneous flaps, 19 cases of trapizius island myocutaneous flaps and 17 cases of rectus abdominis island myocutaneous flaps in this report. Results: All 98 patients with challenging wound on cervico-thoracic region were successfully treated with this method without complications, and obtained functional and cosmetic effectiveness. Conclusion:Challenging wounds in cervico-nuchal region can be repaired with pertoralis major island myocutaneous flap, latissimus dorsi island myocutaneous flap and trapizius island myocutaneous flap, while challenging wounds in thoracic region can be repaired with latissimus dorsi island myocutaneous flap and rectus abdominis island myocutaneous flap. Satisfactory functional and cosmetic results can be obtained.

  1. Reconstruction of through-and-through oromandibular defects by the double-skin paddle fibula osteocutaneous flap: can the skin paddle always be divided?

    Science.gov (United States)

    Kubo, Tateki; Osaki, Yoko; Hattori, Ryo; Kanazawa, Shigeyuki; Hosokawa, Ko

    2013-02-01

    Reconstruction of the through-and-through defects of the oral cavity, involving oral mucosa, bone, and external skin is a major challenge. A single fibula osteocutaneous flap providing two skin islands is an option for such composite reconstruction. The number, location, and size of skin perforators were studied in the distal two thirds of the lower legs in 22 cases of fibula osteocutaneous flap mandibular reconstruction, and whether the skin paddle of the fibula flap could always be divided completely based on two distal perforators was examined. In this study, only 50% of the flaps had two or more distal perforators; thus, it was concluded that the skin paddle of the fibula osteocutaneous flap could not always be divided based on two distal skin perforators.

  2. A novel animal model for skin flap prelamination with biomaterials

    Science.gov (United States)

    Zhou, Xianyu; Luo, Xusong; Liu, Fei; Gu, Chuan; Wang, Xi; Yang, Qun; Qian, Yunliang; Yang, Jun

    2016-09-01

    Several animal models of skin flap construction were reported using biomaterials in a way similar to prefabrication. However, there are few animal model using biomaterials similar to prelamination, another main way of clinical skin flap construction that has been proved to be reliable. Can biomaterials be added in skin flap prelamination to reduce the use of autogenous tissues? Beside individual clinical attempts, animal model is needed for randomized controlled trial to objectively evaluate the feasibility and further investigation. Combining human Acellular Dermal Matrix (hADM) and autologous skin graft, we prelaminated flaps based on inguinal fascia. One, two, three and four weeks later, hADM exhibited a sound revascularization and host cell infiltration. Prelaminated skin flaps were then raised and microsurgically transplanted back to groin region. Except for flaps after one week of prelamination, flaps from other subgroups successfully reconstructed defects. After six to sixteen weeks of transplantation, hADM was proved to being able to maintain its original structure, having a wealth of host tissue cells and achieving full revascularization.To our knowledge, this is the first animal model of prelaminating skin flap with biomaterials. Success of this animal model indicates that novel flap prelamination with biomaterials is feasible.

  3. A novel animal model for skin flap prelamination with biomaterials

    Science.gov (United States)

    Zhou, Xianyu; Luo, Xusong; Liu, Fei; Gu, Chuan; Wang, Xi; Yang, Qun; Qian, Yunliang; Yang, Jun

    2016-01-01

    Several animal models of skin flap construction were reported using biomaterials in a way similar to prefabrication. However, there are few animal model using biomaterials similar to prelamination, another main way of clinical skin flap construction that has been proved to be reliable. Can biomaterials be added in skin flap prelamination to reduce the use of autogenous tissues? Beside individual clinical attempts, animal model is needed for randomized controlled trial to objectively evaluate the feasibility and further investigation. Combining human Acellular Dermal Matrix (hADM) and autologous skin graft, we prelaminated flaps based on inguinal fascia. One, two, three and four weeks later, hADM exhibited a sound revascularization and host cell infiltration. Prelaminated skin flaps were then raised and microsurgically transplanted back to groin region. Except for flaps after one week of prelamination, flaps from other subgroups successfully reconstructed defects. After six to sixteen weeks of transplantation, hADM was proved to being able to maintain its original structure, having a wealth of host tissue cells and achieving full revascularization.To our knowledge, this is the first animal model of prelaminating skin flap with biomaterials. Success of this animal model indicates that novel flap prelamination with biomaterials is feasible. PMID:27659066

  4. Expanded retroauricular skin and fascial flap in congenital microtia reconstruction.

    Science.gov (United States)

    Zhang, Qingguo; Quan, Yuzhu; Su, Yuanda; Shi, Lei; Xie, Yangchun; Liu, Xinhai

    2010-04-01

    The aim of this article is to report the application of expanding retroauricular skin fascia flap, and autogenous costal cartilage for congenital microtia reconstruction. Microtia reconstruction was generally completed in 3 surgical stages. In the first surgical stage, a 50 or 80 mL kidney-shaped tissue expander was inserted subcutaneously in the retroauricular mastoid region. Inflation of saline volume increased up to 60 to 80 mL, and skin flap was expanded for 2 to 3 months postoperatively. In the second surgical stage, removal of tissue expander, formation of retroauricular skin flap, elevation of retroauricular fascia flap, and pedicles of both flaps in remnant ear side were performed. Costal cartilage was harvested from ipsilateral side chest to the ear for reconstruction. The 3D ear framework was sculpted with stabilization of structure, contour and erection. Simultaneously, intermediate full thickness skin graft of 4 x 8 cm was obtained from previous incision site from where costal cartilage was harvested. Cartilage ear framework was anchored between skin flap and fascia flap, and fixed it symmetrically to the opposite normal ear, inferior portion of the ear framework was wrapped by remnant ear lobule, expanded skin flap covered the anterior portion of the framework, fascial flap was draped to the posterior side of framework and helical rim, then fascial flap was surfaced by intermediate full thickness skin graft. Suction drain was inserted and coated between skin flap and framework, drain was removed fifth postoperative day. Tragus construction and conchal excavation with skin graft was performed in the third stage of microtia reconstruction. Between October 2000 and October 2007, 426 cases were diagnosed as unilateral microtia patients and 22 cases were bilateral microtia patients. Therefore, 448 microtia ears were treated with tissue expander and autogenous costal cartilage. In 262 cases, structure of the helix, tragus, conchal excavation

  5. Colgajo de piel en isla con pedículo fasciocutáneo para cuello: caso clínico Island skin flap with fasciocutaneous pedicle for neck reconstruction: case report

    Directory of Open Access Journals (Sweden)

    J.L. Ramón Vera

    2009-06-01

    Full Text Available Los defectos por falta de piel o las secuelas de quemaduras a nivel del cuello presentan gran dificultad de cobertura debido a la escasez de tejidos locales útiles para corregirlos, ya que debemos dar una solución a las graves alteraciones funcionales y estéticas que producen, con un mínimo de secuelas. Presentamos un caso clínico con graves secuelas de quemaduras en cuello que producían retracción importante y que fue resuelto con un colgajo de piel en isla con pedículo fasciosubcutáneo tomado de región subclavicular. Este colgajo presenta irrigación cutánea por medio de arterias cutáneas directas provenientes de la arteria mamaria interna y brinda la oportunidad de solucionar alteraciones a nivel del cuello con gran facilidad para su realización y con mínimas secuelas en la zona donante.Cutaneous defects or burn sequels at the neck level present difficult of covering, due to the poor local tissues, although we should give a solution to the serious functional and aesthetic alterations with minimal sequels. We present a clinical case with burn sequels of the neck that produced important retraction and that was solved whit an island fasciocutaneous pedicle flap from subclavicular region. This flap has skin irrigation supported by the cutaneous arteries coming from the internal mammary artery and gives us the opportunity to solve these alterations at the neck level in an easy way and with minimal sequels in the donor area.

  6. Pedicled Supraclavicular Artery Island Flap Versus Free Radial Forearm Flap for Tongue Reconstruction Following Hemiglossectomy.

    Science.gov (United States)

    Zhang, Senlin; Chen, Wei; Cao, Gang; Dong, Zhen

    2015-09-01

    This study investigated the tongue function and donor-site morbidity of patients with malignant tumors who had undergone immediate flap reconstruction surgery. Twenty-seven patients who had undergone immediate reconstruction after hemiglossectomy were observed. Twelve patients were reconstructed using the pedicled supraclavicular artery island flap (PSAIF) and 15 patients using the free radial forearm flap (FRFF). Flap survival, speech and swallowing function, and donor-site morbidity at the 6-month follow-up were evaluated. All the flaps were successfully transferred. No obvious complications were found in either the transferred flaps or donor regions. Age, sex, defect extent, speech and swallowing function were comparable between the 2 groups. Donor-site complications were less frequent with PSAIF reconstruction than FRFF reconstruction. The PSAIF is reliable and well suited for hemiglossectomy defect. It has few significant complications, and allows preservation of oral function.

  7. Infraareolar pectoralis major myocutaneous island flap as treatment of first choice for deep sternal wound infection.

    Science.gov (United States)

    Simunovic, Filip; Koulaxouzidis, Georgios; Stark, G Bjoern; Torio-Padron, Nestor

    2013-02-01

    Deep sternal wound infection (DSWI) is a grave complication of median sternotomy, associated with high morbidity, mortality and escalating treatment costs. There is general consensus that optimal treatment comprises radical debridement followed by coverage with a vascularised flap. However, there is ongoing debate regarding the ideal operative procedure. We present our experience with the infraareolar pectoralis major island myocutaneous flap (PEC-MI flap) as treatment of first choice in DSWI. Following a retrospective chart review, data pertaining to patient demographics, type of cardiac surgery performed, prevalence of known DSWI risk factors, identified pathogens, duration of surgery, flap-related complications, duration of hospital stay and antibiotic therapy, as well as mortality were noted. Additionally, we describe the operative technique and review the relevant literature. Twenty-five patients underwent coverage with the PEC-MI flap in our department. The average age was 69.2 years. Nineteen patients underwent coronary artery bypass surgery, 10 valve replacement, two aortic replacement surgery and one pericardiectomy. In six cases, no internal mammary artery was used in cardiac surgery, in 11 cases one and in seven cases both internal mammary arteries were used. The average duration of surgery was 154.2 min and the average hospital stay was 28.4 days. Complications which required revision surgery were haematoma in three cases, one wound dehiscence and one recurrent infection. Two cases required coverage with an additional regional flap. The PEC-MI flap has been used as flap of first choice in our clinic for treatment of DSWI. It is sufficient to raise the flap unilaterally, and it does not require skin grafting. The combination of immunocompetent bulky muscle tissue used to obliterate the sternal cavity and the large skin paddle enabling a low-tension skin closure allows reliable and efficient treatment of this severe complication.

  8. The isolated perfused human skin flap model: A missing link in skin penetration studies?

    OpenAIRE

    Ternullo, Selenia; de Weerd, Louis; Flaten, Gøril Eide; Holsæter, Ann Mari; Skalko-Basnet, Natasa

    2016-01-01

    Development of effective (trans)dermal drug delivery systems requires reliable skinmodels to evaluate skin drug penetration. The isolated perfused human skin flap remainsmetabolically active tissue for up to 6 h during in vitro perfusion. We introduce the isolated perfused human skin flap as a close-to-in vivo skin penetration model. To validate the model's ability to evaluate skin drug penetration the solutions of a hydrophilic (calcein) and a lipophilic (rhodamine) fluorescence ...

  9. 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.

  10. Phalloplasty in children and adolescents using the extended pedicle island groin flap.

    Science.gov (United States)

    Perović, S

    1995-08-01

    An operative procedure for phalloplasty is reported that uses an extended pedicle island groin flap. Forming a combined groin and lower abdominal flap based on the superficial iliac and epigastric vessels is the main characteristic of this technique. The flap consists of 3 parts: 1) the lateral narrow hairless part for the neourethra, 2) the medial wide part for neophallus shaft reconstruction and 3) the base of the flap on which a flap pedicle is formed and lengthened by de-epithelializing the skin. The pedicle includes subcutaneous tissue with blood and lymph vessels. The neourethra and neophallus shaft are reconstructed using a tube-within-tube technique. The size of the flap depends on patient build. The flap is transferred to the recipient area, that is to the level of the lower margin of symphysis. Anastomosis of the new and native urethra may be done simultaneously or during the second stage of the procedure. The donor site skin defect is closed by direct approximation. During 3 years (1991 to 1993) this flap technique was performed on 24 patients (age 12 to 18 years). There were 2 main indications for treatment: 1) complete absence of the penis, and so total reconstruction of the phallus was done and 2) small dimensions of the penis or just a penile stump, and so augmentation of the penis was done. Specific indications were female transsexualism in 4 patients, penile amputation in 2 and a small disabled penis in 18 (the exstrophy-epispadias complex, intersex and micropenis). Followup ranged from 6 to 42 months (average 29). A new phallus of satisfactory dimensions was achieved in all cases. Complications included partial necrosis of the flap in 2 patients, fistulas in 2 and stenosis of the urethral anastomosis in 1. These complications were successfully resolved by corrective surgery. The method is simple and timesaving with a minor complication rate. This technique is the available alternative to the most commonly used procedure, that is microsurgical free

  11. The isolated perfused human skin flap model: A missing link in skin penetration studies?

    Science.gov (United States)

    Ternullo, Selenia; de Weerd, Louis; Flaten, Gøril Eide; Holsæter, Ann Mari; Škalko-Basnet, Nataša

    2017-01-01

    Development of effective (trans)dermal drug delivery systems requires reliable skin models to evaluate skin drug penetration. The isolated perfused human skin flap remains metabolically active tissue for up to 6h during in vitro perfusion. We introduce the isolated perfused human skin flap as a close-to-in vivo skin penetration model. To validate the model's ability to evaluate skin drug penetration the solutions of a hydrophilic (calcein) and a lipophilic (rhodamine) fluorescence marker were applied. The skin flaps were perfused with modified Krebs-Henseleit buffer (pH7.4). Infrared technology was used to monitor perfusion and to select a well-perfused skin area for administration of the markers. Flap perfusion and physiological parameters were maintained constant during the 6h experiments and the amount of markers in the perfusate was determined. Calcein was detected in the perfusate, whereas rhodamine was not detectable. Confocal images of skin cross-sections shoved that calcein was uniformly distributed through the skin, whereas rhodamine accumulated in the stratum corneum. For comparison, the penetration of both markers was evaluated on ex vivo human skin, pig skin and cellophane membrane. The proposed perfused flap model enabled us to distinguish between the penetrations of the two markers and could be a promising close-to-in vivo tool in skin penetration studies and optimization of formulations destined for skin administration.

  12. Double-skin paddled superficial temporofascial flap for the reconstruction of full-thickness cheek defect.

    Science.gov (United States)

    Kilinc, Hidir; Geyik, Yilmaz; Aytekin, Ahmet Hamdi

    2013-01-01

    The most common causes of cheek defects include trauma, burn, and tumor resections. In the reconstruction of the defects in this region, it is essential to use similar or adjacent tissue considering the aesthetic and functional properties. For this purpose, numerous local, regional, or distant free flaps were described. The local flaps harvested from the head and neck region are the most frequent methods because of the similar skin color, texture, and compatibility with cheek.In this study, the reconstruction in a 29-year-old male patient who had a full-thickness cheek defect due to tumor resection on the left side was performed, wherein a hairless skin island was carried through the frontal branch of superficial temporal artery for oral mucosa, and a hairy skin island through the parietal branch of the same pedicle was carried for the bearded skin defect. No complication occurred postoperatively and both aesthetic and functional satisfactory results were obtained, providing the oral mucosal and natural beard integrity. Donor-site scarring and temporal alopecia were recorded as the disadvantages of this method.This technique is a useful method for the reconstruction of full-thickness cheek defects because of its advantages including compatibility of color and texture, reliable blood supply, requiring single-session procedure, and being able to carry 2 different skin islands on the same pedicle.

  13. A new skin flap method for total auricular reconstruction in microtia patients with a reconstructed ear canal: extended scalp and extended mastoid postauricular skin flaps.

    Science.gov (United States)

    Hwang, Euna; Kim, Young Soo; Chung, Seum

    2014-06-01

    Before visiting a plastic surgeon, some microtia patients may undergo canaloplasty for hearing improvement. In such cases, scarred tissues and the reconstructed external auditory canal in the postauricular area may cause a significant limitation in using the posterior auricular skin flap for ear reconstruction. In this article, we present a new method for auricular reconstruction in microtia patients with previous canaloplasty. By dividing a postauricular skin flap into an upper scalp extended skin flap and a lower mastoid extended skin flap at the level of a reconstructed external auditory canal, the entire anterior surface of the auricular framework can be covered with the two extended postauricular skin flaps. The reconstructed ear shows good color match and texture, with the entire anterior surface of the reconstructed ear being resurfaced with the skin flaps. Clinical question/level of evidence; therapeutic level IV.

  14. RECONSTRUCTION OF FACIAL SKIN DEFECT BY VARIOUS FLAPS : OUR EXPERIENCE

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    Atishkumar B.

    2015-08-01

    Full Text Available INTRODUCTION : Face represents complete personality of human being. Cosmetically it is very important part of a person especially for woman. There are many situations when due to disease or trauma, facial defect arises, which requires reconstruction by either local or distant surgical flaps . METHODS AND MATERIALS : In rural places, we come across many patients suffering from trauma and skin malignancy of face. These patients require reconstruction done esthetically with local flaps. Objective of this study is to share our exper ience of providing esthetically good results at our secondary referral care center. Hereby, we present case series of 14 patients operated at our institute. These patients were analyzed according to the age, sex, nature of injury and anatomical location of lesion on the face. All these patients were operated and reconstruction of defect was done with various local flaps best suited for respective lesion, under local anesthesia or sedation. Post - operative nature of wound was analyzed for flap viability or fl ap necrosis . RESULTS : Amongst them were 7 male and 7 female, ages ranging from 4 to 80 years. 7out of 14 patients were of basal cell carcinoma, 4 were due to trauma, 2 were due to dog bite and 1 case of recurrent pleomorphic adenoma at root of nose. All patients had excellent flap viability at end of 6 months and flap achieving almost similar color and contour as that of surrounding skin. CONCLUSION : Reconstruction of facial defects by local flaps is very easy and cost effective technique. This can be don e even at secondary referral care centre with minimal availability of facilities

  15. Free Medial Plantar Flap Connection with a Posterior Tibial Artery Flap in Reconstruction of Fore–Mid Foot Skin Defect

    Science.gov (United States)

    Wu, Hao; Sheng, Jia-Gen

    2016-01-01

    Background: Although there are many surgical treatments for covering the skin defect of the fore–mid foot, how to reconstruct the weight-bearing region remains a challenge. The weight-bearing region of the sole needs to withstand the pressure and shearing stresses of walking, so the plantar skin is anatomically different from other skins in the areas of texture, thickness, subcutaneous tissue, etc. Medial plantar flaps that are harvested from the instep region are regarded as the first choice for weight-bearing region reconstruction because of their excellent functional and aesthetic long-term result. However, when facing an extensive skin defect on a weight-bearing area such as a fore–mid foot avulsion, the application of this flap is limited because if we put the flap in a weight-bearing area of the forefoot, the set of vessels will be exposed to outside. Methods: We suggest 2 connected free flaps (posterior tibial artery flap and medial plantar flap) pedicled with 1 set of vessels. The medial plantar flap was used to cover the skin defect of the weight-bearing area in the forefoot. The dorsal skin defect of the injured foot was covered with a posterior tibial artery flap and supplied the medial plantar flap with the posterior tibial vessel. The midfoot skin defect was repaired by a full-skin grafting. Results: Long-term follow-up results showed that the shape and function of the injured limbs recovered almost entirely. Conclusion: This method of connected flaps is suitable for repairing large skin defects of the fore–mid foot. PMID:27975013

  16. Surgical treatment of severe or moderate axillary burn scar contracture with transverse island scapular flap and expanded transverse island scapular flap in adult and pediatric patients--A clinical experience of 15 cases.

    Science.gov (United States)

    Chen, Baoguo; Xu, Minghuo; Chai, Jiake; Song, Huifeng; Gao, Quanwen

    2015-06-01

    Axillary burn scar contracture is common and troublesome. With the aim of restoring the function of the upper extremities, a proper local flap with minor damage and preclusion from recurrence should be developed to guarantee satisfactory results. A minor webbed scar contracture was rectified by Z-plasty. However, severe or moderate contracture must be constructed by a local flap. An island scapular flap has been used in pediatric patients for repairing axillary contracture. However, no detailed description of the use of a transverse island scapular flap (TISF) was reported to correct the deformity. Moreover, an expanded transverse island scapular flap (ETISF) used for increasing the volume of skin for severe axillary contracture in adults and developing children was also not presented. From 2006 to 2013, TISFs were harvested for 12 pediatric patients (5-12 years of age) with 15 sides of severe or moderate axillary burn scar contractures. Four ETISFs were designed for two adult patients (38 and 32 years of age). The flap size was between 10 cm×5 cm and 20 cm×10 cm. In one pediatric patient, a cicatrix was observed on the surface of the flap's donor site. Handheld Doppler was applied to detect the pedicle. The patients were required to lift their upper arms regularly each day after the operation. All 19 flaps survived completely. Axillary burn scar contractures were corrected successfully in 11 patients with no expander implantation. The lifting angle was enhanced considerably with 1-3 years of follow-up in the 11 patients. Only one pediatric patient with cicatrix on the donor site displayed tight skin on the back and a little restraint on the shoulder. The patient's parents were told to intensify the chin-up movement on the horizontal bar. She was in the process of a 3-month follow-up. The lifting angle was also improved significantly in the latter three cases of expander implantation although they were followed up for a short duration of 3 months. Due to poor

  17. 应用外固定架及封闭式负压引流联合腓肠 神经营养血管逆行岛状皮瓣治疗胫、腓骨开放骨折合并皮肤软组织缺损%External fixation and closed suction drainage combined with reverse sural neurocutaneous island flap in treatment of tibia and fibula open fractures with skin and soft tissue defects

    Institute of Scientific and Technical Information of China (English)

    侯占江; 刘明辉; 周世峰; 樊昌东; 夏昊晨

    2011-01-01

    目的 总结应用外固定架及封闭式负压引流联合腓肠神经营养血管逆行岛状皮瓣治疗胫、腓骨开放骨折合并皮肤软组织缺损的效果.方法 2008年6月~2009年6月,胫、腓骨开放骨折18例,患者均行骨折复位外固定架固定.清创后创面范围为5 cm×4 cm~12 cm×9 cm.均采用积极清创后平均16 d VSD治疗,待创面肉芽组织新鲜、感染控制后,采用大小为6 cm×5 cm~13 cm×8 cm腓肠神经营养血管逆行岛状皮瓣修复创面.结果 皮瓣术后1例出现皮瓣远端皮缘坏死,1例术后3 d皮瓣因蒂部缝合过紧压迫出现静脉回流不良,均经对症处理后成活,其余皮瓣顺利成活,切口I期愈合.皮瓣与周围皮肤色泽相似,无臃肿,质地佳.术后皮瓣受力处无破溃,无骨髓炎复发.结论 应用外固定架及封闭式负压引流联合腓肠神经营养血管逆行岛状皮瓣是治疗三度小腿骨折合并皮肤软组织碾挫缺损有效方法之一.%Objective To summarize the application of external fixation and closed suction drainage combined with reverse island skin flap nourished by the nutrient vessels ( SFNV) of the sural nerve in treatment of tibia and fibula open fractures with skin and soft tissue defects. Methods External fixation and vacuum sealing drainage ( VSD) combined with reverse island skin flap nourished by SFNV of the sural nerve was used to repair skin defects of lower one-third of the leg, foot or ankle with tibia and fibula open fractures in 18 patients from July 2008 to June 2009. The sizes of wounds debridement were 5 cm x 4 cm ~ 12 cm x 9 cm. First a positive therapy with VSD was used in mean 16 days after debridement, fracture reduction and external fixation. After the fresh granulation tissues grew and infections in control, defects were repaired by sural neurovascular island flap (size from 6 cm xS cm to 13 cm x8 cm). Results There was a small amount of distal marginal necrosis in 1 case after operation, and a

  18. Reconstruction of the columella and the tip of the nose with an island-shaped forehead flap

    Directory of Open Access Journals (Sweden)

    Vulović Dejan

    2011-01-01

    Full Text Available Background. Posttraumatic and postoperative defects of columella and the tip of the nose are difficult to reconstruct. There are several operative methods described in the literature, and many of them are step-by-step procedures with long duration. The aim of this study was to present one-step procedure for reconstruction of the columella and the tip of the nose with island-shaped arterial forehead flap. Case report. A 45-year old man was submitted to surgical excision of basocellular skin cancer. After the excision, a defect of the columella and tip of the nose the remained, 3 × 2.5 cm in dimensions, with exposed alar cartilages. During the same operation, the defect was covered with an island-shaped arterial forehead flap. Postoperative one-year course was uneventful, without signs of tumor recurrence after one year, and further surgical corrections were unnecessary. Conclusion. Considering the results of our operative technique, we believe that middle island-shaped forehead flap is suitable for reconstruction of the columella and the tip of the nose, due to the following reasons: safe vascularization of flap, similarity of the transferred tissue with the excised one, the procedure is completed in one step, simple surgical technique and uncomplicated healing of a flap-harvesting site.

  19. 前足皮肤缺损的皮瓣修复%Repairing the skin defect of forefoot by flap

    Institute of Scientific and Technical Information of China (English)

    张美英; 刘彬; 路来金

    2013-01-01

    目的 总结不同类型皮瓣修复前足部皮肤缺损的疗效.方法 根据前足皮肤缺损的部位,采用不同类型的外科皮瓣修复50例,其中交腿皮瓣2例,带蒂逆行岛状皮瓣20例,吻合血管的游离皮瓣28例.结果 除3例带蒂逆行岛状皮瓣远端部分坏死,行植皮创面愈合外,其余皮瓣全部成活.创面一期愈合47例,二期愈合3例;术后皮瓣整形17例.随访6个月~2年,足部功能及外形恢复较满意.结论 根据足部皮肤缺损的部位、面积大小及周围组织条件,选择不同类型外科皮瓣修复创面,可获得满意效果.%Objective To summary the efficacy of different types of flap to repair forefoot skin defect.Methods According to the forefoot skin defect site,we applied the different types of surgical flap to repair soft tissue defects of forefoot 50 cases,cross leg skin flap in 2 cases,pedicled retrograde island flap in 20 cases,vascularized free flap in 28 cases.Results In addition to the distal part of the 3 cases pedicled retrograde island flap necrosis,healing of wounds after skin graft,the rest of the flaps survived,wound healed in stage Ⅰ was 47 cases,wound healed in stage Ⅱ was 3 cases.Flap postoperative orthopedic surgery was 17cases.Follow-up of 6 months to 2 years,foot function and shape recovery effect was more satisfactory.Conclusion According to the foot skin defect parts and the size of the defect area and surrounding tissue conditions,it should choose different types of surgical flap to repair wounds,and can obtain satisfactory results.

  20. Comparison of Modifications in Flap Anastomosis Patterns and Skin Incision Types for External Dacryocystorhinostomy: Anterior-Only Flap Anastomosis with W Skin Incision versus Anterior and Posterior Flap Anastomosis with Linear Skin Incision

    Directory of Open Access Journals (Sweden)

    Burcu Dirim

    2015-01-01

    Full Text Available Purpose. To compare the outcomes of external dacryocystorhinostomy (E-DCR by using two different flap anastomosis patterns and skin incision types. Methods. This study included 79 patients (88 eyes with lacrimal drainage system disorders who underwent E-DCR surgery. Fifty eyes of 44 patients (group A underwent E-DCR by suturing anterior and posterior flaps (H-flap of the lacrimal sac with curvilinear skin incision whereas in 38 eyes of 35 patients (group B DCR was performed by suturing only anterior flaps (U-flap with W skin incision. Results. The success rate was evaluated according to lacrimal patency and scar assessment scores. Patency was achieved in 78 patients (88.6%. In terms of groups, patency was 44 eyes (88.0% in group A and 34 eyes (89.5% in group B. There was no statistically significant difference in the success rates of lacrimal patency between the two groups. Further, there was no statistically significant difference concerning cutaneous scar scores. Conclusion. Our study suggests that anastomoses of only anterior flaps or both anterior and posterior flaps have similar success rates; suturing only anterior flaps is easier to perform and shortens the operative time. In addition, W skin incision is a reasonable alternative to curvilinear incision for reducing scar formation.

  1. An Island Flap Technique for Laryngeal Intracordal Mucous Retention Cysts

    Science.gov (United States)

    Izadi, Farzad; Ghanbari, Hadi; Zahedi, Sahar; Pousti, Behzad; Maleki Delarestaghi, Mojtaba; Salehi, Abolfazl

    2015-01-01

    Introduction: Mucous retention cysts are a subtype of intracordal vocal cysts that may occur spontaneously or may be associated with poor vocal hygiene, and which require optimal treatment. The objective of this study was to present a new laser-assisted microsurgery technique for treating intracordal mucous retention cysts and to describe the final outcomes. Materials and Methods: In this prospective study, we assessed the pre-operative and post-operative acoustic analysis, maximum phonation time (MPT), and voice handicap index (VHI) of four patients with a diagnosis of mucous retention cyst. The island flap technique was applied to all patients without any complications. In this procedure, we favored the super-pulse mode using a 2-W power CO2 laser to remove the medial wall of the cyst, before clearing away the lateral wall margins of the cyst using repeat-pulse mode and a 2-W power CO2 laser. Indeed, we maintained the underlying epithelium and lamina propria, including the island flap attached to the vocal ligament. Results: There was a statistically significant improvement in the MPT (pre-op,11.05 s; post-op,15.85 s; P=0.002) and the VHI (pre-operative, 72/120; post-operative,27/120; P=0.001) in all patients. Moreover, jitter and shimmer were refined after surgery, but there was no statistically significant relationship between pre-operative and post-operative data (P=0.071) (P=0.622). In the follow-up period (median, 150 days), there was no report of recurrence or mucosal stiffness. Conclusion: The island flap procedure in association with CO2 laser microsurgery appears to be a safe and effective treatment option for intracordal mucous retention cysts, but needs further investigation to allow comparison with other methods. PMID:26568936

  2. An Island Flap Technique for Laryngeal Intracordal Mucous Retention Cysts

    Directory of Open Access Journals (Sweden)

    Farzad Izadi

    2015-09-01

    Full Text Available Introduction: Mucous retention cysts are a subtype of intracordal vocal cysts that may occur spontaneously or may be associated with poor vocal hygiene, and which require optimal treatment. The objective of this study was to present a new laser-assisted microsurgery technique for treating intracordal mucous retention cysts and to describe the final outcomes.   Materials and Methods: In this prospective study, we assessed the pre-operative and post-operative acoustic analysis, maximum phonation time (MPT, and voice handicap index (VHI of four patients with a diagnosis of mucous retention cyst. The island flap technique was applied to all patients without any complications. In this procedure, we favored the super-pulse mode using a 2-W power CO2 laser to remove the medial wall of the cyst, before clearing away the lateral wall margins of the cyst using repeat-pulse mode and a 2-W power CO2 laser. Indeed, we maintained the underlying epithelium and lamina propria, including the island flap attached to the vocal ligament.   Results: There was a statistically significant improvement in the MPT (pre-op,11.05 s; post-op,15.85 s; P=0.002 and the VHI (pre-operative, 72/120; post-operative,27/120; P=0.001 in all patients. Moreover, jitter and shimmer were refined after surgery, but there was no statistically significant relationship between pre-operative and post-operative data (P=0.071 (P=0.622. In the follow-up period (median, 150 days, there was no report of recurrence or mucosal stiffness.   Conclusion:  The island flap procedure in association with CO2 laser microsurgery appears to be a safe and effective treatment option for intracordal mucous retention cysts, but needs further investigation to allow comparison with other methods.

  3. PRP&F/P MPs improved survival of dorsal paired pedicle skin flaps in rats.

    Science.gov (United States)

    Takikawa, Megumi; Sumi, Yuki; Ishihara, Masayuki; Kishimoto, Satoko; Nakamura, Shingo; Yanagibayashi, Satoshi; Hattori, Hidemi; Azuma, Ryuichi; Yamamoto, Naoto; Kiyosawa, Tomoharu

    2011-09-01

    Skin flap necrosis is a problem encountered postoperatively. The purpose of this study was to evaluate the effects of platelet-rich plasma containing fragmin/protamine microparticles (PRP&F/P MPs) on viability in a rat dorsal paired pedicle skin (DPPS) flap. Two symmetrical adjoining rectangular flaps (8 × 2 cm each) were drawn on the rat dorsum. Two days after PRP&F/P MPs-, PRP-, F/P MPs-, and saline (control)-injections (n = 8 each), flaps were elevated as a random pattern flap without the lateral thoracic, posterior intercostal, and deep circumflex iliac vessels. The flaps were immediately sutured back and the flap survival area was measured 7 d after flap elevation. The flap survival rate in PRP&F/P MPs-injected groups (73.1% ± 4.2%) was significantly higher than those in PRP (64.9% ± 4.0%), F/P MPs (59.4 ± 4.5%), and control (61.2% ± 4.2%) groups. Histologic observation of the flaps showed survived thick granulation tissue and neovascularization in PRP&F/P MPs-injected groups. When PRP&F/P MPs are administered 2 d before the flap elevation, the improved flap survivals are observed. The pre-injection of PRP&F/P MPs may thus represent a promising treatment to prevent skin flap necrosis in reconstructive surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Primary Observations on the Influence of 60Co Local Irradiation on Free Skin Flaps

    Institute of Scientific and Technical Information of China (English)

    杨建荣; 张园

    2002-01-01

    Objective To study the effect of postoperative radiation on free skin flaps.Methods Twenty-nine patients with free skin flaps applied to the plerosis of the postoperative defectwere followed up. Twenty-eight out of 29 patients received forearm free flaps while 1 had anterolater-al femoris skin flaps in a size ranging from 14 cm× 6 cm to 8 cm× 4 cm. These flaps were exposedto 60Co radiation ranging 40-69 Gy. Results Observation during irradiation: no visible changes ofskin flaps and oral mucous membrane were detected when irradiation dose was within 40 Gy; somechanges may be detected over 40 Gy. Observation 1 - 4 months after irradiation: pigmentations werefound in areas of erosion epidermis; skin flaps got dark but without evidence of necrosis. Observation2 years after irradiation: no necrosis happened in 29 skin flaps. Hairs were found on 15 of 29flaps. Sensation occurred within the margin of 1 cm. Conclusion Free skin flap can endure irradi-ation at the dose of 60 Gy.

  5. Differentiated Adipose-derived Stem Cells Promote Reinnervation of Rat Skin Flaps

    Directory of Open Access Journals (Sweden)

    Koichi Tomita, MD, PhD

    2013-06-01

    Conclusions: dASCs could improve flap reinnervation by 2 mechanisms: First, neurotrophic factors produced by dASCs facilitated regrowth of cutaneous axons from the surroundings of flap. Second, nerve growth factor released by dASCs induced the collateral sprouting of undamaged axons in adjacent tissues. In addition to the use of innervated flaps, dASC transplantation therapy could be a new approach to improve the sensory recovery of skin flaps.

  6. Cannula-Assisted Flap Elevation (CAFE): a novel technique for developing flaps during skin-sparing mastectomies.

    Science.gov (United States)

    Grant, Michael D

    2015-02-01

    One of the most challenging procedures in breast surgery is the skin-sparing mastectomy (SSM). Various techniques and incisions have evolved that characterize this procedure; however, what is common in all of them is the smaller the incision, the more difficult it is to develop the skin flaps. A procedure was developed that incorporates the use of liposuction cannulas (without suction) to create the skin flaps. The technique and results are described in this manuscript. From October of 2012 to April 2014, 289 mastectomies (171 patients) were performed using the CAFE procedure on women of all shapes and sizes. Postoperatively, no problems were experienced with flap viability using this technique. The main difference in side effects between the CAFE technique and other standard techniques for developing flaps in SSMs was more bruising than normal, but this resolved rapidly. The results for use of this technique were consistently impressive. The learning curve for this procedure is very short, especially for those who perform SSMs using sharp technique (scissors). Residents and fellows became proficient with the CAFE technique in a relatively short amount of time. Plastic surgeons were pleased with the cosmetic outcomes of their reconstructions that follow this type of mastectomy. Patients were extremely satisfied with their reconstructions as well. Incorporating the use of liposuction cannulas (without suction) makes the creation of flaps for SSM a relatively simple and rapid method. It is especially useful to assist in developing skin flaps with even the smallest of skin incisions.

  7. Assessment of skin flaps using optically based methods for measuring blood flow and oxygenation.

    Science.gov (United States)

    Payette, Jeri R; Kohlenberg, Elicia; Leonardi, Lorenzo; Pabbies, Arone; Kerr, Paul; Liu, Kan-Zhi; Sowa, Michael G

    2005-02-01

    The objective of this study was to compare two noninvasive techniques, laser Doppler and optical spectroscopy, for monitoring hemodynamic changes in skin flaps. Animal models for assessing these changes in microvascular free flaps and pedicle flaps were investigated. A 2 x 3-cm free flap model based on the epigastric vein-artery pair and a reversed MacFarlane 3 x 10-cm pedicle flap model were used in this study. Animals were divided into four groups, with groups 1 (n = 6) and 2 (n = 4) undergoing epigastric free flap surgery and groups 3 (n = 3) and 4 (n = 10) undergoing pedicle flap surgery. Groups 1 and 4 served as controls for each of the flap models. Groups 2 and 3 served as ischemia-reperfusion models. Optical spectroscopy provides a measure of hemoglobin oxygen saturation and blood volume, and the laser Doppler method measures blood flow. Optical spectroscopy proved to be consistently more reliable in detecting problems with arterial in flow compared with laser Doppler assessments. When spectroscopy was used in an imaging configuration, oxygen saturation images of the entire flap were generated, thus creating a visual picture of global flap health. In both single-point and imaging modes the technique was sensitive to vessel manipulation, with the immediate post operative images providing an accurate prediction of eventual outcome. This series of skin flap studies suggests a potential role for optical spectroscopy and spectroscopic imaging in the clinical assessment of skin flaps.

  8. Role of adipose-derived stromal cells in pedicle skin flap survival in experimental animal models.

    Science.gov (United States)

    Foroglou, Pericles; Karathanasis, Vasileios; Demiri, Efterpi; Koliakos, George; Papadakis, Marios

    2016-03-26

    The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent usability, their application includes general surgical risks or possible complications, the primary and most common is necrosis of the flap. To improve flap survival, researchers have used different methods, including the use of adipose-derived stem cells, with significant positive results. In our research we will report the use of adipose-derived stem cells in pedicle skin flap survival based on current literature on various experimental models in animals.

  9. Role of adipose-derived stromal cells in pedicle skin flap survival in experimental animal models

    Institute of Scientific and Technical Information of China (English)

    Pericles; Foroglou; Vasileios; Karathanasis; Efterpi; Demiri; George; Koliakos; Marios; Papadakis

    2016-01-01

    The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent usability, their application includes general surgical risks or possible complications, the primary and most common is necrosis of the flap. To improve flap survival, researchers have used different methods, including the use of adiposederived stem cells, with significant positive results. In our research we will report the use of adipose-derived stem cells in pedicle skin flap survival based on current literature on various experimental models in animals.

  10. Application of skin flaps transplantation in burn surgery in China%皮瓣移植在我国烧伤外科中的应用

    Institute of Scientific and Technical Information of China (English)

    黄晓元

    2008-01-01

    The history and application of surgical flap transplantation in burn wound were briefly reviewed. We outlined skin flap, muscuiocutaneous flap, fascia flap and neurocutaneous vascular flap in this paper and recommended repair deep wounds with flap. All in all, in this review, we hope to provide a meaningful option for clinical application of surgical flap in the future.

  11. Reconstruction of anterior auricular conchal defect after malignancy excision: revolving-door flap versus full-thickness skin graft.

    Science.gov (United States)

    Dessy, Luca Andrea; Figus, Andrea; Fioramonti, Paolo; Mazzocchi, Marco; Scuderi, Nicolò

    2010-05-01

    Skin tumours of the anterior auricular concha are not uncommon. Wider excision and immediate reconstruction are required to reduce the risks of recurrence of the disease, cartilage infection and external ear distortion. Many surgical methods have been described for reconstruction of conchal defects. Post-auricular island flaps, such as the revolving-door (RD) flap, and full-thickness skin grafts (FTSGs) are the most-performed procedures. Although the RD flap has been fully described, it is not widely accepted and many surgeons, in their daily practice, prefer to use FTSG. It is a common experience that FTSGs are more subjected to centripetal contraction, decreasing the structural firmness of the conchal cavity and affecting functional and aesthetic outcomes. Furthermore, FTSGs are more prone to delay in wound healing due to the difficult access to this region that hinders adequate tie-over dressings. Between March 2003 and January 2007, 40 patients affected by T1 and T2 non-melanotic skin cancer and T1 melanoma of the anterior conchal surface of the external ear were included in a prospective study and randomly assigned to the RD reconstructed group or to the FTSG reconstructed group to investigate, compare and define advantages and disadvantages of both the techniques. Visual Analogue Scale (VAS) was used to evaluate the overall outcome and the colour and texture match. No flap or skin graft total loss was observed. Six patients (30%) showed partial failure of FTSG. The RD group demonstrated excellent cosmetic outcome, ideal colour match, adequate structure of external ear, projection and shape. Wilcoxon matched-pairs rank-sum test demonstrated statistically significant higher scores for the RD group compared to the FTSG group (p<0.0001). The RD harvesting technique is easy and quicker than the FTSG technique. RD flap should be considered as the first choice for reconstruction of anterior auricular conchal defects following wider excision of skin tumours.

  12. Effect of topically applied minoxidil on the survival of rat dorsal skin flap.

    Science.gov (United States)

    Gümüş, Nazım; Odemiş, Yusuf; Yılmaz, Sarper; Tuncer, Ersin

    2012-12-01

    Flap necrosis still is a challenging problem in reconstructive surgery that results in irreversible tissue loss. This study evaluated the effect of topically applied minoxidil on angiogenesis and survival of a caudally based dorsal rat skin flap. For this study, 24 male Wistar rats were randomly divided into three groups of eight each. A caudally based dorsal skin flap with the dimensions of 9 × 3 cm was raised. After elevation of the flaps, they were sutured back into their initial positions. In group 1 (control group), 1 ml of isotonic saline was applied topically to the flaps of all the animals for 14 days. In group 2, minoxidil solution was spread uniformly over the flap surface for 7 days after the flap elevation. In group 3, minoxidil solution was applied topically to the flap surface during a 14-day period. On day 7 after the flap elevation, the rats were killed. The average area of flap survival was determined for each rat. Subdermal vascular architecture and angiogenesis were evaluated under a light microscope after two full-thickness skin biopsy specimens had been obtained from the midline of the flaps. The lowest flap survival rate was observed in group 1, and no difference was observed between groups 1 and 2. Compared with groups 1 and 2, group 3 had a significantly increased percentage of flap survival (P minoxidil is vasodilation and that prolonged use before flap elevation leads to angiogenesis, increasing flap viability. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  13. Bilobed skin paddle fibula flap for large oromandibular defects.

    Science.gov (United States)

    Longo, Benedetto; Belli, Evaristo; Pugliese, Pierfrancesco; Ferri, Germano; Santanelli, Fabio

    2013-07-01

    Although the fibula free flap (FFF) is a useful choice for mandible reconstruction, its application for large oromandibular defects is still debated upon. We report the use of FFF with a bilobed perforator-based skin paddle for combined hemiglossectomy, floor-of-the-mouth, tonsillar pillar, and mandibular body defect. A case of an 84-year-old woman with a 2.5 × 3.5-cm exophytic ulcerated mass on the right side of the tongue, extended to omolateral gengival fornix, tonsillar pillar, and mandibular body, is reported. An osteocutaneus FFF with a 7-cm bone strut and a 17 × 10-cm bilobed shaped skin paddle was performed. The longer lobe was used to restore tongue shape, whereas the smaller lobe was used to line the pelvic floor, gingival, and tonsillar pillar. The postoperative period was uneventful. The patient was capable to protrude her neotongue beyond the virtual incisors line and to touch the hard palate at different degrees of mouth opening. The bilobed perforator-based skin paddle FFF is felt to be a sound option for large compound oromandibular defects offering the possibility to safely base the skin component on a single peroneal perforator while achieving effective tongue mobility preservation.

  14. Effects of buflomedil and pentoxifylline on hamster skin-flap microcirculation: prediction of flap viability using orthogonal polarization spectral imaging

    Directory of Open Access Journals (Sweden)

    Denise Salles Coelho da Mota

    2009-01-01

    Full Text Available OBJECTIVE: This study investigated the effects of buflomedil and pentoxifylline, both of which are used in reconstructive surgery of hamster skin flap microcirculation, and evaluated the skin flap survival rate by orthogonal polarization spectral imaging. METHOD: Twenty-four adult male Syrian golden hamsters were divided into three groups: a control (C, 0.1 ml 0.9% saline, buflomedil (B, 3 mg/kg/day, and pentoxifylline group (P, 14.5 mg/kg/day. Treatments administered intraperitoneally were initiated 1 hour before skin flap preparation and continued for 7 days post-operatively at 12-hour intervals. Preparations (skin flaps were divided into 12 fields, which were organized into six bands. Functional capillary density (FCD, in mm/mm², distance from the skin flap base to blood flow cessation (Dist with flow, in cm, percentage of viable skin (VA, in%, and qualitative analysis of blood flow by orthogonal polarization spectral imaging were performed at 1 and 24 hours and on the seventh post-operative day. RESULT: Bands IV, V, and VI presented no flow independent of time. The functional capillary density group B was higher than that of groups C and P, primarily after 24 hours. All groups showed an increase in D with time but reached similar final distances (C = 2.73, B = 2.78 and P = 2.70 cm. Moreover, the percentage of viable areas remained at approximately 50%. The orthogonal polarization spectral imaging was useful to assess viability by counting fields with and without blood flow. CONCLUSIONS: Functional capillary density values were higher in the buflomedil group compared to the control and pentoxifylline groups in this model. Functional capillary density did not influence D or the percentage of VA, and the technique showed favorable potential to assess/predict the viability of skin flaps within 1 h after surgery.

  15. Versatility of the facial artery myomucosal island flap in neopharyngeal reconstruction

    DEFF Research Database (Denmark)

    Frisch, Thomas

    2017-01-01

    BACKGROUND: The facial artery myomucosal (FAMM) island flap is a cheek flap, pedicled on the facial artery and suitable for small to medium-sized reconstructions of the oral cavity and neighboring areas. A novel transposition of the flap to the hypopharynx after laryngectomy is presented...... donor-site morbidity, and recipient tissue similarity count among the advantages. © 2016 Wiley Periodicals, Inc. Head Neck 39: E29-E33, 2017....

  16. Effect of intraoperative platelet-rich plasma and fibrin glue application on skin flap survival.

    Science.gov (United States)

    Findikcioglu, Fulya; Findikcioglu, Kemal; Yavuzer, Reha; Lortlar, Nese; Atabay, Kenan

    2012-09-01

    The experiment was designed to compare the effect of intraoperative platelet-rich plasma (PRP) and fibrin glue application on skin flap survival. In this study, bilateral epigastric flaps were elevated in 24 rats. The right-side flaps were used as the control of the left-side flaps. Platelet-rich plasma, fibrin glue, and thrombin had been applied under the flap sites in groups 1, 2, and 3, respectively. Five days later, all flap pedicles were ligated. Necrotic area measurements, microangiography, and histologic and immunohistochemical evaluations were performed to compare the groups. Platelet-rich plasma reduced necrotic area percentages as compared with other groups. Histologically and microangiographically increased number of arterioles were observed in PRP groups. Thrombin when used alone increased flap necrosis. Vascular endothelial growth factor, platelet-derived growth factor, and transforming growth factor β3 primary antibody staining showed increased neovascularization and reepithelialization in all PRP-applied flaps. This study demonstrated that PRP, when applied intraoperatively under the skin flap, may enhance flap survival. Thrombin used alone was found to be unsuitable in flap surgery.

  17. Reverse island flap with dorsal branch of the proper palmar digital artery for repair of distal finger skin defect in 60 cases%指掌侧固有动脉背侧支逆行岛状皮瓣修复手指远端皮肤缺损60例

    Institute of Scientific and Technical Information of China (English)

    郑晓东; 黄辉强; 陈锦涛; 张沛钠; 张先强; 吴喜钦

    2016-01-01

    目的 报道指掌侧固有动脉背侧支逆行岛状皮瓣修复手指远端皮肤缺损的临床疗效. 方法 自2011年1月至2015年1月,应用指掌侧固有动脉背侧支逆行岛状皮瓣修复手指远端皮肤缺损60例60指.其中示指30指,中指15指,环指10指,小指5指.切取皮瓣面积1.2cm×1.7cm~3.2cm×3.6cm,皮瓣内携带指同有神经背侧支与创面指神经断端进行显微修复,重建皮肤的感觉.供区取腕部或上臂内侧远端全厚植皮.采用英国医学研究会对感觉评定标准对感觉恢复进行评定. 结果 本组60例60指,皮瓣全部成活.12指皮瓣出现张力性水泡,经拆线后,皮瓣顺利成活.随访根据中华医学会手外科学会上肢部分功能评定试用标准TAM法评定:优50指,良10指,优良率100%;48指皮瓣感觉恢复至S4级,12指恢复至S3级;两点辨别觉5~8mm,平均6.5 mm;患者远、近指间关节平均活动度恢复优良.皮瓣肤色红润,质地柔软,无臃肿,无色素沉着,无畏寒表现,无瘢痕增生及挛缩,皮肤痛觉无过敏及再次手术. 结论 此皮瓣对于手指远端皮肤缺损修复是一种简单易行、不损伤主要动脉及神经、感觉恢复良好、术后并发症少、皮瓣成活优良的方法,值得基层医院推广.%Objective To explore the clinical effect of dorsal digital artery reverse island flap in the repair of distal finger skin defect.Methods From January,2011 to January,2015,60 fingers of 60 cases with dorsal branch of the digital artery were used to repair the defect of the distal finger skin.The 30 refers to the index finger,middle finger 15 fingers,10 ring fingers and 5 little fingers.Harvested area of 1.2 cm ×1.7 cm to 3.2 cm × 3.6 cm,the wrist or distal medial arm full thickness skin graft donor site.Evaluation of sensory recovery by the British Medical Research Association.Results All flaps survived.Twelve finger flap tension blisters,and the flaps survived after the stitches.Follow-up of 60 cases

  18. SIMF和FSG修复老年患者颊癌术后缺损的对照研究%Control study on submental island flap and free skin graft in buccal reconstruction of buccal defects after resection of buccal cancers by in aged patients

    Institute of Scientific and Technical Information of China (English)

    梁刚; 郑田; 季平; 何平; 赵洪伟

    2014-01-01

    Objective To observe and evaluate the clinical effect of submental island myocutaneous flap(SIMF) and free skin graft(FSG) for the reconstruction of buccal defect resulted from the buccal carcinomas .Methods Forty-four aged aging patients di-agnosed with the buccal carcinomas were operated by the total dissection of primary tumor and selective neck dissection and recon-structed simultaneously with SIMF(19 cases) and FSG(25 cases) .The degree of postoperative cheek shape ,limitation of mouth o-pening ,speech sound ,and function of chewing were observed and analyzed .Results Eighteen SIMFs were completely survived .The residual muscle flap had a good blood supply after the debridement of skin island in one case ,the successful rate of flaps was 94 .7%(18/19) while 100% (25/25) .The donor site of SIMF was sutured directly .Follow-up was taken in 12 months for all patients .In SIMF group ,the degree of postoperative cheek shape ,limitation of mouth opening ,speech sound ,and function of chewing were bet-ter than those of FSG group in FSG group(P0 .05) .Conclusion The submental island flap is an excellent choice for the reconstruction of cheek defects in aging patients af-ter resection of buccal carcinoma .With acceptable cosmetic ,functional results and reasonable oncological saftety ,SIMF has a prom-ising prospect in head and neck surgery .%目的:探讨颏下岛状皮瓣(SIMF)和游离皮片(FSG)在修复老年患者颊癌术后颊部缺损的临床应用效果。方法44例老年颊癌患者行颊癌根治术和颈淋巴清扫术后同期分别应用颏下SIMF(n=19)和FSG(n=25)修复颊部缺损。比较两组患者术后颊部外形恢复程度、开口受限程度、语音功能、咀嚼功能等情况。结果 SIM F组1例出现皮岛坏死,清创后发现肌瓣血运良好,其余全部成活,皮瓣移植成功率94.7%(18/19),供区直接拉拢缝合FSG组的移植成功率为100.0%(25/25

  19. Comparison of ischaemic preconditioning with surgical delay technique to increase the viability of single pedicle island venous flaps: an experimental study.

    Science.gov (United States)

    Ceylan, Refika; Kaya, Burak; Çaydere, Muzaffer; Terzioğlu, Ahmet; Aslan, Gürcan

    2014-12-01

    The aim of the present study was to investigate the effect of ischaemic preconditioning compared with the surgical delay procedure in an effort to increase the survival rate of single pedicle island venous flaps. Eighteen male Wistar albino rats (250-350 g) were included. A 3 × 4 cm flap was planned at the right lower abdomen of the rat. Superficial epigastric vein constituted the pedicle of the flap. The rats were divided into three groups, each consisting of six rats. In the control group, a single pedicle venous island flap was elevated on each rat and no other surgical procedure was performed. In the ischaemic preconditioning group, ischaemic preconditioning was performed and, in the surgical delay procedure group, the surgical delay technique was performed before flap elevation. The mean necrosis areas were 56.85 ± 14.60%, 28.73 ± 15.60%, and 12.08 ± 3.65% in the control, ischaemic preconditioning, and surgical delay procedure groups, respectively. The necrosis areas were significantly smaller in the ischaemic preconditioning group and surgical delay procedure groups compared to the control group (p = 0.004 and p surgical delay procedure groups. Histopathological parameters including necrosis, abscess formation, and skin ulceration scores were significantly lower in the ischaemic preconditioning group than in the control group, whereas the study groups were similar. In conclusion, ischaemic preconditioning may serve as an adjuvant technique in increasing venous island flap viability.

  20. Effects of Rosmarinus officinalis on the survivability of random-patterned skin flaps: an experimental study.

    Science.gov (United States)

    Ince, Bilsev; Yildirim, Alpagan Mustafa; Okur, Mehmet Ihsan; Dadaci, Mehmet; Yoruk, Ebru

    2015-04-01

    Improving survival of skin flaps used in soft-tissue reconstruction is clinically an important goal, and several systemic and local agents have been used for this purpose. However, a substance that prevents the flap necrosis has not yet been defined. This study aimed to investigate whether a Rosmarinus officinalis extract could improve the skin flap survival. In this study, 21 Wistar albino rats were divided into three groups. Rectangular 8 × 2 cm random-pattern flaps were elevated from the back of the rats. Group I was considered the control group. In Group II, a 0.5-cc of Rosmarinus officinalis oil was applied with an ear bud to the flap area 30 minutes before the flap elevation. After suturing the flaps to their location, the oil was administered twice a day for a week. In Group III, 0.5 cc of the oil was applied twice a day to the area that was elevated for a week until surgery. At the end of the week, the flaps were sutured to their location, and wiped postoperatively twice a day for a week with the oil. Mean percentage of these areas was found to be 29.81%, 58.99%, and 67.68% in Group I, Group II, and Group III, respectively. The mean percentage of the flap survival areas and vessel diameters were significantly greater in the Groups II and III than in the control group (p Rosmarinus officinalis extract can increase the flap survivability.

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

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    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.

  2. Pedicled prelaminated capsular flaps for coverage of skin defect in a rat model.

    NARCIS (Netherlands)

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

    2009-01-01

    SUMMARY: In reconstructive surgery defects are closed using pedicled or free flaps. By raising these flaps the reconstructive surgeon creates new defects, which in turn are closed primarily or with the use of skin grafts. Inevitably, this results in extra scars that may be visible and may also lead

  3. Nasal-skin-fold transposition flap for upper lip reconstruction in a French bulldog.

    Science.gov (United States)

    Benlloch-Gonzalez, Manuel; Lafarge, Stéphanie; Bouvy, Bernard; Poncet, Cyrill

    2013-10-01

    Upper-lip reconstruction after mast-cell tumor-resection in a French bulldog was achieved by using a transposition flap from the nasal-skin-fold and an oral mucosal flap. The new technique is an alternative for reconstruction of extensive upper-lip defects in brachycephalic dogs and achieves satisfactory functional and cosmetic results.

  4. Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face.

    Science.gov (United States)

    Longo, Benedetto; Laporta, Rosaria; Pagnoni, Marco; Campanale, Antonella; Grippaudo, Francesca Romana; Santanelli Di Pompeo, Fabio

    2015-03-01

    Reconstruction of large defects of the lateral region of the face is rather challenging due to the unique color, texture, and thickness of soft tissues in this area. Microsurgical free flaps represent the gold standard, providing superior functional and aesthetic restoration. Purpose of this study was to assess reliability of skin-grafted latissimus dorsi (LD) flap, for a pleasant and symmetric reconstruction of the lateral aesthetic units of the face compared to a control group of patients addressed to perforator flaps. From November 2008 to June 2012, 5 patients underwent skin-grafted LD flap reconstruction of defects involving the lateral aesthetic units of the face, with 8.1 ± 0.5 × 9.7 ± 1.3 cm mean size. A 1-to-4 Likert scale was used to assess skin color, texture, shape, and bulkiness. Using the Pressure-Specified Sensory Device epicritic, proprioceptive, and protopathic sensitivities were tested. Outcomes were compared with those of a control group of 5 patients addressed to reconstruction with perforator flaps (3 anterolateral thigh flap, 2 vertical deep inferior perforator flap). At mean 21-month follow-up all flaps healed uneventfully without need for revisions, all developing more satisfactory results in terms of skin color (P = 0.028) and texture (P = 0.021) match, shape (P = 0.047) and bulkiness (P = 0.012) compared with perforator flaps. No differences in epicritic, proprioceptive, and protopathic sensitivities were observed (P > 0.05) between the two groups. Skin-grafted LD flap may be a suitable option for reconstruction of wide defects of the lateral aesthetic units of the face.

  5. Pre-expanded Intercostal Perforator Super-Thin Skin Flap.

    Science.gov (United States)

    Liao, Yunjun; Luo, Yong; Lu, Feng; Hyakusoku, Hiko; Gao, Jianhua; Jiang, Ping

    2017-01-01

    This article introduces pre-expanded super-thin intercostal perforator flaps, particularly the flap that has a perforator from the first to second intercostal spaces. The key techniques, advantages and disadvantages, and complications and management of this flap are described. At present, the thinnest possible flap is achieved by thinning the pre-expanded flap that has a perforator from the first to second intercostal spaces. It is used to reconstruct large defects on the face and neck, thus restoring function and cosmetic appearance. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Introducing the SKIN score: a validated scoring system to assess severity of mastectomy skin flap necrosis.

    Science.gov (United States)

    Lemaine, Valerie; Hoskin, Tanya L; Farley, David R; Grant, Clive S; Boughey, Judy C; Torstenson, Tiffany A; Jacobson, Steven R; Jakub, James W; Degnim, Amy C

    2015-09-01

    With increasing use of immediate breast reconstruction (IBR), mastectomy skin flap necrosis (MSFN) is a clinical problem that deserves further study. We propose a validated scoring system to discriminate MSFN severity and standardize its assessment. Women who underwent skin-sparing (SSM) or nipple-sparing mastectomy (NSM) and IBR from November 2009 to October 2010 were studied retrospectively. A workgroup of breast and plastic surgeons scored postoperative photographs using the skin ischemia necrosis (SKIN) score to assess depth and surface area of MSFN. We evaluated correlation of the SKIN score with reoperation for MSFN and its reproducibility in an external sample of surgeons. We identified 106 subjects (175 operated breasts: 103 SSM, 72 NSM) who had ≥1 postoperative photograph within 60 days. SKIN scores correlated strongly with need for reoperation for MSFN, with an AUC of 0.96 for SSM and 0.89 for NSM. External scores agreed well with the gold standard scores for the breast mound photographs with weighted kappa values of 0.82 (depth), 0.56 (surface area), and 0.79 (composite score). The agreement was similar for the nipple-areolar complex photographs: 0.75 (depth), 0.63 (surface area), and 0.79 (composite score). A simple scoring system to assess the severity of MSFN is proposed, incorporating both depth and surface area of MSFN. The SKIN score correlates strongly with the need for reoperation to manage MSFN and is reproducible among breast and plastic surgeons.

  7. Estudo da ação da estreptoquinase e do alopurinol em retalhos cutâneos em ilha submetidos à isquemia prolongada: estudo experimental em ratos Study of the effect of streptokinase and allopurinol in island skin flaps submitted to prolonged ischemia: experimental study in rats

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    Tatiana de Moura

    2009-01-01

    Full Text Available OBJETIVO: Estabelecer relação entre a sobrevivência de retalhos cutâneos em ilha submetidos à isquemia prolongada e o uso da estreptoquinase e do alopurinol administrados após o período de isquemia prolongado. MÉTODOS: Foram utilizados 48 ratos machos da raça Wistar, com peso entre 300 e 350g, divididos em quatro grupos com 12 cada um, sendo; grupo controle, alopurinol, estreptoquinase e associação de alopurinol com estreptoquinase, submetidos à dissecção de retalho epigástrico em ilha, seguido de clampeamento do feixe vascular, por oito horas em isquemia mista normotérmica. Após este período, as pinças foram retiradas e cada animal recebeu o esquema terapêutico proposto através de injeção intravenosa. A análise da sobrevivência dos retalhos foi realizada no sétimo dia de pós-operatório. Foram realizadas análises descritivas (% de área necrótica e de variâncias, bem como comparações múltiplas de Dunnett T3 entre os quatro grupos e o teste da mediana. RESULTADOS: O grupo controle apresentou em média 79,88% de necrose da área total. Aqueles que receberam alopurinol apresentaram em média 64,05% de necrose e o grupo que recebeu estreptoquinase apresentou em média 55,52% de necrose. Com a associação das duas drogas, os ratos apresentaram 54,30% em média de necrose do retalho. Aplicando o teste Dunnett e o teste da mediana verificou-se de que o grupo estreptoquinase é o com menor percentual de necrose neste estudo. CONCLUSÃO: A administração sistêmica da estreptoquinase após oito horas de isquemia mista normotérmica resultou em aumento da sobrevivência de retalhos epigástricos em ilha em ratos, quando comparada à administração de alopurinol, associação do alopurinol e estreptoquinase e do grupo controle.BACKGROUND: To establish a relation between the survival rate of island skin flaps submitted to prolonged ischemia and the effect of streptokinase and allopurinol administered after the ischemic

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

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    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.

  9. New advances in the mesenchymal stem cells therapy against skin flaps necrosis

    Institute of Scientific and Technical Information of China (English)

    Fu-Gui; Zhang; Xiu-Fa; Tang

    2014-01-01

    Mesenchymal stem cells(MSCs), multipotential cells that reside within the bone marrow, can be induced to differentiate into various cells, such as osteoblasts, adipocytes, chondrocytes, vascular endothelial progenitor cells, and other cell types. MSCs are being widely studied as potential cell therapy agents due to their angiogenic properties, which have been well established by in vitro and in vivo researches. Within this context, MSCs therapy appears to hold substantial promise, particularly in the treatment of conditions involving skin grafts, pedicle flaps, as well as free flaps described in literatures. The purpose of this review is to report the new advances and mechanisms underlying MSCs therapy against skin flaps necrosis.

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2013-06-01

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

  12. [Efficacy of the treatment of pharyngeal fistula through pectoralis major myocutaneous flap combined with fistula local skin inversion in 20 cases].

    Science.gov (United States)

    Wang, Q; Liu, Y H; Hu, G Q; Zhao, Y

    2016-08-01

    To sum up the efficacy of treatment of pharyngeal fistula through pectoralis major myocutaneous flap combined with fistula local skin inversion in 20 patients. A retrospective analysis of the therapeutic efficacy in 20 cases of laryngeal and laryngopharyngeal cancer with postoperative pharyngeal fistula, to whom double-deck repairing were operated on through pectoralis major myocutaneous island flap combined with inversion of skin around fistula from January 2010 to December 2013. 20 patients were treated by improved pharyngeal fistula inverting suture of pectoralis major myocutaneous flap combined with the skin around the pharyngeal fistula. Flap around the fistula were sutured without tension formation. The pectoralis major myocutaneous flaps were sutured without tension formation covering the inner flanging flap wound. 20 patients were on a nasogastric liquid diet after operation for one week and received antibiotics to prevent infection. Then they all took liquid diet after one week, and had extubation safely later. Stitches were removed 10 more days later. All the twenty patients were recovered successfully, among them, 16 cases recovered in stage Ⅰ and left the hospital 10 days later, 4 cases recovered in stage Ⅱ and left the hospital 20 days later. All the 4 cases recovered in stage Ⅱ were treated with radiotherapy. Fistulas less than 1 cm occurred near their anastomotic stomas at 7 to 14 days after operation. They were healed well by dressing change and pressure dressing. No recurrence was observed during the six months follow-up. Pectoralis major myocutaneous flap combined with fistula local skin inversion is a good way to repair pharyngeal fistula, and it is suitable for the laryngeal and laryngopharynx cancer patients with postoperative throat fistula in an internal diameter larger than 2 cm.

  13. The reverse digital artery island flap: clinical experience in 120 fingers.

    Science.gov (United States)

    Han, S K; Lee, B I; Kim, W K

    1998-04-01

    Fingertip injuries represent the most common type of injuries seen in the upper extremity. Their management is functionally and aesthetically important but at the same time very controversial. The aim of this study is to report usefulness and postoperative results of reverse digital artery island flaps for fingertip reconstruction. From July of 1984 to December of 1995, 120 fingers in 110 patients with defects of the distal phalanx were reconstructed by reverse digital artery island flaps at Korea University Guro Hospital. We reviewed the medical records of our cases and analyzed them in several aspects. In 21 cases, neurorrhaphy was performed to improve sensibility. In the majority of the cases, the defect was covered primarily, whereas in 27 cases it was covered secondarily after composite graft, replantation, and so on. All the flaps survived except for one. Long-term follow-up for more than 6 months was possible in 44 fingers in 41 patients. Light touch and temperature sensation could be detected in all the evaluated flaps. The mean values of the static two-point discrimination test in sensate and insensate flaps were 6.2 and 10.2 mm, respectively. The reverse digital artery island flap is a safe and reliable procedure with a high survival rate and therefore is an excellent choice for coverage of fingertip defects.

  14. Paraexstrophy skin flaps for the primary closure of exstrophy in boys: outmoded or updated?

    Science.gov (United States)

    Purves, J Todd; Gearhart, John P

    2008-10-01

    We evaluated the current application of Duckett paraexstrophy skin flaps for bladder exstrophy reconstruction. We reviewed the records of cases of classic exstrophy treated at our institution between September 1993 and March 2007. A total of 21 patients were identified in whom modified Duckett paraexstrophy skin flaps were used in bladder closure at our institution. Another 12 patients were referred during the same time after closure with complications with flap use. Of the 21 patients who underwent closure at our institution with our modified version of the Duckett flaps 1 (4%) had a complication, that is urethral stricture. This responded to internal urethrotomy and daily intermittent catheterization for 4 months, and the stricture stabilized. Four of the 12 referred patients responded to multiple urethral dilations, 3 underwent open repair with a buccal graft, 2 received a full-thickness skin graft and 3 underwent internal urethrotomy with daily intermittent catheterization for 4 months. Of our 21 patients with internal treatment 14 underwent bladder neck repair, 5 underwent epispadias repair and 2 were awaiting further reconstruction. Six of the 12 referred patients underwent bladder neck repair, 4 underwent epispadias repair and 2 were awaiting further reconstruction. By modifying our version of the Duckett paraexstrophy skin flaps we have lowered our complication rate significantly. While overall use of these flaps has continued to decrease, when they are required, these modifications help avoid complicating strictures and their sequelae in the bladder and upper urinary tract.

  15. Subcutaneous pedicle Limberg flap for repairing skin defects in the face

    Institute of Scientific and Technical Information of China (English)

    LI Jun-hui; XING Xin; OUYANG Tian-xiang; LI Ping; XU Jie; GUO En-tan

    2005-01-01

    Objective:To investigate the effect of a subcutaneous pedicle Limberg flap for the reconstruction of medium-sized skin defects in the face following skin tumor or scar excision. Methods: From August 2002 to June 2004,the subcutaneous pedicle Limberg flap was designed to repair facial skin defects in 17 patients(19 flaps),and the size of the lesions ranged from 2.0 cm×1.9 cm to 5.0 cm×4.5 cm.The operation was performed under general anesthesia in 2 children,and under local anesthesia in the remaining 15 patients. Results: All flaps survived with primary healing postoperatively.With a follow-up from 1 to 22 months,neither short-term nor long-term postoperative complications such as flap necrosis,hematoma,infection,visible dog-ear and trap door deformity were found,and functionally and cosmetically satisfactory outcomes were achieved. Conclusion: This subcutaneous pedicle Limberg flap provides a competitive repair alternative for the treatment of medium-sized skin defects in the face.

  16. [Ketanserin and random skin flaps. An experimental study in the rat].

    Science.gov (United States)

    Achouche, J; Teisseire, B; Laccourreye, O; Hadjean, E

    1994-04-01

    This prospective randomised study in a rodent model was designed to analyse the value of a serotonin antagonist, ketanserin, on the survival of random skin flaps in Wistar rats. Our study demonstrates the statistical value of this molecule. The surface of skin necrosis was statistically lower in the group of rats treated with pre and post operative subcutaneous injection of ketanserin.

  17. The prepuce free flap in 10 patients : modifications in flap design and surgical technique

    NARCIS (Netherlands)

    Werker, Paul M N

    The prepuce free flap was used in 10 oral and oropharyngeal reconstructions. During the course of this study, various modifications took place. Residual penile skin necrosis and skin island necrosis early in the series led to modification of flap design. This solved the donor-site problem by placing

  18. The prepuce free flap in 10 patients : modifications in flap design and surgical technique

    NARCIS (Netherlands)

    Werker, Paul M N

    2002-01-01

    The prepuce free flap was used in 10 oral and oropharyngeal reconstructions. During the course of this study, various modifications took place. Residual penile skin necrosis and skin island necrosis early in the series led to modification of flap design. This solved the donor-site problem by placing

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

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    Fazal A

    2012-01-01

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

  20. Evaluating the Efficacy of a Sternocleidomastoid Flap via Galvanic Skin Responses in Superficial Parotidectomy.

    Science.gov (United States)

    Basut, Oguz; Noyan, Behzat; Demirci, Ugur

    2014-01-01

    In the present study, we evaluated the efficacy of flaps via measurement of galvanic skin responses (GSR) in patients who had undergone superficial parotidectomy either with or without sternocleidomastoid (SCM) muscle flaps. Retrospective study design was used. The setting included University of Uludag School of Medicine Department of Otorhinolaryngology. Eleven patients who had undergone superficial parotidectomy for benign diseases in our clinic between June 2003 and August 2006 were included in the study. SCM muscle flaps were used in four patients. The GSR of the patients were measured using a MP 30 System. The Mann-Whitney U test was used for the analysis of data. There were complaints that resembled Frey's syndrome in three patients in whom flaps had not been performed. Patients with flaps had no complaints. In patients with flaps, no significant GSR changes were observed between the control and operated sides (P > 0.05). In patients without flaps, the GSR levels were significantly higher on the operated side compared to the control side (P SCM flap is an efficient method by which to prevent Frey's syndrome, and the GSR test is beneficial both in diagnosiing and determining the severity of the disease as well as evaluating the efficacy of surgical techniques used to prevent Frey's syndrome.

  1. Reconstruction of finger pulp defect with reversed fasciocutaneous island flap from same finger

    Institute of Scientific and Technical Information of China (English)

    LU Yao-jun; HONG Guang-xiang; XU Nan-wei; HU Zhi-yong; SHAO Lei

    2007-01-01

    Objective: To investigate the clinical curative effect of reconstruction of finger pulp defect by anastomosis of reversed fasciocutaneous island flap with dorsal branch of the digital nerve of the same finger. Methods: The restoration of finger pulp defect with fasciocutaneous island flap from the same finger was conducted in 25 cases (30 fingers) from January 2002 to June 2003. Nine patients (11 fingers) whose flaps with dorsal branch of the digital nerve anastomosed with the digital inherent nerve around the surface of the wound were Group A and the others were Group B. The follow-up was carried out at 3 and 9 months after the operation to observe the shape of finger pulp and the sense restoration between two groups.Results: All flaps of 25 cases (30 fingers) survived. Three months after operation, the patients had fully grown finger pulps and recovered the superficial sensation and tactile sense of finger pulps. The two point discrimination on average was 5.00 mm ± 0.23 mm in Group A and 6.00 mm ± 0.30 mm in Group B. The difference between two groups was highly significant. Nine months later, their senses of finger pulps between two groups were recovered basically. Conclusions:The reversed fasciocutaneous island flap from the same finger is the first choice to reconstruct the finger pulp defect, and the anastomosis of dorsal branch of the digital nerve shall be determined according to the specific condition.

  2. [Assessment of life quality of for patients after tongue reconstruction with radial forearm free flap, anterolateral thigh perforator flap or submental island flap].

    Science.gov (United States)

    Zhao, Yang; Xiang, Jing-Zhou; Liu, Fa-Yu

    2017-02-01

    The aim of this study was to evaluate operation-related factors and quality of life (QOL) for patients after tongue reconstruction with radial forearm free flap (RFFF), anterolateral thigh perforator flap (ALT) or submental island flap (SIF). Totally 59 patients, diagnosed as tongue carcinoma, received glossectomy and simultaneous reconstruction with free flaps including RFFF, ALT or SIF in the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University from October 2004 to October 2014. All patients were followed up for 6 months and completed the University of Washington Quality of Life scale Version 4 questionnaires. The postoperative QOL was compared among the three groups. The data were analyzed using SPSS 21.0 software package. The operation duration of SIF group was significantly shorter than those of RFFF group or ALT group (Pspeech and postoperative pain among the 3 groups. In summary, there may be functional disability for patients after glossectomy and simultaneous reconstruction. The quality of life would be acceptable after tongue reconstruction with RFFF, ALT and SIF.

  3. Hypopharynx and larynx defect repair after resection for pyriform fossa cancer with a platysma skin flap.

    Science.gov (United States)

    Cai, Qian; Liang, Faya; Huang, Xiaoming; Han, Ping; Pan, Yong; Zheng, Yiqing

    2015-02-01

    We used a platysma skin flap to repair larynx and hypopharynx defects to improve postoperative laryngeal function in patients with pyriform fossa cancer. Larynx-sparing surgery and postoperative radiotherapy were used in 10 patients with pyriform fossa cancer. The surgical approaches of lymph node dissection of the neck, vertical partial laryngectomy, and pyriform fossa resection were adopted, and a platysma skin flap was used to repair the resulting defects. In this group, the overall 3-year survival rate was 75% according to the Kaplan-Meier analysis, and the local control rate was 90%. Additionally, all patients were able to speak fluently with mild-to-moderate hoarseness. The tracheal tube was removed in all cases. Laryngeal fistulas were observed in 1 patient during radiotherapy. In conclusion, a platysma skin flap can be used to rebuild the larynx and hypopharynx in larynx-sparing resection for pyriform fossa cancer. These patients can obtain good postoperative function in swallowing, breathing, and pronunciation.

  4. Sensory recovery of non-innervated free flaps and nasolabial island flaps used for tongue reconstruction of oncological defects.

    Science.gov (United States)

    Zhu, L; Zhang, J; Song, X; Hou, W; Wu, S; Chen, W; Svensson, P; Wang, K

    2017-10-01

    The aims of this study were to assess sensory recovery and impact on life quality after tongue reconstruction of oncological defects using different flap types. Thirty-two patients who underwent tongue reconstruction for oncological defects 9·3 months after surgery with non-innervated radial forearm free flaps (RFFFs) (N = 16), non-innervated anterolateral thigh free flaps (ALTFFs) (N = 8) and nasolabial island flaps (NLIFs) (N = 8), and 20 age- and gender-matched healthy controls participated in the study. The modalities assessed were cold detection threshold, warm detection threshold (WDT), cold pain threshold, heat pain threshold (HPT), mechanical detection threshold (MDT), mechanical pain threshold (MPT) and the Chinese version of Oral Health Impact Profile-49. ALTFFs was significantly more sensitive than RFFFs (P = 0·005) and NLIFs (P = 0·014) for WDT, and showed a better sensory recovery than RFFFs for HPT (P = 0·011). ALTFFs and NLIFs showed significantly better sensory recovery than RFFFs for MDT (P sensory recovery for MPT, followed by ALTFFs and lastly RFFFs (P = 0·004). NLIFs also showed the least impact on quality of life measures related to psychological discomfort compared to RFFFs and ALTFFs (P sensory recovery in RFFFs did not depend on gender and post-operative radiotherapy (P > 0·05). Different flaps for tongue reconstruction of oncological defects appear to have different patterns of sensory recovery and impact on quality of life measures. A longer follow-up period and larger number of participants will be needed in future studies. © 2017 John Wiley & Sons Ltd.

  5. Wound tension in rhytidectomy. Effects of skin-flap undermining and superficial musculoaponeurotic system suspension.

    Science.gov (United States)

    Burgess, L P; Casler, J D; Kryzer, T C

    1993-02-01

    This study was conducted to determine the effects of skin-flap undermining and superficial musculoaponeurotic system (SMAS) suspension on wound-closing tension. Nine sides from five fresh-frozen cadavers were used, with closing tension measured at the two main anchor points, anteriorly (A) and posteriorly (P), with and without SMAS plication for minimal (MIN), intermediate (INT), and maximal (MAX) skin-flap undermining. Results indicated that closing tension was significantly decreased with SMAS plication, both A and P, for all three levels of skin undermining. The average decrease in closing tension with SMAS plication was: A-MIN 191 g, A-INT 95 g, A-MAX 83 g, P-MIN 235 g, P-INT 68 g, and P-MAX 70 g (P tension decreased with wider skin-flap undermining, both with and without SMAS plication. The tension-reducing effect of SMAS plication was decreased with wider skin-flap undermining. Regression analysis determined a second-order exponential curve relating closing tension to skin excision.

  6. Salient Points in Reconstruction of Nasal Skin after Tumor Ablation with Local Flaps

    Science.gov (United States)

    Ebrahimi, Ali; Motamedi, Mohammad Hosein Kalantar; Nejadsarvari, Nasrin; Ebrahimi, Azin; Rasouli, Hamid Reza

    2016-01-01

    Objective: A variety of nasal skin reconstruction methods are available to meet the esthetic patient's needs. In this article, we review some of modifications of these procedures and share our experience in reconstruction of different parts of the nasal skin following skin tumor ablation. Patients and Methods: From January 2010 to January 2014, 171 patients underwent nasal skin reconstruction after excising cancerous lesions of the involved nasal skin. The patient's history, pre- and post-operation photographs, and the surgery data were collected and assessed. Demographic data related to the type of cancer, defect size and location, type of reconstruction were collected. Results: A variety of local flaps were used based on location and defect features. Nearly all flaps healed primarily without postsurgical significant complications. Conclusion: According to the results and the outcomes of the operations, we concluded that a certain flaps are more effective than others in nasal skin reconstruction. Local flap reconstruction of the nose has good esthetic result with low complication rate.

  7. [Effectiveness of dorsal metacarpal island flap for treating scar contracture of finger web].

    Science.gov (United States)

    Qian, Jun; Rui, Yongjun; Zhang, Quanrong; Xue, Mingyu; Zhang, Zhihai

    2011-11-01

    To investigate the effectiveness of dorsal metacarpal island flap for treating scar contracture of the finger web. Between June 2009 and December 2010, 10 patients with scar contracture of the finger web were treated. There were 6 males and 4 females with an average age of 30 years (range, 14-57 years). Scar contracture was caused by injury in 8 cases, by burn in 1 case, and by operation in 1 case. The locations were the 1st web space in 1 case, the 2nd web space in 3 cases, the 3rd web space in 5 cases, and the 4th web space in 1 case. The disease duration was 3 to 9 months with an average of 5 months. The maximum abduction was 10-20 degrees. After web space scar release, the dorsal metacarpal island flap (3.5 cm x 1.2 cm-4.0 cm x 2.0 cm in size) was used to reconstruct web space (2.0 cm x 1.0 cm-3.0 cm x 1.8 cm in size). The donor site was directly sutured or repaired with local flaps. At 2 days after operation, necrosis occurred in 1 flap, which healed by extractive treatment. The other flaps survived and wound healed by first intention; all the flaps at donor sites survived and incision healed by first intention. Ten patients were followed up 6 to 15 months (mean, 9 months). The reconstructed web space had good appearance, the maximum abduction was 80 degrees in 1 case of the 1st web space scars contracture, and the maximum abduction was 35-45 degrees (mean, 40 degrees) in the other 9 cases. In 8 scar patients causing by injury, no scar contracture recurred during follow-up. It can achieve good results in appearance and function to use dorsal metacarpal island flap for treating scar contracture of the finger web.

  8. [Reconstruction of zygomatic-facial massive defect using modified bilobed flap after resection of skin cancer].

    Science.gov (United States)

    Ling, Bin; Abass, Keremu; Hu, Mei; Yin, Xiaopeng; Hu, Lulu; Lin, Zhaoquan; Gong, Zhongcheng

    2013-01-01

    To investigate the clinical application of the modified bilobed flap in the reconstruction of zygomatic-facial massive defect after resection of skin cancer. Between August 2009 and October 2011, 15 patients with skin cancer in the zygomatic-facial region underwent defect reconstruction using modified bilobed flaps after surgical removal. There were 12 males and 3 females, aged 52-78 years (mean, 64.1 years). The disease duration was 1-14 months (mean, 4.6 months). Among the patients, there were 11 cases of basal cell carcinoma and 4 cases of squamous cell carcinoma; 1 patient had infection and the others had no skin ulceration; and tumor involved the skin layer in all patients. According to TNM staging, 13 cases were rated as T2N0M2 and 2 cases as T3N0M3. The defect size ranged from 4.0 cm x 2.5 cm to 6.5 cm x 4.0 cm after cancer resection. The modified bilobed flaps consisting of pre-auricular flap and post-auricular flap was used to repair the defect after cancer resection. The size ranged from 4.0 cm x 2.5 cm to 6.5 cm x 4.0 cm of the first flap and from 3.0 cm x 2.0 cm to 5.0 cm x 3.0 cm of the second flap. Partial incision dehiscence occurred in 1 case, and was cured after dressing change; the flaps survived and incision healed primarily in the other cases. Fourteen patients were followed up 12-24 months (mean, 18.7 months). No recurrence was found, and the patients had no obvious face asymmetry or skin scar with normal closure of eyelid and facial nerve function. At last follow-up, the results were very satisfactory in 5 cases, satisfactory in 7 cases, generally satisfactory in 1 case, and dissatisfactory in 1 case. The pre- and post-auricular bilobed flaps could be used to reconstruct the massive defects in the zygomatic-facial region after resection of skin cancer.

  9. Effect of botulinum toxin A and nitroglycerin on random skin flap survival in rats.

    Science.gov (United States)

    Ghanbarzadeh, Kourosh; Tabatabaie, Omid Reza; Salehifar, Ebrahim; Amanlou, Massoud; Khorasani, Ghasemali

    2016-01-01

    A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive. To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model. The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline. BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P<0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45). BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.

  10. Skin-sparing mastectomy and immediate reconstruction with DIEP flap after breast-conserving therapy

    Science.gov (United States)

    Andree, Christoph; Munder, Beatrix; Seidenstuecker, Katrin; Richrath, Philipp; Behrendt, Philipp; Köppe, Tobias; Hagouan, Mazen; Audretsch, Werner; Nestle-Krämling, Carolin; Witzel, Christian

    2012-01-01

    Summary Background Currently about 70% of women who suffer from breast cancer undergo breast-conserving therapy (BCT) without removing the entire breast. Thus, this surgical approach is the standard therapy for primary breast cancer. If corrections are necessary, the breast surgeon is faced with irritated skin and higher risks of complications in wound healing. After radiation, an implant-based reconstruction is only recommended in selected cases. Correction of a poor BCT outcome is often only solved with an additional extended operation using autologous reconstruction. Material/Methods In our plastic surgery unit, which focuses on breast reconstruction, we offer a skin-sparing or subcutaneous mastectomy, followed by primary breast reconstruction based on free autologous tissue transfer to correct poor BCT outcomes. Between July 2004 and May 2011 we performed 1068 deep inferior epigastric artery perforator (DIEP) flaps for breast reconstruction, including 64 skin-sparing or subcutaneous mastectomies, followed by primary DIEP breast reconstruction procedures after BCT procedures. Results In all free flap-based breast reconstruction procedures, we had a total flap loss in 0.8% (9 cases). Within the group of patients after BCT, we performed 41 DIEP flaps and 23 ms-2 TRAM flaps after skin-sparing or subcutaneous mastectomies to reconstruct the breast. Among this group we had of a total flap loss in 1.6% (1 case). Conclusions In cases of large tumour sizes and/or difficult tumour locations, the initial oncologic breast surgeon should inform the patients of a possibly poor cosmetic result after BCT and radiation. In our opinion a skin-sparing mastectomy with primary breast reconstruction should be discussed as a valid alternative. PMID:23197233

  11. Scrotal dartos-fascio-myo-cutaneous flaps for penis elongation after catastrophic iatrogenic skin shaft sub-amputation: A case of recovery using an extremely adaptable flap

    Directory of Open Access Journals (Sweden)

    Alessandro Innocenti, MD

    2016-01-01

    Discussion and conclusion: Various techniques are available for penile skin covering, such as skin grafts or cutaneous flaps. The skin of the scrotum seems to be the most suitable tissue to be used to reconstruct the skin covering of the shaft as it is the most similar. Dartos-fascio-myo-cutaneous flap is a single stage procedure that is easy and safe to perform. It can provide satisfactory cosmetic and functional results, offering a large amount of tissue, with minimal donor site morbidity.

  12. A RARE CASE REPORT OF SQUAMOUS CELL CARCINOMA OF URETHRA ARISING FROM SUBSTITUTED PENILE SKIN FLAP WITH BALANITIS XEROTICA OBLITERANS

    Directory of Open Access Journals (Sweden)

    Rana Pratap

    2016-06-01

    Full Text Available A 44-year-old male presented with ulcerative growth over dorsal penile shaft along with multiple urethrocutaneous fistula. A total penectomy, scrotal excision and perineal urethrostomy were done. Past history of treatment for penile urethral stricture due to Balanitis Xerotica Obliterans (BXO by substitution urethroplasty using pedicled preputial penile skin flap five years back. On gross as well as histopathological examination, the tumour was found to be arising from the skin flap used for substitution. This case highlights the malignant potential of skin affected by BXO and is probably the only case report where a skin flap has turned malignant.

  13. 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。

  14. Turned in fasciocutaneous island flap from face and neck based on subdermal microcirculation for reconstruction of the oral cavity following cancer surgery

    Directory of Open Access Journals (Sweden)

    Kalpesh Jayantkumar Gajiwala

    2016-01-01

    Full Text Available Background: The skin and soft tissues of the face and neck have a rich plexus of dermal-subdermal vessels, which creates the possibility of raising a fasciocutaneous flap based on this vascular supply. A turned in fasciocutaneous island flap (TIFCIF from an adjacent area of the defect can provide a simple substitute to many complex reconstructive procedures. Materials and Methods: Fifteen patients underwent wide excision for oral cancer and upper neck dissection, maintaining bone framework, between August 2010 and June 2014. The reconstruction was done with a 'turned in fasciocutaneous island flap' (TIFCIF from the upper neck-lower face based on subdermal superficial adipofascial microvascular network instead of a specific known feeder vessel. The upper cervical flap, the donor site, when raised during the initial incision and the upper neck dissection, was cut off from the facial artery, the submental artery, the superior thyroid and the transverse cervical arteries. The microcirculation depended largely on the rich vascular plexus formed of the branches of the superficial temporal and the maxillary arteries. The donor site was primarily closed in Fourteen of the Fifteen patients. Eight patients received post-surgery irradiation. Results: All the flaps survived and healed and withstood radiation well. Two patients had flap dehiscence from suture line, of which one needed reattachment while other a minor one healed by itself and one patient had occasional drooling. There was no difficulty in eating or swallowing. Conclusions: A random patterned TIFCIF based on superficial subdermal adipofascial microcirculation, formed of a rich vascular plexus in the face and neck region can provide a simple alternative for intraoral reconstruction.

  15. 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.

  16. Predictors of Proximal Interphalangeal Joint Flexion Contracture After Homodigital Island Flap.

    Science.gov (United States)

    Nakanishi, Akito; Omokawa, Shohei; Iida, Akio; Kaji, Daisuke; Tanaka, Yasuhito

    2015-11-01

    To identify independent predictors of postoperative proximal interphalangeal (PIP) joint contracture after direct-flow homodigital island flap transfer. Forty-four fingertip amputations in 39 patients treated with oblique triangular flaps were evaluated at a minimum of 1 year after surgery. Five variables were examined: patient age, injured finger, mechanism of injury, flap advancement distance, and time required for wound healing. Univariate and multivariate linear regression analyses were performed to identify the extent to which these variables affected the flexion contracture of the PIP joint. The average reduction in the passive extension angle of the PIP joint was 16° at final follow-up. Univariate analysis indicated significant correlations of PIP joint flexion contracture with age, injured finger, and time for wound healing, but no significant correlation with the distance the flap was advanced. Multivariate analysis indicated that the age and duration of wound healing were independent predictors of the flexion contracture of the PIP joint. Elderly people and cases with delayed wound healing are at risk for postoperative PIP joint contracture after homodigital flap transfer. Intervention with early hand therapy and orthotics may be useful in elderly patients with delayed wound healing. Prognostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. Topical application of nitrosonifedipine, a novel radical scavenger, ameliorates ischemic skin flap necrosis in a mouse model.

    Science.gov (United States)

    Fukunaga, Yutaka; Izawa-Ishizawa, Yuki; Horinouchi, Yuya; Sairyo, Eriko; Ikeda, Yasumasa; Ishizawa, Keisuke; Tsuchiya, Koichiro; Abe, Yoshiro; Hashimoto, Ichiro; Tamaki, Toshiaki

    2017-01-16

    Ischemic skin flap necrosis can occur in random pattern flaps. An excess amount of reactive oxygen species is generated and causes necrosis in the ischemic tissue. Nitrosonifedipine (NO-NIF) has been demonstrated to possess potent radical scavenging ability. However, there has been no study on the effects of NO-NIF on ischemic skin flap necrosis. Therefore, they evaluated the potential of NO-NIF in ameliorating ischemic skin flap necrosis in a mouse model. A random pattern skin flap (1.0 × 3.0 cm) was elevated on the dorsum of C57BL/6 mice. NO-NIF was administered by topical injection immediately after surgery and every 24 hours thereafter. Flap survival was evaluated on postoperative day 7. Tissue samples from the skin flaps were harvested on postoperative days 1 and 3 to analyze oxidative stress, apoptosis and endothelial dysfunction. The viable area of the flap in the NO-NIF group was significantly increased (78.30 ± 7.041%) compared with that of the control group (47.77 ± 6.549%, p NIF reduced oxidative stress, apoptosis and endothelial dysfunction, which were evidenced by the decrease of malondialdehyde, p22phox protein expression, number of apoptotic cells, phosphorylated p38 MAPK protein expression, and vascular cell adhesion molecule-1 protein expression while endothelial nitric oxide synthase protein expression was increased. In conclusion, they demonstrated that NO-NIF ameliorated ischemic skin flap necrosis by reducing oxidative stress, apoptosis, and endothelial dysfunction. NO-NIF is considered to be a candidate for the treatment of ischemic flap necrosis.

  18. 下腹部岛状皮瓣修复会阴部瘢痕畸形15例%Low abdomen island flap for the repair of pudendal scar

    Institute of Scientific and Technical Information of China (English)

    郭志谦; 张新合; 杨新蕾; 雷磊; 江碧川; 孟红阳

    2012-01-01

    目的:总结下腹部岛状皮瓣修复会阴部瘢痕畸形的临床经验.方法:回顾性分析下腹部岛状皮 瓣修复会阴部瘢痕挛缩畸形15例患者的临床资料,单纯采用以旋髂浅动静脉为蒂形成的皮瓣3例、单纯采用腹壁浅动静脉为蒂的皮瓣5例, 两组血管均包括在内的皮瓣7例.结果:所有皮瓣均存活,局部畸形纠正,患者满意,经随访6~48个月,皮瓣色泽良好,质 地柔软,排尿排便功能恢复正常,髋部活动无明显受限.结论:下腹部岛状皮瓣转移术可提高会阴部瘢痕畸形的修复质量.%Objective To evaluate the result of repairing the pudendal scar with low abdomen island flap. Metheods Fifteen cases which have been repaired by three types were summarized,including three cases with the island skin flap pedicled with the superficicel iliac circumflex artery,five cases with the island skin flap pedicled with superficial inferior epigastric artery and seven cases pedicled with both of them. Results All flaps survived satisfactorily.Sufferer approve of the change of local abmormality.Followed up for 6 to 48 months.the contour of skin flap were fine.the form of pudendum.function of emiction and defecate activity were normal. Conclution Low abdomen island flap can improve the quality of repairing the pudendal sea.

  19. The adverse effect of selective cyclooxygenase-2 inhibitor on random skin flap survival in rats.

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    Haiyong Ren

    Full Text Available BACKGROUND: Cyclooxygenase-2(COX-2 inhibitors provide desired analgesic effects after injury or surgery, but evidences suggested they also attenuate wound healing. The study is to investigate the effect of COX-2 inhibitor on random skin flap survival. METHODS: The McFarlane flap model was established in 40 rats and evaluated within two groups, each group gave the same volume of Parecoxib and saline injection for 7 days. The necrotic area of the flap was measured, the specimens of the flap were stained with haematoxylin-eosin(HE for histologic analysis. Immunohistochemical staining was performed to analyse the level of VEGF and COX-2 . RESULTS: 7 days after operation, the flap necrotic area ratio in study group (66.65 ± 2.81% was significantly enlarged than that of the control group(48.81 ± 2.33%(P <0.01. Histological analysis demonstrated angiogenesis with mean vessel density per mm(2 being lower in study group (15.4 ± 4.4 than in control group (27.2 ± 4.1 (P <0.05. To evaluate the expression of COX-2 and VEGF protein in the intermediate area II in the two groups by immunohistochemistry test .The expression of COX-2 in study group was (1022.45 ± 153.1, and in control group was (2638.05 ± 132.2 (P <0.01. The expression of VEGF in the study and control groups were (2779.45 ± 472.0 vs (4938.05 ± 123.6(P <0.01.In the COX-2 inhibitor group, the expressions of COX-2 and VEGF protein were remarkably down-regulated as compared with the control group. CONCLUSION: Selective COX-2 inhibitor had adverse effect on random skin flap survival. Suppression of neovascularization induced by low level of VEGF was supposed to be the biological mechanism.

  20. Designing Flaps for Closure of Circular and Semicircular Skin Defects.

    Science.gov (United States)

    Alvarado, Alfredo

    2016-01-01

    Removing skin lesions from the human body is a simple procedure, but closing the resulting defect may prove a difficult task. The surgeon quite often encounters a problem when the lesion is located in a confined anatomical area where the elasticity of the skin is limited or when the lesion is large. To obviate these difficulties, I present 4 new incisions for closure of circular and semicircular skin defects on difficult parts of the human body such as the scalp, face, axilla, back, and sacrococcygeal areas. This article describes a working model made of white bond paper that can be enlarged or reduced in size using a regular copying machine that can be prepared in advance of surgery to make sure that it adapts to a particular anatomical location. Also, it describes a geometrical analysis in order to determine the distortion of the minimal tension lines of the skin, skin wastage, and length of the suture lines. In summary, it is possible to use a variety of skin incisions, taking advantage of the minimal tension lines of the skin and also taking into consideration the anatomical characteristics of the region involved.

  1. Use of Systemic Rosmarinus Officinalis to Enhance the Survival of Random-Pattern Skin Flaps

    Science.gov (United States)

    İnce, Bilsev; Bilgen, Fatma; Gündeşlioğlu, Ayşe Özlem; Dadacı, Mehmet; Kozacıoğlu, Sümeyye

    2016-01-01

    Background Skin flaps are commonly used in soft-tissue reconstruction; however, necrosis can be a frequent complication. Several systemic and local agents have been used in attempts to improve skin flap survival, but none that can prevent flap necrosis have been identified. Aims This study aims to determine whether the use of systemic Rosmarinus officinalis (R. officinalis) extract can prevent flap necrosis and improve skin flap recovery. Study Design Animal experimentation. Methods Thirty-five Wistar albino rats were divided in five groups. A rectangular random-pattern flaps measuring 8×2 cm was elevated from the back of each rat. Group I was the control group. In Group II, 0.2 ml of R. officinalis oil was given orally 2h before surgery. R. officinalis oil was then applied orally twice a day for a week. In Group III, R. officinalis oil was given orally twice a day for one week before surgery. At the end of the week, 0.2 mL of R. officinalis oil was given orally 2 h before surgery. In Group IV, 0.2 mL of R. officinalis oil was injected subcutaneously 2 h before surgery. After the surgery, 0.2 mL R. officinalis oil was injected subcutaneously twice a day for one week. In Group V, 0.2 mL R. officinalis oil was injected subcutaneously twice a day for one week prior to surgery. At the end of the week, one last 0.2 mL R. officinalis oil injection was administered subcutaneously 2 h before surgery. After the surgery, 0.2 mL R. officinalis oil was injected subcutaneously twice a day for one week. Results The mean percentage of viable surface area was significantly greater (p<0.05) in Groups II, III, IV, and V as compared to Group I. Mean vessel diameter was significantly greater (p<0.05) in Groups II, III, IV, and V as compared to Group I. Conclusion We have determined that, in addition to its anti-inflammatory and anti-oxidant effects, R. officinalis has vasodilatory effects that contribute to increased skin flap survival. PMID:27994918

  2. Experimental model for the study of soft tissue fixation methods on skin-pericranium flaps in rats

    National Research Council Canada - National Science Library

    Cavazana, William César; Cuman, Roberto Kenji Nakamura; Takeshita, Wilton Mitsunari; Passeri, Luis Augusto

    2013-01-01

    PURPOSE: To develop an experimental model to study and radiologically monitor displacement of skin flaps in the pericranium of rats subjected to traction and surgical fixation using suture anchored in a skull...

  3. Preparation of two component Fibrin Glue and its clinical evaluation in skin grafts and flaps

    Directory of Open Access Journals (Sweden)

    Jain P

    2003-01-01

    Full Text Available Tissue adhesive is one of the alternative to conventional suturing and has some added advantages. Fibrin glue has been used in obtaining haemostasis following trauma to spleen and liver. It has also been used in repair of dural tear and bronchial fistula. Fibrin glue is a biological tissue adhesive based on the final stage of coagulation wherein. Thrombin acting on fibrinogen converts it into fibrin. Thus, it has two components, one is fibrinogen and another is thrombin. We have prepared both components of fibrin glue. Fibrinogen was obtained from patient's own blood and thrombin from fresh frozen plasma of screened healthy donor. The glue was used in 20 cases requiring skin graft or flap. The results were compared with conventional suturing method. Use of the fibrin glue is simple, safe, cost effective, and rapid technique to fix the skin grafts and flaps with avoidance of peroperative bleeding and postoperative collection. It also has better overall results.

  4. Effect observation on repairing of soft tissue defect with tissue skin flaps%组织皮瓣修复软组织缺损的效果观察

    Institute of Scientific and Technical Information of China (English)

    王占厚; 于晓姗; 王立明; 李格当

    2002-01-01

    @@ Backgroud: With the development of microsurgery and clinical applied anatomy, skin flaps and musculocutaneous flaps with vessel pedicles are primary choices in treatment of soft tissue defect. The transfer of skin flaps and muscular skin flaps with vessel pedicles is rather easy and need't special instruments. Because of utilization of adjacent tissue, the outline is good after operation.

  5. A novel use of the facial artery based buccinator musculo-mucosal island flap for reconstruction of the oropharynx.

    Science.gov (United States)

    Khan, K; Hinckley, V; Cassell, O; Silva, P; Winter, S; Potter, M

    2013-10-01

    The buccinator musculo-mucosal island or Zhao flap can be used to reconstruct a wide range of intra-oral defects including floor of mouth, tonsillar fossa and lateral tongue. We describe our experience with the inferiorly based facial artery buccinator musculo-mucosal flap for a novel use in the reconstruction of oropharyngeal tumours at the tongue base and lateral pharyngeal wall. We prospectively reviewed all patients who underwent buccinator musculo-mucosal island flap reconstruction examining indication, operative details, and post-operative outcomes. We describe our technique for its novel use in lateral pharynx/tongue base reconstruction through neck dissection access. Deeper flaps were adequately visualised and monitored using flexible nasoendoscopy. There were no flap failures with all patients achieving primary healing with minimal complications. All donor sites closed directly with minimal scarring. Two patients reported mild tightness on mouth opening and two patients reported transient weakness of the mandibular branch of the facial nerve. In our experience the buccinator musculo-mucosal island flap is an extremely versatile 'like for like' local flap option due to its long arc of rotation. As inset can be achieved via neck dissection access, this avoids lip/jaw split as per conventional oropharyngeal surgical management further minimising morbidity. We present the first series of its effective use in oropharyngeal reconstruction. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Tissue flap repair strategy for severe defects of skin and soft tissue around the knee joints%膝关节周围严重皮肤软组织缺损的组织瓣修复策略

    Institute of Scientific and Technical Information of China (English)

    沈余明; 马春旭; 胡骁骅; 王成; 张琮

    2015-01-01

    Objective To explore selection and method of tissue flaps for the repair of severe defects of skin and soft tissue around the knee joints.Methods Fifty-four patients with wounds around the knee joints, all accompanied by exposure or necrosis of tendon or bone and exposure of prosthesis, were hospitalized in our burn center from June 2008 to December 2014.Five of them were with knee joint injury.After thorough debridement or tumor resection, the wound area ranged from 5 cm × 5 cm to 46 cm× 22 cm.Three patients were repaired with free latissimus dorsi myocutaneous flaps, 7 were repaired with modified sartorius myocutaneous flaps, 8 were repaired with gastrocnemius myocutaneous flaps, one was repaired with gastrocnemius muscle flap, two were repaired with posterior leg flaps combined with gastrocnemius muscle flaps, one was repaired with femoral biceps muscle flap combined with gastrocnemius muscle flap, 13 were repaired with reverse anterolateral thigh island flaps, two were repaired with reverse anterolateral thigh island flap combined with gastrocnemius myocutaneous flaps, two were repaired with superior lateral genicular flaps, 4 were repaired with reverse posterior thigh island flaps, 11 were repaired with saphenous artery flaps.Patellar ligament was reconstructed in 4 patients.The tissue flap size ranged from 5 cm × 5 cm to 38 cm × 19 cm.Some donor sites were sutured directly, and the others were closed by split-thickness skin grafting obtained from ipsilateral or contralateral legs.Results Among 59 tissue flaps of 54 patients, 55 tissue flaps of 50 patients survived, while necrosis of the distal part was observed in 4 tissue flaps, including one saphenous artery flap, two reverse anterolateral thigh island flaps, and one free latissimus dorsi myocutaneous flap.Among them, 3 flaps with necrosis at the distal part healed after debridement followed by skin grafting, one myocutaneous flap healed by transplanting gastrocnemius myocutaneous flap.During the

  7. Sensitive areolar reconstruction in using a neurocutaneous island flap based on the medial antebrachial cutaneous nerve.

    Science.gov (United States)

    Bertelli, J A; Pereira Filho, O J; Ely, J B

    1999-11-01

    Sensory reconstruction has recently been stressed in breast reconstruction. However, there are no reports concerning the reconstruction of a sensitive areola. The bilateral reconstruction of a sensitive areola using a neurocutaneous flap based on the medial antebrachial cutaneous nerve is reported. The flap was harvested from the distal third of the forearm as an island flap and tunneled to reach the apex of the new breast, which was previously reconstructed using a 135-cc, gel-filled, silicone prosthesis covered by a latissimus dorsi myocutaneous flap. Six months later, fine sensibility in the reconstructed areola was demonstrated. The patient could perceive light touch, pain, and 14 mm two-point discrimination. At 2 months after surgery, 50 percent of cutaneous faulty stimulus location was observed. However, at 4 and 6 months after surgery, faulty location disappeared. Six months after harvesting the medial antebrachial cutaneous nerve, the sensory deficit was minimal; it included a hypoesthesic zone of 4 to 7 cm and an anesthesic zone of 2.5 to 5 cm on the middle third of the forearm. Fifteen months after the procedure, no hypoesthesic zone was observed; only a 2 to 3 cm anesthesic zone on the proximal medial side of the forearm existed. This sensory deficit passed unnoticed by the patient. The technique developed here is a refinement in breast reconstruction, and we think it should be used in selected patients.

  8. Spectral analysis of blood perfusion in the free latissimus dorsi myocutaneous flap and in normal skin

    Energy Technology Data Exchange (ETDEWEB)

    Liu Xudong [Department of Orthopaedic Surgery, Shanghai No. 6 People' s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233 (China); Zeng Bingfang [Department of Orthopaedic Surgery, Shanghai No. 6 People' s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233 (China); Fan Cunyi [Department of Orthopaedic Surgery, Shanghai No. 6 People' s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233 (China); Jiang Peizhu [Department of Orthopaedic Surgery, Shanghai No. 6 People' s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233 (China); Hu Xiao [Department of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030 (China)

    2006-01-07

    To find the properties in the oscillatory components of the cutaneous blood flow on the successful free flap, a wavelet transform was applied to the laser Doppler flowmetry (LDF) signals which were measured simultaneously on the surfaces of the free latissimus dorsi myocutaneous flap and on the adjacent intact skin of the healthy limb, of 18 patients. The frequency interval from 0.0095 to 1.6 Hz was examined and was divided into five subintervals (I: 0.0095-0.021 Hz; II: 0.021-0.052 Hz; III: 0.052-0.145 Hz; IV: 0.145-0.6 Hz and V: 0.6-1.6 Hz) corresponding to endothelial metabolic, neurogenic, myogenic, respiratory and cardiac origins. The average amplitude and total power in the frequency range 0.0095-1.6 Hz as well as within subintervals I, II, IV and V were significantly lower for signals measured on the free flap than those obtained in the healthy limb. However in interval III, they were significantly higher. The normalized spectral amplitude and power in the free flap were significantly lower in only two intervals, I and II, yet in interval III they were significantly higher; no statistical significance was observed in intervals IV and V. The distinctive finding made in this study, aside from the decrease of endothelial metabolic processes and sympathetic control, was the significant increase of myogenic activity in the free flap. It is hoped that this work will contribute towards knowledge on blood circulation in free flaps and make the monitoring by LDF more reliable.

  9. [The dorsal flag flap for skin coverage of finger and thumb-tip injuries].

    Science.gov (United States)

    Stang, Felix; Rab, Matthias; van Schoonhoven, Jörg; Prommersberger, Karl-Josef

    2008-09-01

    Immediate two-step coverage of dorsal finger and thumb-tip soft-tissue defects with a dorsal flag flap, which can bridge over two fingers if necessary. Soft-tissue defects on the dorsal aspect of fingers between the metacarpophalangeal and the distal interphalangeal joint as well as on the tip of the thumb. Large defects, complex hand trauma, need of a sensible thumb tip, infections, noncompliance. Marking of the flap at the middle phalanx and its flagpole pedicle, containing the dorsal digital artery. The breadth should reach to the middle of the finger and the proximal pole should not cross the middle of the proximal phalanx. With tourniquet dissection of the flap above the peritendineum with respect of the dorsal digital artery and subcutaneous veins in the pedicle. Opening of the tourniquet, in the case of flap perfusion transposition of the flap into the defect. Coverage of the donor site with skin graft. Palmar cast splinting in intrinsic-plus position for 1 week, followed by physiotherapy. Pedicle separation after 3 weeks. Continuation of physiotherapy and scar care. In 2006, ten patients were operated on, three of them for reconstruction of the thumb tip. All patients showed a survival of the flap and a good wound healing without complications. One patient developed a flexion contracture at the donor finger due to noncompliance following immobilization. The functional and aesthetic results were satisfactory in all patients, the average DASH Score ("Disabilities of the Arm, Shoulder and Hand") was 16.4, mainly due to the residuals of the overall injury.

  10. [Submental island flap for repair of oral defects after radical resection of early-stage oral squamous cell carcinoma].

    Science.gov (United States)

    Liu, Hanqian; Yu, Huiming; Liu, Jiawu

    2013-09-01

    To evaluate the effectiveness of the submental island flap for repair of oral defects after radical resection of early-stage oral squamous cell carcinoma (OSCC). Between February 2010 and August 2011, 15 cases of early-stage OSCC were treated. Of 15 cases, 9 were male and 6 were female, aged from 48 to 71 years (mean, 63 years). The disease duration was 28-73 days (mean, 35 days). Primary lesions included tongue (3 cases), buccal mucosa (8 cases), retromolar area (2 cases), and floor of mouth mucosa (2 cases). According to TNM classification of International Union Against Cancer (UICC, 2002) of oral cancer and oropharyngeal cancer, 2 cases were classified as T1N0M0 and 13 cases as T2N0M0. The results of the pathologic type were high differentiated squamous cell carcinoma in 11 cases and moderately differentiated squamous cell carcinoma in 4 cases. The defect after resection of the lesion ranged from 5 cm x 3 cm to 8 cm x 6 cm. All the cases underwent radical resection of the primary lesion and immediate reconstruction with submental island flap except 1 case with radial forearm free flap because of no definite venous drainage. The sizes of the submental island flap varied from 6 cm x 4 cm to 9 cm x 6 cm. Operation time ranged from 4 hours and 30 minutes to 7 hours and 10 minutes (mean, 5 hours and 53 minutes) in 14 cases undergoing repair with submental island flap. All the flaps survived completely in 13 cases except 1 case having superficial necrosis of the flap, which was cured after conservative treatment. Temporary marginal mandibular nerve palsy occurred in 1 case, and was cured after 3 months; submandibular effusion was observed in 3 cases, and was cured after expectant treatment. The follow-up period ranged from 8 to 15 months (mean, 10.5 months) in 14 cases undergoing repair with submental island flap. Hair growth was seen on the flap and became sparse after 3 months in 2 male cases. The appearance of the face, opening mouth, swallowing, and speech were

  11. Management of massive mastectomy skin flap necrosis following autologous breast reconstruction.

    Science.gov (United States)

    Patel, Ketan M; Hill, Lauren M; Gatti, Margaret E; Nahabedian, Maurice Y

    2012-08-01

    The optimal management of severe mastectomy skin flap necrosis continues to remain a challenge. Following autologous reconstruction, small or minor areas of ischemia/tissue necrosis can result in multiple office visits, increased expenses due to dressing supplies and nursing care, and revisional operations. The purpose of this study is to describe outcomes of a common management strategy for surgeons when confronted with a patient with extensive mastectomy skin flap necrosis. Between 1997 and 2010, autologous breast reconstructions were performed in 805 women and 1076 breasts. Of these, 12 patients (15 breasts) were identified who met the criteria for massive skin flap loss (>30%). Patient photographs and wound measurements were used to estimate areas of necrosis. All patients were managed initially with local wound care followed by delayed scar excision. Wound closure was ultimately achieved in all patients. Of the patients, 40% were active smokers in the perioperative period. The average patient age was 49.6 (range, 28-59) years with a body mass index of 30.9. The average mastectomy weight was 959.5 g (range, 223-1520). In-office soft-tissue debridement and local wound care was performed until wound closure was complete, which took place at a mean of 120 days (range, 30-300) after initial surgery. The average patient had a mean of 10 office visits before scar revision. There was an average of 1.7 types of dressing changes needed before wound closure. Topical wound therapy included moisturizing gels, wet-to-dry dressing, and antibiotic ointment. Oral antibiotic therapy was used in 60% of patients. Late scar revision was performed in 87% of the patients at an average of 8.9 months (range, 1-14) after initial surgery. After the initial flap surgery, no patient required skin grafting or hospitalization. Early conservative management followed by late scar revision produced excellent results in patients with massive mastectomy skin flap loss. The outcomes described may

  12. Salvianolic acid B enhances in vitro angiogenesis and improves skin flap survival in Sprague-Dawley rats.

    Science.gov (United States)

    Lay, Ing-Shiow; Hsieh, Cheng-Chu; Chiu, Jen-Hwey; Shiao, Ming-Shi; Lui, Wing-Yiu; Wu, Chew-Wun

    2003-12-01

    Insufficient angiogenesis and microcirculatory intravascular clotting have been implicated in the pathophysiology of skin flap failure. Salvianolic acid B (Sal B), isolated from Salvia miltiorrhiza, has been reported to enhance angiogenesis in vitro. This study was aimed to determine the efficacy of Sal B on ischemia-reperfusion injury of the skin flap in Sprague-Dawley rats. Sal B was administered intraperitoneally 2 h before operation, and on the 2nd and 4th days after surgical elevation of an extended epigastric adipocutaneous flap (5 x 7 cm) in ketamine-anesthetized rats. Flap ischemia was achieved by ligating the right superficial epigastric artery and vein and clamping the left superficial epigastric artery and vein for 3 h and then released. Percentage of flap necrosis area (FNA) and plasma levels of aspartate aminotransferase, alanine aminotransferase, creatinine, and malondialdehyde were measured at 7 days after the operation. Animals were divided into six groups, including: vehicle, Sal B low dose (5 mg/kg), Sal B high dose (50 mg/kg) and each with [mesh(+)] or without mesh [mesh(-)] placement. In the three groups with mesh(+), FNA in control flaps was 53.7 +/- 6.9%, whereas low-dose and high-dose Sal B significantly improved flap survival with FNA 27.4 +/- 3.8% and 25.3 +/- 4.3%, respectively (P mesh(-), control flaps were 35.9 +/- 4.5%, whereas high-dose Sal B also significantly improved flap survival with FNA 17.9 +/- 4.7% (P < 0.05, one-way ANOVA). There were no differences in aspartate aminotransferase, alanine aminotransferase, creatinine, or malondialdehyde between groups. We conclude that Sal B attenuates ischemia-reperfusion injury of skin flap, and provides therapeutic potential in reconstructive plastic surgery.

  13. 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.

  14. Application of Skin Flap to the Complex Wound Repair%皮瓣在修复重建复杂创面中的应用

    Institute of Scientific and Technical Information of China (English)

    陈文斌; 朱晓; 刘志安

    2013-01-01

    目的:探讨皮瓣在修复重建复杂创面中的应用。方法:自1997年7月至2012年8月,应用游离皮瓣、带血管蒂岛状皮瓣修复20例因肿瘤或外伤形成的复杂性创面,创面有重要组织外露或功能部位,缺损最大约13cm×35cm最小10cm×20cm,切取相应的大小的皮瓣覆盖创面,继发性创面直接缝合或以植断层皮片覆盖。结果:20例患者皮瓣全部成活,修复后的形态自然、功能恢复程度良好,随访1个月到2年余形态自然。结论:对于复杂的创面修复,术前精心设计、针对每个患者的创面的特点,具体问题,具体分析,选择适合的皮瓣可以最大程度地修复创面,形态和功能都能得到很好的满足。%Objective To study the application of skin flap to the complex wound repair. Method Free or island skin flap were used to repair 20 cases with complex wound which resulted from trauma or tumor,and were characterized by the exposure of important tissue or locating in function area. The maxim of the defect area was 13cm×35cm,and the minimum of the area was 10cm×20cm. The skin flap of the same size was cut off to cover the atea,while the secondary defect was cured by direct suture or skin graft. Result All the skin flap of 20 cases survived completely,with natural structure and good function. After 1 month to 2 years of follow-up, it still showed a natural appearance. Conclusion The complex wound can be repaired well both in appearance and function after careful operation-designing and appropriate flap-selecting according to the characteristics of each wound.

  15. 手部皮肤软组织缺损皮瓣修复78例效果观察%Observation on Surgical Flap for Repairing Skin and Soft Tissue Defects of Hand

    Institute of Scientific and Technical Information of China (English)

    王立; 米高松; 申小青; 张绪华; 粟钦

    2013-01-01

    [Objective]To explore the clinical efficacy of island flap from the dorsal forearm for repairing skin and soft tissue defects in the dorsum of hand .[Methods]Totally 78 cases of skin and soft tissue defects in the dorsum of hand were repaired by 5 different island flaps from dorsal forearm ,which were posterior interosseous artery island flap (PIA) ,reversed island flap supplied by radial osteo-cutaneous branch of anterior interosseous artery (AIAR) ,reversed island flap supplied by superficial branch of radial nerve and its nourishing blood vessels (RN) ,reversed island flap supplied by wrist dorsal branch of ulnar nerve and its nourishing blood vessels (UN ) and reversed island flap supplied by cutaneous branch of radial artery in snuff-box region(RA) .[Results]After operation ,71 flaps survived completely .The necrosis of distal parts of the flaps was found in 1 case of PIA ,2 cases of AIAR ,2 cases of RN and 2 cases of UN .The necrotic flaps were healed after local dress-ing for 2~ 4 weeks .During the follow up for 3 months to 2 years ,blood supply ,elasticity and texture were good .[Conclusion]The reversed island flap from dorsal forearm for repairing skin and soft tissue defects in the dorsum of hand is simple and safe ,and has satisfactory clinical efficacy .%[目的]探讨应用不同的前臂背侧岛状皮瓣修复手背皮肤软组织缺损的临床效果。[方法]应用骨间背侧动脉岛状皮瓣(35例),骨间前动脉桡侧骨皮支逆行岛状皮瓣(15例),桡神经浅支营养血管为蒂的逆行岛状皮瓣(12例),尺神经腕背支营养血管为蒂的逆行岛状皮瓣(8例),桡动脉鼻烟窝皮支逆行岛状皮瓣(8例)5种不同的前臂背侧岛状皮瓣逆行转移修复78例手背皮肤软组织缺损。[结果]术后71例皮瓣完全成活,1例骨间背侧动脉岛状皮瓣,2例骨间前动脉桡侧骨皮支逆行岛状皮瓣,2例桡神经浅支营养血管为蒂的逆行岛状皮瓣,2例尺神经

  16. Experimental model for the study of soft tissue fixation methods on skin-pericranium flaps in rats

    OpenAIRE

    Cavazana,William César; Cuman, Roberto Kenji Nakamura; Takeshita, Wilton Mitsunari; Passeri, Luis Augusto

    2013-01-01

    PURPOSE: To develop an experimental model to study and radiologically monitor displacement of skin flaps in the pericranium of rats subjected to traction and surgical fixation using suture anchored in a skull bone tunnel or with N-butyl-2-cyanoacrylate (HistoacrylTM) surgical adhesive. METHODS: Radiological markers were placed in the subcutis of Wistar rats undergoing subperiosteal detachment of the pericranium with pulling and fixation of the flap. We performed radiography on postoperative d...

  17. A simple skin flap plasty to repair tracheocutaneous fistula after tracheotomy

    Institute of Scientific and Technical Information of China (English)

    Qilin Huang; Haipeng Liu; Shengqing Lü

    2015-01-01

    The tracheocutaneous fistula after tracheostomy is a complex clinical problem.An ideal fistula closure is still difficult at present though a variety of fistula-closing methods have been reported in the literature.We used a turnover skin flap to cover the fistula.All the procedures were completed at bedside under local anesthesia.The fistula was successfully closed and well healed without complications within 7-9 days.It has been proven that this operation is simple,effective,and safe.

  18. [Scapular/parascapular double skin-paddle free flap for transfixing blast injuries of the hand. A case report].

    Science.gov (United States)

    Colson, T; Pozetto, M; Gibert, N; Dautel, G

    2014-06-01

    Balistic transfixing hand traumas require a complex reconstruction management. Stabilization and reconstruction of the injuried tissues need a double skin-paddle coverage. We present an original case report of a double skin-paddle scapular/parascapular free flap used to cover a through and through gunshot injury of the right hand. A 14-years-old patient presents a severe and extensive wound with full-thickness palmar and dorsal skin defects, dislocation of the carpal bones, median nerve and flexor tendons losses. Distal vascularization is maintained by the deep palmar arch system supplied by the ulnar artery. The radial artery is severed at the level of the first dorsal interosseous space. The measured defect of the dorsal skin was 12×7cm and the palmar one was 6×3cm. After skeletal stabilization, tendinous and nerve preparation, the hand coverage was performed using a double skin-paddle scapular/parascapular free flap. The vascular anastomoses include an end-to-side arterial suture between the circumflex scapular and the radial arteries, and an end-to-end venous suture between the circumflex scapular and the dorsal radial veins. The scapular/parascapular double skin-paddle free flap is a safe and reliable technique to achieve a dorsal and palmar hand coverage in lack of local flaps alternatives. It can be used as a good option prior to bone graft, tendinous and nervous reconstruction. Copyright © 2013. Published by Elsevier Masson SAS.

  19. Haemophilus ducreyi associated with skin ulcers among children, Solomon Islands.

    Science.gov (United States)

    Marks, Michael; Chi, Kai-Hua; Vahi, Ventis; Pillay, Allan; Sokana, Oliver; Pavluck, Alex; Mabey, David C; Chen, Cheng Y; Solomon, Anthony W

    2014-10-01

    During a survey of yaws prevalence in the Solomon Islands, we collected samples from skin ulcers of 41 children. Using PCR, we identified Haemophilus ducreyi infection in 13 (32%) children. PCR-positive and PCR-negative ulcers were phenotypically indistinguishable. Emergence of H. ducreyi as a cause of nongenital ulcers may affect the World Health Organization's yaws eradication program.

  20. Haemophilus ducreyi Associated with Skin Ulcers among Children, Solomon Islands

    OpenAIRE

    Marks, M; Chi, KH; Vahi, V; Pillay, A.; Sokana, O; Pavluck, A; Mabey, DC; Chen, CY; Solomon, AW

    2014-01-01

    During a survey of yaws prevalence in the Solomon Islands, we collected samples from skin ulcers of 41 children. Using PCR, we identified Haemophilus ducreyi infection in 13 (32%) children. PCR-positive and PCR-negative ulcers were phenotypically indistinguishable. Emergence of H. ducreyi as a cause of nongenital ulcers may affect the World Health Organization's yaws eradication program.

  1. Examination of tissue oxygen saturation (StO2) changes associated with vascular pedicle occlusion in a rat Island flap model using near-Infrared spectroscopy.

    Science.gov (United States)

    Kagaya, Yu; Ohura, Norihiko; Kurita, Masakazu; Takushima, Akihiko; Harii, Kiyonori

    2015-07-01

    The purpose of this study was to perform continuous StO(2) monitoring of rat island flaps during pedicle vessel occlusion using near-infrared spectroscopy (NIRS) in order to collect experimental data for StO(2) flap monitoring under optimized conditions. Twenty rats were used in this study. The 3 × 3 cm(2) epigastric skin island flaps were elevated on either side. The animals were randomly assigned to two groups; an arterial occlusion group (n = 10) and a venous occlusion group (n = 10). The StO(2) values of the flaps were observed for over 30 min for the pedicle artery or venous occlusion, followed by an additional 30 min release. The baseline StO(2) value was 78.4% ± 3.2% in the arterial occlusion group, compared to 78.5% ± 5.8% in the venous occlusion group, with no significant differences (P > 0.05). The StO(2) values decreased immediately after arterial occlusion, whereas a temporal StO(2) increase was initially observed after venous occlusion, followed by a StO(2) decrease. The StO(2) values decreased 27.3% ± 7.1% after arterial occlusion and 28.4% ± 19.1% after venous occlusion at 30 min after pedicle vessel clamping (P > 0.05). The StO(2) values were 0.4% ± 5.8% lower than baseline 30 min after arterial release (P > 0.05), while 18.9% ± 11.3% lower than baseline 30 min after venous release (P StO(2) changes in flaps with the pedicle vessel occlusion and differentiate between pedicle artery and vein occlusion. Further investigations are needed to obtain definitive evidence associated with predicting the degree of flap viability and determine the practical use of this technique. © 2015 Wiley Periodicals, Inc.

  2. The palatal island mucoperiosteal flap for primary intraoral reconstruction following tumor ablative surgery.

    Science.gov (United States)

    Magdy, Emad A

    2011-11-01

    Reconstruction of intraoral mucosal defects following tumor ablative surgery can be a challenging problem. The objective of this study was to evaluate the use of the palatal island mucoperiosteal flap (PIMPF) in reconstructing intraoral defects resulting from ablative tumor resections. The study included eight consecutive patients who underwent primary reconstruction using the PIMPF following intraoral tumor resections in a 5-year period by a single surgeon at a tertiary referral institute. Patients included five men and three women ranging in age from 32 to 69 years. Four patients were smokers (averaging 40 pack-years). None had received prior irradiation therapy. Resultant surgical defects ranged in size from 6 to 16.5 cm(2) (mean 12.3 ± 3.9) and included areas of soft/hard palate, lateral pharyngeal wall, retromolar trigone and inner cheek. Final pathological findings revealed three benign and five malignant tumors, mostly from minor salivary gland origin. All patients began oral diet between postoperative days 1 and 4 (mean 2 days). All flaps survived well with good postoperative wound healing except one minor flap dehiscence that eventually healed by granulation tissue with no further surgery needed. All donor sites were completely healed by remucosalization within 5-13 weeks. No patients manifested permanent velopharyngeal insufficiency, speech impairment, or airway compromise after a follow-up period ranging from 13 to 56 months (mean 31.3 ± 15.9). The PIMPF was found to be an attractive single-staged versatile and reliable reconstructive option for postero-lateral oral cavity/oropharyngeal defects that provides well-vascularized, sensate mucosa with minimal morbidity.

  3. Reconstruction of facial and cervical scar with the expanded supraclavicular island flaps%扩张的锁骨上皮瓣修复面颈部瘢痕

    Institute of Scientific and Technical Information of China (English)

    杨艳清; 任军; 庞星原; 白彦; 袁伟; 徐威

    2015-01-01

    目的 探讨扩张的锁骨上皮瓣修复面颈部瘢痕的治疗效果.方法 2010年10月至2013年11月,对16例面颈部瘢痕畸形患者,采用以颈横动脉锁骨上皮支为血管蒂的扩张锁骨上皮瓣修复.一期在前胸部埋置扩张器(400 ~600) ml,二期行瘢痕切除、松解及扩张皮瓣修复术,供瓣区直接拉拢缝合.结果 本组16例患者的皮瓣切取面积为12 cm×7 cm ~ 22 cm×11 cm,皮瓣均存活,仅1例患者出现血肿,经行血肿清除术后痊愈.术后经3 ~12个月的随访,皮瓣颜色和质地与受区周围正常皮肤一致,外观无臃肿、切口瘢痕增生不明显.结论 应用扩张的锁骨上皮瓣修复面颈部瘢痕,外形及功能恢复良好,是一种理想的修复方法.%Objective To observe the therapeutic effect of expanded supraclavicular island flaps for facial and cervical scar.Methods From Oct.2010 to Nov.2013,a series of 16 patients with facial and cervical scars were treated by the expanded supraclavicular island flaps,pedicled by the supraclavicular cutaneous branch of transverse cervical artery.In the first stage,the soft tissue expanders (ranging from 400 ml to 600 ml in volume) were implanted in the anterior thoracic region.In the second stage,the facial and cervical scars were removed and the contructures were released,the expanded flap was transferred to cover the defects.The wounds at the donor sites were closed directly.Results The flaps size ranged from 12 cm × 7 cm to 22 cm × 11 cm.All flaps survived with no flap necrosis.Hematoma occurred in one case and healed by debridement.16 patients were followed up for 3-12 months.The color and texture of all flaps matched well with the surrounding skin tissue,no bulky appearance or hypertrophic scar were noticed.Conclusions The expanded supraclavicular island flap is a good choice for repairing facial and cervical scar.The appearance and function can be improved.

  4. A RARE CASE REPORT OF SQUAMOUS CELL CARCINOMA OF URETHRA ARISING FROM SUBSTITUTED PENILE SKIN FLAP WITH BALANITIS XEROTICA OBLITERANS

    OpenAIRE

    2016-01-01

    A 44-year-old male presented with ulcerative growth over dorsal penile shaft along with multiple urethrocutaneous fistula. A total penectomy, scrotal excision and perineal urethrostomy were done. Past history of treatment for penile urethral stricture due to Balanitis Xerotica Obliterans (BXO) by substitution urethroplasty using pedicled preputial penile skin flap five years back. On gross as well as histopathological examination, the tumour was found to be arising from the skin ...

  5. The Clinical Application of Preexpanded and Prefabricated Super-Thin Skin Perforator Flap for Reconstruction of Post-Burn Neck Contracture.

    Science.gov (United States)

    Wang, Chunmei; Zhang, Junyi; Yang, Sifen; Hyakusoku, Hiko; Song, Ping; Pu, Lee L Q

    2016-02-01

    Based on our previous animal study, we applied the "bridging effect" to the neighboring axial flap through preexpansion and prefabrication of a skin perforator flap as a new method to reconstruct a large skin defect after release of severe neck burn scar contracture. Twelve patients suffering from severe post-burn cervical contractures underwent reconstruction of large skin defects after surgical release of severe scar contractures with preexpanded and prefabricated super-thin skin perforator flaps supplied primarily by a number of perforators via the "bridging effect" from the branches of the adjacent arteries as 2-stage procedures. During the first-stage operation, 2 tissue expanders were placed accordingly, and this was followed by a subsequent second-stage procedure where an expanded super-thin skin perforator flap was transposed to reconstruct a large neck skin defect. Follow-up was between 6 months and 3 years in this series. All super-thin skin perforator flaps survived in this series with primary healing except one with a distal flap necrosis that was treated with a subsequent skin graft. All patients have had a good contour with improved range of motion in the neck. The preexpansion and prefabrication of a super-thin skin perforator flap can possibly improve the anastomoses between neighboring subdermal vascular plexuses and extend the supplying area of these vessels to the flap. This method may provide a favorable super-thin skin flap that can be used for reconstruction of large neck defects after release of post-burn cervical scar contracture as demonstrated in this case series.

  6. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural artery flap.

    Science.gov (United States)

    Abhyankar, Suhas V; Kulkarni, Ananta; Agarwal, Naveen Kumar

    2009-10-01

    Ruptured tendoachilles along with skin defect is a complex problem to reconstruct. Both things require a priority. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural arterial flap allows us to perform both. This procedure gives excellent result, shortens the stay, thereby reducing the cost. This method is a simple solution to the complex problem like ruptured tendoachilles with skin defect. In this study, 6 patients with rupture of tendoachilles tendon due to penetrating injury, with skin defect are presented. The repair was done using aponeurotic part of tendoachilles tendon, taken from proximal part of tendoachilles in the midline measuring around 2 to 2.5 cm in width and 8 to 10 cm in length, with intact distal attachment. The tendon was turned upside down by 180 degrees and sutured to the distal stump of the tendoachilles tendon without tension. The skin defect was covered using distally based superficial sural artery flap in the same sitting. The follow-up period was 9 to 30 months. All patients showed good results. In one patient there was distal necrosis of 1.5 cm of the distally based superficial sural artery flap, which healed satisfactorily with conservative treatment. Single stage tendoachilles reconstruction can be used with good functional result and patient satisfaction.

  7. A Case Report on Bilateral Knee Coverage Following Septic Arthritis: Lateral Distal Thigh Island Flap and Medial Head Gastrocnemius Flap Methods

    Directory of Open Access Journals (Sweden)

    Abdolrazaghi

    2016-03-01

    Full Text Available Introduction Septic arthritis is the rheumatological and orthopedic emergency that causes the most difficulties with joints–especially knee and hip joints. The clinical symptoms include pain, swelling, inflammation, stiffness, and a limited range of motion in both active and passive joints. Debridement of the necrotic tissue is one beneficial method for septic arthritis treatment, although soft tissue defects around joints are a challenging issue for surgeons. Our purpose was to investigate the consequences of two flap surgery methods undertaken to repair soft tissue damaged during knee joint debridement caused by septic arthritis. Case Presentation This is a case report concerning a patient who had septic arthritis in the knee area and so underwent soft tissue surgery. The reconstruction methods were not the same for both knees as the lateral distal thigh island flap reparation method was used on the left knee and the medial head gastrocnemius flap method was utilized on the right. We then investigated the results and outcomes of the surgery three months later. Conclusions Lower extremity movement extent was carefully evaluated and, in respect to muscle strength, the patient was able to walk independently three months after the surgery. The patient’s balance was studied and the results showed moderate levels of stability.

  8. A new flap alternative for trochanteric pressure sore coverage: distal gluteus maximus musculocutaneous advancement flap.

    Science.gov (United States)

    Nisanci, Mustafa; Sahin, Ismail; Eski, Muhitdin; Alhan, Dogan

    2015-02-01

    Management of long-term bedridden patients experiencing pressure sores still represents a surgical challenge due to limited flap alternatives and high recurrence rates after the treatment. Fasciocutaneous, musculocutaneous, local perforator-based flaps, and free flaps have all been used for treatment of trochanteric pressure sores. This study presents a new use of distal gluteus maximus (GM) muscle as an advancement musculocutaneous flap for coverage of trochanteric pressure sores in 7 patients. The technique involves design of a long V-shaped skin island over the distal fibers of the GM muscle, beginning from the inferoposterior wound edge and extending inferomedially, almost parallel to the gluteal crease. After its harvest as an island flap on the distal fibers of the GM muscle, the skin paddle can be advanced onto the trochanteric defect, whereas the muscle itself is rotated after severing its insertion to femur. If a second triangular skin island is designed on the proximal fibers of GM muscle to cover an associated sacral defect, 2 coexisting pressure sores can be reconstructed concomitantly with 2 skin paddles on a single muscle belly at 1 surgical setting. Of the 7 patients, 3 had 3 (bilateral trochanteric and sacral), 2 had 2 (sacral and trochanteric), and 2 had 1 (only trochanteric) pressure sores. All ulcers were closed successfully and all of the flaps survived totally without any complication except the one in which we experienced minimal wound dehiscence in the early postoperative period. Conclusively, our current surgical method provided a reliable coverage for trochanteric pressure sores although it was technically straightforward and fast. Additionally, it offers simultaneous closure of 2 pressure ulcers with 2 skin islands on a single muscle flap.

  9. A Previously Discounted Flap Now Reconsidered: MatriDerm and Split-Thickness Skin Grafting for Tendon Cover Following Dorsalis Pedis Fasciocutaneous Flap in Lower Limb Trauma.

    Science.gov (United States)

    Dunne, Jonathan A; Wilks, Daniel J; Rawlins, Jeremy M

    2014-01-01

    The dorsalis pedis flap has reliable vascularity; however, its use is limited by reports of donor site morbidity including infection, delayed healing, exposure of tendons, and later contractures. The purpose of this study was to demonstrate its continued role in lower limb trauma when the donor site is reconstructed with MatriDerm to avoid complications. A 65-year-old man presented with a displaced, Gustilo 3b open transverse fracture of his left distal fibula. He had a 2 cm(2) open wound over his lateral malleolus. Following review of possible local options, a dorsalis pedis fasciocutaneous flap was deemed best for coverage, and the donor site was closed with 1-mm MatriDerm dermal matrix and a 6/1000 inch split-thickness skin graft (STSG) in a single stage. Three months postoperatively, the foot had excellent function and cosmesis, with toes in a neutral position and a full range of movement. The dorsalis pedis flap is a valuable reconstructive option for defects of the foot and ankle. Its major limitation donor site morbidity can be overcome by the additional application of a dermal substitute such as MatriDerm under the STSG.

  10. The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction

    Directory of Open Access Journals (Sweden)

    Mat Saad A

    2009-01-01

    Full Text Available Skin allografts have been used in medical practice for over a century owing to their unique composition as a biological dressing. Skin allografts can be obtained in several preparations such as cryopreserved, glycerol-preserved, and fresh allograft. A glycerol-preserved allograft (GPA was introduced in the early 1980s. It has several advantages compared with other dressings such as ease of processing, storage and transport, lower cost, less antigenicity, antimicrobial properties, and neo-vascularisation promoting properties. Skin allografts are mainly used in the management of severe burn injuries, chronic ulcers, and complex, traumatic wounds. Published reports of the use of skin allografts in association with free flap surgery are few or non existent. We would like to share our experience of several cases of free tissue transfer that utilised GPA as a temporary wound dressing in multiple scenarios. On the basis of this case series, we would like to recommend that a GPA be used as a temporary dressing in conjunction with free flap surgery when required to protect the flap pedicle, allowing time for the edema to subside and the wound can then be closed for a better aesthetic outcome.

  11. Clinical Efficacy of a Modified Nagata Method That Retains the Fascia Pedicle of the Mastoid Skin Flap in Auricular Reconstruction of Chinese Microtia Patients.

    Science.gov (United States)

    Wang, Wang-Shu; Yan, Dong-Mei; Chen, Jun-Yang; Zhang, Duo; Shao, Ying; Peng, Wei-Hai

    2016-03-01

    The purpose of this study was to search for an enhanced blood supply in the distal edge of the skin at the mastoid area in total auricular reconstruction. The authors modified the Nagata method by reserving a subcutaneous fascia pedicle (diameter, 3 to 5 mm) at the intersection of the point 11 to 13 mm from the residual ear tragus (or tragus projection) and 8 to 10 mm from the lowest point of the residual ear lobe. Compared with the traditional Nagata method group, the modified Nagata method group that retained the fascia pedicle of the mastoid skin flap had higher rates of excellent and good flaps (p < 0.05). Auricular reconstruction with the modified Nagata method, retaining the fascia pedicle of the mastoid skin flap, had a reduced incidence of skin flap necrosis.

  12. Treatment of delayed jejunal perforation after irreducible femoral hernia repair with open abdomen management and delayed abdominal closure with skin flap approximation

    Directory of Open Access Journals (Sweden)

    Fahri Yetişir

    2015-01-01

    Conclusion: Delayed bowel perforation may develop after irreducible femoral hernia surgery. OA management with NPT and DAC with skin flap approximation are optimal treatment modalities for the hemodynamically instable patient.

  13. [A COMPARATIVE STUDY ON TREATMENT OF SCAR CONTRACTURE ON FACE, NECK, AND JOINTS WITH PRE-EXPANDED FLAPS AND SKIN GRAFTS].

    Science.gov (United States)

    Gao, Yashan; Zan, Tao; Li, Haizhou; Li, Qingfeng

    2015-09-01

    To study the treatment results of the pre-expanded flaps for scar contracture on face, neck, and joints by comparing with the skin grafts. A total of 240 cases of scar contracture between July 2004 and June 2014 were included in the study by random sampling; skin grafts were used in 120 cases (skin graft group), and pre-expanded flaps in 120 cases (pre-expanded flap group). There was no significant difference in age, sex, injury sites, and disease duration between 2 groups (P>0.05). Re-operation rate and A&F 0-6 quantization score were used to evaluate the treatment results. The patients were followed up 12 to 75 months (mean, 23.47 months) in the skin graft group, and 12 to 61 months (mean, 19.62 months) in the pre-expanded flap group. The re-operation rate of the skin graft group was 72.5% (87/120), and was significantly higher than that of the pre-expanded flap group (19.2%, 23/120) (P=0.000). The re-operation rate of the neck contracture in teenagers was the highest. It was 93.9% in the skin graft group and 35.0% in the pre-expanded flap group. In the patients who did not undergo re-operations, A&F 0-6 quantization score of the skin graft group was 2.85±1.12, and was significantly lower than that of the pre-expanded flap group (5.22±0.74) (t=13.830, P=0.000). Pre-expanded flap for scar contracture on face, neck, and joints has lower re-operation rate and better aesthetic and functional restoration than skin graft. It should be regarded as the preferred method for teenagers.

  14. The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects.

    Science.gov (United States)

    Posch, N A S; Mureau, M A M; Flood, S J; Hofer, S O P

    2005-12-01

    Myocutaneous (MC) free flaps are useful for many reconstructive indications. Perforator flaps have become standard of care. The anterolateral thigh flap (ALT) donor site is popular. With the ALT flap varying sizes of vastus lateralis (VL) muscle can be harvested as a MC flap. The skin islands of these flaps have a great range of freedom when dissected on their perforator. It was hypothesised that the VL-ALT perforator flap would offer adequate tissue volume combining maximal freedom in planning with minimal donor site morbidity. From November 2001 to February 2003 a free partial VL with ALT perforator flap was used in 11 patients to reconstruct large defects. Indications for adding a muscular component were exposed bone, skull base, (artificial) dura, or osteosynthesis material, open sinuses, and lack of muscular bulk. Flaps were planned as standard ALT flaps, after which three types of dissection were performed: I. true MC flap; II. muscle flap with a skin island on one perforator, which could be rotated up to 180 degrees ; III. chimera skin perforator flap with muscle being harvested on a separate branch from the source vessel or on a side branch of the skin perforator. Mean skin size of the MC-ALT flaps was 131 cm2. Mean muscle part size of the MC-ALT flaps was 268 cm3. Muscular parts were custom designed for all defects. No total or partial flap failures were seen. Colour mismatch was seen in 6 of 8 patients, when skin was used in the facial area in this all white population. Excessive flap bulk was found in 8 of 11 patients at 6 weeks, however, only in 2 of 11 patients after 6 months. Patients were satisfied with the functional result (8 of 11 patients) as well as the cosmetic result of their reconstruction (7 of 11 patients). All less satisfied patients had received their flap for external facial skin reconstruction. Donor site morbidity was minimal. The combined free partial VL with ALT perforator flap proved valuable as a (chimera type) MC flap with maximal

  15. Keystone Perforator Island Flap as an Alternative Reconstructive Option for Partial Thickness Alar Defects Up to 1.5 Centimeters.

    Science.gov (United States)

    Kostopoulos, Epameinondas; Agiannidis, Christos; Konofaos, Petros; Kotsakis, Ioannis; Champsas, Grigorios; Frangoulis, Marios; Papadopoulos, Othon; Casoli, Vincent

    2016-07-01

    The ala is a unique landmark of the nose disposing aesthetic and functional properties. The head and neck area is the main site of appearance of nonmelanoma skin cancer. One third of them are located in the nose with an alar preponderance compared with other nasal subunits. Correction of alar defects is a challenging reconstructive task. The keystone perforator island flap (KPIF) was introduced as an alternative in nasal reconstruction by senior authors. In the present case series, KPIFs' application is introduced into the alar subunit as an alternative, versatile, and reproducible reconstructive option, even for the novice plastic surgeon. From April 2014 to September 2015, patients presenting with partial thickness alar defects (≤1.5 cm) secondary to tumor extirpation sustained reconstruction with different types of KPIF. A total of 31 patients (mean age of 72 years) were treated with various types of KPIF. The mean diameter of the defect was 1.14 cm. The vast majority of reconstructions concerned a type IV KPIF (18/31 or 58.1%). Sometimes an upward alar retraction was noted. A minimal rim wedge excision was performed (≤0.3 mm) using counterbalancing correcting sutures. All flaps survived without any sign of venous congestion, whereas the rim healed uneventfully. The mean follow-up period was 6.5 months. KPIF was introduced as a single-stage alternative reconstructive option for partial thickness alar defects, completing author's experience with this flap into such a challenging and aesthetically critical anatomic area.

  16. Syndrome of the trephined (sinking skin flap syndrome) with and without paradoxical herniation: a series of case reports and review.

    Science.gov (United States)

    Gadde, Judith; Dross, Peter; Spina, Michael

    2012-07-01

    Decompressive craniectomy is gaining an increasing role in the neurosurgical treatment of intractable intracranial hypertension in patients with head injury, acute stroke, and severe brain edema. The conversion of the cranium from a "closed box" to an "open box" alters the barometric pressure, cerebrospinal fluid (CSF), and cerebral blood flow (CBF) and may or may not lead to syndrome of the trephined (sinking skin flap syndrome).

  17. Total maxillary reconstruction using a double-barreled and double skin paddle fibular flap after total maxillectomy.

    Science.gov (United States)

    de la Parra, Miguel; Sanchez, Gerardo; Lopez, Jaime; Perez, Adrian; Naal, Norberto

    2013-11-01

    Chondroblastomas are rare entities accounting for approximately 1% of all primary bone tumors. We describe a case of a 7-year-old girl with a giant chondroblastoma of the maxilla, treated with bilateral class III maxillectomy and reconstruction with a double-barreled and double skin paddle fibular free flap. We show evidence of an excellent aesthetic outcome at 6 months' follow up with no evidence of tumor recurrence.

  18. Double Back Cut in Post-mastectomy Breast Skin (Fish-Shaped Skin Paddle) in Delayed Pedicled TRAM Flap Breast Reconstruction.

    Science.gov (United States)

    Berezovsky, Alexander Bogdanov; Pagkalos, Vasileios A; Shoham, Yaron; Krieger, Yuval; Silberstein, Eldad

    2015-08-01

    Breast reconstruction has become standard of care for female patients with breast cancer. The transverse rectus abdominis musculo-cutaneous flap (TRAMf) is the most common method of immediate or delayed autologous breast reconstruction following mastectomy. We share our experience with modified, double back cut of post-mastectomy skin in delayed pedicled TRAMf breast reconstruction, resulting in fish-shaped skin paddle. This sort of back cut is a simple, reliable way to obtain a natural, esthetically pleasant breast mound with inconspicuous hidden scars.

  19. Enhanced survival of ischemic skin flap by combined treatment with bone marrow-derived stem cells and low-level light irradiation.

    Science.gov (United States)

    Moon, Jeong Hwan; Rhee, Yun-Hee; Ahn, Jin-Chul; Kim, Bongkyun; Lee, Sang Joon; Chung, Phil-Sang

    2017-08-23

    The aim of this study is to examine the enhanced survival effect of ischemic skin flap by combined treatment with bone marrow-derived stem cells (BMSCs) and low-level light irradiation (LLLI). The neovasculogenic effect of BMSCs induced by LLLI was detected using a wound healing and tube formation assay. ICR mice were divided into four groups: control group, LLLI group, BMSCs group, and combine-treated group. The percentage of skin flap necrosis area was calculated on the seventh post-operative day. Specimens were harvested for histologic analyses. LLLI promoted BMSC migration and tube formation. The flap survival rate of combined treated group was significantly higher than that of the control group. Histologic results demonstrated a significant increase in neovascularization in the combined treatment group. This study demonstrates that combination treatment of BMSCs and LLLI could enhance the survival of ischemic skin flap in a mouse model.

  20. 网状减张缝合提高张力皮瓣存活率的实验研究%Experiment research on promoting survival rate of tension skin flap after meshed relaxing short incision suture

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective To observe effects of meshed relaxing short incisions on the level of superoxide dismutase and malondialdehyde in rat tension skin flap, and to investigate the mechanism of meshed relaxing short incisions (MRSI) on wound healing process of tension skin flap. Method An experimental model was designed to investingate the changes of superoxide dismutase (SOD) and malondialdehyde (MDA) in rat skin flap tissue each period of wound healing (12h, 24h, 48h, 72h after suture). In the meantime, the biochemical reaction were employed. Results Our results showed that SOD content in rat skin flap tissue from MRSI group were significant higher than that of hypertension group (P≤ 0.05), while MDA content was significantly lower (P≤ 0.05). Conclusion The decrease of MDA contents may be one of the causes that MRSI improves microcirculation of skin flap, and reduces edema and facilitates healing of skin flap.

  1. Repairing skin defects with modified rhomboid flap%改良菱形皮瓣修复皮肤缺损

    Institute of Scientific and Technical Information of China (English)

    刘大海; 张蕊; 钟莉; 汪涛

    2012-01-01

    Objective To summarize clinical experience of skin defects reparation with modified rhomboid flap. Methods 46 patents with skin and soft-tissue defects were admitted to our department since 2006, the focus area ranged from 1.2 cmx0.6 cm to 7.0cmx4.5cm. The modified rhomboid flap was formed beside defect and elevated from superficial fascia layer, transferred into defect without tension. Results All flaps survived with primary healing postoperation except partial necrosis in 2 cases, the aesthetic and functional results were satisfactory with the mild scar after 1 months to 5 years following-up. Conclusion The elevating of modified rhomboid flap is easy and simple. It is a good method for repair of skin defects.%目的:总结改良菱形皮瓣修复皮肤缺损的的应用经验.方法:2006年~2011年,我科应用改良菱形皮瓣修复皮肤缺损共46例,创面最大7.0cm×4.5cm,最小1.2cm×0.6cm.在缺损边缘的一侧设计皮瓣,浅筋膜层内形成皮瓣,无张力下向受区转移修复创面.结果:术后除2例皮瓣尖端散在的表皮坏死外,其余存活良好,创面得以Ⅰ期修复,经1个月~5年随访,切口痕迹不明显,局部外形满意.结论:改良菱形皮瓣制作简单,是修复皮肤缺损的一种良好方法.

  2. 急诊手外科中腹部任意型皮瓣的应用%Application of Abdominal Randomy Skin flap in the Acute Operation for hand

    Institute of Scientific and Technical Information of China (English)

    杨建勋; 王宁

    2002-01-01

    Objective To present the means and effect of repairing hand soft tissue defect. Methods To transplate from 45 patients'randomy skin flap to hand defect area, and cut off the peduncle. Result The survival of skin flap is satisfactory with softness and colorfamiliar to normal skin 1 ~ 3 years after operation. Conclusion Therapy is simple reliable and effective.

  3. The Vasodilator Effect of a Cream Containing 10% Menthol and 15% Methyl Salicylate on Random-Pattern Skin Flaps in Rats

    Science.gov (United States)

    Dölen, Utku Can; Sungur, Nezih; Koca, Gökhan; Ertunç, Onur; Bağcı Bosi, Ayşe Tülay; Koçer, Uğur

    2015-01-01

    Background It is still difficult to prevent partial or full-thickness flap necrosis. In this study, the effects of a cream containing menthol and methyl salicylate on the viability of randompattern skin flaps were studied. Methods Forty female Sprague-Dawley rats were divided into two equal groups. Caudally based dorsal random-pattern skin flaps were elevated, including the panniculus carnosus. In the study group, 1.5 mL of a cream containing menthol and methyl salicylate was applied to the skin of the flap, and saline solution (0.9%) was used in the control group. Upon completion of the experiment, flap necrosis was analyzed with imaging software and radionuclide scintigraphy. Histopathological measurements were made of the percentage of viable flaps, the number of vessels, and the width of the panniculus carnosus muscle. Results According to the photographic analysis, the mean viable flap surface area in the study group was larger than that in the control group (P=0.004). According to the scintigrams, no change in radioactivity uptake was seen in the study group (P>0.05). However, a significant decrease was observed in the control group (P=0.006). No statistically significant differences were observed between the groups in terms of the percentage of viable flaps, the number of vessels, or the width of the panniculus carnosus muscle (P>0.05). Conclusions Based on these results, it is certain that the cream did not reduce the viability of the flaps. Due to its vasodilatory effect, it can be used as a component of the dressing in reconstructive operations where skin perfusion is compromised. PMID:26618115

  4. The Vasodilator Effect of a Cream Containing 10% Menthol and 15% Methyl Salicylate on Random-Pattern Skin Flaps in Rats.

    Science.gov (United States)

    Dölen, Utku Can; Sungur, Nezih; Koca, Gökhan; Ertunç, Onur; Bağcı Bosi, Ayşe Tülay; Koçer, Uğur; Korkmaz, Meliha

    2015-11-01

    It is still difficult to prevent partial or full-thickness flap necrosis. In this study, the effects of a cream containing menthol and methyl salicylate on the viability of randompattern skin flaps were studied. Forty female Sprague-Dawley rats were divided into two equal groups. Caudally based dorsal random-pattern skin flaps were elevated, including the panniculus carnosus. In the study group, 1.5 mL of a cream containing menthol and methyl salicylate was applied to the skin of the flap, and saline solution (0.9%) was used in the control group. Upon completion of the experiment, flap necrosis was analyzed with imaging software and radionuclide scintigraphy. Histopathological measurements were made of the percentage of viable flaps, the number of vessels, and the width of the panniculus carnosus muscle. According to the photographic analysis, the mean viable flap surface area in the study group was larger than that in the control group (P=0.004). According to the scintigrams, no change in radioactivity uptake was seen in the study group (P>0.05). However, a significant decrease was observed in the control group (P=0.006). No statistically significant differences were observed between the groups in terms of the percentage of viable flaps, the number of vessels, or the width of the panniculus carnosus muscle (P>0.05). Based on these results, it is certain that the cream did not reduce the viability of the flaps. Due to its vasodilatory effect, it can be used as a component of the dressing in reconstructive operations where skin perfusion is compromised.

  5. Beneficial Effects of Aminoguanidine on Skin Flap Survival in Diabetic Rats

    Directory of Open Access Journals (Sweden)

    Ayse Ozturk

    2012-01-01

    Full Text Available Random flaps in DM patients have poor reliability for wound coverage, and flap loss remains a complex challenge. The protective effects of aminoguanidine (AG administration on the survival of dorsal random flaps and oxidative stress were studied in diabetic rats. Two months after the onset of DM, dorsal McFarlane flaps were raised. Forty rats were divided into four groups: (1 control, (2 AG, (3 DM, and (4 DM + AG groups. Flap viability, determined with the planimetric method, and free-radical measurements were investigated. In addition, HbA1c and blood glucose levels, body weight measurements, and histopathological examinations were evaluated. The mean flap necrotic areas (% in Groups I to IV were 50.9 ± 13.0, 32.9 ± 12.5, 65.2 ± 11.5, and 43.5 ± 14.7, respectively. The malondialdehyde (MDA and nitric oxide (NO levels were higher in the DM group than in the nondiabetic group, while the reduced glutathione (GSH levels and superoxide dismutase (SOD activity were reduced as a result of flap injury. In the diabetic and nondiabetic groups, AG administration significantly reduced the MDA and NO levels and significantly increased GSH content and SOD enzyme activity. We concluded that AG plays an important role in preventing random pattern flap necrosis.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    an intraperitoneal injection of epinephrine 0.1 mg/kg, dobutamine 0.3 mg/kg, or saline (0.5 ml). The rats were euthanized after 7 days and the viable area of the flap was compared between the groups using a digital imaging and computer software. RESULTS: Seven rats/flaps were excluded from the study due...

  7. Clinical application of head and face axial pattern tissue (skin)flap%头面部轴型组织(皮)瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    匡斌; 陈云瀛; 邝石峰; 邓健; 邓国三; 黄广香

    2001-01-01

    Objective To introduce the application of several axial pattern tissue (skin) flaps of head and face. Methods Several axial pattern tissue flaps include temporal fascial flap, mandibular skin flap and forehead skin flap were applied to twenty-nine patients to construct the defect of their face, orbit and nose. Results Except one case had small range necrosis in the distant edge of the flaps, all tissue (skin) flaps survived. The facial appearance and the shape of reconstructed nose showed well. Conclusion It is effective to use facial tissue (skin)flaps with different blood supply pattern to repair facial defect or to reconstruct organs. The effect is definite.%目的 介绍多种头面部轴型组织(皮)瓣的临床应用。方法 分别应用以颞浅动脉、面动脉、滑车上动脉及内眦动脉为蒂的多种组织(皮)瓣转移修复面部、眶部缺损及行鼻再造手术29例。结果 除1例皮瓣远端出现小范围坏死外,所有组织(皮)瓣均成活,修复面部外形及再造鼻外形良好。结论 以不同血供方式形成多种面部组织(皮)瓣,用于修复面部缺损或行器官再造,疗效确切。

  8. Reconstruction of a palmar infection related tissue defect with heterodigital island flap in a diabetic patient: A case report

    Directory of Open Access Journals (Sweden)

    Candemir Ceran

    2014-08-01

    Full Text Available Hand infections are particularly important in diabetic patients, because of the rapid progression and high risk of morbidity. Infections should be treated emergently with sufficient debridement and appropriate antibiotics. Comorbid situations, type of infection and late intervention are important predisposing factors to complications such as tissue necrosis. Tissue defects should be reconstructed with a similar tissue that does not cause movement restrictions or contractures that have adequate thickness. In this study, heterodigital island flap in reconstruction of a palmar defect caused by infection in a diabetic patient is presented. [Hand Microsurg 2014; 3(2.000: 62-65

  9. The Relationship between Oxygen Saturation and Color Alteration of a Compromised Skin Flap: Experimental Study on the Rabbit

    Directory of Open Access Journals (Sweden)

    Theddeus O. H. Prasetyono

    2013-09-01

    Full Text Available Background The aim of this study was to collect important data on the time of oxygensaturation change in relation to skin flap color alteration using non-invasive pulse oximetryto evaluate its ability to provide continuous monitoring of skin flap perfusion.Methods An experimental study on the monitoring of blood perfusion of 20 tube-islandgroin flaps of 10 male New Zealand rabbits was performed using pulse oximetry. The animalswere randomly assigned to one of two groups representing a blockage of either arterial orvenous blood flow. The oxygen saturation change and clinical color alteration were monitoredfrom the beginning of vessel clamping until the saturation became undetectable. The resultwas analyzed by the t-test using SSPS ver. 10.0.Results The mean times from the vessel clamping until the saturation became undetectablewere 20.19±2.13 seconds and 74.91±10.57 seconds for the artery and vein clamping groups,respectively. The mean time of the clinical alteration from the beginning of vein clampingwas 34.5±11.72 minutes, while the alteration in flaps with artery clamping could not bedetected until 2.5 hours after clamping.Conclusions The use of neonate-type reusable flex sensor-pulse oximetry is objective andeffective in early detection of arterial and vein blockage. It provides real-time data on vesselocclusion, which in turn will allow for early salvaging. The detection periods of both arterialocclusion and venous congestion are much earlier than the color alteration one may encounterclinically.

  10. Indications, outcome and complications with axial pattern skin flaps in dogs and cats: 73 cases.

    Science.gov (United States)

    Field, E J; Kelly, G; Pleuvry, D; Demetriou, J; Baines, S J

    2015-12-01

    To determine the indications, frequency of complications and long term outcome associated with axial pattern flaps used to repair wound defects in dogs and cats. Medical records from two independent referral centres for dogs and cats undergoing wound repair with an axial pattern flap were reviewed. Seventy-three animals were included, 49 dogs: 24 cats. Indications for axial pattern flaps were chronic wounds (43/73; 59%) and closure following tumour resection (30/73; 41%). Axial pattern flaps used were: thoracodorsal, caudal superficial epigastric, reverse saphenous conduit, superficial brachial, deep circumflex iliac, superficial cervical, caudal auricular, lateral thoracic, cranial superficial epigastric, genicular and superficial temporal. Postoperative complications occurred in 64 patients (89%) and 8 patients (11%) had no complications. Complications were: dehiscence, swelling of the flap, necrosis, infection, discharge and seroma. Flap outcome was excellent in 16 patients (23%), good in 29 (41%), fair in 21 (30%) and poor in 5 (7%). There is a high complication rate associated with axial pattern flaps but these are usually easily managed and long term outcome is excellent, in either species. © 2015 British Small Animal Veterinary Association.

  11. Polidocanol injection for chemical delay and its effect on the survival of rat dorsal skin flaps.

    Science.gov (United States)

    Menevşe, Gülsüm Tetik; TeomanTellioglu, Ali; Altuntas, Nurgül; Cömert, Ayhan; Tekdemir, Ibrahim

    2014-06-01

    Surgical delay is an invasive method requiring a two-stage surgical procedure. Hence, methods that may serve as an alternative to surgical delay have become the focus of interest of research studies. From a conceptual view, any technique that interrupts the blood flow along the edges of a proposed flap will render the flap ischemic and induce a delay phenomenon. Polidocanol (Aethoxysklerol(®)-Kreussler) was initially used as a local anesthetic. Nowadays, it has been used as a sclerosing agent to treat telangiectasias and varicose veins. The aim of this experimental study was to investigate the effects of polidocanol injected around the periphery of a random flap as a sclerosing agent on flap delay and survival in a random flap model. A preliminary histopathologic study was performed on two rats to evaluate the sclerosing effect and distribution of polidocanol injection. After the preliminary study, the main study was carried out with three groups: group 1: dorsal flap (n = 10); group 2: dorsal flap + surgical delay (n = 10), group 3: dorsal flap + chemical delay (n = 10). Tissue samples obtained from the flap and injection area revealed destruction of intradermal vessels. The area affected with sclerosis was limited to 0.1 cm beyond the injection site. Mean viable flap areas were 52.1 ± 4.38% (44.0-58.2) in group 1, 64.8 ± 8.92% (57.2-89.2) in group 2, and 71.8 ± 5.18% (64.0-84.0) in group 3. A statistically highly significant difference was found between the surgical delay and chemical delay groups versus the group without delay (p surgical and chemical delay groups (p = 0.056). In conclusion, this study has shown that polidocanol injection around the dorsal flap in the rat is a safe and easy method for nonsurgical delay. The results have shown a flap survival benefit that is superior to controls and equivalent to surgical delay. The clinical application of polidocanol, already in clinical practice for occlusal of telangiectasias, for surgical delay appears

  12. Systemic Preconditioning by a Prolyl Hydroxylase Inhibitor Promotes Prevention of Skin Flap Necrosis via HIF-1-Induced Bone Marrow-Derived Cells

    Science.gov (United States)

    Takaku, Mitsuru; Tomita, Shuhei; Kurobe, Hirotsugu; Kihira, Yoshitaka; Morimoto, Atsushi; Higashida, Mayuko; Ikeda, Yasumasa; Ushiyama, Akira; Hashimoto, Ichiro; Nakanishi, Hideki; Tamaki, Toshiaki

    2012-01-01

    Background Local skin flaps often present with flap necrosis caused by critical disruption of the blood supply. Although animal studies demonstrate enhanced angiogenesis in ischemic tissue, no strategy for clinical application of this phenomenon has yet been defined. Hypoxia-inducible factor 1 (HIF-1) plays a pivotal role in ischemic vascular responses, and its expression is induced by the prolyl hydroxylase inhibitor dimethyloxalylglycine (DMOG). We assessed whether preoperative stabilization of HIF-1 by systemic introduction of DMOG improves skin flap survival. Methods and Results Mice with ischemic skin flaps on the dorsum were treated intraperitoneally with DMOG 48 hr prior to surgery. The surviving area with neovascularization of the ischemic flaps was significantly greater in the DMOG-treated mice. Significantly fewer apoptotic cells were present in the ischemic flaps of DMOG-treated mice. Interestingly, marked increases in circulating endothelial progenitor cells (EPCs) and bone marrow proliferative progenitor cells were observed within 48 hr after DMOG treatment. Furthermore, heterozygous HIF-1α-deficient mice exhibited smaller surviving flap areas, fewer circulating EPCs, and larger numbers of apoptotic cells than did wild-type mice, while DMOG pretreatment of the mutant mice completely restored these parameters. Finally, reconstitution of wild-type mice with the heterozygous deficient bone marrow cells significantly decreased skin flap survival. Conclusion We demonstrated that transient activation of the HIF signaling pathway by a single systemic DMOG treatment upregulates not only anti-apoptotic pathways but also enhances neovascularization with concomitant increase in the numbers of bone marrow-derived progenitor cells. PMID:22880134

  13. Systemic preconditioning by a prolyl hydroxylase inhibitor promotes prevention of skin flap necrosis via HIF-1-induced bone marrow-derived cells.

    Directory of Open Access Journals (Sweden)

    Mitsuru Takaku

    Full Text Available BACKGROUND: Local skin flaps often present with flap necrosis caused by critical disruption of the blood supply. Although animal studies demonstrate enhanced angiogenesis in ischemic tissue, no strategy for clinical application of this phenomenon has yet been defined. Hypoxia-inducible factor 1 (HIF-1 plays a pivotal role in ischemic vascular responses, and its expression is induced by the prolyl hydroxylase inhibitor dimethyloxalylglycine (DMOG. We assessed whether preoperative stabilization of HIF-1 by systemic introduction of DMOG improves skin flap survival. METHODS AND RESULTS: Mice with ischemic skin flaps on the dorsum were treated intraperitoneally with DMOG 48 hr prior to surgery. The surviving area with neovascularization of the ischemic flaps was significantly greater in the DMOG-treated mice. Significantly fewer apoptotic cells were present in the ischemic flaps of DMOG-treated mice. Interestingly, marked increases in circulating endothelial progenitor cells (EPCs and bone marrow proliferative progenitor cells were observed within 48 hr after DMOG treatment. Furthermore, heterozygous HIF-1α-deficient mice exhibited smaller surviving flap areas, fewer circulating EPCs, and larger numbers of apoptotic cells than did wild-type mice, while DMOG pretreatment of the mutant mice completely restored these parameters. Finally, reconstitution of wild-type mice with the heterozygous deficient bone marrow cells significantly decreased skin flap survival. CONCLUSION: We demonstrated that transient activation of the HIF signaling pathway by a single systemic DMOG treatment upregulates not only anti-apoptotic pathways but also enhances neovascularization with concomitant increase in the numbers of bone marrow-derived progenitor cells.

  14. [Reconstruction of combined skin and bilateral artey defects at palmar side of fingers by free posterior interrosseous artery flap in a bridge fashion].

    Science.gov (United States)

    Xu, Bao-cheng; Liang, Gang; Chen, Fu-sheng

    2012-05-01

    To investigate the feasibility and therapeutic effect of free posterior interrosseous artery flap in a bridge fashion for combined skin and bilateral artery defects at palmar side of fingers. 6 cases with combined skin and bilateral artery defects at palmar side of fingers were treated with long-pedicled free posterior interrosseous artery flap in a bridge fashion. The flap size ranged from 3.5 cm x 2.0 cm to 6.5 em x 3.0 cm. The wounds at donor sites were closed directly. All the 6 flaps survived completely without any complication, and the wounds healed primarily. The blood supply and vein drainage in all the 6 fingers were normal. 4 cases were followed up for 1-12 months (average, 7 months). Satisfactory cosmetic and functional results were achieved. The flaps looked a little bit thicker than the surrounding tissue. The long-pedicled free posterior interrosseous artery flap in a bridge fashion is a good option for reconstruction of the combined skin and bilateral artery defects at palmar side of fingers in one stage.

  15. 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.

  16. SU-E-T-09: A Clinical Implementation and Optimized Dosimetry Study of Freiberg Flap Skin Surface Treatment in High Dose Rate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Syh, J; Syh, J; Patel, B; Wu, H; Durci, M [Willis-Knighton Medical Center, Shreveport, LA (United States)

    2015-06-15

    Purpose: This case study was designated to confirm the optimized plan was used to treat skin surface of left leg in three stages. 1. To evaluate dose distribution and plan quality by alternating of the source loading catheters pattern in flexible Freiberg Flap skin surface (FFSS) applicator. 2. To investigate any impact on Dose Volume Histogram (DVH) of large superficial surface target volume coverage. 3. To compare the dose distribution if it was treated with electron beam. Methods: The Freiburg Flap is a flexible mesh style surface mold for skin radiation or intraoperative surface treatments. The Freiburg Flap consists of multiple spheres that are attached to each other, holding and guiding up to 18 treatment catheters. The Freiburg Flap also ensures a constant distance of 5mm from the treatment catheter to the surface. Three treatment trials with individual planning optimization were employed: 18 channels, 9 channels of FF and 6 MeV electron beam. The comparisons were highlighted in target coverage, dose conformity and dose sparing of surrounding tissues. Results: The first 18 channels brachytherapy plan was generated with 18 catheters inside the skin-wrapped up flap (Figure 1A). A second 9 catheters plan was generated associated with the same calculation points which were assigned to match prescription for target coverage as 18 catheters plan (Figure 1B). The optimized inverse plan was employed to reduce the dose to adjacent structures such as tibia or fibula. The comparison of DVH’s was depicted on Figure 2. External beam of electron RT plan was depicted in Figure 3. Overcall comparisons among these three were illustrated in Conclusion: The 9-channel Freiburg flap flexible skin applicator offers a reasonably acceptable plan without compromising the coverage. Electron beam was discouraged to use to treat curved skin surface because of low target coverage and high dose in adjacent tissues.

  17. Computer-assisted teaching of skin flap surgery: validation of a mobile platform software for medical students.

    Directory of Open Access Journals (Sweden)

    David P de Sena

    Full Text Available The purpose of this study was to develop and validate a multimedia software application for mobile platforms to assist in the teaching and learning process of design and construction of a skin flap. Traditional training in surgery is based on learning by doing. Initially, the use of cadavers and animal models appeared to be a valid alternative for training. However, many conflicts with these training models prompted progression to synthetic and virtual reality models. Fifty volunteer fifth- and sixth-year medical students completed a pretest and were randomly allocated into two groups of 25 students each. The control group was exposed for 5 minutes to a standard text-based print article, while the test group used multimedia software describing how to fashion a rhomboid flap. Each group then performed a cutaneous flap on a training bench model while being evaluated by three blinded BSPS (Brazilian Society of Plastic Surgery board-certified surgeons using the OSATS (Objective Structured Assessment of Technical Skill protocol and answered a post-test. The text-based group was then tested again using the software. The computer-assisted learning (CAL group had superior performance as confirmed by checklist scores (p<0.002, overall global assessment (p = 0.017 and post-test results (p<0.001. All participants ranked the multimedia method as the best study tool. CAL learners exhibited better subjective and objective performance when fashioning rhomboid flaps as compared to those taught with standard print material. These findings indicate that students preferred to learn using the multimedia method.

  18. [Covering losses of cutaneous substance of the leg and foot using skin flaps. Apropos of 76 cases].

    Science.gov (United States)

    Oberlin, C; Alnot, J Y; Duparc, J

    1988-01-01

    Between 1983 and 1987, 76 flap grafts were performed in the leg and foot. In general, 3 types of flap were used: --51 ipsilateral flaps, the majority of which were musculo-cutaneous flaps from the medial head of gastrocnemius (17 cases). --17 cross-leg flaps from the opposite limb, the majority of which were medial fascio-cutaneous flaps (13 cases). --8 free flaps, making use of microsurgical techniques. The indications for cross-leg flaps and free flaps have become more limited in favour of local regional pedicle flaps. The lower part of the leg and amputation stumps in the foot are easily covered by distal leg pedicle flaps and amputation stumps of the upper third of the leg can be covered by a flap of fascia lata with a distal pedicle based on the superolateral branches of the peri-articular plexus of the knee.

  19. Bi-pedicled V-Y gastrocnemius myocutaneous flap for repairing Achilles tendon and overlying skin defect: the anatomic basis and clinical application

    Institute of Scientific and Technical Information of China (English)

    XU Yong-qing; ZHU Yue-liang; YANG Jun; LI Jun; DING Jing; LU Sheng

    2007-01-01

    Objective: To study the anatomic basis of the bi-pedicled V-Y gastrocnemius myocutaneous flap for repairing the composite Achilles tendon defect. Methods: The pedicle anatomy of the bi-pedicled V-Y gastrocnemius myocutaneous flap was examined on 30 cadaver specimens. The sliding distances of the flap were measured at different knee flexion degrees. The bi-pedicled V-Y gastrocnemius myocutaneous flap was applied in 12 cases of Achilles tendon defect with simultaneous skin and soft tissue defect. Results: The sural arteries could be classified into four types. After cutting off the gastrocnemius origin with a "Z-shaped" incision, the sliding distance of the flap reached (3.7±0.5)cm when the knee flexed 0°,(4.9±0.7)cm when the knee flexed 30°,(6.7±0.7)cm when the knee flexed 60°and (9.2±0.9)cm when the knee flexed 90°. All the defects healed. The patients recovered ambulation with satisfactory knee and ankle function.The follow-up was 4 months -12 years. Conclusions: Different sural artery types should be noticed during the harvest of the bi-pedicled V-Y gastrocnemius myocutaneous flap. With 90°knee flexion,this flap is suitable for one-stage repair of composite Achilles tendon defect within 9.2 cm±0.9 cm.

  20. Esthetic result of rhomboid flap repair after breast-conserving surgery for lower quadrant breast cancer lesion with skin invasion: report of two cases.

    Science.gov (United States)

    Tanaka, Satoru; Nohara, Takehiro; Nakatani, Shuichi; Iwamoto, Mitsuhiko; Sumiyoshi, Kazuhiro; Kimura, Kosei; Takahashi, Yuko; Sato, Nayuko; Tanigawa, Nobuhiko

    2011-06-01

    Breast-conserving surgery (BCS) has been increasingly performed as a standard operative strategy for patients with breast cancer. The primary purpose of BCS is to acquire both local control and good cosmetic results. An insignificant difference in cancer treatment results has been shown between BCS and total mastectomy. However, achieving sufficiently cosmetic results can be difficult, particularly in patients with tumors that are large or localized to the lower quadrant. To avoid breast deformities and asymmetries after BCS, immediate reconstruction using autologous tissue has been accepted as the standard option. Rhomboid skin and adipose flap repair is a simple, less invasive procedure than the myocutaneous flap, which has primarily been performed in patients with upper quadrant lesions. We herein report the cases of two patients with lower quadrant breast cancer with skin invasion, who underwent BCS with immediate breast repair using a rhomboid flap. This procedure is therefore worth considering as one of the first options for immediate repair after BCS.

  1. 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

  2. Reduction of mandibular residual ridge after vestibuloplasty. A two-year follow-up study comparing the Edlan flap, mucosal and skin graft operations

    DEFF Research Database (Denmark)

    Hillerup, Søren; Eriksen, Erik; Solow, B

    1989-01-01

    Mandibular residual ridge reduction (RRR) after Edlan flap vestibuloplasty, buccal mucosal graft, and split skin graft vestibuloplasty was measured on lateral cephalometric radiographs obtained 1, 3, 6, 12 and 24 months postsurgery in 50 patients. The ridge reduction was most severe during the im...

  3. Small random pattern skin flaps in repair of facial skin defects%应用随意微小皮瓣术修复颜面皮肤缺损58例效果评价

    Institute of Scientific and Technical Information of China (English)

    戚稼; 朱小红; 蒋屏东; 翟建新; 杨莉佳

    2012-01-01

    目的:评价随意微小皮瓣修复颜面部皮肤外科手术后皮肤缺损的效果.方法:58例颜面部皮肤外科手术患者采用随意微小皮瓣修复皮肤缺损.结果:7种58例随意微小皮瓣修复颜面部皮肤缺损,55例术后效果满意,无牵拉变形,瘢痕隐蔽.3例患者出现术后皮瓣远端青紫或周边出现表皮水疱现象,随访均痊愈.随意微小皮瓣最常用于颊部,其次是额部、鼻部、眼睑、口唇及口周部位、颞部、眉部、下颏.应用最多的是皮下蒂滑行推进皮瓣.结论:合理设计个性化随意微小皮瓣修复颜面部皮肤缺损,可获得满意疗效.%Objective: To explore the effects of small random pattern skin flaps in repair of facial skin defects in dermatologic surgery. Methods: Specific small random pattern skin flaps were designed for repair of facial skin defects in 58 patients after the resection of their lesions. Results: A totle of 7 kinds of 58 pieces of small random pattern skin flaps were designed and applied in repair of facial skin defects. Of all patients, 55 achieved excellent effects with a concealed scar left but without facial deformation. The distal ends of flaps became cyanoderma and superficial blister appeared around it in 3 patients, which healed in the subsequent follow - up. The predilection sites for the formation of skin flaps in decreasing order were bucca, followed by foreheads, nose, eyelids, lips, tempus, eyebrows and mandible regions. The most widely used were sliding advancement skin flaps. Conclusion: Reasonable design of small random pattern skin flaps may result in satisfying thera eutic and cosmetic effects for repair of facial skin defects.

  4. Effects of sildenafil on the viability of random skin flaps Os efeitos do sildenafil na viabilidade de retalhos cutâneos randômicos

    Directory of Open Access Journals (Sweden)

    Sumara Marques Barral

    2011-08-01

    Full Text Available PURPOSE: To assess the viability of McFarlane skin flaps in rats with administration of sildenafil. METHODS: Twenty Wistar rats were distributed into two groups: Control (dorsal skin flap, subdermal application of saline solution at 0.9% and Study (dorsal skin flap, subdermal application of sildenafil. Seven days after the surgery, flaps were photographed and graphically rendered. Then, they were analyzed with AutoCAD software. Three biopsies (proximal, medial and distal of each flap were collected for histological analysis. RESULTS: Macroscopic analysis showed that animals of the study group had greater necrotic areas (p=0.003 in the dorsal skin flaps. Additionally, histological analysis of the distal third of these flaps showed a tendency to less granulated tissue formation in animals treated with sildenafil. CONCLUSION: Sildenafil subdermally was associated with lower viability of the random skin flap in rats.OBJETIVO: Avaliar a viabilidade de retalhos cutâneos de ratos à McFarlane após a administração de sildenafil. MÉTODOS: Vinte ratos Wistar foram distribuídos em dois grupos: Controle (confecção do retalho cutâneo dorsal, aplicação subdérmica de solução salina a 0,9% e Estudo (confecção do retalho cutâneo dorsal, aplicação subdérmica de sildenafil. Sete dias após a operação, os retalhos foram fotografados e representados graficamente, para serem analisados com o programa AutoCad. Três biópsias (cranial, média e caudal foram coletadas de cada retalho, para análise histológica. RESULTADOS: A análise macroscópica evidenciou que os animais do grupo Estudo apresentaram maiores áreas de necrose (p=0,003 nos retalhos cutâneos dorsais. Além disso, a análise histológica dos terços distais dos retalhos mostrou uma tendência à formação de menos tecido de granulação nos animais que receberam o sildenafil. CONCLUSÃO: O sildenafil subdérmico esteve associado com uma pior viabilidade tecidual dos retalhos cut

  5. Use of previously burned skin as random cutaneous local flaps in pediatric burn reconstruction

    NARCIS (Netherlands)

    Barret, JP; Herndon, DN; McCauley, RL

    2002-01-01

    Reconstruction after post-burn scarring remains a challenge. It is especially true in the severely burned patient, who normally presents with a paucity of donor sites Healed skin from areas that had been burned and skin from grafted areas (termed as previously burned skin) have been occasionally use

  6. Use of previously burned skin as random cutaneous local flaps in pediatric burn reconstruction

    NARCIS (Netherlands)

    Barret, JP; Herndon, DN; McCauley, RL

    Reconstruction after post-burn scarring remains a challenge. It is especially true in the severely burned patient, who normally presents with a paucity of donor sites Healed skin from areas that had been burned and skin from grafted areas (termed as previously burned skin) have been occasionally

  7. [Repairing degloving injury of distal phalanx with homodigital bilobed flaps tiled].

    Science.gov (United States)

    Jiang, Qiting; Feng, Mingsheng; Jiang, Zhiwei; Liu, Jinzhu

    2012-07-01

    To study the methods and effectiveness of repairing degloving injury of the distal phalanx with homodigital bilobed flaps tiled. Between April 2008 and June 2011, 40 patients (40 fingers) with degloving injury of the distal phalanx were treated, which were caused by machine. There were 30 males and 10 females, aged from 18 to 56 years (mean, 30 years). The time from injury to operation was 1-5 hours (mean, 2.5 hours). Affected fingers included index in 13 cases, middle finger in 11 cases, ring finger in 9 cases, and little finger in 7 cases. The defect area ranged from 3.0 cm x 2.0 cm to 5.5 cm x 3.8 cm. All cases complicated by pollution and exposure of tendon and phalanx, 5 cases by phalangeal fractures, and tendon insertion had no rupture. The end dorsal branches of digital artery island flaps and digital arterial island flaps were used in 14 cases, the end dorsal branches of digital artery island flaps and near dorsal branches of digital artery island flaps in 18 cases, and the end dorsal branches of digital artery island flaps and superficial palmar digital veins arterilization island flaps in 8 cases. The area of the upper flaps ranged from 2.0 cm x 1.5 cm to 2.6 cm x 2.2 cm and the area of the next leaf flaps ranged from 2.5 cm x 2.0 cm to 3.5 cm x 2.5 cm. The donor sites were covered with free flaps. Flap blister occurred in 13 cases and vascular crisis in 3 cases. The flaps survived in 40 cases, wound healing by first intention was achieved in 38 cases, and by second intention in 2 cases. The donor skin-grafting was survival. After operation, 30 patients were followed up 8 to 20 months with an average of 10.6 months. The flaps had satisfactory appearance and soft texture, and the finger tip had no touch pain. The sensory function of the flaps was restored at 4-6 weeks after operation; two-point discrimination was 6.0 to 10.0 mm in 24 flaps at 12-15 months. According to the total active movement (TAM) evaluation system introduced by the American Society for

  8. Thenar reversed island flap combined with thumb dorsoulnar neurocutaneous vascular flap for repairing of distal thumb degloving injury%大鱼际逆行岛状皮瓣联合拇指尺背侧皮神经营养血管皮瓣修复拇指末节套脱伤

    Institute of Scientific and Technical Information of China (English)

    沈泳; 施海峰; 钱俊; 吴柯; 芮永军

    2016-01-01

    transferred to cover the dorsum of the thumb.The donor sites were closed by either direct suture or by full thickness skin graft.Results All the flaps in the 12 cases survived uneventfully.Postoperative follow-up ranged from 6 to 18 months,with an average of 10 months.The appearance,texture and color of the flaps were satisfactory.Sensory and motor function recovery were excellent in 8 cases,good in 3 cases and fair in 1 case according to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association.Two-point discrimination of the thenar reversed island flap on the thumb pulp was 6.9 to 9.5 mm(average 7.8 mm),while that of the dorsoulnar neurocutaneous vascular flap on the dorsum of the thumb was 7.0 to 11.0 mm (average 8.5 rnm).According to the British Medical Research Council (BMRC) rating sensory function recovery was S2 to S4,with an average of S3+.Conclusion Combined transfer of thenar reversed island flap and dorsoulnar neurocutaneous vascular flap from the thumb is a surgical procedure that is simple,does not require dissection of deep anatomical structures,preserves known blood vessels,causes minor surgical trauma and leads to satisfactory results in repairing distal thumb degloving injury.

  9. 股直肌岛状肌皮瓣修复瘫痪患者股骨大转子压疮效果%Repair of bedsore over greater trochanter in paraplegic patients with rectus femoris island myocutaneous flap

    Institute of Scientific and Technical Information of China (English)

    赵遵江; 张保德; 刘勇; 章荣涛; 梁其国; 胡育栋; 徐良媛; 王修坤

    2014-01-01

    Objective To observe the effect of rectus femoris island myocutaneous flap for repairing bedsores in Ⅲ and Ⅳphases at the femoral greater trochanter area as a result of paraplegia.Methods Thirteen paraplegic patients who suffered bedsores in Ⅲ and Ⅳ phases at the greater trochanter of femur area were hospitalized from July 2009 to June 2013.The bedsores ranged from 4.5 cm ×4.0 cm to 10.0 cm × 9.0 cm in area.After debridement,the size of soft tissue defect ranged from 5.0 cm ×4.5 cm to 10.5 cm × 10.0 cm.Rectus femoris island myocutaneous flaps were used to repair these defects,with flap area ranging from 5.0 cm×5.0 cm to 11.0 cm ×10.0 cm and muscular pedicle length ranging from8 to 12 cm.The donor sites of muscular pedicle were closed by direct suture,while those resulted from forming myocutaneous flap were closed by the transplantation of autologous skin obtained from thigh.Results Necrosis appeared at the edge of myocutaneous flap in one patient,and it was healed after dressing change.The other 12 myocutaneous flaps survived well.Patients were followed up for 2 to 30 months,and bedsore did not recur.Conclusions Rectus femoris island myocutaneous flap,with characteristics of reasonable design,large donor area,big rotation angle,and with wear-,tear-,and pressure-resistance,is suitable for repairing bedsores at Ⅲ and Ⅳ phases at the greater trochanter of femur area in paraplegic patients.%目的 观察用股直肌岛状肌皮瓣修复瘫痪患者股骨大转子Ⅲ~Ⅳ期压疮的效果.方法 2009年7月-2013年6月,笔者单位收治13例股骨大转子Ⅲ~Ⅳ期压疮瘫痪患者,压疮面积为4.5 cm ×4.0 cm~10.0 cm ×9.0 cm,扩创后缺损面积为5.0 cm ×4.5 cm~10.5 cm ×10.0 cm.采用股直肌岛状肌皮瓣修复创面,肌皮瓣面积为5.0 cm ×5.0 cm~11.0 cm×10.0 cm,肌蒂长8~12 cm.肌蒂切取区直接拉拢缝合固定,肌皮瓣切取区行自体大腿皮移植封闭. 结果 12例肌皮瓣全部成活;1例肌皮瓣的边

  10. Estudo da isquemia e reperfusão em retalhos cutâneos de ratos The study of the ischemia and reperfusion in skin flaps of rats

    Directory of Open Access Journals (Sweden)

    Frederico Alonso Sabino de Freitas

    2002-01-01

    Full Text Available INTRODUÇÃO: Múltiplos fatores têm sido implicados na patogênese da lesão de isquemia/reperfusão da pele, incluindo as espécies reativas de oxigênio. OBJETIVO: Estudar a lesão de isquemia/reperfusão em retalhos cutâneos de ratos avaliando os níveis teciduais do malonildialdeído (MDA e xantina oxidase (XO. MÉTODOS: Foram utilizados 8 ratos Wistar, com peso entre 300 - 400g, sendo confeccionados 2 retalhos epigástricos por animal (controle e experimento, um deles submetido à 16h de isquemia (RI seguida de 45 min de reperfusão (RR e o outro controle (RC. Foram colhidas 3 biópsias de pele dos retalhos (RC, RI, RR e encaminhadas para dosagem de MDA e XO. RESULTADOS: A análise bioquímica mostrou aumento significativo dos níveis teciduais de MDA e XO após a reperfusão em relação aos retalhos controles. CONCLUSÃO: Retalhos epigástricos de ratos submetidos à 16h de isquemia e 45min de reperfusão apresentam elevação dos níveis teciduais de MDA e XO, caracterizando a lipoperoxidação da membrana celular.INTRODUCTION: Multiple factors have been implicated in the pathogenesis of reperfusion injury in the skin, including the reactive oxygen species. OBJECTIVE: The aim was to evaluate the effect of reperfusion injury in the rat skin flap evaluated by tissue assay for malonyldialdehyde (MDA and xanthine oxidase (XO. METHODS: 8 Wistar rats were used, between 300-400g weight and two identical epigastric flaps were raised in each animal (control and experiment, the vasculature of one flap was left intact and in the second flap the arterial pedicle was clamped for 16 hours and reperfused for 45 minutes. Skin samples were obtained from each flap after these periods of time and submitted to MDA and XO analysis. RESULTS: Reperfused flaps had significantly increased MDA and XO values compared to the control flaps biopsies. CONCLUSION: The lipid peroxidation levels were higher in the rat epigastric skin flaps subjected to 16 hours of

  11. Elaboration of an algorithm for preserving a projective skin flap above the tumor when planning subcutaneous mastectomy from an aesthetically acceptable area in patients with breast nodule cancer

    Directory of Open Access Journals (Sweden)

    A. R. Khamitov

    2016-01-01

    Full Text Available Indications for the conservation of the skin flap over the tumor for potential offset of the operational access in aesthetically acceptable zone in patients with primary nodular breast cancer are discussed in the article. The survey results of 203 patients (T1–2N0–3M0 are analyzed. The study revealed that the risk factors affecting the skin flap involvement are the presence of the skin flattening as well as topographic and anatomical characteristics: tumor < 3 cm, located at a depth of < 0.46 ± 0.2 cm, tumor ≥ 3 cm located at a depth of < 1.66 cm. Based on the data the algorithm for immediate breast reconstruction from aesthetically acceptable zone for surgical oncologist is compiled.

  12. [Thigh and leg musculo-cutaneous island flap for giant bilateral trochanteric and perineal pressure sores coverage: Extreme treatment in spinal cord injury].

    Science.gov (United States)

    André, A; Crouzet, C; De Boissezon, X; Grolleau, J-L

    2015-06-01

    Surgical treatment of perineal pressure sores could be done with various fascio-cutaneous or musculo-cutaneous flaps, which provide cover and filling of most of pressure sores after spinal cord injuries. In rare cases, classical solutions are overtaken, then it is necessary to use more complex techniques. We report a case of a made-to-measure lower limb flap for coverage of confluent perineal pressure sores. A 49-year-old paraplegic patient developed multiple pressure sores on left and right ischial tuberosity, inferior pubic bone and bilateral trochanters with hips dislocation. Surgical treatment involved a whole right thigh flap to cover and fill right side lesions, associated to a posterior right leg musculo-cutaneous island flap to cover and fill the left trochanteric pressure sore. The surgical procedure lasted 6.5 hours and required massive blood transfusion. Antibiotics were adapted to bacteriological samples. There were no postoperative complications; complete wound healing occurred after three weeks. A lower limb sacrifice for coverage of a giant perineal pressure sores is an extreme surgical solution, reserved to patients understanding the issues of this last chance procedure. A good knowledge of vascular anatomy is an essential prerequisite, and allows to shape made-to-measure flaps. The success of such a procedure is closely linked to the collaboration with the rehabilitation team (appropriate therapeutic education concerning transfers and positioning). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  13. Reconstruction of the thumb tip using palmar neurovascular flaps.

    Science.gov (United States)

    Harenberg, P S; Jakubietz, R G; Jakubietz, M G; Schmidt, K; Meffert, R H

    2012-04-01

    Reconstruction of the tip of the thumb using a neurovascular flap. Transverse defects of the thumb's tip or large defects of the palmar pulp (max. 2.0-2.5 cm) with exposure of bone and/or tendons. Extensive crush injury, heavy wound contamination, circulatory disorders, acute infection, very large defects (> 2.0-2.5 cm finger length), circumferential soft tissue defects, and previous defects/operations (relative). Supine position, hand supinated, tourniquet, loupe magnification. Mid-lateral incisions along both sides of the finger running from the defect to the interphalangeal joint (small defect) or proceeding further proximally. Careful elevation of the flap including both neurovascular bundles leaving dorsal branches of the bundles (long fingers only) and the flexor tendon sheath intact. Suture of the flap in either flexion position (i.e., advancement flap) (Moberg) or by creating an island-flap through an additional transverse skin incision along the flap's base (O'Brien). Finally, closure of the defect at the flap's base using a full thickness skin graft, Z plasty, or V-Y plasty. Plaster cast (finger slightly flexed) for 2 weeks. Reliable method. Good functional results with good sensibility and only minor reduction in range of motion.

  14. [Long term evaluation of sensation sequelae of bipedicled digital advancement island flaps. Comparison of clinical and electrophysiological results. Apropos of 13 cases].

    Science.gov (United States)

    Milliez, P Y; Parain, D; Menard, J F; Magnier, P; Plot, E

    1994-06-01

    Thirteen homodigital bipedicle island flaps for digital pulp amputation were reviewed to allow a better evaluation of sensory sequelae. A clinical and electrophysiological study of the sensory score of the pulp were compared to the contralateral normal digit and expressed in relative values. Sensory sequelae, even minor, are constant. The summated scores of dynamic and static 2 point discrimination test, appeared correlated to the electrophysiological amplitude modulations. This result seems particularly interesting as it adds another test for the objective evaluation of sensitivity.

  15. Hypospadias: the release of chordee without dividing the urethral plate and onlay island flap (92 cases)

    Science.gov (United States)

    Mollard, P; Castagnola, C

    1994-10-01

    Standard teaching states that the correction of fibrous chordee requires division of the urethral plate. Subsequently, it is necessary to reconstruct the urethra using tubular urethroplasty, which carries a significant incidence of complications, for example stenosis. In fact, we have demonstrated that it is possible to release severe chordee associated with hypospadias simply by dissecting the urethral plate of the corpora rather than dividing it. Between 1989 and 1993 we operated on 101 patients with hypospadias with fibrous chordee. The release of chordee was achieved without dividing the plate in 92 patients (91%), including all 71 cases of penile hypospadias, 11 perineal hypospadias and 10 reoperations. A total of 92 urethroplasties was performed with an onlay flap and 19 complications occurred in 15 patients.

  16. The latissimus dorsi-groin-lymph node compound flap: A comprehensive technique with three features including skin coverage, restoration of motor function, and prevention of upper limb lymphedema.

    Science.gov (United States)

    Nicoli, Fabio; Orfaniotis, Georgios; Lazzeri, Davide; Lim, Seong Yoon; Kiranantawat, Kidakorn; Chen, Pei-Yu; Ciudad, Pedro; Chilgar, Ram M; Sapountzis, Stamatis; Sacak, Bulent; Chen, Hung-Chi

    2016-11-01

    Reconstruction of complex upper extremity defects requires a need for multiple tissue components. The supercharged latissimus dorsi (LD)-groin compound flap is an option that can provide a large skin paddle with simultaneous functional muscle transfer. It is necessary to supercharge the flap with the superficial circumflex iliac pedicle to ensure the viability of its groin extension. In this report, we present a case of a supercharged LD-groin flap in combination with vascularized inguinal lymph nodes, which was used for upper limb reconstruction in a young male patient, following excision of high-grade liposarcoma. Resection resulted in a 28 cm × 15 cm skin defect extending from the upper arm to the proximal forearm, also involving the triceps muscle, a segment of the ulnar nerve and the axillary lymph nodes. Restoration of triceps function was achieved with transfer of the innervated LD muscle. Part of the ulnar nerve was resected and repaired with sural nerve grafts. Post-operatively, the flap survived fully with no partial necrosis, and no complications at both the recipient and donor sites. At 1-year follow up, the patient had a well-healed wound with good elbow extension (against resistance), no tumor recurrence, and no signs of lymphedema. We believe this comprehensive approach may represent a valuable technique, for not only the oncological reconstruction of upper extremity, but also for the prevention of lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:689-694, 2016.

  17. Analysis of the Changes in Circulation of Sub-dermal Vascular Network Flap Made from Flap-type Skin Avulsion and Replanted to Origin Site%皮瓣型皮肤撕脱伤修成暴露真皮下血管网皮瓣回植创面的血循环变化分析

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To find out the characteristics of the changes in circulation of sub-dermal vascular network flap made from flap-type skin avulsion Injury and replanted to origin site. Method: Pig skin avulsion model was used in this experiment. Flap's blood circulation was monitored and surviving flap length measured. Result. Flap blood circulation was markedly improved. Conclusion: Sub-dermal vascular network flap made from skin avulsion flap and replanted to origin site can improved the survival length of the flap.%目的:了解皮肤撕脱伤修成暴露真皮下血管网皮瓣回植创面的血循环变化特点和对皮瓣成活的影响。方法:以猪为实验对象,制作皮肤撕脱伤模型,观察皮瓣的血循环变化和成活情况。结果:将撕脱瓣修成暴露真皮下血管网的皮瓣再回植,可以使皮瓣血循环显著改善。结论:将撕脱瓣修成暴露真皮下血管网的皮瓣再回植,可以使皮瓣成活长度显著增加。

  18. Repair of tissue defect of lower leg and toot with reverse islaud skin flaps with sural nerve and blood supplying vessels%腓肠神经营养血管逆行皮瓣修复小腿下段及足部组织缺损

    Institute of Scientific and Technical Information of China (English)

    胡骁骅; 沈余明; 王志永; 陈忠; 黎明; 覃凤均; 张国安

    2009-01-01

    Objective To observe the clinical effect of reverse island skin flaps with sural nerve and blood supplying vessels on repair of tissue defect of lower leg and foot. Methods Fifty-six patients with lower leg and foot tissue defects were hospitalized from June 1997 to August 2007. Among them, 10 patients suffered from soft tissue defect of lower leg; 38 patients suffered from wound infection, exposure of fracture of tibia and fibula, and osteonecrosis; 8 patients suffered from heelstick tissue defect, bone adhering sear, and osteomyelitis. The defects were repaired with sural nerve and blood vessel nourished reverse island skin flaps (46 cases) and myocutaneous flaps(10 cases). The size of flaps ranged from 5 cm×4 cm to 22 cm×16 cm. Flap donor sites were closed by direct suture or free skin grafting. Results Flaps in 55 cases sur-vived. Patients were followed up 3-6 months, there was no complication, and they were healed with satisfac-tory texture and appearance. The patients could walk normally, but with unsatisfactory sensory recovery. In one patient, the flap was broken and ulcerated 1 month after operation on account of leaving behind necrotic tibia. It was healed after second operation. Conclusions Sural nerve and blood vessel nourished reverse island skin flap or myocutaneous flap transplantation is an effective treatment for repair of soft tissue defect of lower leg and foot.%目的 了解腓肠神经营养血管逆行皮瓣修复小腿下段及足部组织缺损的临床效果.方法 1997年6月-2007年8月,笔者对56例小腿下段及足部组织缺损患者(小腿下段软组织缺损10例;创面感染,胫、腓骨骨折外露,骨坏死38例;足部组织缺损、贴骨瘢痕、骨髓炎8例)的创面,采用腓动脉穿支供血的腓肠神经营养血管逆行岛状皮瓣(46例)或肌皮瓣(10例)进行修复.皮瓣面积5 cm ×4 cm~22 cm × 16 cm,供瓣区直接拉拢缝合或行游离植皮封闭.结果 其中55例患者术后皮瓣

  19. Capsaicin on the viability of random-pattern skin flaps in rats Capsaicina na viabilidade de retalhos isquêmicos randômicos em ratos

    Directory of Open Access Journals (Sweden)

    Gustavo Roberto de Godoy

    2010-10-01

    Full Text Available PURPOSE: To evaluate the effects of capsaicin on the viability of ischemic random-pattern skin flaps in rats. METHODS:Forty EPM1-Wistar rats were randomized into two groups of 20 animals each, the capsaicin group and the control group. A random-pattern skin flap measuring 10 x 4cm was raised and a plastic barrier was placed between the flap and the donor site. After the surgical procedure, the control group was treated with an inert vehicle in the form of a cream applied uniformly to a rayon bandage which, in turn, was applied to the surface of the skin flap. The capsaicin group was treated in the same way, but in this case capsaicin was added to the cream. This procedure was repeated for two consecutive days. RESULTS: There was a significantly smaller amount of flap necrosis in the capsaicin group (35.07% than in the control group (44.75% (p=0.035. CONCLUSION:Topical administration of capsaicin improved the viability of ischemic random-pattern skin flaps in rats.OBJETIVO: Avaliar os efeitos da capsaicina na viabilidade de retalhos isquêmicos randômicos em ratos. MÉTODOS: Quarenta ratos EPM1-Wistar foram distribuídos ao acaso em dois grupos de 20 animais cada, um grupo capsaicina e um grupo controle. Um retalho isquêmico randômico medindo 10 x 4cm foi elevado e uma barreira plástica foi colocada entre o retalho e a área doadora. Após o procedimento cirúrgico, o grupo controle foi tratado com um veículo inerte sob a forma creme aplicado uniformemente sobre uma atadura de rayon, que, por sua vez, foi aplicada à superfície do retalho. O grupo capsaicina foi tratado da mesma forma, porém a capsaicina foi adicionada ao creme. Este procedimento foi repetido por dois dias consecutivos. RESULTADOS: Houve uma quantidade significativamente menor da necrose do retalho no grupo capsaicina (35,07% comparado ao grupo controle (44,75% (p=0,035. CONCLUSÃO: A administração tópica da capsaicina melhorou a viabilidade de retalhos isquêmicos rand

  20. Reconstruction of cervical scar contracture using axial thoracic flap based on the thoracic branch of the supraclavicular artery.

    Science.gov (United States)

    Ma, Xianjie; Li, Yang; Wang, Lu; Li, Weiyang; Dong, Liwei; Xia, Wei; Su, Yingjun

    2014-09-01

    Cervical scar contracture causes both physical and psychological distress for burn patients. Many pedicle flaps or skin grafting have been suggested for reconstruction of cervical scar contracture with variable results in the literature. The authors present the axial thoracic flap based on the thoracic branch of the supraclavicular artery (TBSA) for reconstruction of cervical scar contracture. Postburn scar contractures in anterior neck region of 66 patients had been reconstructed with the axial pattern thoracic flaps based on the TBSA, including 1 expanded and 10 nonexpanded pedicle flaps, and 9 expanded and 46 nonexpanded island pedicle flaps, during 1988 through 2012. After removing and releasing the cervical scar contracture, the flap was designed in the thoracic region. The axial artery of the flap is the TBSA bifurcating from the intersection point of sternocleidomastoid muscle and omohyoid muscle with several concomitant veins as the axial veins. The flap can be designed in a large area within the borders of the anterior border of the trapezius muscle superiorly, the middle part of the deltoid muscle laterally, the midsternal line medially, and the level 3 to 4 cm below nipples inferiorly. After incisions were made along the medial, inferior, and lateral border, dissection was performed toward the pedicle. Donor site was closed directly in expanded cases and with skin grafting in nonexpanded cases. Cervical scar contractures were repaired with good functional and cosmetic results in 64 cases among this cohort. Flap tip necrosis in other 2 cases, caused by postoperative hematoma, was repaired by skin grafting. The color and texture of all flaps were fitted with those of the surrounding skin. The donor sites all healed primarily. The flap sensation in the thoracic region regained in the early stage postoperatively and that in cervical area recovered completely after 6 months according to the report of the patients. With reliable blood supply based on the

  1. Effects of Silk Sericin on Incision Wound Healing in a Dorsal Skin Flap Wound Healing Rat Model

    Science.gov (United States)

    Ersel, Murat; Uyanikgil, Yigit; Akarca, Funda Karbek; Ozcete, Enver; Altunci, Yusuf Ali; Karabey, Fatih; Cavusoglu, Turker; Meral, Ayfer; Yigitturk, Gurkan; Cetin, Emel Oyku

    2016-01-01

    Background The wound healing process is complex and still poorly understood. Sericin is a silk protein synthesized by silk worms (Bombyx mori). The objective of this study was to evaluate in vivo wound healing effects of a sericin-containing gel formulation in an incision wound model in rats. Material/Methods Twenty-eight Wistar-Albino rats were divided into 4 groups (n=7). No intervention or treatment was applied to the Intact control group. For other groups, a dorsal skin flap (9×3 cm) was drawn and pulled up with sharp dissection. The Sham operated group received no treatment. The Placebo group received placebo gel without sericin applied to the incision area once a day from day 0 to day 9. The Sericin Group 3 received 1% sericin gel applied to the incision area once a day from day 0 to day 9. Hematoxylin and eosin stain was applied for histological analysis and Mallory-Azan staining was applied for histoimmunochemical analysis of antibodies and iNOS (inducible nitric oxide synthase), and desmin was applied to paraffin sections of skin wound specimens. Parameters of oxidative stress were measured in the wound area. Results Epidermal thickness and vascularization were increased, and hair root degeneration, edema, cellular infiltration, collagen discoloration, and necrosis were decreased in Sericin group in comparison to the Placebo group and the Sham operated group. Malonyldialdehyde (MDA) levels were decreased, but superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities were increased in the sericin group. Conclusions We found that sericin had significant positive effects on wound healing and antioxidant activity. Sericin-based formulations can improve healing of incision wounds. PMID:27032876

  2. Skin-sparing mastectomy and immediate reconstruction with DIEP flap after breast-conserving therapy

    OpenAIRE

    Andree, Christoph; Munder, Beatrix; Seidenstuecker, Katrin; Richrath, Philipp; Behrendt, Philipp; Köppe, Tobias; Hagouan, Mazen; Audretsch, Werner; Nestle-Krämling, Carolin; Witzel, Christian

    2012-01-01

    Summary Background Currently about 70% of women who suffer from breast cancer undergo breast-conserving therapy (BCT) without removing the entire breast. Thus, this surgical approach is the standard therapy for primary breast cancer. If corrections are necessary, the breast surgeon is faced with irritated skin and higher risks of complications in wound healing. After radiation, an implant-based reconstruction is only recommended in selected cases. Correction of a poor BCT outcome is often onl...

  3. Application of the flaps of limberg in reconstruction of facial skin defect%Limberg皮瓣在面部缺损创面修复中的应用

    Institute of Scientific and Technical Information of China (English)

    金骥; 刘元波; 宋彬; 朱珊; 臧梦青; 刘东红

    2012-01-01

    Objective To explore the ideal way of using the flaps of Limberg in reconstruction of facial skin defect. Methods 9 cases were diagnosed as skin cancer or nevus of the face on the pathological examination.They were resected and reconstructed using the flaps of Limberg. Results All wounds healed by first intention without venous congestion or infection of the flaps.The color.texture and contour matched well with the face. The incisions were along the margin of the facial aesthetic unit, leaving inconspicuous scars.During 3 to 6 months of follow-up, no tumor or nevus recurred.Doctors and patients are satisfied with the results. Conclusion The flaps of Limberg is a safe and effective procedure for correction of facial skin defect.However, Several principles should be followed when applying the flap. The rotational flap should be designed in the most flexible area and covered an entire aesthetic unit to take the advantage of The Trap Door Deformity. To avoid "Dog ear deformity",subcutaneous pedicle could be employed. If the defect is round, the reading man procedure would be more efficient and preferably.%目的:观察Limberg皮瓣修复面部缺损创面的效果.方法:9例面部肿物切除后皮肤软组织缺损患者设计Limberg皮瓣修复创面.其中肿瘤患者3例;色素痣患者6例.结果:9例患者术后皮瓣均未出现动脉供血和静脉回流障碍,皮瓣色泽、质地较好;伤口Ⅰ期愈合,随访3~6月未见肿物或色素痣复发,瘢痕不明显,形态满意.结论:Limberg皮瓣修复面部中小缺损创面效果良好.设计原则包括:将旋转瓣设计在临近皮肤最松弛区域并且最好完整覆盖一个凸出的美学单位;如果局部旋转后发生猫耳畸形,可以使用皮下蒂皮瓣或者改良的Limberg皮瓣(DuFourmentel皮瓣);如缺损为圆形,用阅读者皮瓣(the reading man procedure)效果可能更好.

  4. 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.

  5. 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.

  6. 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....

  7. Local full-thickness skin graft of the donor arm--a novel technique for the reduction of donor site morbidity in radial forearm free flap.

    Science.gov (United States)

    Riecke, B; Assaf, A T; Heiland, M; Al-Dam, A; Gröbe, A; Blessmann, M; Wikner, J

    2015-08-01

    A novel technique to reduce donor site morbidity after radial forearm free flap (RFFF) harvest, using a local full-thickness skin graft (FTSG), is described. Thirty consecutive patients undergoing RFFF for head and neck reconstruction were enrolled in a prospective study. Donor site defect closure was performed with spindle-shaped FTSGs excised from the wavelike skin incision made for the vascular pedicle. Both the removal site of the FTSG on the volar forearm and the covered RFFF donor site healed uneventfully in 29 cases, with no impairment of function related to the skin graft. No skin graft failure and no exposure, tenting, or adherence of the flexor tendons occurred. All patients expressed satisfaction with postoperative pain, the functional outcome, and cosmetic appearance. Primary donor site defect closure could be achieved in all cases with the use of a local FTSG. This graft can be gained at the access incision for the vascular pedicle, avoids expansion of the incision for a local flap technique, and does not prolong wound healing, and thus reduces both donor site and graft site morbidity of the RFFF. This technique leads to an inconspicuous aesthetic result with no apparent relevant functional deficits and avoids the need for a second donor site.

  8. Flap monitoring by transcutaneous PO2 and PCO2: importance of transcutaneous PCO2 in determining follow-up treatment for compromised free flaps.

    Science.gov (United States)

    Hashimoto, Ichiro; Nakanishi, Hideki; Takiwaki, Hirotsugu; Takase, Maki Toda; Yamano, Masahiro; Sedo, Hiromichi

    2007-07-01

    The authors conducted a two-part study to determine whether transcutaneous oxygen pressure (TcPO (2)) and transcutaneous carbon dioxide pressure (TcPCO (2)) can be used to monitor flap viability after transplantation. The first part was an animal study in which TcPO (2) and TcPCO (2) were measured in 10 epigastric island flaps subjected to arterial or venous ischemia. The second part was a clinical study in which both were measured in 27 free skin flaps. In the experimental study, TcPO (2) decreased to nearly 0 mmHg after 10 minutes of arterial and venous ischemia. TcPCO (2) increased to 100 mmHg after 60 minutes of either type of ischemia. In the clinical study, congestion was suspected in six flaps on the basis of clinical signs alone. Three congested flaps with TcPCO (2) more than 90 mmHg were selected for intervention. The remaining three congested flaps, with TcPCO (2) 80 mmHg or less, survived completely without further treatment. The TcPO (2) of all treated flaps and of the six flaps not requiring further treatment was 0 mmHg. Results of experimental study indicate that TcPO (2) is more sensitive than TcPCO (2) to flap ischemia. However, results of clinical study suggest that it is very hard to distinguish congested flaps from healthy flaps by TcPO (2) alone. The authors believe that a congested flap with a TcPCO (2) more than 90 mmHg requires further treatment.

  9. Bipaddle radial forearm flap for head and neck reconstruction.

    Science.gov (United States)

    Zhang, Yi Xin; Xi, Wenjing; Lazzeri, Davide; Zhou, Xiao; Li, Zan; Nicoli, Fabio; Zenn, Michael R; Torresetti, Matteo; Grassetti, Luca; Spinelli, Giuseppe

    2015-03-01

    Although the radial forearm free flap has become a workhorse flap in head and neck reconstruction, the skin grafting of the donor is the main drawback resulting in an unacceptable contour deformity and an unsightly appearance. Several technical modifications have been therefore applied to the radial forearm (RF) flap marking, elevation, and inset to overcome this major shortcoming. In this article, we report our clinical series with the bipaddle RF flap. The authors described their 11 cases of head and neck oncologic reconstruction with the bipaddle RF flap. The skin island is designed longer and narrower and split into 2 separate skin paddles each nourished by a proximal and a distal independent perforators raising from the radial artery so that the donor site could be closed directly. The narrow design of the skin paddle and the subsequent splitting in its 2 components applying the "perforator-pedicle propeller flap method" allow for the changing of the flap shape according to the shape of the recipient site defect. From 2007 to 2013, the bipaddle RF flap method was used in 11 patients to restore head and neck defects following cancer ablation. The mean age of the patients was 43 years, ranging from 31 to 50 years. The location of the defects was the tongue (n = 7) and the intraoral region (n = 4). The defect sizes varied from 4 × 5 cm to 5 × 6 cm, and the flap maximum width was 3 cm with mean area of 26.4 cm. The healing was uneventful in all patients with excellent cosmetic and functional results of both donor site and recipient site after 20 months of mean follow-up. The bipaddle RF free flap is a reliable and versatile option for the reconstruction of a wide range of soft tissue defects of head and neck region. This method allows for a customized resurfacing of the defect because of its large variability in shape and size. The harvesting site is closed primarily, and a second donor site for skin graft is avoided.Clinical Question, Level of Evidence

  10. Respiratory allergies and skin test reactivity in high school students in Tenerife, Canary Islands, Spain.

    Science.gov (United States)

    García-Ramos Alonso, E; Fernández-Caldas, E; Seleznick, M J; Lockey, R F

    1992-01-01

    The prevalence of skin test reactivity to 22 aeroallergens and of allergic respiratory diseases was determined in 501 high school students on the island of Tenerife, Spain. Two hundred seventy-seven students (55.2%) had at least one positive prick skin test (wheal > or = 2 mm). Two hundred sixteen students (43.1%) had symptoms of upper or lower respiratory tract allergies [24 (4.7%) had asthma with or without rhinitis and 192 (38.3%) seasonal or perennial rhinitis alone]. Two hundred eighty-five students (56.8%) were asymptomatic. One hundred per cent of the students with asthma, 87.5% of the students with rhinitis and 27.7% of the asymptomatic students had at least one positive skin test. The prevalence of positive skin tests was significantly higher in symptomatic than in asymptomatic students (p = 0.0001). One hundred seventy students (33.9%) had a family history of respiratory allergic diseases. The prevalence of positive skin tests among these students was significantly higher than in students without such history (p = 0.0001). Thus, there is a high prevalence of allergic respiratory diseases and skin test reactivity to aeroallergens among high school students in Tenerife. Significant correlations were found between family history, positive skin tests and respiratory allergic symptoms.

  11. PENILE-SCROTAL SKIN FLAP IN PENILE ELONGATION%阴茎根部阴囊皮瓣阴茎延长术

    Institute of Scientific and Technical Information of China (English)

    陈文斌; 朱晓云; 刘治安; 陈晓燕; 候元林

    2013-01-01

    目的:探讨使用阴囊皮瓣在阴茎延长术中临床疗效。方法:在阴茎根部背侧作“十”字形切口,并上移1.5cm ,切开皮肤,纵行切开阴茎浅筋膜,并在浅浅筋膜下分离切断浅悬韧带和部分深悬韧带,以阴茎深静脉为限。切底结扎止血后,根据延长海绵体的多少,于阴茎根部拟议设计相应大小的阴囊皮瓣覆盖,阴囊切口直接缝合。结果:对112例的延长,平均延长3-5.0cm ,术后都能保持良好的长度,明显改善性生活的质量。结论:阴囊皮瓣具有血运丰富,易成活、富有弹性、不易回缩、不易留有瘢痕。尤其是感觉良好的优点;因此:在阴茎延长中,选择阴囊皮瓣作为供区覆盖创面较为理想。%Objectives To investigate the clinical theraping effect of penile -scrotal skin flap in penile elongation .Methods In the back of penile root we take a“+”shape incision ,then cut the skin ,penile superficial fascia ,the suspensory ligament of shallow and part of the deep without damaging the deep penile venous .After complete ligation and hemostasis we design the corresponding size of the penile -scrotal skin flap in the penile root to cover the secondary wound according to the size of elongated cavernousbody and suture the scrotal incision derectly . Results 112 cases elongate 3 -5cm on an average ,and the length could be kept well .Their sexy lives are apparently improved .Conclusions The scrotal skin flap has many advantages such as rich blood supply ,easy survival ,good elasticity ,few retraction ,not apprarent scar and espe-cially good feeling .Therefore ,scrotal skin flap is an ideal way to cover the secondary wound in the operation of penile elongation .

  12. Clinical analysis of skin flap necrosis following modified radical mastectomy in breast cancer%乳腺癌改良根治术后皮瓣坏死临床分析

    Institute of Scientific and Technical Information of China (English)

    王从玉; 王琦

    2014-01-01

    目的:探讨乳腺癌改良根治术后皮瓣坏死发生的原因及预防措施。方法回顾分析我院2010年1月至2013年1月86例行乳腺癌改良根治术的临床资料。结果86例乳腺癌患者中,皮瓣坏死23例,坏死率为26.7%,其中切缘坏死19例,腋窝坏死4例。结论皮瓣游离方法、皮瓣厚度、电刀停留时间长短、皮瓣缝合张力、切口方向及引流方式等与皮瓣坏死的发生密切相关,通过改进上述方法,以期能降低皮瓣坏死发生机率,提高患者生存质量。%Objective To explore the cause and preventive measures of the skin flap necrosis following breast cancer opera-tion.Methods Eighty-six patients with breast cancer following modified radical mastectomy were retrospectively investigated in our hospi-tal.The association among thickness of skin flap,tension of the skin flap,direction of the incision,and different drainage ways was investiga-ted.Results Out of 86 patients with breast cancer following modified radical mastectomy,23 cases suffered from skin flap necrosis,including 19 necrosis of incisal margin and 4 axillary necrosis.The incidence of skin flap necrosis was 26.7%.Conclusion There is a close relation be-tween skin flap necrosis and operating methods such as the way to free skin flap,thickness of skin flap,suture tension,incision direction and drainage.Reasonable aforementioned methods might decrease the rate of skin flap necrosis and improve the life quality of patients.

  13. Buttocks island shape fasciocataneous flap in the repair of sacrococcygeal pressure sores%臀部岛状筋膜皮瓣修复骶尾部褥疮的临床应用

    Institute of Scientific and Technical Information of China (English)

    邱福奎; 廖文伦; 朱丽娟

    2009-01-01

    Objective To discuss the application and effect of buttocks island shape fascivcataneous flap in the repair of sacrococcygeal pressure sore.Methods According to the donor anatomical characteristis and the recipient damaged situation,taking superior gluteal as the rotatory point,four lobate island shape fasciocataneous flap were designed.The depth of got flap reached the deep fascia, but did not damage the gluteus maximus, the flap was rotated 90 degree to repair injured areas.Then the donor area were won over and sutured.Results From 2000 years to 2008 years the clinical practice were performed in 14 patients, after the technique the flap completely survived, the quality of flap was soft, the appearance of flaps was satisfied.Conclusion The clinical effect of the buttocks island shape fasciocataneus flap in the repair of sacrococcygeal pressure scors is satisfied.its appearance is full, also does not affect the activity of the hip joint.%目的 探讨臀部岛状筋膜皮瓣修复骶尾部褥疮的应用及效果.方法 根据供区解剖特点和受区病损情况进行皮瓣设计,以臀上动脉为旋转点设计四叶岛状筋膜瓣,皮瓣仅达深筋膜,不损伤臀大肌,旋转90°修复创面,供区拉拢缝合.结果 2000~2008年临床应用14例,术后皮瓣全部成活,皮瓣质地柔软,外形满意.结论 应用臀部岛状筋膜皮瓣修复骶尾部褥疮临床效果满意,外形饱满,且不影响髋关节活动.

  14. 袖状蒂岛状环形包皮瓣尿道成形术一期修复会阴型尿道下裂%One-stage urethroplasty with circumferential vascular pedicle preputial island flap for perineal hypospadias

    Institute of Scientific and Technical Information of China (English)

    朱再生; 吴汉; 李瑞阳; 汪定海

    2010-01-01

    Objective To report the treatment of perineal hypospadias with one-stage urethroplaty with circumferential vascular pedicle preputial island flap. Methods A circumferential incision was made proximal to the corona and the urethral plate to correct chordee. A U-shaped skin incision was then made surrounding the meatus, and extended to the dorsal prepuce and parallel to the first incision. The tissue between the prepuce and dartos was dissected on the dorsum of penis to fix the prepuce as a neourethra.After mobilizing the loop shaped skin flap through the button-hole of the pedicle, the internal and external sides of the loop were sutured to construct a new urethra, the catheter was removed 10-14 days (mean,12.8 days ) after operation. Results Since 1997, 22 patients with perineal hypospadias were treated.Primary healing was achieved in 18 cases(81.8% ). Fistula happened in 4 patients. Among them, one case with meatal stenosis was treated with dilatation. Another 3 patients were reoperated. The neourethral flap was 3.50-18.00 cm (mean, 9.43 cm) in length. All patients were followed up for more than 6 months. Good cosmetic appearance was achieved in 72. 7% (16/22) of the patients. Conclusions The circumferential vascular pedicle preputial island flap has advantages of good blood supply and autograft for new meatus, which allows the chordee correction and urethroplaty at one stage. It is a good method for the treatment of perineal hypospadias with severe chordee and penoscrotal transposition.%目的 探讨袖状蒂岛状环形包皮瓣尿道成形术一期修复会阴型尿道下裂的临床效果.方法 距冠状沟0.5 cm处环形切开包皮内板和尿道板,脱套以纠正阴茎下曲.沿尿道板两侧平行切开,近端绕尿道口后会合,呈U形,远端环绕包皮到背侧,使新尿道皮瓣呈环状.解剖供应皮瓣的深层皮下组织与阴茎皮肤,形成血管蒂.经纽扣样孔隙,转移环状皮瓣至腹侧.缝合岛状环形皮瓣的内、外缘,形

  15. Three-dimensional anatomical vascular distribution in the pectoralis major myocutaneous flap.

    Science.gov (United States)

    Rikimaru, Hideaki; Kiyokawa, Kensuke; Inoue, Youjirou; Tai, Yoshiaki

    2005-04-15

    In head and neck reconstruction, the pectoralis major myocutaneous flap, located adjacent to the area of reconstruction, is a very useful and easy-to-prepare flap. However, it is reported to have an unstable blood circulation that could result in partial necrosis of the skin island. The current study investigated the detailed three-dimensional vascular network in the flap to establish a method of preparation with a stable circulation. The pectoralis major muscle and the anterior chest skin on 12 sides of eight fresh cadavers were subjected to angiographic procedures in which contrast medium was injected selectively to the internal thoracic artery and the thoracoacromial artery. On another fresh cadaver, resin was injected in the same manner, and a clear specimen of the pectoralis major myocutaneous flap was prepared. The pectoralis major muscle consists of two anatomical vascular territories that the choke vessels in the muscle at the level of the fourth costal cartilage divide into cranial and caudal sides. The chest skin area on the caudal side where the skin island of the flap is prepared receives its blood supply from a dense anastomotic network formed by the fourth, fifth, and sixth intercostal perforating branches. The blood flow in the pectoral branch of the thoracoacromial artery runs through the choke vessels that dilate at the elevation of the pectoralis major myocutaneous flap, first into the fourth intercostal perforating branches; then to the anastomotic vascular network of the fourth, fifth, and sixth intercostal perforating branches; and finally to reach the periphery of the skin island.

  16. Experiencia en reconstrucción auricular en cáncer de piel con colgajo en "quesadilla" Experience in auricle reconstruction after skin carcinoma with "quesadilla" flap

    Directory of Open Access Journals (Sweden)

    C. Gutiérrez Gómez

    2008-06-01

    Full Text Available La reconstrucción auricular es una de las más difíciles ya que implica reproducir las sofisticadas y delicadas formas del pabellón auricular. Cuando hay que resecar piel en la oreja por un cáncer cutáneo y dejamos expuesto el cartílago, sin pericondrio, suele suceder que al colocar injertos no hay una integración adecuada de los mismos por las caprichosas formas y relieves del pabellón auricular; cuando es necesario resecar el pericondrio estamos obligados a cubrir el defecto con un colgajo y no con un simple injerto. Frente a esta dificultad técnica, diseñamos un colgajo ricamente vascularizado que preserva el cartílago no afectado con una buena cubierta y al mismo tiempo respeta la anatomía de la oreja. Para la cobertura del cartílago auricular anterior usamos un colgajo fasciocutáneo posterior que se asemeja a un plato típico de la cocina mexicana que llamamos "quesadilla", donde el cartílago por su color blanco recuerda el queso y el gran colgajo fasciocutaneo recuerda la tortilla que cubre al queso. Este colgajo incluye la piel enrollada del hélix, que en un segundo tiempo retornará a su lugar de origen anatómico mediante una z-plastía asimétrica. Presentamos, de entre una serie de 13 pacientes con carcinoma de pabellón auricular, 2 casos resueltos mediante esta técnica.Auricle reconstruction is one of the most difficult techniques because of the sophisticated and delicates forms of the ear. When we need to remove the auricular skin, preserving the cartilage is very important to keep the shape of the auricle. If treating an auricular skin cancer we find an unaffected cartilage, we can use a skin grafting, but in such delicates forms and curves many times it results inappropriate or the lack of pericondrium difficult skin graft integration. When pericondrium is affected, we will need a skin flap to cover de defect. We designed a rich vascularized flap that preserves the unaffected cartilage with an adequate coverage

  17. A Retrospective Volume Matched Analysis of the Submental Artery Island Pedicled Flap as Compared to the Forearm Free Flap: Is It a Good Alternative Choice for the Reconstruction of Defects of the Oral Cavity and Oropharynx?

    Science.gov (United States)

    Aslam-Pervez, Nawaf; Caldroney, Steven J; Isaiah, Amal; Lubek, Joshua E

    2017-08-12

    The submental artery island pedicled flap (SMIF) is an underused alternative for reconstruction of head and neck defects after tumor ablation. The purpose of this study was to perform a comparative evaluation of reconstructive outcomes based on surgical site and ablative defect volume in patients who underwent reconstruction with the SMIF versus the forearm free flap (FFF). A retrospective cohort study of all patients with oral cavity and oropharyngeal defects reconstructed with the SMIF and a cohort of patients with similar volume defects reconstructed with the FFF were compared for oncologic safety and viability of equivalent reconstructive outcomes. All statistical comparisons were assessed by analysis of variance and Fisher exact test. Average age was 61.8 years in the SMIF group versus 57.9 years in the FFF group. The most common defect was located in the tongue, with squamous cell carcinoma being the most common pathology identified. Flap volumes were similar (SMIF, 38.79 cm(3); FFF, 39.77 cm(3)). Significant comparative outcomes identified with SMIF versus FFF reconstruction included shorter anesthesia times (815 vs 1,209 minutes; P speech and swallowing function. Mean follow-up was 15.5 months. This is the first study to compare the SMIF with the FFF for reconstruction of oral cavity defects based on ablative volume deficit. The SMIF is a viable surgical option compared with the FFF that can be considered oncologically safe in the N0 neck, allowing for an excellent esthetic reconstruction, with decreased operative time, hospital stay, and donor site morbidity. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  18. 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.

  19. Reduction of mandibular residual ridge after vestibuloplasty. A two-year follow-up study comparing the Edlan flap, mucosal and skin graft operations.

    Science.gov (United States)

    Hillerup, S; Eriksen, E; Solow, B

    1989-10-01

    Mandibular residual ridge reduction (RRR) after Edlan flap vestibuloplasty, buccal mucosal graft, and split skin graft vestibuloplasty was measured on lateral cephalometric radiographs obtained 1, 3, 6, 12 and 24 months postsurgery in 50 patients. The ridge reduction was most severe during the immediate postoperative period. The different operation methods did not give rise to significant variations in the reduction pattern, neither did the sex of the patient appear to be an important factor. The temporary increase of mandibular resorption after vestibuloplasty surgery is of a magnitude comparable to the average RRR during 1 year in full denture wearers with a long denture experience.

  20. [EFFECTIVENESS OF DIFFERENT FLAPS FOR REPAIR OF SEVERE PALM SCAR CONTRACTURE DEFORMITY].

    Science.gov (United States)

    Pang, Mengru; Xiao, Haitao; Wang, Huaisheng; Liu, Xiaoxue; Chen, Junjie; Cen, Ying

    2016-03-01

    To evaluate the effectiveness of different flaps for repair of severe palm scar contracture deformity. Between February 2013 and March 2015, thirteen cases of severe palm scar contracture deformity were included in the retrospective review. There were 10 males and 3 females, aged from 14 to 54 years (mean, 39 years). The causes included burn in 9 cases, hot-crush injury in 2 cases, chemical burn in 1 case, and electric burn in 1 case. The disease duration was 6 months to 6 years (mean, 2.3 years). After excising scar, releasing contracture and interrupting adherent muscle and tendon, the soft tissues and skin defects ranged from 6.0 cm x 4.5 cm to 17.0 cm x 7.5 cm. The radial artery retrograde island flap was used in 2 cases, the pedicled abdominal flaps in 4 cases, the thoracodorsal artery perforator flap in 2 cases, the anterolateral thigh flap in 1 case, and the scapular free flap in 4 cases. The size of flap ranged from 6.0 cm x 4.5 cm to 17.0 cm x 7.5 cm. All flaps survived well. Venous thrombosis of the pedicled abdominal flaps occurred in 1 case, which was cured after dressing change, and healing by first intention was obtained in the others. The mean follow-up time was 8 months (range, 6-14 months). Eight cases underwent operation for 1-3 times to make the flap thinner. At last follow-up, the flaps had good color, and the results of appearance and function were satisfactory. Severe palm scar contracture deformity can be effectively repaired by proper application of different flaps.

  1. The use of pedicled skin flap for buried penis%带蒂岛状包皮瓣在隐匿阴茎矫治术中的应用

    Institute of Scientific and Technical Information of China (English)

    马俊梅; 曾莉; 单伟; 黄桂珍; 马丽; 黄鲁刚

    2011-01-01

    Objective To study the outcome of using pedicled skin flap of foreskin for phalloplasty in the management of complete buried penis.Methods A retrospective review was carried out in West China Hospital between July 1994 and August 2011.Results The follow up period ranged from 1 month to 7 years (mean 16 months).All patients achieved good results and got satisfactory appearance.There was no voiding problem,wound infection,and skin necrosis.Conclusions Buried penis could be classified into two types according to skin deficiency (partial or complete).The appropriate timing of surgery is preschool stage.If the patient is extremely obese,dietary restriction and vigorous exercise should be done before surgical correction.The modified Devines operation is simple and can achieve satisfactory results in partially buried penis,whereas the transverse preputial island flap penoplasty is ideal in treating completely buried penis.%目的 介绍带蒂岛状包皮瓣在隐匿阴茎矫治术中的应用.方法 总结分析四川大学华西医院从1994年7月至2011年8月收治的56例应用带蒂岛状包皮瓣阴茎成形术矫治的完全型隐匿阴茎患儿的临床资料,结合文献探讨该手术的要点及优缺点.结果 所有56例患儿术后获得了1个月至7年(平均1.4年)的随访,术后效果均满意,包皮水肿轻,阴茎显露好,无阴茎回缩及复发发生,未见明显瘢痕挛缩.结论 隐匿阴茎可根据阴茎皮肤的缺失情况分为完全型和部分型以指导手术的选择并评估手术的疗效.恰当的手术年龄以学龄前为佳,伴有肥胖的隐匿阴茎患儿最好在减轻体重后考虑手术,改良Devine法治疗部分型隐匿阴茎,带蒂岛状包皮瓣阴茎成形术用于治疗完全型隐匿阴茎都有较好的手术效果.

  2. Evaluation of mandibular reconstruction with free vascularized fibular flap

    Institute of Scientific and Technical Information of China (English)

    Krishna Gopal Bhuju; Shuzhong Xing; Hualian Liu

    2008-01-01

    Objective: To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods:The clinical data of 63 patients were reviewed, 35 male and 28 female(age range l6 to 73 years). Aesthetic and functional outcomes were evaluated by follow-up and/or telephone conversation. Results:Among the 63 fibular flaps, 29 were osteocutaneous flaps with one or two skin islands. All the flaps were surviving well and the success rate was 100%. Long term donor site disability was not recorded for any patient. Thirty-one patients responded for aesthetic and functional evaluation, 20 cases(64.5%) reported their facial appearance as excellent or good, 11 (35.48%) felt fair; 14 cases (45%) could eat unrestricted diet, 17(55%) could eat soft diet; 21 cases were(67.67%) speech normal, 10(22.33%) speech intelligible. Conclusion:Free fibular flap reflects good functional and esthetic results with a high degree of consistency, and acceptable level of complications, and we strongly believe the vascularized fibular flap is the first choice for mandibular reconstruction.

  3. Free lateral tarsal flap transfer for repair of skin defects of the hand%游离足跗外侧皮瓣移植修复手部软组织缺损

    Institute of Scientific and Technical Information of China (English)

    王晓峰; 李基民; 蔡晓明; 李学渊

    2012-01-01

    目的 探讨应用游离足跗外侧皮瓣移植修复手部软组织缺损的临床效果.方法 对35例手部软组织缺损,采用以足跗外侧动脉血管为蒂的足跗外侧皮瓣游离移植,皮瓣切取面积为4 cm×3 cm~8 cm×4 cm.结果 术后皮瓣全部存活,经6~ 18个月的随访,皮瓣质地好,不臃肿,色泽与手部皮肤相似,感觉恢复良好,手功能满意.结论 足跗外侧皮瓣的血管解剖恒定、皮瓣质量好,是修复中小面积的手部软组织缺损的有效方法.%Objective To explore the clinical efficacy of repairing hand skin defect by free lateral tarsal flap transfer.Methods Lateral tarsal flap free transplantation based on the lateral tarsal artery was carried out to repair skin defects of the hand in 35 cases.The size of flap ranged from 4 cm × 3 cm to 8 cm × 4 cm.Results All skin flaps survived.The follow-up time was 6 to 18 months.The flaps showed good texture and color match with no bulkiness.The sensory recovery was good and hand function was satisfactory.Conclusion The free lateral tarsal flap has a relatively consistent vascular pedicle.The flap is easy to dissect,thus is a useful option to repair small and medium size skin defects in the hand.

  4. 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.

  5. 带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植修复手部及前臂复杂皮肤缺损%Double Pedicled Flap Transfer Combining Groin Flap and Tensor Fascia Lata Myocutaneous Flap to Repair Complex Skin Defects of Hand and Forearm

    Institute of Scientific and Technical Information of China (English)

    徐文辉; 刘富岗; 崔志; 刘威; 时永科; 冯东亮

    2014-01-01

    目的:介绍带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植治疗手部及前臂复杂创面的手术方法和临床效果。方法:对7例手、腕及前臂部广泛皮肤套脱伤的患者,4例手部洞穿伤患者,2例全手逆行撕脱伤患者,急诊一期采用带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植修复皮肤缺损。髂腹股沟部供区创面直接闭合,大腿部供区创面取全厚层皮片植皮覆盖。术后半个月拆线,并进行皮瓣夹蒂训练,术后3周根据皮瓣夹蒂训练情况酌情断蒂,断蒂时将皮瓣内的腹壁浅神经、股前外侧皮神经分别于受区皮神经吻合。断蒂术后1~2个月分期皮瓣修整。结果:13例皮瓣全部存活,受区、供区伤口I期愈合。术后随访2~6个月,皮瓣柔软,质地良好,皮瓣温痛感觉良好,外形无臃肿,无坏死及破溃;总优良率为84.6%。结论:带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植治疗手部及前臂复杂创面,相对其他带蒂联合皮瓣移植患者手部体位较舒适,手术操作简单,安全性高,易于推广。%Objective:To introduce the surgical techniques and clinical outcomes of double pedicled flap transfer combining groin flap and tensor fascia lata myocutaneous flap to treat complex skin defects of hand and forearm. Method:Seven cases of hand or wrist and forearm were due to degloving injuries,four cases of penetrating injuries of hand,two cases of entire hand due to degloving injuries,were treated by transferring groin flap along with pedicled tensor fascia lata myocutaneous flap. All cases were treated with emergent one stage operation. The donor site of the groin flap was closed directly,while the wound at the donor site of the covered by full-tiffckness skin graft. Stitches were removed two weeks after the surgery when pedicle clamping exercise was initiated. Pedicle separation was done about after three weeks flap transfer

  6. Disposal of the small saphenous vein trunks during sural neurocutaneous island flap transplantation for repairing soft tissue defects of the foot and ankle%腓肠神经营养皮瓣移植修复足踝软组织缺损中小隐静脉干的处理

    Institute of Scientific and Technical Information of China (English)

    吴文; 章莹; 夏远军; 尹飚

    2008-01-01

    背景:在临床上应用和报道中小隐静脉在皮瓣中所起的作用及血管近端蒂如何处理意见不尽一致.目的:应用腓肠神经营养血管皮瓣逆行转移修复足背、足跟及踝部软组织缺损,观察分析不同方式处理小隐静脉对皮瓣成活的影响.设计、时间及地点:病例对比观察,于1998-03/2007-04在解放军广州军区广州总医院完成.对象:将56例足背、足跟及踝部软组织缺损的患者按手术方式分为2组,结扎小隐静脉近端蒂皮瓣组38例,小隐静脉近端与受区大隐静脉或其属支吻合组18例.方法:应用腓肠神经营养血管皮瓣逆行移植修复时,皮瓣切取面积为3.5 cm×4.0 cm~4.0 cm×4.5 cm的病例35例;皮瓣切取面积为4.0cm×4.5 cm~10.0 cm×12.0 cm的病例21例.主要观察指标:不同切取面积及移植方式的皮瓣成活效果.结果:[1]皮瓣切取面积为(4.0×4.5)cm~(10.0×12.0)cm时,移植后未出现静脉危象:皮瓣切取面积为(3.5×4.0)cm~(4.0×4.5)cm时,结扎小隐静脉近端的患者中5例出现术后静脉危象.[2]在皮瓣切取面积为(3.5×4.0)cm-(4.0×4.5)cm时,移植后小隐静脉近端与受区大隐静脉或其属支吻合皮瓣出现坏死的概率低于结扎小隐静脉近端蒂皮瓣(P=0.017 67).结论:切取皮瓣面积小于(4.0×4.5)cm时,应将小隐静脉近端与受区大隐静脉或其属支吻合.小隐静脉在皮瓣中并非过路浅静脉.对皮瓣有营养作用.%BACKGROUND: Scholars disagree with each other about the small saphenous vein effects on skin flap and how to dispose vascular proximal pedicles.OBJECTIVE: To analyze effects of different methods of the small saphenous vein disposal on flap survival using sural neurocutaneous island flap retrograde metastasis for repairing defects of soft tissue of instep, heelstick and ankle.DESIGN, TIME AND SETTING: The case control observation experiment was performed at the General Hospital of Guangzhou Military Area Command of Chinese PLA

  7. Endothelin receptor blockade improves oxygenation in contralateral TRAM flap tissue in pigs.

    Science.gov (United States)

    Erni, D; Wessendorf, R; Wettstein, R; Schilling, M K; Banic, A

    2001-07-01

    Partial skin and fat necrosis is the most common complication occurring in TRAM flaps. It is related to disturbances of the microcirculation and oxygenation in the contralateral part of the flap. It may be hypothesised that the development of necrosis is promoted by the vasoconstrictor endothelin, the production of which is enhanced in ischaemic flap tissues. The purpose of this study was to evaluate the effect of tezosentan, a new endothelin receptor blocker, on microcirculation and oxygenation in experimental TRAM flaps. The administration of tezosentan began preoperatively (3 mg/kg body weight) and then continued at a rate of 1.5 mg/kg/h. A TRAM flap with a skin island measuring 16 x 8 cm was raised in the middle of the epigastrium in minipigs. The flap was pedicled on the right superior epigastric vessels. Microcirculatory blood flow was measured with laser Doppler flowmetry and tissue oxygen tension was measured with a Clark-type microprobe. Dominant subcutaneous veins were cannulated in both the ipsilateral and the contralateral parts of the flap. Subdermal tissue oxygen tension in the contralateral part of the flap was significantly reduced 4h after surgery to 5 mmHg (ca. 48 mmHg in normal tissue) in the control group, but to only 12 mmHg in the group that had been administered tezosentan (Peffluent of the contralateral part of the flap, although microcirculatory blood flow remained virtually unchanged. Our findings suggest that tezosentan improves oxygenation and metabolism in the jeopardised contralateral flap tissue, probably as a result of a decrease in venous vascular resistance and fluid extravasation.

  8. 颏下动脉岛状瓣在颜面部软组织缺损修复中的应用%Application of the Submental Artery Island Flap for Repairing Facial Soft Tissue Defect

    Institute of Scientific and Technical Information of China (English)

    王贺红; 汪春兰; 赵宇

    2015-01-01

    Objective To explore the application of the submental artery island flap in repairing facial soft tissue defect. Methods From July 2007 to 2014, 10 cases with facial soft tissue defect were admitted in this study. Primary lesions in-cluded trauma (2 cases), buccal mucosa squamous cell carcinoma (SCC, 4 cases), buccal basal cell carcinoma (BCC, 1 case), and scar hyperplasia caused by burning or scalding (3 cases). Flaps ranging from 3 cm ×6 cm to 4 cm×10 cm were designed according to the size and location of the facial defects to repair facial soft tissue defects. Results Pale, swell and/or conges-tion were observed in all flaps postoperative, but the situation improved 5 days later. Partial necrosis was observed in 1 case but healed by dressing. All the patients were followed up for 3-12 months, full thickness skin which was used to cover the donor-site in 3 cases shrank inordinately during followed-up. Appearance and functions of the recipient site were satisfacto-ry. The scar of the donor-sites was not conspicuous. Conclusion The submental artery island flap is similar with the facial soft tissue on color and texture, and it offers the advantages of simplicity, reliability and aesthetic result, so it is an excellent choice for repairing facial defects and deformity.%目的:探讨颏下动脉岛状瓣在修复颜面部软组织缺损中的应用。方法2007年7月至2014年3月,收治颜面部软组织缺损患者10例,其中外伤2例,面部鳞癌4例,面部基底细胞癌1例,烫伤或烧伤后瘢痕增生3例。根据缺损位置及大小设计颏下动脉岛状瓣进行修复,最小为3 cm×6 cm,最大为4 cm×10 cm。结果术后皮瓣存在不同程度的肿胀苍白及淤血,5 d后逐渐改善。1例皮瓣远端出现坏死,经换药处理愈合。术后随访3~12个月,3例供皮区采用全厚皮覆盖创面,随访期间发现皮片不同程度收缩。其余受区外观及功能均较满意,供区瘢痕隐蔽。结论颏下

  9. Perioperative nursing for coloboma after tongue cancer resectionby treatment of forearm free skin flap prothesis%前臂游离皮瓣修复舌癌切除后缺损围术期护理

    Institute of Scientific and Technical Information of China (English)

    徐静

    2012-01-01

    Objective To summarize the perioperative nursing methods for coloboma after tongue cancer resection by treatment of forearm free skin flap prothesis. Methods Preoperative nursing and postoperative nursing were applied for 33 patients who had coloboma after tongue cancer resection, they were treated with forearm free skin flap prothesis. Blood supply of skin flap and vascular crisis were observed rigorously. Results All the patients'skin flaps survived well, and 2 pait-ents'flaps survived on the effective treatment of vascular crisis. Conclusion Positive and effective perioperative nursing for coloboma after tongue cancer resection by treatment of forearm free skin flap prothesis can extremely improve the success rate of surgery and postoperative life quality of patients.%目的 总结前臂游离皮瓣修复舌癌切除后缺损围术期的护理方法.方法 对33例前臂游离皮瓣移植修复舌癌术后缺损的患者进行术前、术后的护理,尤其是严密观察皮瓣血运,及早发现血管危象.结果 33例患者皮瓣全部成活,其中有2例是在及时发现并尽早处理血管危象后成功.结论 通过对前臂游离皮瓣修复舌癌术后缺损患者进行积极有效的围术期护理,极大提高了手术成功率和患者术后生活质量.

  10. 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....... The color Doppler ultrasonography study detected a sizeable perforator at the level of the modiolus lateral to the angle of the mouth within a radius of 1 cm. This confirms the anatomical findings of previous authors and indicates that the modiolus perforator is a consistent anatomical finding, and flaps...

  11. Functional and aesthetic outcome and survival after double free flap reconstruction in advanced head and neck cancer patients.

    Science.gov (United States)

    Posch, Nicole A S; Mureau, Marc A M; Dumans, Antoine G; Hofer, Stefan O P

    2007-07-01

    Extensive composite defects in the head and neck area may require the use of double free flap reconstructions. These reconstructions are not only surgically challenging but also challenging to patients. A realistic perspective on general outcome for the patient seems important. From January of 2002 to August of 2003, double free flap reconstructions were used in 12 patients with extensive composite head and neck defects following malignant tumor (n = 7) and osteoradionecrosis (n = 5) resection. Six patients had a standardized interview, physical examination, and clinical photographs. All reconstructions were performed using an osteocutaneous fibula flap in combination with an anterolateral thigh flap (n = 8), a radial forearm flap (n = 1), or a lateral thigh flap (n = 1). The total flap survival rate was 96 percent. Mean mandibular bone defects were 10 cm. Mean skin island sizes of osteocutaneous fibula flaps were 67 cm. Mean external skin reconstruction flap sizes were 117 cm. Mean overall survival time was 20 months in patients with malignant tumors. Patients with osteoradionecrosis reconstruction survived free of disease for an average period of 38 months. Three patients (50 percent) were very satisfied, one was neutral, and two were very dissatisfied with their functional and aesthetic results. Objective evaluation of function showed mainly deteriorated speech (83 percent) and oral incontinence (67 percent). Objective evaluation of aesthetics showed mainly color mismatch (67 percent) and flap contracture of external flaps (50 percent). Reconstruction of these major composite through-and-through defects will often result in a modest functional and aesthetic outcome. Because selected patients require these procedures, the authors give information that matches with realistic expectations.

  12. 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.

  13. Aplicação de retalho cutâneo no tratamento cirúrgico do hemangiopericitoma canino Surgical treatment of canine hemangiopericytoma using skin flap

    Directory of Open Access Journals (Sweden)

    Julia Maria Matera

    1998-03-01

    records of 6 dogs treated at the Veterinary Teaching Hospital of the University of São Paulo between July 1994 and July 1996 were reviewed for tumor features, skin flap technique and postoperative follow up. The dogs in this study were 3 females and 3 males; the mean age was 9 years. One dog was mixed breed and the other dogs were Poodle (2; Boxer (1; German Shepherd(1 and Pekingeese(1. The majority of tumors (5 tumors were located on the limbs and l was located on the perineal region. Skin flap techniques used were : H- plasty (2, W-plasty(1, transposition flap (2, single pedicle advancement flap (1. The sutures were removed 10 to 15 days after surgery. Five dogs had 100% viability of flap skin and necrosis ocurred in one dog which had a survival of 89% of the flap. One dog died 15 months after the surgery because of nontumor related causes. No evidence of recurrence was noted and tumor free interval ranged from 4-20 months. Wide surgical excision of the canine hemangiopericytoma seems to be an eficient therapy since no recurrence ocurred. Familiarity with techniques of skin flap creation can provide the surgeon with alternatives to close a large wound resulting from tumor excision. Skin flaps can bypass many problems in open wound management including delayed healing and greater expenses.

  14. Histamine iontophoresis on the viability of random skin flap in rats Iontoforese de histamina na viabilidade do retalho cutâneo randômico em ratos

    Directory of Open Access Journals (Sweden)

    Ivaldo Esteves Júnior

    2009-02-01

    Full Text Available PURPOSE: To evaluate the effects of the histamine iontophoresis on the random skin flap viability in rats. METHODS: Sixty adult male Wistar rats were used. A cranially-based dorsal skin flap measuring 10 x 4 cm was raised and a plastic barrier was placed between the flap and its bed. After the surgical procedure, the animals were randomized into four groups (G1-G4 (n=15 each group as follows: G1 (control - sham electrical stimulation, G2 (electrical stimulation - direct current electrical stimulation, G3 (histamine - histamine and sham electrical stimulation and G4 (histamine iontophoresis - transdermal iontophoresis of histamine. In all groups the procedures were performed immediately after the surgery and on the two subsequent days. The percentage of flap necrosis was measured on the seventh postoperative day. RESULTS: The mean and the respective standard deviation of the percentage of flap necrosis areas were as follows: G1 (control - 47.87 ± 9.13%, G2 - 51.49 ± 8.19%, G3 - 46.33 ± 8.32% and G4 - 30.82 ± 11.25%. The G4 group presented a significantly smaller amount of flap necrosis when compared to the other groups (pOBJETIVO: Avaliar o efeito da iontoforese de histamina na viabilidade do retalho cutâneo randômico em ratos. MÉTODOS: Foram utilizados 60 ratos adultos e machos da linhagem Wistar. O retalho cutâneo de base cranial, medindo 10x4 cm, foi elevado no dorso dos animais e uma barreira plástica foi interposta entre o retalho e a área doadora. Após o procedimento operatório, os animais foram distribuídos aleatoriamente em 4 grupos (G1-G4 (n=15 em cada grupo a saber: G1 (controle - simulação da estimulação elétrica, G2 (estimulação elétrica - estimulação elétrica com corrente direta, G3 (histamina - histamina e simulação da estimulação elétrica e G4 (iontoforese de histamina - iontoforese transdérmica de histamina. Em todos os grupos os procedimentos foram realizados imediatamente após a operação e nos 2

  15. The Application of Nasolabial Fold Flaps in Repair of Facial Skin Defect%鼻唇沟皮瓣在面部皮肤缺损修复中的应用

    Institute of Scientific and Technical Information of China (English)

    朱黎

    2011-01-01

    Objective To explore the application of nasolabial fold flaps in repair of facial skin defect.Method The nasolabial fold flaps were used to repair 25 cases of facial skin defect after facial tumor surgery and 6 cases of facial skin defect caused by trauma. Among them, there were 15 cases of nose defect, 8 cases of facial skin defect, 3 cases of buccal defect, and 5 cases of regio palpebralis inferior defect. The most widespread defect was 3.0 cm × 4.5 cm. The flaps were designed along the nasolabial fold, the width of flaps stem was about1.5 cm,and the length of flaps was according to the defect scope. The length breadth ratio of axial flaps and sliding flaps reached 5:1 and 4:1, respectively. Results Flaps survived in all 31 cases of facial skin defect with satisfactory appearance. The color and texture of flaps was similar to the surrounding skin, and the sense of touch and temperature was recovered. The facial scar in the flaps donor region was unclear and had no secondary deformity. Conclusion Nasolabial fold flaps is ideal for repair of facial skin defect because of abundant blood support, and flexible transfer, the color, texture and outline of them can achieve better matching and coordination with facial skin%目的 探讨鼻唇沟皮瓣在面部皮肤缺损修复中的应用.方法 应用鼻唇沟皮瓣一期修复面部肿瘤术后缺损25例,外伤等造成缺损6例;其中修复鼻缺损15例,面部皮肤缺损8例,唇颊部缺损3例,下睑部缺损5例.缺损最大面积3.0 cm×4.5 cm,皮瓣沿鼻唇沟走行方向设计,蒂宽约1.5 cm,长度根据缺损范围确定,轴型皮瓣长宽比例可达5:1,滑型皮瓣长宽比例可达4:1.结果 31例皮瓣全部成活,外形恢复满意,皮瓣质地皂泽均与周围皮肤接近,触觉及温度觉存在.面部供瓣区瘢痕隐蔽,无继发畸形.结论 鼻唇沟皮瓣血运丰富,转移灵活,色泽、质地、轮廓等方面能与面部多处皮肤达到较好的匹配和协调,是修复面部皮肤缺损的理想方法之一.

  16. The rat saphenous flap: a fasciocutaneous free flap model without panniculus carnosus.

    Science.gov (United States)

    Mutaf, M; Tasaki, Y; Tanaka, K; Fujii, T

    1995-10-01

    The rat saphenous flap is described as a new experimental model for free flap studies. This is a fasciocutaneous free flap based on the saphenofemoral vascular pedicle. The flap may include the entire medial aspect of the lower leg between the knee and ankle. Thirty flaps were harvested from 15 inbred rats. Each flap was transferred to the anterior neck of a recipient rat of the same inbred strain so that 15 flaps were vascularized free flaps using the standard end-to-end microvascular technique and the other 15 flaps were nonvascularized free grafts. All but two (technical failure) of the vascularized flaps showed complete survival, whereas all nonvascularized flaps completely necrosed 2 weeks after transfer. It was concluded that the rat saphenous flap has several advantages such as a long and consistent vascular pedicle, ease of harvest, and an all-or-none survival pattern. Furthermore, as a unique feature of this flap, histological analysis revealed that the rat saphenous flap is composed of the skin and underlying fascia without panniculus carnosus. We therefore suggest that the rat saphenous flap is the first true fasciocutaneous free flap model in the rat. In this paper, in addition to illustrating the anatomy of the saphenous vessels and describing a new fasciocutaneous free flap model based on these vessels, we have documented some anatomical details of the rat leg that have never been described in the literature related to the rat anatomy.

  17. Application of local skin flap for skin tumor of scalp and face or neck after surgical ablation%局部皮瓣修复头面颈部皮肤肿瘤切除后缺损

    Institute of Scientific and Technical Information of China (English)

    赵文斌; 叶建州; 杨恩品; 欧阳晓勇; 杨瑾

    2011-01-01

    目的:探讨局部皮瓣一期修复头面颈部皮肤肿瘤切除后缺损的效果.方法:2006年1月~2010年12月收治155例头面颈部皮肤肿瘤病例,采取将肿瘤及其边缘0.1 ~ 3cm正常组织一起切除并彻底清创的方法,综合考虑创面的性质、部位、大小等因素,设计局部皮瓣一期修复切除后遗留的创面,术后随访期6个月~2年.结果:本组155例患者的切口均Ⅰ期愈合,皮瓣全部成活.术后随访6个月~2年,形态、功能良好,瘢痕不明显,无并发症,效果满意.结论:采用局部皮瓣Ⅰ期修复头面颈部皮肤软组织缺损(大小2.0cm × 1.5cm~7.0cm×4.0cm),手术简单易行、适应证广、疗效较好,是比较理想的方法.%Objective To investigate the effect and advantage of using local skin flap for the reconstruction of mediumsized skin and soft tissue defect. Methods From January 2006 to December 2010,Skin and soft tissue defect on the head .face or neck in 155 patients were repaired with local skin flaps , according to the lesion type.location.and size, tumors were excised including the 0.1 to 3cm normal tissue around the tumor and the wounds were debrided completely .The defects were immediately repaired by using local skin flap.After operation.all patients were persevered to follow up for 6 months to 2 years. Results Raps in all 155 patients survived with primary healing postoperatively. All patients were followed for 6 months to 2 years.the postoperative contour and function was satisfactory. No complicationoccurred .All patients were satisfied with the cosmetic appearance. Conclusion The local skin flap is an effective way to repair skin and soft tissue defect on the head ,face or neck.The size of the defect which were repaired ranged from 2.0cmx 1.5cm to 7.0cmx4.0cm. Operation is simple .indication is extensive and results are satisfactory.

  18. Short-Term Memory Impairment and Left Dorsolateral Prefrontal Cortex Dysfunction in the Orthostatic Position: A Single Case Study of Sinking Skin Flap Syndrome

    Directory of Open Access Journals (Sweden)

    Luca Sebastianelli

    2015-01-01

    Full Text Available We describe the case of a patient who underwent craniectomy for hemorrhage of the left parietal lobe. Three weeks later, orthostatic memory impairment was detected as initial symptom of sinking skin flap syndrome (SSFS. This deficit was examined by neuropsychological testing and associated with a posture-dependent increase in the delta/alpha ratio at the F3 electrode, an electroencephalographic (EEG index related to brain hypoperfusion. This EEG spectral alteration was detected in a brain region that includes the left dorsolateral prefrontal cortex, an area known to be involved in memory processing; therefore we hypothesize that SSFS induced reversible hypoperfusion of this otherwise undamaged cortical region. Neither of these findings was present after cranioplasty. This case suggests that SSFS may induce neuropsychological deficits potentially influencing outcome in the postacute phase and is further evidence supporting the clinical benefits of early cranioplasty.

  19. Treatment of degloving injury involving multiple fingers with combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap.

    Science.gov (United States)

    Han, Fengshan; Wang, Guangnan; Li, Gaoshan; Ping, Juan; Mao, Zhi

    2015-01-01

    Our aim was to summarize the treatment of degloving injury involving multiple fingers using combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap. Each degloved finger was debrided under microscopic guidance and embedded in the superficial layer of the abdominal fascia. The abdominal skin was sutured to the skin on the back and side of the hand to promote circumferential healing. After removal, the only remaining injured region was on the flexor surface, and this was repaired by multiple dorsal toe flaps, toe-web flaps, and dorsalis pedis flaps to provide blood vessels and sensory nerves. All fingers had proper flap thickness 3-6 months after surgery, and required only lateral Z-plasty modification with web deepening and widening to narrow the fingers and extend their relative length. We completed flap-graft and finger narrowing for 25 fingers in eight patients. Abdominal skin flaps and dorsal toe flaps were grafted, and resulted in both firmness and softness, providing finger flexibility. The dorsal toe flap provided good blood circulation and sensory nerves, and was used to cover the finger-flexor surface to regain sensation and stability when holding objects. During the 1-8 years of follow-up, sensation on the finger-flexor side recovered to the S3-4 level, and patient satisfaction based on the Michigan Hand Outcomes Questionnaire was 4-5. Flap ulcers or bone/tendon necrosis were not observed. Treatment of degloving injury involving multiple fingers with combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap was effective and reliable.

  20. 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.

  1. Skin-sparing mastectomy and immediate latissimus dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes

    Directory of Open Access Journals (Sweden)

    Kim Zisun

    2012-11-01

    Full Text Available Abstract Background Skin-sparing mastectomy (SSM and latissimus dorsi (LD flap immediate breast reconstruction (IBR is a tailored surgical procedure. The surgical and patient-reported outcome (PRO of SSM and LD IBR were assessed. Methods Retrospective data of 146 SSMs performed by a single surgeon was reviewed. Among patients included in the data, 65 patients underwent SSM and LD IBR without a prosthetic implant. A survey estimating the degree of patient satisfaction (poor, fair, good, and excellent as regards the cosmetic outcomes of surgery was performed. The patients were divided into two groups according to their degree of satisfaction (excellent group versus non- excellent group, and analysis was done to identify factors affecting the highest patient satisfaction. Results The mean age of the patients was 48.4 years, and pathological results were: infiltrating ductal carcinoma (n = 48, 73.8%, ductal carcinoma in situ (n = 15, 23.1%, and others (n = 2, 3.1%. One patient received postmastectomy radiotherapy. After a mean follow-up of 34 months, no local recurrence occurred. There was no skin necrosis or LD flap loss. Donor site morbidities were seroma (n = 8, 12.3%, scarring (n = 8, 12.3%, and back pain (n = 6, 9.2%. Fifty patients (76.9% were satisfied and 40% reported their degree of satisfaction as excellent. Breast symmetry (P P P = 0.021, and panel assessment score (P Conclusions Our SSM and LD IBR was safe, with no local recurrence and low morbidities, and produced a sufficiently high level of patient satisfaction. Achieving breast symmetry and nipple cosmesis would be the key to meeting the patient’s expectation.

  2. Efecto protector de la toxina botulínica en colgajos cutáneos The protective effect of botulinum toxin on skin flaps

    Directory of Open Access Journals (Sweden)

    C.X. Astudillo Carrera

    2011-06-01

    the flap, c 9 with an application of type A botulinum toxin 7 days before surgery and d, 9 with type A botulinum toxin with epinephrine applied transsurgery in all the flap. The skin flaps were analyzed 7 days after surgery with Image J program and the T Student test. We take a medium of the necrotic area: a for the controls of 72.17 ± 3.9%, b botulinum toxin transsurgery 5.09 ± 1.2% p = 0.032, c botulinum toxin applied 7 days before 24.97 ± 2.7% p = 0.041 and d botulinum toxin with epinephrine 23.90 ± 3.9% p = 0.045. We conclude that botulinum toxin acts as a protector against the suffering process - ischemia of the tissues, thanks to its vasodilator action and that it should be applied in the beginning of the surgical procedure.

  3. 低旋转点外踝上皮瓣修复前足创面的临床应用%Clinical Application of Sub-pivoting Point Extramalleolus Epithelial Skin Flap in Repalring Soft Tissue Defects of the Forefoot

    Institute of Scientific and Technical Information of China (English)

    沈强; 李仲影; 王晓琴; 景晓虎; 吕杰

    2012-01-01

    Objective To explore the clinical effect of sub-pivoting point extramalleolus epithelial skin flap in repairing the soft tissue defects of the forefoot. Methods 39 patients with the soft tissue defects in forefoot admitted during March 2007 and May 2010 were traumatic soft tissue loss in proleg, 13 patients combined with injury of the bone and joint. Ordinary debride-ment was done and integrity of anterior and posterior tibial artery was assured. We designed the skin flap and used sub-pivoting point extramalleolus epithelial skin flap in repairing defects. Results All the flaps survived. Veins articulo appeared at distal end of 1 patients skin flap 2 d after operation, and the skin flap was put back after demolishing suture line of skin of pivoting point. The distal skin necrosis occurred in 4 skin flaps, and secondary healing came after changing dressings. We observed appearance of skin flap, texture, pigmentation and cicatricial contracture 6 months-2 years postoperative. 9 patients'Cutaneous sensation bated due to intraoperative superficial peroneal nerve injury. Conclusion It is an effective method in repairing the soft tissue defects in the forefoot to cut sub-pivoting point extramalleolus epithelial skin flap.%目的 探讨低旋转点外踝上皮瓣在修复前足皮肤软组织缺损中的应用.方法 2007年3月-2010年5月收治前足皮肤软组织缺损39例,均为外伤性前足软组织缺损,合并骨与关节损伤13例.伤后常规清创,确定胫前动脉、胫后动脉是否完好,设计皮瓣并应用低旋转点外踝上皮瓣修复缺损.结果 所有皮瓣成活,1例术后2d皮瓣远端出现静脉危象,拆除旋转点处皮肤缝线后皮瓣恢复正常,4例皮瓣远端皮肤部分浅表性坏死,经换药处理后二期愈合.本组随访6个月~2年,皮瓣外观、质地优良,无色素沉着、瘢痕挛缩等情况,9例足背外侧皮肤感觉减退,考虑为术中损伤腓浅神经所致.结论 低旋转点外踝上皮瓣切取较

  4. Aesthetic Subunit Reconstruction Facilitated with V-Y Island Advancement Flaps on the Face: A Case Report

    Directory of Open Access Journals (Sweden)

    Jaime Eduardo Pachón Suárez, MD

    2014-05-01

    Full Text Available Summary: The reconstruction of complex facial soft-tissue defects is a challenge that is often encountered by the plastic surgeon. Careful planning and knowledge of the aesthetic subunits that border the defect are paramount to achieve optimal results. We present a case of a 56-year-old woman who underwent excision of a large disfiguring chronic xanthelasma that extended from canthus to canthus across the nasal bridge. An aesthetic outcome was achieved by use of bilateral V-Y nasolabial flaps combined with a V-Y glabella advancement, which allowed for a tension-free like-for-like subunit reconstruction.

  5. Selecting principal to repair the shank soft tissue defect by pedicled skin flaps%带蒂皮瓣修复小腿部组织缺损的选择原则

    Institute of Scientific and Technical Information of China (English)

    赵胡瑞; 邓万祥; 董晖; 黎苑; 王建元; 马磊; 杜永军

    2011-01-01

    Objective: To investigate the selecting principal to repair the shank soft tissue traumatic defect by the local pedicled skin flaps. Methods: A total of 226 cases between January 1999 and December 2009 were collected. The shank soft tissue traumatic defects from different regions, different extent and different conditions were repaired respectively by clockwise or reversed pedicled skin flaps and other typologic skin flaps with axial pattern blood vessel or neurocutaneous vascular flap as well as fascio - cutaneous flap. Results: A total of 186 cases in 226 flaps had a good healing, 6 cases had a chronic sinus tract, and the skin edges of the 21 fascio -cutaneous flaps and sural neuromusculocutaneous flaps had the necrosis, all healed by changing dressings, the other 13 sural neuromusculocutaneous flaps had a postoperative grey skin edge in the distal end, but didn' t affect to heal. The 6 musculocutaneous flaps appeared fat and clumsy and all the supplied petaloid area had a better skingrafting healing. The pitting gradually became shallow alongwith the postoperative time. Conclusion: It has an ideal reconditioning effect to repair the shank soft tissue traumatic defect by the prothesis of local pedicled skin flaps, based on the appropriate selecting principal .%目的:探讨小腿部外伤性组织缺损使用局部带蒂皮瓣修复术式的选择原则.方法:选取1999-01~2009-12间226例小腿部不同部位、不同程度、不同条件的组织缺损,分别采用带蒂的顺、逆行皮瓣、以及其他类型的轴型血管皮瓣和神经营养血管皮瓣及筋膜皮瓣进行修复.结果:226例皮瓣中186例愈合过程顺利.余40例皮瓣中6例发生慢性窦道,21例筋膜皮瓣及腓肠神经营养皮瓣皮缘坏死,均经换药治愈;13例腓肠神经营养血管皮瓣术后远端皮缘色泽暗紫,未影响愈合;6例肌皮瓣外观臃肿,供瓣区植皮愈合良好.凹陷情况随着术后时间的延长逐渐变浅.结论:采用局部带

  6. 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.

  7. 个体化皮瓣在舌再造中的临床应用%Clinical Application of Individuation Skin Flap in Tongue Reconstruction

    Institute of Scientific and Technical Information of China (English)

    田鑫; 莫立根; 张涛; 郑厚普; 由金萍; 陈卫峰

    2012-01-01

    目的 依照头颈肿瘤外科修复重建原则,给予舌癌根治术后,采用个体化皮瓣进行舌再造,使患者的吞咽度语言功能早日恢复,提高患者对手术的依从性,最大程度的减少精神创伤.方法 对67例舌鳞癌患者在根治术中应用皮瓣移位或皮瓣移植完成修复重建,在皮瓣设计上采取个体化,并从患者术后恢复情况、并发症发生情况、对手术的依从性及其可能产生的精神创伤等方面进行判定及分析.结果 术后舌创面I期愈合67例,1例血管栓塞患者抢救成功,其他无不良并发症,修复成活率为100%.再造舌外形大部分良好,吞咽功能恢复正常,语言功能恢复优或良,患者心理状况良好.结论 个体化皮瓣进行舌再造术的成功率高,并发症发生率低,功能恢复良好,且患者的依从性高,精神创伤小,值得推广.%Objective To explore the application of individuation skin flap in tongue reconstruction, which may make a patient's swallowing and language function recover soon, increase a patient's compliance to surgery, and reduce a patient's mental trauma to the most degree. Method Sixty-seven cases of patients with tongue squamous cell carcinoma were given radical surgery and adopted by implementing individuation skin flap shift and transplantation for tongue reconstruction. The results of postoperative recovery situation, the occurrence of complications,surgical compliance , and the possible mental trauma of the patients were judged and analyzed. Results Sixty-seven cases were healed up during I period of surface wound. Thrombosis occurred in 1 patient, while he was reseued successfully. The other patients had no complications. Survival rate of skip flap is 100%. Most of the recreated tongue's shapes were good. Swallowing function returned to normal, and language functional recovery was excellent or good. Patient's psychological situation was good. Conclusion The surgery of individuation skin flap in tongue

  8. 负压封闭引流术联合皮瓣移植在慢性溃疡创面中的应用%Application of the vacuum sealing drainage technique combined with skin flap in chronic ulcerative wounds

    Institute of Scientific and Technical Information of China (English)

    郭晓波; 李金晟; 张菊芳; 贾明; 曹树英; 唐亮; 蔡莺莲

    2012-01-01

    目的 探讨负压封闭引流术(vacuum sealing drainage,VSD)联合皮瓣移植治疗慢性溃疡性创面的可行性及有效性.方法 2009年6月至2011年8月,应用VSD联合皮瓣移植治疗不同病因致慢性溃疡性创面者15例,经辅助应用VSD于创面1~6次,待感染控制、肉芽组织生长良好后选择皮瓣转移修复刨面.结果 除1例皮瓣尖端小面积坏死,经皮片移植后愈合外,其余皮瓣均存活良好,创面一期愈合,术后随访6~24个月,无一例感染复发.结论 VSD联合皮瓣移植治疗慢性溃疡性创面,具有并发症少、皮瓣存活率高、术后感染不易复发的特点,临床效果显著.%Objective To explore the feasibility and efficacy of the vacuum sealing drainage (VSD) technique combined with skin flap for the treatment of chronic ulcerative wounds.Methods From June 2009 to Aug.2011,the VSD technique combined with skin flap has been applied in the treatment of 15patients with chronic ulcerative wounds caused by various reasons.The VSD was applied to the wound for 1-6 times.When infection was controlled and fresh granulation grew,skin flap was used to cover the wound.Results Flap necrosis happened in a small area at the distal end in one case,which healed after skin graft.All the other flaps survived with primary healing.The patients were followed up for 6-24 months postoperatively with no recurrence of infection.Conclusions VSD combined with skin flap is an ideal choice for reconstruction of chronic ulcerative wounds.h has the advantages of low complications,reliable flap survival rate,and low infection recurrence.

  9. Clinical Application of Ultra Long Sural Nerve Nourishing Blood Vessels and Skin Flaps%超长腓肠神经营养血管皮瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    易美林; 段砚方; 唐江南; 安伟; 胡景煌; 李厚东; 徐成华; 涂江晖

    2015-01-01

    Objective Discuss the clinical application results of delayed transplant of the ultra long sural nerve nourishing blood vessels and skin flaps. Methods Such delayed transplant therapy was applied in 5 patients with exposed deep tissues of tendons and bones. Two weeks before cutting skin flaps, delayed inverted U⁃shaped notches were made in crus back upper 1/3 under popliteal fossa planar, reaching to deep fascia deep layer, and then were sutured in situ. The skin flaps were cut in the conventional way two weeks later and transplanted to the wound site. The survival rate of the flaps and the status of wound healing were observed. Results Transplanted flaps in 5 patients all survived and recovered good appearance and texture in follow⁃ups of three months to one year. Conclusion Application of delayed transplant of the ultra long sural nerve nourishing blood vessels and skin flaps to repair the soft tissue defect in the ankle and upper shank increases the length of skin flap, expands the area for repair, and features easy cut, reliable blood supply and good effect.%目的:探讨延迟转移超长腓肠神经营养血管皮瓣的临床应用效果。方法对5例伴有肌腱、骨质等深部重要组织外露的创伤患者行超长腓肠神经营养血管皮瓣转移治疗,皮瓣切取前2周,在腘窝平面下小腿后侧上1/3做延迟倒“U”形切口,深达深筋膜深层,原位缝合,2周后常规切取皮瓣转移至患处,观察皮瓣成活情况及创面愈合效果。结果5例患者皮瓣全部成活;随访3个月~1年,5例患者的皮肤质地及外形均恢复较好。结论采用超长腓肠神经营养血管皮瓣延迟转移修复小腿上端及足踝部软组织缺损,增加了皮瓣长度,扩大了皮瓣修复范围,且切取简便,供血可靠,效果良好。

  10. 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.

  11. Lateral upper arm retrograde island flap transfer for coverage of stump wound after forearm amputation%上臂外侧逆行岛状皮瓣修复前臂截肢后残端创面

    Institute of Scientific and Technical Information of China (English)

    许亚军; 陈政; 包岳丰; 周晓; 张辉; 周建东; 陈学明

    2014-01-01

    目的 介绍上臂外侧逆行岛状皮瓣修复前臂近端截肢后残端创面的临床经验.方法 对前臂近端截肢后残端创面采用上臂外侧逆行岛状皮瓣修复.结果 临床应用共10例,术后皮瓣8例顺利存活,2例血流稍许受限,拆除蒂部缝线后完全存活.有6例获得3个月的随访,残端伤口愈合佳,皮瓣外形满意,不臃肿,肘关节伸屈活动基本正常,能满足接装义肢的需要.结论 采用上臂外侧逆行岛状皮瓣是修复前臂残端创面的好方法.%Objective To introduce the clinical experience of the application of lateral upper arm retrograde island flap for coverage of stump wound after forearm amputation.Methods The lateral upper arm retrograde island flap was transferred to cover the wound at the stump that was resulted from forearm amputation.Results This flap was applied in a total of 10 cases.Flaps in 8 cases survived uneventfully.Compromised perfusion was observed in 2 cases which were remedied by removing stitches at the pedicle.These 2 flaps also survived completely.Sufficient follow-up was obtained in 6 cases for 3 months.The stump wounds healed well.The flaps were not bulky.The appearance and elbow function were satisfactory.The stump met requirements for prosthetic fitting.Conclusion Lateral upper arm retrograde island flap is a good option for coverage of stump wound after forearm amputation.

  12. Primary care and pattern of skin diseases in a mediterranean island

    Directory of Open Access Journals (Sweden)

    Lyronis Ioannis

    2006-01-01

    Full Text Available Abstract Background In Greece where primary health care services are not fully developed, patients with simple or minor conditions have to attend to hospitals to be treated. We analysed the data of patients with cutaneous disorders attending the tertiary referral hospital on the Island of Crete, with the aim to identify the most common conditions that patients complain of, in order to define the areas where the education of General Practitioners in Dermatology must focus. Methods All patients attending the Dermatology ambulatory office in the Emergency Department of the University General Hospital of Heraklion from January 2003 to December 2003 were included in this retrospective analysis. The medical records of the patients (history, physical examination and laboratory investigations were analysed to ascertain the diagnosis and the management of cases. All patients were evaluated by qualified dermatologists. Results A total of 3715 patients attended the Dermatology Clinic. Most patients were young adults in the age group 21–40 years (38.4%, and the male to female ratio was 1 to 1.2. Allergic skin diseases, mostly dermatitis and urticaria (35.7% were the most common for attendance, followed by infectious diseases (26.1% and insect bites (10.2%. Inflammatory and autoimmune disorders accounted for 7.9% of the cases. Pruritus of unknown origin was diagnosed in 6.3% of patients. Skin tumors were detected in 2.7%. The management of the vast majority of cases (85.0% consisted of advice with or without a prescription, while only 4.8% of patients required admission. Conclusion Allergic and infectious skin diseases were the most common cutaneous diseases in patients attending this tertiary University hospital, while the management of most patients did not require specialised care. On the basis of the present data, the training of primary health care providers in Dermatology should emphasize these common conditions, with the aim of improving primary

  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. Repair of penis skin defects with scrotal flaps pedicled with different vessels%应用不同血管蒂阴囊皮瓣修复阴茎皮肤缺损

    Institute of Scientific and Technical Information of China (English)

    刘小容; 刘玉生; 陈可琼; 高雁; 黄伟龙; 黎德燕; 张晓玲

    2011-01-01

    目的 探讨应用两种带不同血管蒂的阴囊皮瓣修复阴茎皮肤缺损的方法及效果.方法 对阴茎皮肤肿瘤患者,应用Mohs法切除病变组织,并对切除标本进行快速冰冻切片,直至切除干净,最大限度地保留阴茎的正常组织;对感染者于Buck's筋膜浅面将肉芽组织完整切除.根据阴茎皮肤缺损的大小设计大于缺损面积10%的皮瓣.自2003年8月至2010年6月,应用带血管蒂阴囊皮瓣修复阴茎皮肤缺损共13例,其中8例应用阴囊前动静脉蒂皮瓣修复,5例应用阴囊中隔血管蒂皮瓣修复.结果 1例阴囊前动静脉蒂皮瓣由于转移隧道过紧出现远端少许坏死,经换药后伤口愈合,其余皮瓣完全存活.所有患者随访3个月至2年,阴茎外形及功能恢复满意,阴囊无变形,供区瘢痕不明显.结论 阴囊皮瓣薄,无皮下脂肪,具有伸展性,与阴茎皮肤类似;对阴茎皮肤部分或全部缺损者应用阴囊前动静脉蒂或阴囊中隔血管蒂的阴囊皮瓣修复,可获得阴茎外形及功能满意的修复效果.%Objective To explore the methods and effects of skin defects of the penis repaired with two kinds of scrotal flaps pedicled with different vessels. Methods The penile skin neoplasm was resected by Mohs surgery and phallic normal tissue was reserved as possible as we could. The excised specimen was performed the rapid frozen section; for the penile skin with infection, granulation tissue was cut completely on superficial layer of Buck's fascia. The flaps were designed over-sized by 100% according to the penile skin defects. From August 2003 to June 2010. the skin defects of the penis were repaired with the scrotal flaps pedicled with various vessels in 13 cases. including flaps pedicled with anterior scrotal vessels in 8 cases and pedicled with scrotal septal vessels in 5 cases. Results All the flaps survived completely except one flap pedicled with anterior scrotal vessels was necrosis on remote end because of

  15. [Development and current status of perforator flaps].

    Science.gov (United States)

    Xu, Dachuan; Zhang, Shimin; Tang, Maolin; Ouyang, Jun

    2011-09-01

    To provide a comprehensive review for development and existing problems of the perforator flaps. The related home and abroad literature concerning perforator flaps was extensively reviewed. 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. 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.

  16. Free digital artery flap: an ideal flap for large finger defects in situations where local flaps are precluded.

    Science.gov (United States)

    Wong, Chin-Ho; Teoh, Lam-Chuan; Lee, Jonathan Y-L; Yam, Andrew K-T; Khoo, David B-A; Yong, Fok-Chuan

    2008-03-01

    The heterodigital arterialized flap is increasingly accepted as a flap of choice for reconstruction of large finger wounds. However, in situations where the adjacent fingers sustained concomitant injuries, the use of this flap as a local flap is precluded. This paper describes our experience with the free digital artery flap as an evolution of the heterodigital arterialized flap. Four patients with large finger wounds were reconstructed with free digital artery flap. Our indications for digital artery free flap were concomitant injuries to adjacent fingers that precluded their use as donor sites. The arterial supply of the flap was from the digital artery and the venous drainage was from the dominant dorsal vein of the finger. The flap was harvested from the ulnar side of the finger. The digital nerve was left in situ to minimize donor morbidity. The donor site was covered with a full-thickness skin graft and secured with bolster dressings. Early intensive mobilization was implemented for all patients. All flaps survived. No venous congestion was noted and primary healing was achieved in all flaps. In addition to providing well-vascularized tissue for coverage of vital structures, the digital artery was also used as a flow-through flap for finger revascularization in one patient. Donor-site morbidity was minimal, with all fingers retaining protective pulp sensation and the distal and proximal interphalangeal joints retaining full ranges of motion. In conclusion, the free digital artery flap is a versatile flap that is ideal for coverage of large-sized finger defects in situations where local flaps are unavailable. Donor-site morbidity can be minimized by preservation of the digital nerve, firmly securing the skin graft with bolster dressings, and early mobilization of the donor finger.

  17. Clinical application of lateral lower leg flap to repair skin defect of the hand%小腿外侧皮瓣修复手部皮肤缺损的临床应用

    Institute of Scientific and Technical Information of China (English)

    庄加川; 李敏姣; 陈国荣; 白印伟; 吴耿; 柯于海; 林慧鑫; 张振伟

    2012-01-01

    目的 探讨小腿外侧皮瓣修复手部皮肤缺损的临床应用.方法 对15例手部皮肤缺损面积大小约2.5 cm×3.2 cm~3.8 cm×5.0 cm的患者,采用小腿外侧皮瓣游离移植修复.皮瓣穿支动脉与手部动脉、伴行静脉或皮下静脉与手背静脉吻合,小腿供区创面直接缝合.结果 15例皮瓣全部存活,1例皮瓣术后出现血管危象,行手术探查重新吻合血管后存活,4例皮瓣术后3个月行皮瓣整形术.术后随访时间为2个月至2年,平均11个月,手部皮瓣外观满意,功能恢复良好;小腿供区隐蔽,创面仅留线状瘢痕.结论 小腿外侧皮瓣修复手部皮肤缺损是一种较理想的方法.%Objective To explore the clinical applications of lateral lower leg flap to repair skin defects of the hand.Methods The lateral lower leg flap was used to cover skin defect of the hand in 15 patients with defect area measuring approximately 2.5 cm × 3.2 cm to 3.8 cm × 5.0 cm.The flap was transferred by anastomosing the flap perforator artery to the artery of the hand,the venae commitante or subcutaneous vein of the flap to the veins on dorsum of the hand.The donor site was dosed directly.Results All 15 flaps survived.Postoperative vascular crisis occurred in one flap.The flap survived after surgical exploration and re-anastomosis of the vessels.Flap plasty was done in 4 cases 3 months after the primary surgery.Postoperative follow-up ranged from 2 months to 2 years,with an average of 11 months.The skin flaps at the hand had satisfactory appearance.Hand function recovered well.The donor site was concealing.Only a linear scar was left.Conclusion Lateral lower leg flap is a relatively ideal method to repair skin defect of the hand.

  18. 头静脉周围血管营养皮瓣修复皮肤缺损45例%Repairing skin and soft tissue defect in 45 cases by vasculotrophic flaps around cephalic vein

    Institute of Scientific and Technical Information of China (English)

    王宣生; 周巨良; 应素兰; 石小龙; 王振翼; 李庆泰

    2014-01-01

    Objective To discuss the clinical effect of treating skin defect with vasculotrophic flaps around cephalic veins. Methods We used 45 vasculotrophic flaps around cephalic veins to treat 45 patients with skin defect, from February 2008 to March 2012. The follow-up time was 6 months to 1 year, 10 months on average. Based on the surgical methods, the surgical flaps were divided into two classes, one was antegrade flap, with the flap at the distal end of the pedicle. And the other was retrograde flap, with the flap at the proximal of the pedicle. Type I of the second class:reflux vein could be found inside the wound surface, and the cephalic vein inside the flap was anastomosed with the reflux vein inside the wound surface. Type II of the second class: reflux vein could not be found inside the wound surface, and the cephalic vein inside the flap tissues was ligated. Flaps were cut from deep fascial layer, the pedicle width has cephalic vein as the center, not less than 3.0 cm, and the flap length-to-width ratio should not be greater than 5:1. The pedicle of free flap has a strip of skin for reducing tension during suturing. The superficial cutaneous nerves should be kept when cutting the skin flaps. Results Through the method of vasculotrophic flaps around cephalic veins, 45 flaps all survived. As the cutaneous nerve was kept when cutting the flaps, the sensory function of the body was good. Conclusion The cephalic veins exist inside the fascia tissues, and have more concentrated arteries around to supply blood, which provide nutrition to cephalic veins and peripheral tissues. Various vasculotrophic flaps around cephalic veins could be designed by utilizing these tissues for blood supply. As the skin flaps only contain cephalic veins and don't injure nerves and arteries, the damage to the limb is small and higher survival rate, so it has broad application prospects.%目的:探讨头静脉周围血管营养皮瓣修复皮肤缺损的临床疗效。方法对2008年2

  19. 网状减张小切口缝合法提高大鼠背部张力皮瓣存活机制%Mechanism research on promoted survival rate of tension skin flap after meshed relaxing short incision suture

    Institute of Scientific and Technical Information of China (English)

    年申生; 吴岳嵩; 苏佳灿; 侯铁胜; 张春才

    2002-01-01

    Objective To observe effects of meshed relaxing short incisions (MRSI) on the content of endothelin (ET) in rat tension skin flap,and to investigate the mechanism of meshed relaxing short incisions(MRSI) on wound healing process of tension skin flap.Method We designed an experimental model to investigate the change of ET content caused by MRSI and observe the distribution of ET in rat skin flap tissue each period of wound healing.In the meantime,the immunohistochemistry and auto image analysis were employed.Results Our results showed:(1) ET positive immunologic reaction granules involved in small vascular endothelial cell in rat skin flap tissue increased with prolonging of time within 3 days;(2) the content of ET in MRSI group were significant lower than that of hypertension group (P< 0.05) .Conclusion The decrease of ET contents may be one of the causes that MRSI improves microcirculation of skin flap, and reduces edema and facilitates healing of skin flap.

  20. Aesthetic applications of random pattern skin flap in repair of facial soft tissue defects%随意型皮瓣在面部软组织缺损美学修复中的应用

    Institute of Scientific and Technical Information of China (English)

    王淑琴; 谭谦; 郑东风; 许澎; 葛华强; 林樾; 燕辛

    2016-01-01

    Objective To discuss the effects of random pattern skin flap on the repair of facial soft tissue defects as well as its aesthetic applications.Methods In view of the facial soft tissue defects caused by various reasons,36 cases of patients were repaired according to the defect location,size,design such as "the kite" flap,adjacent pedicle flap or V-Y glide flaps.Results After operation,all flaps were survived;Incisions were healed at stage Ⅰ;follow-up for 2 to 12 months,the cosmetic results were satisfactory.Conclusions The random pattern skin flap can be applied to repair facial soft tissue defects with aesthetic effects.The flap's texture and color have no obvious difference from nor mal skin;postoperative incision scar is slightly,and it can retains the facial appearance and function to the maximum limit.%目的 探讨随意型皮瓣在修复面部软组织缺损中的美学效果.方法 针对各种原因所致的面部软组织缺损,根据缺损部位所处的面部美学亚单位、缺损形态及缺损面积等设计随意型皮瓣,如旋转皮瓣、推进皮瓣、易位皮瓣、“风筝”皮瓣等,对36例患者进行修复.切口设计顺皮纹方向,切口无张力缝合.结果 术后36例患者的皮瓣全部成活,切口均Ⅰ期愈合,切口瘢痕轻微,随访2~1 2个月,美学效果满意.结论 应用随意型皮瓣修复面部软组织缺损,皮瓣质地柔软,色泽无明显差异,能最大限度地保留面部美观及功能.

  1. [Shift the skin paddle in an additional incision improves the result: Study of a series of 82 breast reconstructions by latissimus dorsi flap and prosthesis implantation at 10 years].

    Science.gov (United States)

    Chiriac, S; Dissaux, C; Bruant-Rodier, C; Djerada, Z; Bodin, F; François, C

    2016-11-17

    The position of the skin paddle on the breast area is a fundamental element for the breast reconstructions by latissimus dorsi flap and prosthesis implantation. Should, as Millard advocated, to recreate the initial defect and include it in the mastectomy scar or is it better in an additional incision as have others authors. This study compares the long-term morphological results of these two attitudes, with or without additional incision.

  2. 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.

  3. 游离腓动脉穿支筋膜瓣修复手部皮肤缺损%Free adipofascial flap from peroneal perforator artery for repair of hand skin defects

    Institute of Scientific and Technical Information of China (English)

    李学渊; 滕晓峰; 黄剑; 陈宏; 章伟文; 陈德松

    2010-01-01

    Objective To explore the surgical technique and clinical outcomes of applying the free adipofascial flap nourished by musculocutaneous perforators of the peroneal artery to repair soft tissue defects of the hand. Methods Six cases of skin defects in the hand were treated from December 2007 to October 2009 with free peroneal artery perforator fascial flap. The size of the raised flaps ranged from 5.0 cm × 4.5 cm to 10 cm × 7 cm. In most cases the musculocutaneous branch was chosen as the vascular pedicle for anastomosis.The blood vessels were anastomosed in an end-to-side fashion. The transferred fascial flap was covered with split thickness skin graft, while the donor site was closed directly. Results All the adipofascial flaps survived uneventfully. The skin graft over the fascial flap showed over 90% survival in 4 cases and 80% survival in 2 cases after 7 days. Follow-up time ranged from 3 to 12 months. Flap bulkiness was seen in one case which underwent debulking procedure 3 months later. The appearance of other 5 cases was satisfactory with only slight flap bulkiness. Only a linear scar was left at the calf donor site. Conclusion The free adipofascial flap was a modification of peroneal perforator flaps to minimize morbidity and improve cosmoses of the donor site. The adipofascial flap can also fill the void caused by soft tissue defects and provide better condition for functional reconstruction.%目的 探讨应用游离腓动脉穿支筋膜瓣修复手部软组织缺损,减少供区损伤的方法和临床效果.方法 2007年12月至2009年10月,对6例手部皮肤缺损患者,应用游离腓动脉肌皮穿支筋膜瓣进行修复,切取面积为5.0 cm×4.5 cm~10.0 cm×7.0 cm,以肌皮穿支为蒂.动脉血管蒂与受区血管采用端侧吻合,受区筋膜瓣行断层植皮覆盖.供区创面直接缝合.结果 术后6例筋膜瓣全部存活;术后7 d,筋膜表面植皮成活大于90%4例,80%2例.随访时间为3~12个月,1例皮瓣臃肿,术后3

  4. 扩张后皮瓣修复面颈部瘢痕挛缩畸形%Repair of cicatrical eontractnre in face and neck regions with expanded skin flap

    Institute of Scientific and Technical Information of China (English)

    沈余明; 胡骁骅; 王浩; 黎明; 张国安

    2009-01-01

    目的 了解扩张后皮瓣治疗面颈部烧伤后瘢痕挛缩畸形的效果.方法 利用83个皮肤扩张器对38例烧伤后面颈部瘢痕挛缩畸形患者进行治疗.扩张器容量为100~600 mL,扩张时间3~5个月.扩张器置入部位大部分为正常皮肤,但其中10个扩张器置入烧伤后稳定软化的瘢痕下.扩张后行皮瓣转移术.本组有3例患者的扩张器置于斜方肌下部深筋膜层内,行以颈横动脉深支为蒂的远位扩张皮瓣移植.结果 38例患者术后皮瓣均成活,效果满意.其中8例术后发生血肿、感染等并发症,经处理后均未影响治疗效果.30例患者随访3~24个月,皮瓣颜色、质地均佳,外形及功能明显改善.结论 扩张后皮瓣是治疗面颈部烧伤后瘢痕畸形的最佳方法.在局部无正常皮肤的情况下,扩张瘢痕皮肤及远位扩张也是良好的选择.%Objective To observe the result of repairing deformity due to eicatrieal contracture in face and neck regions with expanded skin flap. Methods Eighty-three skin expanders with volume ran-ging from 100 to 600 mL were implanted into 38 patients with scars in face and neck regions after burn. The expansion time ranged from 3 to 5 months. Most expanders were implanted under normal skin. Ten expand-ers were implanted under stable intenersted scars after healing of burn, and flaps therefrom were transplan-ted;3 expanders were implanted into deep fascia layer of trapezius, and remote expanded skin flaps with deep branch of transverse cervical artery as the pedicle were formed and transplanted. Results All flaps survived in 38 cases with satisfactory results. Complications including hematoma and infection after surgery occurred in 8 cases, but they did not affect therapeutic effect after treatment. Thirty patients were followed up for 3 to 24 months. It was found that the color and texture of skin flaps were good ;appearance and func-tion were obviously improved. Conclusions Expanded skin flap is the

  5. Lateral supramalleolar antidromic perforator flap for skin and soft tissue defects of the forefoot and midfoot%外踝上逆行穿支皮瓣修复前中足皮肤软组织缺损

    Institute of Scientific and Technical Information of China (English)

    高翔; 尤涛; 邓英虎; 王欣; 张可可; 李胜华

    2014-01-01

    目的:探讨外踝上逆行穿支皮瓣修复前中足皮肤软组织缺损的临床疗效。方法采取回顾性方法对我院2008年1月至2013年10月间15例足背皮肤软组织缺损患者应用外踝上逆行穿支皮瓣修复的治疗效果进行分析。结果本组皮瓣13例全部成活,2例皮瓣部分边缘坏死,经换药后愈合。随访时间为6~19个月,平均随访时间(12.5±0.5)个月。术后未见有皮瓣和皮片磨损的情况发生,且外观比较满意,穿鞋也无影响。患者的临床治疗总有效率100%。结论临床中外踝上逆行穿支皮瓣修复足背皮肤软组织缺损效果显著,能够有效的提高患者的临床治疗效果,且避免二次手术,值得临床中应用与推广。%Objective To investigate the clinical effects of lateral supramalleolar antidromic per-forator flap on repairing skin and soft tissue defects of the forefoot and midfoot.Methods The therapeutic effects of lateral supramalleolar antidromic perforator flap were retrospectively analyzed in 15 patients with skin and soft tissue defects of the dorsal foot from January 2008 to December 2013.Results The flap sur-vived in 13 cases.Two cases had flap edge necrosis and healed after dressing change.The follow-up time ranged from 6 months to 19 months,with an average of(12.5 ±0.5 )months.No abrasions of flap or skin graft were observed.The appearance was satisfactory and it did not affect wearing shoes.The total effective rate was 100%.Conclusion In the treatment of skin and soft tissue defects of the dorsal foot,lateral su-pramalleolar antidromic perforator flap can effectively improve clinical efficiency and avoid reoperation, which is worthy of being spread in clinical practice.

  6. Cosmetic repair of nasal defects with medial pedicle skin flap of the upper arm%上臂内侧带蒂皮瓣在创伤后鼻缺损美容整形中的应用

    Institute of Scientific and Technical Information of China (English)

    张鲜英; 刘毅; 王刚

    2016-01-01

    Objective To investigate the methods to repair traumatic defects on nose with medial pedicle skin tube ( flap) of the upper arm.Methods Eleven patients with nasal defects were repaired in our department from Nov.2008 to Jan.2015.To repair their defect,all patients were treated with medial pedicle skin tube ( flap) of the upper arm.Among them skin tubes( flap) were formed,transferred and repaired simultaneously in 8 patients;for the rest 3 patients,skin tubes( flap) of upper arms were formed in the first stage,nasal defect was transferred and re-paired in the second stage,and noses were successfully reconstructed with pedicle division in the third stage.Re-sults All the 11 patients achieved good blood circulation in skin flaps and good ventilation in nasal cavity.The fol-low-up of 9 patients showed that during the first 3 months after the operation,the color of skin tube ( flap) was obvi-ously different from the surrounding skin,but gradually similar after 1 year.Besides,bilateral nostrils achieved sym-metry with good appearance.The cosmetic repair was basically achieved.Conclusion The design for medial pedi-cle skin tube ( flap) of the upper arm is not restricted comparatively,but it significantly improves the tissue survival rate by supplying sufficient tissue.It might be a better alternative for those patients who prefer not to leave new scars on their faces.%目的:探讨上臂内侧皮管(瓣)带蒂移植在创伤后鼻缺损美容整形中的应用。方法2008年11月~2015年1月,笔者应用上臂内侧带蒂皮管(瓣)修复创伤后鼻缺损11例(男性9例,女性2例;年龄18~43岁),其中一期皮管(瓣)成形同时转移修复8例,其余3例采用一期上臂形成皮管(瓣)、二期带蒂转移修复鼻缺损、三期皮管断蒂完成鼻再造。结果本组11例患者鼻部转移皮瓣血运良好,鼻腔通气功能良好。随访9例,1~3个月时颜色与周围皮肤相差较大,1年后颜色相近,

  7. A new submerged split-thickness skin graft technique to rebuild peri-implant keratinized soft tissue in composite flap reconstructed mandible or maxilla.

    Science.gov (United States)

    Fang, Wei; Ma, Wei; Ma, Wei-guang; Li, De-hua; Liu, Bao-lin

    2012-03-01

    The objective of this study was to introduce our preliminary experience on a submerged split-thickness skin graft (STSG) technique combined with secondary vestibuloplasty to rebuild keratinized peri-implant soft tissue and oral vestibule for patients with large oromandibular defects reconstructed by composite flaps. Five patients were enrolled in this study. Stage 1 was submerged STSG and simultaneous implant placement. Stage 2 was the uncovering of the STSG and vestibuloplasty. The implant-borne fixed denture was inserted after this 2-stage treatment. All patients were followed for at least 12 months (average 18 months). Eighteen implants were placed. The rebuilt peri-implant keratinized soft tissue was healthy clinically. The STSG graft had firm adherence to the underlying periosteum. The vestibule had adequate depth to maintain local hygiene. All implants were osseointegrated and all implant-borne prostheses were functioning well. Submerged STSG technique combined with secondary vestibuloplasty may become a feasible and effective solution to rebuild keratinized soft tissue before dental implant restoration. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Soft tissue profile changes after mandibular vestibuloplasty. A two-year follow-up study comparing the Edlan flap, mucosal and skin graft methods.

    Science.gov (United States)

    Hillerup, S; Solow, B

    1990-02-01

    It is the aim of the present study to examine the pattern of postoperative changes in the soft tissue profile of 50 edentulous patients after 3 common types of mandibular vestibuloplasty, the Edlan flap operation (n = 15), the buccal mucosal graft (n = 19), and the skin graft vestibuloplasty (n = 16). The soft tissue profile changes were recorded on lateral cephalometric radiographs taken preoperatively, and after 1, 3, 6, 12, and 24 months post surgery. The 3 groups did not differ with respect to clinical features or presurgical cranio-facial morphology. Neither was any significant difference in postoperative profile changes found between the groups. The surgery gave rise, directly and indirectly, to a number of changes in the facial soft tissue profile many of which were interrelated. The chin thickness increased by 2.3 mm, and the lower lip height exhibited a reduction of 1.8 mm at 1 month after surgery as a direct consequence of the operation. After 3 months the profile changes were mostly associated with the reduction of the anterior face height (overclosure).

  9. Clinical outcomes of synthetic measures for preventing skin flap necrosis after mastectomy%防止乳腺癌术后皮瓣坏死措施的临床效果

    Institute of Scientific and Technical Information of China (English)

    徐志坚

    2009-01-01

    Objective To observe the outcomes of applying the synthetic measures for preventing skin flap necrosis after mastectomy. Methods The synthetic measures for preventing skin flap necrosis after mastectomy were applied in 98 patients (group A) undergoing modified radical mastectomy. The clinical outcomes were compared with those in 80 cases (group B) undergoing conventional modified radical rnastectomy. Results Skin flap necrosis in group A occurred in 2 cases (2. 0%), which was significantly lower than that in 15 cases (18. 6%) in group B (P<0.01). Subcutaneous dropsy in group A occurred in 3 cases (3. 1%),which was significantly lower than that in 27 cases (33.7%) in group B (P<0. 01). Conclusion The keys for preventing skin flap necrosis are selecting a reasonable thikness of skin flap, avoiding suture tension, preventing lymphoduct transudation, using effective drainage with two tubles and packing properly.%目的 探讨降低乳腺癌改良根治术后皮瓣坏死发生率的方法 .方法 对98例乳腺癌改良根治术患者(A组)采用了预防皮瓣坏死的综合措施,其结果 与以往实施的80例乳腺癌改良根治术病例(B组)进行比较.结果 B组皮瓣坏死15例(18.6%),皮下积液27例(33.7%).A组皮瓣坏死2例(2.0%).皮下积液3例(3.1%),均明显低于B组(P<0.01).结论 预防乳腺癌改良根治术后皮瓣坏死的关键是合理的皮瓣厚度,避免皮瓣缝合张力,防止淋巴管漏,有效双管引流和合适包扎.

  10. Clinical application of expanded submental island flap in facial soft tissue defect%颏下动脉颈部岛状扩张皮瓣修复面部软组织缺损

    Institute of Scientific and Technical Information of China (English)

    李峰永; 李养群; 陈文; 李强; 周传德; 唐勇; 杨喆; 赵穆欣

    2009-01-01

    目的 探讨以颏下动脉为蒂的颈部扩张皮瓣在面部软组织缺损修复中的临床应用效果.方法 2004年9月至2008年9月,应用以颏下血管为蒂的颈部岛状扩张皮瓣修复面部软组织缺损12例.手术分两期进行,一期行颈部扩张器植入术,二期以一侧颏下动脉为蒂,设计岛状皮瓣转移修复面部软组织缺损.皮瓣的最大面积16 cm×9 cm.结果 12例皮瓣全部成活,其中1例因静脉回流不畅而出现皮瓣远端表皮坏死,经换药等治疗后愈合.4例获得远期随访,随访时间为6个月至2年,皮瓣质地及色泽均接近面部正常组织,外形满意,颈部供区瘢痕隐蔽、活动无明显受限.结论 颏下动脉走行恒定,颈部扩张后可以提供较大面积高质量的皮肤组织,以颏下动脉为蒂的颈部岛状扩张皮瓣是修复面部损伤后瘢痕挛缩及面部浅表肿瘤切除后组织缺损的较好的方法.%Objective To investigate the application of the expanded submental island flap in facial soft tissue defect. Method 12 patients with facial soft tissue defects were treated with the expanded submental island flaps during September 2004 to September 2008. At the first stage, soft tissue expander was implanted in the neck. At the second stage, the submental island flap was designed to repair the facial soft tissue defect. The largest size of the flap was about 16 cm×9 cm. Result All flaps survived well except for one case of partial epidermal necrosis at the distal part of the flap. The wound healed with dressing. 4 patients were followed up for 6~24 months with satisfactory results. Conclusion The submental artery was a constant branch of facial artery.Large cervical flap with high quality tissue can be provided after expansion. The expanded submental island flap is a good choice for repairing the facial soft tissue defect.

  11. Early application of examethasone improves the survival of autogenous island flap and prognosis of patients with burn scar after transplantation%烧伤后瘢痕修复早期应用地塞米松:对自体岛状皮瓣移植存活和预后的影响

    Institute of Scientific and Technical Information of China (English)

    於国军; 王光军; 张大维; 程宏宇

    2015-01-01

    BACKGROUND:Autologous island flap transplantation is the main therapy for burn scars. Floating and necrosis of transplanted flaps mainly impact the therapeutic effects. Dexamethasone has immunoregulatory function during trauma and stress process. OBJECTIVE:To investigate the effect of dexamethasone on immune balance of Th1/Th2 and prognosis in patients with burn scars undergoing autologous island flap transplantation. METHODS:Sixty-eight patients with burn scars undergoing transplantation of pedicled island flap were selected and randomly divided into control group and experimental group. Patients in the two groups were treated with negative pressure drainage under skin flap, infection prevention, improvement of microcirculation. After that, dexamethasone sodium phosphate (0.2 mg/kg) was immediately given in the experimental group, and the dose gradualy decreased after 3 days until drug withdrawal at 7 days. Levels of Th1, Th2, Th1/Th2 and interferon-γ, interleukin-4 were compared between the two groups before and 1 week after transplantation. In addition, incidence rates of skin flap necrosis, hemodynamic disorder, and effusion were compared between the two groups. RESULTS AND CONCLUSION:The levels of Th1, Th2, Th1/Th2, interferon-γ and interleukin-4 had no obvious differences between the two groups before flap transplantation. At 1 week after transplantation, the levels of Th1 and Th1/Th2 were higher, while the levels of Th2, interferon-γ and interleukin-4 were lower in the experimental group than the control group. Moreover, the incidence of complications was also lower in the experimental group than the control group. In conclude, dexamethasone can decrease the incidence of complications after island flap transplantation, which is maybe the result of adjusting immune balance of Th1/Th2.%背景:烧伤瘢痕自体岛状皮瓣移植修复是主要的治疗方法,移植后皮瓣漂浮、坏死是影响移植后效果的主要原因,地塞米松具有免疫调

  12. Reconstruction of Complex Facial Defects Using Cervical Expanded Flap Prefabricated by Temporoparietal Fascia Flap.

    Science.gov (United States)

    Zhang, Ling; Yang, Qinghua; Jiang, Haiyue; Liu, Ge; Huang, Wanlu; Dong, Weiwei

    2015-09-01

    Reconstruction of complex facial defects using cervical expanded flap prefabricated by temporoparietal fascia flap. Complex facial defects are required to restore not only function but also aesthetic appearance, so it is vital challenge for plastic surgeons. Skin grafts and traditional flap transfer cannot meet the reconstructive requirements of color and texture with recipient. The purpose of this sturdy is to create an expanded prefabricated temporoparietal fascia flap to repair complex facial defects. Two patients suffered severe burns on the face underwent complex facial resurfacing with prefabricated cervical flap. The vasculature of prefabricated flap, including the superficial temporal vessel and surrounding fascia, was used as the vascular carrier. The temporoparietal fascia flap was sutured underneath the cervical subcutaneous tissue, and expansion was begun in postoperative 1 week. After 4 to 6 months of expansion, the expander was removed, facial scars were excised, and cervical prefabricated flap was elevated and transferred to repair the complex facial defects. Two complex facial defects were repaired successfully by prefabricated temporoparietal fascia flap, and prefabricated flaps survived completely. On account of donor site's skin was thinner and expanded too fast, 1 expanded skin flap was rupture during expansion, but necrosis was not occurred after the 2nd operation. Venous congestion was observed in 1 patient, but after dressing, flap necrosis was not happened. Donor site was closed primarily. Postoperative follow-up 6 months, the color, texture of prefabricated flap was well-matched with facial skin. This method of expanded prefabricated flap may provide a reliable solution to the complex facial resurfacing.

  13. Treatment of refractory wounds on the buttock and sacrococcygeal region using skin flap and free skin graft transplantation%皮瓣及皮片移植治疗臀骶尾部难愈创面

    Institute of Scientific and Technical Information of China (English)

    张绪生; 刘毅; 张斌; 肖斌; 张鲜英

    2009-01-01

    A total of 121 patients with the refractory wounds on the bttock and sacrococcygeal region were selected.There were 109 cases of paraplegia and pressure sore,including 48 cases of sinus tract type,45 cases of ulcer type,11 cases of mixed type,and 5 cases of multiple occurrence type.There were 12 cases of non-paraplegia,containing 8 cases of electric burn,3 cases of trauma,and 1 case of local blockage infection.After resection of the necrotic tissues,synovial bursa and parabiotic tissues,the wounds were repaired by primary surgical procedures with local skin flaps,myocutaneous flaps and free skin grafting.After resection of the necrotic tissues,the wounds were recovered by secondary procedures with myocutaneous flaps and free skin grafting.After resection of the necrotic tissues,the exposed wounds were healed by dressing change.Of the 121 cases,the primary surgical reconstructed of the wounds were found in 78 cases,with the cure rate of 64.46%.The secondary surgical reconstructed of the wounds were in 39 cases,with the cure rate of 32.23%.The wounds of 4 cases were recovered by dressing change after debridement,with the cure rate of 3.31%.It might be the most effective ways to deal with the refractory wounds on the buttock and sacrococcygeal region that improving the local blood circulation by dressing change,physiotherapy and torrefaction and treating the wounds in the perioperative stage by cleaning the wounds,unobstructed effluvium secretion and avoiding long-pressure of the wounds.%纳入121例臀骶尾部压疮患者,其中截瘫压疮109例,包括窦道型48例,溃疡型45例,混合型11例,多发型5例;非截瘫创面12例,包括电烧伤8例,外伤3例,局部封闭感染1例.切除坏死组织、滑膜囊及间生态组织,Ⅰ期局部皮瓣、肌皮瓣加皮片移植修复;彻底切除坏死组织,Ⅱ期选用皮瓣加皮片移植覆盖创面;清除坏死组织及死骨,伤口开放换药愈合.121例患者中伤口Ⅰ期愈合78例,愈合率64.46%;

  14. 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.

  15. 组织工程化皮瓣的构建%Construction of tissue-engineered skin flap in vitro

    Institute of Scientific and Technical Information of China (English)

    陈伟; 姜平; 陈晓炜; 廖云君; 高建华

    2012-01-01

    Objective To construct a tissue-engineered skin flap using composite skin and adipose tissue constructed by adipose-derived stem cells(ASCs).Methods Human ASCs isolated from adipose tissue were cultured and identified for their adipogenic,osteogenic and chondrogenic differentiation potentials.ASCs were then mixed with collagen gel for adipogenic induction and observed 15 days later with inverted microscope,oil-red O staining and HE staining.To construct the composite skin,keratinocytes and fibroblasts were isolated from human foreskin.The fibroblasts were mixed with collagen gel and cultured for 5 days,and keratinocytes were seeded on the gel for 4 days before transfer of the culture to air-liquid interface for culture for another 10 days.The adipose tissue and composite skin were then assembled according to the structure of normal skin and cultured for 3 days with HE staining observation.Results The cultured ASCs were capable of adipogenic,osteogenic and chondrogenic differentiation,and adipogenic induction of the ASCs-gel complex for 15 days resulted in adipogenic differentiation of the ASCs in gel.The assembled tissue-engineered skin consisted of 3 layers,including a suprabasal layer formed by the stratified and differentiated keratinocytes,the middle layer and sublayer containing numerous cells,and a underlying sublayer formed by the adipogenic ASCs.Conclusion Tissue-engineered skin flap can be constructed by assembling composite skin and adipose derived from cultured keratinocytes,fibroblasts,and ASCs.%目的 应用脂肪组织来源干细胞(ASCs)在体外构建组织工程脂肪并与已构建的复合皮组装培育,试构建出含脂肪层的组织工程化皮瓣.方法 (1)构建组织工程脂肪从脂肪组织中分离培养ASCs并进行三系分化诱导鉴定.ASCs与胶原凝胶混合并进行体外成脂诱导,诱导15d后分别进行倒置显微镜、油红O染色及HE染色观察.(2)构建复合皮从包皮组织中分离培养表皮细胞(Kc)和

  16. Cross finger flaps.

    Science.gov (United States)

    Kisner, W H

    1979-01-01

    Proper fingertip reconstruction requires good skin and soft tissue coverage, preservation of function and as normal an appearance as possible. The cross finger flap results in negligible joint stiffness, minimal morbidity and little work-time loss. An important factor is the conservation of finger length permitted by this technique. This method of repair is underutilized. It is indicated in several types of fingertip amputations where bone shortening would be detrimental.

  17. 包皮皮瓣一期修复尿道下裂的经验%Experience of Hypospadias Stage I Repair Using Tranverse Cutting Islandform Prepuce Skin Flap

    Institute of Scientific and Technical Information of China (English)

    孙毅伦; 孙超

    2009-01-01

    目的 总结包皮皮瓣法修复尿道下裂的经验.方法 对1997~2009年本科22例采用包皮皮瓣法进行尿道成形的尿道下裂患儿进行回顾性分析,其中1例联合用尿道口为基底的阴囊矩形皮瓣作尿道成形.结果 本组病例均获随访,时间3个月~4年,阴茎外观良好,阴茎下弯矫正满意,排尿通畅.一次手术成功19例,占81.8%;术后尿瘘3例.2例经第二次手术修补后痊愈,1例自愈,尿道狭窄1例行狭窄段切除端端吻合痊愈.结论手术包皮皮瓣设计合理,掌握好适应证,手术技巧,加强术后处理,能获得良好的临床疗效.%Objective To summarize the experience of tranverse cutting the is landform prepuce skin flap technique applied to the hypospadias. Methods 22 children with hypospadias treated using urethroplasty with cross cutting is landform prepuce skin flap technique were reviewed. 1 case of them except that the opera-tion was carried out, they have a duplay throplasty by using scrotum rectangular skin flap with urethra orifice base. operation. Results All the cases were follwed up for 3 months to 4 years, the appearance of peris of the children was normal, chordee of scrotum was satisfactory corrected, emiction unobstructed, once the operation success rate reached 81.8% (19cases) ,but 3 cases occurred urethral fistula complication, and 2 cases of them were well recovery after the second the operation, their urethral stricture improvement by normosthenuria. Con-clusion The operation procedure is conform to anatomy-physiological feature, projection reasonableness, tranve-rse anastomotic continuious suture can obviously decrease urethral fistula morbidity. Specially hypospadias with chordee of scrotum, using cross cutting lslandform prepuce srin flap technique and quick pulse rectangular skin flap grafting on urethra orifice base is a better choice for the disease.

  18. Clinical application of the medial upper arm free flap for repair of skin defect of the hand%上臂内侧游离皮瓣修复手部皮肤缺损的临床应用

    Institute of Scientific and Technical Information of China (English)

    庄加川; 李敏姣; 陈乐锋; 陈国荣; 叶学浪; 张振伟

    2015-01-01

    目的 探讨应用上臂内侧游离皮瓣修复手部皮肤缺损的临床效果.方法 自2010年4月至2013年3月对10例手部皮肤缺损患者采用上臂内侧皮瓣游离移植修复,行尺侧上副动脉-手部受区动脉、伴行静脉或皮下静脉-手背静脉吻合重建皮瓣血液循环,上臂供区直接缝合闭合创面.结果 10例上臂内侧游离皮瓣全部存活;1例术后出现血管危象,手术探查发现动脉吻合口内有血栓形成,取出血栓后重新吻合血管后皮瓣存活.2例术后3个月行皮瓣整形术.8例患者术后随访2个月至2年,平均11个月,手部皮瓣外观满意,质地好,未见明显萎缩.手指屈伸活动功能恢复良好,屈曲75°~ 90°,伸直-5°~0°.上臂内侧供区创面仅留线性瘢痕.结论 上臂内侧游离皮瓣修复手部皮肤缺损是一种较理想的方法.%Objective To evaluate the clinical results of medial upper arm free flap transfer in the treatment of skin defects of the hand.Methods From April 2010 to March 2013,a total of 10 cases of skin defects of the hand were treated with medial upper arm flap transfer.Flap circulation was re-established by anastomosing the superior ulnar collateral artery to the recipient artery of the hand,and the concomitant vein or subcutaneous vein to the dorsal veins of the hand.The donor site wound was directly closed.Results All 10 flaps survived completely.Vascular crisis occurred in 1 case.Surgical exploration revealed a thrombus at the artery anastomosis site.The flap survived after removal of the thrombus and re-anastomosis of the arteries.Two cases underwent flap de-bulking procedures 3 months postoperatively.Eight of the 10 cases had postoperative follow-up ranging from 2 months to 2 years with an average of 11 months.The appearance of the flaps at the hand was satisfactory.Flap texture was good with no obvious atrophy.Range of motion of the fingers recovered well.Finger flexion achieved 75° to 90°while finger extension-5

  19. 多种背阔肌瓣游离移植修复下肢缺损%Application of latissimus dorsi flap in different forms in repair of skin and soft tissue defects in lower extremities

    Institute of Scientific and Technical Information of China (English)

    张丕红; 黄晓元; 龙剑虹; 范鹏举; 任利成; 曾纪章; 肖目张

    2009-01-01

    Objective To explore repair methods of skin and soft tissue defects in lower extremities with free latissimus dorsi flaps. Methods Forty-two patients with wounds and soft tissue defects in lower extremities, including 4 cases on knee, 22 cases on leg, 15 cases on ankle and foot, 1 case with extensive a-vulsion from knee to dorsum of foot, were hospitalized in our unit from February 1996 to February 2008. Wounds or soft tissue defects were respectively repaired with latissimus dorsi musculoeutaneous flaps, latissi-mus dorsi muscle flaps, latissimus dorsi perforator flaps with preserved vascular sleeves, 2 double-leaf seg-mental latissimus dorsi compound flaps after debridement. The flaps ranged from 18 cm×8 cm to 40 cm×18 cm in size. The donor sites were covered by skin grafting in 19 cases. Results All wounds were healed primarily except vascular crisis occurred in 3 cases, partial necrosis of skin at donor site in 2 cases, and graft site(1 case). Follow-up for 3 to 24 months of 31 patients showed: six cases received two-stage plastic operation on account of bulkiness with trouble in wearing shoes, and mild contraction of muscular flap in 3 cases. Conclusions Latissimus dorsi flap in various forms can be satisfactory for repair of large skin and soft tissue defects in lower extremities.%目的 寻找应用背阔肌瓣游离移植修复下肢缺损的方法.方法 1996年2月-2008年2月,笔者单位应用游离背阔肌瓣修复下肢皮肤及组织缺损患者42例,其中膝部4例,小腿22例,足、踝部15例,膝下至足背严重撕脱1例.清创后采用背阔肌肌皮瓣、背阔肌肌瓣植皮、保留肌袖的背阔肌穿支皮瓣、分叶背阔肌组织瓣修复创面.组织瓣切取范围18 cm×8 cm~40 cm × 18cm.结果 除3例患者术后发生血管危象,2例供区植皮和1例肌瓣植皮部分坏死外,其余患者创面均一次性愈合.随访3~24个月,6例患者皮瓣外形臃肿,影响穿鞋,再次行皮瓣修薄术;3例肌瓣植

  20. 耳甲腔软骨皮瓣旋转联合耳后舌形皮瓣矫正杯状耳%Correction of cup ear by rotation of auricular concha cartilage skin flap and postauricular tongue-shaped flap

    Institute of Scientific and Technical Information of China (English)

    刘闪; 谭谦; 吴杰; 郑东风; 周宏礽; 许澎; 王淑琴; 葛华强

    2011-01-01

    Objective To discuss a new method to correct the moderate and severe congenital cup ear deformities. Methods From May 2005 to August 2009, totally 13 patients ( moderate in 10 cases and severe in 3 cases) with congenital cup ear deformity were corrected by rotation of auricular concha cartilage flap and postauricular tongue-shaped skin flap. Results After 3 to 24 months follow-up, 10 patients were all satisfied with expanded helix , enlarged cavum conchae and nearly normal auricle. Conclusion The application of rotation of auricular concha cartilage flap and postauricular tongue-shaped skin flap can obtain the satisfactory results in correcting moderate and severe congenital cup ear deformities.%目的 探讨一种简明有效的手术方法,矫正中重度杯状耳畸形.方法 自2005年5月至2009年8月,应用耳甲腔软骨皮瓣旋转联合耳后舌形皮瓣,修复中重度杯状耳畸形13例,其中中度者10例,重度者3例.结果 对10例患者术后随访3~24个月,术后耳轮舒展,耳甲腔扩大,耳郭接近正常大小,效果满意.结论 采用耳甲腔软骨皮瓣旋转加耳后舌形皮瓣矫正中重度杯状耳畸形,可取得较满意的效果.

  1. Regional flaps in head and neck reconstruction: a reappraisal.

    Science.gov (United States)

    Colletti, Giacomo; Tewfik, Karim; Bardazzi, Alessandro; Allevi, Fabiana; Chiapasco, Matteo; Mandalà, Marco; Rabbiosi, Dimitri

    2015-03-01

    Starting from our experience with 45 consecutive cases of regional pedicled flaps, we have underlined the effectiveness and reliability of a variety of flaps. The marketing laws as applied to surgical innovations are reviewed to help in the understanding of why regional flaps are regaining wide popularity in head and neck reconstruction. From January 2009 to January 2014, 45 regional flaps were harvested at San Paolo Hospital to reconstruct head and neck defects. These included 35 pectoralis major muscular and myocutaneous flaps, 4 lower trapezius island or pedicled flaps, 3 supraclavicular flaps, 2 latissimus dorsi pedicled flaps, and 1 fasciocutaneous temporal flap. The basic literature of marketing regarding the diffusion of new products was also reviewed. Two myocutaneous pectoralis major flaps were complicated by necrosis of the cutaneous paddle (one complete and one partial). No complete loss of any of the 45 flaps was observed. At 6 months of follow-up, 2 patients had died of multiple organ failure after prolonged sepsis. The 43 remaining patients had acceptable morphologic and functional results. Regional and free flaps appear to compete in many cases for the same indications. From the results of the present case series, regional flaps can be considered reliable reconstructive choices that are less expensive than their free flap alternatives. The "resurrection" of regional flaps can be partially justified by the changes in the global economy and the required adaptation of developed and developing countries. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. 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....

  3. Paramedian forehead flap thinning using a flexible razor blade.

    Science.gov (United States)

    Justiniano, Hilda; Edwards, Julia; Eisen, Daniel B

    2009-03-15

    Paramedian forehead flaps are sometimes required to resurface large or deep nasal defects. The flap often needs to be thinned to match the contour of the surrounding skin at the recipient site. We describe a technique to thin the distal potion of the paramedian forehead flap using a flexible razor blade, the Dermablade. Once familiar with it, this same technique may be applied to thin other interpolation flaps.

  4. “Emergency” definitive reconstruction of a necrotising fasciitis thigh debridement defect with a pedicled TRAM flap

    Science.gov (United States)

    Hughes, Tom; Yu, Jonathan T.S.; Wong, Kai Yuen; Malata, Charles M.

    2013-01-01

    INTRODUCTION Necrotising fasciitis (NF) is a rare, severe, rapidly progressing and life-threatening synergistic infection primarily affecting the superficial fascia. A novel method of definitive and aesthetic reconstruction of NF thigh defects by using a pedicled transverse rectus abdominis myocutaneous (TRAM) flap without recourse to temporising skin grafts is presented. PRESENTATION OF CASE A 30-year-old parous woman presented in extremis with fulminant NF of her left anteromedial thigh. Following emergency radical debridement and intensive care stabilisation she was reconstructed 48 h later in a single stage with a pedicled TRAM flap islanded on the ipsilateral deep inferior epigastric vessels. There was excellent contour restoration of her thigh and coverage of the exposed femoral vessels. DISCUSSION Pedicled flaps based on the rectus abdominis muscle provide a large, readily available reconstructive option for correction of substantial regional defects as herein illustrated. They are robust when based on dominant inferior vascular pedicle with a long reach and wide arc of rotation when designed transversely (as a TRAM flap). CONCLUSION This case also illustrates that definitive flap reconstruction of NF can be successfully undertaken in the emergent setting, thereby negating the need for large areas of skin grafting which can lead to contractures with consequent functional impairment and suboptimal aesthetic results. PMID:23548707

  5. 腹部带蒂皮瓣修复手部深度烧伤的围手术期护理%Perioperatie nursing for abdominal pedicled skin flaps for repairing deep burn in hands

    Institute of Scientific and Technical Information of China (English)

    方梅; 宁花兰; 郗奉菊; 刘胜; 邹志强; 黄丽容; 徐华; 李新强

    2009-01-01

    目的 探讨完整的腹部带蒂皮瓣修复手部深度烧伤围手术期护理程序.方法 对48例采用腹部带蒂皮瓣手术修复手部深度烧伤的患者进行全方位的护理进行总结,包括术前疾病评估、配合清创换药、心理护理、体位和皮肤准备,感染控制,术后疼痛护理、皮瓣观察、体位护理、并发症防治、功能锻炼、康复指导等.结果 48例患者腹部皮瓣移植成活,供瓣区受瓣区均生长良好.出院后3~6个月追踪,除3例术前神经血管指骨产重毁损功能丧失外,其余病例手部日常功能恢复良好.结论 采用全方位多学科护理知识科学护理是腹部带蒂皮瓣修复手部深度烧伤患者的有力保障,以确保手术成功、肢体功能恢复、生活质量提高、社会生存能力增强.%Objective To explore to build up a complete set of care program for patients underwent abdominal pedicled skin flaps for repairing deep burn in hands. Methods Onmidirecional nursing including preoperative assessment, cooperation with debridement and dressing change, mental nursing, body position and skin provision, infection control, postoperative pain nursing, observation of flap circulation, position nursing, prevention of complications, functional exercise, rehabilitation instruction were used in the reconstruction of shallow defects in 48 patients underwent abdominal pedicled skin flaps for repairing deep burn in hands. Then the nursing was summarized. Results The abdominal flap transplantation successod in all of the 48 cases. The donor site of flap and the receptor site of flap glowed weLl. The mean postoperative follow-up period was 3~6 months, and the satisfactory improvement in hand function was obtained in all patients except for 3 cases suffered from postoperative sever injury and loss of function of neurovascular phalange. Conclusions Omnidirectional nursing can ensure the success of operation, the recovery of limb function, the improvement of

  6. 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.

  7. Preservation of venous outflow improves transverse rectus abdominis musculocutaneous flap survival following vascular delay.

    Science.gov (United States)

    Tsoutsos, D; Gravvanis, A; Kakagia, D; Ghali, S; Papalois, A

    2009-01-01

    The rat abdominal island model has proved to be a reliable and reproducible model for the study of surgical delay procedures. It has been customary to simultaneously divide both the artery and the accompanying vein to obtain maximum survival of the rat TRAM flap undergoing delay procedure. This study evaluates the effect of selective arterial interruption compared to standard vascular delay on flap survival in the rat TRAM flap model. Thirty-six Wistar rats were randomly assigned to three groups (n=12), depending on the vascular ligation selected for the initial experimental delay stage. In group A (control group) no vessels were ligated. In group B the right deep inferior epigastric vessels were preserved and the right superior and left inferior and superior deep vessels were ligated. In group C the right inferior epigastric vessels and the left inferior epigastric vein were preserved while superior epigastric vessels and the left inferior epigastric artery were ligated. For the second stage one week later, TRAM flaps were elevated based on the right deep inferior epigastric vessels, re-inset in their original position and digitally photographed. Skin island viability was determined 96 hours later using digital photography and image-analysis software SigmaScan (SPSS, Inc., Chicago, IL). The percentage of flap survival in control group A was 50+/-6%, in group B 60+/-4% and in group C 85+/-4%. The occlusion of the three vascular pairs in group B improved the survival percentage in comparison to the control group A, but this did not achieve statistical significance. In contrast, the percentage of flap survival in control group C was statistically significant compared to groups A and B (p<0.05, ANOVA). Zone IV exhibited no necrosis in any group C animals. This indicates that delay with preservation of the venous outflow of zone IV results in increased blood supply.

  8. 改良耳道皮瓣耳道口扩大成形的研究%Research of modified skin flap of external canal in auditory canal shaping to enlarge

    Institute of Scientific and Technical Information of China (English)

    王东; 李同丽; 陈煜; 李欣

    2012-01-01

    Objective:To investigate the new method of modified skin flap of external canal in auditory canal shaping to enlarge at radical mastoidectomy in endaural incision. MethodsFrom 1999 to 2009,412 patients with 428 ears in operation were randomly divided into two groups. Patients underwent open mastoidectomy and some patients were performed concurrent tympanoplasty. A group (control group)were operated in traditional skin flap of external canal,B group is modified group. Bleed and effusion from the wound surface,the time of dry ear and the change of diameter of extermal acoustic meatus after one year were observed after the surgeries and deal the results with SPSS. Resell: The difference had statistical significance in bleed and effusion from the wound surf ace, the time of dry ear and the shrink of external acoustic meatus in 12 months among two groups. Conclnsion; Modified skin flap of external canal in auditory canal shaping to enlarge can help to make a no-wound dehiscence by wiping out the raw surface of external acoustic meatus. It is better than traditional skin flap of external canal.%目的:探索耳内切口乳突根治术时行改良耳道皮瓣法扩大耳道口的新方法.方法:1999-2009年我科选择行开放式乳突根治术或同期行鼓室成形术的病例421例(428耳),随机分为A、B组.A组为对照组,行传统耳道皮瓣法;B组为改良组,行改良的耳道皮瓣法.所有病例观察术后的出血、渗出情况,干耳时间及1年后耳道口的变化情况.结果:统计学分析表明,改良组较对照组在术后出血、渗出、干耳时间及耳道口缩小方面均差异有统计学意义.结论:改良耳道皮瓣法扩大耳道口成形后,消灭了外耳道的创面,形成了无创面的耳道口,比传统皮瓣法有较多优点.

  9. Reconstruction of auricle with expansive skin flap and Medpor framework in childhood%应用耳后扩张皮瓣及多孔高密度聚乙烯支架行儿童全耳廓再造

    Institute of Scientific and Technical Information of China (English)

    张本寿; 贾凌; 邓云; 林子豪; 季健; 赵跃中; 郑翔; 徐志久; 魏福堂; 水祥兵; 许良标

    2008-01-01

    Objective To study the methodology and results of the auricle repair with expanded skin flap in mastoid process area and Medpor support in children with congenital malformation.Methods Thirty cases of congenital malformation were enrolled with age ranged from 5~16 years old.Whole auricles were all reconstructed with an expanded skin flap in mastoid process area and Medpor support.Resuits In all successful cases.their repaired auricles had the natural complexion and profile,and the positions were symmetric with healthy one,but in 2 cases(age group of 11-16 years),the expanded skin flap had less skin grafting.Conclusion It is suggested that optional operation time might be selected before 10 years old,because their psychological trauma could be avoided owing to microtia and in that age the size of the expanded flap is larger enough to reconstruct the ear as their auricle iS well-developed.%目的 探讨儿童先天性小耳畸形采用耳后扩张皮瓣及多孔高密度聚乙烯(Medpor)支架做全耳廓再造的方法和效果.方法 对30例年龄5~16岁先天性小耳畸形患者,采用耳后皮肤扩张及Medpor支架法行全耳廓再造术.结果 30例皆获成功,再造耳廓肤色正常,形态与位置与健侧基本对称.但其中11~16岁组的5例中,有2例扩张的皮瓣面积略有不足,需另以小块局部筋膜瓣和皮片移植补充;而5~10岁组的25例,扩张的皮瓣面积皆足以包裹整个Medpor支架,无需另外植皮.结论 本术式的手术时机选择最好在10岁以前,一是避免患儿因小耳畸形受到社会讥讽造成的心理创伤,二是耳廓发育已接近成熟,耳后皮肤扩张皮瓣面积已足敷再造之需.

  10. Comparison of transverse island flap onlay and tubularized incised-plate urethroplasties for primary proximal hypospadias: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Dongdong Xiao

    Full Text Available PURPOSE: This meta-analysis was conducted to compare postoperative outcomes between transverse island flap (TVIF onlay and tubularized incised-plate (TIP urethroplasties for primary proximal hypospadias. MATERIALS AND METHODS: A comprehensive literature search updated to 21st May 2014 was carried out for relevant studies. After literature identification and data extraction, odds ratio (OR with 95% confidential interval (CI was calculated to compare postoperative complication rate between TVIF onlay and TIP. Meta-regression and subgroup analyses were applied to find potential affective factors. RESULTS: A total of 6 studies including 309 patients receiving TVIF onlay and 262 individuals subjected to TIP met inclusion criteria. The synthetic data suggested that TVIF onlay and TIP were comparable in terms of total complication rate (OR 0.85, 95% CI 0.56-1.30, p = 0.461, fistula (OR 0.68, 95% CI 0.38-1.21, p = 0.194, recurrent curvature (OR 1.16, 95% CI 0.43-3.12, p = 0.766, dehiscence (OR 0.95, 95% CI 0.33-2.74, p = 0.920, diverticulum (OR 1.90, 95% CI 0.53-6.78, p = 0.321, meatal stenosis (OR 0.74, 95% CI 0.20-2.77, p = 0.651 and urethral stricture (OR 1.49, 95% CI 0.41-5.50, p = 0.545, without significant heterogeneity for each comparison group. Meta-regression and subgroup analyses revealed no significant findings. One-way sensitivity analysis indicated that the results were stable. No publication bias was detected using both funnel plot and Egger's test. Also, there were no obvious differences observed in cosmetic and functional outcomes. CONCLUSIONS: This meta-analysis suggests that TVIF onlay and TIP urethroplasties are clinically equivalent. Given the inherent limitations of included studies, this conclusion should be interpreted with caution and wait to be confirmed by more well-designed randomized controlled trials with high quality in the future.

  11. Rotational flaps in oncologic breast surgery. Anatomical and technical considerations.

    Science.gov (United States)

    Acea Nebril, Benigno; Builes Ramírez, Sergio; García Novoa, Alejandra; Varela Lamas, Cristina

    2016-01-01

    Local flaps are a group of surgical procedures that can solve the thoracic closure of large defects after breast cancer surgery with low morbidity. Its use in skin necrosis complications after conservative surgery or skin sparing mastectomies facilitates the initiation of adjuvant treatments and reduces delays in this patient group. This article describes the anatomical basis for the planning of thoracic and abdominal local flaps. Also, the application of these local flaps for closing large defects in the chest and selective flaps for skin coverage by necrosis in breast conserving surgery.

  12. Comportamento do estresse oxidativo e da capacidade antioxidante total em ratos submetidos a retalhos cutâneos isquêmicos Oxidative stress and total antioxidant status in ischemic skin flaps in rats

    Directory of Open Access Journals (Sweden)

    Moacir Cymrot

    2004-01-01

    Full Text Available OBJETIVO: Estudar o comportamento do estresse oxidativo (MDA e da defesa antioxidante (CAT, em fragmentos de retalhos cutâneos randômicos isquêmicos em ratos. MÉTODOS: Foram utilizados 18 ratos adultos jovens, machos (Wistar EPM-1, 290 a 350g, submetidos à elevação de retalho cutâneo de base cranial no dorso, divididos em três grupos (N=6 em função do tempo pós-operatório: imediato (POI, terceiro e sétimo dias (PO3 e PO7, respectivamente. Ao final, foram coletadas amostras de sangue periférico e fragmentos de tecido do retalho e de área cutânea normal fora do retalho para dosagem de MDA e de CAT. RESULTADOS: Para MDA no soro, o grupo POI apresentou valores significativamente menores que os grupos PO3 e PO7, os quais não diferiram entre si. Não foi encontrada diferença entre os valores das amostras cutâneas em nenhum dos três grupos estudados. Para os valores da capacidade antioxidante total (CAT não houve diferença significante entre os três grupos, quando analisado o soro dos animais, no entanto, para as amostras de fragmentos cutâneos, os valores diminuíram significativamente em função do tempo. CONCLUSÃO: A inexistência de diferença para os valores de MDA nas amostras cutâneas entre os grupos e a diminuição dos valores da CAT ao longo do tempo sugere que a presença de necrose na porção distal dos retalhos dos animais do grupo PO7 decorra, não somente da agressão oxidativa, mas também da diminuição da capacidade de defesa antioxidante local.PURPOSE: to study oxidative stress (MDA and total antioxidant status (CAT in fragments of randomic ischemic skin flaps from rat dorsum. METHODS: 18 male rats, young adults (Wistar EPM-1, 290 - 350g, that underwent elevation of randomic ischemic flaps from dorsum, were divided in three groups (N=6, according to post-operative time-points: immediate (POI, third and seventh post-operative days (PO3 and PO7, respectively. At the end, peripheral blood samples and tissue

  13. 上肢大面积皮肤撕脱伤反鼓取皮原位植皮9例分析%In Situ Autologous Skin Grafting with Skin Flap Taken on Reverse Side Using Drum Type Dermatome in the Treatment of Large Area Skin Avul-sion Wound of Upper Limbs (9 Case Reports)

    Institute of Scientific and Technical Information of China (English)

    陈殿伟; 王庆生; 汪强; 蔡延深

    2012-01-01

      Objective To explore the effect of autologous skin transplantation with skin flap taken on reverse side using drum type dermatome in treating extensive skin avulsion of upper limbs. Methods Retrospective analysis was con-ducted on 9 patients with extensive skin avulsion of the upper limbs admitted to our hospital from April 2006 to June 2010. All the patients underwent urgent debridement. The avulsed skin soft tissue deprived of blood supply was removed, shaved into medium split thickness skin flaps using drum type dermatome, and replanted them on the wound. Layering dressing was applied with Amikacin Saline gauzes as the inner layer, aseptic bandages in the middle and cotton pads as the outer layer. The injured extremities were suspended post operation to avoid local compression. The outer layer of dressing was changed 3 days post operation and the suture was removed 12 days post operation. Results More than 95% of the transplant survived in the 9 cases. Sporadical small wounds healed with the dressing change of MEBO and no second operation was required. Function of the injured extremities restored sufficiently with exercise. Conclusion Autologous skin transplantation with skin flap taken on reverse side using drum type dermatome is a relatively ideal surgical approach to treating extensive skin a-vulsion of upper limbs. Adequate debridement and hemostasis with appropriate dressing and overhanging to avoid compres-sion can increase the survival rate of the transplant.%  目的探讨上肢大面积皮肤撕脱伤反鼓取皮植皮术的临床效果。方法回顾性分析2006年4月至2010年6月收治的9例上肢大面积皮肤撕脱伤患者病历资料,急诊行清创术,将撕脱失去血供的皮肤软组织取下,用鼓式取皮机修成中厚皮片后,原位回植于创面,术区分层包扎,内层用阿米卡星盐水纱布、消毒绷带包扎,外层用棉垫包扎,术后悬吊,避免局部受压,术后3 d 更换外层敷料,12 d

  14. Modified cup flap for volar oblique fingertip amputations

    Directory of Open Access Journals (Sweden)

    Ahmadli, A.

    2016-02-01

    Full Text Available We describe a modified volar “V-Y cup” flap for volar fingertip defects that do not exceed more than half of the distal phalanx for better aesthetic and functional outcome. In seven cases out of eight, the flap was elevated with a subdermal pedicle, whereas in one case, the flap was elevated as an island on the bilateral neurovascular bundle. The fingertips have been evaluated for sensibility using standard tests, hook nail deformity and patient satisfaction. Seven flaps have survived completely. The flap with skeletonized bilateral digital neurovascular bundle has shown signs of venous insufficiency on the 5 postoperative day with consecutive necrosis. Suturing the distal edges of the flap in a “cupping” fashion provided a normal pulp contour. The modified flap can be used for defects as mentioned above. Subdermally dissected pedicle-based flap is safe and easy to elevate. The aesthetic and functional outcomes have been reported to be satisfactory.

  15. 游离股前外侧皮瓣修复四肢皮肤软组织缺损12例临床疗效分析%Analysis of Clinical Curative Effect of the Free Anteriolateral Skin Flap of Thigh Repair Soft Tissue Damage of Limbs 12 Cases

    Institute of Scientific and Technical Information of China (English)

    孔靖

    2013-01-01

      目的:探讨游离股前外侧皮瓣修复四肢皮肤软组织缺损的临床疗效。方法:2008年1月~2012年6月,采用吻合血管的游离股前外侧皮瓣修复四肢皮肤软组织缺损12例,皮瓣切取面积8cm×12cm~24cm×14cm。结果:12例皮瓣均成活,术后随访3~18个月,所有患者创面愈合良好,功能恢复满意。结论:游离股前外侧皮瓣存活率高,血运丰富,部位隐蔽,是修复四肢皮肤软组织缺损的理想皮瓣。%Objective:To explore the result of repairing the limbs soft tissue defect of removing anterolateral skin flap of thigh. Methods:From January 2008 to June 2012, the vascular anastomosis of free shares anterolateral skin flap to repair defects of soft tissue limbs in 12 cases, flap chipped area 8 cm × 12 cm~24 cm × 14 cm. Results:12 cases are the flap survival and were followed up for 3 to 18 months, all patients wound healing is good, the function recovered satisfactorily. Conclusion:The survival rate of free anterolateral skin flap is high, the supply of rich blood, location concealed, the free anterolateral skin flap is an ideal flap for repairing defects of soft tissure.

  16. The rehabilitation care of island- like skin flap prothesis in the refractory wound surface%难愈性创面岛状(肌)皮瓣修复术康复护理

    Institute of Scientific and Technical Information of China (English)

    徐西宁; 刘毅; 高山

    2001-01-01

    Objective To explore whether the combined interventions of preoperative period rehabilitation care can promote the primary healing of refractory wound surfaces(enormous bad sore, radioactive ulcers, carcinomatous wound surfaces, diabetic ulcers, etc.) Methods Adapt combined rehabilitation care such as preoperative psychological care, dealing with the wound surfaces standardly, improving general nutritional states, keeping functional positions after operation and sports training. Results In the 34 cases of this group, the wound surfaces of 33 cases had no contracture and deformity, and got primary healing except 1 case of secondary healing after skin retransplantation because of the subcutaneous necrosis. Conclusion The combined interventions of rehabilitation care in the skin flap prothesis of refractory wound surfaces are effective in preventing the dysfunction of joints and muscles after healing.

  17. 多叶皮瓣在头面部皮肤缺损修复中的应用%Application of multi-leaf flap in head and facial skin defects

    Institute of Scientific and Technical Information of China (English)

    董晓宏; 姜海山; 柴勇; 郭杰

    2012-01-01

    Objective To investigate the use of multi-leaf Hap for head and facial larger skin defects. Methods With the local tnmescent anesthesia, we designed different size and number of leaf flap according to the location and size of tissue defeet, and repaired the wound by rotation and advancement. Results We a-chieved good results for 12 patients with facial defects after trauma and tumor resection by the application of miilti-leaf flap. Conclusion The application of miilti-leaf flap can make full use of loose skin around the larger defects, reduce the additional damage and obtain good clinical results, which is a worthy and effective method.%目的 探讨多叶皮瓣修复头面部较大面积皮肤缺损的临床疗效.方法 在局部肿胀麻醉下,根据组织缺损的部位和大小设计不同大小和数量的分叶皮瓣,依次旋转推进修复创面.结果 12例患者均Ⅰ期愈合,皮瓣张力小,无坏死发生,术后瘢痕不明显,无并发症发生,取得了良好的效果.结论 多叶皮瓣减少了附加损伤,可获得较好的临床效果,是一种值得推广的有效方法.

  18. Submental Island Flap for the Reconstruction of Oral and Maxillofacial Soft Tissue Defects%颏下皮瓣在修复口腔颌面部软组织缺损中的应用

    Institute of Scientific and Technical Information of China (English)

    王晓军; 郝志红; 郭俊梅; 郭琦; 于永红; 刘焕磊

    2012-01-01

    目的:评价颏下皮瓣在口腔颌面部软组织缺损修复中的应用.方法:采用颏下皮瓣修复口腔颌面部软组织缺损26例,年龄35~80岁;男性18例,女性8例;恶性肿瘤21例,均排除淋巴结转移,良性病变3例,外伤致软组织缺损2例;均用颏下皮瓣修复,皮瓣大小为(3.5 cmx8.0 cm)~(4.0 cm×10.0 cm).结果:25例皮瓣一期愈合,有1例皮瓣创口裂开,延期愈合.受区外形及功能恢复良好,术后随诊4~20个月,皮瓣在术后2~3个月有10%~15%的缩小.结论:颏下皮瓣制备简单、安全,修复口腔颌面部中小型软组织缺损效果良好.%Objective: To evaluate the clinical results of submental island flap in the restoration of soft tissue defects in orofacial region. Methods: 26 oral and maxillofacial defect patients were retrospectively reviewed. The ages of the patients ranged from 35 to 80 years, 18 were male, 8 were female. Malignant tumors were 21 cases while benign lesions were 3 case and trauma deformity in 2 cases. The sizes of submental island flap varied from 3.5 cmx8.0 cm to 4.0 cmxlO.O cm. Result: Flaps healed with first intension in 25 cases. One case showed wound dehiscence and then a delayed healing. Functions and appearances of the defects were well restored in all patients. Conclusions: Submental flap is reliable for reconstruction of small and mid-sized defects in oral and maxillofacial region.

  19. Abdominal Skin Flaps in the Repair of 108 Patients with Complex Defects of Upper Extremity%腹部皮瓣修复上肢复杂损伤108例

    Institute of Scientific and Technical Information of China (English)

    王恒; 胡洪良; 沈卫军; 王战磊; 闫纪涛; 龚俊武

    2016-01-01

    目的:探讨应用腹部皮瓣修复上肢复杂损伤的临床疗效及安全性。方法:回顾性分析2011年8月-2014年8月在本院接受腹部皮瓣修复上肢复杂损伤的108例患者的临床资料。术后随访6~12个月,观察修复效果。结果:108例患者皮瓣均成活,其中101例获得随访,随访率为93.5%。随访101例患者皮瓣血运良好,皮瓣质地柔软,厚度适中,触之弹性较好,皮瓣恢复保护性感觉,两点分辨觉15 mm左右。供区愈合良好,无明显瘢痕,仅有少量增生,上肢功能基本得到恢复。1例患者因皮瓣下血肿压迫出现皮瓣供血障碍,经拆除部分缝线后血运恢复;2例多指脱套损伤患者在修复后对外观不甚满意,经二期整形修复后满意出院;2例手部掌背两侧复合脱套伤患者修复后精细活动功能受到轻微的影响。101例随访患者中96例评价满意,满意率为95.0%。结论:腹部皮瓣适用于修复各类上肢复杂性损伤,安全可靠。不过,临床需要加强修复过程的护理,以切实减少后遗症,提高患者生存质量。%Objective:To investigate the clinical efficacy and safety of the application of abdominal skin flaps in the repair of complex defects of upper extremity.Method:The clinical data of 108 patients with complex defects of upper extremity who accepted abdominal skin flaps admitted to our hospital from August 2011 to August 2014 were retrospectively analyzed.The postoperative followed-up was taken for 6 to 12 months,the repair effects were observed.Result:All flaps of the 108 cases survived,and 101 cases got followed-up service,so the follow-up rate was 93.5%.The flaps of the followed-up 101 cases were soft with good blood circulation,the thickness of the skin was moderate,the elasticity of the skin was good with touching,the sense of protection of the skin flaps restored,the two-point-discrimination of the digits was 15 mm.The donor sites healed

  20. Flap prefabrication and stem cell-assisted tissue expansion: how we acquire a monoblock flap for full face resurfacing.

    Science.gov (United States)

    Li, Qingfeng; Zan, Tao; Li, Haizhou; Zhou, Shuangbai; Gu, Bin; Liu, Kai; Xie, Feng; Xie, Yun

    2014-01-01

    Total face skin and soft-tissue defects remain one of the biggest challenges in reconstructive surgery. Reconstruction of the entire face with uniform coverage and delicate features is difficult to achieve. To avoid the patchwork result seen in multiple flaps and skin grafts, 1 monoblock flap that has similar color, texture, and thickness might be an ideal option to minimize the incisional scars and several surgical procedures but is unavailable with current approaches because of the lack of sufficient matched tissue and the unreliable blood supply for such a large flap. To acquire a monoblock flap for full face reconstruction, we combine the prefabricated flaps, skin overexpansion, and bone marrow mononuclear stem cell transplantation for total facial resurfacing. In this article, we present our experience from our case series that provides universally matched skin and near-normal facial contour. It is a reliable and an excellent reconstructive option for massive facial skin defect.

  1. Anatomy and clinic application of reverse-flow island flaps on dorsal thumb web with dorsoulnar artery of thumb as a pedicle%拇指尺侧指背动脉为蒂的虎口背侧逆行岛状皮瓣的解剖与临床应用

    Institute of Scientific and Technical Information of China (English)

    史增元; 尹维刚; 俞淼; 董文伟; 毛海蛟; 唐旭

    2014-01-01

    Objective To explore a surgical treatment of skin defects on the thumb by reverse-flow island flaps on dorsal thumb web with dorsoulnar artery of thumb as a pedicle.Methods The origin,courses and distribution of dorsoulnar artery of thumb from 70 adult cadaveric hand specimens perfused by red latex were explored.Skin defects on the thumb of 8 cases were repaired with reverse-flow island flaps on dorsal thumb web.The cut areas of flaps vary from 4.5 cm × 3.0 cm to 7.5 cm × 4.0 cm.Results There were 4 types of the dorsoulnar artery of thumb basing on the origin and courses.Type Ⅰ was outside the first dorsal interosseous muscle type,which was the dorsoulnar artery of thumb mainly originated from the first dorsal metacarpal artery and cross through the surface of the first dosal interosseous muscle(42.9%).Type Ⅱ was under the first dorsal interosseous muscle type,which was from the thumb principal artery or deep branch of radial artery and run under the first dorsal interosseous muscle(41.4%).Type Ⅲ was mixed type from the anastomose point of above two arteries at the level of the first metacarpophalangeal joint(11.4%).Type Ⅳ was absence type (4.3%).Eight flaps fully survived.Excellent texture and satisfying appearance of the flaps as well as normal thumb web function were verified after 8 months' follow-up.Conclusion It is significant to determine the type of dorsoulnar artery of thumb to decide different operations due to the artery's considerable variation.The reverse-flow island flap on dorsal thumb is an ideal method to repair soft tissue defect on the thumb for its convenient operating and little effect in the donor area.%目的 探讨拇指尺侧指背动脉为蒂虎口背侧逆行岛状皮瓣修复拇指皮肤缺损的手术方法.方法 用70侧成人尸手标本,经动脉灌注红色乳胶,解剖观测拇指尺侧指背动脉的来源、走行和分布范围.在临床上应用该逆行岛状皮瓣修复8例拇指

  2. Antioxidant support in composite musculo-adipose-fasciocutaneous flap applications: an experimental study.

    Science.gov (United States)

    Bozkurt, Mehmet; Kapi, Emin; Kulahci, Yalcin; Gedik, Ercan; Ozekinci, Selver; Isik, Fatma Birgul; Celik, Yusuf; Selcuk, Caferi Tayyar; Kuvat, Samet Vasfi

    2014-02-01

    Free radicals are chemicals that play roles in the etio-pathogenesis of ischaemia-reperfusion injury. Various antioxidants have been used in an attempt to mitigate the damage induced by these chemicals. In the present study, the antioxidative effects of grape seed extract (proanthocyanidin), tomato extract (lycopene), and vitamin C (ascorbic acid) on a composite re-established-flow inferior epigastric artery based rectus abdominis muscle-skin flap model on which experimental ischaemia was induced were investigated. The rats have been administered antioxidants for 2 weeks prior to the surgery and for 2 more weeks thereafter. Macroscopic, histopathological, and biochemical analyses were carried out at the decision of the experiment. It was found that flap skin island necrosis was significantly reduced in the proanthocyanidin, lycopene, vitamin C groups (p < 0.001). Statistical analyses showed significant decreases in inflammation, oedema, congestion, and granulation tissue in the proanthocyanidin and lycopene groups compared to the vitamin C and control groups (p < 0.001). When the viability rates of fat and muscle tissues were examined, significant improvements were found in the proanthocyanidin and lycopene groups in comparison to the other groups (p < 0.001). Serum antioxidant capacity measurements revealed significant differences in the lycopene group compared to all other groups (p < 0.001). It is concluded that lycopene and proanthocyanidin are protective antioxidants in rat composite muscle-skin flap ischaemia-reperfusion models.

  3. Posterior interosseous free flap: various types.

    Science.gov (United States)

    Park, J J; Kim, J S; Chung, J I

    1997-10-01

    The posterior interosseous artery is located in the intermuscular septum between the extensor carpi ulnaris and extensor digiti minimi muscles. The posterior interosseous artery is anatomically united through two main anastomoses: one proximal (at the level of the distal border of the supinator muscle) and one distal (at the most distal part of the interosseous space). In the distal part, the posterior interosseous artery joins the anterior interosseous artery to form the distal anastomosis between them. The posterior interosseous flap can be widely used as a reverse flow island flap because it is perfused by anastomoses between the anterior and the posterior interosseous arteries at the level of the wrist. The flap is not reliable whenever there is injury to the distal forearm or the wrist. To circumvent this limitation and to increase the versatility of this flap, we have refined its use as a direct flow free flap. The three types of free flaps used were (1) fasciocutaneous, (2) fasciocutaneous-fascia, and (3) fascia only. Described are 23 posterior interosseous free flaps: 13 fasciocutaneous flaps, 6 fasciocutaneous-fascial flaps, and 4 fascial flaps. There were 13 sensory flaps using the posterior antebrachial cutaneous nerve. The length and external diameter of the pedicle were measured in 35 cases. The length of the pedicle was on average 3.5 cm (range, 3.0 to 4.0 cm) and the external diameter of the artery averaged 2.2 mm (range, 2.0 to 2.5 mm). The hand was the recipient in 21 patients, and the foot in 2. All 23 flaps covered the defect successfully.

  4. Using Local Flaps in a Chest Wall Reconstruction after Mastectomy for Locally Advanced Breast Cancer

    Directory of Open Access Journals (Sweden)

    Joo Seok Park

    2015-05-01

    Full Text Available BackgroundSurgical ablation for locally advanced breast cancer results in large chest wall defects, which can then be managed with local flaps or skin grafts. The purpose of this article is to evaluate the outcomes of three types of local skin flaps.MethodsAmong 25 local flaps in 24 patients, 6 were bilateral advancement (BA flaps, 9 were thoracoabdominal (TA flaps, and 10 were thoracoepigastric (TE flaps. Clinical outcomes were compared including complications, the need for a secondary surgical intervention, and the timing of adjuvant therapy.ResultsThe mean defect size was 436.2 cm2. Two patients with TA flaps and 6 patients with TE flaps developed distal flap necrosis, and skin grafts were needed to treat 2 patients with TE flaps. Radiation was administered to the BA, TA, and TE patients after average postoperative durations of 28, 30, or 41 days, respectively. The incidence of flap necrosis tended to be higher in TE patients, which lead to significant delays in adjuvant radiation therapy (P=0.02.ConclusionsThree types of local skin flaps can be used to treat large chest wall defects after the excision of locally advanced breast cancer. Each flap has its own merits and demerits, and selecting flaps should be based on strict indications based on the dimensions and locations of the defects.

  5. First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study

    Science.gov (United States)

    Muyldermans, Thomas

    2009-01-01

    Extensive pulp (zone 4) defects of the thumb, with the exposure of tendon or bone, are challenging reconstructive problems. Surgical treatment includes the use of local, regional, and free flaps. The first dorsal metacarpal artery flap has been used successfully for defects of the thumb. The innerved first dorsal metacarpal artery flap from the dorsum of the index finger was first described by Hilgenfeldt and refined by Holevich. An island flap carried on a neurovascular pedicle consisting of the first dorsal metacarpal artery was first demonstrated by Foucher and Braun. Seven innervated FDMCA island flaps were performed from May 2005 until July 2007 for thumb reconstruction. There were three women and four men with an average age of 54.9 years (range 28–89 years). The mean follow-up period was 15.4 months (range 4–29 months). The dominant hand was involved in six (85.7%) patients. In a retrospective clinical study, the following criteria were evaluated: (1) etiology of the defect, (2) time of reconstruction (primary vs. delayed), (3) survival rate of flap, (4) sensory function (Semmes–Weinstein monofilaments, static 2-PD, pain, cortical reorientation), (5) TAM measured with the Kapandji index, and (6) subjective patient satisfaction (SF 36). Four patients presented with trauma, two patients with defects after tumor resection and one with infection of the thumb. The flap was used for immediate reconstruction in three (42.9%) patients and for delayed reconstruction in four (57.1%) patients. Delayed reconstruction was performed 4.75 (1–12) months after initial trauma or first surgery. The donor area was grafted with full-thickness skin grafts in all cases. All flaps survived. The mean SWMF was 3.31 g and average statis 2-PD over the flap was 10.57 mm. Pain at the flap scored 3.71 over 10 and at the donor site 2.17 over 10. Paresthesia at the flap scored 0.57 over 4 and at the donor site 0.33 over 4. Complete cortical reorientation was only seen in one

  6. Uso do retalho nasogeniano musculocutâneo em ilha, por via submandibular, na reconstrução do soalho da boca Nasolabial musculocutaneous submandibular island flap in the reconstruction of the floor of the mouth

    Directory of Open Access Journals (Sweden)

    Gyl Henrique Albrecht Ramos

    1998-02-01

    Full Text Available O retalho nasogeniano com pedículo inferior tem sido utilizado, por via transbucal (supramandibular, na reconstrução do soalho da boca. A descrição da técnica de confecção do retalho nasogeniano musculocutâneo em ilha por via submandibular e a viabilidade do mesmo, tendo-se como parâmetro a necrose do retalho, são os objetivos deste estudo. Complementarmente, fez-se uma avaliação da mobilidade da língua, da capacidade de articulação dos fonemas orais no pós-operatório e procurou-se identificar através de análise estatística os fatores que pudessem estar correlacionados com a necrose do retalho. Foram operados nove pacientes considerados como T2, cinco como T3 e três como T4, sendo que todos foram submetidos a algum tipo de esvaziamento cervical. Dos dezessete retalhos, um teve necrose total, e outro, necrose parcial, proporcionando uma viabilidade de 88,3%. Em nenhum dos casos ocorreu fístula orocutânea. A avaliação da mobilidade da língua e da capacidade de articulação dos fonemas orais demonstrou resultados próximos do normal.Even though not supplying the same quantity of tissue as the frontal, deltopectoral and cervical flaps, the nasolabial flap is an excelent option for the correction of defects of small to moderate extension because of its spread, tissue composition and safety in relation to its blood nutrition. The present study tries to demonstrate the surgical technique used and the results obtained in seventeen nasolabial musculocutaneous submandibular island flaps used for mouth floor reconstruction after exeresis of malign tumors of the lower floor, in the period from December 1990 to July 1995, in the Service of Surgery of Head and Neck of Erasto Gaertner Hospital, in Curitiba. The basic objectives were to reconstruct the continuity of the buccal mucous membrane and preserve the mobility of the tongue (anterior 1/3 to the maximum. Only one out of the seventeen surgery cases is female and the predominant

  7. Reconstruction of lateral forefoot using reversed medial plantar flap with free anterolateral thigh flap.

    Science.gov (United States)

    Fujioka, Masaki; Hayashida, Kenji; Senju, Chikako

    2014-01-01

    Skin defects of the heel have frequently been reconstructed using the medial plantar flap; however, forefoot coverage has remained a challenge, because the alternatives for flap coverage have been very limited. We describe a case of malignant melanoma on the lateral forefoot that was radically removed and reconstructed successfully with a distally based medial plantar flap, together with a free anterolateral thigh flap. The advantages of this flap include that it does not reduce the vascular supply to the foot owing to reconstruction of the medial plantar vascular systems, reduces the risk of flap congestion, minimizes donor site morbidity, and enables the transport of structurally similar tissues to the plantar forefoot. We believe this technique is a reasonable reconstructive option for large lateral plantar forefoot defects.

  8. Mastoid fascia kite flap for cryptotia correction.

    Science.gov (United States)

    Simon, François; Celerier, Charlotte; Garabedian, Erea-Noël; Denoyelle, Françoise

    2016-11-01

    Cryptotia is one of the most common malformations of the upper auricle with aesthetic and functional consequences, however there is no standard treatment. We present the surgical technique and results of a kite flap procedure which can be used in the different cryptotia subtypes. We reviewed all patients treated in our department from 2010 to 2015, using a mastoid fascia kite flap technique. The incision of this local flap follows the retro-auricular sulcus along the rim of the helix superiorly and drawing a skin paddle inferiorly. The mastoid fascia is exposed and a superiorly and posteriorly based flap is drawn and detached from the skull. Finally, the skin paddle is rotated and sutured between the superior helix and temporal skin creating the superior sulcus. The retro-auricular incision is closed directly inferiorly. Six patients (mean age 12) and seven ears were studied. One patient had bilateral cryptotia and only two had a normal contralateral ear. Mean follow-up was of 45 months. There was no skin necrosis, no complications reported and no revision surgery. We describe a reliable flap with a simple design and improved aesthetic result, as the thickness of the flap projects the helix well, the scar is entirely hidden in the retro-auricular sulcus and the direct suture induces a harmonious medialization of the inferior part of the ear and earlobe. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Reconstruction of a Large Anterior Ear Defect after Mohs Micrographic Surgery with a Cartilage Graft and Postauricular Revolving Door Flap

    Directory of Open Access Journals (Sweden)

    Stephanie Nemir

    2015-01-01

    Full Text Available A novel postauricular revolving door island flap and cartilage graft combination was employed to correct a large defect on the anterior ear of an 84-year-old man who underwent Mohs micrographic surgery for an antihelical squamous cell carcinoma. The defect measured 4.6 × 2.4 cm and spanned the antihelix, scapha, a small portion of the helix, and a large segment of underlying cartilage, with loss of structural integrity and anterior folding of the ear. The repair involved harvesting 1.5 cm2 of exposed cartilage from the scaphoid fossa and then sculpting and suturing it to the remnant of the antihelical cartilage in order to recreate the antihelical crura. The skin of the posterior auricle was then incised just below the helical rim and folded anteriorly to cover the cartilage graft. The flap remained attached by a central subcutaneous pedicle, and an island designed using the full-thickness defect as a stencil template was pulled through the cartilage window anteriorly to resurface the anterior ear. This case demonstrates the use of the revolving door flap for coverage of large central ear defects with loss of cartilaginous support and illustrates how cartilage grafts may be used in combination with the flap to improve ear contour after resection.

  10. Perforator-to-perforator musculocutaneous anterolateral thigh flap for reconstruction of a lumbosacral defect using the lumbar artery perforator as recipient vessel.

    Science.gov (United States)

    Mureau, Marc A M; Hofer, Stefan O P

    2008-05-01

    Reconstruction of large-sized lumbosacral or sacral defects often is not possible using local or regional flaps, making the use of free flaps necessary. However, the difficulty of any microsurgical procedure in this region is complicated by the need to search for potential recipient vessels to revascularize the flap. In the present case, a free musculocutaneous anterolateral thigh flap to cover a large-sized and deep lumbosacral defect was used. Arterial anastomosis was performed, connecting the cutaneous anterolateral thigh (ALT) perforator to the perforator of the second lumbar artery. In this fashion, the arterial circulation through the flap was flowing reversely through the muscle. The concomitant vein of the descending branch of the lateral circumflex femoral artery was hooked up to the thoracodorsal vein using a long interposition vein graft because the perforator of the second lumbar vein was too small. Postoperative healing was uneventful. In conclusion, a successful reconstruction of a lumbar defect has shown that local perforators in the lumbar area may be accessible for easier perforator-to-perforator anastomoses and that the muscular part of the musculocutaneous ALT flap can survive on retrograde arterial perfusion from a perforator of the skin island.

  11. Blood flow autoregulation in pedicled flaps

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  12. 接合神经的甲皮瓣修复拇指皮肤软组织缺损%Toe nail flap with nerve anastomoses for repairing thumb skin soft tissue defect

    Institute of Scientific and Technical Information of China (English)

    张荣峰; 孙新君; 江海廷; 张福田

    2016-01-01

    Objective To investigate the clinical outcomes and experience of using thumb nail flaps with nerve anastomoses to repair thumb nail bed and skin soft tissue defect. Methods From January 2006 to January 2014, 32 cases were using emergency thumb nail flap transplantation to repair thumb skin soft tissue injury with nail bed defects. All the cases were treated with toe bottom nerve and finger intrinsic nerve anastomoses, cutaneous branch of peroneal nerve and superfical branch of radial nerve anastomoses, and the donor sites were directly sutured. Results All thumb nail flaps in 32 cases survived after surgery. After 12~36 months of follow up, the thumbs were in good shape, the nails grew well, and the color of flaps was close with the surrounding skin; all had good sensory and motor function, and two-point discrimination of finger pulps was 4~8 mm. According to Chinese Medical Association of Hand Surgery branch of replantation and reconstruction of function evaluation test standard, 25 cases were excellent, 6 cases were good, 1 case was acceptable, and no bad cases occured, and the excellent and good rate was 96.9%. Conclusion Using the method of toe bottom nerve and finger intrinsic nerve anastomoses, cutaneous branch of peroneal nerve and superfical branch of radial nerve anastomoses, emergency free hallux toe nail flap to repair thumb injury with nail bed defects, the appearance and functions of thumbs after surgery are satisfactory, and the nerve function recovers well.%目的:探讨采用接合神经的甲皮瓣修复拇指甲床及皮肤软组织缺损的临床疗效。方法2006年1月-2014年1月,急诊应用甲皮瓣移植修复伴有甲床缺损的拇指皮肤软组织损伤32例,均将趾底神经-指固有神经接合,腓神经皮支与桡神经浅支接合,供区直接缝合。结果术后32例甲皮瓣全部成活,随访12~36个月,拇指外观良好,指甲生长良好,皮瓣颜色与周围皮肤近

  13. Experimental model for low level laser therapy on ischemic random skin flap in rats Modelo experimental para laserterapia de baixa intensidade em retalho cutâneo randômico isquêmico em ratos

    Directory of Open Access Journals (Sweden)

    Rodrigo Paschoal Prado

    2006-08-01

    Full Text Available PURPOSE: To develop an experimental model to be used in the study of low level Laser therapy on viability of random skin flap in rats. METHODS: The sample was 24 Wistar-EPM rats. The random skin flap measured 10 x 4 cm and a plastic sheet was interposed between the flap and donor site. Group 1 (control underwent sham irradiation with diode laser (830 nm. Group 2 was submitted to laser irradiation with diode laser (830 nm. The animals were submitted to Laser therapy with 36 J/cm² energy density (72 seconds immediately after the surgery and on the four subsequent days. The probe was usually held in contact with the skin flap surface on a point at 2.5 cm cranial from the flap base. On the seventh postoperative day, the percentage of necrotic area was measured and calculated. RESULTS: Group 1 reached an average necrotic area of 48.86%, Group 2 - 23.14%. After the statistic analysis, compared with the control group, Group 2 showed a statistically significant increase in survival area (pOBJETIVO: Propor o desenvolvimento de um modelo experimental para verificar o efeito da laserterapia de baixa intensidade na viabilidade do retalho cutâneo randômico em ratos. MÉTODOS: A amostra constituiu-se de 24 ratos, da linhagem Wistar-EPM. O retalho cutâneo randômico foi realizado com dimensões de 10x4 cm e uma barreira plástica foi interposta entre o mesmo e o leito doador. O Grupo 1 (controle, foi submetido a uma simulação de tratamento com a irradiação laser de diodo (830 nm. O Grupo 2 foi submetido à irradiação laser de diodo (830 nm. Os animais foram submetidos a terapia a laser com densidade de energia de 36 J/cm2 (72 segundos imediatamente após a operação e nos outros quatros dias subseqüentes. A caneta do laser foi posicionada a 90 graus em contato com o retalho cutâneo em um ponto a 2,5 cm da base cranial do retalho. No sétimo dia pós-operatório foram calculadas as porcentagens da área de necrose. RESULTADOS: O Grupo 1 apresentou

  14. The influence of zi-hua burn cream on the survival of random skin flaps in rats%紫花烧伤膏对大鼠随意型皮瓣成活的影响

    Institute of Scientific and Technical Information of China (English)

    刘斌钰; 刘斌焰; 李丽芬; 何引飞; 王亚荣

    2013-01-01

    目的 观察紫花烧伤膏对大鼠皮瓣存活的影响,并探讨其作用机制.方法 Wistar 大鼠72只,随机分为紫花组(外用紫花烧伤膏)、阳性对照组(外用海普林乳膏)、阴性对照组(未手术组)和模型组(外用凡士林),每组18只.在大鼠背部设计蒂在头侧的8 cm×2 cm的随意型皮瓣,2次/日涂药,观察大鼠皮瓣成活情况;比较术后1、2、3和7d血清超氧化物歧化酶(SOD)、丙二醛(MDA)、一氧化氮(NO)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)的变化并行组织形态学检查.结果 皮瓣成活面积百分比:紫花组(73.58±10.74)%,模型组(33.40±16.05)%,紫花组比模型组提高了54.61% (Q =10.63,P<0.01),与海普林组(71.65±11.92)%比较,差异无统计学意义(P>0.05);紫花组血清SOD和NO含量高于模型组,MDA、TNF-α和IL-6含量低于模型组(P<0.01),与海普林组比较,差异无统计学意义(P>0.05).术后7d紫花组与海普林组皮瓣组织水肿、坏死及炎性细胞浸润较模型组轻,肉芽组织、成纤维细胞增生明显,紫花组有大量新生的毛细血管形成,皮瓣血管所占面积明显高于模型和海普林组(P<0.01).结论 紫花烧伤膏可明显改善大鼠皮瓣血液循环,提高皮瓣的成活率,其机制可能与抗自由基损害、改善局部微循环、提高NO的含量、降低TNF-α和IL-6水平、减少炎性因子释放,改善氧化应激状态,减轻炎性反应有关.%Objective To observe the effect of zi-hua burn cream on the survival of skin flaps in rats,and its mechanisms.Methods 72 Wistar rats,were randomly divided into four groups as zi-hua group(n =18,external application of alfalfa burn cream),control group(n =18,external application of heparin sodium cream),model group(n =18,external application of vaseline),negative control(n =18,no operation).8 cm × 2 cm random skin flaps with pedicle on the side of head were designed on the back of Wistar rats.The drug was applied on

  15. Total endoscopic free flap harvest of a serratus anterior fascia flap for microsurgical lower leg reconstruction

    Directory of Open Access Journals (Sweden)

    Erdmann, Alfons

    2014-04-01

    Full Text Available [english] Background: A tremendous number of free flaps have been developed in the past. As the surgical result depends not only on a successful flap transfer but also on the harvest, this paper details the procedures for undertaking the first total endoscopic harvest of a serratus fascia flap for free flap transplantation to the lower leg. Patient and methods: In September 2012 we performed the first total endoscopic serratus anterior fascia free flap harvest. The incision of 2.5 cm length was made 10 cm in front of anterior muscle border of the latissimus dorsi at level with the midthorax. After insertion of a flexible laparoscopic single port system we started CO gas insufflation. We used this setting to meticulously prepare a neo cavity between atissimus dorsi and M. serratus anterior. The vessels were dissected and the thoraco-dorsal nerve was separated. With a second auxiliary incision we used a clamp to support the raising of the fascia flap from the underlying muscle. Finally we clipped the vessels to the latissimus dorsi muscle and the flap vessels at the Arteria and Vena axillaris. The flap was extracted via the 2.5 cm incision.Results: We were able to perform a total endoscopic harvest of a serratus fascia flap for free flap reconstruction of soft tissues. With this new operative technique we were able to avoid a long skin incision, which in our view lowers the morbidity at the harvest area.Conclusion: We describe a new method for the total endoscopic harvest of the serratus fascia flap for free flap transfer. The flap was harvested within reasonable time and following surgery leaves the patient with minimal donor site morbidity compared to the open technique.

  16. The Clinical Application of Anterolateral Thigh Flap

    Directory of Open Access Journals (Sweden)

    Yao-Chou Lee

    2011-01-01

    Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe.

  17. The study of expanded tri-lobed flap in a rabbit model: possible flap model in ear reconstruction?

    Directory of Open Access Journals (Sweden)

    Yüreklý Yakup

    2003-12-01

    Full Text Available Abstract Background Local flaps are widely used in reconstructive surgery. Tri-lobed skin flap is a relatively new flap and there has been no experimental model of this flap. This flap can be used for repair of full thickness defects in the face, ears and alar region. Based on the size of ears in a rabbit, we designed a model of ear reconstruction using expanded tri-lobed flap. Local flaps are more advantageous in that they provide excellent color and texture matching up with those of the face, adequately restore ear contour, place scars in a favorable location and ideally accomplish these goals in a single stage with minimal donor site morbidity. Methods Eight adult New Zealand rabbits were divided into two groups. 50 ml round tissue expander were implanted to four rabbits. After completion of the expansion, a superiorly based tri-lobed flap was elevated and a new ear was created from the superior dorsal skin of each rabbit. Scintigraphy with Technetium-99m pertecnetate was performed to evaluate flap viability. Results Subtotal flap necrosis was seen in all animals in non-expanded group. New ear in dimensions of the original ear was created in expanded group without complication. Perfusion and viability of the flaps were proved by Technetium-99m pertecnetate scintigraphy. Conclusion According to our knowledge this study is the first to demonstrate animal model in tri-lobed flap. Also, our technique is the first application of the trilobed flap to the possible ear reconstruction. We speculated that this flap may be used mastoid based without hair, in human. Also, tri-lobed flap may be an alternative in reconstruction of cylindrical organs such as penis or finger.

  18. Retrograde Island Fascia Refers to Clinical Analysis With Fingertip Defect Back Flap%逆行岛状筋膜蒂指背皮瓣修复同指指端缺损的临床分析

    Institute of Scientific and Technical Information of China (English)

    邝靖

    2015-01-01

    Objective To apply the same finger dorsal island fasciocutaneous pedicle flap technique clinical effects of treatment for patients suffering from diseases of the implementation of fingertip defect research.Methods In our hospital from2012 August to 2014 August suffering from fingertip defect disease 90 patients were randomly divided into control and treatment groups, with an average 45 cases in each group. Abdominal pedicle flap technique using the control group for patients with treatment; using the same means of retrograde dorsal fascia island flap technique in patients treated with the implementation of treatment.Results The number of adverse reactions in the perioperative treatment of surgical repair; hand function in patients treated with normal time and defect treatment plan to implement total time was significantly shorter than the control group; fingertip defect disease treatment is better than the control group; the results significantly less than the control group.Conclusion The same refers to the dorsal fascia retrograde island flap technique for patients suffering from diseases of fingertip defect implementation of clinical treatment effect is very obvious.%目的:对应用同指逆行岛状筋膜蒂指背皮瓣修复技术对患有指端缺损疾病的患者实施治疗的临床效果进行研究。方法选择在该院2012年8月—2014年8月就诊的患有指端缺损疾病的患者90例,随机分为对照组和治疗组,平均每组45例。采用腹部带蒂皮瓣技术对对照组患者实施治疗;采用同指逆行岛状筋膜蒂指背皮瓣修复技术对治疗组患者实施治疗。结果治疗组患者手部功能恢复正常时间(50.24±7.68)d和缺损修复治疗计划实施总时间(12.25±3.44)d明显短于对照组(74.92±10.64)、(17.59±4.51)d;指端缺损疾病治疗效果(总有效率93.4%)明显优于对照组(总有效率75.6%);在手术修复治疗的围术期出现不良反应的人数(1

  19. Applicaiotn of modified pectoralis major myocutaneous island flap in head and neck surgeries%改良的胸大肌岛状肌皮瓣在头颈外科的应用

    Institute of Scientific and Technical Information of China (English)

    陈晓红; 韩德民; 黄志刚; 房居高; 倪鑫; 周维国; 王琪; 李平栋

    2009-01-01

    目的 总结保护供区胸大肌功能和颈部外形美观的改良式胸大肌岛状肌皮瓣安全制作方法 .方法 采用改良的胸大肌岛状肌皮瓣修复头颈部缺损17例,其中6例复发性喉癌和下咽癌,4例下咽癌,3例舌根癌,2例复发性上颌窦癌,1例扁桃体癌,1例术后下咽癌术后咽瘘.术前超声检查标记胸肩峰动脉胸肌支走行,以胸肌支最下一个分支进入胸肌的起始位置(最下入肌点)和内乳动脉第四肋间穿支连线为轴设计单血管蒂的岛状肌皮瓣;在皮瓣顶部切口水平向外沿腋前线向上切开;保留胸内侧和部分胸外侧神经;维持胸大肌锁骨部完整,经锁骨上或锁骨下将肌皮瓣送到受区.结果 术中发现胸肩峰动脉胸肌支最下入肌点全部分布在胸肋部,该点距锁骨中点最下缘平均(4.9±1.2)cm(x±s,下同),术前超声定位最下入肌点的准确率为76.5%(13/17);内乳动脉的第四肋间穿支距离胸骨外侧缘(1.8±0.5)cm.17例胸大肌岛状肌皮瓣中,除1例下咽癌术中解离血管蒂时损伤血管放弃外,其余16例均成活,手术成功率为94.1%.术后1例舌根癌患者胸大肌远端与残舌分离,通过换药缝合后痊愈;2例出现术后咽瘘,均系放疗后复发下咽癌,换药后创面愈合.术后4周至3个月复查,胸大肌功能正常,颈部外形良好.结论 改良胸大肌岛状肌皮瓣不仅保留了胸大肌结构和功能,实现高位缺损的修复,还维持颈部和上胸部良好外观.术前超声检查标记胸肩峰动脉的胸肌支走行和最下入肌点位置有利于术中准确操作.%Objective To preserve the function of the donor site and good cervical shape, a modified pectoralis major myocutaneous island flap was designed. Methods The modified pectoralis major myocutaneous flaps were used to repair primarily the defect in head and neck surgery. In all 17 cases, six cases were patients with recurrence of larynx or hypopharynx cancer, four cases with

  20. Laser 830nm na viabilidade do retalho cutâneo de ratos submetidos à nicotina Laser 830nm on the viability of skin flaps in rats submitted of nicotine

    Directory of Open Access Journals (Sweden)

    Lais Mara Siqueira das Neves

    2011-01-01

    Full Text Available OBJETIVO: Investigar os possíveis efeitos da laserterapia com laser diodo 830nm ao se contrapor a ação da nicotina na viabilidade do retalho cutâneo em ratos. MÉTODOS: Foram utilizados 16 ratos Wistar, distribuídos em 2 grupos de 8: Grupo 1- submetido à técnica cirúrgica, para obtenção dos retalhos cutâneos randômicos de base cranial, com injeção subcutânea de nicotina em uma dose de 2mg/Kg/dia, uma semana antes e uma semana após o procedimento cirúrgico e simulação da radiação laser; Grupo 2- similar ao grupo 1, cujos retalhos cutâneos randômicos de base cranial foram submetidos à irradiação do laser imediatamente após a cirurgia e nos 4 dias subsequentes. Após a eutanásia, as áreas de necrose e de tecido viável foram examinadas através do método de pesagem do Gabarito de Papel e pelo método semi-automático de análise de imagens (Mini-Mop®. RESULTADOS: Os resultados foram analisados estatisticamente através do teste ANOVA. Os valores de porcentagem de área de necrose através do método de análise mostraram uma diminuição da área de necrose no grupo 2 onde foi aplicado laser. CONCLUSÃO: O laser 830nm foi eficaz na melhora da viabilidade do retalho cutâneo em ratos submetido à ação da nicotina. Nível de evidência II: Estudos terapêuticos - Investigação dos resultados do tratamento.OBJECTIVE: To investigate the possible effects of laser diode 830nm counter to the action of nicotine on the viability of the skin flap in rats. METHODS: 24 Wistar-albino rats were used, divided into 3 groups of 8: Group 1 - subject to the surgical technique to obtain the random skin flap in cranial base, subcutaneous injection of nicotine of 2mg/Kg/dia a week before and one week after surgery and simulation of laser. Group 2 - similar to group 1, the random skin flap in the cranial base were subjected to laser irradiation immediately after surgery and on thesubsequent 4 days. After euthanasia, areas of necrosis and

  1. The improvement of living quality for the patient with carcinoma of esophagus: Reconstruction for the defect of pharynx and cervical esophagus with inferior antebrachial skin flap on the basis of retaining the laryngeal function%改善食道癌患者生存质量 :保留喉功能下前臂皮瓣重建咽及颈段食管缺损

    Institute of Scientific and Technical Information of China (English)

    李庆生; 王跃建; 陈伟雄; 杜学亮

    2001-01-01

    Objective To investigate the effect of reconstruction for inferior pharyngeal and cervical esophagus defect with inferior antebrachial skin flaps on the living quality of patients after surgery. Method Perform radical operation of the tumor, but retain larynx and trachea. Free antebrchial skin flaps were used to reconstruct the defect of inferior pharynx and cervical esophagus. Roll the skin flap to form a skin tube, and then carry out anastomosis with floor of mouth and cervical esophagus. Result The laryngeal function was retained after surgery. And permanent orifice of trachea was unnecessary. The effect was satisfying. The vocalization wasn't affected and food- intake through oral was normal in the 2 patients followed up. Conclusion It is a feasible way to reconstruct the inferior pharynx and cervical esophagus defect caused by radical operation of the tumor at pharynx and cervical esophagus. It can improve the living quality of patients effectively.

  2. Experience of nursing care in repairing the wound of the radical operation of tongue cancer with forearm free skin flaps%应用前臂游离皮瓣修复舌癌根治术后创面的护理

    Institute of Scientific and Technical Information of China (English)

    孙姝玲; 佘小伟

    2016-01-01

    Objective To explore the nursing care in repairing the wound of the radical operation of tongue cancer with forearm free skin flaps. Methods Retrospective analysis of 45 cases of the radical operation of tongue cancer patients, repaired the defects with forearm free skin flaps prothesis, post operation closely monitoring flap blood supply, color, expansion rate, and give symptomatic management. Results All flaps survived after 72 hours of operation with a series of measures,such as heat preservation, anticoagulation. Conclusion Post operation full knowledge in forearm free skin flaps, careful observation and nursing are an important guarantee to ensure the flap survival and successful operation .%目的:探讨舌癌术后前臂游离皮瓣修复的护理方法。方法:回顾性总结2008年10月-2015年8月我院收治的45例前臂游离皮瓣修复舌癌术后软组织缺损患者的临床资料,术后密切监测皮瓣的血供、色泽、膨胀率等,并予以对症处理。结果:术后72h,经保温、抗凝等一系列措施干预后,全部皮瓣存活。结论:术后对前臂桡侧皮瓣的充分认知,细致的观察和护理,是保证皮瓣存活及手术成功的重要保证。

  3. Efeito da hialuronidase na sobrevida de retalhos cutâneos em ratas Hyaluronidase effect on the suvival of skin flaps in female rats

    Directory of Open Access Journals (Sweden)

    Cristhian Enrique Acevedo-Bogado

    2002-01-01

    Full Text Available O insucesso de retalhos devido a necrose total ou parcial não é um fato isolado. O edema pode ser um fator importante na perda do retalho. A hialuronidase degrada o ácido hialurônico presente no tecido conjuntivo que está envolvido na homeostase da água na matriz extracelular, e pode ser importante na melhora da sobrevida de retalhos. O objetivo do presente estudo foi avaliar a efetividade da hialuronidase na melhora da sobrevida de retalhos cutâneos em ratas. Quarenta e duas ratas Wistar distribuídas em quatro grupos foram incluídas na pesquisa. Praticou-se um retalho randomizado de 7 x 2 cm no dorso do animal. Três grupos receberam tratamento pós-operatório durante quatro dias. O grupo A (n=11 recebeu 100 UI/dia de hialuronidase, o grupo B (n=11 50 UI/dia de hialuronidase e o grupo C (n=10 água destilada. O grupo D (n=10 não recebeu tratamento. Foi avaliada a área de necrose e submetido a análise estatística. As taxas de necrose no dia 7 foram: no grupo A 38,69% (± 9,26, grupo B 38,20% (± 15,05, grupo C 51,97% (± 8,37 e grupo D 45,90% (± 12,57. Houve diferença estatisticamente significante (pFlap failure related to total or partial necrosis is not a rare event. Flap edema could be an important factor on flap losing. Hyaluronidase breaks down the hyaluronic acid existing in the connective tissue, which is involved on water homeostasis of intercellular ground substance, and may be important on increasing flap survival. The aim of this study was to evaluate the effectiveness of hyaluronidase on improving cutaneuos flap survival in rats. Forty-two Wistar rats divided in four groups were included in this study. It was made a 7 x 2 cm random flap in the dorsal aspect of the animal. Three groups received post-operative treatment during four days. Group A (n=11 received 100 UI per day of hyaluronidase, group B (n=11 50 UI per day and group C (n=10 received distilled water. Group D (n=10 was not treated. It was evaluated the

  4. A CONTRAST ANALYSIS OF 135 CASES OF OSMIDROSIS TREATED BY RESECTING APOCRINE SWEAT GLAND WITH SKIN FLAP METHOD%皮瓣法微创腋臭切除术135例分析

    Institute of Scientific and Technical Information of China (English)

    孙卫海; 张宝成; 郭莉; 李燕; 吴小会; 陈潮

    2012-01-01

    目的 通过历史对照探索微孔引流术在皮瓣法腋臭切除术中的作用.方法 腋臭患者76例采用微孔引流行皮瓣法腋臭切除术作为治疗组,去除大汗腺及毛囊后在皮瓣上用尖刀片沿皮纹戳数个长约3mm的微孔进行引流,缝合切口后用弹力绷带包扎压迫手术区敷料.未采用微孔引流术的腋臭患者59例作为对照组进行历史对照研究,术后3d及7d换药,10d拆线并观察皮瓣成活情况,术后3~6个月进行随访.结果 2组患者均未发生切口感染.对照组出现血肿7例,其中皮肤坏死5例,出现瘢痕增生18例,腋窝皮肤皱褶9例及腋臭根治不彻底12例.治疗组出现表皮水疱8例,切口瘢痕增生6例,腋窝皮肤皱褶2例,无复发病例.治疗组治愈率明显高于对照组(P<0.01),治疗组血肿、瘢痕形成及复发率明显低于对照组(P<0.01).结论 微孔引流术可提高皮瓣法腋臭切除术疗效,而且并发症较少.%Objective To investigate the effects of resecting apocrine sweat gland with skin flap method in treating osmidrosis. Methods Seventy - six patients with osmidrosis were treated using skin flap method,named treatment group,which was punctured with sharp scalpel. The micropores were used for drainage, and the width was just 3mm. After removing apocrine sweat glands and hair follicles, the incision was sewed up. Gauze under both of axilla were pressed with 8 - shaped elastic bandage. Another 59 cases of osmidrosis, treated in the past with the same method only without micropore drainage, were named as control group. Historical case - control study was conducted. The incisions were examined at the 3d and 7d respectively, and the sutures were removed at the lOd. Follow - up study was carried out in all the patients between 3 and 6 months after the operation. Results No incision infection was found in both groups. There were 7 cases of hematoma,5 cases of skin necrosis, 18 cases of scar,9 cases of wrinkled skin,and 12

  5. The interpectoral fascia flap.

    Science.gov (United States)

    Beer, Gertrude M; Manestar, Andrew; Manestar, Mirjana

    2008-09-01

    Despite the great number of pedicled and free flaps that are available for defect and contour repair, the number of fascia flaps with an axial blood supply are sparse. Such flaps with their gliding function are mandatory, whenever coverage with very thin, well-vascularized tissue is necessary. To the currently established fascia flaps, (the temporoparietal fascia flap, the radial forearm fascia flap, the lateral arm fascia flap, and the serratus anterior fascia flap), we want to add a new fascia flap, the interpectoral fascia flap. We dissected the interpectoral fascia flap from 20 cadavers. In each of the 40 hemichests, the trunk of the thoracoacromial vessels was selectively injected with red polyurethane and the tissue containing the pectoral branches was separated from the overlying pectoralis major muscle and converted into an independent fascia flap. The maximum flap length was 13.5 cm and the maximum breadth was 10.3 cm. The length of the vascular pedicle before entering the flap was 3.9 cm +/- 1.4 cm with a range of 1.5-6.8 cm. Concerning the arc of rotation, all 40 flaps reached the posterior axillary fold, and 29 flaps (73%) reached the mandibular border. This new fascia flap has applications as pedicled and as free flap. The pedicled flap is used in the neck region, in the axillary region and as gliding tissue between the nipple-areola complex and the pectoralis major muscle. The usage of the fascia flap as a free flap has similar characteristics as the other fascia flaps.

  6. 逆行腓肠神经营养血管蒂带薄层肌肉岛状皮瓣修复胫骨慢性骨感染缺损创面%Treatment of the wound of bone defect and exposure in chronic infection of tibia with the myofascial and cutaneous island flap pedicled with collateral vessel nourished by retrograde sural nerve

    Institute of Scientific and Technical Information of China (English)

    覃松; 喻忠斌; 夏晓枫; 车彪; 刘骏; 王凯

    2016-01-01

    目的:探讨逆行腓肠神经营养血管蒂带薄层肌肉岛状皮瓣修复胫骨慢性骨感染缺损创面的方法及临床疗效。方法应用腓肠神经营养血管蒂岛状筋膜肌皮瓣逆行转位修复12例胫骨慢性骨髓炎后骨缺损并骨外露患者,皮肤软组织缺损为9~16 cm2。结果12例均获得随访,时间16~72个月。12例转移肌皮瓣均一期存活,伤口愈合时间14~21 d。1例肌皮瓣静脉回流障碍,行网状打孔并以肝素钠溶液冲洗网孔1周后皮瓣成活;1例皮瓣边缘部分坏死,经换药3周后愈合;所有感染均治愈。结论应用腓肠神经营养血管蒂岛状筋膜肌皮瓣逆行转位修复胫骨慢性骨髓炎后骨缺损并骨外露疗效理想。%Objective To explore the therapeutic effects of myofascial and cutaneous island flap pedicled with collat-eral vessel nourished by retrograde sural nerve for the wound of bone defect and exposure in chronic infection of tibia. Methods 12 cases of tibia chronic osteomyelitis combined with bone defect and exposure were treated with myofas-cial and cutaneous island flap pedicled with collateral vessel nourished by retrograde sural nerve. The area of the tis-sue defect ranged from 9 cm2 to 16 cm2 . Results 12 cases were followed up for 16 ~72 months. All flaps survived after operation and the flaps had survived within 14 to 21 days. 1 flap with venous drainage barriers survived by net punching and heparin sodium solution flushing mesh flaps in a week, 1 flap with margin necrosis was healed with dressing change after 3 weeks;all infections were cured. Conclusions Treatment of bone defect and exposure in tibi-a with the myofascial and cutaneous island flap pedicled with collateral vessel nourished by retrograde sural nerve is an effective technique.

  7. 乳腺癌术后皮瓣坏死及皮下积液的预防%Prevention of skin flap necrosis and subcutaneous hydrops after breast cancer operation

    Institute of Scientific and Technical Information of China (English)

    赵利平; 李晓勇; 李建; 曹强

    2013-01-01

    Objective: To explore the ways of preventation of skin flap necrosis and subcutaneous hydrops after breast cancer operation. Methods:Total of 280 patients with breast cancer were divided into four groups. All patients were performed operation with Stewart incision. In group A and B,electrome and scalpel were used to dissociate the skin flap in operation, persistent negative pressure suction with single silica gel tube was performed after operation in group A, negative pressure suction with rubber tube was performed after operation in group B. In group C and D, scalpel was used to dissociate the skin flap in operation, persistent negative pressure suction with single silica gel tube was performed after operation in group C, negative pressure suction with rubber tube was performed after operation in group D. Results:In group A and B.the rates of skin flap necrosis were 4.00% (3/75)and 13. 33% ( 10/75) ;13. 85% (9/ 65 ) and 29. 23% (19/65) in group C and D. The difference between group A and B, A and C, B and D, C and D was significant(P <0. 05). In group A and B,the rates of subcutaneous hydrops were 5. 33% (4/75) and 16. 00% (12/ 75 ) ; 18. 46% ( 12/65 ) and 33. 85% (22/65 ) in group C and D. The difference between group A and B, A and C, B and D,C and D was significant( P < 0. 05). Conclusion: In the breast cancer surgery, the electrome and scalpel to dissociate the skin flap in operation, and persistent negative pressure suction with single silica gel tube after operation could prevent the skin flap necrosis and subcutaneous hydrops effectively.%目的:探讨预防乳腺癌术后皮瓣坏死及皮下积液发生的方法.方法:2006年10月-2011年10月我院280例乳腺癌患者行乳腺癌改良根治术,切口均采用Stewart横切口,A组75例采用手术刀加电刀分离皮瓣,术后单根硅胶管持续负压吸引;B组75例采用手术刀加电刀分离皮瓣,术后普通橡胶管接胃引流壶负压吸引;C组65例采用单纯电刀分离皮瓣,术

  8. Debridement bone grafting and transfer of skin flap as the treatment for traumatic osteomyelitis%清创植骨皮瓣转移治疗创伤性胫骨骨髓炎

    Institute of Scientific and Technical Information of China (English)

    王秉璞; 王明新; 李强; 马方军

    2011-01-01

    目的 总结清创植骨及皮瓣转移治疗创伤性骨髓炎的方法和疗效.方法 2003年3月~2008年7月,对16例创伤性骨髓炎合并骨及软组织缺损病例,采用清创植骨,选择腓肠肌皮瓣10例、足背皮瓣2例、腓肠神经营养皮瓣2例、交腿皮瓣2例一期修复创面,观察术后皮瓣成活情况、骨折愈合情况及骨髓炎治愈情况.结果 术后随访6~38个月,平均9个月.骨愈合时间6~13个月,平均7.5个月.根据Paley骨折愈合评分标准:优15例,良1例.功能评定结果为优良13例,中2例,差1例.13例伤口Ⅰ期愈合,2例Ⅱ期愈合,1例窦道形成.结论 创伤性骨髓炎通过彻底清创、松质骨粒植骨、选择合适的邻近皮瓣转移修复等可以一期治愈.且具有疗效确切、疗程短、简单易行等特点.%Aim To summarize( describe ) the method and clinical effects of debridement grafting and transfer of skin flap in treatment of traumatic osteomyelitis. Methods From March 2003 to July 2008,16 patients with traumatic osteomyelitis in lower limb combined with bone and soft tissue defect were included in this study. We used the debridement,bone grafting, and selected the gastrocnemius flap in 10 cases,2 cases of dorsal foot flap,2 cases of flap, cross leg flap 2 cases of a wound repair. Results The results were followed up for 6 ~38 months,an average of 9 months. Bone healing time was 6 ~ 13 months, mean 7.5 months. According to the Paley score,there were excellent 15 and good 1. Functional results were 13 excellent and good,2 fair and 1 poor. Wound healing in 13 cases of stage I , Ⅱ healing in 2 cases, 1 case with obvious sinus. Conclusion Traumatic osteomyelitis were able to heal by first intention,by debridement, cancellous bone graft particles,selection of appropriate adjacent flap repair,which was effective, short course, and easy.

  9. Microporous decompression plus blood therapy in the treatment of hand retrograde island small flap venous crisis%微孔减压加滴血疗法治疗手部逆行岛状小皮瓣静脉危象

    Institute of Scientific and Technical Information of China (English)

    董虎林; 崔彦明; 石娜; 石慧征

    2013-01-01

      目的探讨微孔减压加滴血疗法治疗手部逆行岛状小皮瓣静脉危象的疗效.方法18例患者采用微孔减压加滴血疗法治疗手部逆行岛状小皮瓣静脉危象.结果本组18例中皮瓣全部成活16例,皮瓣远端0.2 cm坏死1例,表皮坏死1例.结论微孔减压加滴血疗法操作简单、创伤小、效果好,是一种治疗手部逆行岛状小皮瓣静脉危象的理想方式.%Objective To study the curative effect of microporous decompression and blood therapy in the treatment of hand retrograde island flap vein crisis of small. Methods 18 cases of patients with microporous decompression and blood therapy got the treatment of small hand reversed island flap vein crisis.Results The group 18 cases were treated by open porous decompression plus blood therapy, all the flaps survived in 16 cases, the flap of distal 0.2 cm necrosis in 1 cases, epidermal necrosis in 1 cases. Conclusion Microporous decompression plus blood therapy has the advantages of simple operation、less trauma、good effect, which is an ideal treatment of hand retrograde island small flap venous crisis.

  10. Fascia-only anterolateral thigh flap for extremity reconstruction.

    Science.gov (United States)

    Fox, Paige; Endress, Ryan; Sen, Subhro; Chang, James

    2014-05-01

    The ability to use the anterolateral thigh (ALT) flap as a vascularized fascial flap, without skin or muscle, was first documented by Koshima et al in 1989. The authors mention the possibility of using the fascia alone for dural reconstruction. Despite its description more than 20 years ago, little literature exists on the application of the ALT flap as a vascularized fascial flap. In our experience, the ALT flap can be used as a fascia-only flap for thin, pliable coverage in extremity reconstruction. After approval from the institutional review board, the medical records and photographs of patients who had undergone fascia-only ALT free flaps for extremity reconstruction were reviewed. Photographic images of patients were then matched to patients who had undergone either a muscle-only or a fasciocutaneous free flap reconstruction of an extremity. Photographs of the final reconstruction were then given to medical and nonmedical personnel for analysis, focusing on aesthetics including color and contour. Review of cases performed over a 2-year period demonstrated similar ease of harvest for fascia-only ALT flaps compared to standard fasciocutaneous ALT flaps. Fascia-only flaps were used for thin, pliable coverage in the upper and lower extremities. There was no need for secondary procedures for debulking or aesthetic flap revision. In contrast to muscle flaps, which require muscle atrophy over time to achieve their final appearance, there was a similar flap contour from approximately 1 month postoperatively throughout the duration of follow-up. When a large flap is required, the fascia-only ALT has the advantage of a single-line donor-site scar. Photograph comparison to muscle flaps with skin grafts and fasciocutaneous flaps demonstrated improved color, contour, and overall aesthetic appearance of the fascia-only ALT over muscle and fasciocutaneous flaps. The fascia-only ALT flap provides reliable, thin, and pliable coverage with improved contour and color over

  11. A new flap design for release of parallel contracture bands: dual opposing five-flap z-plasty.

    Science.gov (United States)

    Ersoy, Burak

    2014-12-01

    Skin contractures secondary to burn and other types of trauma can be encountered on almost every part of human body, best addressed by a custom treatment protocol tailored for each patient. Skin graft, local flap as well as distant flap options are available, each with intrinsic advantages and disadvantages. In the presence of weblike contracture the utilization of local tissue, when available, is a prefered approach for a relatively better appearance through a reasonably simpler surgical intervention, compared to skin graft applications and distant flap options. Among many other techniques and modalities utilized for this purpose, the dual opposing five-flap z-plasty method which is a novel method designed as a modification of the paired five-flap z-plasty technique promises to be a useful treatment option for the release of parallel contracture bands with satisfactory results in selected patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  12. 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.

  13. 腹部扩张真皮下血管网皮瓣修复手背瘢痕的临床研究%CLINICAL STUDY ON ABDOMINAL EXPANDED SUBDERMAL VASCULAR PLEXUS SKIN FLAPS FOR REPAIRING DORSAL HAND SCAR

    Institute of Scientific and Technical Information of China (English)

    王生钰; 谢建华; 李再桂; 刘海华; 张克录; 张永强

    2012-01-01

    目的 探讨应用腹部扩张真皮下血管网皮瓣修复手背及手指背侧大面积瘢痕的方法及临床疗效.方法 2005年5月-2010年10月,收治16例手背及手指背侧瘢痕患者.男13例,女3例;年龄10~35岁,平均22.5岁.致伤原因;烧伤10例,热压伤4例,烫伤2例.瘢痕形成1年6个月~2年,平均21个月.患者掌指关节与指间关节屈曲受限,瘢痕范围为11cm×7cm~18cm×10cm.一期行腹部扩张器置入术;注水完成2周后行二期手背瘢痕切除、扩张皮瓣带蒂移位修复术,扩张皮瓣范围为12cm×9cm~19cm× 12cm;二期术后14d行三期皮瓣断蒂以及手指分开、指蹼成形.腹部供区直接拉拢缝合.结果 术后皮瓣均顺利成活,创面Ⅰ期愈合.供区切口均Ⅰ期愈合.16例患者均获随访,随访时间1年2个月~3年,平均2年3个月.皮瓣质地柔软,弹性佳.末次随访时手功能按手部指关节主动活动(TAM)法评定;获优13例,良2例,差1例;优良率93.7%.结论 腹部扩张真皮下血管网皮瓣血供重建速度快、成活面积大、质地良好,是修复手背大面积瘢痕的较好方法.%Objective To explore the method and effectiveness of abdominal expanded subdermal vascular plexus skin flaps in repairing dorsal hand scar. Methods Between May 2005 and October 2010, 16 cases of dorsal hand scars were treated with the abdominal expanded flaps. There were 13 males and 3 females, aged 22.5 years on average (range, 10-35 years). Defect was caused by burn in 10 cases, hot crush injury in 4 cases, and scald injury in 2 cases. The average scar formation was 21 months (range, 1 year and 6 months to 2 years). The patients had flexion restriction of metacarpophalangeal joint and interphalangeal joint. The scar size ranged from 11 cm × 7 cm to 18 cm ×10 cm. The expander was implanted in abdominal skin and inflated with water regularly at the first stage. After 2 weeks, the expanded pedicled flap was trasferred to repair wounds in which scars

  14. Clinical analysis of adjacent skin flap in reconstruction of oral and maxillofacial soft tissue defects%邻位皮瓣修复口腔颌面部软组织缺损的临床分析

    Institute of Scientific and Technical Information of China (English)

    王仁欣; 王恒琨; 郑晓涛

    2013-01-01

    pedicle flap technology including maxillofacial and neck local advancement flaps,nasolabial flaps.Results All flaps of 30 patients survived after surgery:one case with the flaps area mild infection symptoms,II healing, and 29 patients with stage I healing;After at least six months of follow-up observation of facial morphology and function,it is found that:1 patient’s affected side numbness of the mouth was slightly askew and mouth slightly limited;cancer patients without recurrence;The flaps of all patients more matched with the surrounding skin tissue in terms of color, texture, contour, and incision scar tissue was soft;100%of facial morphology satisfaction,96.67%of the facial features satisfaction.Conclusion To the patients with maxillofacial soft tissue defects caused by trauma or surgical removal of the lesion,according to the principle of the nearest drawn ,taking ortho position flaps repair is worthy of clinical application,it has many advantages such as easy operating, easy mastering,the flaps convenient easy to survive,better blood supply,satisfactory facial morphology and function recovery,etc.

  15. Colgajo miocutáneo de glúteo mayor en isla con cierre V en Y para la cobertura de úlceras isquiáticas Island miocutaneous gluteus maximus flap for coverage of ischiatic ulcers

    Directory of Open Access Journals (Sweden)

    S. Llanos Olmedo

    2006-03-01

    percentage and are a challenge for clinicians. Most of the time causes long hospital stays, multiple surgical procedures and complex antimicrobial therapy. Coverage can be done with several myocutaneous flaps, including gluteus maximus, biceps femoris, gracilis, tensor fascia lata, semitendinosus, semimembranosus, etc. In this study we used the myocutenous gluteus maximus flap, in which we incorporate, as a variation, a perforating irrigated cutaneous island with V-Y advancement without tension. Our goal was to demostrate that the myocutaneous gluteus maximus flap could be the first choice procedure in ischiatic ulcers. We propose, as a surgical variant, the complete liberation of the muscle, which provides a wide range of rotation. In adittion, this variant, includes a cutaneous island with V-Y advancement without tension. All of this reduces morbidity and percentage of relapse. Thirteen flaps V-Y advancement and rotation myocutenous gluteus maximus flaps were made to cover grade III and IV ischiatic ulcers. The asociated diseases were tetraplegia y paraplegia due to medular injury and familiar spastic paraplegia. Follow up was from 6 months to 7 years and, to date, no morbidity or relapse has been documented. In our experience the myocutenous gluteus maximus flap would be the firts choice in ischiatic ulcers treatment because of their large volume and abundant irrigation and because of its migration from cefalic to caudal. the closure without tension is due to the complete disecction of the muscle and the cutaneous island V-Y advancement. We assume this is the reason for the absense of relapse and complications.

  16. Closure of Large Pressure Ulcers utilizing the Principles of Limberg flap

    Directory of Open Access Journals (Sweden)

    Kumar Pramod

    2001-01-01

    Full Text Available A prospective study of 17 patients (21 Limberg flaps in 19 pressure ulcers was done to establish the efficacy of Limberg flap. . Limberg flaps were used in only those cases where primary closure was not possible. This flap was found to be simple to execute and short-term results were satisfactory. Also, it spares underlying muscles for future use. None of the flaps showed necrosis. Partial wound dehiscence was noticed in 7 (33.33% cases, which was managed by secondary suturing in four cases, by split skin graft in one case and by second Limberg flap in one case.

  17. Periosteal double fibular composite ectocnemial skin flap for repairing skin defect of the tibia%骨膜内双段腓骨复合小腿外侧皮瓣移植修复胫骨及皮肤缺损

    Institute of Scientific and Technical Information of China (English)

    王辉; 范启申; 任志勇; 魏长月

    2014-01-01

    目的:探讨下肢胫骨及皮肤缺损同时修复的临床方法。方法将腓血管制成1个或2个血管襻,该血管襻携带皮瓣,再将多段腓骨于骨膜内复合在一起,使成为一个骨膜包裹的粗骨修复胫骨与皮肤缺损。有丰富血运的骨膜,其骨膜下新生骨活跃,该新生骨充填骨膜内与腓骨段间隙、包绕腓骨,使移植腓骨增粗。结果3例胫骨缺损均获得良好骨愈合,移植骨无折断,皮瓣成活良好。供腓骨侧踝关节稳定,伸屈范围正常,功能恢复正常。结论骨膜内双段腓骨复合小腿外侧皮瓣移植是修复胫骨与皮肤缺损的良好方法。%Objective To investigate the clinical method of simultaneous repair of tibia and skin defect of lower limbs. Methods Peroneal artery vascular loop made 1 or 2, the vascular loop carries flaps, fibular periosteum composite together, makes a thick bone repair of tibial periosteum wrapping and skin defects. Periosteum with extensive blood supply, its active subperiosteal new bone, periosteal new bone filling in the gap, wrapped around the fibula tibia and fibula, fibula graft augmentation. Results Good results were obtained for 3 cases of defect of the tibia bone healing, bone graft without breaking, flap was good. By-fibular side ankle stability, Flex scope properly, functions returned to normal. Conclusion Periosteum double fibular composite ectocnemial skin flap repair of skin defect of the tibia and good practices.

  18. Effects of Alprostadil on coagulation system in patients undergoing skin flap transplantation%前列地尔对皮瓣移植患者术后凝血系统的影响

    Institute of Scientific and Technical Information of China (English)

    石健; 赵钢; 程春生; 查朱青

    2016-01-01

    目的:探讨前列地尔对游离皮瓣移植患者术后凝血系统的影响。方法将哈尔滨市第五医院2012年2月~2014年8月收治的200例四肢游离皮瓣移植术后患者纳入观察范围,根据随机原则分为常规治疗组与前列地尔组,每组各100例。常规治疗组使用低分子右旋糖酐、肝素以扩容、抗凝,前列地尔组在常规治疗的基础上于手术当天给予前列地尔注射液(曼新妥,10μg溶于100mL生理盐水)静脉点滴,连续7d。观察患者术后24、72h皮瓣肿胀程度、疼痛评分、患者术后凝血功能检测及72h血管危象发生率。结果前列地尔组术后24h和72h的皮瓣肿胀程度评分、术后72h疼痛评分明显低于常规治疗组( P<0.05);前列地尔组术后72h血管危象发生率(1.0%)明显低于常规治疗组发生率(5.71%,P=0.02);两组患者术后同一时间点,凝血各项指标的检测结果比较,差异无显著性( P=1.18)。结论游离皮瓣移植术后应用前列地尔能有效维持皮瓣移植患者术后凝血系统的稳定,抑制血小板聚集,防止肢体肿胀与减轻疼痛,减少血管危象的发生,具有临床应用价值。%Objective To investigate the effects of Alprostadil at different time points on coagulation system in patients undergoing skin flap transplantation.Methods Two-hundred patients undergoing free skin flap trans-plantation from Feb.2012 to Aug.2014 in our department were selected and equally divided into conventional treat-ment group and Alprostadil group.Patients in the conventional group were treated with low molecular dextran and heparin for expansion and anticoagulation.Patients in the Alprostadil group were added with intravenous injection of Alprostadil on the basis of conventional treatment from the day of surgery for 7d.The turgidity of skin flap,pain score,vascular crisis occurrence,and determination of coagulation function in patients were

  19. [Expanded pedicled forearm flap for reconstruction of multiple finger amputations].

    Science.gov (United States)

    Alvarez Jorge, A; Martelo Villar, F

    2000-05-01

    Soft-tissue injuries of the hand frequently require flap coverage to preserve structures damaged at the time of injury or to facilitate later reconstruction. The radial forearm flap makes local tissue readily available and offers a simple method of reconstruction. Secondary augmentation of the skin flap by means of tissue expansion appears to be a useful alternative to improve the possibilities of reconstruction. This case report describes a primary reconstruction of a hand with multiple finger amputations using both techniques: Forearm flap and tissue expansion.

  20. Medial circumflex femoral artery flap for ischial pressure sore

    Science.gov (United States)

    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 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. PMID:19881020

  1. The distally based lateral sural neuro-lesser saphenous veno-fasciocutaneous flap: anatomical basis and clinical applications.

    Science.gov (United States)

    Wang, Chen; Xiong, Zhuyou; Xu, Jing; Zhang, Li; Huang, He; Li, Guangzao

    2014-09-01

    Soft tissue management around the lower third of the leg and foot presents a considerable challenge to the plastic surgeon. The aim of this research was to investigate the anatomical relationships of artery, nerve, vein and other adjacent structures in the posterolateral region of the calf, and our experience with using a distally based island flap pedicled with the lateral sural nerve and the lesser saphenous vein for soft tissue reconstruction of lower third of leg, foot, and ankle defects in 15 patients. Five fresh cadavers (ten lower limbs) were infused with colored red latex. The origin of the nutrient vessel of the lesser saphenous vein and the lateral sural nerve was identified. Based on the anatomical studies, an island flap supplied by the vascular axis of the lesser saphenous vein and the lateral sural nerve was designed for clinical reparative applications in 15 cases. The nutrient vessel of the lesser saphenous vein and the lateral sural nerve originates from the superficial sural artery, musculocutaneous perforators of the posterior tibial artery, and septocutaneous perforators of the peroneal artery in different segment of the calf. Meanwhile, these vessels have many sub-branches nourishing subcutaneous tissue and skin, form a favorable vascular chain around the nerve and the vein, and also communicate with vascular plexus of superficial and deep fascia. Among 15 flaps, 13 showed complete survival (86.66 %), while marginal flap necrosis occurred in one patient (6.67 %) and distal wound dehiscence in another (6.67 %). Their appearance and function were satisfactory, with feeling maintained in the heel and lateral side of the foot. The distally based flap pedicled with the lateral sural nerve and lesser saphenous vein was a reliable source for repairing soft tissue defects in the lower leg and foot due to its advantages of infection control, high survival rate, and sufficient blood supply without the need to sacrifice a major blood vessel.

  2. The relative survival of composite free flaps in head and neck reconstruction.

    Science.gov (United States)

    Van Genechten, M L V; Batstone, M D

    2016-02-01

    Various composite free flaps are available for reconstruction of bony head and neck defects. The aim of this study was to compare the relative success of four different bony free flaps. One hundred and seventy-three microvascular composite free flap reconstructions for bony defects of the head and neck region, performed over the period April 2008 to April 2015, were reviewed retrospectively. The type of free flap, indication for free flap reconstruction, age at harvesting of the free flap, use of pre- or postoperative radiotherapy, and free flap failure were examined. For the 173 reconstructions performed, 84 fibula free flaps, 43 iliac crest free flaps, 32 scapula free flaps, and 14 osteocutaneous radial forearm free flaps were harvested. The mean age at time of harvesting was 40.7 years for the iliac crest, 57.3 years for the fibula, 64.3 years for the scapula, and 73.9 years for the osteocutaneous radial forearm free flap. No complete free flap failure was documented, nor was there any failure of bony segments. Three fibula flap skin paddles did not survive. No returns to theatre for salvage were required. This study showed no difference in the survival rates of these four types of composite free flap.

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

    Directory of Open Access Journals (Sweden)

    Min Jae Lee

    2012-07-01

    Full Text Available BackgroundThe anterolateral thigh (ALT perforator flap has become a popular option for treating soft tissue defects of lower extremity reconstruction and can be combined with a segment of the vastus lateralis muscle. We present a comparison of the use of the ALT fasciocutaneous (ALT-FC and myocutaneous flaps.MethodsWe retrospectively reviewed patients in whom free-tissue transfer was performed between 2005 and 2011 for the reconstruction of lower extremity soft-tissue defects. Twenty-four patients were divided into two groups: reconstruction using an ALT-FC flap (12 cases and reconstruction using a vastus lateralis myocutaneous (VL-MC flap (12 cases. Postoperative complications, functional results, cosmetic results, and donor-site morbidities were studied.ResultsComplete flap survival was 100% in both groups. A flap complication was noted in one case (marginal dehiscence of the ALT-FC group, and no complications were noted in the VL-MC group. In both groups, one case of partial skin graft loss occurred at the donor site, and debulking surgeries were needed for two cases. There were no significant differences in the mean scores for either functional or cosmetic outcomes in either group.ConclusionsThe VL-MC flap is able to fill occasional dead space and has comparable survival rates to ALT-FC with minimal donor-site morbidity. Additionally, the VL-MC flap is easily elevated without myocutaneous perforator injury.

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

    Directory of Open Access Journals (Sweden)

    Min Jae Lee

    2012-07-01

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

  5. 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.

  6. Skin and Neourethral Necrosis in Staged Hypospadias Repair

    Directory of Open Access Journals (Sweden)

    Alireza Mirshemirani

    2016-05-01

    Full Text Available Complications in hypospadias surgery are not uncommon however penile skin or flap necrosis is rarely reported. Ischemia of the flap or graft is a major complication in two stage repair of hypospadias. A 2-year old boy with proximal penile hypospadias, operated earlier for chordee correction and urethral plate formation with a preputial flap, presented for stage 2 repair. Ten days after surgery patient developed skin and neourethral necrosis. Early debridement was done followed by coverage with scrotal flaps.

  7. Skin and Neourethral Necrosis in Staged Hypospadias Repair.

    Science.gov (United States)

    Mirshemirani, Alireza; Mahdavi, Alireza; Sarafi, Mehdi

    2016-01-01

    Complications in hypospadias surgery are not uncommon however penile skin or flap necrosis is rarely reported. Ischemia of the flap or graft is a major complication in two stage repair of hypospadias. A 2-year old boy with proximal penile hypospadias, operated earlier for chordee correction and urethral plate formation with a preputial flap, presented for stage 2 repair. Ten days after surgery patient developed skin and neourethral necrosis. Early debridement was done followed by coverage with scrotal flaps.

  8. Reconstrucción de la subunidad estética de la ceja con un colgajo temporal en isla de cuero cabelludo Aesthetic reconstruction of the eyebrow unit using a temporal island scalp flap

    Directory of Open Access Journals (Sweden)

    J. Gaona Silva

    2010-09-01

    Full Text Available La reconstrucción de las cejas juega un papel importante en la Cirugía Reconstructiva facial, debido a que la ausencia o deformidad de las mismas altera la expresión y las características de la cara, ejerciendo una influencia poderosa en la apariencia de la región periorbitaria, así como en el aspecto y en la autoestima de los pacientes. Describimos una técnica quirúrgica basada en el empleo de un colgajo temporal en isla de cuero cabelludo para la reconstrucción de la subunidad estética de la ceja y presentamos 3 casos de pacientes con defectos alopécicos de las cejas reconstruidos mediante dicha técnica.Eyebrow reconstruction plays an important role in facial Reconstructive Surgery. Absence or deformity of the eyebrows alter the expression and other features in the face exerting a powerful influence in the appearance of the periorbital region, so in the aspect as well as in the self-esteem of the patients. This paper describes the use of a temporal island scalp flap technique to reconstruct the eyebrow unit and we present 3 patients who underwent eyebrows reconstruction with this technique.

  9. Application of local flap in emergent reconstruction of the skin and soft tissue defects after facial trauma%局部皮瓣在面部创伤性皮肤软组织缺损急诊修复中的应用

    Institute of Scientific and Technical Information of China (English)

    何小川; 胡纯兵; 周滨; 刘震; 高志丹; 吴国平; 郭力

    2012-01-01

    Objective To explore the procedures of reconstruction emergency for skin and soft tisue defects due to trauma with local flap based on plastic surgical principles and techniques.Methods Thirty-two patients with facial defects caused by tramua were treated.After strict debridement of the wound of the skin and soft tissue,the flaps were designed according to the wound condition with plastic surgical principles.Subcutaneous SMAS pedicle flap,V-Y advancement flap,orbicularis flap,nasolabial groove flaps and others were chosen for wound repair,to suture and close the wound meticu lously.Results All of 32 treated cases,the wounds were primary healing.After 6-18 months follow-up,there was no obvious scar formation or functional problems.Second stage reconstruction was not needed since the cosmetic effect was perfect.Conclusions It is a satisfactory and effective method to emergently treat the skin and soft tissue defects after facial trauma with local flap based on the plastic surgical principles,which is well worth popularizing in clinic.%目的 探索依据整形外科原则应用局部皮瓣急诊修复面部创伤性软组织缺损的效果.方法 对32例面部皮肤软组织即时性创伤性缺损,于严格清创后,根据创面缺损情况,按整形外科原则分别设计皮下浅表肌腱膜系统(SMAS)蒂皮瓣、V-Y推进皮瓣、眼轮匝肌蒂岛状皮瓣、鼻唇沟皮瓣等修复创面,精细缝合关闭伤口.结果 32例伤口均Ⅰ期愈合,随访6~18个月,无明显瘢痕增生,无功能障碍,无需Ⅱ期修复,美容效果良好.结论 遵照整形外科基本原则采用局部皮瓣修复面部创伤性皮肤软组织缺损,可获得满意的效果,值得临床推广应用.

  10. A comparative study on the two kinds of methods of nursing care of skin flap after modified radical mastectomy%乳腺癌改良根治术后两种皮瓣护理方法的对照研究

    Institute of Scientific and Technical Information of China (English)

    苏建薇; 叶翠玲; 梁清梅; 林栩雁; 黄伟钊

    2009-01-01

    Objective: To explore the impact of different methods of nursing care of skin flap on flap recovery and the pa-tients'comfort after modified radical mastectomy. Methods: 158 patients were randomly divided into control group (n=97) and experimental group (n=61). The traditional pressurized bandaging was used in control group and non -pressurized bandaging was applied in experimental group, comparing the amount of drainage, the days of extubation, subcutaneous fluid collection, skin flap necrosis, wound healing, degree of skin lesions and the scoring of patient's comfort of the first 3 days after modified radical mastectomy. Results: No significant differences were found in the comparison of the days of extubation, subcutaneous fluid col-lection, skin flap necrosis and phase Ⅰ wound healing between the two groups [P>0.05) ; however, the amount of drainage the first 3 days after operation was less in experimental group than that in control group (P0.05).但实验组术后前3 d的引流量明显少于对照组(P<0.01);患者术后24 h及72 h舒适度评分均明显高于对照组(P<0.01);术后术野以外皮肤红肿发生率明显低于对照组(P<0.01),皮肤水泡发生率低于对照组(P<0.05).结论:无加压的皮辩护理可取得与传统加压包扎相同的疗效,且具有操作简单、患者感觉舒适、便于观察等优点.

  11. Nursing care of sectioned skin-flap ligation for early pedicle cut-off in 93 patients with Ⅲ-grade burns%93例Ⅲ度烧伤患者分段结扎皮瓣早期断蒂的护理

    Institute of Scientific and Technical Information of China (English)

    林玉丹; 黄书润; 邱双双; 李丽香; 沈秋凤

    2011-01-01

    This paper introduces the nursing care of sectioned skin-flap ligation for early pedicle cut-off in 93 patients with Ⅲ-grade burns. During pedicle ligation,nursing care focused on close observation of blood circulation of the skin flap,especially within the 24 hours after ligation,so as to detect and deal with problems as early as possible and prevent ischemia and necrosis of skin flap. Careful and gentle operations to relieve patients' pain on the premise of tight ligation. After ligation,the key points were changing dressings timely to prevent wound infection and suture reaction,as well as early functional exercises after pedicle cut-off. The average time of pedicle cut-off in the 93 patients was 10 days with good therapeutic outcome and without necrosis of skin flap.%对93例接受分段结扎皮瓣早期断蒂的患者进行观察及护理.认为护理要点包括:每次结扎蒂部时均严密观察皮瓣血液循环,特别是结扎后24h内,及时发现问题,并采取积极的处理措施,建立皮瓣情况评估单,预防皮瓣缺血、坏死;结扎时做到耐心沟通,动作轻柔,既保证扎紧蒂部又能减轻患者的疼痛;结扎后加强换药,减少伤口感染及线头反应等并发症;断蒂后尽早行功能锻练.本组平均断蒂时间10d,结扎或断蒂后皮瓣无坏死,随访结果满意.

  12. What Is the Ideal Free Flap for Soft Tissue Reconstruction? A Ten-Year Experience of Microsurgical Reconstruction Using 334 Latissimus Dorsi Flaps From a Universal Donor Site.

    Science.gov (United States)

    Kim, Jeong Tae; Kim, Sang Wha; Youn, Seungki; Kim, Youn Hwan

    2015-07-01

    Microsurgical free tissue transfer is regarded as the best available method of tissue reconstruction for intractable defects. The ideal soft tissue flap is thought to be the anterolateral thigh flap. On the basis of 334 procedures involving the latissimus dorsi (LD) flap, we discuss the advantages of the LD flap over the current universal option, and we aimed to establish whether the LD could also gain universal status in all reconstructive fields.Three hundred thirty-four reconstructive procedures using the LD flap were performed in 322 patients between September 2002 and July 2012. In accordance with defect characteristics, we performed 334 procedures using flaps, which included the LD muscle flap with skin graft, the myocutaneous flap, the muscle-sparing flap, the perforator flap, the chimeric flap, and the 2-flap technique using the serratus anterior branch.Flap-related complications occurred in 21 patients (6.3%), including total and partial flap failure. In 253 cases, the donor site was closed primarily, and in the remaining cases, we used split-thickness skin grafts. Donor-site complications occurred in 20 cases (6%). In 11 of the 182 cases, no suitable perforators were identified during surgery.The advantages of the LD as a donor site include the possibility of various harvesting positions without position change, versatility of components, availability of muscle to fill extensive defects, and presence of thick fascia to enable full abdominal reconstruction. On the basis of our experience, we concluded that this flap has the potential to be used as widely as, or in preference to, the anterolateral thigh flap in most reconstructive areas.

  13. Comparison of curative effects between chitosan artificial skin membrane and vaseline gauze in the treatment of medium-thick skin flap donor site%甲壳胺人工皮膜与凡士林纱布治疗中厚层皮片供区的疗效比较

    Institute of Scientific and Technical Information of China (English)

    黄秦邶; 陈陆平; 吕惠玲; 蔡建

    2015-01-01

    目的:比较甲壳胺人工皮膜与凡士林纱布治疗中厚层皮片供区的临床效果。方法骨外科具有完整临床资料以大腿部作为中厚层皮片供区的病例46例作为研究对象,随机分为观察组22例(采取甲壳胺人工皮膜治疗)和对照组24例(采取凡士林纱布治疗),对比两组治疗方法的临床效果。结果经过平均6个月随访,对照组瘙痒、皲裂或者溃疡以及脱屑的发生率为45.8%,高于观察组13.6%;色素脱失或沉着、瘢痕的发生率对照组明显高于观察组,观察组的两点辨别觉亦明显优于对照组,差异有统计学意义(P<0.01)。结论甲壳胺人工皮膜能有效地保护中厚层皮片供区创面,再生皮肤外形良好,质量高,并发症少,疗效确切,值得应用推广。%Objective To compare the curative effects between chitosan artificial skin membrane and vaseline gauze in the treatment of medium-thick skin flap donor site. Methods There were 46 patients with complete clinical data and medium-thick skin flap donor site in thigh as study subjects. They were randomly divided into observation group with 22 cases (received chitosan artificial skin membrane) and control group with 24 cases (received vaseline gauze). Clinical effects of the two groups were compared. Results After follow-up for average 6 months, the control group had higher incidences of pruritus, rahagades, anabrosis and desquamation as 45.8% than 13.6% of the observation group. The control group also had higher incidences of depigmentation, chromatosis, and scar then the observation group. The observation group had much better two-point identification feeling than the control group. Their difference had statistical significance (P<0.01). Conclusion Chitosan artificial skin membrane can effectively protect medium-thick skin flap donor site with good appearance and quality of regenerated skin. This method provides few complications and precise effect, and it is

  14. 足底的血管构筑与跖弓皮瓣、肌皮瓣对足跟缺损的修复%VASCULAR ARCHITECTURE IN SOLE AND ARCUS PLANTARIS SKIN OR MYOCUTANEOUS FLAP TO REPAIR HEEL DEFECT

    Institute of Scientific and Technical Information of China (English)

    李桦; 陈国华; 章惠英

    2000-01-01

    Objective: To provide anatomic basis of 3 set vascular network for using arcus plantaris skinor myocutaneous flap to repair the heel defect. Methods: 20 preserved adult cadavers and 4 adultcadavers perfused with red latex via artery were dissected, the origins, courses, branches, distri-butions and anastomosis of medial and lateral plantar arteries were observed. Results: Therewere 3 set vascular networks in sole of feet. 1. Medial branch and lateral branch of medial plan-tar artery course deep to the abductor hallucis, forming medial vscular network in sole. 2. Lateralbranch of medial plantar artery anostomosed with minor branch of lateral plantar artery forms thesuperficial plantar arch between the aponeurosis plantaris and flexor digitorum brevis. 3. Medialbranch of medial plantar artery anostomosed with main branch of lateral plantar artery forms thedeep plantar arch between oblique head of adductor hallucis and interosseus muscles. Conculsion:The 3 set vascular network provide reliable blood supply for skin or myocutaneous flap. Espicial-ly medial plantar mycutaneous flap has 2 set of blood supply origining medial and lateral branchesof medial plantar artery. If one branch was damaged, the other would nourishes the flap.%目的:用跖弓皮瓣、肌皮瓣修复足跟缺损,提供足底三套血管网分布特点的解剖学依据。方法:在20例福尔马林、4例红色乳胶灌注的成人尸体标本上,观察足底内、外侧动脉的起始、行径、分支及其吻合情况。结果:足底共有三套血管网供血:1.足底内侧动脉的内、外侧支在 展肌深面分支分布,形成足底内侧血管网。2.足底内侧动脉外侧支与足底外侧动脉的分支在足底腱膜与趾短屈肌之间吻合形成足底浅弓。3.足底内侧动脉的内侧支与足底外侧动脉的主干在 收肌斜头与骨间肌之间形成足底深弓。结论:足底的三套血管网,为利用跖弓皮瓣、肌皮瓣修复提供了可

  15. 低位皮支高位切取骨间背侧动脉逆行岛状皮瓣的临床应用%Clinical Application of Low Cutaneous Branches in High Cutting Took Bone between Dorsal Artery Retrograde Island Flap

    Institute of Scientific and Technical Information of China (English)

    吴迪; 利春叶; 黄河; 刘华红; 罗勇坚; 魏建营

    2011-01-01

    目的:介绍低位肌间隙筋膜皮肤穿动脉改良传统骨间背侧皮瓣的切取方法以及对各种不同受伤类型的治疗效果.方法:设计倒水滴状皮瓣,利用其皮角携带前臂中下1/3低位肌间隙皮肤穿动脉切取高位骨间背侧皮瓣11例,评价术后手指总的主动活动度.结果:术后皮瓣全部顺利成活,优9例,良和可各1例.结论:该术式避免了传统骨间背侧皮瓣切取中骨间背侧神经的解剖与损伤,使手术大为简化.%Objective: To introduce low muscle fascia and skin clearance improve wear the traditional posterior interosseous artery flap cut. Method: Inverted teardrop-shaped flap, with its leather carrying angle of the forearm in the 1 / 3 lower of the low clearance of skin muscle arteries cut through the high posterior interosseous flap in 11 cases, the total active finger was evaluated activity. Result: All flaps survived well, excellent in 9 cases, good and could be in 1. Conclusion: This technique avoids the traditional posterior interosseous flap in the posterior interosseous nerve anatomy and injury, the surgery greatly simplified.

  16. Heel and foot reconstruction using reverse-flow posterior tibial flap.

    Science.gov (United States)

    Satoh, K; Sakai, M; Hiromatsu, N; Ohsumi, N

    1990-04-01

    Island flaps supplied by the intermuscular cutaneous perforator (IMCP) from a deep vessel, such as the peroneal flap pedicled by IMCP from the peroneal vessel or the anterior tibial flap supplied by IMCP from the anterior tibial vessel, are reported to be useful in reconstructive procedures for soft-tissue defects of the lower leg. However, the posterior tibial flap, pedicled by IMCP from the posterior tibial vessel, has not yet been fully described. The posterior tibial flap can be used either as a normal-flow or as a reverse-flow flap. It is particularly versatile as a reverse-flow flap for reconstruction of soft-tissue defects of the heel and foot. Three reverse-flow posterior tibial flaps were clinically applied, without venous anastomosis, to reconstruct heel and foot defects, and all three survived completely. The operative procedure and its characteristics are described.

  17. Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft

    DEFF Research Database (Denmark)

    Toft, Peter B

    2016-01-01

    skin graft. RESULTS: All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after...

  18. 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

    目的 探讨四肢电烧伤创面皮瓣修复的修复方法和手术适应证. 方法 1997年5月-2014年6月,共收治四肢电烧伤后软组织缺损患者38例,分别于电烧伤后7~14d内采用了皮瓣修复,其中局部旋转皮瓣4例,鱼际皮瓣1例,示指背侧皮瓣2例,交腿皮瓣1例,足底内侧皮瓣1例,带蒂背阔肌皮瓣2例,前臂骨间后动脉逆行岛状皮瓣4例,掌背动脉逆行岛状皮瓣4例,髂腹股沟皮瓣10例;游离桡动脉皮瓣1例,游离背阔肌皮瓣1例,游离股前外侧皮瓣3例;前臂后侧骨间前动脉穿支逆行岛状皮瓣1例,小腿后侧穿支逆行岛状皮瓣2例,小腿前外侧穿支逆行岛状皮瓣1例.皮瓣切取范围42.0 cm×13.0 cm~6.0 cm×3.0 cm.结果 术后随访时间4~42个月,平均6、7个月.皮瓣完全成活35例,占92.1%;尖端部分坏死3例,占7.9%.坏死部分经局部换药均在术后1个月内自行愈合.肢体和手的外形较为满意,手腕部电烧伤病例28例,功能优和良共15例,占57.1%;中8例,占28.6%;差5例,占14.3%. 结论 对电烧伤创面进行早期皮瓣修复,是保护肢体深部组织结构、预防控制继发感染、最大限度保留肢体功能的有效方法.%Objective To investigate the surgical indications and repair methods for the treatment of electrical bums in the limbs.Methods Thirty-eight cases since May,1997 to June,2014 who underwent flap treatment in 7-14 days after electrical bums was summarized.Among these patients,4 cases were treated by local flaps,1 case was treated by thenar flap,2 cases were treated by dorsal island skin flap of the index finger,1 case was treated by cross-leg flap,1 case was treated by medial plantar skin flap;2 cases were treated by pedicle latissimus dorsi flaps,4 cases were treated by antebrachial flap with a pedicle of the posterior interosseous artery,4 cases were treated by metacarpal artery reversed island flaps,10 cases were treated by groin flaps;1 case was treated by free radial

  19. "V"形皮瓣推移成形术治疗手指末节离断伤%Skin flap advanced plasty for the isolated distal segment finger

    Institute of Scientific and Technical Information of China (English)

    陈诗强

    2010-01-01

    目的 探讨手指末节离断缺损并骨外露的治疗方法.方法 采用指腹皮瓣推移成形术治疗手指末节离断缺损并骨外露84例.结果 手指末节离断缺损并骨外露84例,男50例,女34例.年龄14个月~46岁;其中钝器切割伤26例,机器碾压伤48例,门夹伤5例,狗咬伤5例.受伤时间0.5~13 h.指腹皮瓣推移后全部成活,外观美观,皮肤感觉良好,皮瓣推移成形修复指端缺损及骨外露,取得良好效果,末节缺损后对手的功能基本无影响.结论 采用皮瓣推移成形术,能一步到位,术后患肢愈合良好,外观功能无差异,不会再缩短患肢,不需二期手术,也可以在门诊手术治疗,不须住院,手术创伤小,出血量少,术后恢复快,且方法简单易行,对技术及设备均没有严格的要求,是治疗手指末节离断伤的一种简单及有效的手术方法.%Objective To try find out the treatment method of the isolated distal segment finger. Methods 84 cases with the isolated distal segment finger were treated by skin flap advanced plasty. Results There were 50 cases in men and 34 cases in female. The age was from 14 month to 46 year old. 26 cases were injuried by blunt cutting ,48 cases by inventory mangled injury ,5case by door clip and 5 case by dog bitting. The injuried time was 0.5 to 13 hours. Advanced skin flap in all cases were alive. The appearance of all injuried fingers were good and the function was one of effective and simple methods for the isolated distal segment finger. Conclusion Adopt piece of the skill developing skin, can achieve a goal in one leap, skill future trouble limb coalescence is fine, the outward appearance function has no difference, be unable to shorten the trouble limb again,have no need of two phasese of operation, also not bad in outpatient service operation treat, do not have to be in hospital. The operation wound is small, bleeding amounts are few, the skill queenrecovers quickly, method is easy to do and

  20. The keystone-design perforator-based flap for leg defects: a synthesis of philosophies

    Directory of Open Access Journals (Sweden)

    Jerry R John

    2014-09-01

    Full Text Available Aim: The classical keystone-design flap, although elegantly employed for various trunk defects, has limited movement on the leg. This study aims to modify the keystone-design flaps for leg defects. Methods: A keystone-design flap, in which perforators are identified and dissected, is described specifically for elliptical defects overlying the tibia. Results: It retains the unique advantages of both the perforator island flap concept as well as the keystone-design philosophy. Conclusion: The technique as well as the possibilities of raising such flaps over various areas of the leg is outlined.

  1. Value of the post-operative CT in predicting delayed flap failures following head and neck cancer surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bitna; Yoon, Dae Young; Seo, Young Lan; Park, Min Woo; Kwon, Kee Hwan; Rho, Young Soo; Chung, Chul Hoon [Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of)

    2017-06-15

    To identify post-operative computed tomography (CT) findings associated with delayed flap failures following head and neck cancer surgery. We retrospectively reviewed 60 patients who underwent flap reconstruction after head and neck cancer surgery and post-operative (3–14 days) contrast-enhanced CT scans for suspected complications. Patients were divided into two groups: delayed flap failure patients (patients required flap revision) (n = 18) and flap success patients (n = 42). Clinical data (age, sex, T-stage, type of flap, and time interval between reconstruction surgery and CT) and post-operative CT findings of flap status (maximum dimension of the flap, intra- or peri-flap fluid collection and intra- or peri-flap air collection, fat infiltration within the flap, fistula to adjacent aerodigestive tract or skin, and enhanced vascular pedicle) were assessed and compared between the two groups. CT findings showed that the following flap anomalies were observed more frequently in the delayed flap failure group than in the flap success group: intra- or peri-flap fluid collection > 4 cm (61.1% vs. 23.8%, p < 0.05), intra- or peri-flap air collection > 2 cm (61.1% vs. 2.4%, p < 0.001), and fistula to adjacent aerodigestive tract or skin (44.4% vs. 0%, p < 0.001). The maximum dimension of the flap, fat infiltration within the flap, and enhanced vascular pedicle were not associated with delayed flap failures. A large amount of fluid or air collection and fistula are the CT findings that were associated with delayed flap failures in patients with suspected post-operative complications after head and neck cancer surgery.

  2. Versatility of the Anterolateral Thigh Free Flap: The Four Seasons Flap

    Science.gov (United States)

    Di Candia, Michele; Lie, Kwok; Kumiponjera, Devor; Simcock, Jeremy; Cormack, George C.; Malata, Charles M.

    2012-01-01

    Presented at the following academic meetings: ○ 56th Meeting of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery (SICPRE) Fasano (Brindisi), Italy, September 26-29, 2007 ○ 42nd Meeting of the European Society for Surgical Research (ESSR), Warsaw, Poland, May 21-24, 2008 ○ Winter Meeting, British Association of Plastic, Reconstructive and Aesthetic Surgeons, (BAPRAS) London, December 1-3, 2009 Background: The anterolateral free flap has become increasingly popular at our institution year on year. We decided to review our experience with this flap and study the reasons for this trend. Methods: A retrospective review of all anterolateral thigh free flaps performed at Addenbrooke's University Hospital from the available charts was carried out. This chart review included patients' demographics, indications, flap size, recipient vessels used, ischemia time, flap, and donor site outcomes. All flap perforator vessels were located preoperatively using a handheld Doppler ultrasound probe. Results: From October 1999 to December 2008, 55 anterolateral thigh flaps were performed in 55 patients to reconstruct a variety of soft-tissue defects (upper and lower limbs, chest wall, skull base, head and neck). Flap size ranged 12 to 35 cm in length and 4 to 11 cm in width. During flap elevation, the main supply to the flap was found to be a direct septocutaneous perforator in 41% (n = 23) of the cases as opposed to a musculocutaneous perforator, which was found in 59% (n = 32). The mean ischemia time was 82 minutes (range, 62-103). The overall flap success rate was 100%. Two flaps were successfully salvaged after reexploration for venous congestion. The donor site morbidity was minimal. The mean follow-up time was 18 months (range, 2-48). Discussion and Conclusion: The anterolateral thigh free flap was found to be a very reliable flap (100% success) across a wide range of clinical indications. It facilitates microvascular anastomoses as evidenced by the short

  3. Tratamiento del xantogranuloma palpebral en el adulto mediante colgajos en isla del área zigomática Treatment of adult eyebrow xanthogranuloma with a zygomatic island flap

    Directory of Open Access Journals (Sweden)

    C. León Llerena

    2009-06-01

    Full Text Available El término Xantoma, introducido por Frank Smith en 1869, significa tumor amarillo. El Xantogranuloma en el adulto es una afección cutánea inusual, de localización única, sin afectación visceral y que no remite espontáneamente. La afectación palpebral representa el 25% de los casos y en la mayoría de los casos suele ser un nódulo solitario. Presentamos el caso de un paciente varón de 58 años que acude a nuestro Servicio de Cirugía Plástica por presentar extensas lesiones palpebrales nodulares y bilaterales, de crecimiento lento y coloración amarillenta. Las lesiones fueron diagnosticadas histopatológicamente como xantogranulomas. El defecto palpebral fue reparado mediante un colgajo en isla del área zigomática, descrito por Heywood en 1991, modificado en su diseño original. Nuestro objetivo es describir el Xantogranuloma en el adulto por tratarse de una patología poco frecuente, sus características histológicas y sus posibles diagnósticos diferenciales. Destacamos la utilidad y versatilidad del colgajo zigomático ampliado como una excelente alternativa para la reparación de amplios defectos cutáneos palpebrales inferiores.The term anthoma, meaning yellow tumor, was introduced by Frank Smith in 1869. Xanthogranuloma in adults is an unusual single-site, cutaneous tumor, with no visceral involvement and without spontaneous regress. Palpebral xanthomas account for 25% of all cases, most of which usually involve a solitary nodule. We present a 58-year-old man who was referred to our Plastic Surgery Service with large, yellowish, slow-growing, bilateral palpebral lesions. The histological diagnosis was xanthogranuloma. The palpebral defect was repaired using an island flap from the zygomatic area, described by Heywood in 1991 and modified from the original design. We describe adult xanthogranulomas, which are unusual lesions, and discuss the histological study and differential diagnosis. We also draw atention to the usefulness

  4. 阴茎腹外侧皮瓣耦合法尿道成形Ⅰ期修复阴茎阴囊型尿道下裂%Ventral-lateral penile skin flap combined with mucosa or skin grafting for urethroplasty: single-stage procedure for penoscrotal hypospadias

    Institute of Scientific and Technical Information of China (English)

    谢林海; 李强; 李森恺; 周传德; 李峰永; 周宇; 丁健; 曹玉娇; 张思娅

    2013-01-01

    目的 评价阴茎腹外侧皮瓣在尿道成形中的作用.方法 根据解剖特点设计一个含畸形尿道海绵体的阴茎腹外侧皮瓣.横断短缩的尿道板以彻底矫直阴茎,尿道板缺损段移植颊黏膜或包皮内板皮片,与皮瓣耦合成形尿道,Ⅰ期修复原发阴茎阴囊型尿道下裂.结果 本组共16例患者.所用阴茎腹外侧皮瓣均血供良好、长宽足够、术后无坏死.移植组织7例为颊黏膜,9例为包皮内板皮肤.术后并发症包括尿道口狭窄2例(12.5%)和尿道口腹侧小块组织坏死而遗留大口型尿道下裂1例(6.25%).余患者Ⅰ期治愈,无并发症,术后随访0.5~2.0年,阴茎无弯曲,外观良好,尿道开口正位.结论 应用腹外侧皮瓣耦合移植组织成形尿道有利于阴茎矫直,术后尿道瘘及狭窄发生率低,是修复阴茎阴囊型尿道下裂的较好术式.%Objective To evaluate the effect of ventral-lateral penile skin flap in urethroplasty. Methods While performing single-stage procedure for penoscrotal hypospadias, a ventral-lateral penile skin flap including abnormal corpus spongiosum that beneath it was formed according to its anatomical characteristic, the u-rethral plate was transected to complete penile straightening, the plate defect was corrected by buccal mucosa or inner foreskin grafting. The neourethra was constructed with a combination of the flap, the plate, and the graft. Results Totally 16 patients were included. The flap was well vascularized and wide enough, long enough for urethroplasty, no flap necrosis occurred postoperatively. Buccal mucosa and inner foreskin grafting were performed in 7 and 9 cases, respectively. Complications were meatus stricture in 2 cases and necrosis of small piece of ventral glanular tissue in 1 case. The former demanded second operation; the latter resulted in a me-gameatus. The remaining cases were cured without complications. All patients were followed for 0. 5 to 2. 0 years, penile appearance was

  5. Reversed sural neurocutaneous island flap combined with external fixation to repair the soft tissue defect in the heelstick%外固定支架结合腓肠神经营养血管逆行岛状皮瓣转移治疗足跟软组织缺损

    Institute of Scientific and Technical Information of China (English)

    贾鹏; 万春友; 舒衡生; 王凯

    2015-01-01

    Objective:To investigate the clinical effect of the reversed sural neurocutaneous island flap combined with external fixation to repair the soft tissue defect in the heelstick. Methods:Sixteen cases of the heelstick soft tissue defects were treated with the reversed sural neurocutaneous island flap combined with external fixation. The wound secretion bacteria cultures and drug sensitive test were performed on all patients before operation and thorough debridement, then the reversed sural neurocutaneous island flap was applied (area of flap 4 cm×6 cm-12 cm×9 cm). Finally, the adaptive external fixation according to associated injuries was used in operation. Results:All patients were followed up for 5 to 36 months, and the mean follow-up period was 12 months. The flaps of 16 cases all survived. All flaps were fine quality, Wear-resisting, without obvious contracture, no ulcer, infection or necrosis occurred in the weight area. The function of ankles were good, with the dorsal extension of 0° to 20°and the plantar flexion of 30° to 40°. Conclusion:The reversed sural neurocutaneous island flap combined with external fixation can improve the limb function and the flap survival with good clinical effect.%目的:探讨外固定支架结合腓肠神经营养血管逆行岛状皮瓣转移治疗足跟软组织缺损的疗效。方法:应用组合式外固定支架及Ilizarov外固定支架结合腓肠神经营养血管逆行岛状皮瓣转移术修复足跟皮肤缺损16例。术前常规行创面分泌物细菌培养和药敏试验,术中彻底清创,再行腓肠神经营养血管逆行岛状皮瓣转移(皮瓣面积4 cm×6 cm~12 cm×9 cm),最后根据合并伤的不同选择适合的外固定支架固定。结果:所有病例均获得随访,随访时间5~36个月,平均12个月,16例皮瓣全部成活,皮瓣质地优良,耐磨,无明显挛缩,负重功能区未发生破溃及感染坏死。踝关节背伸0°~20°,跖屈30°~40

  6. 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.

  7. Research the method of axillary osmidrosis treatment use filmy skin flap in armpit wrink%腋窝皱襞切口薄皮瓣法治疗腋臭的研究

    Institute of Scientific and Technical Information of China (English)

    张郑; 李亮

    2010-01-01

    Objective Study the curative effect of axillary osmidrosis treatment,that incision in armpit wrink, orthoptic cut off the gland to filmy skin flap. Methods Collect axillary osmidrosis patient 197 example in recent years, adoption armpit wrink 394 example, the scope of surgical operation super the armpit hair distribute 1 cm, swelling anaesthesia, orthoptic cut off the armpit organization 5 cm under skin include big gland, keep the operation scope to vessal net flap under skin. Hematischesis thoroughly use a double pole electricity hemostasis,keep dnge after operation,bandaging in pressure,sutures out after 7 d. Results The foul smell standard reference the Tung-Chain' standard of axillary osmidrosis curative effect evaluation. cure 387 armpit, accout of 97.97% ;show excellence 7 example, accout of 2.03%; invalid 0. The armpit hair varity: obvious reduc 368example,have 90.4%; general rduce 19 example, have 9.66%; not obvious reduce 0. Perspire condition:Obvious reduce 342 example,have 86.80%; not obvious Improvement 52 example,have 13.20% ;Have no variety 0. The surgical operation instauration time average about 7 days. Complication:necrosis on the edge of the skin is 8; scar formation on the incision is 3 example; hematoma is 1 example; the shoulder joint is limit accout of 0. Conclusion The method of axillary osmidrosis treatment use filmy skin flap in armpit wrink, it have exterimination foundation of anatomy and pathology, which can cause axillary osmidrosis, this operation is simple, curative effect is credibility, the wound is small, complication is little etc. utmost match the principle of orthopedic surgery, worthy of clinical application.%目的 探讨腋窝皱襞切口直视剪除大汗腺至薄皮瓣法治疗腋臭的疗效.方法 收集近年来腋臭患者197例,采用腋窝皱襞切口394个,手术范围超腋毛分布l cm,肿胀麻醉,直视下剪除包含大汗腺的腋部皮下组织5 mm左右,直至手术范围皮肤形成真皮下血管网皮瓣.

  8. Cervicopectoral flap in head and neck cancer surgery

    Directory of Open Access Journals (Sweden)

    Sivrioglu Nazan S

    2003-12-01

    Full Text Available Abstract Background Reconstruction of the head and neck after adequate resection of primary tumor and neck dissection is a challenge. It should be performed at one sitting in advanced tumors. Defects caused by the resection should be closed with flaps which match in color, texture and hair bearing characteristics with the face. Cervicopectoral flap is a one such flap from chest and neck skin mainly used to cover the cheek defects. Methods This study included twelve patients presenting with cancer of the head and neck to Izmir Ataturk Training Hospital and Adnan Menderes University Hospital. Tumor resection and neck dissection was performed in one session by the same surgeon. A single incision was made and a medially based cervicopectoral fascio-cutaneous flap was used for surgical exposure in neck dissection and for closure of defects after tumor resection. Results There was no major complication. Two flaps had partial superficial epidermolysis at the suture line. Good aesthetic and functional results were achieved. Conclusion The cervicopectoral flap is an excellent alternative for the reconstruction of head and neck. Harvesting and application of the flap is rapid and safe. Only a single incision is sufficient for dissection and flap elevation. This flap achieves perfect surgical exposure, makes neck dissection easy and allows one to perform both tumor resection and neck dissection in one session.

  9. The transverse musculo-cutaneous gracilis flap for breast reconstruction: How to avoid complications.

    Science.gov (United States)

    Bodin, Frédéric; Dissaux, Caroline; Dupret-Bories, Agnes; Schohn, Thomas; Fiquet, Caroline; Bruant-Rodier, Catherine

    2016-01-01

    The transverse musculocutaneous gracilis (TMG) flap has become a common solution for breast reconstruction. However, the safe skin paddle limits are not yet understood. In this study, we attempted to address this issue based on our experiences with inferior and posterior skin paddle extension. Forty-four breast reconstructions with TMG flaps performed between November 2010 and January 2014 were analyzed retrospectively. For the first 20 cases, the flap skin paddle was extended 3 cm posteriorly to the middle thigh (group 1). For the next 20 flaps (group 2), the posterior tip was limited to this line, whereas more fat was recruited inferiorly. In the four cases of group 3, the skin flap was extended posteriorly with a second vascular pedicle from the profunda artery perforator (PAP) flap. The weights and the dimensions of the flaps, operating durations, and postoperative complications of the entire series were analyzed. Groups 1 and 2 were statistically compared. Flap complications were statistically more frequent in group 1 compared with group 2 (45 vs. 0%, P = 0.0012); 40% posterior flap tip necrosis was observed in group 1. Conversely, donor site complications were statistically more frequent in group 2 than in group 1 (40 vs. 5%, P = 0.019) with 35% inner thigh dehiscence. In the TMG with extended PAP flap group, the operating duration was 77 min longer compared with the rest of the series with no donor site complications. In one case, limited necrosis occurred at the anterior skin tip. Harvesting the posterior portion of the TMG up to the middle of the posterior thigh may lead to partial flap necrosis. Extending subcutaneous fat removal under the inferior skin incision may increase the risk of donor site complications. Adding a second vascular pedicle from the PAP flap may improve posterior TMG tip perfusion at the expense of a longer operation. © 2015 Wiley Periodicals, Inc.

  10. 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.

  11. The Application of the Penile-scrotal Skin Flap for Male to Female Transsexual%阴茎阴囊皮瓣在男变女变性术中的应用

    Institute of Scientific and Technical Information of China (English)

    赵玉斌; 赵少华; 牟少春; 杨彪炳; 唐胜建

    2012-01-01

    Objective To investigate the application of the penile-serotal skin flap in the reconstruction of pudendum and vaginal of male to female transsexual. Methods The penile-serotal flap was used in the reconstruction of pudendum and vaginal. And the dorsal portion of the glans penis with the dorsal neurovascular pedicle was used for the reconstruction of clitoris. From January 1996 to December 2010, there were 14 men received male-female transgender surgery. Results All the 14 men survived with morphology satisfaction. One patient suffered from the rectovaginal fistula and was cured by neoplasty. The mean follow-up was 7 years and there was no severe complication. 5 patients were married and felt satisfactory to their sex life with the masculine companion, because the clitoris could erect normally and the voluptus was sensitive. Conclusions Application of penis-scrotum flap for the reconstruction of vagina, clitoris and vulva can take full advantage of their external genitalia material. And it is an ideal surgical method for the vaginal, clitoral, and vulval substitution.%目的 探讨阴茎阴囊皮瓣在男变女变性术中再造阴蒂、阴道及外阴的应用价值.方法 自1996年1月至2010年12月,在我院行男变女变性术的14例患者,应用阴茎阴囊皮瓣再造阴道、外阴,并以带血管神经蒂的部分龟头组织进行阴蒂再造.结果 14例易性癖患者再造阴道、阴蒂、外阴等组织均在2周~1月内成活,再造阴道内壁弹性较好,外阴形态满意,遂出院.1例患者术后出现直肠阴道瘘,经行修补术及加强换药后痊愈出院.3例患者术后3月出现再造阴道组织变浅及变窄,1年后二期行阴道挛缩畸形矫正术.14例患者均获随访,随访时间平均7年,5例患者已结婚,婚后与男性伴侣性生活时阴蒂能正常勃起且感觉较敏锐.结论 应用阴茎阴囊皮瓣再造阴道、阴蒂、外阴组织能充分利用患者本身的外生殖器材料,是一种比较理想的手术方式.

  12. 扩张耳后皮瓣联合自体肋软骨移植矫正耳甲腔型小耳畸形%Expanded post-auricular skin flap combined with autologous rib cartilage framework for correction of concha-type microtia

    Institute of Scientific and Technical Information of China (English)

    于晓波; 蒋海越; 潘博; 赵延勇; 林琳

    2014-01-01

    Objective To explore the clinical effect of the method by using an expanded postauricular skin flap combined with autologous rib cartilage framework for correction of concha-type microtia.Methods The operation were performed in three stages.The expander was implanted under post-auricular skin at the first stage and expanded skin flap was formed.At the second stage,the expander was taken out and the expanded skin flap was transferred with autologous rib cartilage framework and skin graft for correction of microtia.At the third stage,the reconstructed ear was revised and new concha was formed.Results From August 2008 to August 2011,108 cases with 113 concha-type microtia were corrected by this method.All patients healed primarily and were followed up for 6 months to 3 years.The reconstructed ears had a good appearance and position,and were symmetric to ear on the healthy sides.Conclusions Using expanded post-auricular skin flap combined with autologous rib cartilage framework is a reliable method for concha-type microtia.%目的 探讨应用耳后扩张皮瓣联合自体肋软骨支架移植矫正先天性耳甲腔型小耳畸形的临床效果.方法 手术分3期:一期制备耳后扩张皮瓣,二期扩张器取出、扩张皮瓣转移、自体肋软骨支架移植、中厚皮片移植术,三期再造耳修整,耳甲腔成形术.结果 2008年8月至2011年8月,应用上述方法修复先天性耳甲腔型小耳畸形108例113只耳,术后患者伤口均一期愈合,均获随访6个月至3年,平均12个月.患者术后再造耳廓形态良好,外耳解剖结构清晰,颅耳角位置、大小、形态与健侧基本一致.结论 扩张耳后皮瓣法联合肋软骨支架移植是修复耳甲腔型小耳畸形的一种较理想可靠的方法.

  13. [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.

  14. 血流动力学指标对创伤后软组织缺损带血管蒂修复术后皮瓣坏死的预测价值#%Predictive Value of Hemodynamic Index of Trauma with Vascular Pedicle to Repair Soft Tissue Defect after Surgery with Skin Flap Necrosis

    Institute of Scientific and Technical Information of China (English)

    黄德金

    2015-01-01

    目的:探讨血流动力学指标对创伤后软组织缺损带血管蒂修复术后皮瓣坏死的预测价值。方法:选取2010年2月至2014年3月期间我院确诊并通过带血管蒂修复术治疗后皮瓣坏死的创伤后软组织缺损患者50例作为修复组,依据皮瓣坏死程度分为重度组、中度组、轻度组,选取同期体检中心健康人员10例作为健康组,对所有受试者均进行不同时点的血流速度(BFV)、血流灌注量相对值(BPR)检测,采用Spearman分析法对血流动力学指标与皮瓣坏死程度关系进行分析,统计分析所有受试者的血流动力学指标。结果:修复组患者各时点BFV、BPR水平明显低于健康组,差异有统计学意义(P<0.05);在各时点BFV、BPR水平方面:重度组<中度组<轻度组,差异有统计学意义(P<0.05);Spearman分析法结果显示,BFV、BPR水平与皮瓣坏死程度呈负相关(r1=-0.512;P1<0.05;r2=-0.671;P2<0.05)。结论:BFV、BPR与皮瓣的存活具有密切联系,可作为预测带血管蒂修复术治疗创伤后软组织缺损患者术后皮瓣坏死的重要预测指标。%Objective: To discuss the predictive value of hemodynamic index of trauma with vascular pedicle to repair soft tissue defect after surgery with skin flap necrosis.Methods:50 patients with skin flap necrosis were selected in our hospitals as repair group, according to the degree of skin flap necrosis,all patients were divided into heavy group, medium group, mild group, at the same time 10 cases of the healthy physical examination center person were selected as healthy group, all the subjects were tested different point of blood flow velocity (BFV), blood perfusion relative (BPR), Spearman analysis on the relationship between hemodynamic and the degree of the skin flap necrosis,analysed the hemodynamic parameters of all subjects.Results:Repair group each point BFV, BPR was significantly lower than

  15. 扩张颞浅血管蒂头部皮瓣移植联合激光脱毛修复面部皮肤缺损%Scalp flaps pedicled with superficial temporal vessel and hair removal for reconstruction of facial skin defects

    Institute of Scientific and Technical Information of China (English)

    陈石海; 于海生; 刘庆丰; 麦慧; 韦强; 廖明德

    2012-01-01

    目的 探讨扩张颞浅血管蒂头部皮瓣移植联合激光脱毛修复面部皮肤缺损的临床效果.方法 2010年1月至2011年12月,对6例面部大面积瘢痕患者,应用扩张颢浅血管蒂头部皮瓣移植联合激光脱毛治疗.治疗过程分三期进行.一期:根据面部瘢痕的大小和形状在同侧头部放置皮肤扩张器,术后定期注水扩张.二期:待扩张头皮组织量达到要求后,取出扩张器,形成颞浅血管蒂的头部皮瓣,移植修复面部皮肤缺损.三期:二期术后2周,开始对移植皮瓣进行激光脱毛,一般4~6次治疗后皮瓣毛发消脱干净.结果 6例7块皮瓣完全覆盖面部皮肤缺损,血供良好,全部存活,供区皮肤直接拉拢缝合;激光脱毛效果肯定.经术后6个月至1年随访,皮瓣与周围皮肤组织在色泽、质地、厚度等方面较匹配,面部轮廓、形态及美学效果均满意.结论 扩张颞浅血管蒂头部皮瓣移植联合激光脱毛是修复面部大面积皮肤缺损的较好方法.%Objective To investigate the therapeutic effect of scalp flaps pedicled with superficial temporal vessel and hair removal for reconstruction of facial skin defects.Methods From Jan.2010 to Dec.2011,6 cases with large facial skin defects were treated with scalp flaps pedicled with superficial temporal vessel and hair removal.At the first stage,the skin expanders were implanted subcutaneously at the homolateral side according to the defect size.After the expansion was finished,the expanded flaps pedicled with superficial temporal vessel were used to reconstruct the facial skin defects at the second stage.2 weeks after operation,hair removal was performed to remove the hair on flaps.4-6 treatments were needed.Results Seven flaps in 6 cases were survived completely.The wounds at donor sites were closed directly.The effect of hair removal was reliable.The patients were followed up for 6 months to 1 year.The flap color,texture and thickness had a good match with

  16. [Thoracodorsal pedicled perforator flap for chest wall and breast reconstruction in children: Illustration with two clinical cases].

    Science.gov (United States)

    Minetti, C; Colson, T; Gisquet, H; Pujo, J; Brix, M; Simon, E

    2014-02-01

    Perforator flaps represent a new approach in reconstructive surgery including the thoracodorsal perforator flap. It can be used as a free or pedicled tissue transfer. By exposing two clinical cases, we demonstrate that this flap is an interesting option for children and adolescents chest wall skin coverage with less morbidity compared to myocutaneous latissimus dorsi flap. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  17. Intercostal artery perforator propeller flap for reconstruction of trunk defects following sarcoma resection.

    Science.gov (United States)

    Zang, Mengqing; Yu, Shengji; Xu, Libin; Zhao, Zhenguo; Zhu, Shan; Ding, Qiang; Liu, Yuanbo

    2015-06-01

    Trunk defects following soft tissue sarcoma resection are usually managed by myocutaneous flaps or free flaps. However, harvesting muscle will cause functional morbidities and some trunk regions lack reliable recipient vessels. The intercostal arteries give off multiple perforators, which distribute widely over the trunk and can supply various pedicle flaps. Our purpose is to use various intercostal artery perforator propeller flaps for trunk oncologic reconstruction. Between November 2013 and July 2014, nine intercostal artery perforator propeller flaps were performed in seven patients to reconstruct the defects following sarcoma resection in different regions of the trunk, including the back, lumbar, chest, and abdomen. Two perforators from intercostal arteries were identified for each flap using Doppler ultrasound probe adjacent to the defect. The perforator with visible pulsation was chosen as the pedicle vessel. An elliptical flap was raised and rotated in a propeller fashion to repair the defects. There were one dorsal intercostal artery perforator flap, four dorsolateral intercostal artery perforator flaps, three lateral intercostal artery perforator flaps, and one anterior intercostal artery perforator flap. The mean skin paddle dimension was 9.38 cm in width (range 6-14 cm) and 21.22 cm in length (range 13-28 cm). All intercostal artery perforator flaps survived completely, except for marginal necrosis in one flap harvested close to the previous flap donor site. The intercostal artery perforator propeller flap provides various and valuable options in our reconstructive armamentarium for trunk oncologic reconstruction. To our knowledge, this is the first case series of using intercostal artery perforator propeller flaps for trunk oncologic reconstruction and clinical application of dorsolateral intercostal artery perforator flaps. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All

  18. The effect of topical minoxidil pretreatment on nonsurgical delay of rat cutaneous flaps: further studies.

    Science.gov (United States)

    Gümüş, Nazım; Odemiş, Yusuf; Tuncer, Ersin; Yılmaz, Sarper

    2013-08-01

    The purpose of this study was to determine the effectiveness of topically applied minoxidil in the pharmacological delay phenomenon and to demonstrate the comparable microscopic and macroscopic changes between minoxidil-pretreated flaps and surgically delayed flaps. A modified version of the McFarlane flap was used. Group 1 rats, in which a caudally based dorsal skin flap was raised and sutured back, were the control group. In group II, minoxidil solution was spread over the marked skin flap area for 7 days. On the 7th day, a caudally based dorsal skin flap was elevated and then sutured back. Group III rats underwent a surgical delay procedure alone. On the 7th day after flap elevation, evaluation was done by histologic examination and calculation of the flap survival areas in all groups. The lowest flap survival rate appeared in group I and was statistically different from groups II and III. The mean surviving skin flap area in the minoxidil-pretreated group was significantly larger than that in the control group. After histologic evaluation, moderate angiogenesis was also detected in group II. We also found that surgical delay significantly reduced flap necrosis when compared to the minoxidil pretreatment group. According to our study, minoxidil may be considered an effective vasoactive agent for the stimulation of angiogenesis in rat cutaneous flaps and capable of achieving pharmacological delay and increasing flap survival. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  19. The Anconeus Muscle Free Flap: Clinical Application to Lesions on the Hand

    Directory of Open Access Journals (Sweden)

    Byung-Joon Jeon

    2017-09-01

    Full Text Available Background It can be difficult to select an appropriate flap for various defects on the hand. Although defects of the hand usually must be covered with a skin flap, some defects require a flap with rich blood supply and adequate additive soft tissue volume. The authors present their experience with the anconeus muscle free flap in the reconstruction of various defects and the release of scar contractures of the hand. Methods Ten patients underwent reconstruction of the finger or release of the first web space using the anconeus muscle free flap from May 1998 to October 2013. Adequate bed preparations with thorough debridement or contracture release were performed. The entire anconeus muscle, located at the elbow superficially, was harvested, with the posterior recurrent interosseous artery as a pedicle. The defects were covered with a uniformly trimmed anconeus muscle free flap. Additional debulking of the flap and skin coverage using a split-thickness skin graft were performed 3 weeks after the first operation. Results The average flap size was 18.7 cm2 (range, 13.5–30 cm2. All flaps survived without significant complications. Vein grafts for overcoming a short pedicle were necessary in 4 cases. Conclusions The anconeus muscle free flap can be considered a reliable reconstructive option for small defects on the hand or contracture release of the web space, because it has relatively consistent anatomy, provides robust blood supply within the same operative field, and leads to no functional loss at the donor site.

  20. The management of bony burn with skin flap transplant with preservation of sequestrum%保留死骨皮瓣转移覆盖治疗骨烧伤

    Institute of Scientific and Technical Information of China (English)

    陈锦河; 郑庆亦; 郑健生; 蔡少甫

    2001-01-01

    目的 探讨骨烧伤后保留死骨的治疗方法,以求提高骨烧伤治疗质量,缩短病程,减少并发症。 方法  回顾性总结分析1992年以来,利用不去除死骨或仅去除部分死骨,覆盖皮瓣修复创面手术方法的特点。 结果  用该手术法治疗骨烧伤36例,无骨感染、骨髓炎、病理骨折等并发症发生。 结论  该治疗方法具有封闭创面可靠,缩短骨烧伤病程和减少并发症等优点。%Objective To study the management of bony burn,so as to improve the quality of bony burn treatment,to decrease the complications and to shorten the course.  Methods Retrospective review of 36 cases with bony burn cured since 1992 was done in terms of treatment strategy before skin flap transplant to cover the burn wound,i e sequestrum preserved or partial removal. Results There exhibited no complications,such as infection,osteomyelitis and pathologic bone fracture in all these cases. Conclusion The treatment strategy described here could be advocated in view of its reliable coverage of the wound,shortening of the bony burn course and reduction of complication.

  1. 预构皮瓣的研究与应用进展%Advances in the research and application of prefabricated flap

    Institute of Scientific and Technical Information of China (English)

    王宇翀; 薛春雨

    2014-01-01

    Prefabricated flap is so named as the skin flap is prepared by prefabricating a circulation-rich skin flap by implanting a named blood vessel or a portion of fascia which is incorporated with rich blood supply.After the flap has been proven as a flap supplied by ample blood supply,it is transplanted to a wound as a local or free transplantation.The core of prefabricated flap is vascularization.Beside the different methods of prefabrication,vascularization can be facilitated by use of growth factors and cytokines,skin and soft tissue expansion technique,and biomaterial.Prefabricated flap is currently widely used in clinic.With the advances in the research of prefabrication technology and advances in its clinical application,prefabricated flap transplantation is becoming a promising strategy in wound healing.

  2. 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...

  3. 应用改良掌背皮瓣修复手指中、远节皮肤缺损%The clinical application of improved dorsal metacarpal flap in repairing of the middle and distal segment of finger skin defects

    Institute of Scientific and Technical Information of China (English)

    李星星; 朱旭勇; 周磊; 赵昌杰; 陈志阳

    2015-01-01

    目的:报道改良掌背皮瓣修复手指中、远节皮肤组织缺损的临床应用。方法:2011年3月-2014年9月,采用改良掌背皮瓣治疗各指中、远节皮肤缺损8例。将掌背皮瓣的旋转点位于指蹼以远、近节指间关节近1.0cm之间。皮瓣切取面积:2.0cm×2.0cm~5.5cm×3.5cm。结果:7例皮瓣全部成活,1例皮瓣远端部分坏死经换药等处理瘢痕愈合。术后平均随访6个月,皮瓣外形、色泽、血运良好,厚薄适中,两点辩别觉1.1~2.5cm手部功能满意。结论:改良掌背皮瓣(将皮瓣旋转点向远端推移至指蹼以远)修复手指中、远节皮肤组织缺损的临床疗效良好。%Objective To discuss the clinical application of improved dorsal metacarpal flap in repairing of the middle and distal segment of finger skin defects. Methods Summary of 8 cases with skin defects in the middle and distal segment of finger were repaired with improved dorsal metacarpal flap since March 2011 to September 2014.The rotation point of the dorsal metacarpal flap located in Webbed finger refers to Far and near section between nearly 1cm of the interphalangeal joint. The area of the flap was cut out is from 2.0cmí2.0cm- 5.5cmí3.5cm. Results 7 cases flaps were all survived,one distal portion of the flap necrosis was scar healed by dressing and other treatment.Good appearance,colour and lustre,blood supply of the flap, medium thickness,two- point discrimination 1.1cm to 2.5cm and satisfaction of hand function have been seen after an average followed - up of 6 months. Conclusion There was a good clinical efficacy improved dorsal metacarpal flap in repairing of the middle and distal segment of finger skin defects.

  4. 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.

  5. 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

  6. 3D 打印个性化钛网结合游离皮瓣修复上颌缺损的探索%Exploration on repairing maxillary defects by 3D printed individuation titanium mesh combined with free skin flap

    Institute of Scientific and Technical Information of China (English)

    羊书勇; 郑维银; 李晨军; 李浩; 鄢兰元; 卢艳鹏; 米增媛; 张薏

    2014-01-01

    Objective To summarize the experience of repairing maxillary defects by 3D printed individuation titanium mesh prosthesis combined with free skin flap,and analyze the indications,method,and factors affecting the success or failure of the operation. Methods From Jan. of 2013 to Dec. of the same year,3D printing technology was used to prepare the individuation titanium mesh prosthesis and repair the sophisticated maxillary defects of 12 patients combined with vascular anastomosis free skin flap. Immediate repair was provided for all patients. Results All 12 ones were successfully repaired,and their outline forms were good. Conclusion Reparation of sophisticated maxillary defects by 3D printed individuation titanium mesh prosthesis combined with free skin flap is a reasonable and effective way.%目的:总结采用3D 打印技术制备个性化钛网修复体,并结合游离皮瓣用于口腔颌面部缺损修复的经验,对这一方法的用途、应用方法、成败因素等加以分析。方法2013年1~12月,应用3D 打印技术制备个性化钛网修复体,结合血管吻合游离皮瓣修复复杂的上颌组织缺损12例,所有病例均为即刻修复。结果12例病例均修复成功,外形良好。结论采用3D 打印技术预制个性化钛网修复体,结合游离皮瓣修复上颌组织缺损,是一条合理有效的治疗途径。

  7. Effects of vascular endothelial growth factor on survival of surgical flaps: a review of experimental studies.

    Science.gov (United States)

    Fang, Taolin; Lineaweaver, William C; Chen, Michael B; Kisner, Carson; Zhang, Feng

    2014-01-01

    Partial or complete necrosis of skin flaps remains a significant problem in plastic and reconstructive surgery. Growth factors have shown promise in improving flap survival through increased angiogenesis and blood supply to the flap. Vascular endothelial growth factor (VEGF) is the most widely investigated and successful one. But the mechanisms of the effects are still not very clear. In the course of a series of experiments, we indicated that tissue survival of surgical flaps could be improved by both preoperative (sustained phase effect) and intraoperative (acute phase effect) application of VEGF. We reviewed both experimental and clinical investigations on the use of VEGF with surgical flaps to summarize the evidence of both phases of VEGF activity in promotion of flaps survival in detail. With the combinations of acute and sustained phases of effects, VEGF protein and gene, VEGF morphologic actions, and VEGF histochemical modulations suggest a pattern of VEGF activity that can be superimposed on classic descriptive mechanisms of tissue survival of flaps.

  8. A case of nonisland pedicled foot fillet flap for below-knee amputation stump wound: treatment option for compartment syndrome after fibular free flap surgery.

    Science.gov (United States)

    Hwang, Jae Ha; Kim, Kwang Seog; Lee, Sam Yong

    2014-02-01

    Despite the frequent use of the fibular free flap, there have been no reports of severe compartment syndrome of the donor leg that necessitated limb amputation. A 66-yr-old man had a fibular osseous free flap transfer from the left leg to the mandible that was complicated by postoperative compartment syndrome. An extensive chronic leg wound resulted, which was treated with multiple debridements and finally with below-knee amputation. Successful coverage of the below-knee amputation stump was accomplished with a nonisland pedicled foot fillet flap. Various foot fillet flaps may be used acutely as a free or an island pedicled flap, but dissection of the vascular pedicle may be difficult in a chronically inflamed wound because of inflammation and adhesions to surrounding tissue. The nonisland pedicled foot fillet flap may be considered as a useful option for treatment of a chronically inflamed stump wound after below-knee amputation.

  9. Complex Technique of Large Sural Flap: An Alternative Option for Free Flap in Large Defect of the Traumatized Foot

    Directory of Open Access Journals (Sweden)

    Naser Mohammadkhah

    2011-04-01

    Full Text Available The distally based sural fasciocutaneous flap has become a main part of the reconstruction of the lower leg, heel and foot. However, perfusion problems and venous congestion have been reported. Over the past decade, several flap modifications have been reported to improve flap viability and to solve a myriad of reconstructive needs. The purpose of this paper is to describe our experience in harvesting the reversed large sural flap from the proximal and middle third of the leg for large defects on the foot. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had large defects on their foot. The technique was done in 3 parts: 1- the flaps were designed in the proximal third of the leg five centimeter lipofascial tissue was protected around the pedicle in distal part; 3- The pivot point was located in seven to eight cm proximal the lateral malleolus before the first fasciocutaneous perforators arising from the peroneal artery. Sural flaps from the proximal and middle third of the leg were designed in13 patients who had large defects on their foot. No flap necrosis or split thickness skin graft loss occurred. The flaps healed by the 3rd week excluding two patients. This study supports the application of our technique as a safe, easy and useable method in large defects of the foot. The results showed low rates of ischemia, venous congestion, dehiscence, infection and flap necrosis. Proximal extended and large distally based sural flap is an alternative to free tissue transfer for large defect reconstruction of the foot.

  10. 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

  11. Distally based lateral sural cutaneous nerve nutrient vessels island flap pedicled by posterior tibial artery perforator: anatomical basis and clinical applications%胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣的临床解剖与应用

    Institute of Scientific and Technical Information of China (English)

    张宇; 高秋明; 李泽宇; 刘畅; 时培晟; 邓小文

    2016-01-01

    目的 研究胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣移位修复足踝创面的临床解剖与应用.方法 选取红色乳胶动脉灌注的2侧新鲜和8侧4%甲醛固定下肢标本于手术显微镜下进行解剖研究,观察胫后动脉、腓肠外侧皮动脉及腓肠外侧皮神经的解剖学特征.根据解剖学结果设计皮瓣.纳入2007年2月至2012年6月行胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣修复的患者15例,观察疗效.结果 设计以胫后动脉在小腿远端穿支为蒂的胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣,胫后动脉穿支由腓肠外侧皮神经-腓肠神经营养血管链、穿支与腓肠外侧皮动脉间吻合血管两条供血通路逆行灌注.15例患者中移植皮瓣全部成活13例;9例静脉回流良好,移植皮瓣完全成活,6例术后出现静脉危象,其中2例移植皮瓣远端部分坏死.随访12例,随访34~ 98个月,皮瓣质地及外观良好,术后6个月皮瓣两点辨别觉(12 ±4) mm;踝关节功能优5例、良5例、中3例、差2例.结论 胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣血供充分且受解剖变异影响小,可用于踝周和足底内侧负重区皮肤缺损的修复.%Objective To study the anatomical basis of distally based lateral sural cutaneous nerve nutrient vessels island flap pedicled by posterior tibial artery perforator and its clinical application in foot ankle wound repair.Methods Eight sides of 4% formaldehyde-fixed and 2 sides of fresh cadavers were infused with colored red latex and dissected under operating microscope.The posterior tibial artery,lateral sural cutaneous artery,lateral sural cutaneous nerve were observed.Based on the results of anatomic study,the flaps were designed for clinical reparative application.From February 2007 to June 2012,15 patients underwent reparative operation of in foot ankle wound with distally based lateral sural cutaneous nerve nutrient vessels island flap

  12. 外固定支架复合交腿皮瓣修复胫骨粉碎性骨折合并皮肤坏死%External Fixator Combined with Cross-leg Flap in Treatment of Tibia Comminuted Fracture with Skin Necrosis

    Institute of Scientific and Technical Information of China (English)

    初殿伟; 王玮; 杨术旺; 景士忠

    2013-01-01

    目的:总结外固定支架复合交腿带蒂皮瓣治疗胫骨粉碎性骨折合并皮肤坏死的临床效果.方法:2006年6月至2011年6月,收治胫骨粉碎性骨折合并皮肤坏死28例,男20例,女8例,年龄20~56岁.其中车祸伤18例,压砸伤8例,坠落伤2例,合并骨折区周围皮肤坏死范围6 cm×3 cm~18 cm×8 cm.以外固定支架或结合少量内固定恢复胫骨稳定性,均采用对侧小腿交腿带蒂皮瓣对坏死创面在彻底清创下进行修复,供区创面采用游离植皮或直接缝合.结果:术后1例皮瓣创缘部分坏死继发感染,经换药处理后创缘Ⅱ期愈合,其余患者皮瓣均成活,供区植皮成活,创面愈合良好.术后患者均获随访,随访时间3个月皮瓣外形满意,质地优良.1例胫骨中下段粉碎性骨折延迟愈合,余患者胫骨骨折于术后3~4个月临床愈合,患肢功能基本恢复,能够部分负重行功能锻炼.结论:外固定支架复合交腿皮瓣是治疗胫骨粉碎性骨折合并皮肤坏死的安全有效方法.%Objective To summarize the clinical effects of external fixator combined with cross-leg flap in the treatment of tibia communicated fracture with skin necrosis.Methods From June 2006 to June 2011,totally 28 cases of tibia communicated fracture with skin necrosis were hospitalized,aged from 20 to 56 years old and included 20 males and 8females.Of the patients,there were 18 ones from traffic accidents,8 ones from crash injuries and 2 ones from falling injuries,with the scopes of skin nec rosis ranging from 6 cm×3 cm to 18 cm×8 cm.External fixator,or internal fixator in some cases,was used for the stabilitv of the tibia.The cross-leg flap from the contralateral leg was applied to the repair of the wound after debridement and the wound at the donar area was treated with free skin graft or direct suture.Results One patient suffered from partial necrosis with secondary infection occurred at the edge of the flap,and then underwent delayed healing

  13. [Application of tensor fascia lata pedicled flap in reconstructing trochanteric pressure sore defects].

    Science.gov (United States)

    Karabeg, Reuf; Dujso, Vanis; Jakirlić, Malik

    2008-01-01

    Tensor fascia lata pedicled flap is one of the most useful flaps for reconstruction pressure sore defects on trochanteric region. Debate exists on the safe dimension of the flap, as distal tip necrosis can be encountered. The aim of the current study is to report experience of Clinic for Plastic and Reconstructive Surgery, Clinical University Center of Sarajevo, with tensor fascia lata pedicled flap in reconstructing trochanteric pressure sore defects. From January 1993 to December 2007, 39 pedicled TFL flaps were used for reconstruction trochanteric pressure sore defects in 34 patients. We used 3 local flaps for reconstruction of small trochanteric defects and one direct suture. In our study we had 43 trochanteric pressure sores and in 9 patients pressure sores were bilateral. The age ranged from 9 to 65, with average age 41,2. The resulting trochanteric defects in this study were due to debridement of pressure sore. The size of the flaps used ranged from 15 x 6 cm to 30 x 15 cm. All flaps survived. Distal tip necrosis occurred in 4 cases. All 4 cases developed in a very large flap beyond the safe limits. Wound dehiscence occurs in 3 cases. There was minimal donor side morbidity in the form of partial skin loss in 1 case. The average follow up period in this study ranged from 6 months to 15 years. Tensor fascia lata flap is reliable flap. Donor site morbidity is minimal. Problem with the flap can be encountered if the flap is not harvested with the safe limits and properly designed. Proper preoperative preparations must be taken into consideration. Chronic skin ulcers, such as pressure sores, that are refractory to conventional local wound therapies, are good examples of potential beneficiaries of the TFL musculocutaneous flap.

  14. An anatomic and clinical study of the adductor magnus tendon-descending genicular artery bone flap.

    Science.gov (United States)

    Huang, Dong; Wang, Hai-Wen; Xu, Da-Chuan; Wang, Hong-Gang; Wu, Wei-Zhi; Zhang, Hui-Ru

    2011-01-01

    The composite tissue flap of the descending genicular vessels with the adductor magnus tendon is a newly developed, reliable method to repair the Achilles tendon and relevant skin defects. The aim of this study was to evaluate the anatomy of the adductor magnus tendon-descending genicular artery bone flap, and the feasibility and value for the repair of the Achilles tendon and relevant skin defects. There were 34 adult specimens used for the anatomy of this flap. The descending genicular artery originates 10.5 ± 1.6 cm above the adductor tubercle, with a diameter of 1.8 ± 0.6 mm and a length of 1.2 ± 0.5 cm. Its articular branch is distributed in the adductor magnus tendon and the medial condyle of the femur. The saphenous branch has a diameter of 1.1 ± 0.3 mm and is distributed in the skin of the upper medial calf. A total of 16 cases of trauma-induced Achilles tendon damage and calcaneus and skin defects were repaired with the vascularized adductor magnus tendon bone flap, including the reconstruction of Achilles tendon insertion and repair of relevant skin defects. All of the composite tissue flaps were viable, the skin sensation of the flaps was recovered, and all patients walked with a normal gait. Our results suggested that the adductor magnus tendon-descending genicular artery bone flap is an alternative method to repair composite tissue defects of the Achilles tendon.

  15. Vaginoplasty with an M-Shaped Perineo- Scrotal Flap in a Male-to-female Transsexual

    Directory of Open Access Journals (Sweden)

    Nasu,Yasutomo

    2007-12-01

    Full Text Available To date, many techniques have been reported for vaginoplasty in male-to-female trans-sexual (MTFTS patients, such as the use of a rectum transfer, a penile-scrotal flap and a reversed penile flap. However, none of these procedures is without its disadvantages. We developed a newly kind of flap for vaginoplasty, the M-shaped perineo-scrotal flap (M-shaped flap, using skin from both sides of the scrotum, shorn of hair by preoperative laser treatment. We applied this new type of flap in 7 MTFTS patients between January 2006 and January 2007. None of the flaps developed necrosis, and the patients could engage in sexual activity within 3 months of the operation. The M-shaped flap has numerous advantages: it can be elevated safely while retaining good vascularity, it provides for the construction of a sufficient deep vagina without a skin graft, the size of the flap is not influenced entirely by the length of the penis, and it utilizes skin from both sides of the scrotal area, which is usually excised.

  16. 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.

  17. Subcutaneous pedicle propeller flap: An old technique revisited and modified!

    Directory of Open Access Journals (Sweden)

    Durga Karki

    2016-01-01

    Full Text Available Background: Post-burn axillary and elbow scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of abduction and extension that should be achieved, respectively, while treating either of the joint. The aim of this paper is to highlight the use of subcutaneous pedicle propeller flap for the management of post-burn axillary and elbow contractures. Methodology: This is a prospective case study of axillary and elbow contractures managed at a tertiary care hospital using propeller flap based on subcutaneous pedicle from 2009 to 2014. Surgical treatment comprised of subcutaneous-based pedicle propeller flap from the normal tissue within the contracture based on central axis pedicle. The flap was rotated axially to break the contracture. The technique further encompassed a modification, a Zig-Zag incision of the flap, which was seen to prevent hypertrophy along the incision line. There was a mean period of 12 months of follow-up. Results: Thirty-eight patients consisting of 22 males and 16 females were included in this study among which 23 patients had Type II axillary contractures and 15 had moderate flexion contractures at elbow joint. The post-operative abduction achieved at shoulder joint had a mean of 168° whereas extension achieved at elbow had a mean of 175°. The functional and aesthetic results were satisfactory. Conclusion: The choice of surgical procedure for reconstruction of post-burn upper extremity contractures should be made according to the pattern of scar contracture and the state of surrounding skin. The choice of subcutaneous pedicle propeller flap should be emphasised because of the superior functional results of flap as well as ease to learn it. Moreover, the modification of propeller flap described achieves better results in terms of scar healing. There is an inter-positioning of healthy skin in between the graft, so it prevents scar band formation all around the flap.

  18. Reconstruction of large skin and soft tissue defect in the front upper of tibia with free flap of anastomosis saphenous vessels%吻合隐血管的游离皮瓣修复胫前中上段大面积皮肤软组织缺损

    Institute of Scientific and Technical Information of China (English)

    周洪杰; 隋海明; 杜全红; 史永安; 迟涛胜; 丛海波

    2015-01-01

    目的 探讨游离皮瓣修复胫前中上段大面积皮肤软组织缺损时吻合受区隐血管的可行性.方法 2009年6月-2014年4月,收治伴有胫前中上段大面积皮肤软组织缺损患者16例,其中男10例,女6例;年龄24~ 56岁,平均34.5岁,经全身支持治疗并多次清创结合VSD治疗后行创面修复手术,术前均设计采用吻合隐血管的游离股前外侧皮瓣移植修复. 结果 14例按术前设计进行,2例改用吻合健侧胫后血管的交腿皮瓣修复(1例隐动脉管径过细,1例隐动脉长段损伤变性栓塞,均不适合行血管吻合),14例吻合隐血管的皮瓣全部成活,其中12例一期愈合,2例皮瓣远端尖部部分坏死,经换药后逐渐愈合.13例经过6个月~2年随访,皮瓣外观无臃肿、质地优良,软组织缺损创面修复满意. 结论 胫前中上段大面积皮肤软组织缺损的游离皮瓣移植修复可选择吻合受区隐血管.%Objective To explore the feasibility of repairing the large area skin and soft tissue defect in thefront upper of tibia by free flap with anastomosis of saphenous vessels.Methods From June,2009 to April,2014,16 cases (10 males and 6 females) of large area skin and soft tissue defect in the front upper of tibia were treatedwith free flap.The ages ranged from 24 to 56 years old,averaged of 34.5 years old.The supportive therapy and repeated debridement combined with VSD,and designed to use free anterolateral thigh flap with anastomosis of saphenous vessels before repairing operation.Results Fourteen patients accorded with preoperative design,in which 2 cases were adopted cross leg flap anastomosis posterior tibia vessels of the healthy side (1 case of saphenous artery diameter too small,and 1 case of saphenous artery long injury degeneration,unsuitable for vascular anastomosis).All 14 flaps survived,expect 2 cases were part-necrosis in the end of the flap,and gradually healed by dressing exchange.Conclusion Reconstruction of large area skin

  19. Skin and Neourethral Necrosis in Staged Hypospadias Repair

    OpenAIRE

    2016-01-01

    Complications in hypospadias surgery are not uncommon however penile skin or flap necrosis is rarely reported. Ischemia of the flap or graft is a major complication in two stage repair of hypospadias. A 2-year old boy with proximal penile hypospadias, operated earlier for chordee correction and urethral plate formation with a preputial flap, presented for stage 2 repair. Ten days after surgery patient developed skin and neourethral necrosis. Early debridement was done followed by coverage wit...

  20. Bilateral V-Y flap for a perianal basal cell carcinoma: A case report

    Directory of Open Access Journals (Sweden)

    José P. Rivera-Chavarría

    2016-01-01

    Conclusion: Treatment modalities include early wide local excision to clear margins, ensuring further local recurrence and distant metastasis. The use of local V-Y advancement fasciocutaneous flaps may be another valid option for the reconstruction of perianal skin defects, with less morbidity than other flaps described in the literature.

  1. The anatomy and clinical application of reverse saphenous nerve neurocutaneous flaps for reparing skin defects of forefoot%逆行足内侧隐神经营养血管皮瓣修复足前部皮肤缺损的解剖与临床应用

    Institute of Scientific and Technical Information of China (English)

    毛海蛟; 史增元; 尹维刚; 徐达传; 刘振新

    2015-01-01

    目的 探讨逆行足内侧隐神经营养血管皮瓣修复足前部皮肤缺损的疗效.方法 采用50侧经动脉灌注红色乳胶的成人足标本,解剖观测内踝前动脉、跗内侧动脉的前后分支、拇趾底内侧动脉浅支、足底内侧动脉浅支和隐神经营养血管及其与邻近动脉的吻合关系,并根据解剖结果设计逆行足内侧隐神经营养血管皮瓣修复足前部皮肤缺损.结果 解剖结果表明,足拇展肌表面的动脉网,足拇展肌上缘动脉弓在隐神经周围、足背和足底内侧形成血管网,构成逆行足内侧隐神经营养血管皮瓣的血供基础.2006年10月至2011年10月,临床应用该皮瓣11例,皮瓣切取范围2.5 cm×3.5 cm~7.5 cm×8.5 cm,供区以全厚皮片移植覆盖.术后所有皮瓣均成活,随访6~18个月,平均10个月,皮瓣色泽、质地、外形良好,患足行走正常,皮瓣及供区无溃疡发生.结论 应用逆行足内侧隐神经营养血管皮瓣修复足前部皮肤缺损,血供可靠,操作简单,创伤小,是修复足前部皮肤缺损的理想皮瓣供区.%Objective To investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot.Methods In the anatomic study,50 cadaveric feet were injected with red latex and the anastomosis,distribution and external diameters of medialtarsal artery,medial anterior malleolus artery,medial plantar artery,the superficial branch of the medial basal hallucal artery and saphenousnerve nutritional vessels were observed.Based on anatomic research results,we designed the reverse saphenous nerve neurocutaneous flaps for repairing skin defects of forefoot.Results The blood supply of reverse saphenous nerve neurocutaneous flaps were based on the vasoganglion,which consist of arterial arch at the superior border of abductor hallucis and arterial network on the surface of abductor hallucis around the saphenous nerve and medial pedis flap.From Oct.2006 to Oct.2011,the reverse

  2. Skin-reducing mastectomy.

    Science.gov (United States)

    Nava, Maurizio B; Cortinovis, Umberto; Ottolenghi, Joseph; Riggio, Egidio; Pennati, Angela; Catanuto, Giuseppe; Greco, Marco; Rovere, Guidubaldo Querci Della

    2006-09-01

    The authors propose a combined flap technique to reconstruct large and medium-sized ptotic breasts in a single-stage operation by use of anatomical permanent implants. The authors enrolled 28 patients fulfilling criteria for skin-sparing mastectomy and presenting with ptotic breasts whose areola-to-inframammary fold distance was more than 8 cm. All reconstructions were performed as a single-stage procedure. After preoperative planning, a large area in the lower half of the breast was deepithelialized according to the conventional Wise pattern. Mastectomy was then carried out. To perform reconstructions, the inferomedial fibers of the pectoralis major muscle were dissected and sutured to the superior border of the inferior dermal flap. An anatomical implant was then inserted into the pouch, which was closed laterally with the previously harvested serratus anterior fascia. Skin flaps were finally closed down to the inframammary fold. The authors performed 30 procedures on 28 patients. The medium size anatomical implants was 433 cc. Twelve women achieved symmetrization in a single stage ending in a symmetric inverted-T scar. The overall complication rate was 20 percent, with four cases (13 percent) complicated by severe, extensive necrosis of the skin flaps requiring implant removal. Breast cancer treatment must nowadays optimize cosmetic results. This can be accomplished in selected cases by means of a single-stage operation that the authors call "skin-reducing mastectomy." The final scars imitate those of cosmetic surgery. Careful patient selection and improvement in the learning curve may reduce the complication rate.

  3. Ischemia and reperfusion in skin flaps: effects of mannitol and vitamin C in reducing necrosis area in a rat experimental model Isquemia e reperfusão de retalhos cutâneos: efeitos do manitol e vitamina C na redução de áreas de necrose em modelo experimental no rato

    Directory of Open Access Journals (Sweden)

    Winston Bonetti Yoshida

    2005-10-01

    Full Text Available PURPOSE: The aim of the present study was to develop an experimental model of ischemia-reperfusion injury in rat skin flap and to verify the effect of mannitol and vitamin C on reducing necrosis area. METHODS: A 6-x 3-cm groin skin flap was raised and submitted to 8 hours of ischemia by clamping the vascular pedicle and to 7 days of reperfusion. The animals were divided in four groups: S1 and S2 (10 animals each and C and T (14 animals each. In groups S1 and S2 skin flaps were not submitted to ischemia and animals received lactated Ringer's solution (S1 and antioxidant solution (S2 . In groups C and T, flaps were subjected to 8 hours of warm ischemia and animals received Lactated Ringer's solution (Group C and antioxidant solution immediately before reperfusion, (Group T. Flap survival was evaluated on the seventh day using a paper template technique and computer-assistant imaging analysis of necrotic and normal areas. RESULTS: Statistical analysis showed no area differences between groups C and T. CONCLUSION: The experimental model provided consistent necrotic area in control groups and drugs used were not effective in improving skin flap survival.OBJETIVO: Neste trabalho foi padronizado modelo experimental de isquemia e reperfusão em retalho cutâneo em ratos no qual estudou-se possibilidade de uma solução antioxidante, composta por Ringer lactato, vitamina C e manitol de reduzir a área de necrose. MÉTODOS: O modelo consistiu de levantamento de retalho cutâneo axial de 6,0 x 3,0cm, submetido à isquemia de 8 horas e reperfusão de 7 dias. Os animais foram divididos em quatro grupos: grupos S1, S2 (10 animais cada, C e T (14 animais cada. Nos grupos S1 e S2 todos os procedimentos dos demais grupos foram efetuados, exceto a isquemia e reperfusão: S1 recebeu apenas Ringer lactato e S2 a solução antioxidante. Os grupos C e T foram submetidos à isquemia. O grupo C recebeu somente Ringer lactato e o grupo T a solução antioxidante. No 7

  4. Use of lateral circumflex femoral artery system free flaps in skull base reconstruction.

    Science.gov (United States)

    Camporro, Daniel; Fueyo, Angel; Martín, Clara; Carnero, Susana; Llorente, José L

    2011-05-01

    We present a 10-year retrospective study at a tertiary center designed to evaluate the advantages, complications, and comparative results using lateral circumflex femoral artery (LCFA) system free flaps for cranial base reconstruction. In this study, a cranial base defect refers to exposed intracranial contents to the skin, paranasal sinuses, nasopharynx, oropharynx, or oral cavity. These defects resulted from resections of primary or recurrent neoplasms or from secondary problems after cranial base surgery. We performed 20 flaps in 20 patients. The selection of flap was as follows: 8 combinations of anterolateral/anteromedial thigh flaps with vastus lateralis muscle or tensor fascia lata flaps, 6 ALT fasciocutaneous flaps, and 6 muscle/myocutaneous flaps. The flap's success rate was 95% (19/20). Early major complications included 1 perioperative death, and there was 1 myocardial infarction. Minor complications included 1 partial (12%) flap loss, 2 temporal cerebrospinal fluid leak, 2 donor-site hematoma, 2 minor wound breakdown, 3 facial nerve weakness, and 4 donor-site numbness. Among 20 patients undergoing LCFA system flap reconstruction, 12 are alive and disease free. Local recurrence occurred in 1 patient. She underwent ablative surgery and a new successful free flap (forearm flap); after 2 years, the patient is disease free. The LCFA system flaps in skull base reconstruction provide versatility in flap design and availability of adequate tissues to fill dead space, and it offers vascularized fascia to augment dural repairs. It also provides a very long pedicle and allows simultaneous flap harvest with low donor-site morbidity.

  5. Deep inferior epigastric perforator flap for breast reconstruction: experience with 43 flaps

    Institute of Scientific and Technical Information of China (English)

    YAN Xiao-qing; YANG Hong-yan; ZHAO Yu-ming; YOU Lei; XU Jun

    2007-01-01

    Background In the past decade, there has been increasing breast reconstructions after mastectomy. The ideal material for reconstruction of a breast is fat and skin. The transverse rectus abdominis myocutaneous (TRAM) flap has been the gold standard for breast reconstruction until recently. Abdominal wall function is a major concern for plastic surgeons in breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore preserves adequate abdominal wall competence. The aim of this study was to summarize our experience in breast reconstruction with DIEP flap.Methods Between March 2000 and August 2005, a total of 43 breast reconstructions were performed on 40 patients by our surgeons using DIEP flap (3 patients had bilateral procedures), 14 of them were immediate surgeries and 26 were delayed. Abdominal function, satisfaction with the donor site and reconstructed breast, and the sensation recovery was assessed respectively during follow-up.Results The mean age of the patients was 38.6 years (range, 28-50). The size of the flaps was 11 cm×26 cm in average (height 10-12 cm, width 15-33 cm). The mean length of the vascular pedicles was 9.3 cm (range, 7-12). The patients were followed up for a mean of 16 months (range, 6-30 months). During the follow-up, 2 (5%) patients had total flap loss, 2 (5%) had partial necrosis, 4 (9%) had wound edge necrosis in the abdomen, and 1 had axillary seroma. None of the patients had hernia, and all of them were able to resume their daily activities after the operation. Patient satisfaction with the reconstructed breast rated high, 95% of the patients achieved spontaneous return of sensation in the reconstructed breast, but none of them had a sensation equivalent or approximate to the normal.Conclusions The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectus muscle. It can reduce

  6. [Cover flaps for loss of substance on the heel. Apropos of 8 cases].

    Science.gov (United States)

    Mulfinger, C; Bardot, J; Legre, R; Aubert, J P; Magalon, G; Bureau, H

    1993-10-01

    The anatomical and function characteristics of the heel region explain the large number of methods used and the differences of opinion particularly in relation to the repair of weightbearing zones. Our study is based on 28 patients in whom we performed: ten regional flaps, six cross-leg flaps, sixteen microsurgical flaps. The temporal fascia free flap provides good results on the posterior surface with minimal sequelae at the donor site. The medial plantar flap appears to be the most suitable flap for weight-bearing zones. Cross-lep flaps allow satisfactory repair of the weightbearing zone, but the scarred appearance of the donor site is inaesthetic and immobilisation is uncomfortable. The problem of large defects is still not resolved and no really satisfactory method is available among the various distant, skin, myocutaneous, pure muscle or cross-leg flaps. The solution may reside in a combination of two flaps allowing better adaptation to the morphology of the heel. The importance of heel sensation, particularly in the weight-bearing zone, led to the concept of the use of sensitive or resensitised flaps. After a review of the literature and our results, we did not find any correlation between the sensitivity obtained and the success of the reconstruction. It therefore seems useless to perform microscopic nerve sutures in order to resensitise distant heel flaps. The patient's cooperation is essential in every case to compensate for the decreased sensitivity by means of increased visual surveillance and the wearing of suitable shoes.

  7. Ulnar forearm osteocutaneous flap harvesting using Kapandji procedure for pre-existing complicated fibular flap on mandible reconstruction--cadaveric and clinical study.

    Science.gov (United States)

    Lin, Chih-Hung; Liao, Chun-Ta; Lin, Cheng-Hung; Tan, Bien-Keem; Lee, Chun-Ta

    2015-05-01

    It is not uncommon that after using a fibular flap for lower gum cancer reconstruction, nonunion, chronic osteomyelitis, or fibular bone exposure occurs, which requires a composite bone and soft tissue reconstruction. Radial forearm osteocutaneous flap possesses the risk of stress fracture. Ulnar forearm osteocutaneous flap can be another option for small bone defect reconstruction. Six patients who had undergone fibular flap for mandible reconstructions and sustained either bone exposure (3 patients), chronic osteomyelitis (1 patient), malocclusion (1 patient), or osteoradionecrosis (1 patient) underwent ulnar forearm osteocutaneous flap with 3-cm ulnar bone for touch-up procedure. The distal radioulnar joints were fused with a screw. Six ulnar forearm osteocutaneous flap dissections were also performed on 4 fresh frozen cadavers to clarify the anatomic distribution of the distal ulnar artery. All 6 ulnar forearm osteocutaneous flaps survived with one re-exploration for venous occlusion. All presented bone union. Comparable to the clinical dissection, the cadaveric distal ulnar artery demonstrates a periosteal branch that runs between the proper ulnar nerve and dorsal sensory nerve. This periosteal branch comes out of an ulnar artery approximately 3 cm proximal to the wrist joint. Ulnar forearm osteocutaneous flap can provide a secondary flap of wide skin paddle and small segment bone for specific mandibular defect after a fibular flap transfer.

  8. [Early effectiveness of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects].

    Science.gov (United States)

    Chen, Yongfeng; Zhang, Kai; Li, Jiancheng; Xu, Jingcheng; Liao, Shengkai; Xu, Tao

    2011-09-01

    To investigate the method of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects and its effectiveness. Between March 2005 and May 2010, 17 patients with palatomaxillary defects were treated. There were 11 males and 6 females with an age range of 45-74 years (mean, 62.5 years), including 1 case of benign tumor and 16 cases of malignant tumors (7 cases of squamous cell carcinoma of palate, 1 case of recurring squamous cell carcinoma of palate, 1 case of malignant melanoma of palate, 1 case of adenoid cystic carcinoma of palate, 1 case of malignant melanoma of maxilla, 1 case of ductal carcinoma of maxilla, and 4 cases of squamous cell carcinoma of maxilla). The maxillectomy defect ranged from 7.0 cm x 5.5 cm to 10.0 cm x 7.5 cm. According to Brown's classification for the maxillectomy defect, there were type II in 15 cases, type III in 2 cases. Palatomaxillary defects were repaired with radial forearm free flap and buccal fat pad in 11 cases, and with radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap pedicled with temporal muscle in 6 cases. The effectiveness was evaluated after operation by observing the vitality of the flap, the functions of speech, swallowing, breath, and the facial appearance. All cases were followed up 6-12 months without tumor recurrence. All flaps and skin grafts at donor sites survived. The functions of speech, swallowing, and breath were normal without obvious opening limitation. The facial appearance was satisfactory without obvious maxillofacial deformity. No enophthalmos occurred in patients with orbital floor and infraorbital rim defects. The patients had no oronasal fistula with satisfactory oral and nasal functions. According to the type of palatomaxillary defects, it can have good early effectiveness to select combining radial forearm free flap and buccal fat pad or combining radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap for

  9. 阴囊纵隔翼型皮瓣修复包皮环切术后隐匿型阴茎皮肤短缺%THE WING-LIKED SKIN FLAP WITH SCROTAL SEPTAL VASCULAR PEDICLE IN THE TREATMENT OF CONCEALED PENIS AFTER CIRCUMCISION

    Institute of Scientific and Technical Information of China (English)

    陈辉; 刘凡

    2001-01-01

    目的:用阴囊纵隔翼型皮瓣修复包皮环切术后患者的隐匿型阴茎皮肤短缺。方法:对3例包皮环切术后隐匿型阴茎皮肤不足的病人,用阴囊纵隔翼型皮瓣修复。结果:3例均荻成功,术后即获得立竿见影的良好效果。随访6个月~12个月,阴茎外形满意,发育良好。结论:用该皮瓣修复包皮环切术后隐匿型阴茎皮肤短缺具有血供良好,取材方便、结构相似,外形良好的优点。%Objective: To develop a method for repairing of skin defect of concealed penis after circumcision. Methods:The wing-liked skin flap with scrotal septal vascular pedicle was designed and applied to 3 patients with skin defect of concealed penis after circumcision. Results: All operations were successful. During a follow-up period of 6~12 months, both the shape and development of phalluses were satisfactory. Conclusion: The repair of skin defect of concealed penis after circumcision by this way is one of the best choices. This method had some merits such as the tissue flap has good blood supply,it is easy to elevate, and penis has good appearance following correction.

  10. The 'reading man flap' for pressure sore reconstruction.

    Science.gov (United States)

    Sapountzis, Stamatis; Park, Hyoung Joon; Kim, Ji Hoon; Chantes, Achilleas; Beak, Rong Min; Heo, Chan Yeong

    2011-09-01

    The treatment of pressure sores represents a significant challenge to health care professionals. Although, pressure wound management demands a multidisciplinary approach, soft tissue defects requiring reconstruction are often considered for surgical management. Myocutaneous and fasciocutaneous flaps can provide stable coverage of pressure sores. Here, we describe our experience using a recent fasciocutaneous flap, which is named 'reading man' flap, in sacral, ischial, and trochanteric pressure sores. During a period of 1 year the authors operated 16 patients, 11 men, and 5 women, using the reading man flap. The ages of the patients ranged from 24 to 78 years. The location of pressure sores was 8 sacral, 5 ischial, and 3 trochanteric pressure sores. The mean size of pressure sores was 8 cm × 9 cm. All pressure sores covered bt the Reading Man flap healed asymptomatically. After follow-up of 2-8 months, no recurrences were encountered and no further surgical intervention was required. The reading man flap was found to be a useful technique for the closure of pressure sore in different anatomic locations. The advantage of tension-free closure and the minimal additional healthy skin excision made this flap a useful tool in pressure sore reconstructions.

  11. "Mini paddle" for monitoring the fibular free flap in mandibular reconstruction.

    Science.gov (United States)

    Al Qattan, M M; Boyd, J B

    1994-01-01

    The use of a "mini" skin paddle to monitor the fibular free flap for mandibular reconstruction is described. The paddle is easy to inset, can be excised later under local anesthesia, and yet is adequate for postoperative monitoring.

  12. The effects of different doses of 670 nm diode laser on skin flap survival in rats O efeito de diferentes doses de laser de diodo 670 nm na viabilidade de retalho cutâneo randômico em ratos

    Directory of Open Access Journals (Sweden)

    Cristiano Schiavinato Baldan

    2012-02-01

    Full Text Available PURPOSE: To investigate the effects of different low-level laser therapy (LLLT doses on random skin flap rats. METHODS: Forty Wistar rats were randomly divided in four groups. The control group (CG was not irradiated. The experimental groups were irradiated with a diode laser 670 nm with different energies per point: group 2 (G2 with 0.06 J; group 3 (G3 0.15 J and group 4 (G4 0.57 J. The three groups were irradiated in 12 equally distributed points in the cranial skin flap portion. They were submitted to the irradiation during the immediate, first and second postoperative days. The necrosis area was evaluated in the seventh postoperative day. RESULTS: The CG shows 49.35% of necrosis area in the skin flap; G2, 39.14%; G3, 47.01% and G4, 29.17% respectively. There was a significantly difference when G4 was compared with CG`s skin flap necrosis area. CONCLUSION: The low-level laser therapy diode 670 nm with 0.57 J energy per point increases the survival in randomic skin flap rats.OBJETIVO: Investigar os efeitos de diferentes doses de laserterapia de baixa intensidade na viabilidade de retalhos cutâneos randômicos em ratos. MÉTODOS: Quarenta ratos Wistar foram randomizadamente distribuídos em quatro grupos. O grupo controle (GC não foi irradiado. Os animais dos grupos experimentais foram irradiados por laser de diodo (670 nm com as seguintes energias ofertadas por ponto: grupo 2 (G2 0,06J; grupo 3 (G3 0,15 J e grupo 4 (G4 0,57 J. Os três grupos foram irradiados em 12 pontos igualmente distribuídos na porção cranial do retalho cutâneo. Todos os animais dos grupos 2, 3 e 4 foram submetidos ao protocolo de irradiação por três dias consecutivos, iniciando no pós-operatório imediato. A área necrótica foi avaliada no sétimo dia pós-operatório. RESULTADOS: A porcentagem de área necrótica apresentou-se da seguinte forma, nos diferentes grupos: GC= 49,35%, G2= 39,14%, G3= 47,01 e G4= 29,17%. Foi encontrada diferença estatisticamente

  13. Pearls for perfecting the mastoid interpolation flap.

    Science.gov (United States)

    Justiniano, Hilda; Eisen, Daniel B

    2009-06-15

    Helical rim ear defects can present a reconstructive challenge to the Mohs surgeon. Multiple options exist including wedge excision, helical rim advancement flaps, bilobed flap, and grafts, to name a few. Wedge excision of the ear may result in a noticeable anteverted, smaller ear, and disrupts auricular cartilage with the possibility of chondritis and excess pain. Helical rim advancements can result in anteversion of the ear and a smaller lobule. Mastoid interpolation flaps, which are also called retroauricular to auricular flaps, can be a useful alternative in patients who are willing to return for a second procedure. They are easy to perform and can result in a highly aesthetic reconstruction in which the ear size and form are maintained. The donor skin comes from an area that is hidden from view and heals with minimal complications. We present our suggestions for performing these reconstructions. Ways to optimize results, potential pitfalls, and postoperative care instructions are discussed. Step by step videos are included with this manuscript.

  14. 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

  15. Superficial Circumflex Iliac Artery Perforator Flap for Dorsalis Pedis Reconstruction.

    Science.gov (United States)

    Tashiro, Kensuke; Yamashita, Shuji

    2017-04-01

    Reconstruction of dorsalis pedis with soft tissue is challenging because it needs to preserve thin structure to ensure that the patient will be able to wear shoes. Here, we report the use of a thin superficial circumflex iliac artery perforator (SCIP) flap in dorsalis pedis reconstruction. A 67-year-old man presented with a third-degree burn, which exposed his extensor tendons. A thin SCIP flap from the left inguinal region measuring 15 × 4 cm was transferred to the dorsalis pedis region. Postoperatively, no major cosmetic or functional problems were observed. Because the invasiveness of the donor site is nearly same between SCIP flap and skin graft from inguinal region, SCIP flap is better solution in point of textural qualities for dorsalis pedis reconstruction.

  16. A totally laparoscopic peritoneal free flap for reconstruction of hand

    Institute of Scientific and Technical Information of China (English)

    En-Qi Guo; Qing-Ping Xie

    2016-01-01

    Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons.Here,we present a case of hand reconstruction with a totally laparoscopic peritoneal flap.The anterior rectus sheath was preserved in situ.The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand.The defect of the dorsal hand was 17 cm × 12 cm.The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications.A following split-thickness skin graft offered the successful wound closure.Motor and sensory function improved gradually within the first year follow-up.The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue defects accompanied by exposed tendons on the hand and foot.

  17. Noninvasive Free Flap Monitoring Using Eulerian Video Magnification

    Directory of Open Access Journals (Sweden)

    Yuan Fang Liu

    2016-01-01

    Full Text Available Eulerian Video Magnification (EVM can enhance subtle changes in videos to reveal what was once invisible to the naked eye. In this proof of concept study, we investigated using EVM as a novel form of free flap monitoring. Free flaps with skin paddles were filmed in the operating room with manipulation of their pedicles. In a representative 77-year-old female who received a latissimus dorsi-serratus-rib composite free flap, EVM was able to detect blockage of arterial or venous supply instantaneously, providing a visible representation through degree of color change in videos. EVM has the potential to serve as a powerful free flap monitoring tool with the benefit of being noninvasive, sensitive, easy-to-use, and nearly cost-free.

  18. Reconstruction of the replanted hand with latissimus dorsi muscle and serratus anterior fascia combined flap.

    Science.gov (United States)

    Ozçelik, Derya; Uğurlu, Kemal; Turan, Tuğrul

    2003-04-01

    Reconstruction with the latissimus dorsi muscle flap, combined with the serratus anterior fascia flap, was performed to cover two large and separate palmar and dorsal forearm skin defects in a patient, whose hand had been replanted 20 days earlier after traumatic amputation at the distal forearm level. As a result, a total forearm amputation was salvaged by microsurgical replantation and a free combined flap of the subscapular system. This new application of the combined flap allowed the reconstruction of large and separate wounds of the replanted hand, and provided gliding surfaces for tendons.

  19. 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. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. 320排CT灌注成像在头面部皮瓣移植前血供评价方面的应用价值%Value of 320-detector row perfusion CT in the pre-transplantation evaluation of head and facial skin flaps

    Institute of Scientific and Technical Information of China (English)

    许开元; 肖丹丹; 王彬; 王春梅; 杨思奋; 张雪林; 高芳琴

    2014-01-01

    目的:应用320排动态容积灌注CT扫描技术分析其在评估头颈面部皮瓣血供中的价值。方法研究对象为2011年8月~2013年4月间行全脑灌注的患者,共576例患者行320排CT全脑灌注CT检查。所有纳入研究的患者均无颈外动脉系统异常,因其他原因行头颅灌注CT检查的患者。获得的容积灌注数据通过体部灌注软件进行分析,并测量扫描区域内不同皮瓣的血流量值。皮瓣的供血动脉也可同时获得。获得的容积扫描数据经后处理后得到伪彩图,可进行兴趣区灌注血流(BF)值测量,测量时尽可能避开血管。动态容积扫描技术同时可获得扫描区域的血管信息,为穿支皮瓣移植提供基本信息。结果测量所有患者头面部皮瓣的BF值,包括额部、眼睑、鼻背部、颊部、颞部、枕部、颈部皮瓣,BF值分别为(127±7.7)、(268.0±31.1)、(229.0±50.9)、(67.8±9.5)、(140.3±5.5)、(163.8±15.5)、(123.5±12.5)ml/min。不同区域的皮瓣血供差别较大,眼睑与鼻背部皮瓣BF值较高,颊部BF值较低。检查同时也可获得不同期相皮瓣供血动静脉的图像,显示率为100%。结论320排动态容积灌注扫描技术可为接受头面部自体皮瓣移植患者提供有效的术前血供评估。灌注与解剖图像的融合有助于皮瓣术前设计。%Objective To investigate the value of 320-detector row perfusion CT in the pre-transplantation evaluation of blood supply of head and facial flaps.Methods Whole-head perfusion CT was performed on 576 patients with normal external carotid arteries using a 320-detector row CT system from August 2011 to April 2013.The number of visible feeding arteries and draining veins in the skin flaps on CTA was recorded.Pseudo color map was generated from the volume data using the body perfusion software.Blood flow of each skin flap within the scan region was measured.Results The blood flow

  1. Experimental study on composite flap for repair of bone defect of rabbit model of leg and foot skin trauma%复合皮瓣修复兔模型腿和足骨缺损皮肤创伤的研究

    Institute of Scientific and Technical Information of China (English)

    王志斌; 王黎敏; 张慧鹏

    2015-01-01

    目的 探讨复合皮瓣修复兔模型小腿皮肤创伤缺损的应用效果.方法 选择新西兰大白兔36只,通过装置模拟重物砸伤、挤压伤等,建立大白兔胫骨或跖骨骨折和小腿及足部软组织缺损的动物模型,成功27只,并采用异体骨移植、带胫骨骨膜的复合皮瓣修复胫骨骨折和皮肤缺损,其中串联带隐神经和骨膜的胫后动脉复合组织瓣修复前足2只.结果 27只模型的复合皮瓣全部成活,3例皮瓣远端表层部分坏死,经换药创面愈合.术后X线复查,移植异体骨对位好,恢复了兔的足弓.本组随访3~9个月,平均5个月,植入的异体骨骨性愈合,未见明显吸收、感染和排斥反应等并发症.足外形美观,可正常行走.结论 应用异体骨移植,取材方便,可恢复足弓.采用带骨膜的复合胫前动脉逆行皮瓣,不影响患足的供血,加速骨的愈合.缩短疗程,操作简单,外形好,可恢复大白兔模型足的行走功能.%Objective To investigate the effect of application of composite flap for repairing leg skin defect in rabbit traumatic model.Methods Thirty-six New Zealand rabbits by device simulation,bruise,crush injury,animal model rabbit tibia orfracture of metatarsal bone and soft tissue defects of leg and foot,27 cases were successful,and the use of allogeneic bone transplantation,with tibial periosteumcomposite flap for repair of tibial fracture and skin defect,wherein the series with hidden nerve and periosteum of the posterior tibial artery composite tissue flap to repair forefoot in 2 cases.Results The composite skin flaps in 27 cases survivedand 3 cases of the model,the distal end of the flap surface partial necrosis,healed by dressing.Postoperative X-ray review,allograft bone alignment,restorefoot transverse and longitudinal arch.The patients were followed up for 3 months to 9 months,implant bone allograft bone healing,no obvious absorption,infection and rejection and other complications.The foot of

  2. 手背逆行筋膜皮瓣在手指皮肤软组织缺损修复中的应用%Application of dorsal retrograde fascia flap of hands in the operation of fingers skin and soft tissue defect repairation

    Institute of Scientific and Technical Information of China (English)

    王华; 关志广; 方建勇; 胡发明; 赵立聪; 陈国威

    2013-01-01

    Objective Discussion on the use of hand reverse fascio-cutaneous flap in clinical effect of finger skin and soft tissue defect to improve the success rate of operation.Methods 35 cases including 38 fingers injury,together with 11 fractura,or 12 fingers’ nerves injury,or 8 tendon rupture.The defect minimum area is 2.5cm x2.0cm and the maximum area is 5.0cm x3.0cm.These were treated with retrograde fascial flap to repaird.Seven cases of them,coincide the cutaneous nerve of skin flap with the broken fingers to reconstruct the finger pulp feeling of the patients.Results In these 35 cases,the maximum area of skin flap is 4.0cm×1.8cm,and the minimum area is 1.5cmx1.2cm.The width of the pedicle is 1.0~1.5cm.All fascial flap of hands were survived,except 2 cases with ischemia and necrosis in the far-end of the flap after the treatment of secondary healing.One year follow-up,we were satisfied with the appearance of the fingers and the function of flexion and extension of the fingers.The sense of the two-point discrimination is 4.0~8.0mm.Conclusion The advantages of this method is obvious.The repairation has reserved finger length and kept hand in good shape.The survival rate is higher.The operation is simpler,without sacrifice of major arteries,and the hospitalization time is shorter.%目的:探讨利用手背逆行筋膜皮瓣修复在手指皮肤软组织缺损的临床效果,提高手术成功率.方法:对本院收治的35例患者38指,其中合并骨折11例,指神经损伤12例,肌腱断裂8例,缺损面积最小2.5cm×2.0cm,最大5.0cm×3.Ocm,所有病例均应用手背逆行筋膜皮瓣修复进行修复.其中7例吻合皮瓣的皮神经和手指断端的指神经,重建指腹感觉.结果:本组35例,皮瓣面积最大为4.0cm×1.8cm,最小为1.5cm×1.2cm,蒂宽1.0 ~ 1.5cm.除2例皮瓣远端缺血、坏死,经处理后二期愈合外,其余筋膜皮瓣全部成活.随访1年,外观满意,手指伸屈功能恢复良好,指腹两点辨别觉4.0~8.Omm.

  3. Spontaneous Flapping Flight

    Science.gov (United States)

    Vandenberghe, Nicolas; Zhang, Jun; Childress, Stephen

    2004-11-01

    As shown in an earlier work [Vandenberghe, et. al. JFM, Vol 506, 147, 2004], a vertically flapping wing can spontaneously move horizontally as a result of symmetry breaking. In the current experimental study, we investigate the dependence of resultant velocity on flapping amplitude. We also describe the forward thrust generation and how the system dynamically selects a Strouhal number by balancing fluid and body forces. We further compare our model system with examples of biological locomotion, such as bird flight and fish swimming.

  4. REPAIRING HALLUX METATARSOPHALANGEAL SKIN AND SOFT TISSUE DEFECTS WITH MEDIAL FLAP WITH DOUBLE BLOOD SUPPLY SYSTEM IN ELDERLY PATIENTS%带两套血供的足内侧皮瓣修复老年患者(足母)趾跖趾关节附近皮肤软组织缺损

    Institute of Scientific and Technical Information of China (English)

    周晓; 许亚军; 芮永军; 寿奎水; 陈学明

    2013-01-01

    Objective To investigate the effectiveness of repairing hallux metatarsophalangeal skin and soft tissue defect with medial flap with double blood supply system in elderly patients.Methods Between June 2011 and March 2012,9 cases (9 toes) of skin and soft tissue defect at hallux metatarsophalangeal joint were treated with medial flap with double blood supply system.There were 7 males and 2 females,aged 60-70 years (mean,65.4 years).Injury included crush injury in 5 cases,traffic accident injury in 4 cases.The interval of injury and operation ranged from 3 hours to 5 days (mean,35 hours).The patients had bone or tendon exposure with pollution of wounds.The size of defects ranged from 2.0 cm × 1.5 cm to 2.5 cm × 2.0 cm.The size of flaps ranged from 2.0 cm × 1.7 cm to 3.0 cm × 2.2 cm.Medial dorsal nerves were anastomosed with toe nerves to recover flap sensation.The donor site was repaired with skin grafting.Results All 9 flaps and skin grafting survived completely,and primary healing of wounds were obtained.Nine patients were followed up 6-8 months (mean,7 months).The colour,texture,and contour of the flaps were good.The two-point discrimination of the flaps was 12-16 mm (mean,14 mm) at last follow-up.The patients could walk normally.No scar contracture formed at donor site.No wear occurred.Conclusion The medial flap with double blood supply system can be used to repair hallux metatarsophalangeal skin and soft tissue defect in elderly patients because the flap can be easily obtained,has good blood supply,and has no injury to the main artery and nerve.%目的 探讨带两套血供的足内侧皮瓣修复老年患者(足母)趾跖趾关节附近皮肤软组织缺损的疗效.方法 2011年6月-2012年3月,收治9例(9趾)(足母)趾跖趾关节附近皮肤软组织缺损老年患者.男7例,女2例;年龄60~70岁,平均65.4岁.致伤原因:挤压伤5例,交通事故伤4例.伤后至手术时间为3h~5d,平均35h.创面污染,均伴骨或

  5. 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

  6. 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.

  7. [Repair of middle and lower face scars using alar thin expanded cervical flap with pedicle in anterior neck].

    Science.gov (United States)

    Xu, Lisi; Li, Yangqun; Tang, Yong; Chen, Wen; Yang, Zhe; Zhao, Muxin; Ma, Ning; Feng, Jun

    2014-04-01

    To explore the application of alar thin expanded cervical flap with pedicle in anterior neck for large scars on middle and lower face. From February 2000 to July 2013, 26 patients with scars on the middle and lower face were treated with the alar thin expanded cervical flaps with pedicle in anterior neck. After the skin of anterior neck was expanded by implanting skin expanders, alar thin expanded cervical flap with pedicle in anterior neck was obtained with size of 163-275 cm(2). Then the scars on the middle and lower face with the size of 135-196 cm(2) were excised, with the area of excision allowing full coverage of the expanded flap. The flap was rotated and advanced to the middle and lower face, and the incision was closed in layers. The 26 patients were followed up for 2 to 24 months. Twenty-one flaps survived, with good appearance and function. Four flaps showed venous retardation at distal part, and only one flap showed necrosis of the right edge. They were healed by free skin grafting. The alar thin expanded cervical flap not only makes maximum use of expanded flap on the premise of ensuring blood supply, but also guarantees good color, texture, and contour of face and neck.

  8. Preventive transposition of anterior tibial myofascial flaps for tibial fractures with delayed skin necrosis%预防性胫前肌-筋膜瓣转位在并发延迟皮肤坏死的胫骨骨折患者的应用

    Institute of Scientific and Technical Information of China (English)

    简超; 陶圣祥; 谭金海; 丁帆; 许刚; 阿米特

    2014-01-01

    Objective To discuss the effect of preventive transposition of anterior tibial myofas-cial flaps for tibial fractures complicated with severe skin and soft tissue injuries and delayed necrosis. Methods Fourteen cases of tibial fractures with severe skin and soft tissue injuries were selected for one-stage fixation combined with preventive transposition of anterior tibial myofascial flaps. The skin was cov-ered with grafts followed after the occurrence of delayed necrosis. Wound healing,fracture healing and com-plications were closely observed. Results All wounds got healed without any infective complications. Thir-teen cases were followed up and all fractures healed without bone exposure,osteomyelitis and other compli-cations. One case was lost to follow-up. Conclusion Preventive transposition of anterior tibial myofascial flaps is a safe,simple and effective management for the treatment of tibial fractures with delayed skin nec-rosis and avoidance of related complications.%目的:探讨预防性胫骨前肌-筋膜瓣转位在胫骨骨折合并重度皮肤软组织损伤发生延迟坏死病例中应用的临床疗效。方法对14例合并重度皮肤软组织损伤的胫骨骨折患者行Ⅰ期骨折固定联合预防性胫前肌-筋膜瓣转位术,发生皮肤延迟坏死后予以植皮,观察其伤口愈合情况、随访骨折愈合及并发症情况。结果14例患者伤口均愈合,无感染并发症,随访13例,骨折均愈合,无骨外露、骨髓炎等并发症,1例失访。结论预防性胫前肌-筋膜瓣转位是一种安全、简便、有效的治疗并发延迟皮肤坏死的胫骨骨折的措施。

  9. Multipaddled anterolateral thigh chimeric flap for reconstruction of complex defects in head and neck.

    Directory of Open Access Journals (Sweden)

    Canhua Jiang

    Full Text Available The anterolateral thigh flap has been the workhouse flap for coverage of soft-tissue defects in head and neck for decades. However, the reconstruction of multiple and complex soft-tissue defects in head and neck with multipaddled anterolateral thigh chimeric flaps is still a challenge for reconstructive surgeries. Here, a clinical series of 12 cases is reported in which multipaddled anterolateral thigh chimeric flaps were used for complex soft-tissue defects with several separately anatomic locations in head and neck. Of the 12 cases, 7 patients presented with trismus were diagnosed as advanced buccal cancer with oral submucous fibrosis, 2 tongue cancer cases were found accompanied with multiple oral mucosa lesions or buccal cancer, and 3 were hypopharyngeal cancer with anterior neck skin invaded. All soft-tissue defects were reconstructed by multipaddled anterolateral thigh chimeric flaps, including 9 tripaddled anterolateral thigh flaps and 3 bipaddled flaps. The mean length of skin paddle was 19.2 (range: 14-23 cm and the mean width was 4.9 (range: 2.5-7 cm. All flaps survived and all donor sites were closed primarily. After a mean follow-up time of 9.1 months, there were no problems with the donor or recipient sites. This study supports that the multipaddled anterolateral thigh chimeric flap is a reliable and good alternative for complex and multiple soft-tissue defects of the head and neck.

  10. [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.

  11. Palmar contracture release with arterialized venous instep flap: An anatomical and clinical study.

    Science.gov (United States)

    Zor, Fatih; Yalçın, Bülent; Tekin, Levent; Eski, Muhitdin; Işık, Selcuk; Şengezer, Mustafa

    2015-07-01

    Plantar skin has similar histologic features to the palmar area and appears to be the ideal tissue for reconstruction of the palmar region. In this study, an anatomic examination was performed to determine the superficial venous architecture of the instep area, and the use of arterialized venous instep flaps for palmar contracture release was assessed. The anatomical study was performed on 12 fresh cadaver feet. The arterialized venous instep flap, including the skin, subcutaneous tissue and superficial venous plexus, was harvested. To determine the venous structure, dissection (n = 6) and injection-corrosion (n = 6) techniques were used. In the clinical study, nine arterialized venous instep flaps were used for palmar contracture release. All flaps were harvested above the deep fascia and included skin, subcutaneous fat, and the superficial venous plexus. At the plantar site of the flap, two or three veins, one of which was used, were dissected for a sufficient length for the arterial anastomosis. The saphenous vein was used for the venous anastomosis. Dissection and injection-corrosion techniques revealed that the flap had 7-12 and 4-6 veins at its plantar and superior edges, respectively, with numerous anastomoses and interconnections between the veins. The flap dimensions were between 3 × 5 cm and 4 × 6 cm. All flaps survived, with two partial flap necrosis that healed with spontaneous epithelization. No debulking procedures were undertaken and all flaps adapted well to the recipient site. The arterialized venous instep flap is a good alternative to reconstruct palmar contractures by adding similar tissue that is thin and pliable with minimal donor site morbidity. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. The anatomical and neurophysiological basis of the sensate free TRAM and DIEP flaps.

    Science.gov (United States)

    Yap, L H; Whiten, S C; Forster, A; Stevenson, J H

    2002-01-01

    Recent developments in autogenous breast reconstruction using the rectus abdominis myocutaneous free flap include attempts to reinnervate the flap tissue. We have carried out anatomical studies to determine the nature of abdominal-wall cutaneous innervation, with particular emphasis on the harvesting of sensate flaps. Dissections were performed on four embalmed and 12 fresh human cadavers (32 sides). The lowest five intercostal nerve trunks were identified and traced to the lateral border of the rectus sheath. A detailed dissection of the intramuscular course of the nerves and associated vasculature was performed. The relationship of the nerves to the vascular perforators used for rectus abdominis myocutaneous flaps was determined visually, and confirmed histologically. In contrast to previous studies, we show that nerves supplying cutaneous sensation can travel with both medial and lateral vascular perforators. In order to confirm clinically useful innervation, the abdominal flap skin of five patients undergoing TRAM flap reconstruction was stimulated electrically, and sensory recordings were made directly from the related intercostal nerve just prior to flap harvest. These studies represent, to our knowledge, the first clinical application of neurophysiological techniques to outline the perforator neurosomes of flaps based on the deep inferior epigastric vascular axis. We provide the first comprehensive study of abdominal-wall innervation with regard to sensate free-flap harvest. Our dissections show complex patterns of abdominal skin innervation that have not been previously described. The implications for sensate free TRAM and DIEP flap reconstructions, as well as the potential for more accurate inclusion of innervated flap skin, are discussed. Copyright 2002 The British Association of Plastic Surgeons.

  13. Clinical application of the dorsalis pedis free flap for reconstruction of oral cancer defects.

    Science.gov (United States)

    Kalfarentzos, Evagelos; Ma, Chunyue; Tian, Zhuowei; Zhu, Hanguang; He, Yue

    2015-02-01

    The purposes of this study were to evaluate the clinical application and efficacy of the dorsalis pedis fasciocutaneous flap in the reconstruction of oral cavity defects and to assess the associated donor-site morbidity. From September 2009 to December 2012, 7 patients with associated oral cavity defects resulting from tumor resection underwent reconstruction with a dorsalis pedis fasciocutaneous flap. Surgical anatomy and harvesting procedure of the dorsalis pedis flap are described. Special consideration was given to the associated donor-site morbidity. All flaps survived without any complications. All 7 flaps were based on the dorsalis pedis artery and the greater saphenous vein for perfusion and drainage respectively. In all 7 cases, the donor site was closed with a full-thickness skin graft, with no associated healing complications or functional deficit of the foot. The resulting scar was well hidden in the lower extremity. The dorsalis pedis fasciocutaneous flap is a thin and pliable flap sharing many similarities with the radial forearm flap, thus making it ideal for intraoral reconstruction. Proper intraoperative and postoperative care of the donor site can result in minimal morbidity, as shown in this study. This flap may provide an ideal alternative to the radial forearm free flap, with the added advantages of a well-hidden scar and a high level of patient satisfaction. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

    Science.gov (United States)

    Kwon, Soo-Ha; Tsai, Chia-Hsuan; Chang, Kai-Ping; Kao, Huang-Kai

    2017-01-01

    Introduction Oncological resection of the tongue can be reconstructed using a multitude of free flaps. The medial sural artery perforator (MSAP) flap has been well described in the literature in terms of its anatomy and harvest. However, functional outcome studies of post-reconstruction tongue defects using the MSAP flap have not been reported. This study represents the largest outcome study of patients with tongue reconstructions using MSAP flaps and a comprehensive review of its use. Materials and methods From December of 2010 to October of 2015, 579 patients with subtotal glossectomy and free flap reconstructions in Chang Gung Memorial Hospital were retrospectively reviewed. 27 patients were reconstructed with MSAP flap. The pre- and intra-operative factors, as well as flap-related factors were analyzed. Post-operative complications and functional outcomes were evaluated. Donor site assessment were also conducted. Results A 96.3% flap survival rate was found with an average total operating time of 6 hours and 18 minutes. 84.6% of patients had primary closure of the donor site with and the remaining either had skin grafts or delayed closure. Donor site closure can be achieved primarily with no functional deficit. Speech intelligibility remained for most patients. 100% of patients resumed normal oral feeding. Conclusion The MSAP flap is a small to medium sized flap most suited for subtotal glossectomy defects where optimal outcomes can be achieved in terms of speech clarity and restoration of oral intake. PMID:28182639

  15. Clinical observation of ankle cutaneous defect repaired by flap prosthetics%皮瓣修复踝关节周围软组织缺损的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王道明; 曾荣铭; 余榕

    2016-01-01

    Objective To investigate the repair of ankle cutaneous defect with flap prosthetics. Methods There were 30 cases ankle cutaneous defect, who had been repaired with 6 kinds of skin flaps. Local gyral flap in 7 cases, distal sural neurocutaneous flap in 5 cases, distal perforators peroneal artery flap in 6 cases, posterior tibial artery perforators flap in 6 cases, reverse lateral supramalleolar island flap in 1 case, and free anterolateral femoral cutaneous flap in 5 cases. The dimensions of the flap ranged from 3 cm ×3 cm to 19 cm ×9 cm. Results 26 cases were one-stage survival, 2 cases of distal sural neurocutaneous flap partly necrosised and healed after change dressings, 1 case of posterior tibial artery perforators flap distal 1/4 portion necrosised and healed after two stage skin-grafting, 1 case of distal perforators peroneal artery flap venous crisis occurred and healing under-scab after distal portion bleeding therapy. Conclusion The application of flap prothesis can cure kinds of ankle cutaneous defect nicely.%目的:探讨应用外科皮瓣技术修复常见的踝关节周围软组织缺损的临床疗效。方法对2007-2014年收治的踝关节周围软组织缺损30例,行6种外科皮瓣技术修复,其中局部转移皮瓣7例,远端蒂腓肠神经皮瓣5例,远端蒂腓动脉皮穿支皮瓣6例,胫后动脉皮穿支皮瓣6例,逆行外踝上岛状皮瓣1例,游离股前外侧穿支皮瓣5例。切取皮瓣最小3 cm×3 cm,最大19 cm×9 cm。结果30例皮瓣中26例Ⅰ期全部成活;2例远端蒂腓肠神经岛状皮瓣远端部分坏死,经局部换药治疗后创面愈合;1例胫后动脉皮穿支皮瓣远端1/4部分坏死,经Ⅱ期植皮后闭合创面;1例远端蒂腓动脉皮穿支皮瓣术后出现静脉危象,行远端放血处理后,后期