WorldWideScience

Sample records for vascularized skin flaps

  1. Value of a skin island flap as a postoperative predictor of vascularized fibula graft viability in extensive diaphyseal bone defect reconstruction.

    Science.gov (United States)

    Guo, Q-F; Xu, Z-H; Wen, S-F; Liu, Q-H; Liu, S-H; Wang, J-W; Li, X-Y; Xu, H-H

    2012-09-01

    To evaluate the feasibility and reliability of free vascularized fibular graft with skin island flap for reconstruction of large diaphyseal bone defect. The clinical results of vascularized fibular graft and experiences related to the importance and reliability of a monitoring island flap for the reconstruction of various long-bone defects were reviewed in 87 patients. Bony reconstruction was achieved in 82 of the 87 patients. Arterial thrombosis of anastomosed vessel in two patients and venous congestion of monitoring flap in nine patients occurred in the early postoperative periods. All of them were managed by immediate thrombectomy and reanastomosis, alternatively the thrombotic veins were replaced by new veins to anastomose with the superficial veins in five patients. Partial flap necrosis was noted in six patients, but additional surgical intervention was not required. The vascularized fibula survived and bony fusion was achieved in all patients. Postoperative stress fractures of the fibula graft occurred in 19 (21.8%) patients (once in seven patients, twice in five patients, three or more times in seven) as the mechanical stress to the graft increased. Included fracture on the tibia in 12 patients, humerus in one and femur in six. Treatments included casting in 11 patients, percutaneous pinning in one case, and adjustment of external fixator in seven patients. Bony union was finally achieved an average of 9.6 months after fracture. Correct alignment between the recipient bone and the external fixator is a prerequisite to preventing graft fracture. Vascularized fibula transfer is a valuable procedure for long-bone defects, and a skin island-monitoring flap is a simple, extremely useful, and reliable method for assessing the vascular status of vascularized fibula. Level IV. Retrospective study. Copyright © 2012. Published by Elsevier Masson SAS.

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

    Directory of Open Access Journals (Sweden)

    Satish P Bhat

    2013-01-01

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

  4. Axial pattern skin flaps in cats.

    Science.gov (United States)

    Remedios, A M; Bauer, M S; Bowen, C V; Fowler, J D

    1991-01-01

    The major direct cutaneous vessels identified in the cat include the omocervical, thoracodorsal, deep circumflex iliac, and caudal superficial epigastric arteries. Axial pattern skin flaps based on the thoracodorsal and caudal superficial epigastric arteries have been developed in cats. Rotation of these flaps as islands allows skin coverage to the carpus and metatarsus, respectively. The thoracodorsal and caudal superficial epigastric flaps provide a practical, one-step option in the reconstruction of large skin defects involving the distal extremities of cats.

  5. Dermatosurgery Rounds - The Island SKIN Infraorbital Flap

    Directory of Open Access Journals (Sweden)

    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.

  6. [The influence of estradiol on histomorphology of skin flaps with ischemia reperfusion injury].

    Science.gov (United States)

    Jianlong, Wu; Ruixing, Hou; Guangliang, Zhou; Jihui, Ju

    2015-09-01

    To study the influence of estradiol on histomorphology of skin flaps with ischemia reperfusion injury. 48 adult male Wistar rats aged 12-14 weeks old, were randomly divided into control group (group I), ischemia-reperfusion group (group II), saline group (group III), estradiol group (group IV). Superficial epigastric artery axial flap, 3 cm x 6 cm in size, was made in the left lower quadrant abdominal of each rat. Flap model with ischemia-reperfusion injury was established by using the nondestructive micro vascular clamp to clamp the superficial epigastric artery. The general condition of the flap was observed after operation. At 7 days after operation, the survival rate of the flap was detected, the flaps were harvested to receive histology and ultrastructural observation. The neutrophils level of the superficial epigastric vein were tested. 7 days after operation, the survival rate of the flap in group IV was significantly higher than that in group II, III (P organization structure in flap.

  7. 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 .

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Vascularized Fibula Flaps for Mandibular Reconstruction: An ...

    African Journals Online (AJOL)

    For decades, osseous vascularised flaps have been used for reconstruction of the mandible with the vascularised fibula flap (VFF) remaining the commonly used osseous free flap, reasons ranging from its adequate bone and pedicle length to its receptive dental implant placement quality. This report considers a modest use ...

  10. Transfer of free vascular cutaneous flaps by microvascular anastomosis. Results in six dogs.

    Science.gov (United States)

    Fowler, J D; Miller, C W; Bowen, V; Johnston, G H

    1987-01-01

    Skin defects on the distal extremities of six dogs were reconstructed with free vascular cutaneous transfers by microvascular anastomosis. The donor flaps were based on the superficial cervical artery and vein. In five of the dogs, bone was exposed and skin was lost from half of the circumference of the limb. Two had infected fractures with sequestra and three had acute shearing injuries. The sixth dog had sensory denervation of the left antebrachium and a carpal acral lick granuloma. Before surgery, the patency of potential recipient vessels was confirmed with arteriography in five dogs and an ultrasonic doppler in one dog. Microvascular technique was used to reestablish circulation to the flaps after they were transferred to the recipient site. Total ischemic time of the flaps averaged 100 minutes. All flaps survived. Successful reconstruction of the cutaneous defects was achieved in these six cases.

  11. The Effect of Omeprazole Usage on the Viability of Random Pattern Skin Flaps in Rats.

    Science.gov (United States)

    Şen, Hilmi; Oruç, Melike; Işik, Veysel Murat; Sadiç, Murat; Sayar, Hamide; Çitil, Rana; Korkmaz, Meliha; Koçer, Uğur

    2017-06-01

    Necrosis of random pattern flaps caused by inadequate blood flow, especially in the distal part of the flap is one of the biggest challenges in reconstructive surgery. Various agents have been used to prevent flap ischemia. In this study, we used omeprazole, which is a potent inhibitor of gastric acidity to increase flap viability. In this study, 35 Wistar-Albino type rats which were divided into 5 equal groups were used. Random-pattern dorsal skin flaps were raised in all groups at seventh day of the study. Group 1 was accepted as control group, and the rats in this group was only given distilled water intraperitoneally for 14 days. Group 2 and group 3 received 10 and 40 mg/kg omeprazole daily for 14 days, respectively. Group 4 and group 5 were given distilled water for the first 7 days and then after the operations they received 10 and 40 mg/kg omeprazole daily for 7 days, respectively. Survival rates of the flaps were examined seventh day after elevation of the flaps by digital imaging and scintigraphy. After assessment of the amount of necrosis, number of vascular structures were counted histopathologically. Percentage of flap necrosis was found to be less in all omeprazole received groups. On digital imaging, percentages of flap necrosis in the study groups were statistically significantly lower than that of the control group (P 0.05).In the histopathologic specimens, it was detected that the mean number of vessels in proximal (a) and distal (c) portions of the flap in the study groups showed a significant increase when compared with the control group (P < 0.01 for groups 2, 4 and 5, and P < 0.05 for group 3). In conclusion, possible clinical usage of medications increasing gastrin during flap surgeries can be thought as a positive contributor. In this sense, this study showed that parenteral administration of omeprazole in skin flap surgery increases flap viability possibly by increasing gastrin levels.

  12. Experience With Ventral Penile Skin Island Flap urethroplasty | Ntia ...

    African Journals Online (AJOL)

    Background:Island flap techniques currently used in urethroplasty utilize the prepuce and the dorsal penile skin. Our experience with a one-stage island flap urethroplasty for urethral strictures utilizing the ventral penile skin is described. Patients and Method: This is a longitudinal study of seventy six consecutive patients ...

  13. Response of rat skin flaps to sinusoidal electromagnetic fields

    International Nuclear Information System (INIS)

    Herbst, E.

    1987-01-01

    Electrical stimulation to heal bone fractures has been used clinically since the early 1970s. As a result of treatment with either direct current or electromagnetic fields, there was an indication that the electrical signals enhanced the ingrowth of blood vessels into the treated area. This possibility was one of the reasons for the initial studies on the influence of pulsed electromagnetic fields (PEMFs) on healing of skin flaps. These investigations reported a decrease in the amount of necrosis of a skin flap after PEMF treatment. The skin flap model was chosen in these studies, as it is generally accepted for the investigation of the influence of different treatments on wound healing. The skin flap is a partially detached portion of the skin which retains part of its blood supply. However, if the flap is too long for its width, part of it will die after the transfer. Flap necrosis, therefore, represents a difficult clinical problem, especially in classes where a large area has to be covered. In the present study the authors address whether enhanced skin flap survival after treatment with PEMF is signal specific, that is , whether one could obtain similar results using various sinusoidal electromagnetic fields (SEMFs). Specifically, they investigated the influence on skin flap survival of SEMFs with different frequencies but the same maximum of dB/dt

  14. Ulnar-based skin flap for Dupuytren's fasciectomy.

    Science.gov (United States)

    Ali, Syed N; McMurtrie, Andrew; Rayatt, Sukh; Roberts, Jeremy O

    2006-01-01

    The mainstay of treatment for symptomatic Dupuytren's disease is operation. Various skin incisions have been described, showing that there is no single best incision. We describe an ulnar-based skin flap for excision of palmar disease. This flap allows excellent exposure of the diseased area, and provides good access to the palmar aponeurosis including the difficult area on the ulnar side of the little finger. Healing is reliable and digital disease can be approached with a skin extension as required. Recurrent disease can be treated by raising the same flap again.

  15. Efficacy of In Vivo Electroporation-Mediated IL-10 Gene Delivery on Survival of Skin Flaps.

    Science.gov (United States)

    Seyed Jafari, S Morteza; Shafighi, Maziar; Beltraminelli, Helmut; Weber, Benedikt; Schmid, Ralph A; Geiser, Thomas; Gazdhar, Amiq; Hunger, Robert E

    2018-04-01

    Despite advances in understanding the underlying mechanisms of flap necrosis and improvement in surgical techniques, skin flap necrosis after reconstructive surgery remains a crucial issue. We investigated the efficacy of electroporation-mediated IL-10 gene transfer to random skin flap with an aim to accelerate wound healing and improve skin flap survival. Nine male Wistar rats (300-330 g) were divided in two groups (a) control group (n = 5), only surgery no gene transfer, and (b) experimental group, received electroporation-mediated IL-10 gene transfer 24 h before the surgery as prophylaxis (n = 4). Random skin flap (McFarlane) was performed in both groups. Planimetry, Laser Doppler imaging, and immunohistochemistry were used to evaluate the effect of IL-10 gene transfer between study groups at day 7. Electroporation-mediated IL-10 gene transfer decreased percentage of flap necrosis (p value = 0.0159) and increased cutaneous perfusion compared to the control group (p value = 0.0159). In addition, Spearman's rank correlation showed a significant negative correlation between percentage of flap necrosis and Laser Index (p value = 0.0083, r -0.83, respectively). Furthermore, significantly higher mean CD31 + vessel density was detected in the experimental group compared to the control group (p value = 0.0159). Additionally, semi-quantitative image analysis showed lower inflammatory cell count in experimental group compared to control group (p value = 0.0317). In vivo electroporation-mediated IL-10 gene transfer reduced necrosis, enhanced survival and vascularity in the ischemic skin flap.

  16. Hypothyroidism improves random-pattern skin flap survival in rats.

    Science.gov (United States)

    Rahimpour, Sina; Nezami, Behtash Ghazi; Karimian, Negin; Sotoudeh-Anvari, Maryam; Ebrahimi, Farzad; Taleb, Shayandokht; Mirazi, Naser; Dehpour, Ahmad Reza

    2012-11-01

    The protective effect of hypothyroidism against ischemic or toxic conditions has been shown in various tissues. We investigated the effect of propylthiouracil (PTU)/methimazole (MMI)-induced hypothyroidism and acute local effect of MMI on the outcome of lethal ischemia in random-pattern skin flaps. Dorsal flaps with caudal pedicles were elevated at midline and flap survival was measured at the seventh day after surgery. The first group, as control, received 1 mL of 0.9% saline solution in the flap before flap elevation. In groups 2 and 3, hypothyroidism was induced by administration of either PTU 0.05% or MMI 0.04% in drinking water. The next four groups received local injections of MMI (10, 20, 50, or 100 μg/flap) before flap elevation. Local PTU injection was ignored due to insolubility of the agent. Hypothyroidism was induced in chronic PTU- and MMI-treated groups, and animals in these groups showed significant increase in their flap survival, compared to control euthyroid rats (79.47% ± 10.49% and 75.48% ± 12.93% versus 52.26% ± 5.75%, respectively, P hypothyroidism improves survival of random-pattern skin flaps in rats. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Non-invasive vascular imaging in perforator flap surgery

    International Nuclear Information System (INIS)

    Saba, Luca; Piga, Mario; Atzeni, Matteo; Ribuffo, Diego; Rozen, Warren Matthew; Alonso-Burgos, Alberto; Bura, Raffaella

    2013-01-01

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

  18. Non-invasive vascular imaging in perforator flap surgery

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-02-15

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

  19. [Application of the tension skin flap with different shapes in the pedicle of the reverse neurocutaneous island flap].

    Science.gov (United States)

    Li, Meng; Lan, Xu; Zheng, Ping; Liu, Xing-Yan; Gao, Qiu-Ming; Song, Ming-Jia

    2013-08-01

    To investigate the effects of the tension skin flap with different shapes on the transplantation of the reverse neurocutaneous island flap. From January 2006 to January 2012,there were 21 patients in the study (including 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 tension 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 x 2.0 cm to 8.0 cm x 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 x 4.0 cm to 13.0 cm x 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. 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 appearance. 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.

  20. An algorythmic approach to restoration of the fronto-naso-periorbital skin defects using the forehead flaps.

    Science.gov (United States)

    Tan, Onder

    2010-01-01

    The classic forehead flaps, which are designed vertically, two-staged and exteriorised pedicled peninsular flaps, are still a reconstructive option for nasal and periorbital defects. However, some drawbacks such as conspicuous donor-site scar, multi-staged procedure, rather short pedicle, hairy appearance (in narrow foreheads), and inability to use the forehead flap when the donor site is involved are often encountered during surgery. To avoid these issues, three unusual designs of the forehead flap are presented, and also a new algorithm is proposed to guide surgeons in their solutions. Nineteen patients (10 women and nine men) were managed with 21 forehead flaps to restore the nasal, medial canthal and frontal defects caused by skin tumours. The flaps were applied as interpolation island, V-Y island, and transverse peninsular designs in 12, four and three patients, respectively. All donor sites were closed primarily except one, where a split thickness skin graft was used. The average follow-up was 14 months. All flaps survived (totally) but in one partial necrosis developed. Aesthetic and functional recoveries were acceptable in all patients. Based on the algorithm presented, the forehead flaps with their superb anatomic characteristics including rich vascular supply and pliable skin can be safely used in either classic or extraordinary fashion for small to medium sized defects of the nasoorbital and frontal regions.

  1. Experience with Quartey's Distal Penile Island Skin Flap ...

    African Journals Online (AJOL)

    Objective: To evaluate our experience with Quartey's distal penile island skin flap urethroplasty in the treatment of urethral stricture in two tertiary hospitals in South Western Nigeria. Patients and Methods: Between June 2002 and May 2005, 18 patients with a mean age of 42.2 years (range: 25 – 75 years) underwent distal ...

  2. The use of pedicled prepucial skin flap urethroplasty for proximal ...

    African Journals Online (AJOL)

    The use of pedicled prepucial skin flap urethroplasty for proximal bulbomembraneous urethral stricture in children: an easy alternative to transpubic urethroplasty. Harshjeet S. Bal, Jujju J. Kurian and Sudipta Sen. Objective Pediatric urethral strictures are not uncommon, and a myriad of treatment options is available.

  3. Reconstruction of Nasal Skin Cancer Defects with Local Flaps

    International Nuclear Information System (INIS)

    Salgarelli, A. C.; Bellini, P.; Multinu, A.; Consolo, U.; Magnoni, C.; Francomano, M.; Fantini, F.; Seidenari, S.

    2011-01-01

    Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose.

  4. Reconstruction of Nasal Skin Cancer Defects with Local Flaps

    Directory of Open Access Journals (Sweden)

    A. C. Salgarelli

    2011-01-01

    Full Text Available Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose.

  5. Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study.

    Science.gov (United States)

    Matsen, Cindy B; Mehrara, Babak; Eaton, Anne; Capko, Deborah; Berg, Anastasia; Stempel, Michelle; Van Zee, Kimberly J; Pusic, Andrea; King, Tari A; Cody, Hiram S; Pilewskie, Melissa; Cordeiro, Peter; Sclafani, Lisa; Plitas, George; Gemignani, Mary L; Disa, Joseph; El-Tamer, Mahmoud; Morrow, Monica

    2016-01-01

    Rates of mastectomy with immediate reconstruction are rising. Skin flap necrosis after this procedure is a recognized complication that can have an impact on cosmetic outcomes and patient satisfaction, and in worst cases can potentially delay adjuvant therapies. Many retrospective studies of this complication have identified variable event rates and inconsistent associated factors. A prospective study was designed to capture the rate of skin flap necrosis as well as pre-, intra-, and postoperative variables, with follow-up assessment to 8 weeks postoperatively. Uni- and multivariate analyses were performed for factors associated with skin flap necrosis. Of 606 consecutive procedures, 85 (14 %) had some level of skin flap necrosis: 46 mild (8 %), 6 moderate (1 %), 31 severe (5 %), and 2 uncategorized (0.3 %). Univariate analysis for any necrosis showed smoking, history of breast augmentation, nipple-sparing mastectomy, and time from incision to specimen removal to be significant. In multivariate models, nipple-sparing, time from incision to specimen removal, sharp dissection, and previous breast reduction were significant for any necrosis. Univariate analysis of only moderate or severe necrosis showed body mass index, diabetes, nipple-sparing mastectomy, specimen size, and expander size to be significant. Multivariate analysis showed nipple-sparing mastectomy and specimen size to be significant. Nipple-sparing mastectomy was associated with higher rates of necrosis at every level of severity. Rates of skin flap necrosis are likely higher than reported in retrospective series. Modifiable technical variables have limited the impact on rates of necrosis. Patients with multiple risk factors should be counseled about the risks, especially if they are contemplating nipple-sparing mastectomy.

  6. Role of Pectoralis Major Myocutanuos Flap in Salvage Laryngeal Surgery for Prophylaxis of Pharyngocutaneuos Fistula and Reconstruction of Skin Defect

    International Nuclear Information System (INIS)

    Mebeed, A.; Hussein, H.A.; Saber, T.Kh.; Zohairy, M.A.; Lotayef, M.

    2009-01-01

    This study was carried out to minimize the incidence of pharyngocutaneous fistula (PCF) following salvage laryngeal surgery using vascularized pedicle pectoralis major myocutaneous flap (PMMC) for enhancing wound healing, rapid intake of oral feeding, reconstruction of desqauamated irradiated skin, achieving short hospital stay and protection against catastrophic blow out mortality. Patients and Methods: This case series study of sixteen patients carried out from May 2005 to July 2009, at the National Cancer Institute, Cairo University where we applied PMMC flap in salvage laryngeal surgery for those with high risk to develop complications: Patients of poor general conditions (anemia, hypoproteinaemia, diabetics) and/or poor local conditions for healing (irradiated neck, extensive local or nodal recurrence with skin desquamation, infiltration or tumor fungation which need extensive resection). Five cases had been treated with primary cobalt radiotherapy laryngeal field only and 4 cases laryngeal field with draining neck nodes, while photon therapy was given in 4 cases as laryngeal field only and 3 cases laryngeal field with draining neck nodes. All cases were squamous cell carcinoma (13 cases grade 2, 2 cases grade 3 and one case grade 1) proved before radiotherapy. Supraglottic recurrence was detected in 7 cases (43.75%) and glottis in 9 cases (56.25%). Following salvage surgery, 11 cases were staged T3 NO, Nl and N2, 3 cases were T2 NO or Nl and 2 cases were T4 N2 with skin infiltration. Tracheostomy was there in 4 cases. Results: The study included fifteen males (93.75%) and one female (6.25%), age was between 38-73 years (mean=55.5 years). Five cases were operated on as total laryngectomy with excision of skin flaps + PMMC flap, 4 cases as total laryngectomy with skin flap excision + functional block neck dissection + PMMC flap and 7 cases as total laryngectomy -f block neck dissection with skin, excision (modified radical in 4 cases and radical in 3 cases

  7. Safety of long-term subcutaneous free flap skin banking after skin-sparing mastectomy.

    Science.gov (United States)

    Verstappen, Ralph; Djedovic, Gabriel; Morandi, Evi Maria; Heiser, Dietmar; Rieger, Ulrich Michael; Bauer, Thomas

    2018-03-01

    A persistent problem in autologous breast reconstruction in skin-sparing mastectomies is skin restoration after skin necrosis or secondary oncological resection. As a solution to facilitate reconstruction, skin banking of free-flap skin has been proposed in cases where the overlying skin envelope must be resected, as this technique spares the patient an additional donor site. Herein, we present the largest series to date in which this method was used. We investigated its safety and the possibility of skin banking for prolonged periods of time. All skin-sparing mastectomies and immediate autologous breast reconstructions from December 2009 until June 2013 at our institution were analysed. We identified 31 patients who underwent 33 free flap reconstructions in which skin banking was performed. Our median skin banking period was 7 days, with a maximum duration of 171 days. In 22.5% of cases, the banked skin was used to reconstruct overlying skin defects, and in 9.6% of cases to reconstruct the nipple-areolar complex. Microbiological and histological investigations of the banked skin revealed neither clinical infections nor malignancies. In situ skin banking, even for prolonged periods of time, is a safe and cost-effective method to ensure that skin defects due to necrosis or secondary oncological resection can be easily reconstructed.

  8. [Flap repair for vascular prosthesis exposure after artificial blood vessel bypass surgery for critical limb ischemia].

    Science.gov (United States)

    Wu, Wei-wei; Wu, Hao; Zeng, Ang; Bai, Ming; Zeng, Rong; Chen, Yu; Liu, Chang-wei

    2013-08-01

    To investigate the effectiveness of flap repair for vascular prosthesis exposure after the artificial blood vessel bypass surgery for critical limb ischemia. From August 2007 to December 2011, bypass surgery with vascular prosthetic grafts were performed in 192 patients with critical limb ischemia.Five patients among them (2.6%) suffered from vascular prosthesis exposure 6 to 13 days after the previous surgery, including 4 males and 1 female, with a median age of 68 years(arranged from 52 to 81 years). The surgical managements included surgical debridement and local flap or transferred muscle-cutaneous flap repair to preserve the prosthetic vascular grafts. Three patients underwent Z-plasty with local flap repair, while 2 patients underwent transferred rectus abdominis or rectus femoris muscle flap repair of the wounds. After the surgery, prosthetic vascular graft was successfully preserved in 4 of the 5 cases with first intention healing. At a median follow-up of 38 months (arranged from 5 to 57 months), all the 4 limbs were salvaged with patent of the prosthetic grafts.One flap failed to heal and the prosthetic graft had to be removed due to infection and hemorrhage. An above-knee-amputation was performed due to severe limb ischemia. The vascular prosthesis exposure is often a disaster after artificial blood vessel bypass surgery for critical limb ischemia.Local flap or transferred muscle-cutaneous flap repair is an effective surgical management to salvage the exposed graft and the affected limb.

  9. Edmund Prince Fowler Award Thesis. Evaluation of random skin flap survival in a porcine model.

    Science.gov (United States)

    Pratt, M F

    1996-06-01

    The pathophysiology of random skin flap necrosis in the pig model was studied the effects of several drugs on skin flap survival were examined. The investigated drugs included acetylsalicylic acid (ASA), pentoxifylline (PTX), prostaglandin E2 (PGE2), and an experimental 21-aminosteroid, U-74389G. Each drug altered different parameters known to be associated with tissue necrosis. Demonstrated mechanisms of skin flap failure included the alteration of erythrocyte flexibility and platelet function and the activation of neutrophils with resultant accumulation of damaging oxygen-free radicals. Random skin flap survival did not improve with ASA but did improve significantly with PTX, PGE2, and U-74389G. The results of this study underscore the importance of neutrophil-mediated necrosis in the pathophysiology of skin flap failure. The data further demonstrate the need to develop drugs aimed at reversing or preventing the tissue damage from oxygen-free radicals in order to enhance the survival of random skin flaps.

  10. Bilateral axillary skin fold flaps used for dorsal thoracic skin wound closure in a dog : clinical communication

    Directory of Open Access Journals (Sweden)

    B. G. Nevill

    2010-05-01

    Full Text Available A 10-year-old greyhound-cross dog was presented with a large, chronic skin wound extending over the interscapular region. The substantial skin defect was closed by making use of bilateral axillary skin fold flaps. It was possible to elevate the 2 skin flaps sufficiently to allow them to meet at the dorsal midline and thus facilitate complete closure of a large and awkwardly positioned wound. Small dorsal areas of the skin flaps underwent necrosis, but the resulting defects were closed without difficulty in a subsequent procedure. To the author's knowledge, this is the 1st clinical report of the use of bilateral axillary skin fold flaps in this fashion and describes an additional use of a versatile skin flap procedure.

  11. BCL-2 and Bax Expression in Skin Flaps Treated with Finasteride or Azelaic Acid.

    Science.gov (United States)

    Ayatollahi, Seyyed Abdulmajid; Ajami, Marjan; Reyhanfard, Hamed; Asadi, Yasin; Nassiri-Kashani, Mansour; Rashighi Firoozabadi, Mehdi; Davoodi, Sayed Hossein; Habibi, Esmaeil; Pazoki-Toroudi, Hamidreza

    2012-01-01

    Despite all modern surgical techniques, skin flap that is considered as the main method in most reconstructive surgeries puts the skin tissue at danger of necrosis and apoptosis derived from ischemia. Therefore, finding a treatment for decreasing the apoptosis derived from flap ischemia will be useful in clinic. In present study, we evaluated the effect of azelaic acid 20% and finasteride on expression of BCL-2 and bax proteins after the skin flap surgery. For this purpose, 21 rats were entered in three groups including control, azelaic acid 20% and finasteride, all experienced skin flap surgery and then flap tissue was assessed for determining the expression of proteins in 5 slices prepared from each rat that were graded between - to +++ scales. Both azelaic acid and finasteride increased the expression of BCL-2 protein (p azelaic acid in preserving the flap after the ischemia reperfusion insult.

  12. Human adipose-derived stem cell spheroid treated with photobiomodulation irradiation accelerates tissue regeneration in mouse model of skin flap ischemia.

    Science.gov (United States)

    Park, In-Su; Chung, Phil-Sang; Ahn, Jin Chul; Leproux, Anais

    2017-11-01

    Skin flap grafting is a form of transplantation widely used in plastic surgery. However, ischemia/reperfusion injury is the main factor which reduces the survival rate of flaps following grafting. We investigated whether photobiomodulation (PBM) precondition prior to human adipose-derived stromal cell (hASC) spheroid (PBM-spheroid) transplantation improved skin tissue functional recovery by the stimulation of angiogenesis and tissue regeneration in skin flap of mice. The LED had an emission wavelength peaked at 660 ± 20 nm (6 J/cm 2 , 10 mW/cm 2 ). The expression of angiogenic growth factors in PBM-spheroid hASCs was much greater than that of not-PBM-treated spheroid or monolayer-cultured hASCs. From immunochemical staining analysis, the hASCs of PBM-spheroid were CD31 + , KDR + , and CD34 + , whereas monolayer-cultured hASCs were negative for these markers. To evaluate the therapeutic effect of hASC PBM-spheroid in vivo, PBS, monolayer-cultured hASCs, and not-PBM-spheroid were transplanted into a skin flap model. The animals were observed for 14 days. The PBM-spheroid hASCs transplanted into the skin flap ischemia differentiated into endothelial cells and remained differentiated. Transplantation of PBM-spheroid hASCs into the skin flap ischemia significantly elevated the density of vascular formations through angiogenic factors released by the skin flap ischemia and enhanced tissue regeneration at the lesion site. Consistent with these results, the transplantation of PBM-spheroid hASCs significantly improved functional recovery compared with PBS, monolayer-cultured hASCs, and not-PBM-spheroid treatment. These findings suggest that transplantation of PBM-spheroid hASCs may be an effective stem cell therapy for the treatment of skin flap ischemia.

  13. Deep inferior epigastric artery (DIEA) skin flap: clinical experience of 15 cases.

    Science.gov (United States)

    Kostakoğlu, N; Keçik, A

    1998-01-01

    Skin flaps devoid of rectus muscle, raised on a single musculocutaneous perforator (14 cases), and on two musculocutaneous perforators (1 case) of the deep inferior epigastric artery (DIEA) were used in 14 patients to cover various defects during a period of 3 years. The flaps were raised on the perforator arising slightly lateral to the centre of the muscle below the umbilicus, which is a sub-branch of the lateral branch of DIEA. The defects were located on the upper limb in four, the lower limb in nine, and the scalp and forehead in the remaining two cases. In one patient, the flap was preexpanded for 4 weeks prior to transfer. The longest flap was 40 x 12 cm, and the widest flap was 30 x 18 cm in dimension. All donor defects were closed primarily. Two flaps were lost due to venous thrombosis on the fourth postoperative day. Tip necrosis was observed in two flaps, both of which were salvaged from venous thrombosis at 36 hours and 5 days postoperatively. The remaining 11 flaps survived completely. The DIEA skin flap was found to provide the following benefits: (1) the largest available skin flap where the donor site could be closed primarily; (2) decreased possibility of abdominal wall weakness and hernia formation; and (3) potential of obtaining a thin flap either by trimming of the subcutaneous fat or by preexpansion.

  14. [Clinical application of free vascularized flaps based on the wrist cutaneous branch of ulnar artery in repairing finger soft tissue defect].

    Science.gov (United States)

    Tang, Yang-Hua; Zeng, Lin-Ru; Huang, Zhong-Ming; Yue, Zhen-Shuang; Xu, Can-Da; Xin, Da-Wei

    2014-09-01

    To investigate the methods and clinical effects of repairing finger soft tissue defect with free vascularized flaps based on the wrist cutaneous branch of ulnar artery. From February 2010 to December 2012, 16 patients with finger soft tissue defects were repaired by free vascularized flaps based on the wrist cutaneous branch of ulnar artery, including 10 males and 6 females with an average age of 38.2 years old ranging from 18 to 52 years. Among them, 5 cases caused by hot crush injury, 8 cases caused by machine crush injury, 3 cases caused by firecracker burst injury. The defect area varied from 1.3 cm x 2.3 cm to 2.6 cm x 5.0 cm. The flap area varied from 1.5 cm x 2.5 cm to 2.8 cm x 5.2 cm. The appearance and two-point discrimination of flap were observed after operation. All flaps survived and wounds healed primarily. No wound infection and skin necrosis were found in donor site and recipient site. Among repair methods, direct suture in forearm donor site had 11 cases and skin graft had 5 cases. All patients were followed up from 6 to 24 months with an average of 10.8 months. The appearance of flap was not fat or clumsy, texture and color were similar to the recipient site, the sensation were good, two-point discrimination was 6 to 9 mm. The appearance of donor site were well complicated with mild scarring without dysfunction obviously. The free vascularized flaps based on the wrist cutaneous branch of ulnar artery has the advantages of vascular anatomy constant,thickness moderate and carry sensory nerves, etc, which is effective way to repair finger soft tissue defects.

  15. Long-Term Outcomes of Simultaneous Skin and Bowel Flaps for Esophageal Reconstruction.

    Science.gov (United States)

    Imaizumi, Atsushi; Liem, Anita A; Yang, Chun-Fan; Chen, Wency; Chen, Shih-Heng; Chen, Hung-Chi

    2015-08-01

    Esophageal reconstruction can be performed with skin or bowel flaps. The choice of flap remains controversial, as the long-term outcomes of skin flaps cannot always be assessed in patients with limited life expectancies due to advanced malignancy, unlike the pediatric and benign cases which have had esophageal reconstruction using bowel flaps. We report the long-term clinical and histopathological outcomes in a series of 45 cases repaired with combined skin and bowel flaps.Four patients developed symptomatic strictures after corrosive esophageal injuries were repaired with a combination of a tubed free radial forearm fasciocutaneous flap and a pedicled bowel flap. On average, 24 years had passed since uneventful initial esophageal reconstructions. Barium esophagograms were obtained in all cases and pathological examination was performed upon all surgical specimens.The cutaneous portions of the reconstructed esophagus exhibited a variety of findings on barium examination. Each of the 4 cases developed an esophagocutaneous fistula after revision; an average of 4 surgeries was required to close these fistulae. The inner surfaces of the portion of esophagus repaired with skin flaps showed extensive ulceration, polypoid lesions, and fibrosis. Pathology specimens from skin flaps showed extensive acute and chronic inflammation, microabscesses, fibrosis, and acanthosis, with depletion and degeneration of the pilosebaceous units. By contrast, adjacent parts of the esophagus repaired with bowel were widely patent with normal appearing mucosa.Our findings indicate that a bowel flap is durable with good tolerance to gastrointestinal content over long periods, whereas skin flaps often developed morphological changes and could not maintain long-term esophageal function without eventual stricture and dysphagia. We therefore recommend use of bowel flaps for esophageal reconstruction in patients with long life expectancy.

  16. Free vascularized flaps for reconstruction of the mandible: complications, success, and dental rehabilitation.

    Science.gov (United States)

    van Gemert, Johannes T M; van Es, Robert J J; Rosenberg, Antoine J W P; van der Bilt, Andries; Koole, Ron; Van Cann, Ellen M

    2012-07-01

    To evaluate complications and success of mandibular reconstruction with free fibula flaps, iliac crest flaps, and forearm flaps with reconstruction plates and to evaluate dental rehabilitation after these reconstructions. Eighty-three patients with segmental mandibular defects were included. Correlation analyses were used to determine the relationship between reconstruction type and clinical parameters with recipient-site complications and success. The dental rehabilitation was evaluated in successfully reconstructed survivors. Multivariate analyses showed significant correlations between flap type and success (P < .0001). Of the patients, 51 (61%) were alive 2 years after the reconstruction. Mandibular reconstruction with a free forearm flap and reconstruction plate was associated with higher complication rates at the recipient site and higher failure rates compared with reconstruction with free vascularized bone flaps. Of the 32 successfully reconstructed survivors, 14 (44%) had a complete dental rehabilitation, of which 10 had dental implants and 4 did not. Only 6 (29%) of the edentulous survivors ultimately had an implant-supported prosthesis. Reconstruction of the mandible with a free vascularized bone flap is superior to reconstruction with a free forearm flap with a reconstruction plate. Complete dental rehabilitation was reached in fewer than half of the surviving patients. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Vascularized dorsal dartos flap to prevent fistula in tubularized incised plate urethroplasty for primary distal and mid shaft hypospadias

    Directory of Open Access Journals (Sweden)

    A. K. M. Zahid Hossain

    2016-08-01

    Full Text Available The aim of the present study was to evaluate the importance of neourethral covering using vascularized dorsal flap for preventing fistula in Tabularized incised plate (TIP urethroplasty. The study included 52 children (aged 2-10 years who had hypospadias repaired including 44  with distal and 8  with mid shaft hypospadias. In all children, a standard tabularized incised plate urethroplasty was followed by reconstruction of new surrounding urethral tissue. A longitudinal dartos flap was harvested from excessive dorsal preputial and penile hypospadiac skin and transposed to ventral side by a buttonhole maneuver. It was sutured to the glans wings and the neomeatus and to the corpora covernosa over the neo-urethra. Thus the new urethra was completely covered with well-vascularzed subcutaneous tissue. At a mean follow-up of 18 months, the result was successful with no fistula or urethral stenosis, except 2 of the mid penile hypospadias. All patients had good functional and cosmetic results with straight penis and vertical slit shaped meatus at the tip of the penis. The 2 patients developed tiny fistula, which were closed spontaneously after meatal dilatation. In conclusion, urethral covering should be part of TIP urethroplasty. A dorsal well-vascularized dartos flap, button holed ventrally is a good choice for preventing fistula for distal and mid shaft hypospadias. 

  18. [Digital artery bilobed flap for the treatment of skin degloving injury of thumb].

    Science.gov (United States)

    Zhang, Yang; Xin, Chang-Tai

    2014-04-01

    To explore clinical effects of digital artery bilobed flap for the treatment of skin degloving injury of thumb. From January 2007 to December 2012, 45 patients with skin degloving injury of thumb were treated with grafting of digital artery bilobed flap. There were 39 males and 6 females, ranging in age from 19 to 46 years, with an average of 32 years. The disease course ranged from 0.5 to 15 h. Eighteen patients suffered from defect of palmar skin above nail root and nail bed, 19 patients suffered from skin degloving injury of thumb phalangette, and 8 patients had whole skin degloving injury of thumb. The double lobe flaps were designed at the ulnar side of middle finger and the radial side of ring finger according to the defect of thumb skin. The arteria digitalis communis between the middle and ring fingers and its two branches of arteriae digitales propriae supplying the two fingers were used as a vessel pedicle. The flap with digitales proprii nervi was transposed and used to cover the exposed phalanx of thumb. Full thickness graft was used for the donor site. Observation of the appearance, texture, color and wear resistance of flap, appearance, color and depression of grafting area, skin feeling, and finger activities was conducted. All the flaps and grafts were alive. Forty-three patients were followed up with an average duration of 25 months, and two patients lost follow-up. The color and texture of the flaps were similar to that of the contralateral thumb pulp. The average two point discrimination was 4.2 +/- 0.3 mm. The color of graft skin was slightly deeper than that of the surroundings skin. Digital artery bilobed flap graft is an effective and ideal operation, which is of low risk and high success rates for skin degloving injury of thumb.

  19. Development of In Vitro Isolated Perfused Porcine Skin Flaps for Study of Percutaneous Absorption of Xenobiotics

    Science.gov (United States)

    1987-06-30

    Dunston; the secretarial and administrative assistance of M. Locke ; and the scientific contributions of Drs. V. Scheidt, T. Manning, and L. Dix for...artery in the flap plus that distal skin which is perfused through its dermal-subdermal plexus . Island flaps survive to at least the same length as

  20. A Simple Strategy in Avulsion Flap Injury: Prediction of Flap Viability Using Wood's Lamp Illumination and Resurfacing with a Full-thickness Skin Graft

    Directory of Open Access Journals (Sweden)

    Hyoseob Lim

    2014-03-01

    Full Text Available Background Extensive degloving injuries of the extremities usually result in necrosis of the flap, necessitating comprehensive skin grafting. Provided there is a sufficient tool to evaluate flap viability, full-thickness skin can be used from a nonviable avulsed flap. We used a Wood's lamp to determine the viability of avulsed flaps in the operation field after intravenous injection of fluorescein dye. Methods We experienced 13 cases during 16 months. Fifteen minutes after the intravenous injection of fluorescein dye, the avulsed skin flaps were examined and non-fluorescent areas were marked under Wood's lamp illumination. The marked area was defatted for full-thickness skin grafting. The fluorescent areas were sutured directly without tension. The non-fluorescent areas were covered by defatted skin. Several days later, there was soft tissue necrosis within the flap area. We measured necrotic area and revised the flap. Results Among all the cases, necrotic area was 21.3% of the total avulsed area. However, if we exclude three cases, one of a carelessly managed patient and two cases of the flaps were inappropriately applied, good results were obtained, with a necrotic area of only 8.4%. Eight patients needed split-thickness skin grafts, and heel pad reconstruction was performed with free flap. Conclusions A full-thickness skin graft from an avulsed flap is a good method for addressing aesthetic concerns without producing donor site morbidity. Fluorescein dye is a useful, simple, and cost-effective tool for evaluating flap viability. Avulsed flap injuries can be managed well with Wood's lamp illumination and a full-thickness skin graft.

  1. Plastic surgery for large wound defects using vascularized flops in treatment of skin and soft-tissue tumors

    International Nuclear Information System (INIS)

    Korotkevich, E.A.; Zalutskij, I.V.; Ismail-Zade, R.S.; Frolov, G.N.

    1992-01-01

    The results were presented on plastic and reconstructive -anaplastic surgery in resection of locally spread and relapse tumors of the skin and soft tissues after multiple courses of radiation and combined treatment. 38 patients with skin melanoma and softtissue sarcomas received radio- and/or chemotherapy in preoperative period under conditions of local hyperthermia of the tumor. Two types of plasty of large wound defects using vascularized flaps were considered

  2. The Use of Vascularized Fascia as Carrier in Cases of Prelaminated Fasciocartilaginous and Osseofascial Flaps.

    Science.gov (United States)

    Tsagarakis, Myron; Spyropoulou, Georgia-Alexandra; Lykoudis, Efstathios; Papalois, Apostolos; Tsimponis, Antonis; Fragia, Constantina; Iconomou, Thomais; Papadopoulos, Othon

    2016-05-01

    Background This experimental study investigates the use of vascularized fascia as carrier for prelaminated cartilage and bone flaps. Methods A total of 30 male New Zealand white rabbits were divided into two equal groups (A and B). The fascia surrounding the inguinal fat and superficial inferior epigastric vessels was dissected. In group A, the fascia was wrapped around a template (20 × 40 mm) of cartilage harvested from the rabbit's ear. In group B, the fascia was wrapped around a 15 × 35 mm piece of rib cortical bone. After a maturation period of 4 weeks, group A was subdivided into three groups (A1, A2, and A3). In group A1 (six animals) the animals were sacrificed and the flaps were sent for histological examination, in A2 (six animals) the flaps were rotated 180 degrees and anchored at knee level, and in A3 (two animals) the flaps were transferred as free flaps to the right SIE (superficial inferior epigastric vessels). The animals of subgroups A2 and A3 were sacrificed after another maturation period of 2 weeks and the flaps were sent for histological examination. After a maturation period of 6 weeks, group B was subdivided into three subgroups (B1, B2, and B3) corresponding to the cartilage subgroups. Subgroups B2 and B3 were sacrificed after 2 weeks. Results All flaps of groups A and B demonstrated good viability apart from one specimen of subgroup B2. Angiogenesis was present in all groups. Conclusion Meticulously dissected vascularized fascia can be successfully used for prelamination of complex fasciocartilaginous or osseofascial flaps. The required maturation periods are 4 and 6 weeks, respectively. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. Angiogenic response pattern during normal and impaired skin flap re-integration in mice: a comparative study.

    Science.gov (United States)

    Schürmann, Christoph; Schmidt, Nadine; Seitz, Oliver; Pfeilschifter, Josef; Frank, Stefan

    2014-12-01

    Distal skin flap necrosis represents a severe complication in surgery. This study investigated angiogenic responses in healthy and impaired pedicled skin flap tissue in normal and diabetic mice. Histologic, qRT-PCR, ELISA and immunoblot techniques determined expression and localization of angiogenesis-related growth factors, receptors and cell types upon skin flap re-integration. Skin flap tissue re-integration was severely disturbed in diabetic mice. Impaired skin flap tissue lost early VEGF expression from wound margin keratinocytes and markedly reduced expression of endothelium-specific receptors Tie-2 and FLT-1. Numbers of blood vessels were reduced in impaired flaps. In addition, HIF-1α protein was absent from disturbed skin flap tissue. Reduced VEGF expression and the loss of epithelium in disturbed skin flaps were paralleled by the appearance of VEGF expressing inflammatory infiltrate. In summary, our data show a dysregulated spatial and temporal pattern of angiogenic processes during skin flap re-integration in diabetic mice. Our data suggest that reduced expression of angiogenic receptors in skin flap tissue might contribute to a loss of VEGF function in impaired tissue. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  4. [A study on the survival mechanism of the reverse-flow axial skin flap].

    Science.gov (United States)

    Ya, Zumeng; Chen, Zongji

    2002-07-01

    To investigate the survival mechanisms of the reverse-flow flap. A skin flap measuring 8.0 cm x 2.5 cm based on the left deep circumflex iliac vessel (DCIV) was designed and elevated on the rat's dorsum with 4.0 cm of it's length crossing the midline. The flap was served as the reverse-flow flap model. The survival area, the dynamic microcirculation including flow direction, microvessel number, caliber, pressure and vasculature were assessed respectively at 6 hour, 24 hour, 48 hour, 72 hour, 7 day and 14 day after operation. The average gradient of perfusion pressure was 0 kPa before operation and was 4.9 KPa postoperatively between the proximal and the distal site of the flap. By anastomosis of bilateral DCIV, the blood flow run in a reversed pattern in the region distal to the midline. No venous valves were observed. Distal congestion developed in 20% of the flaps within 72 h. After that, the number and caliber of venous anastomosis increased with pressure dropping in the midline region. The axial vessels extended its branches progressively along the dilated anastomotic rami. As a result, the vasculature of the flap became similar to that of the conventional axial flap by the 14th day. With these changes, flap congestion was alleviated gradually and subsided within 7 days. All the flaps survived completely. Anastomosis connecting the two axial vessels is the circulation route of the reverse-flow flap. By the gradient pressure between the proximal and distal region, blood is driven reversely. Within 72 h, the distal part is susceptible to congestion. In this period, increasing number and caliber and decreasing pressure of anastomosis is important mechanism to support the circulation. After that, the new vasculature similar to the conventional axial flap provides the flap with reliable and permanent blood supply.

  5. Myocutaneous v/s micro vascular free flaps in oral cavity reconstruction - a comparative study.

    Science.gov (United States)

    Nayak, Umanath K; Swain, Bharatendu

    2004-04-01

    Micro vascular free tissue transfer scores over the traditional myocutaneous flaps by providing better cosmesis and function. However, the increased operating tine and costs and the necessity for two operating teams sometimes, negate these advantages and even where this facility is freely available, myoentancous flaps continue to be widely used.To determine the ideal choice of reconstruction in patients after oral resection, we compared our experience with these two methods of reconstruction. Since 1997, when we first started micro vascular reconstruction, 17 patients have undergone this procedure for oral reconstruction. During this same period, 40 patients had pectoralis major myocutaneous flap reconstruction of the oral cavity. These two groups are compared with regard to cosmetic and functional results (as measured by patient's level of satisfaction) operating time, duration of hospitalization, cost and complications. Eightv seven percent of the patients in the micro vascular group and 75% in the myocutaneous group were satisfied with the cosmetic and functional results. In the microvascular group, average operating time was increased by 4 hours; hospitalization by 3 days and average cost of treatment was doubled. Flap failures and re-explorations were significantly higher in the micro vascular group.Based on these results, we would like to suggest the ideal method of reconstruction of the oral cavity in specific subgroups of patients in a corporate hospital setting.

  6. Association between skin flap thickness and Frey's syndrome in parotid surgery.

    Science.gov (United States)

    Durgut, Osman; Basut, Oguz; Demir, Uygar Levent; Ozmen, Omer A; Kasapoglu, Fikret; Coskun, Hakan

    2013-12-01

    Frey's Syndrome is a frequent complication of parotid surgery. The aim of this study was to evaluate the association between skin flap thickness and Frey's Syndrome in patients who underwent superficial parotidectomy. Thirty adult patients were randomized into 2 groups: subcutaneous and subsuperficial musculoaponeurotic (sub-SMAS) skin elevation. In both groups skin flap thickness was measured by a micrometer at defined points. The patients were queried for subjective Frey's Syndrome and Minor's test was performed for objective Frey's Syndrome. The thickness of skin flap in the subcutaneous group was significantly less than that in the sub-SMAS group. There was no statistical significance between skin flap thickness and objective Frey's Syndrome, although the dimension of the colored area in the subcutaneous group was larger compared with that of the sub-SMAS group: 7.5 cm(2) (0-48 cm(2) ) and 0.5 cm(2) (0-18 cm(2) ), respectively. In conclusion, sub-SMAS elevation of the skin flap in parotid surgery provides better results regarding Frey's Syndrome. Copyright © 2012 Wiley Periodicals, Inc., A Wiley Company.

  7. Vascularized fibula flap onlay for salvage of pathologic fracture of the long bones.

    Science.gov (United States)

    Friedrich, Jeffrey B; Moran, Steven L; Bishop, Allen T; Wood, Christina M; Shin, Alexander Y

    2008-06-01

    Long bone pathologic fractures, especially when radiation-induced, represent a significant and difficult-to-treat entity. The ultimate goal of treatment is limb salvage; however, there are no treatment methods that guarantee bony healing. The vascularized fibula flap has revolutionized bone reconstruction, including that of the long bones. The authors report the results of onlay vascularized fibula flaps for pathologic long bone fractures and the outcomes and complications of this reconstruction method. Records of patients who underwent long bone pathologic fracture reconstruction with the vascularized fibula onlay flap were reviewed retrospectively. Records were analyzed for reconstruction details, time to bony union, subsequent operations, clinical and functional outcomes, and complications associated with harvest and reconstruction. Twenty-five patients met the study criteria. Twenty-one patients demonstrated bony fracture union at an average of 11 months after fibular flap onlay grafting. Two patients who had experienced bony union ultimately required amputations for reasons unrelated to reconstruction. All four patients whose fibular flap failed later obtained limb salvage after further procedures. Thirteen of 25 patients achieved a good or excellent functional outcome as judged by a common oncologic reconstruction functional outcome scale. Postsurgical complications were common in this patient group, with a total of 22 distinct complications (88 percent incidence). Despite a high complication rate, this study demonstrates that pathologic long bone fracture salvage with an onlay fibula flap achieves relatively good clinical and functional outcomes. Limb salvage was made possible in a majority of patients, all of whom experienced a difficult problem in the form of long bone pathologic fractures.

  8. The Boomerang-shaped Pectoralis Major Musculocutaneous Flap for Reconstruction of Circular Defect of Cervical Skin

    Directory of Open Access Journals (Sweden)

    Shuchi Azuma, MD

    2017-11-01

    Full Text Available Summary:. We report on a patient with a recurrence of oral cancer involving a cervical lymph node. The patient’s postexcision cervical skin defect was nearly circular in shape, and the size was about 12 cm in diameter. The defect was successfully reconstructed with a boomerang-shaped pectoralis major musculocutaneous flap whose skin paddle included multiple intercostal perforators of the internal mammary vessels. This flap design is effective for reconstructing an extensive neck skin defect and enables primary closure of the donor site with minimal deformity.

  9. Internal Mammary Vessels’ Impact on Abdominal Skin Perfusion in Free Abdominal Flap Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Solveig Nergård, MD

    2017-12-01

    Conclusions:. Using the IMV in free abdominal flap breast reconstruction had a significant effect on abdominal skin perfusion and may contribute to abdominal wound healing problems. The reperfusion of the abdominal skin was a dynamic process showing an increase in perfusion in the affected areas during the postoperative days.

  10. Medial sural perforator plus island flap: a modification of the medial sural perforator island flap for the reconstruction of postburn knee flexion contractures using burned calf skin.

    Science.gov (United States)

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

    2012-06-01

    The medial sural perforator island flap may be suitable for the reconstruction of postburn knee flexion contractures. However, postburn knee flexion contractures are usually associated with burns of the calf, which is the donor site of the medial sural perforator flap. Thus, there are concerns regarding the safety of raising medial sural perforator flaps from burned calves. Between 2005 and 2010, 12 patients (11 males and 1 female) with postburn knee flexion contractures associated with second-degree burns of the calf (that healed by secondary intention) underwent reconstruction using a medial sural perforator island flap (based on the medial sural perforator) or medial sural perforator plus island flap (based on the medial sural perforator and other vessels that are pedicles of the sural flaps). All 12 flaps, which ranged in size from 7 to 15 cm in width and from 9 to 23 cm in length, survived completely. Of the 12 flaps, three were medial sural perforator island flaps and nine were medial sural perforator plus island flaps. Of the nine medial sural perforator plus island flaps, two included the lesser saphenous vein, five included the lesser saphenous vein and its accompanying artery, and two included the lesser saphenous vein, the distal sural nerve and their accompanying arteries. Healing of all donor sites was uncomplicated. All patients were completely satisfied with their results. Although this series is not large, the authors are convinced that some reliable medial sural perforators are usually present under second-degree burned calf skin that healed by secondary intention, and that the medial sural perforator island flap or the medial sural perforator plus island flap can be safely used even though the skin may not be as pliable as normal skin. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. 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...... group), and 54% ± 9% in the dobutamine group (n = 16) (p = 0.02 compared to the saline group and p = 0.001 compared to the epinephrine group). CONCLUSIONS: Intraoperative intraperitoneal injection of dobutamine improves skin flap survival in rats, whereas intraperitoneal epinephrine tends to decrease...

  12. The vascularized groin lymph node flap (VGLN): Anatomical study and flap planning using multi-detector CT scanner. The golden triangle for flap harvesting.

    Science.gov (United States)

    Zeltzer, Assaf A; Anzarut, Alexander; Braeckmans, Delphine; Seidenstuecker, Katrin; Hendrickx, Benoit; Van Hedent, Eddy; Hamdi, Moustapha

    2017-09-01

    A growing number of surgeons perform lymph node transfers for the treatment of lymphedema. When harvesting a vascularized lymph node groin flap (VGLNF) one of the major concerns is the potential risk of iatrogenic lymphedema of the donor-site. This article helps understanding of the lymph node distribution of the groin in order to minimize this risk. Fifty consecutive patients undergoing abdominal mapping by multi-detector CT scanner were included and 100 groins analyzed. The groin was divided in three zones (of which zone II is the safe zone) and lymph nodes were counted and mapped with their distances to anatomic landmarks. Further node units were plotted and counted. The average age was 48 years. A mean number of nodes of 6.5/groin was found. In zone II, which is our zone of interest a mean of 3.1 nodes were counted with a mean size of 7.8 mm. In three patients no nodes were found in zone II. In five patients nodes were seen in zone II but were not sufficient in size or number to be considered a lymph node unit. On average the lymph node unit in zone II was found to be 48.3 mm from the pubic tubercle when projected on a line from the pubic tubercle to the anterior superior iliac spine, 16.0 mm caudal to this line, and 20.4 mm above the groin crease. On average the lymph node unit was a mean of 41.7 mm lateral to the SCIV-SIEV confluence. This study provides increased understanding of the lymphatic anatomy in zone II of the groin flap and suggests a refined technique for designing the VGLNF. As with any flap there is a degree of individual patient variability. However, having information on the most common anatomy and flap design is of great value. © 2017 Wiley Periodicals, Inc.

  13. Vascularized Bipedicled Pericranial Flaps for Reconstruction of Chronic Scalp Ulcer Occurring after Cranioplasty

    Directory of Open Access Journals (Sweden)

    Seok Ho Yoon

    2013-07-01

    Full Text Available BackgroundIntractable chronic scalp ulcers with cranial bone exposure can occur along the incision after cranioplasty, posing challenges for clinicians. They occur as a result of severe scarring, poor blood circulation of the scalp, and focal osteomyelitis. We successfully repaired these scalp ulcers using a vascularized bipedicled pericranial flap after complete debridement.MethodsSix patients who underwent cranioplasty had chronic ulcers where the cranial bone, with or without the metal plate, was exposed along the incision line. After completely excising the ulcer and the adjacent scar tissue, subgaleal dissection was performed. We removed the osteomyelitic calvarial bone, the exposed metal plate, and granulation tissue. A bipedicled pericranial flap was elevated to cover the defect between the bone graft or prosthesis and the normal cranial bone. It was transposed to the defect site and fixed using an absorbable suture. Scalp flaps were bilaterally advanced after relaxation incisions on the galea, and were closed without tension.ResultsAll the surgical wounds were completely healed with an improved aesthetic outcome, and there were no notable complications during a mean follow-up period of seven months.ConclusionsA bipedicled pericranial flap is vascularized, prompting wound healing without donor site morbidity. This may be an effective modality for treating chronic scalp ulcer accompanied by the exposure of the cranial bone after cranioplasty.

  14. A novel technique for repair of mid-penile hypospadias using a preputial skin flap: results of 110 patients.

    Science.gov (United States)

    Elmoghazy, Hazem; Hussein, Mohamed M; Mohamed, Elnisr; Badawy, Abdelbasset; Alsagheer, Gamal; Abd Elhamed, Ahmed Mamdouh

    2016-12-01

    Several techniques have been used to repair mid-penile hypospadias; however, high failure rates and major complications have been reported. In this study, we describe a novel technique using a well-vascularized flap of the inner and outer preputial skin. A total of 110 male children with hypospadias underwent repair by our technique between 2008 and 2015. The inclusion criteria were children with mid-penile or slightly more proximal hypospadias, with or without ventral chordae, and an intact prepuce of the cobra eyes variety. Recurrent cases, patients with other preputial types, and circumcised children were excluded from this study. The prepared flap was sutured in its natural longitudinal orientation to the created urethral plate strip to form a neo-urethra over a urethral catheter. Outcome measures included surgical success without the formation of a urethra-cutaneous fistula, no ischaemia of the flaps, glans dehiscence or infection and functional outcome and cosmetic appearance. The median follow-up duration was 3.3 years. There were 63 cases of mid-penile hypospadias (57.3 %), and in 47 cases (42.7 %), the meatus was slightly more proximal. The age of the patients ranged from 1.1 to 8.0 years, with a mean age of 4.6 ± 1.2 years. Surgery was successful in 106 (96.4 %) cases. Minor complications occurred in 11 patients (10 %) and included oedema of glans in ten patients and bluish discoloration on the ventral aspect of the glans close to the suture line in three patients. All patients improved within 2 weeks after surgery. Long-term follow-up revealed a properly functioning urethra with a forward, projectile, single, compact, and rifled urinary stream of adequate calibre and cosmetically acceptable repair. No cases of meatal retraction, meatal stenosis, urethral stricture, or acquired urethral diverticulum occurred. Our technique is different from the split prepuce in situ technique. We create a narrow strip of the urethral plate that facilitates

  15. 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.

  16. Usefulness of V-Y Advancement Flap for Defects after Skin Tumor Excision

    Directory of Open Access Journals (Sweden)

    Ki Hyun Kwon

    2012-11-01

    Full Text Available BackgroundAfter skin tumor excision on the face, extremities, or trunk, the choice of treatment for a skin defect is highly variable. Many surgeons prefer to use a local flap rather than a skin graft or free flap for small- or moderately-sized circular defects. We have used unilateral or bilateral V-Y advancement flaps, especially on the face. Here we evaluated the functional and aesthetic results of this technique.MethodsAll of the patients were pathologically diagnosed with squamous cell carcinoma (SCC, basal cell carcinoma (BCC, or malignant melanoma or premalignant lesion (Bowen's disease. Thirty-two patients underwent V-Y advancement flap repair (11 unilateral and 21 bilateral from January 2007 to June 2011. We analyzed the patients' age and satisfaction, and location and size of defect. The patients were followed up for 6 months or more.ResultsThere were 22 women and 10 men. The ages ranged from 47 to 93 years with a mean age of 66 years. The causes were SCC in 15 cases, BCC in 13 cases, malignant melanoma in 1 case, Bowen's disease in 2 cases, and another cause in 1 case. The tumor locations were the face in 28 patients, and the scalp, upper limb, and flank each in one patient. All of the flaps survived and the aesthetic results were good. Postoperative recovery was usually rapid, and no complication or tumor recurrence was observed.ConclusionsThe V-Y advancement flap is often used not only for facial circular defects but also for defects of the trunk and extremities. Its advantages are less scarring and superior aesthetic results as compared with other local flap methods, because of less scarification of adjacent tissue and because it is an easy surgical technique.

  17. Combination of ischemic preconditioning and postconditioning can minimise skin flap loss: experimental study.

    Science.gov (United States)

    Akcal, Arzu; Sirvan, Selami Serhat; Karsidag, Semra; Görgülü, Tahsin; Akcal, Mehmet Akif; Ozagari, Aysim; Tatlidede, Soner

    2016-08-01

    Ischaemic preconditioning and postconditioning, which consist of one or a series of short ischaemic events. This study aimed to determine the efficiency of post-conditioning a flap in the minimisation of flap loss after a preconditioned skin flap. The rats were divided into five groups: sham group, control group, pre-con group, post-con group, and pre + post-con group. On postoperative days 3 and 7, the entire flaps along with the margins of necrosis were traced onto transparent sheets. The areas of intact skin and tissue were recorded. The flap necrosis area and percentage of necrosis were calculated for each animal. The necrotic area percentage of the control group was found to be significantly higher than those of the other groups on Days 3 and 7 (p = 0.01 and p = 0.03, respectively). The necrotic area percentage of the pre-con group was significantly higher than the pre + post-con group on Day 7 (p = 0.01). VEGFR-3 expression was observed at a rate of more than 50% in the post-con group. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels. The necrotic areas was reduced in the flaps of the pre-con, post-con, and pre + post-con groups and the combined preconditioning and postconditioning group has reduced necrotic area compared to preconditioning of the skin flap. The protective effect was observed on day 7 for combined ischaemic preconditioning and postconditioning. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels.

  18. The Effect of Mature Adipocyte-Derived Dedifferentiated Fat (DFAT) Cells on a Dorsal Skin Flap Model.

    Science.gov (United States)

    Kashimura, Tsutomu; Soejima, Kazutaka; Asami, Takashi; Kazama, Tomohiko; Matsumoto, Taro; Nakazawa, Hiroaki

    2016-01-01

    Dedifferentiated fat (DFAT) cells, isolated from mature adipose cell, have high proliferative potential and pluripotency. We report on the expansion of flap survival areas on the back of rats administrating DFAT cells. Intraperitoneal adipose tissue was collected from a male Sprague-Dawley (SD) rat. The mature fat cells were cultured on the ceiling surface of culture flask to isolate DFAT cells. On day 7 of the culture, the flask was inverted to allow normal adherent culture. A dorsal caudal-based random pattern flap measuring 2 × 9 cm was raised on each SD rat. We prepared a control group (n = 10) and a flap base injection group in which DFAT cells were injected 2 cm from the flap base (n = 10) and a flap center DFAT injection group (n = 10). In which DFAT cells at 1 × 106 cells/0.1 ml were injected beneath the skin muscle layers of the flap. The flap survival areas were assessed on day 14 after surgery. The mean flap survival rates of the control group, flap center injection group and flap base injection group were 53.6 ± 6.1%, 50.6 ± 6.4% and 65.8 ± 2.4%, respectively. The flap survival areas significantly expanded in the flap base injection group (p cells into the flap base promoted the expansion of survival areas.

  19. Immediate Breast Reconstruction with Expander Assisted Latissimus Dorsi Flap after Skin Sparing Mastectomy

    International Nuclear Information System (INIS)

    Abdalla, H.M.; Shallan, M.A.; Fouad, F.A.; Elsayed, A.A.

    2006-01-01

    Background and Purpose: The latissimus dorsi my-ocutaneous flap (LDMF) used to. be the standard practice far breast reconstruction; haw ever, with the increased use of tissue expanders and the development of the transverse rectus-abdomen's myocutaneaus flap for autologous tissue breast reconstruction, its use has decreased. To. reassess the role of the LDMF in breast reconstruction, a prospective study was performed to. evaluate women who. had a skin sparing mastectomy followed by immediate reconstruction with a latissimus dorsi flap and tissue expander implant. Patients and Methods: Twenty-five women with early breast cancer underwent immediate latissimus dorsi my-ocutaneaus flaps with tissue expander after skin sparing mastectamy. The ancalagic safety at skin sparing mastectamy, the pastaperative aesthetic results and camplicatians were evaluated. Results: Between May 2003 and April 2005, 25 can-secutive wamen diagnased with breast cancer underwent skin sparing mas tecta my and expander assisted immediate latissimus darsi breast recanstructian. Their median age was 42 years, ranging fram 34 to 48 years. The pracedure duratian ranged fram 2.5 to. 6 haurs, with a median at 3.9 haurs, hawever, expansian was campleted by 4 manths (range I to. 8 manths). Patients were discharged 7 days after surgery with a range af 5 to. 15 days. The camplicatian rate was law, manifesting with skin flap necrosis in 12%, waund infectian in 4%, and part site extrusian in 4%. There was no. flap lass. With the exceptian af serama farmatian, the danar site marbidity was law (seroma 40%, hematama 4%, back pain 8%, and limited arm mavement 4%). No. lacal recurrence was recorded. The aesthetic result af surgery was rated as excellent in 20%, gaad in 60%, fair in 24%, and paar in 4% af cases. The duratian af past-aperative fallaw up was 14.7 manths, ranging fram 6 to 24 manths. Conclusions: Skin sparing mastectamy and immediate breast recanstructian is an ancalagically safe technique. The use

  20. [Saphenous perforator flap].

    Science.gov (United States)

    Winkel, R; Tajsic, N; Husum, H; Schlageter, M; Hanebuth, G; Hoffmann, R

    2013-04-01

    Replacement of full thickness soft tissue defects in the lower leg and ankle, appropriate to the defect and following the course of blood vessels feeding the skin of a distally hinged fasciocutaneous flap most reliably based on the individual anatomy of distal perforators of the posterior tibial artery. Full thickness soft tissue defects, up to 12 cm in length and up to 8 cm in width. Sufficient vascularization of the foot required, in osteomyelitis, and when joints, fractures, implants and tendons are exposed and when a split skin graft, a local flap, a suralis perforator flap or a free flap is not indicated. For patients, in whom a 1-2 h operation is not possible; necessity of angioplasty; decollement or scars around the distal perforators of the posterior tibial artery; local infection or necrosis of soft tissues and/or bone, which cannot be totally excised. Radical debridement; flap dissection without tourniquet; microdissection; design of the flap on the skin: pivot point ~ 10 cm (6-14 cm) proximal of the tip of the medial malleolus; base ~ 5 cm in width, between the course of the saphenous nerve and of the great saphenous vein and the Achilles tendon; adipofascial pedicle up to 15 cm in length sited over the septum between soleus and flexor digitorum muscles, following the course of the saphenous nerve, with a central skin stripe, which expands into a proximal skin island; skin island is outlined similar to the defect, but larger by 1 to 2 cm, surrounded by an adipofascial border: adjustment of the planning as well as of the elevation of these flaps according to the individual position and the caliber of perforators requires in each case the search for a perforator at the estimated pivot point. Delay of transposition, if the division of more than one perforator proximal to the pivot point obviously diminishes circulation. No "tunnelling "of the pedicle; defects of skin due to the elevation of the flap are replaced by split and meshed skin grafts or temporary

  1. Use of penile skin flap in complex anterior urethral stricture repair: our experience

    International Nuclear Information System (INIS)

    Nadeem, A.; Asghar, M.; Kiani, F.; Alvi, M.S.

    2017-01-01

    Objective: To present our experience of treatment of complex anterior urethral strictures using penile skin flap. Study Design: Descriptive, case series. Place and Duration of Study: Department of urology Combined Military Hospital Malir Cantonment, Karachi and Armed Forces Institute of Urology, Rawalpindi from Jan 2012 to Feb 2014. Material and Methods: Total 18 patients with complex anterior urethral strictures and combined anterior and bulborurethral strictures were included. Patients underwent repair using Orandi or circularfacio-cutaneous penile skin flap depending upon the size and site of stricture. First dressing was changed after two days and an in dwelling silicone two way foleycatheter was kept in place for three weeks. Graft was assessed with regards to local infection, fistula formation and restricturing. Re-stricture was assessed by performing uroflowmetery at 6 months and 1 year. Ascending urethrogram was reserved for cases with less than 10 ml/sec Q max on uroflowmetery. Repair failure was considered when there was a need for any subsequent urethral procedure asurethral dilatation, dorsal visual internal urethrotomy, or urethroplasty. Results: Overall success rate was 83.3 percent. Of all the patients operated 1(5.6 percent) had infection with loss of flap, 3(16.7 percent) had urethral fistula and none had re stricture confirmed by uroflowmetery. Conclusion: In our study the excellent results of the penile skin flap both in anterior urethral strictures and combined anterior and bulbar urethral strictures are quite encouraging. It is easy to harvest and seems anatomically more logical. (author)

  2. One-stage treatment and reconstruction of Gustilo Type III open tibial shaft fractures with a vascularized fibular osteoseptocutaneous flap graft.

    Science.gov (United States)

    Zhen, Ping; Hu, Yun-Yu; Luo, Zhuo-Jing; Liu, Xing-Yan; Lu, Hao; Li, Xu-Sheng

    2010-12-01

    .3 % (four of 28), and a poor result occurred in one case (3.5%). The free fibular vascularized osteoseptocutaneous flap grafting is an effective alternative in management of Type III open tibial fractures using a one-stage procedure. The grafted fibula offers good fracture stabilization plus a vascularized bone graft, and the fibular flap can also provide a large piece of mobile skin to cover the soft tissue defect in Type III open tibial fractures. The free osteoseptocutaneous flap also serves as a visible monitor of the adequacy of the circulation of the grafted fibula.

  3. Color Doppler Sonographic and Cadaveric Study of the Arterial Vascularity of the Lateral Upper Arm Flap.

    Science.gov (United States)

    Sun, Ruimei; Ding, Yu; Sun, Chuanzheng; Li, Xiaojiang; Wang, Jinde; Li, Lei; Yang, Jie; Ren, Yanxin; Zhong, Zhaoming

    2016-04-01

    To determine the importance of adequate preoperative assessment with color Doppler sonography to assist in the successful transfer of lateral upper arm flaps by studying the lateral upper arm flap with color Doppler sonography and analyzing the anatomic features of the radial collateral artery. A clinical case-control study was performed. The radial collateral artery was studied with color Doppler sonography in 15 healthy volunteers. The origins, courses, variations, and locations of the perforators of the radial collateral artery were recorded. The results and data from the color Doppler sonographic investigation were compared with an anatomic study that was performed on 22 adult cadaveric upper limb specimens. The volunteer group (14 of 15 volunteers) and the cadaveric group (19 of 22 upper arm specimens) clearly showed that the branch pattern of the arterial supply was as follows: brachial artery → deep brachial artery → radial collateral artery → posterior radial collateral artery → myocutaneous perforator. Variations in the origin of the radial collateral artery were identified in 1 volunteer bilaterally and in 3 upper arm specimens. The diameters of the artery and vein measured at the distal insertion of the deltoid and the origin of the deep brachial artery were not significantly different between the volunteer and cadaver groups (P > .05). Due to the difference in measuring methods, the length of the vascular pedicles was significantly different between the groups (P arm flap transfer. © 2016 by the American Institute of Ultrasound in Medicine.

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

    Directory of Open Access Journals (Sweden)

    Bilsev İnce

    2016-12-01

    Full Text Available 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.

  5. The Effect of Low-Dose Nitroglycerin Ointment on Skin Flap Necrosis in Breast Reconstruction after Skin-Sparing or Nipple-Sparing Mastectomy

    Directory of Open Access Journals (Sweden)

    Min Ho Yun

    2017-11-01

    Full Text Available Background Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy. Methods A total of 73 cases of breast reconstruction after nipple-sparing and skin-sparing mastectomy at our institution from March 2012 to January 2017 were retrospectively studied. Of these patients, 52 received nitroglycerin ointment (4.5 mg application to the skin around the nipple-areolar complex from August 2015 to January 2017, while 21 received fusidic acid ointment from March 2012 to August 2015. The number of patients who experienced necrosis of the breast skin flap was counted in both groups. Results Skin flap necrosis developed in 2 (3.8% patients who were treated with nitroglycerin ointment and 5 (23.8% patients who did not receive nitroglycerin ointment treatment. Patients who did not receive nitroglycerin ointment treatment had a significantly higher risk of mastectomy skin flap necrosis than patients who did (odds ratio=7.81; 95% confidence interval, 1.38 to 44.23; P=0.02. Conclusions Low-dose nitroglycerin ointment administration significantly decreased the rate of skin flap necrosis in patients who underwent breast reconstruction after skin-sparing or nipple-sparing mastectomy, without increasing the incidence of the side effects of nitroglycerin.

  6. Medical adhesive-related skin injuries associated with vascular access.

    Science.gov (United States)

    Hitchcock, Jan; Savine, Louise

    2017-04-27

    Establishing vascular access and preventing infection, both at insertion and during ongoing care is generally the top priority; the maintenance of optimal skin integrity is often a distant secondary consideration. Skin can react to different types of dressings or adhesives, or problems can arise relating to the securement of lines or the development of sensitivities to cleaning solutions. Clearly, these scenarios are not limited to the securement of vascular access devices; however, a patient with a long-term vascular access device may not have other options for vascular access, which makes this a very important and yet largely unrecognised area. A review of the limited literature that existed up to March 2015 showed it was typically concerned with skin tears connected with dressings and removal, and contact irritant dermatitis. The tissue viability team and vascular access team reviewed the current products associated with a typical vascular access dressing to ensure it was fit for purpose and where at all possible had good scientific literature for validation. The team worked proactively to recognise those patients at risk with the early identification of potential medical adhesive-related skin injuries (MARSI). To facilitate this an algorithm was developed that offers a step-by-step approach, clearly outlining what to do to prevent MARSI and its treatment should it develop. These reactions can result from other factors than the dressing alone, and an increase in these kinds of skin reaction in patients who are on chemotherapy regimens is being explored further. Through the implementation of an algorithm, education for both staff and patients and collaborative working between vascular access and tissue viability teams, a reduction in these phenomena has been seen despite an increasing number of at-risk patients.

  7. The use of pedicled prepucial skin flap urethroplasty for proximal ...

    African Journals Online (AJOL)

    Objective: Pediatric urethral strictures are not uncommon, and a myriad of treatment options is available. The use of pedicled prepucial skin to augment a narrowed urethra is one of the useful methods. In this study, we describe the successful use of this technique in three children with stricture of the proximal ...

  8. Effect of systemic piracetam treatment on flap survival and vascular endothelial growth factor expression after ischemia-reperfusion injury.

    Science.gov (United States)

    Tuncer, Serhan; Ayhan, Suhan; Findikcioglu, Kemal; Ergun, Hakan; Tuncer, Ilhan

    2011-09-01

    The effects of piracetam on flap survival, ischemia-reperfusion (I/R) injury, and vascular endothelial growth factor (VEGF) expression were evaluated in this study. Unipedicled epigastric flap model was used in 36 rats and was evaluated within 4 groups. The flap was elevated and untreated in Group 1. Postoperative piracetam treatment was given for 7 days in Group 2. In Group 3, 4 hours of ischemia and 2 hours of reperfusion were applied. I/R was applied to Group 4 and piracetam was given 30 minutes before reperfusion and postoperatively for 7 days. Laser Doppler flowmetry was used to measure blood flow changes. VEGF expression was determined using immunohistochemical methods on tissue samples taken after the completion of 2 hours reperfusion in groups 3 and 4. Flap necrosis was measured on the day 7 in all groups. Blood flow rates did not show significant difference between piracetam treated and untreated I/R groups. Piracetam significantly reduced necrosis area both in ischemic and nonischemic flaps ( P piracetam-treated Group 4 compared with Group 3 ( P = 0.005). This experimental study demonstrates that systemic piracetam treatment improves survival of pedicled flaps, reduces necrosis amounts, and increases VEGF expression in I/R induced flaps. © Thieme Medical Publishers.

  9. Reconstruction of severe atherosclerotic and obstructive diabetic feet using thoracodorsal artery perforator flaps with long vascular pedicles.

    Science.gov (United States)

    Kim, Sang Wha; Sung, Il Hoon; Kim, Youn Hwan

    2018-03-01

    Foot ulcers in diabetic patients often require free flaps. A long vascular pedicle is mandatory so that more proximal vessels can be used as recipient vessels, especially when the flap is used to reconstruct distal foot defects. We evaluated the outcome of diabetic foot defect that were reconstructed using thoracodorsal artery perforator (TDAP) flaps with long vascular pedicles. We reconstructed the foot defects of 22 diabetic patients. Nineteen patients were male, and the mean age was 56.4 years. The defects were located in big toe in 11 patients; fourth and/or fifth toe, including lateral aspect of the foot, in 8 patients; and dorsum of the foot, medial plantar, and first metatarsal medial head in 1 patient each. CT angiography showed that the two main vessels of the lower leg remained intact in 7 patients, only one vessel was intact in the lower leg of 11, and no vessels were visible in 4. The flap size ranged between 5 × 4 cm 2 and 18 × 11cm 2 , with a mean pedicle length of 16.5 cm. The anterior tibial artery was used as the recipient vessel in 15 patients, while the posterior tibial artery was used in 7. All the flaps survived. Three wound disruptions and two partial flap losses healed conservatively, without further surgery. Ulcer due to diabetes recurred in three cases. The mean follow-up period was 46.1 months. All wounds healed completely. TDAP flaps with long vascular pedicles may be a viable choice for reconstructing defects in the feet of diabetic patients. © 2017 Wiley Periodicals, Inc.

  10. Hemimandibulectomy and vascularized fibula flap in bisphosphonate-induced mandibular osteonecrosis with polycythaemia rubra vera.

    Science.gov (United States)

    Ghazali, N; Collyer, J C; Tighe, J V

    2013-01-01

    This report presents the successful management of an advanced and refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) by hemimandibulectomy and an osteocutaneous fibula flap reconstruction in a patient with polycythaemia rubra vera, a rare haematological condition in which there is increased risk of thrombosis and haemorrhage. Union of the vascularized bone with the mandible depends on obtaining a BRONJ-free margin and rigid fixation of the bony ends. Magnetic resonance imaging can provide accurate delineation of necrotic bone and area of osteomyelitis. Placement of a 1cm margin beyond this can envisage a BRONJ-free margin. Aggressive medical management of polycythaemia rubra vera by venesection, asprin and cytoreduction therapy along with anticoagulant prophylaxis against thromboembolic events in the first 2 weeks following major surgery can provide the basis of a good surgical and flap outcome. Nevertheless, the possibility of unpredictable haemorrhage must be considered throughout. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Use of the medial femoral condyle vascularized bone flap in traumatic avascular necrosis of the navicular: a case report.

    Science.gov (United States)

    Holm, Janson; Vangelisti, Garrett; Remmers, Jared

    2012-01-01

    The medial femoral condyle vascularized bone flap has a high success rate in published literature regarding its use in nonunions and avascular necrosis of the upper and lower extremities. It is reported to have minimal donor site morbidity and the ability to provide structural support and torsional strength to load-bearing areas. The flap has found particular success in the treatment of scaphoid nonunions. The tarsal navicular, similar to the scaphoid, is largely articular cancellous bone with little surface area for vascular inflow. These anatomic features make the navicular prone to nonunion and avascular necrosis in traumatic scenarios. We describe a case of nonunion and avascular necrosis of the tarsal navicular occurring as sequelae of a high-impact midfoot injury sustained in an automobile accident. After an initial attempt at open reduction and internal fixation with midfoot bridge plating, subsidence and nonunion resulted. An attempt at arthrodesis of the talonavicular and naviculocuneiform joints was then undertaken. This too failed, leading to the development of additional collapse and avascular necrosis. The site was treated with a medial femoral condyle vascularized bone flap. In this single case, the patient returned to pain-free ambulation and reported excellent outcomes and functional capacity. Although we present a successful case, a larger case series is necessary to establish the use of this flap as a reliable option for the treatment of nonunion and avascular necrosis of the tarsal navicular. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Oromandibular reconstruction with chimeric double-skin paddle flap based on peroneal vessel axis for synchronous opposite double oral cancer.

    Science.gov (United States)

    Huang, Shih-Tsai; Liu, Wen-Chung; Chen, Lee-Wei; Yang, Kuo-Chung

    2015-05-01

    Synchronous double oral cancer represents the minority of cases of head and neck cancer. After tumor ablation, 2 separate oromandibular defects, even combined with a through-and-through oral defect, pose a serious reconstructive challenge. The ideal method for reconstruction remains controversial. Based on the peroneal vessel axis, a chimeric double-skin paddle peroneal fasciocutaneous or fibular osteomyocutaneous flap could be designed to accomplish the difficult reconstruction. Six male patients, each with 2 separate oromandibular defects after tumor ablation of synchronous double oral cancer, received double-skin paddle flap reconstruction with 3 peroneal fasciocutaneous and 3 fibular osteomyocutaneous flaps. All 6 flaps survived; however, complications included 1 skin paddle lost due to insufficient perfusion of a visible perforator, and 1 superficial necrosis occurring over the tip of a longer skin paddle. One postoperative intraoral infection and 1 donor site infection were also reported. During follow-up, 3 months later, 1 patient succumbed to local recurrence and bony metastasis. One patient developed a new cancer in the maxillary gingiva, and another had osteoradionecrosis 8 months later. Four patients gained acceptable cosmesis with good oral competence. A chimeric flap based on the peroneal artery could provide a segment of fibular bone, 1 or 2 skin paddles, and a cuff of the flexor hallucis longus muscle simultaneously. For 1-stage reconstruction of separate oromandibular defects after tumor ablation of synchronous double oral cancer, this design could provide all components at 1 transfer.

  13. Surgical treatment of an exposed orbital implant with vascularized superficial temporal fascia flap.

    Science.gov (United States)

    Basterzi, Yavuz; Sari, Ayca; Sari, Alper

    2009-03-01

    Orbital implants are often used for the correction of volume deficit after enucleation or evisceration. An orbital implant enhances aesthetics and improves mobility of the subsequent prosthetic eye. With advancements in technology and techniques, implant-related complication rates have been decreased. However, implant exposition as one of the most common complications of socket surgery is still a problem for the oculoplastic surgeon. Many factors are thought to cause orbital implant exposure: Large implants, tension on the wound, and textured surface of the implant may cause a breakdown of the covering layers over the implant. Inadequate fibrovascular ingrowth into the porous implant is the most important factor. Various surgical methods have been described to cover the defect, most offering the use of various tissues as a graft, which are not always satisfactory. We describe a case with silicone implant exposition that was managed with a vascularized superficial temporal fascia flap. According to our knowledge, this is the first article reporting the usage of a vascular tissue in the management of an orbital implant exposure.

  14. SU-F-P-58: Squamous Cell and Basal Cell Carcinoma of the Skin Treated with a Freiburg Flap Applicator

    Energy Technology Data Exchange (ETDEWEB)

    Dou, K; Li, B [MedStar Health RadAmerica, Mercy Radiation Oncology, Baltimore, MD (United States); Jacobs, M; Laser, B [Mercy Medical Center Radiation Oncology, Baltimore, MD (United States)

    2016-06-15

    Purpose: To treat squamous cell and basal cell carcinoma of the skin with the Freiburg flap applicator using a high dose rate modality of an Elekta Flexitron or MicroSelectron for radiation delivery by compensating the dose deviation resulting from the incomplete scatter environment. Methods: Patients were selected to have lesions greater than or equal to 2cm. A mask might be needed depending on special locations. The lesions on the eyelid and face presented in this research were, however, treated without a mask. Cutting the flap into a shape conformal to the target and attaching it to the mask were used in order to make the treatment reproducible. Patients were scanned with a Philips Big Bore Brilliant CT. A 1cm margin was added to the lesion. An Elekta Oncentra Brachy treatment planning system ver. 4.3 was used for treatment planning. 40 Gy in 10 or 8 fractions was prescribed to the 1cm depth. The Freiburg flap was aligned and verified by CT scanning prior to treatment. Results: Three patients with squamous cell and basal cell carcinoma of the skin were treated with the Freiburg flap applicator. Lesion sizes ranged from 2cm to 6 cm in a maximum dimension. With treatment planning, we made a dose correction for compensating the dose deviation resulting from the incomplete scatter environment of the flap applicators exposed to air. The flap was also covered by a 4cm bolus in order to obtain more back scattered radiation during treatment. Six month follow up showed a very good cosmetic result. Conclusion: The Freiburg flap brachytherapy offers a non-invasive skin cancer treatment with a high skin dose delivered to the tumor while a low dose sparing the surrounding health tissue. It is a promising alternative to skin cancer surgery or external beam radiation therapy.

  15. The free vascularized flap and the flap plate options: comparative results of reconstruction of lateral mandibular defects

    NARCIS (Netherlands)

    Shpitzer, T.; Gullane, P. J.; Neligan, P. C.; Irish, J. C.; Freeman, J. E.; van den Brekel, M.; Gur, E.

    2000-01-01

    OBJECTIVES/HYPOTHESIS: Reconstruction of the mandible and oral cavity after segmental resection is a challenging surgical problem. Although osteocutaneous free flaps are generally accepted to be optimal for reconstruction of anterior defects, the need for bony reconstruction for a pure lateral

  16. [Repair of skin and soft tissue defects at distal end of finger and donor site with relaying reversed perforator flaps].

    Science.gov (United States)

    Deng, Chengliang; Wei, Zairong; Sun, Guangfeng; Tang, Xiujun; Jin, Wenhu; Li, Hai; Wu, Bihua; Wang, Dali

    2015-04-01

    To explore the clinical effects of relaying reversed perforator flaps in repairing skin and soft tissue defects at distal end of finger and donor site. Seventeen patients (17 fingers) with skin and soft tissue defects at distal end of finger were hospitalized from June 2011 to June 2013. The reversed digital artery perforator flap with branch of digital nerve was used to repair the defect. The first donor site was repaired by dorsal metacarpal artery perforator flap; the second donor site was closed by suturing. The area of skin defect at distal end of finger ranged from 2.0 cm x 1.5 cm to 3.0 cm x 2.0 cm, and the area of digital artery perforator flap and dorsal metacarpal artery perforator flap ranged from 2.2 cm x 1.5 cm to 3.6 cm x 2.5 cm and 2.5 cm x 2.0 cm to 4.2 cm x 3.0 cm, respectively. All the 34 flaps survived completely. Cyanosis and partial necrosis of the epidermis appeared in 1 flap, which was healed after dressing change. All the patients were followed up for 1 to 18 months, with mean time of 8 months. The color, texture and appearance of flaps were satisfactory. There was no depression or breakdown in the first donor sites. Some linear scars appeared in the second donor sites, but they did not affect the general appearance. The donor sites at joint or tendon did not affect the joint activity after healing. The results of function evaluation of range of active movement of the fingers were excellent in 15 cases and good in 2 cases. The results of sensation of the flaps were S3 in 1 finger, S4 in 2 fingers, and S5 in 14 fingers. The distance of two-point discrimination of flaps ranged from 5 to 7 mm, with mean distance of 6 mm. Relaying reversed perforator flap, with reliable blood supply and both donor sites in the hand, can improve the appearance and function of the first donor site as well as repair skin and soft tissue defects at distal end of finger.

  17. Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?

    Science.gov (United States)

    Bahl, Manisha; Pien, Irene J; Buretta, Kate J; Hwang, E Shelley; Greenup, Rachel A; Ghate, Sujata V; Hollenbeck, Scott T

    2016-08-01

    Nipple-areola complex (NAC) and skin flap ischemia and necrosis can occur after nipple-sparing mastectomy (NSM). The purpose of this study was to correlate vascular findings on MRI with outcomes in patients who underwent NSM. Female patients at a single institution who underwent NSM and had a preoperative breast MRI between 2010 and 2014 were identified. Medical records were reviewed for patient demographics, surgical factors, and complications. Magnetic resonance images were reviewed by 2 radiologists, blinded to outcomes, for the presence of dual vs single blood supply to the breast. The association between blood supply on MRI with ischemic and necrotic complications after NSM was analyzed. One hundred and sixty-four NSM procedures were performed in 105 patients (mean age 45.5 years, range 25 to 69 years) who had a preoperative MRI. The majority of procedures were performed for malignancy (89 of 164 [54.3%]) or prophylaxis (73 of 164 [44.5%]). Nipple-areola complex or skin flap ischemia or necrosis occurred in 40 (24.4%) breasts. Ischemia or necrosis after NSM was less likely to occur in breasts with dual compared with single blood supply (20.8% vs 38.2%; p = 0.03). There was no association between surgical complications and age, BMI, smoking history, previous radiation therapy, indication for NSM, surgical specimen weight, surgical incision type, reconstruction approach, or operating surgeon on univariate analysis. Preoperative MRI characterization of breast vascularity can be considered when planning NSM. The presence of a dual blood supply to the breast on MRI is associated with a decreased risk of nipple-areola complex and skin flap ischemia and necrosis after NSM. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  18. 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.

  19. Anatomy and vascularization of the flexor hallucis longus muscle and its implication in free fibula flap transfer: an anatomical study.

    Science.gov (United States)

    Sassu, Paolo; Acland, Robert D; Salgado, Christopher John; Mardini, Samir; Ozyurekoglu, Tuna

    2010-02-01

    Contracture as well as weakness of the flexor hallucis longus (FHL) are possible complications following free fibula flap harvest. Possible causes have been related to fibrotic change of the muscle either due to devascularization or compartment-like syndrome after a tight wound closure. This study elucidates the vascularization and nerve supply of the FHL muscle after fibula flap harvest in a fresh cadaver model.A fibula bone flap was harvested through a lateral approach in 20 fresh limbs. The popliteal artery was isolated and injected with a silicone compound, the muscle isolated, and its neurovascular supply visualized.The distal third and fourth portion of the FHL muscle was always found to be located in a more compressed and deeper compartment. The peroneal artery was entirely filled by the silicone compound in 17 fresh cadaver limbs with at least one branch supplying the distal fourth of the FHL. The posterior tibialis artery was filled in all limbs and an average of 2 branches was found to supply the muscle. In all dissections, the nerve supplying the FHL originated from the tibialis nerve with an average of three branches perforating the muscle.Following fibula harvest, the FHL muscle will maintain vascular supply through the distal portion of the peroneal artery and the posterior tibialis artery. Nerve injury to the FHL muscle is unlikely during flap harvest.

  20. The use of a dorsal double-wing flap without skin grafts for congenital syndactyly treatment: A STROBE compliant study.

    Science.gov (United States)

    Dong, Yanzhao; Wang, Yisheng

    2017-07-01

    Numerous techniques have been developed that use various flaps to treat syndactyly. Skin grafts have often been used to cover remaining surgical defects. The long-term aim of surgery is to find new methods of separating the digits without using skin grafts. This paper describes a new surgical technique for the correction of simple, incomplete, and complete syndactyly. The technique consists of a dorsal double-wing flap to cover the newly created web space and zigzag incisions in the fingers, thus avoiding the use of skin grafts in this space. Overall, 35 web spaces in 24 patients were treated using this technique. Patient follow-up ranged from 6 months to nearly 5 years. There were no complications such as hematoma, infection or flap necrosis, and no fingers needed skin grafts after separation. The average operative time for each web space was approximately 45 minutes. Ninety-seven percent of patients treated with the dorsal double-wing flap procedure achieved good function, and superior cosmetic results following a single surgery. The technique is simple, rapid, safe, and easily performed and does not require the use of skin grafts.

  1. [EFFECTIVENESS OF ADVANCED SKIN FLAP AND V-SHAPED VENTRAL INCISION ALONG THE ROOT OF PENILE SHAFT FOR CONCEALED PENIS].

    Science.gov (United States)

    Lin, Junshan; Li, Dumiao; Zhang, Jianxing; Wu, Qiang; Xu, Yali; Lin, Li

    2015-09-01

    To investigate effectiveness of advanced skin flap and V-shaped ventral incision along the root of penile shaft for concealed penis in children. Between July 2007 and January 2015, 121 boys with concealed penis were treated with advanced skin flap and V-shaped ventral incision along the root of penile shaft. The age varied from 18 months to 13 years (mean, 7.2 years). Repair was based on a vertical incision in median raphe, complete degloving of penis and tacking its base to the dermis of the skin. Advanced skin flap and a V-shaped ventral incision along the root of penile shaft were used to cover the penile shaft. The operation time ranged from 60 to 100 minutes (mean, 75 minutes). Disruption of wound occurred in 1 case, and was cured after dressing change; and primary healing of incision was obtained in the others. The follow-up period ranged from 3 months to 7 years (median, 24 months). All patients achieved good to excellent cosmetic results with a low incidence of complications. The results were satisfactory in exposure of penis and prepuce appearance. No obvious scar was observed. The penis had similar appearance to that after prepuce circumcision. A combination of advanced skin flap and V-shaped ventral incision along the root of penile shaft is a simple, safe, and effective procedure for concealed penis with a similar appearance result to the prepuce circumcision.

  2. [Repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger].

    Science.gov (United States)

    Chang, Shusen; Jin, Wenhu; Wei, Zairong; Sun, Guangfeng; Wang, Bo; Deng, Chengliang; Tang, Xiujun; Zeng, Xueqin; Nie, Kaiyu

    2016-04-01

    To investigate the therapeutic effects of repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger. Thirteen patients with skin and soft tissue defects at distal end of 13 fingers were hospitalized from September 2013 to January 2015. After debridement, the wound area of finger ranged from 1.2 cm × 0.8 cm to 1.8 cm × 1.5 cm. Serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger were used to repair the defect. The flaps were interruptedly sutured. The areas of bilaterally pedicled V-Y advancement flap and serrated flap with digital proper artery and nerve pedicle ranged from 0.52 to 1.11 and 2.60 to 5.23 cm(2,) respectively. All flaps of 13 patients survived completely. The patients were followed up for 6 to 24 months. The color and texture of the flaps were good. After reconstruction, the finger tips were in round in shape. The appearance of the fingers was consistent with that of the normal fingers, and joint motility was normal. No hook-nail deformity or knuckle dysfunction was found. Sensation of the flaps was estimated as S4, and the distance of two-point discrimination ranged from 2 to 3 mm. The recovery of the joint motion function of the fingers was excellent. Serrated flap with digital proper artery and nerve pedicle, combined with bilaterally pedicled V-Y advancement flap from the injured finger can repair the skin and soft tissue defects at distal end of finger with reliable blood supply and simple operative technic. It also could avoid the formation of deformity subsequent to a linear scar, and a satisfactory appearance with good function could be obtained.

  3. Use of skin stretching techniques before bilateral caudal superficial epigastric axial flaps in a dog with severe burns.

    Science.gov (United States)

    Zingel, Michelle M; Sakals, Sherisse A

    2017-08-01

    This report describes how 2 days of skin stretching facilitated a tension-free closure of single event bilateral caudal superficial epigastric flaps in a dog with severe hindquarter burns. Full healing at all surgical sites with only minor dehiscence and without further treatment or abnormalities of gait or coat regrowth was achieved.

  4. 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; Karbek Akarca, Funda; Ozcete, Enver; Altunci, Yusuf Ali; Karabey, Fatih; Cavusoglu, Turker; Meral, Ayfer; Yigitturk, Gurkan; Oyku Cetin, Emel

    2016-04-01

    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. 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. 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. We found that sericin had significant positive effects on wound healing and antioxidant activity. Sericin-based formulations can improve healing of incision wounds.

  5. 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

  6. The impact of superficial femoral artery (SFA) occlusion on the outcome of proximal sartorius muscle transposition flaps in vascular surgery patients.

    Science.gov (United States)

    Töpel, Ingolf; Betz, Thomas; Uhl, Christian; Steinbauer, Markus G

    2011-04-01

    To demonstrate the feasibility and safety of proximal sartorius muscle rotational flaps in patients with peripheral occlusive artery disease. Retrospective analysis of 53 patients with 56 proximal sartorius muscle flaps. Indication for a flap procedure was postoperative calcitrant lymphorrhea in nine, graft at risk in 13, and graft infection in 34 procedures. Pre- and postoperative patencies of the superficial femoral artery (SFA) and profundal femoral artery (PFA) were documented. Flap viability, wound healing, and limb salvage were examined at follow-up. In 59% of the procedures in this series, the SFA was occluded. The PFA was patent in all patients. Flap viability (100% vs 94%), rate of new (4% vs 6%), and recurrent infections (9% vs 6%), loss of vascular reconstruction rate (9% vs 9%), and limb salvage rate (100% vs 88%) did not differ significantly between the SFA patent and the SFA occluded group. There were four new infections (7%) and three recurrent infections (5.5%) during follow-up, five of which led to a loss of reconstruction. In four of those five patients, the sartorius flap was viable. Two patients died during the immediate postoperative period from septic multi-organ failure (3%). At a median follow-up of 6.4 months, 54 flaps were viable and wound closure was achieved in all surviving 51 patients. Limb salvage rate was 93%. Biologic protection procedures as local muscle flaps are vital adjuncts to vascular surgery techniques in the treatment of complicated wounds in the groin. Occlusion of the SFA in the presence of a patent PFA is not associated with an increased risk of flap loss in proximal sartorius muscle rotational flaps. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-01-01

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

  8. 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.

  9. New perspective on the in vivo use of cold stress dynamic thermography in integumental reconstruction with the use of skin-muscle flaps.

    Science.gov (United States)

    Kolacz, Szymon; Moderhak, Mateusz; Jankau, Jerzy

    2017-05-15

    Among the problems encountered by plastic surgeons is the reconstruction of defects following tumors. One of the reconstructive options is trans rectus abdominis (TRAM) flap. Despite that anatomy is well explored, marginal flap necrosis may develop. To minimize the complications, imaging examinations were designed to determine the degree of flap perfusion. One of them is the thermographic examination. We examined 38 patients who had undergone 10 reconstructive breast surgeries with a pedicled TRAM ipsilateral flap, 10 patients with a TRAM contralateral flap, and 18 patients with a TRAM supercharged flap. Each operated patient underwent a thermographic examination before the surgery, after the dissection of the skin-muscle flap, immediately after suturing flap, and during the first and seventh day after the surgery. The collected data were then processed to yield results in a numerical form and compared with clinical examination. The aim of this study is to evaluate the efficacy of new thermal model calculation of dT norm and t 90_10 in cold stress dynamic thermography in the in vivo assessment of intraoperative and postoperative skin blood supply in humans before ischemic lesions become clinically apparent. Of 38 patients participating in the study, nine patients developed marginal necrosis of the skin flap despite intraoperative clinical evaluation of blood supply. Explicit circulatory disorders apparent in a clinical examination developed after 24 h. Cold stress t norm and t 90_10 dynamic thermography can be a helpful additional tool to assess and monitor the blood supply to the flap skin both intraoperatively and postoperatively. Active dynamic thermography; cold stress dynamic thermography, thermography; TRAM; flap necrosis; flap monitoring, breast reconstruction. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. [Reconstruction of oral mucosa with a micro-vascularized fascia-cutaneous flap from the forearm].

    Science.gov (United States)

    Burgueño García, Miguel; Cebrián Carretero, José Luis; Muñoz Caro, Jesús Manuel; Arias Gallo, Javier

    2002-01-01

    Epidermoid carcinoma of jugal mucosa is an aggressive tumor. Its treatment is based on broad excision and reconstruction in order to avoid fibrosis and restriction of mouth opening. Neck dissection and radiotherapy are indicated in selected cases. We display our experience with microvascularized flaps with the aim of preventing the flaws. We reconsider 8 patients (representing 10 flaps) handle in our Department. Besides we discuss other therapeutic alternatives after the growth's removal. The conclusion reached is that the mucovascularized forearm flaps give a great quantity of thin tissue and therefore so results to be the best option for the reconstruction of the jugal mucosa.

  11. Modification of the superficial cervical axial pattern skin flap for oral reconstruction.

    Science.gov (United States)

    Dundas, James M; Fowler, J David; Shmon, Cindy L; Clapson, J Brian

    2005-01-01

    To describe an extended pedicle flap based on the superficial cervical artery (SCA) for closure of oral defects in dogs. Anatomic study; in vivo experimental study. Canine cadavers (13) and 3 dogs. The prescapular branch of the SCA was cannulated and perfused with a lead oxide gelatin mixture. The area perfused by 1 SCA was examined as was the rostral extent of the flap. Staged implantation was performed to evaluate flap performance in vivo. In stage 1, the flap was prepared for implantation into the oral cavity. In stage 2, the flap was fully developed to include the 1 degrees, 2 degrees, and partial 3 degrees angiosome of 1 SCA pedicle. The flap was transposed by a bridging incision and a parapharyngeal tunnel into the oral cavity. The flap was used to reconstruct a partial-thickness defect created in the palate. The territory of the contralateral SCA was captured in all cadavers. The full flap reached the level of the canine teeth in all cadavers. In live dogs, necrosis was not observed after implantation into partial-thickness defects and dehiscence was minimal. Loss of pliability secondary to de-epithelialization and staging resulted in a limitation of rostral reach of the flap. Whereas the flaps did not reach as far rostrally as anticipated, they survived well in the harsh oral environment. The flap may be modified to reconstruct full-thickness palatal defects. The extended SCA pattern flap may be adapted for closure of oral defects.

  12. In utero Plastic Surgery in Zurich: Successful Use of Distally Pedicled Random Pattern Transposition Flaps for Definitive Skin Closure during Open Fetal Spina Bifida Repair.

    Science.gov (United States)

    Meuli, Martin; Meuli-Simmen, Claudia; Mazzone, Luca; Tharakan, Sasha J; Zimmermann, Roland; Ochsenbein, Nicole; Moehrlen, Ueli

    2017-12-20

    One of the intraoperative challenges of fetal spina bifida repair is skin closure when there is an extended skin defect. Thus, we examined whether distally pedicled random pattern transposition flaps (TFs) are a valid option to overcome this problem. All patients undergoing in utero repair of spina bifida with application of a TF for back skin closure were analyzed focusing on intraoperative flap characteristics and postoperative flap performance. In 30 (70%) of the 43 fetuses a primary skin closure was achieved, in 5 (12%) a skin substitute was used, and in 8 (18%) a TF was applied. Flap raising and insertion was uneventful and perfusion was sufficient in all 8 fetuses (100%). In 3 fetuses (37%) the donor sites were closed primarily, and in 5 (63%) a skin substitute was used for coverage. At birth, 7 flaps were viable and provided robust skin coverage over the center of the former lesion. Complications included a small skin defect with CSF leakage in 1 patient (13%). During open fetal spina bifida repair, TFs can be safely and efficaciously used to obtain solid and durable skin coverage over lesions too large to allow conventional primary skin closure. © 2017 S. Karger AG, Basel.

  13. Significance of vascular endothelial growth factor expression in skin melanoma

    Directory of Open Access Journals (Sweden)

    Gajanin Vesna

    2010-01-01

    Full Text Available Background/Aim. Melanoma is a heterogeneous disease of skin and mucous membranes which shows significant increase in incidence worldwide in the past decades. In the process of forming new blood vessels stimulators of angiogenesis participate. There is an increase production of vascular endothelial growth factor (VEGF-C and VEGF-D, which expression cause change of endothelial cells, and higher degree of tumor's aggressiveness. The aim of this research was to determine the level of VEGF expression in skin melanoma in different body regions and in different primary stages of the disease. Methods. The research was conducted on bioptic materials of skin in 39 patients. On excision-made materials a routine histological preparation was done and following parameters were determined: histological type, alteration thickness (according to Breslow, Clark level, TNM (Tumor Nodus Metastasis stage (pT, alteration width, thickness of lymphocytic infiltration in the tumor, mitotic index, phase of the tumor growth, presence of ulcerations, cellular type of the tumor, localization and level of VEGF expression. Results. Analysis confirmed that 61.54% of skin melanoma showed a high VEGF expression. Nodular and acral lentiginous melanomas showed more frequently a high level of VEGF expression, while superficial spreading melanoma showed a lower level of VEGF expression (p = 0.032, p < 0.05. A higher level of expression was present in thicker melanomas (higher in the Breslow stage; p = 0.011, p < 0.05. The width of the lesion did not have an influence on the level of VEGF expression in melanoma (U =142.000, p = 0.273. Conclusion. Melanomas show a higher level of VEGF expression. Nodular and acral lentiginous types of melanoma show a high level of VEGF expression, while superficial spreading melanoma shows a lower level of VEGF expression. Melanomas in higher-stage disease (Breslow, Clark, pTNM show a higher level of VEGF expression.

  14. 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.

  15. 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

    PURPOSE: To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery. METHODS: This was a retrospective case-series of 8 patients who underwent...... was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free...... excision to avoid eye discomfort. CONCLUSION: Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases....

  16. 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

    Full Text Available Los colgajos cutáneos de patrón vascular randomizado son de gran utilidad en Cirugía Reconstructiva; un aporte vascular adecuado es el factor más importante para la supervivencia de los mismos. Realizamos un estudio experimental levantando un total de 36 colgajos en el dorso de 9 conejos (4 en cada conejo: a 9 controles, b 9 con aplicación de toxina botulínica tipo A transoperatoria a lo largo del colgajo, c 9 con toxina botulínica tipo A aplicada 7 días antes del procedimiento quirúrgico, y, d 9 con aplicación de toxina botulínica tipo A transoperatoria más epinefrina. El análisis de los colgajos se realizó a través de imágenes digitales que se examinaron con el programa ImageJ. Efectuamos el análisis estadístico con la prueba T de Student. La evaluación final de los colgajos se realizó al séptimo día, tiempo en el cual se obtuvo: a una media de área necrótica en los controles del 72.17 ± 3.9% ; b en los que se aplicó toxina botulínica transoperatoria el porcentaje de aérea necrótica fue del 5.09 ± 1.2% p = 0.032; c en aquellos en los que la toxina botulínica se aplicó 7 días antes del procedimiento se reportó necrosis del 24.97 ± 2.7% p = 0.041 y d en los que se aplicó toxina botulínica transoperatoria más epinefrina el porcentaje de necrosis fue del 23.90 ± 3.9% p = 0.045. Concluimos que la toxina botulínica tipo A actúa como protector contra el proceso de sufrimiento-isquemia de los tejidos, debido a su acción vasodilatadora, recomendando su aplicación al inicio del procedimiento quirúrgico.Random-pattern cutaneous flaps are very useful in Reconstructive Surgery; an adequate vascular contribution is an important factor for the survival of the flaps. We designed an experimental study elevating a total of 36 dorsal flaps, divided in 4 groups: a 9 were controls, to which 0.9% physiological solution was applied, b 9 with a transoperatory application of type A botulinum toxin throughout the length of

  17. Total Maxillary Reconstruction Using a Double-Barreled and Double Skin Paddle Fibular Flap after Total Maxillectomy

    Directory of Open Access Journals (Sweden)

    Miguel de la Parra

    2013-11-01

    Full Text Available 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. Improvement of Tissue Survival of Skin Flaps by 5α-Reductase Inhibitors: Possible Involvement of Nitric Oxide and Inducible Nitric Oxide Synthase

    Science.gov (United States)

    Karimi, Ali Asghar; Ajami, Marjan; Asadi, Yasin; Aboutaleb, Nahid; Gorjipour, Fazel; Malekloo, Roya; Pazoki-Toroudi, Hamidreza

    2015-01-01

    Background: Skin flap grafting is a popular approach for reconstruction of critical skin and underlying soft tissue injuries. In a previous study, we demonstrated the beneficial effects of two 5α-reductase inhibitors, azelaic acid and finasteride, on tissue survival in a rat model of skin flap grafting. In the current study, we investigated the involvement of nitric oxide and inducible nitric oxide synthase (iNOS) in graft survival mediated by these agents. Methods: A number of 42 male rats were randomly allocated into six groups: 1, normal saline topical application; 2, azelaic acid (100 mg/flap); 3, finasteride (1 mg/flap); 4, injection of L-NG-nitroarginine methyl ester (L-NAME) (i.p., 20 mg/kg); 5, L-NAME (20 mg/kg, i.p.) + azelaic acid (100 mg/flap, topical); 6, L-NAME (20 mg/kg, i.p.) + finasteride (1 mg/flap, topical). Tissue survival, level of nitric oxide, and iNOS expression in groups were measured. Results: Our data revealed that azelaic acid and finasteride significantly increased the expression of iNOS protein and nitric oxide (NO) levels in graft tissue (P azelaic acid- and finasteride-mediated survival of the skin flaps. PMID:25864816

  19. 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

  20. Dorsalis pedis arterialized venous flap for hand and foot

    Directory of Open Access Journals (Sweden)

    YU Guang

    2012-04-01

    Full Text Available 【Abstract】Objective: To report the results of re-pair 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 dor-sum 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 sur- vived 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. Key words: Surgical flaps; Reconstructive surgical procedures; Hand; Foot

  1. [The application of microvascular anastomotic coupler in vascular anastomosis of free tissue flap for reconstruction of defect after head and neck cancer resection].

    Science.gov (United States)

    Zhang, Y J; Wang, Z H; Li, C H; Chen, J

    2017-09-07

    Objective: To investigate the application and operation skills in vein anastomosis by microvascular anastomotic coupler (MAC) in reconstruction of defects after head and neck cancer resection. Methods: From August 2015 to July 2016, in Department of Head and Neck Surgery, Sichuan Cancer Hosipital, 17 cases underwent the reconstruction of defects after head and neck cancer resection with free tissue flaps, including forearm flaps in 11 casess, anterolateral flaps in 4 casess and fibula flaps in 2 casess. Totally 17 MAC were used, including 14 MAC for end-to-end anastomosis and 3 MAC for end-to-side anastomosis. SPSS 22.0 software was used to analyze the data. Results: Venous anastomoses in 17 free tissue flaps were successfully completed, with no anastomotic errhysis. All flaps survived well. The time required for vascular anastomoses with MAC varied 2-9 min, with average time of (4.2±2.3) min, which was significantly shorter than that with manually anastomosis (17.4 ± 2.7) min ( t =15.1, P anastomosis in free tissue flap for reconstruction of defect after head and neck cancer resection, which requires for less operation time and shows good results.

  2. Repair of deep tissue defects in the posterior talocrural region using a superficial temporal fascia free flap plus thin split-skin grafting in extensively burned patients

    Science.gov (United States)

    Yang, Xuekang; Zhao, Hui; Liu, Mengdong; Zhang, Yue; Chen, Qiaohua; Li, Zhiqiang; Han, Juntao; Hu, Dahai

    2018-01-01

    Abstract The aim of this study was to describe the scheme, surgical procedures, and clinical outcomes for the early repair of deep wounds of the posterior talocrural region in extensively burned patients with a method combining a superficial temporal fascia free flap with thin split-skin grafting. From January 2013 to February 2016, 9 extensively burned patients with deep tissue defects of the posterior talocrural region were treated in our department (2 patients had bilateral deep tissue defects of the posterior talocrural region). All 11 wounds were repaired using a superficial temporal fascia free flap and thin split-skin grafting. After the operation, survival of the fascia flaps and grafted skin was observed, and the appearance and functional recovery of the grafts were evaluated. Follow-up information was reviewed, and complications were documented. All 11 fascia flaps survived completely. Two cases of partial skin necrosis healed after the second application of skin grafts. The appearance and function of recipient sites were well restored in all patients over a follow-up period of 5 to 14 months. Deep tissue defects of the posterior talocrural region can be effectively repaired with our method combining a superficial temporal fascia free flap with thin split-skin grafting. This method offers the advantages of a good appearance, strong resistance to infection, minimal damage at the donor site, short course of disease, and good prognosis. PMID:29504968

  3. Possible role of mechanical force in regulating regeneration of the vascularized fat flap inside a tissue engineering chamber.

    Science.gov (United States)

    Ye, Yuan; Yuan, Yi; Lu, Feng; Gao, Jianhua

    2015-12-01

    In plastic and reconstructive surgery, adipose tissue is widely used as effective filler for tissue defects. Strategies for treating soft tissue deficiency, which include free adipose tissue grafts, use of hyaluronic acid, collagen injections, and implantation of synthetic materials, have several clinical limitations. With the aim of overcoming these limitations, researchers have recently utilized tissue engineering chambers to produce large volumes of engineered vascularized fat tissue. However, the process of growing fat tissue in a chamber is still relatively limited, and can result in unpredictable or dissatisfactory final tissue volumes. Therefore, detailed understanding of the process is both necessary and urgent. Many studies have shown that mechanical force can change the function of cells via mechanotransduction. Here, we hypothesized that, besides the inflammatory response, one of the key factors to control the regeneration of vascularized fat flap inside a tissue engineering chamber might be the balance of mechanical forces. To test our hypothesis, we intend to change the balance of forces by means of measures in order to make the equilibrium point in favor of the direction of regeneration. If those measures proved to be feasible, they could be applied in clinical practice to engineer vascularized adipose tissue of predictable size and shape, which would in turn help in the advancement of tissue engineering. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. 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 BackgroundThe aim of this study was to collect important data on the time of oxygen saturation change in relation to skin flap color alteration using non-invasive pulse oximetry to evaluate its ability to provide continuous monitoring of skin flap perfusion.MethodsAn experimental study on the monitoring of blood perfusion of 20 tube-island groin flaps of 10 male New Zealand rabbits was performed using pulse oximetry. The animals were randomly assigned to one of two groups representing a blockage of either arterial or venous blood flow. The oxygen saturation change and clinical color alteration were monitored from the beginning of vessel clamping until the saturation became undetectable. The result was analyzed by the t-test using SSPS ver. 10.0.ResultsThe mean times from the vessel clamping until the saturation became undetectable were 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 clamping was 34.5±11.72 minutes, while the alteration in flaps with artery clamping could not be detected until 2.5 hours after clamping.ConclusionsThe use of neonate-type reusable flex sensor-pulse oximetry is objective and effective in early detection of arterial and vein blockage. It provides real-time data on vessel occlusion, which in turn will allow for early salvaging. The detection periods of both arterial occlusion and venous congestion are much earlier than the color alteration one may encounter clinically.

  5. 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.

  6. Long-term donor-site morbidity after vascularized free fibula flap harvesting: Clinical and gait analysis.

    Science.gov (United States)

    Feuvrier, Damien; Sagawa, Yoshimasa; Béliard, Samuel; Pauchot, Julien; Decavel, Pierre

    2016-02-01

    The aim of this study was to determine the clinical morbidity and changes in gait temporal spatial parameters after harvesting of a vascularized free fibula flap. This study included 11 patients (mean age: 52 ± 17 years) and 11 healthy controls (mean age: 50 ± 14 years). The patients were assessed between 5 and 104 months post surgery. The study consisted of a subjective functional evaluation with two validated clinical scores (Kitaoka Score and Point Evaluation System (PES) score), clinical and neurological examination of the legs, and evaluation of gait temporal spatial parameters while walking at a comfortable speed. The mean functional Kitaoka score was 78/100, and the mean PES score of 12.18 was considered average. At the time of the review, five patients had sensory disorders, two had toe deformities, and eight had pain at the donor site. The gait analysis showed that the patient's comfortable walking speed was significantly lower in comparison to that of the controls, and that stride length and cadence were reduced. In addition, most of the gait-specific parameters were significantly different. The donor leg displayed greater variability during walking. To reduce the risk of falling, this study revealed that the patients' gait pattern had changed as they took a more cautious approach during walking. Early rehabilitation is expected to help improve and/or restore the physical abilities of patients after harvesting of the vascularized free fibula flap. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. [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.

  8. Increased vascular resistance in vasodilated skin an indicator of diabetic microangiopathy?

    DEFF Research Database (Denmark)

    Faris, I B; Lassen, N A

    1982-01-01

    The method of isotope clearance has been used to investigate the vascular resistance in skin in severely atherosclerotic patients with and without diabetes. Dilatation of the skin vessels was achieved by the injection of histamine with a radioactive tracer (99mTc). The perfusion pressure of the s...

  9. 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.

  10. The trapezius osteomusculocutaneous flap in dogs.

    Science.gov (United States)

    Philibert, D; Fowler, J D

    1993-01-01

    A pedicled osteomusculocutaneous flap, composed of the cervical part of the trapezius muscle with its overlying skin and the central spine and body of the scapula, was elevated on the prescapular branch of the superficial cervical vascular pedicle in four dogs. The flap was replaced in an orthotopic location. Bone viability was evaluated using histology, fluorescence bone labeling, and angiography. Bone from the scapular spines had a high percentage of viable osteocytes, positive fluorescence, and vessels were outlined in the angiographic study. Bone from the body of the scapula was not viable based on similar criteria.

  11. A first vascularized skin equivalent as an alternative to animal experimentation.

    Science.gov (United States)

    Groeber, Florian; Engelhardt, Lisa; Lange, Julia; Kurdyn, Szymon; Schmid, Freia F; Rücker, Christoph; Mielke, Stephan; Walles, Heike; Hansmann, Jan

    2016-01-01

    Tissue-engineered skin equivalents mimic key aspects of the human skin, and can thus be employed as wound coverage for large skin defects or as in vitro test systems as an alternative to animal models. However, current skin equivalents lack a functional vasculature limiting clinical and research applications. This study demonstrates the generation of a vascularized skin equivalent with a perfused vascular network by combining a biological vascularized scaffold (BioVaSc) based on a decellularized segment of a porcine jejunum and a tailored bioreactor system. Briefly, the BioVaSc was seeded with human fibroblasts, keratinocytes, and human microvascular endothelial cells. After 14 days at the air-liquid interface, hematoxylin & eosin and immunohistological staining revealed a specific histological architecture representative of the human dermis and epidermis including a papillary-like architecture at the dermal-epidermal-junction. The formation of the skin barrier was measured non-destructively using impedance spectroscopy. Additionally, endothelial cells lined the walls of the formed vessels that could be perfused with a physiological volume flow. Due to the presence of a complex in-vivo-like vasculature, the here shown skin equivalent has the potential for skin grafting and represents a sophisticated in vitro model for dermatological research.

  12. Lateral calcaneal artery perforator-based skin flaps for coverage of lower-posterior heel defects.

    Science.gov (United States)

    Wang, Sui-Jiang; Kim, Yu-Dan; Huang, Hai-hua; Wu, Ze-Yong; Lu, Ling; Chen, Hai-Fang; Guo, Xiao-Rui; Wei, Xiao-Hua

    2015-04-01

    Perforator-based flaps have been explored across almost all of the lower leg except in the Achilles tendon area. This paper introduced a perforator flap sourced from this area with regard to its anatomic basis and clinical applications. Twenty-four adult cadaver legs were dissected to investigate the perforators emerging along the lateral edge of the Achilles tendon in terms of number and location relative to the tip of the lateral malleolus, and distribution. Based on the anatomic findings, perforator flaps, based on the perforator(s) of the lateral calcaneal artery (LCA) alone or in concert with the perforator of the peroneal artery (PA), were used for reconstruction of lower-posterior heel defects in eight cases. Postoperatively, subjective assessment and Semmes-Weinstein filament test were performed to evaluate the sensibility of the sural nerve-innerved area. The PA ended into the anterior perforating branch and LCA at the level of 6.0 ± 1.4 cm (range 3.3-9.4 cm) above the tip of the lateral malleolus. Both PA and LCA, especially the LCA, gave rise to perforators to contribute to the integument overlying the Achilles tendon. Of eight flaps, six were based on perforator(s) of the LCA and two were on perforators of the PA and LCA. Follow-up lasted for 6-28 months (mean 13.8 months), during which total flap loss and nerve injury were not found. Functional and esthetic outcomes were good in all patients. The integument overlying the Achilles tendon gets its blood supply through the perforators of the LCA primarily and that of through the PA secondarily. The LCA perforator(s)-based and the LCA plus PA perforators-based stepladder flap is a reliable, sensate flap, and should be thought of as a valuable procedure of choice for coverage of lower-posterior heel defects in selected patients. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. 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.

  14. 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...

  15. Mechanical properties of an artificial vascularized human skin

    Science.gov (United States)

    Passot, A.; Cabodevila, G.

    2011-05-01

    In order to make blood sample tests an artificial skin similar to that of the baby's heel is modeled and realized. The most superficial bloodstream and the two main layers of the skin -epidermis and dermis- have to be recreated. Studies and capillaroscopies of the baby's heel give characteristics of these layers and the bloodstream. The skin is viscohyperelastic, but the choice of materials that will be used is based on the Young's modulus. The epidermis layer is based on a stronger less adhesive silicon rubber Elastosil. The dermis layer is composed of a mixture based on a very soft sticky silicon rubber Silgel and Sylgard. The mixture of Silgel with 5% Sylgard has an elastic modulus of 48 kPa which is similar to that of the dermis. The artificial skin is an assembly of several layers including a layer of Sylgard that is structured by a mold representing the capillary network and adapted to manufacturing processes in a clean room. Each layer is deposited by spin coating and is combined with the other through adhesion. Mechanical tests such as tension are performed to verify the mechanical properties of the artificial skin.

  16. 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 reconstruct the defect. The perforators are marked with a hand-held Doppler probe and multiple flaps are designed. The appropriate flap is elevated after identifying the perforator(s). Dissection of the perforator(s) or complete incision of the flap margins are not mandatory if the flap is mobilized...... adequately to cover the defect. Defects measuring 3 x 3 cm up to 20 x 20 cm at diverse locations were successfully reconstructed in 20 of 21 patients with 26 flaps. Pedicled perforator flaps offer us reliable and satisfactory results of reconstruction at different anatomic territories of the body. It sounds...

  17. The Megameatus, Intact Prepuce Variant of Hypospadias: Use of the Inframeatal Vascularized Flap for Surgical Correction

    Directory of Open Access Journals (Sweden)

    Marc Cendron

    2018-03-01

    Full Text Available IntroductionThe megameatus intact prepuce (MIP variant of hypospadias is a rare variant of hypospadias that is diagnosed either early at the time of circumcision or later as the foreskin is retracted. The true incidence of the anomaly is difficult to determine precisely as some patient never come to medical attention but is felt to under 5% of all cases of hypospadias. The purposes of this study are to review the embryology and clinical findings of MIP and then, in light of a personal experience, present a series of patients evaluated for MIP who were treated with a modification of the Mathieu technique.Materials and methodsA PubMed search of all articles in the MIP variant of hypospadias was carried out followed by an exhaustive review of the literature. The charts of all patients evaluated and treated at Boston Children’s Hospital by MC between 2007 and 2017 were reviewed retrospectively. The patients were divided into two groups: those who underwent the standard procedure and those who underwent a repair using a modification of the Mathieu procedure using an inframeatal flap.ResultsThe embryologic explanation of the MIP variant is not clear but failure of the distal, glanular portion of the urethra to tubularize results in spectrum of abnormality characterized by a deep glanular groove and an abnormal opening of the urethra anywhere from the mid-glans to a subcoronal location. Surgical repair is complicated by a wide distal urethra which may be injured if not properly identified. Overall good outcomes were noted with one patient experiencing a urethra cutaneous fistula in the first group and one patient having a mild glans dehiscence in the second.ConclusionThe MIP variant of hypospadias is a rare variant of hypospadias that presents as a spectrum of urethral anomaly. Surgical repair may not always be necessary but if surgical repair is carried out, the Mathieu technique modification may offer better anatomic delineation of the urethra and

  18. 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

  19. 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.

  20. Facial reconstruction with a unique osteomyocutaneous DCIA perforator flap variant: a case report.

    Science.gov (United States)

    Wechselberger, G; Schwaiger, K; Hachleitner, J; Oberascher, G; Ensat, F; Larcher, L

    Anatomical variance of the deep circumflex iliac artery is of high clinical value in facial reconstruction using a deep circumflex iliac artery perforator (DCIAP) flap. We present the case of a 76-year-old woman treated with an osteomyocutaneous DCIAP flap variant for facial reconstruction. We also review here the literature on DCIA perforator flaps and the different anatomical variances, which might bring clinical benefits. The observed anatomy in our patient offered the possibility to raise a free flap variant with high mobility of a large skin paddle and a long vascular pedicle combined with a variable osteomuscular portion. The characteristics of the flap thus raised help overcome the disadvantages of the conventional DCIAP flap and offer excellent options for facial reconstruction.

  1. Cyanoacrylate Skin Microsealant for Preventing Surgical Site Infection after Vascular Surgery : A Discontinued Randomized Clinical Trial

    NARCIS (Netherlands)

    Vierhout, Bastiaan P.; Ott, Alewijn; Reijnen, Michel M. P. J.; Oskam, Jacques; Ott, Alewijn; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.

    Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a

  2. Mineralization/Anti-Mineralization Networks in the Skin and Vascular Connective Tissues

    OpenAIRE

    Li, Qiaoli; Uitto, Jouni

    2013-01-01

    Ectopic mineralization has been linked to several common clinical conditions with considerable morbidity and mortality. The mineralization processes, both metastatic and dystrophic, affect the skin and vascular connective tissues. There are several contributing metabolic and environmental factors that make uncovering of the precise pathomechanisms of these acquired disorders exceedingly difficult. Several relatively rare heritable disorders share phenotypic manifestations similar to those in ...

  3. Vascular effects of leukotriene D4 in human skin

    DEFF Research Database (Denmark)

    Bisgaard, H

    1987-01-01

    as a mediator of the axon reflex, and show that LTD4 causes a direct vasodilatory effect that is not mediated via histamine or cyclooxygenase products. The laser-Doppler flowmeter was applied for dynamic studies of the vasopressor response in the skin during a Valsalva maneuver, and the relative changes...... in blood flow were confirmed by control estimates of the blood flow rate by a 133xenon washout method. The pressor response to a Valsalva maneuver was reversed by local nerve block, but not affected by LTD4. Therefore LTD4 did not interfere with the sympathetic activity on the cutaneous vessels...

  4. Use of a hypogastric flap and split-thickness skin grafting for a degloving injury of the penis and scrotum: A different approach

    Directory of Open Access Journals (Sweden)

    Selvan S

    2009-01-01

    Full Text Available Penile and scrotal skin avulsions are not common events and are caused usually by accidents with industrial machines or agricultural machines. We report a case of a 27-year-old newly married thin-built patient with avulsion and traumatic degloving of the penile and scrotal skin, with exposure of the corpora cavernosa and copus spongiosum of penis and testes as his loose clothes got entangled in a paddy harvesting machine accidently. Reconstruction was performed using a hypogastric flap and split skin graft, achieving a satisfactory aesthetic result and sexual functions.

  5. Development of the isolated perfused porcine skin flap for in vitro studies of percutaneous absorption pharmacokinetics and cutaneous biotransformation

    International Nuclear Information System (INIS)

    Carver, M.P.

    1988-01-01

    The isolated perfused porcine skin flap (IPPSF) has proven to be a valuable in vitro tool for studying the physiology and biochemistry of skin and for identifying biochemical and histological markers of direct cutaneous toxicity. The present experiments were undertaken for two purposes: (1) to develop a pharmacokinetic model, based on dermal penetration in the IPPSF, which is predictive of percutaneous absorption in vivo, and (2) to examine cutaneous biotransformation of the important agricultural poison parathion (P). Dosing solutions of 14 C-radiolabelled compounds representing 3 chemical classes-organic acid/base [benzoic acid (B), caffeine (C)], organophosphate (OP) pesticides, and steroid hormones, were applied topically in ethanol at 40 μm cm -2 , both in vivo and on the IPPSF. A 3-compartment pharmacokinetic model describing mass transfer from the surface (C 1 ), diffusion through epidermis and dermis (C 2 ), and transfer into the perfusate (C 3 ), was developed based on flux through the IPPSF from 0-8 hr. Model simulations were predictive of percutaneous absorption in vivo for the OP's and steroids. Modification of the basic 3-compartment model to account for fast and slow tissue-release processes (B) and for flux-dependent perfusage flow increases (C), provided excellent in vivo-in vitro correlation over all 7 compounds

  6. Reconstruction of the Tibia with a Bipedicle Fibular Flap

    Directory of Open Access Journals (Sweden)

    Ahmet Kahraman

    2016-03-01

    Full Text Available Tibial defects can be caused by trauma, congenital, osteomyelitis, or cancers. The tibia is the main bone for bearing the body. It is a big bone, and the difficulty of the reconstruction of tibia is importance to repair it. The fibular bone is a good provider for repairing the tibia defects. Generally, the repair was planned be a free vascularized flap. The most important disadvantage is the low calibration. In early age in particular, the original thickness of the tibia is reached after the surgery with a good follow-up process and rehabilitation. In this case; a 22-year-old female patient had a multi-part post-traumatic fracture of the left tibia and was administered to our plastic surgery inpatient clinic. The bone defect was reconstructed with a bipedicle fibular flap taken from the same leg. The fibula was embedded into the medulla with a screw plate, and fixation was applied with an external fixator. Wherefore the loss of skin, skin flap of fibula bottomed of perforators was not used. A vascularized anterolateral thigh flap, which was obtained from the other leg, was used to reconstruct the skin defect. One year after surgery, the bone viability was perfect. The integrity of the skeleton was created without shortening the leg. The rehabilitation of the patient was continued for repowering and resizing the fibula up to tibia. In this case report, we wanted to share our experience for repairing the tibia defect with using a bipedicle fibular flap.

  7. Twin digital and in-step neurovascularised free flaps for reconstruction of the degloved mutilated hands.

    Science.gov (United States)

    Oh, S J; Koh, S H; Chung, C H

    2010-11-01

    Degloved mutilated hand injury results in severe contracture of palmar surfaces after avulsion defects of soft tissue and insensate scarring of amputated digits at the proximal interphalangeal level. In an effort to restore the basic function of such hands, we simultaneously used a sensate in-step free flap for re-surfacing the first web space and sensate twin digital free flaps for re-surfacing the palmar defects of the thumb and index finger. Three male patients sustained degloved mutilated hand injury from a machine in a factory. The average age of the patients was 26 years. These injuries were reconstructed by concomitant twin digital neurovascularised free flaps harvested on the contralateral hands and the in-step neurovascularised free flaps harvested on the feet. The lateral plantar vascular pedicle of the in-step flaps was anastomosed to the vascular pedicle of the twin digital flaps by a flow-through fashion. All flaps survived. These flaps provided durable sensate coverage and improved pinch and grasp. The morbidity of donor fingers and feet was minimal. These described flaps supply durable glabrous sensate skin of prehensile function in degloved mutilated hands. Our method is useful in the reconstruction of degloved mutilated hands with amputated stumps of the thumb and counter digit more than 3 cm in length required for pinch and grip. Copyright © 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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

    NARCIS (Netherlands)

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

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  10. Interleukin 17 drives vascular inflammation, endothelial dysfunction, and arterial hypertension in psoriasis-like skin disease.

    Science.gov (United States)

    Karbach, Susanne; Croxford, Andrew L; Oelze, Matthias; Schüler, Rebecca; Minwegen, Daniel; Wegner, Joanna; Koukes, Lija; Yogev, Nir; Nikolaev, Alexei; Reißig, Sonja; Ullmann, Alexander; Knorr, Maike; Waldner, Maximilian; Neurath, Markus F; Li, Huige; Wu, Zhixiong; Brochhausen, Christoph; Scheller, Jürgen; Rose-John, Stefan; Piotrowski, Carolin; Bechmann, Ingo; Radsak, Markus; Wild, Philipp; Daiber, Andreas; von Stebut, Esther; Wenzel, Philip; Waisman, Ari; Münzel, Thomas

    2014-12-01

    Interleukin (IL)-17A is regarded as an important cytokine to drive psoriasis, an inflammatory skin disease marked by increased cardiovascular mortality. We aimed to test the hypothesis that overproduction of IL-17A in the skin leading to dermal inflammation may systemically cause vascular dysfunction in psoriasis-like skin disease. Conditional overexpression of IL-17A in keratinocytes caused severe psoriasis-like skin inflammation in mice (K14-IL-17A(ind/+) mice), associated with increased reactive oxygen species formation and circulating CD11b(+) inflammatory leukocytes in blood, with endothelial dysfunction, increased systolic blood pressure, left ventricular hypertrophy, and reduced survival compared with controls. In K14-IL-17A(ind/+) mice, immunohistochemistry and flow cytometry revealed increased vascular production of the nitric oxide/superoxide reaction product peroxynitrite and infiltration of the vasculature with myeloperoxidase(+)CD11b(+)GR1(+)F4/80(-) cells accompanied by increased expression of the inducible nitric oxide synthase and the nicotinamide dinucleotide phosphate (NADPH) oxidase, nox2. Neutrophil depletion by anti-GR-1 antibody injections reduced oxidative stress in blood and vessels. Neutralization of tumor necrosis factor-α and IL-6 (both downstream of IL-17A) reduced skin lesions, attenuated oxidative stress in heart and blood, and partially improved endothelial dysfunction in K14-IL-17A(ind/+) mice. Dermal overexpression of IL-17A induces systemic endothelial dysfunction, vascular oxidative stress, arterial hypertension, and increases mortality mainly driven by myeloperoxidase(+)CD11b(+)GR1(+)F4/80(-) inflammatory cells. Depletion of the GR-1(+) immune cells or neutralization of IL-17A downstream cytokines by biologicals attenuates the vascular phenotype in K14-IL-17A(ind/+) mice. © 2014 American Heart Association, Inc.

  11. Current approaches to free flap monitoring.

    Science.gov (United States)

    Chao, Albert H; Lamp, Susan

    2014-01-01

    Postoperative monitoring of free flaps remains an essential component of care in patients undergoing microsurgical reconstructive surgery. Early recognition of vascular problems and prompt surgical intervention improve the chances for flap salvage. Physical examination remains the cornerstone of free flap monitoring, but more recently, additional technologies have been developed for this purpose. In this article, current approaches to free flap monitoring are reviewed.

  12. Free microvascular transplantation of the trapezius musculocutaneous flap in dogs.

    Science.gov (United States)

    Philibert, D; Fowler, J D; Clapson, J B

    1992-01-01

    A musculocutaneous flap based on the prescapular branch of the superficial cervical artery and including the cervical part of the trapezius muscle and overlying skin was transplanted over a defect created on the medial side of the contralateral tibia in four dogs by using microvascular technique. The donor and recipient sites in three dogs were examined clinically for 21 days, after which they were examined angiographically and histologically. All dogs were free of lameness by hour 48. Seromas formed at the donor site between days 7 and 15. One vascular pedicle was traumatized at hour 40, and the dog was euthanatized. Three flaps survived with minimal necrosis. Edema of the flaps was severe from days 5 to 11. Angiograms showed complete perfusion of the flaps, and survival was confirmed histologically. Esthetic appearance and function were good in one dog at month 7.

  13. 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

  14. Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing total mastectomy: report of 14 cases.

    Science.gov (United States)

    Iglesias, Martin; Gonzalez-Chapa, Diego R

    2013-08-01

    Some authors have mentioned that the endoscopic harvesting of the latissimus dorsi muscle flap for breast reconstruction is an uncommon technique that has been abandoned due to its technical complexity. Therefore, its use for immediate breast reconstruction after skin-sparing total mastectomies is reported for only a few patients, without clinical images of the reconstructed breast or of the donor site. This report describes 14 breast reconstructions using the aforementioned approach, with the latissimus dorsi muscle flap harvested by endoscopy plus the insertion of a breast implant in a single surgical procedure. The objective is to show images of the long-range clinical aesthetic results, both in the reconstructed breast and at the donor site as well as the complications so the reader can evaluate the advantages and disadvantages of the technique. From 2008 to 2011, 12 women who experienced skin-sparing total mastectomy and 2 women who underwent modified radical mastectomy were reconstructed using the aforementioned technique. The average age was 42 years (range 30-58 years), and the average body mass index was 29 kg/m(2) (range 22-34 kg/m(2)). Three patients were heavy smokers: one had undergone a previous abdominoplasty; one had hepatitis C; and one had undergone massive weight loss. Immediate reconstructions were performed for 11 patients, and 3 reconstructions were delayed. The implant volume ranged from 355 to 640 ml. The average endoscopic harvesting time was 163.5 min (range 120-240 min), and the average bleeding was 300 ml. Four patients experienced seromas at the donor site. Acceptance of the reconstructed breast was good in six cases, moderate in seven cases, and poor in one case. Acceptance of the donor site was good in 13 cases and moderate for 1 case. Endoscopic harvesting of the latissimus dorsi muscle has technical difficulties that have limited its acceptance. However, this technique offers the same quality of breast reconstruction as the

  15. Seromuscular Colonic Flap for Intrapelvic Soft-Tissue Coverage: A Reconstructive Option for Plastic Surgeons When Traditionally Used Flaps Are Not Available

    Directory of Open Access Journals (Sweden)

    Johnathon Aho

    2015-01-01

    Full Text Available Background. Reconstruction of intrapelvic defects can be a challenging problem in patients with limited regional muscle flap options and previously resected omentum. In such situations, alternative methods of mobilizing vascularized tissue may be required. Methods. A case of a patient that underwent pelvic extirpation for recurrent rectal cancer who had limited donor sites for flap reconstruction is presented. The mucosa was removed from a blind loop of colon, and a pedicled seromuscular flap based on the colonic mesentery was placed into the pelvis for vascularized soft-tissue coverage and elimination of dead space. Results. The postoperative course was only complicated by a small subcutaneous fluid collection beneath the sacrectomy skin incision, which was drained with radiological assistance. The patient recovered without any major postoperative complications. Conclusion. Seromuscular colonic flap is a useful option for soft-tissue coverage after pelvic extirpation and should be considered by plastic surgeons when other reconstruction options are not available.

  16. The Technique and Benefits of Angiographic Embolization of Inferior Epigastric Arteries Prior to Pedicled TRAM Flap Breast Reconstruction: Results from a Single Center.

    Science.gov (United States)

    Sever, Alysse J; Patel, Chirag; Albeer, Yahya; Darian, Vigen B

    2017-12-01

    To report a single center's experience with selective arterial embolization of the deep inferior epigastric arteries (DIEA) prior to pedicled TRAM flap breast reconstruction including techniques and outcomes. Retrospective chart review was performed for 15 patients who underwent pedicled TRAM flap breast reconstruction after selective embolization of bilateral DIEA. Data were analyzed to display the spectrum of postoperative outcomes following the TRAM flap procedure status post-selective angiographic embolization of the bilateral DIEA to improve vascularity of the TRAM flaps by rendering the tissue partially ischemic to undergo neovascularization. We then compared our results to historical controls of those delayed by ligating the DIEA via traditional surgical means to see if the outcomes are similar. We also compared our results to historical non-delayed TRAM flap reconstruction. One patient had a small area of partial flap skin necrosis, and no patients had total flap loss. 13.3% of patients had clinically significant TRAM flap fat necrosis. Outcomes of TRAM flaps delayed by selective arterial embolization are comparable to historical controls of those delayed by traditional surgical means and better than non-delayed flaps. Angiographic delayed TRAM flap reconstruction procedure is a reasonable safe alternative to the surgical delayed TRAM flap reconstruction procedure with less morbidity and is better than non-delayed TRAM flap procedures.

  17. Propeller TAP flap

    DEFF Research Database (Denmark)

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

    2013-01-01

    The aim of this study was to examine if a propeller thoracodorsal artery perforator (TAP) flap can be used for breast reconstruction. Fifteen women were reconstructed using a propeller TAP flap, an implant, and an ADM. Preoperative colour Doppler ultrasonography was used for patient selection...... to identify the dominant perforator in all cases. A total of 16 TAP flaps were performed; 12 flaps were based on one perforator and four were based on two. A permanent silicone implant was used in 14 cases and an expander implant in two. Minor complications were registered in three patients. Two cases had...... 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...

  18. 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

  19. Protective effect of telomerase-based 16-mer peptide vaccine (GV1001) on inferior epigastric island skin flap survivability in ischaemia-reperfusion injury rat model.

    Science.gov (United States)

    Lee, Yung Ki; Nata'atmaja, Beta Subakti; Kim, Byung Hwi; Pak, Chang Sik; Heo, Chan Yeong

    2017-06-01

    Ischaemia-reperfusion injury (IRI) results in oxidative damage and a profound inflammatory reaction, leading to cell death. GV 1001 is a telomerase-based 16-mer peptide vaccine developed against cancer. However, it has also been reported to possess antioxidant and anti-inflammatory properties. The aim of this study was to determine if GV 1001 can reduce the negative effects caused by IRI in a rat skin flap model owing to its anti-oxidant and anti-inflammatory properties. In order to evaluate the effect of GV 1001, 5 × 5 cm 2 inferior epigastric artery based island skin flaps were dissected in 39 8-week-old Sprague-Dawley rats weighing 220-270 g. The rats were divided into three groups: (I) non-ischaemic group; (II) IRI with saline; and (III) IRI with 10 mg GV 1001 treatment. Drugs were administered intra-muscularly directly before and after ischaemia. Flap survival area, neutrophil infiltration, cytokine levels (interleukin [IL]-1, IL-6, and tumour necrosis factor-α), malondialdehyde (MDA) level, and superoxide dismutase (SOD) activity were measured. Flap survivability was analysed at 7 days after surgery. Flap survival area was significantly larger in group III than in group II. Cytokine release level was also significantly lower in group III. Neutrophil infiltration grade, MDA level, and SOD activity slightly decreased in Group III; however, the changes were not statistically significant. These results imply that GV 1001 exerts a protective effect against IRI through antioxidant effects, reducing reactive oxygen species, and suppressing the inflammatory cascade.

  20. Fournier?s gangrene - delayed pedicle flap based upon the anterior abdominal wall

    Directory of Open Access Journals (Sweden)

    Ania Sliwinski

    2014-06-01

    Full Text Available Introduction Fournier’s gangrene is a poly-microbial necrotizing fasciitis that involves the perineum and/or external genitalia. Urgent surgical debridement is well recognized as essential acute treatment yet unique challenges arise for plastic surgical reconstruction to obtain a complete functional recovery. This case describes a successful delayed pedicle flap repair based upon the anterior abdominal wall. Case description A 24 year old man was admitted to ICU ten days after elective circumcision with Fournier’s gangrene. He underwent a number of surgical debridements, and was referred for plastic surgical management. He had penile reconstruction using a random pattern abdominal flap, which was performed as a three stage procedure including flap vascular delay technique. Discussion Perineal and penile skin loss can be significant and is difficult to repair. Various techniques have been used to reconstruct lost tissue: skin grafts, transposition of the testes and spermatic cords to the thigh, flaps, and other types of pediculated myocutaneous flaps. Muscle flap reconstruction provides an environment that allows for complete regeneration of the urethral epithelium but is bulky and unsightly. Skin grafts contract and may produce painful and dysfunctional reconstructions. This novel technique produces a functional, and aesthetic reconstruction. Conclusion Penile skin recovery following Fournier’s gangrene recovery is problematic. This case demonstrates the functionality of a delayed flap repair using the anterior abdominal wall.

  1. An analysis of free flap failure using the ACS NSQIP database. Does flap site and flap type matter?

    Science.gov (United States)

    Kwok, Alvin C; Agarwal, Jayant P

    2017-09-01

    We sought to use the NSQIP database to determine the national rate and predictors of free flap failure based upon flap sites and flap types. Free flaps were identified using the 2005-2010 NSQIP database. We examined overall flap failure rates as well as failure rates based upon flap sites (head and neck, extremities, trunk, and breast) and flap types (muscle, fascial, skin, bone, and bowel flaps). Univariate and multivariate analyses were used to determine predictors of flap failure. There were 1,187 microvascular free tissue transfers identified. The overall flap failure rate was 5.1%. Head and neck flaps had the highest rate of free flap failure at 7.7%. Prolonged operative time is an independent predictor of flap failure for all free flaps (OR: 2.383, P = 0.0013). When examining predictors of failure by flap site, free flaps to the breast with prolonged operative time are independently associated with flap failure (OR: 2.288, P = 0.0152). When examining predictors of flap failure by flap type, muscle based free flaps with an ASA classification ≥3 are associated with flap failure (P = 0.0441). Risk factors for free flap failure differ based upon flap site and flap type. Prolonged operative time is an independent risk factor for the failure of free flaps used for breast reconstruction. An ASA classification ≥3 is associated with the failure of free muscle based flaps. Our findings identify actionable areas that may help to improve free flap success. © 2016 Wiley Periodicals, Inc.

  2. Monitoring of Myocutaneous Flaps by Measuring Capillary Glucose and Lactate Levels: Experimental Study.

    Science.gov (United States)

    Guillier, David; Moris, Vivien; Cristofari, Sarra; Gerenton, Brice; Hallier, Anna; Rizzi, Philippe; Henault, Benoit; Zwetyenga, Narcisse

    2018-04-01

    In surgery, certain defects require reconstruction with a microsurgical flap. The free flap failure rate varies between 2% and 5%. Vascular thrombosis is the most frequent complication and represents 15% to 73% of failures. The success rate of salvage therapy is greater when salvage surgery is early. Currently, clinical monitoring is the criterion standard but many noninvasive or minimally invasive techniques have been developed to improve early diagnosis of complications of vascular thrombosis. The aim of our experimental study was to compare clinical assessments with measurements of capillary glycemia and lactatemia during the monitoring of free flaps. Myocutaneous latissimus dorsi flaps with skin paddles were created in pigs under general anesthesia. For each animal, 2 flaps were created (right and left) using the same technique. Four groups were made: group 1 (no flap ligation: control group), group 2 (flap with permanent ligation of the artery), group 3 (flap with permanent ligation of the two veins), group 4 (flap with transient ligation of the artery and 2 veins for 1 hour). The postoperative monitoring protocol consisted of monitoring the clinical, biological (glucose and lactate), and histological parameters. Eight animals were operated on and sixteen flaps were created. Each flap was clinically and biologically tested 25 times. Clinical, biological, and histological monitoring showed significant variations between the groups. The analysis of variance of capillary glycemia and lactatemia showed statistically significant difference between control group and group 2 (P < 0,0001), group 3 (P < 0,0001), or group 4 (P < 0,0001). There were no histological abnormalities after transient ligature at different times contrary to permanent ligature. Measuring capillary levels of lactate and glucose associated with clinical monitoring may shorten the time to diagnosis of flap failure. Ultimately, this will save lives and achieve better functional and aesthetic results.

  3. Subciliary skin-muscle flap approach in patients with orbital fractures

    Directory of Open Access Journals (Sweden)

    Seyed Esmail Hassanpour

    2008-06-01

    Full Text Available Background: Selection of a suitable incision for orbital floor and medial wall fractures is one of the challenging problems in plastic surgery. The most frequently used is the subciliary step skin muscle incision with advantages including: adequate exposure and acceptable cosmetic result and disadvantages such as ectropion and skin necrosis.In this article we have tried to determine the rate of complications of this incision in a series of patients with orbital trauma that have been operated by the authors in 15khordad hospital during a three years period  (September 2000-september 2003.Methods: This retrospective review includes 52consecuative cases of orbital trauma (61 eye referred to our center who have been operated by authors. Step skin-muscle incision approach was used for reduction and fixation of orbital rim and floor fractures .These patients have been evaluated according to causes of fractures, kind and number of incisions, hospital stay, and complications of step skin-muscle incision. The mean duration of postoperative follow-up was two years.Results: Among the 52 patients reviewed, there were 48 males and 4 females; their mean age was 29 years (range: 15-67 years. Injuries were on the left side in 25 (49% patients, on the right side in 18(35% patients and both sides in 9 (16% patients. The main cause of trauma was car accident (50%. Six patients had scleral show 1-2 mm, five of them were managed by non

  4. The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Mark A. Lee, MBBS, FRACS

    2014-05-01

    Conclusions: Breast reconstruction using the scarless latissimus dorsi flap is time effective, requires no patient repositioning, and uses standard breast instrumentation. It is safe and versatile while reducing the risk of exposed prosthesis if native skin necrosis occurs. It is a vascularized alternative to acellular dermal matrices.

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

    International Nuclear Information System (INIS)

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

    2015-01-01

    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. 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.

  7. 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.

  8. Evaluation of laser treatment response of vascular skin disorders in relation to skin properties using multi-spectral imaging

    Science.gov (United States)

    de Roode, Rowland; Noordmans, Herke Jan; Rem, Alex; Couwenberg, Sharon; Verdaasdonk, Rudolf

    2008-02-01

    There can be a large variation in response between laser treatments of vascular malformations like port-wine stains even in one patient. This could be ascribed to variations in the skin properties like tint (melanin) and perfusion (redness) which will influence the effectiveness of the laser dosimetry. To obtain a better understanding of the relation between skin properties just before treatment, laser dosimetry and clinical response, a multi-spectral dermatoscope is applied. A sequence of calibrated images is captured from 400 to 720 nm. Images at the treatment laser wavelength (532 nm) show the absorbing structures during laser exposure. Images of different treatment sessions of one patient were matched with dedicated registration software to quantify the results of the laser treatment (change in blood vessels structure, effect on pigment). For feasibility, images were collected from 5 patients and used to determine the optimal wavelength combination strategies. The image matching software gives an objective impression of the improvement, e.g. the clearing of the port-wine stain over time or pigment reactions, which will facilitate the discussion with the patient about the end point of treatment. The multi-spectral dermatoscope and software developed enables the evaluation of large patient series which will result in objective data to advise the dermatologist on the optimal laser dosimetry in future in relation to the skin properties.

  9. [Three-dimensional gait analysis of patients with osteonecrosis of femoral head before and after treatments with vascularized greater trochanter bone flap].

    Science.gov (United States)

    Cui, Daping; Zhao, Dewei

    2011-03-01

    To provide the objective basis for the evaluation of the operative results of vascularized greater trochanter bone flap in treating osteonecrosis of the femoral head (ONFH) by three-dimensional gait analysis. Between March 2006 and March 2007, 35 patients with ONFH were treated with vascularized greater trochanter bone flap, and gait analysis was made by using three-dimensional gait analysis system before operation and at 1, 2 years after operation. There were 23 males and 12 females, aged 21-52 years (mean, 35.2 years), including 8 cases of steroid-induced, 7 cases of traumatic, 6 cases of alcoholic, and 14 cases of idiopathic ONFH. The left side was involved in 15 cases, and right side in 20 cases. According to Association Research Circulation Osseous (ARCO) classification, all patients were diagnosed as having femoral-head necrosis at stage III. Preoperative Harris hip functional score (HHS) was 56.2 +/- 5.6. The disease duration was 1.5-18.6 years (mean, 5.2 years). All incisions healed at stage I without early postoperative complications of deep vein thrombosis and infections of incision. Thirty-five patients were followed up 2-3 years with an average of 2.5 years. At 2 years after operation, the HHS score was 85.8 +/- 4.1, showing significant difference when compared with the preoperative score (t = 23.200, P = 0.000). Before operation, patients showed a hip muscles gait, short gait, reduce pain gait, and the pathological gaits significantly improved at 1 year after operation. At 1 year and 2 years after operation, step frequency, pace, step length and hip flexion, hip extension, knee flexion, ankle flexion were significantly improved (P petronas wave appeared at swing phase; the preoperative situation was three normal phase waves. These results suggest that three-dimensional gait analysis before and after vascularized greater trochanter for ONFH can evaluate precisely hip vitodynamics variation.

  10. 45Ca distribution and transport in saponin skinned vascular smooth muscle

    International Nuclear Information System (INIS)

    Stout, M.A.; Diecke, F.P.

    1983-01-01

    45 Ca distribution and transport were studied in chemically skinned strips of caudal artery from Kyoto Wistar rats. Sarcolemmal membranes were made hyperpermeable by exposure for 60 min to solutions containing 0.1 mg/ml of saponin. Skinned helical strips responded with graded contractions to changes in ethylene glycol bis-(beta-aminoethyl ether)-N,N'-tetraacetic acid buffered free Ca solutions (10(-7) to 10(-5) M) and were sensitive to the Mg-ATP concentration. Tissues loaded in the presence of 10(-7) M Ca contracted in response to 10 mM caffeine. These experiments indicate the strips are skinned and possess a functional regulatory and contractile system and an intact Ca sequestering system. 45 Ca distributes in three compartments in skinned caudal artery strips. The Ca contents of two components are linear functions of the Ca-ethylene glycol bis-(beta-aminoethyl ether)-N,N'-tetraacetic acid concentration and desaturate at rapid rates. They correspond to the extracellular and cytoplasmic spaces. A significantly smaller component releases Ca at comparatively slower rates. 45 Ca uptake by the slow component consists of an ATP-dependent and an ATP-independent fraction. The 45 Ca content of the ATP-dependent fraction is a function of the free Ca concentration and is independent of the Ca-ethylene glycol bis-(beta-aminoethyl ether)-N,N'-tetraacetic acid concentration. Its content was enhanced by oxalate and was abolished by Triton X-100 skinning solutions. The ATP-independent component was not affected by Triton X-100 skinning and may represent Ca binding to cytoplasmic molecules and structures. The sequestered Ca was released with caffeine or Ca but not by epinephrine. The observations indicate that the sarcoplasmic reticulum and mitochondria of vascular smooth muscle strips skinned with saponin retain their functional integrity after saponin skinning

  11. The saphenous neurovascular free flap.

    Science.gov (United States)

    Acland, R D; Schusterman, M; Godina, M; Eder, E; Taylor, G I; Carlisle, I

    1981-06-01

    A new neurovascular free-flap donor area on the medial side of the knee is described. The flap is supplied by the saphenous artery, a branch of the descending genicular artery. It is drained both by the long saphenous vein and by the saphenous venae comitantes. Its nerve supply is from the medial femoral cutaneous nerve above the knee and the saphenous nerve below the knee. The flap is thin, has a long vascular pedicle (up to 15 cm) and a dependable nerve supply, and can be made quite large. The principal disadvantage is the donor wound, which requires grafting in most cases. We describe the anatomy of the saphenous flap, the method of raising it, and our early clinical experience with it both as a free flap and as a pedicled flap. Potential uses of the saphenous flap and its broader significance in relation to flaps on the lower extremity are briefly discussed.

  12. Recovery of sensation in immediate breast reconstruction with latissimus dorsi myocutaneous flaps after breast-conservative surgery and skin-sparing mastectomy.

    Science.gov (United States)

    Tomita, Koichi; Yano, Kenji; Hosokawa, Ko

    2011-04-01

    In breast reconstruction, sensation in the reconstructed breasts affects the patients' quality of life along with its aesthetic outcome. Fortunately, less invasive procedures such as breast-conservative surgery (BCS) and skin-sparing mastectomy (SSM) have greatly contributed to the improved aesthetic outcome in immediate breast reconstruction. However, there are few reports on the recovery of breast sensation after BCS and SSM. We retrospectively reviewed 104 consecutive patients who underwent immediate breast reconstruction with the latissimus dorsi myocutaneous flap between 2001 and 2006 at our institution. The sensations of pain, temperature, touch, and vibration were examined at the nipple and skin envelope during the follow-up period (range: 12-61 months, mean: 31 months), and a stratified analysis was performed to determine the critical factors affecting the sensation recovery after BCS and SSM. We found that large breast size significantly impaired the recovery of sensation in the nipple and skin envelope after BCS as well as SSM. Older age and high body mass index value were the factors which negatively affected the sensation in the skin envelope after SSM. While all our BCS patients underwent postoperative radiation therapy, it did not negatively affect the recovery of sensation in SSM patients. On the basis of these findings, we could further improve the sensation of the reconstructed breasts after BCS and SSM. Especially after SSM, the use of innervated flaps is recommended in the patients with large breast, increased age, or obesity when the nipple-areola complex is resected.

  13. Repair of deep tissue defects in the posterior talocrural region using a superficial temporal fascia free flap plus thin split-skin grafting in extensively burned patients: A retrospective case series.

    Science.gov (United States)

    Yang, Xuekang; Zhao, Hui; Liu, Mengdong; Zhang, Yue; Chen, Qiaohua; Li, Zhiqiang; Han, Juntao; Hu, Dahai

    2018-01-01

    The aim of this study was to describe the scheme, surgical procedures, and clinical outcomes for the early repair of deep wounds of the posterior talocrural region in extensively burned patients with a method combining a superficial temporal fascia free flap with thin split-skin grafting.From January 2013 to February 2016, 9 extensively burned patients with deep tissue defects of the posterior talocrural region were treated in our department (2 patients had bilateral deep tissue defects of the posterior talocrural region). All 11 wounds were repaired using a superficial temporal fascia free flap and thin split-skin grafting. After the operation, survival of the fascia flaps and grafted skin was observed, and the appearance and functional recovery of the grafts were evaluated. Follow-up information was reviewed, and complications were documented.All 11 fascia flaps survived completely. Two cases of partial skin necrosis healed after the second application of skin grafts. The appearance and function of recipient sites were well restored in all patients over a follow-up period of 5 to 14 months.Deep tissue defects of the posterior talocrural region can be effectively repaired with our method combining a superficial temporal fascia free flap with thin split-skin grafting. This method offers the advantages of a good appearance, strong resistance to infection, minimal damage at the donor site, short course of disease, and good prognosis. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  14. [COMPARISON OF REPAIR EFFECT BETWEEN CHIMERIC ANTEROLATERAL THIGH FLAP AND SERIES-WOUND FLAPS FOR DEFECT AFTER RESECTION OF ORAL AND MAXILLOFACIAL CANCER].

    Science.gov (United States)

    Yang, Heping; Zhang, Hongwu; Chen, Haidi; Yang, Shuxiong; Wang, Jun; Hu, Dawang

    2016-04-01

    To compare the effectiveness of complex defects repair between using chimeric anterolateral thigh flap and series-wound flaps after resection of oral and maxillofacial cancer. After resection of oral and maxillofacial cancer, defect was repaired with chimeric anterolateral thigh flap in 39 patients between January 2011 and July 2014 (chimeric anterolateral thigh flap group); and defect was repaired with series-wound flaps in 35 patients between January 2009 and December 2010 (series-wound flaps group). There was no significant difference in gender, age, duration of disease, tumor type, tumor staging, defect location, and defect area between 2 groups (P > 0.05). The operation time, flap harvesting and microvascular anastomosis time, stomach tube extraction time, and oral feeding time were recorded and compared between 2 groups, and postoperative complications were observed; the effectiveness was evaluated according to clinical efficacy evaluation table of bone and soft tissue defects reconstruction surgery in oral and maxillofacial region. Vascular crisis occurred in 2 cases of chimeric anterolateral thigh flap group, and 4 cases of series-wound flaps group. Partial necrosis appeared at distal end of a series-wound flaps, and oral fistula and infection developed in 3 series-wound flaps. The other flaps and the grafted skin at donor site survived; wounds at recipient site healed by first intention. The operation time, stomach tube extraction time, and oral feeding time of chimeric anterolateral thigh flap group were significantly shorter than those of series-wound flaps group (P oral closure function, chew, language performance, and swallowing scores of the chimeric anterolateral thigh-flap group were significantly better than those of the series-wound flaps group (P oral cavity holding water test, and occlusion scores between the 2 groups (P > 0.05). Using chimeric anterolateral thigh flap for defect repair after resection of oral and maxillofacial cancer can

  15. Temporal-based pericranial flaps for orbitofrontal Dural repair: A technical note and Review of the literature

    Directory of Open Access Journals (Sweden)

    Esther Dupépé

    2016-03-01

    Conclusions: A temporal-based pericranial flap represents an alternative vascularized pedicle flap to the classic frontal-based pericranial flap used in orbitofrontal dural repair. In certain clinical settings, the temporal-based flap may be preferable.

  16. A modified free chimeric osteocutaneous fibular flap design for head and neck reconstruction: experience on a series of 10 cases.

    Science.gov (United States)

    Roan, Tyng-Luen; Chen, Chien-Chang; Yu, Yen-Chen; Hsieh, Jung-Hsien; Horng, Shyue-Yih; Tai, Hao-Chih; Cheng, Nai-Chen; Chien, Hsiung-Fei; Tang, Yueh-Bih

    2013-09-01

    We have previously described a modified chimeric fibular osteocutaneous flap design based on a combination of a traditional fibular flap and a peroneal artery perforator fasciocutaneous flap for mandible and adjacent soft tissue reconstruction. The purpose of this article is to share our experience with a larger case series utilizing this new technique for mandible and adjacent soft tissue reconstruction after cancer wide excision surgery and a more detailed description on these flaps harvesting procedures. Ten patients (age range from 32 to 63 years), who had segmental defect of mandible and adjacent soft tissue defect after cancer wide excision surgery, received mandible and adjacent soft tissue reconstruction based on the modified chimeric fibular flap design. The skin paddle based on peroneal perforators ranged from 9 cm × 3.5 cm to 10 cm × 10 cm and the mean pedicle length was 8.9 cm. Four patients underwent primary closure of the donor site. Three flap salvage procedures were performed due to vascular thrombosis and all flaps survived well. Nine patients had acceptable outer appearance, and one patient complained of cheek sunken. All patients had at least 3-cm interincisor distance during a mean of 12-month follow-up period. The modified chimeric osteocutaneous fibula flaps were feasible design with few intermuscular septum problems during bone fixation. Furthermore, it provided larger skin paddles with few restrictions to reconstruct the cheek skin defect. Copyright © 2013 Wiley Periodicals, Inc.

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

    Science.gov (United States)

    Yetişir, Fahri; Sarer, A Ebru; Acar, Hasan Zafer; Yazıcıoglu, Omer; Basaran, Basar

    2015-01-01

    We show the management of a delayed jejunal perforation, after irreducible femoral hernia operation with the help of negative pressure therapy (NPT) and delayed abdominal closure (DAC) with skin flap approximation in an elderly woman for the first time in the literature. A 76 year-old woman was admitted to the emergency department with irreducible femoral hernia and ileus. After examining the femoral hernia sac and noting the presence of viable intestine within the hernia sac, a femoral hernia repair with mesh was performed. At postoperative day 1 she started to defecate and oral intake was started. The patient was discharged on postoperative day 3. On postoperative day 8, she was re-admitted to the emergency department with septic shock. The patient underwent reoperation. Septic abdomen and delayed perforation from strangulated part of the jejunum were seen. A jejunostomy was opened and patient was treated with open abdomen management and delayed abdominal closure with skin flap. The ostomy was closed 4 months later. The exact mechanism of delayed presentation of small bowel perforation remains controversial. Delayed intestinal perforation has rarely been reported after blunt abdominal trauma (BAT), conductive burn injuries of the bowel with cautery, or necrosis of strangulated bowel in a hernia sac. Open abdomen (OA) management is a life-saving and challenging strategy in severe generalized peritonitis. 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. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. A Surgical Approach to the Harvest of the Vascularized Submandibular and Submental Lymph Node Flap: The "Through-the-Gland" Dissection Technique.

    Science.gov (United States)

    Nonomura, Hideaki; Tan, Bien-Keem; Tan, Pearlie W W; Goh, Terence

    2018-04-01

    Extremity lymphedema is a pathological condition resulting from absence of lymph nodes and disease of lymphatic vessels, often due to oncologic clearance of lymph nodes. In recent years, vascularized lymph node transfer has become a rapidly emerging method of lymphatic reconstruction shown to lead to lymphatic regeneration. In particular, lymphatic flaps based on the submental artery have shown good results with its favorable donor site and available nodes. The lymph nodes here are in close relation to the submandibular gland and require careful dissection around and through the gland for safe harvest. We studied this region of the neck and describe the blood supply to the lymph nodes, their variable positions in relation to the gland, and our technique of dissecting through the submandibular gland while keeping the lymph nodes' hilar blood supply intact. We dissected 2 cadaver heads (4 sides of the neck) to study the submandibular and submental lymph nodes, where to locate them in relation to the submandibular gland and how best to dissect through the submandibular gland for access while keeping the hilar supply intact. We applied this knowledge in 6 clinical cases and provide a brief description of our "through-the-gland" dissection technique. The submandibular lymph nodes may lie (1) superficial and posterior to the gland, (2) between the superficial and deep parts of the submandibular gland, or (3) anteriorly and submental. They are classified as superficial, deep, and submental, respectively. The through-the-gland dissection technique gave the surgeon improved access and exposure to the lymph nodes. It also facilitated safer dissection because their hilar blood supply is well visualized. The through-the-gland technique of harvesting vascularized submandibular lymph node flaps is a safe technique that allows the surgeon to clearly identify and preserve blood supply of lymph nodes.

  19. New Possible Surgical Approaches for the Submammary Adipofascial Flap Based on Its Arterial Supply

    Directory of Open Access Journals (Sweden)

    Ehab M. Elzawawy

    2016-01-01

    Full Text Available Introduction. Submammary adipofascial flap (SMAF is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction of partial mastectomy defects. It is also used to cover breast implants. Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The aim of the work was to identify perforator vessels supplying SMAF and define their origin, site, diameter, and length. Materials and Methods. The flap was designed and dissected on both sides in 10 female cadavers. SMAF outline was 10 cm in length and 7 cm in width. The flap was raised carefully from below upwards to identify the perforator vessels supplying it from all directions. These vessels were counted and the following measurements were taken using Vernier caliper: diameter, total length, length inside the flap, and distance below the submammary skin crease. Conclusions. The perforators at the lateral part of the flap took origin from the lateral thoracic, thoracodorsal, and intercostal vessels. They were significantly larger, longer, and of multiple origins than those on the medial part of the flap and this suggests that laterally based flaps will have better blood supply, better viability, and more promising prognosis. Both approaches, medially based and laterally based SMAF, carry a better prognosis and lesser chance for future fat necrosis than the classical cranially based flap.

  20. MicroCT angiography detects vascular formation and regression in skin wound healing

    Science.gov (United States)

    Urao, Norifumi; Okonkwo, Uzoagu A.; Fang, Milie M.; Zhuang, Zhen W.; Koh, Timothy J.; DiPietro, Luisa A.

    2016-01-01

    Properly regulated angiogenesis and arteriogenesis are essential for effective wound healing. Tissue injury induces robust new vessel formation and subsequent vessel maturation, which involves vessel regression and remodeling. Although formation of functional vasculature is essential for healing, alterations in vascular structure over the time course of skin wound healing are not well understood. Here, using high-resolution ex vivo X-ray micro-computed tomography (microCT), we describe the vascular network during healing of skin excisional wounds with highly detailed three-dimensional (3D) reconstructed images and associated quantitative analysis. We found that relative vessel volume, surface area and branching number are significantly decreased in wounds from day 7 to day 14 and 21. Segmentation and skeletonization analysis of selected branches from high-resolution images as small as 2.5 μm voxel size show that branching orders are decreased in the wound vessels during healing. In histological analysis, we found that the contrast agent fills mainly arterioles, but not small capillaries nor large veins. In summary, high-resolution microCT revealed dynamic alterations of vessel structures during wound healing. This technique may be useful as a key tool in the study of the formation and regression of wound vessels. PMID:27009591

  1. 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...... experience using freestyle facial perforator flaps, we have located areas where perforators are consistently found. This study is focused on a particular perforator lateral to the angle of the mouth; the modiolus and the versatile modiolus perforator flap. METHODS: A cohort case series of 14 modiolus...... perforator flap reconstructions in 14 patients and a color Doppler ultrasonography localization of the modiolus perforator in 10 volunteers. RESULTS: All 14 flaps were successfully used to reconstruct the defects involved, and the location of the perforator was at the level of the modiolus as predicted...

  2. Clear Cell Adenocarcinoma Arising from Endometriosis in the Groin: Wide Resection and Reconstruction with a Fascia Lata Tensor Muscle Skin Flap

    Directory of Open Access Journals (Sweden)

    Shozo Yoshida

    2018-01-01

    Full Text Available We herein report a case of clear cell carcinoma arising from endometriosis in the groin in a 53-year-old woman. The findings of MRI and FDG/PET-CT indicated a malignant tumor, and surgical biopsy confirmed adenocarcinoma of the female genital tract. The tumor including a part of the abdominal rectus muscle and rectus sheath, subcutaneous fat, skin, and the right inguinal ligament was resected en bloc. The defect in the abdominal wall was reconstructed with a fascia lata tensor muscle skin flap. The tumor was composed of clear cell adenocarcinoma arising from extrapelvic endometriosis. The patient received chemotherapy with gemcitabine and carboplatin for 6 cycles and had no evidence of recurrence 7 months after the treatment. We herein described the diagnosis and surgical management of endometriosis-associated carcinoma in the groin.

  3. Perforator anatomy of the radial forearm free flap versus the ulnar forearm free flap for head and neck reconstruction.

    Science.gov (United States)

    Hekner, D D; Roeling, T A P; Van Cann, E M

    2016-08-01

    The aim of this study was to investigate the vascular anatomy of the distal forearm in order to optimize the choice between the radial forearm free flap and the ulnar forearm free flap and to select the best site to harvest the flap. The radial and ulnar arteries of seven fresh cadavers were injected with epoxy resin (Araldite) and the perforating arteries were dissected. The number of clinically relevant perforators from the radial and ulnar arteries was not significantly different in the distal forearm. Most perforators were located in the proximal half of the distal one third, making this part probably the safest location for flap harvest. Close to the wrist, i.e. most distally, there were more perforators on the ulnar side than on the radial side. The ulnar artery stained 77% of the skin surface area of the forearm, showing the ulnar forearm free flap to be more suitable than the radial forearm free flap for the restoration of large defects. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. Hyperspectral Imaging Provides Early Prediction of Random Axial Flap Necrosis in a Preclinical Model.

    Science.gov (United States)

    Chin, Michael S; Chappell, Ava G; Giatsidis, Giorgio; Perry, Dylan J; Lujan-Hernandez, Jorge; Haddad, Anthony; Matsumine, Hajime; Orgill, Dennis P; Lalikos, Janice F

    2017-06-01

    Necrosis remains a significant complication in cutaneous flap procedures. Monitoring, and ideally prediction, of vascular compromise in the early postoperative period may allow surgeons to limit the impact of complications by prompt intervention. Hyperspectral imaging could be a reliable, effective, and noninvasive method for predicting flap survival postoperatively. In this preclinical study, the authors demonstrate that hyperspectral imaging is able to correlate early skin perfusion changes and ultimate flap survival in a preclinical model. Thirty-one hairless, immunocompetent, adult male mice were used. Random pattern dorsal skin flaps were elevated and sutured back into place with a silicone barrier. Hyperspectral imaging and digital images were obtained 30 minutes, 24 hours, or 72 hours after flap elevation and before sacrifice on postoperative day 7. Areas of high deoxygenated hemoglobin change (124; 95 percent CI, 118 to 129) seen at 30 minutes after surgery were associated with greater than 50 percent flap necrosis at postoperative day 7. Areas demarcated by high deoxygenated hemoglobin at 30 minutes postoperatively had a statistically significant correlation with areas of macroscopic necrosis on postoperative day 7. Analysis of images obtained at 24 and 72 hours did not show similar changes. These findings suggest that early changes in deoxygenated hemoglobin seen with hyperspectral imaging may predict the region and extent of flap necrosis. Further clinical studies are needed to determine whether hyperspectral imaging is applicable to the clinical setting.

  5. Scabies in a bilateral hand allograft recipient: An additional mimicker of acute skin rejection in vascularized composite allotransplantation.

    Science.gov (United States)

    Kanitakis, Jean; Morelon, Emmanuel

    2017-06-01

    Vascularized composite tissue allografts include skin, which frequently undergoes, in the early post-graft period, acute rejections. The diagnosis of acute rejection may be difficult as it can be mimicked by several dermatoses. We present a bilateral hand allograft recipient who developed, 16.5 years post-graft, cutaneous lesions raising suspicion about rejection. Physical examination and skin biopsy were diagnostic of scabies. This ectoparasitosis should be added in the list of dermatoses that can mimic allograft rejection in vascular composite allografts. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. 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. Copyright © 2010 Wiley-Liss, Inc.

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

    Directory of Open Access Journals (Sweden)

    Babu Bajantri

    2013-01-01

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

  8. Evaluation of an isotope washout technique to measure skin vascular resistance and skin perfusion pressure: influence of age, site and arterial surgery

    International Nuclear Information System (INIS)

    Duncan, H.J.; Faris, I.B.

    1986-01-01

    1. A simplified isotope (sup(99m)Tc) washout technique has been devised to calculate the skin perfusion pressure (SPP) and skin vascular resistance (SVR). This test is simple, requires inexpensive equipment and is well tolerated by patients. 2. SPP and SVR were calculated in 20 patients 30 years of age and in 15 patients with peripheral vascular disease (PVD). With increasing age the SPP and SVP were increased. The SPP was similar to the mean arterial pressure in normal individuals but was decreased in patients with PVD. The SPP is a useful indicator of the severity of the PVD. 3. The SPP and SVR were higher in the calf than in the foot. This is probably related to the decrease in pressure in the distal arterial tree. 4. SPP was increased by 110% and skin blood flow by 190% by arterial reconstructive surgery. This test may be of use in assessing the effectiveness of arterial surgery. (author)

  9. Cosmetic reconstruction of a nasal plane and rostral nasal skin defect using a modified nasal rotation flap in a dog

    NARCIS (Netherlands)

    ter Haar, G.; Buiks, S.C.; Kirpensteijn, J.

    2013-01-01

    Abstract OBJECTIVE: To report reconstruction of a defect of the nasal plane and the rostral dorsum of the nose in a dog using a nasal rotation flap with Burow's triangles. STUDY DESIGN: Clinical report. ANIMALS: Mixed-breed dog (1.5 years, 8.6 kg). METHODS: A nasal defect caused by chronic

  10. [Preventing lower limb amputations in patients suffering from diabetic foot syndrome and peripheral vascular disease - opportunities and limitations].

    Science.gov (United States)

    Schirmer, S; Ritter, R G; Rice, A; Frerichs, O; Wehage, I C; Fansa, H

    2011-12-01

    The number of patients suffering from a diabetic foot syndrome is increasing. In many cases large plantar or heel defects can only be reconstructed by using a free flap. The free parascapular flap is an alternative to free muscle flaps in the reconstruction of plantar or heel defects. Donor site morbidity is low. Autologous bypass reconstruction or an angioplasty can increase extremity perfusion. PATIENTS AND OPERATIONS: 52 patients with a diabetic foot syndrome have been reconstructed since 2007. 23 of them required a free tissue transfer. On average these patients were 68.7 years of age. A parascapular flap was used in 15 cases, a latissimus dorsi flap with a skin graft in 4 cases, a gracilis muscle flap with a skin graft in 3 cases. In one case a free instep flap of the contralateral foot, which had to be amputated, was used. In 13 cases the flap was anastomosed to the autologous bypass, in one case an AV loop was used. 22 flaps healed primarily. Only 1 patient was not able to walk at discharge. There was one flap loss. 4 patients required an amputation later on due to bypass failure or infection. 2 patients died due to cardiac arrest at the rehabilitation clinic. If the correct indication is met, free flaps can prevent diabetes-derived amputations of the lower limb. The parascapular flap can be used for plantar and heel defects. Flap harvesting is quick due to the constant vascular anatomy. The donor site morbidity is low. Reconstruction requires revascularisation in an interdisciplinary setting including vascular surgeons and radiologists. Limb salvage reduces mortality and improves quality of life. Revascularisation and reconstruction should best be done in a single surgical procedure. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Surgical Repair of Mid-shaft Hypospadias Using a Transverse Preputial Island Flap and Pedicled Dartos Flap Around Urethral Orifice.

    Science.gov (United States)

    Liang, Weiqiang; Ji, Chenyang; Chen, Yuhong; Zhang, Ganling; Zhang, Jiaqi; Yao, Yuanyuan; Zhang, Jinming

    2016-08-01

    To evaluate the effects, particularly the incidence of anastomotic fistula, of a pedicled dartos flap around the urethral orifice in the treatment of urethroplasty of mid-shaft hypospadias. A total of 46 cases of congenital mid-shaft hypospadias were included in this study. The patients ranged in age from 0.7 to 25.4 years and the average was 5.8 years. The patients received penis chordee correction. A transverse preputial island flap was developed for urethral reconstruction. The proximal dartos of the urethral orifice was used to develop a pedicled dartos flap, which was transposed to cover and strengthen neourethral anastomosis. The ventral penile skin defect was repaired by another flap. The 46 patients were examined during follow-up visits for 6 months to 3 years. An anastomotic fistula was observed in one case (2.2 %). Scar healing without fistula was observed in another patient due to poor blood supply to part of the ventral penile skin. No other incidences of fistula, urethral rupture, flap necrosis, wound infections, urinary tract (meatal) stenosis, or urethral diverticulum were observed in the patients. A pedicled dartos flap around the urethral orifice can take advantage of well-vascularized local tissue to add a protective layer to the proximal aspect of the neourethral anastomosis for reducing the incidence of anastomotic fistula in mid-shaft hypospadias repair using a transverse preputial island flap. 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 .

  12. The anatomic basis for a trapezius muscle flap in dogs.

    Science.gov (United States)

    Philibert, D; Fowler, J D; Clapson, J B

    1992-01-01

    The anatomy of the cervical part of the trapezius muscle and its dominant vascular supply, the prescapular branch of the superficial cervical artery, was studied by dissection and selective angiography of 16 canine cadavers. The prescapular branch of the superficial cervical artery supplies blood to the skin of the caudal half of the neck and the cervical part of the trapezius muscle and is a minor contributor to other muscles of the neck. In these dogs, the mean length of the vascular pedicles was 4.4 cm and the mean diameter was 1.0 mm. With this information, it is possible to design a broad musculocutaneous flap suitable for reconstructive microsurgery in dogs. The potential for successful incorporation of the scapular spine in such a flap remains uncertain.

  13. Fibrin glue instillation under skin flaps to prevent seroma-related morbidity following breast and axillary surgery.

    Science.gov (United States)

    Sajid, Muhammad S; Hutson, Kristian H; Rapisarda, Ignazio F; Bonomi, Riccardo

    2013-05-31

    Fibrin glue (FG) combines fibrinogen and thrombin, under the presence of factor XIII and calcium chloride, and produces a 'fibrin clot' as would occur through the natural clotting cascade. FG is thought to close over any small vessels including lymphatics that are too small for conventional surgical closure, thereby reducing seroma formation, seroma incidence and related comorbidities. To assess the evidence on the effectiveness of FG in people undergoing breast and axillary surgery and to establish whether FG is an efficient modality to prevent postoperative seroma and seroma-related outcomes. We searched the Cochrane Breast Cancer Group's (CBCG) Specialised Register (9 December 2011), the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1 2012), MEDLINE (9 December 2011), EMBASE (9 December 2011), LILACS (22 October 2012), SCI-E (22 October 2012), the World Health Organization's International Clinical Trial Registry (9 December 2011) and ClinicalTrials.gov (22 October 2012). Randomised controlled trials (RCTs) comparing the effectiveness of FG in terms of reducing the postoperative seroma incidence and related comorbidities in people undergoing breast and axillary surgery. At least two review authors independently scrutinised search results, selected eligible studies and extracted the data. The pooled analysis of the extracted data was achieved by the statistical analysis on Review Manager software. The quality of studies was assessed using The Cochrane Collaboration's 'Risk of bias' tool. The search of four standard electronic databases yielded 119 potentially relevant studies but only 18 RCTs involving 1252 people were found suitable for statistical analysis. There was significant heterogeneity among trials and the majority of trials were of poor quality. The use of FG under skin flaps following breast and axillary surgery failed to reduce the incidence of postoperative seroma (risk ratio (RR) 1.02; 95% Confidence Interval (CI) 0.90 to 1.16, P

  14. 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.

  15. 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

  16. THERAPY OF SKIN VASCULAR MALFORMATIONS USING COPPER VAPOR LASER AND PULSED DYE LASER

    Directory of Open Access Journals (Sweden)

    Svetlana V. Klyuchareva

    2018-01-01

    Full Text Available Aim. Comparison of effectiveness of the application of copper vapor laser (CVL and pulsed dye laser (PDL in clinical practice. Development of choice criteria of the more effective method of treatment.Materials and methods. The clinical data using CVL and PDL in the treatment of skin vascular malformations are presented. The treatment gave good results in removing of dysplastic skin vessels in 2 and 6 months. The treatment was not painful, and patients did not need general and local anesthesia. The results were presented concerning computer modeling of selective heating of vessels in tissue with CVL and PDL radiation. These results allowed to determine the depth of location and dimensions of vessels for selective and secure removing and the safe dosage ranges were found.Results. On the base of the calculated data, one could conclude that the mode of heating of dysplastic vessels with micropulse series of CVL is more safe and effective than the mode of powerful short pulses in the case of PDL.

  17. Tubed groin skin phalloplasty: a case report. | Abubakar | Nigerian ...

    African Journals Online (AJOL)

    mutilation, felonious assault or accidental trauma1. The use of tubed groin skin flap is a multistage procedure. It has the advantage of proximity to the pubic region. It finds its use in places with a deficiency of expertise in micro vascular techniques.

  18. Prelaminated extended temporoparietal fascia flap without tissue expansion for hemifacial reconstruction.

    Science.gov (United States)

    Altındaş, Muzaffer; Arslan, Hakan; Bingöl, Uğur Anıl; Demiröz, Anıl

    2017-10-01

    Disfigurement of the face caused by postburn scars, resected congenital nevi and vascular malformations has both functional and psychological consequences. Ideal reconstruction of the facial components requires producing not only function but also the better appearance of the face. The skin of the neck, supraclavicular or cervicothoracic regions are the most commonly used and the most likely source of skin for facial reconstruction in those techniques which prefabrications with tissue expansion are used. This retrospective cohort study describes the two staged prelaminated temporoparietal fascia flap which eliminates the usage of tissue expansion by using skin graft harvested from the neck and occipital region and the application of this flap for the lower three-fourths of the face. 5 patients received prelaminated temporoparietal fascia flap without tissue expansion for facial resurfacing. The mean age at surgery was 39, 2 years (range, 17-60 years). The average follow up was 21.6 months (range, 10-48 months). The size of the raised prelaminated temporoparietal fascia flaps ranged from 9 × 8 cm to 14 × 10 cm. All flaps survived after second stage. Varied degrees of venous congestion were observed after flap insets in all cases but none required any further treatment for the congestion. The entire lesion could not be resected due to the large size of the lesion in all patients. Two stage prelaminated temporoparietal fascia flap with skin graft is an effective technique for the reconstruction of partial facial defects in selected patients. It is simple, quick, safe and reliable, and requires no expansion of skin or no microsurgery. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  19. Revisit of Nasolabial Flap in the Reconstruction of Defects Involving ...

    African Journals Online (AJOL)

    with a free radial forearm flap; this adapts very well to the defects, preserves tongue mobility and remains soft and mobile ... free radial forearm flap techniques for oral floor reconstruction, the routine need for local and regional flaps has ..... The Arterial Anatomy of Skin Flap. New York: Churchill Livingstone; 1986. 14. Zhao Z ...

  20. Dorsal hand coverage with free serratus fascia flap

    DEFF Research Database (Denmark)

    Fotopoulos, Peter; Holmer, Per; Leicht, Pernille

    2003-01-01

    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....

  1. The freestyle pedicle perforator flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Jackson, Ian T; Westvik, Tormod S

    2015-01-01

    BACKGROUND: Perforating vessels are a consistent anatomical finding and well described in the current literature. Any skin flap can be raised on a subcutaneous pedicle as long as it contains at least one supplying perforator. Perforator flaps have been interlinked with microsurgery and generally...... not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso. METHODS: We retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle pedicled...... perforator flaps for moderate-sized defects of the truncus and extremities. We registered indications, flap size and localization, success rate, and complications. Most importantly, we describe a simple approach to the design of freestyle pedicled perforator flaps and elaborate on technical aspects...

  2. Internal Mammary Artery Perforator flap

    NARCIS (Netherlands)

    Schellekens, P.P.A.

    2012-01-01

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

  3. Optical spectroscopy of radiotherapy and photodynamic therapy responses in normal rat skin shows vascular breakdown products

    Science.gov (United States)

    Teles de Andrade, Cintia; Nogueira, Marcelo S.; Kanick, Stephen C.; Marra, Kayla; Gunn, Jason; Andreozzi, Jacqueline; Samkoe, Kimberley S.; Kurachi, Cristina; Pogue, Brian W.

    2016-03-01

    Photodynamic therapy (PDT) and radiotherapy are non-systemic cancer treatment options with different mechanisms of damage. So combining these techniques has been shown to have some synergy, and can mitigate their limitations such as low PDT light penetration or radiotherapy side effects. The present study monitored the induced tissue changes after PDT, radiotherapy, and a combination protocol in normal rat skin, using an optical spectroscopy system to track the observed biophysical changes. The Wistar rats were treated with one of the protocols: PDT followed by radiotherapy, PDT, radiotherapy and radiotherapy followed by PDT. Reflectance spectra were collected in order to observe the effects of these combined therapies, especially targeting vascular response. From the reflectance, information about oxygen saturation, met-hemoglobin and bilirubin concentration, blood volume fraction (BVF) and vessel radius were extracted from model fitting of the spectra. The rats were monitored for 24 hours after treatment. Results showed that there was no significant variation in the vessel size or BVF after the treatments. However, the PDT caused a significant increase in the met-hemoglobin and bilirubin concentrations, indicating an important blood breakdown. These results may provide an important clue on how the damage establishment takes place, helping to understand the effect of the combination of those techniques in order to verify the existence of a known synergistic effect.

  4. Single-stage reconstruction of flexor tendons with vascularized tendon transfers.

    Science.gov (United States)

    Cavadas, P C; Pérez-García, A; Thione, A; Lorca-García, C

    2015-03-01

    The reconstruction of finger flexor tendons with vascularized flexor digitorum superficialis (FDS) tendon grafts (flaps) based on the ulnar vessels as a single stage is not a popular technique. We reviewed 40 flexor tendon reconstructions (four flexor pollicis longus and 36 finger flexors) with vascularized FDS tendon grafts in 38 consecutive patients. The donor tendons were transferred based on the ulnar vessels as a single-stage procedure (37 pedicled flaps, three free flaps). Four patients required composite tendon and skin island transfer. Minimum follow-up was 12 months, and functional results were evaluated using a total active range of motion score. Multiple linear regression analysis was performed to evaluate the factors that could be associated with the postoperative total active range of motion. The average postoperative total active range of motion (excluding the thumbs) was 178.05° (SD 50°). The total active range of motion was significantly lower for patients who were reconstructed with free flaps and for those who required composite tendon and skin island flap. Age, right or left hand, donor/motor tendon and pulley reconstruction had no linear effect on total active range of motion. Overall results were comparable with a published series on staged tendon grafting but with a lower complication rate. Vascularized pedicled tendon grafts/flaps are useful in the reconstruction of defects of finger flexor tendons in a single stage, although its role in the reconstructive armamentarium remains to be clearly established. © The Author(s) 2014.

  5. Sensing vascularization of ex-vivo produced oral mucosal equivalent (EVPOME) skin grafts in nude mice using optical spectroscopy

    Science.gov (United States)

    Vishwanath, Karthik; Gurjar, Rajan; Kuo, Shiuhyang; Fasi, Anthony; Kim, Roderick; Riccardi, Suzannah; Feinberg, Stephen E.; Wolf, David E.

    2014-03-01

    Repair of soft tissue defects of the lips as seen in complex maxillofacial injuries, requires pre-vascularized multi-tissue composite grafts. Protocols for fabrication of human ex-vivo produced oral mucosal equivalents (EVPOME) composed of epithelial cells and a dermal equivalent are available to create prelaminated flaps for grafting in patients. However, invivo assessment of neovascularization of the buried prelaminated flaps remains clinically challenging. Here, we use diffuse reflectance spectroscopy (DRS) and diffuse correlation spectroscopy (DCS) to non-invasively quantify longitudinal changes in the vessel density and blood-flow within EVPOME grafts implanted in the backs of SCID mice and subsequently to determine the utility of these optical techniques for assessing vascularization of implanted grafts. 20 animals were implanted with EVPOME grafts (1x1x0.05 cm3) in their backs. DRS and DCS measurements were obtained from each animal both atop the graft site and far away from the graft site, at one week post-implantation, each week, for four consecutive weeks. DRS spectra were analyzed using an inverse Monte Carlo model to extract tissue absorption and scattering coefficients, which were then used to extract blood flow information by fitting the experimental DCS traces. There were clear differences in the mean optical parameters (averaged across all mice) at the graft site vs. the off-site measurements. Both the total hemoglobin concentration (from DRS) and the relative blood flow (from DCS) peaked at week 3 at the graft site and declined to the off-site values by week 4. The optical parameters remained relatively constant throughout 4 weeks for the off-site measurements.

  6. Microvascular free flaps in the management of war wounds with tissue defects

    Directory of Open Access Journals (Sweden)

    Kozarski Jefta

    2003-01-01

    Full Text Available Background. War wounds caused by modern infantry weapons or explosive devices are very often associated with the defects of soft and bone tissue. According to their structure, tissue defects can be simple or complex. In accordance with war surgical doctrine, at the Clinic for Plastic Surgery and Burns of the Military Medical Academy, free flaps were used in the treatment of 108 patients with large tissue defects. With the aim of closing war wounds, covering deep structures, or making the preconditions for reconstruction of deep structures, free flaps were applied in primary, delayed, or secondary term. The main criteria for using free flaps were general condition of the wounded, extent, location, and structure of tissue defects. The aim was also to point out the advantages and disadvantages of the application of free flaps in the treatment of war wounds. Methods. One hundred and eleven microvascular free flaps were applied, both simple and complex, for closing the war wounds with extensive tissue defects. The main criteria for the application of free flaps were: general condition of the wounded, size, localization, and structure of tissue defects. For the extensive defects of the tissue, as well as for severely contaminated wounds latissimus dorsi free flaps were used. For tissue defects of distal parts of the lower extremities, scapular free flaps were preferred. While using free tissue transfer for recompensation of bone defects, free vascularized fibular grafts were applied, and in skin and bone defects complex free osteoseptocutaneous fibular, free osteoseptocutaneous radial forearm, and free skin-bone scapular flaps were used. Results. After free flap transfer 16 (14,4% revisions were performed, and after 8 unsuccessful revisions another free flaps were utilized in 3 (37,5% patients, and cross leg flaps in 5 (62,5% patients. Conclusion. The treatment of war wounds with large tissue defects by the application of free microvascular flaps

  7. Flap Basics II: Advancement Flaps.

    Science.gov (United States)

    Shew, Matthew; Kriet, John David; Humphrey, Clinton D

    2017-08-01

    A mastery of advancement flap design, selection, and execution greatly aids the surgeon in solving reconstructive dilemmas. Advancement flaps involve carefully planned incisions to most efficiently close a primary defect in a linear vector. Advancement flaps are subcategorized as unipedicle, bipedicle, V-to-Y, and Y-to-V flaps, each with their own advantages and disadvantages. When selecting and designing an advancement flap, the surgeon must account for primary and secondary movement to prevent distortion of important facial structural units and boundaries. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. The Effect of MHC Antigen Matching Between Donors and Recipients on Skin Tolerance of Vascularized Composite Allografts.

    Science.gov (United States)

    Shanmugarajah, K; Powell, H; Leonard, D A; Mallard, C; Albritton, A; Harrington, E; Randolph, M A; Farkash, E; Sachs, D H; Kurtz, J M; Cetrulo, C L

    2017-07-01

    The emergence of skin-containing vascularized composite allografts (VCAs) has provided impetus to understand factors affecting rejection and tolerance of skin. VCA tolerance can be established in miniature swine across haploidentical MHC barriers using mixed chimerism. Because the deceased donor pool for VCAs does not permit MHC antigen matching, clinical VCAs are transplanted across varying MHC disparities. We investigated whether sharing of MHC class I or II antigens between donors and recipients influences VCA skin tolerance. Miniature swine were conditioned nonmyeloablatively and received hematopoietic stem cell transplants and VCAs across MHC class I (n = 3) or class II (n = 3) barriers. In vitro immune responsiveness was assessed, and VCA skin-resident leukocytes were characterized by flow cytometry. Stable mixed chimerism was established in all animals. MHC class II-mismatched chimeras were tolerant of VCAs. MHC class I-mismatched animals, however, rejected VCA skin, characterized by infiltration of recipient-type CD8 + lymphocytes. Systemic donor-specific nonresponsiveness was maintained, including after VCA rejection. This study shows that MHC antigen matching influences VCA skin rejection and suggests that local regulation of immune tolerance is critical in long-term acceptance of all VCA components. These results help elucidate novel mechanisms underlying skin tolerance and identify clinically relevant VCA tolerance strategies. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  9. Mechanisms and Mediators of Inflammation: Potential Models for Skin Rejection and Targeted Therapy in Vascularized Composite Allotransplantation

    Directory of Open Access Journals (Sweden)

    Theresa Hautz

    2012-01-01

    Full Text Available Vascularized composite allotransplantation (VCA is an effective treatment option for patients suffering from limb loss or severe disfigurement. However, postoperative courses of VCA recipients have been complicated by skin rejection, and long-term immunosuppression remains a necessity for allograft survival. To widen the scope of this quality-of-life improving procedure minimization of immunosuppression in order to limit risks and side effects is needed. In some aspects, the molecular mechanisms and dynamics of skin allograft rejection seem similar to inflammatory skin conditions. T cells are key players in skin rejection and are recruited to the skin via activation of adhesion molecules, cytokines, and chemokines. Blocking these molecules has not only shown success in the treatment of inflammatory dermatoses, but also prolonged graft survival in various models of solid organ transplantation. In addition to T cell recruitment, ectopic lymphoid structures within the allograft associated with chronic rejection in solid organ transplantation might contribute to the strong alloimmune response towards the skin. Selectively targeting the molecules involved offers exciting novel therapeutic options in the prevention and treatment of skin rejection after VCA.

  10. [The gluteus maximus inferior split-muscle flap for the cover of ischiatic pressure ulcers: Study of 61 cases].

    Science.gov (United States)

    Vincent, P-L; Pinatel, B; Viard, R; Comparin, J-P; Gir, P; Voulliaume, D

    2016-12-01

    The coverage of ischiatic pressure ulcers is characterized by a significant recurrence rate (8-64% depending on the series). It therefore seems necessary to introduce the concept of saving in the use of muscle flaps available to avoid being in a situation of therapeutic impasse. The gluteus maximus inferior split-muscle flap allows a tailored coverage to the ischiatic pressure ulcers grade IV with skin defect less than 8cm after surgical debridement. It is associated with an advancement-rotation skin flap removed above the sub-gluteal fold. The surgical treatment is performed in a single-stage (care+coverage), undercovered by probabilistic antibiotic per- and postoperative then secondarily adapted. After excision of the cavity, a gluteus maximus inferior split-muscle flap was realized. The inferior gluteal artery ensures the muscular flap vascularization. Afterwards, patients follow a rehabilitation program in a specialized center. Sixty-one flaps were performed in 55 patients between September 2000 and January 2015. Fifty-nine (97%) were conducted in first-line and 2 (3%) for covering recurrent pressure ulcers. After a mean duration of 4 years and 8 months follow-up, 13 pressure ulcers (21.3%) relapsed. If reoperation, a simple remobilization of the muscle flap was achieved in 54% of cases, a myocutaneous flap of biceps femoris in 23% and surgical abstention in a patient with non-compliant perioperative care. The gluteus maximus inferior split-muscle flap, simple to implement, provides coverage of ischial pressure sores while sparing muscle flaps usually used for this indication. The recurrence rate associated with the gluteus maximus inferior split-muscle flap is comparable to biceps femoris and gluteus maximus muscle flaps (totally harvested). It does not sacrifice function gluteus maximus muscle and can be performed in the valid patient. This flap keeps the Superior split-muscle, mobilized in case of sacral pressure ulcer. The gluteus maximus inferior split

  11. Management of long segment anterior urethral stricture (≥ 8cm using buccal mucosal (BM graft and penile skin (PS flap: outcome and predictors of failure

    Directory of Open Access Journals (Sweden)

    Gamal A. Alsagheer

    Full Text Available ABSTRACT Purpose To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM graft or ventral onlay penile skin flap (PS for anterior urethral stricture ≥ 8cm. Patients and methods Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed. Results Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow-up. Stricture recurrence was detected in 7 (30.4% patients out of BM group while in 6 (23.1% patients out of PS group (p value= 0.5. No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant. Conclusion On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.

  12. 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

  13. Saphenous artery-based flap models in rats: new flap designs for experimental studies.

    Science.gov (United States)

    Aksam, Ersin; Aksam, Berrak; Demirseren, Mustafa Erol; Yavuz, Huban Sibel Orhun

    2016-12-01

    Experimental research using laboratory animals provides substantial data about reconstructive surgery. However, the literature does not include any experimental studies that have used flap models on the hind limbs of rats. To gain an understanding of the physiology of lower-extremity flaps and of flap failures, this study assessed the cutaneous perforators of the saphenous artery, and new flap models were designed for the hind limbs of rats. The experiment was designed to include three stages and used 35 rats. The first stage involved mapping the perforators of the saphenous artery. In the second stage, the contents and structures of McFarlane, epigastric, and anterior hind limb flap tissues were compared histologically. The third stage of the study involved designing and comparing different flaps for the hind limbs of the rats and included random flaps, perforator-based peninsular flaps, perforator-based island flaps, and perforator-based flaps with rotated pedicles. Postoperative necrosis ratios were evaluated using computer-based software. Mapping of the saphenous artery perforators revealed an average of 2.2 septocutaneous arteries in each hind limb. Histologic studies showed thick dermis and panniculus carnosus in the McFarlane flaps, thick dermis, and thin panniculus carnosus layers in the epigastric flaps, and thin subcutaneous tissue with no panniculus carnosus tissue in the skin of the hind limbs. The results of the flap studies that used random flaps showed a 52.4% necrosis, while there was no necrosis when perforator-based peninsular flaps, island flaps, and flaps with rotated pedicles were used. New flap models used on the saphenous artery perforators of the hind limbs of rats can provide valuable information about the physiology of lower-extremity flaps. New studies can also be designed based on these flap models to acquire more knowledge about pathologic conditions such as ischemia and venous insufficiency. Copyright © 2016 Elsevier Inc. All rights

  14. [Application of high frequency color Doppler ultrasound in anterolateral thigh flap surgery].

    Science.gov (United States)

    Xiao, Haitao; Shi, Yingyu; Wang, Huaisheng; Liu, Yong; Zhang, Yange; Cen, Ying

    2013-02-01

    To investigate the effectiveness of high frequency color Doppler ultrasound for detecting perforators in the anterolateral thigh (ALT) flap surgery. Between February 2011 and July 2012, 8 patients underwent high frequency color Doppler ultrasound to detect the perforator anatomy before ALT flap surgery. There were 5 males and 3 females, aged 21-46 years (mean, 34 years). Defects were caused by excision of squamous cell carcinoma in 2 cases, by scalp avulsion in 2 cases, by soft tissue necrosis after neck trauma in 1 case, by excision of groin fibrosarcoma in 1 case, by excision of groin melanoma in 1 case, and by malformation of the face in 1 case. The defect size varied from 12 cm x 7 cm to 22 cm x 18 cm. The perforator with wider caliber, faster flow speed, and shorter intramuscular trajectory was selected, and the flap was designed according to the observed results, which size varied from 14 cm x 9 cm to 25 cm x 20 cm. The donnor sites were repaired by free skin graft. Totally, 19 perforators in the flap area were detected by high frequency color Doppler ultrasound, and 18 were identified during operation, with an accuracy rate of 94.7%. The point going out muscle, the travel and direction of perforators observed during operation were basically in accordance with those detected by high frequency color Doppler ultrasound. The other flaps survived, and obtained healing by first intention except 1 flap which had partial fat necrosis with healing by second intention. The skin graft at donor site survived. All patients followed up 4-16 months (mean, 8 months). The flaps had good color and texture. High frequency color Doppler ultrasound is a valuable imaging modality for the preoperative assessment of the vascular supply for ALT flap.

  15. The effects of local nitroglycerin on the surgical delay procedure in prefabricated flaps by vascular implant in rats Efeitos da nitroglicerina tópica na autonomização de retalhos pré-fabricados por implante vascular em ratos

    Directory of Open Access Journals (Sweden)

    Jairo Zacchê de Sá

    2012-12-01

    Full Text Available PURPOSE: To evaluate the effect of local nitroglycerin on the viable area of a prefabricated flap for vascular implant in rats, and to investigate the surgical delay procedure. METHODS: A femoral pedicle was implanted under the skin of the abdominal wall in forty Wistar rats. The animals were divided into four groups of ten: group 1 - without surgical delay procedure and local nitroglycerin; group 2 - with surgical delay procedure, but without local nitroglycerin; group 3 - without surgical delay procedure, but with local nitroglycerin; and group 4 - with simultaneous surgical delay procedure and local nitroglycerin. The percentages of the viable areas, in relation to the total flap, were calculated using AutoCAD R 14. RESULTS: The mean percentage value of the viable area was 8.9% in the group 1. 49.4% in the group 2; 8.4% in the group 3 and 1.1% in the group 4. There was significant difference between groups 1 and 2 (p=0.005, 1 and 4 (p=0.024, 2 and 3 (p=0.003, 2 and 4 (p=0.001. These results support the hypothesis that the closure of the arterial venous channels is responsible for the phenomenon of surgical delay procedure. CONCLUSION: Local nitroglycerin did not cause an increase in the prefabricated viable flap area by vascular implantation and decreased the viable flap area that underwent delay procedures.OBJETIVO: Avaliar o efeito da nitroglicerina tópica sobre a área viável de um modelo de retalho pré-fabricado por implante vascular em ratos e analisar o mecanismo de autonomização cirúrgica aplicada a retalhos pré-fabricados. MÉTODOS: Foram utilizados 40 ratos Wistar. No primeiro tempo cirúrgico - 20 ratos foram submetidos a implante do pedículo femoral na região subdérmica da parede abdominal, e 20 submetidos à autonomização cirúrgica de retalho cutâneo de parede abdominal e, simultaneamente, implante do pedículo femoral na região subdérmica deste retalho. No segundo tempo - após três semanas e em todos os animais

  16. Versatality of supraclavicular flap in neck, face, and upper chest region coverage

    International Nuclear Information System (INIS)

    Almas, D.; Masood, T.; Dar, M.F.; Noman, B.

    2015-01-01

    The objective is to analyze the utility of the island supraclavicular flap in a region where skin graft cannot be used and free flap is not feasible. We assessed complications and functional outcomes. Study Design: Prospective descriptive study. Place and Duration of Study: The study was done at plastic and reconstructive surgery department CMH Rawalpindi during the period of 03 year from October 2011 to October 2014. Material and Patients: An island supraclavicular artery flap was used to reconstruct oncologic, and post burn neck contractures release defects. 30 patients were included in the study. Doppler probe was used to help with localization of vascular pedicle. All the patients with scarring in both shoulder regions, history of radiation to neck and undergoing radical neck dissection were excluded. Results: A total of 30 patients were included 20 (66.6%) male and 10 (33.3%) were female. Oncologicre section was followed by immediate reconstruction with island supraclavicular artery flap. Post burn contractures were released and covered by a pedicled supraclavicular artery flap. The recipient sites were neck, face, oral and upper chest region. The average harvest time was 1 and half hour. Donor site was closed primarily in 22 (73.3%) while 8 (26.6%) require skin grafting. Post burn contractures needed scar management with intralesional steroid, pressure garments and scar revision with Z-plasty in 4(13.3%) cases. 1 (3.3%) flap failed completely and the defect was covered with a skin graft. We had 01 (3.3%) mortality due to respiratory obstruction, despite adequate flap perfusion for 24 hours. Minor complications included, partial flap loss, seroma, and haematoma formation. In addition hypertrophied scar, spreading scar and keloid formation occurred at the donor site 18 (60%). Conclusion: Island supraclavicular artery flap with an easy learning curve is a reliable flap. It has a good colour and texture match with minimal donor site morbidity. It is an excellent

  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. Experimental model for transcutaneous electrical nerve stimulation on ischemic random skin flap in rats Modelo experimental para estimulação elétrica nervosa transcutânea em retalho cutâneo randômico isquêmico em ratos

    OpenAIRE

    Richard Eloin Liebano; Lydia Masako Ferreira; Miguel Sabino Neto

    2003-01-01

    The objective of this paper was to develop an experimental model to be used in the study of Transcutaneous Electrical Nerve Stimulation (TENS) on viability of random skin flap in rats. The sample was 15 Wistar-EPM rats. The random skin flap measured 10x4 cm and a plastic barrier was placed between the flap and the donnor site. The animals were submited to TENS for 1 hour immediately after the surgery and on the two subsequent days. On the seventh postoperative day, the percentage of necrotic ...

  19. Use of the Teres Major Muscle in Chimeric Subscapular System Free Flaps for Head and Neck Reconstruction.

    Science.gov (United States)

    Tomlinson, Andrew R; Jameson, Mark J; Pagedar, Nitin A; Schoeff, Stephen S; Shearer, A Eliot; Boyd, Nathan H

    2015-09-01

    We present what we believe to be the first case series in which the teres major muscle is used as a free flap in head and neck reconstruction. To describe our experience with the teres major muscle in free flap reconstruction of head and neck defects and to identify advantages of this approach. A retrospective review was performed at 2 tertiary care centers between February 1, 2007, and June 30, 2012. Data analysis was conducted from July 31, 2014, through December 1, 2014. Teres major muscle free flap for use in head and neck reconstruction. Indications for use, complications, and outcomes including donor site morbidity. The teres major free flap was used in 11 patients as a component of chimeric subscapular system free flaps for a variety of complex head and neck defects. The teres major muscle was used to fill soft-tissue defects of the neck, face, and nasal cavity; it provided substantial soft-tissue volume but was less bulky than the latissimus dorsi muscle. The teres major muscle was also used to provide protection for vascular anastomoses and/or great vessels and to enhance soft-tissue coverage of the mandibular reconstruction plate. In addition, the muscle was selected as a substrate for skin grafting where inadequate neck skin remained. Flap survival occurred in 10 of 11 flaps (91%). Two flaps (18%) demonstrated venous congestion that was managed successfully. Two patients (18%) developed minor recipient-site complications (submental fistula and infection with recurrent wound dehiscence and plate exposure). All donor sites healed well, with chronic, mild shoulder pain noted in 2 patients (18%) and no postoperative seromas observed in any patient. Addition of the teres major muscle to a subscapular system free flap is an option for reconstruction of a variety of complex head and neck defects, particularly when a moderate amount of soft tissue is required. In select cases, the teres major muscle may have advantages over the latissimus dorsi muscle.

  20. Effective Use of a Silicone-induced Capsular Flap in Secondary Asian Rhinoplasty

    Directory of Open Access Journals (Sweden)

    Jae Yong Jeong, MD

    2014-06-01

    Full Text Available Summary: Performing secondary rhinoplasty in patients who underwent primary rhinoplasty using a silicone implant is difficult due to thinning of nasal skin and formation of a capsule. Excess capsule formation can cause capsular contracture, resulting in short nose deformity or implant deviation, migration, or implant demarcation. Revision rhinoplasty using a capsular flap, dorsal silicone implant, and tip plasty was performed in 95 Korean patients (91 women and 4 men; mean age, 27 years who previously underwent primary augmentation rhinoplasty using silicone implants. The capsular flap was composed by creating a dual plane above the anterior capsule and below the posterior capsule. The existing silicone implant was removed, and a new silicone implant was placed under the posterior capsule. The patients were followed up for 6 months to 4 years (mean, 31.7 months. Of the 95 patients who underwent secondary augmentation rhinoplasty using a capsular flap, 88 patients (92.6% showed satisfactory results. There was no hematoma or nasal skin vascular compromise. There was no visible or palpable capsule resorption or recurrent capsular contracture. Early implant malpositioning (within 30 days postoperatively was observed in 4 patients, and tip shape dissatisfaction (within 60 days postoperatively was reported by 3 patients. Four patients underwent revision surgery and had successful outcomes. Nasal augmentation using a silicone implant and capsular flap in secondary rhinoplasty avoids complications caused by removal of the capsule. Recurrent capsule formation or clinically noticeable resorption of the capsular flap was not observed in this study.

  1. The gracilis myocutaneous free flap: a quantitative analysis of the fasciocutaneous blood supply and implications for autologous breast reconstruction.

    Directory of Open Access Journals (Sweden)

    Iain S Whitaker

    Full Text Available BACKGROUND: Mastectomies are one of the most common surgical procedures in women of the developed world. The gracilis myocutaneous flap is favoured by many reconstructive surgeons due to the donor site profile and speed of dissection. The distal component of the longitudinal skin paddle of the gracilis myocutaneous flap is unreliable. This study quantifies the fasciocutaneous vascular territories of the gracilis flap and offers the potential to reconstruct breasts of all sizes. METHODS: Twenty-seven human cadaver dissections were performed and injected using lead oxide into the gracilis vascular pedicles, followed by radiographic studies to identify the muscular and fasciocutaneous perforator patterns. The vascular territories and choke zones were characterized quantitatively using the 'Lymphatic Vessel Analysis Protocol' (LVAP plug-in for Image J® software. RESULTS: We found a step-wise decrease in the average vessel density from the upper to middle and lower thirds of both the gracilis muscle and the overlying skin paddle with a significantly higher average vessel density in the skin compared to the muscle. The average vessel width was greater in the muscle. Distal to the main pedicle, there were either one (7/27 cases, two (14/27 cases or three (6/27 cases minor pedicles. The gracilis angiosome was T-shaped and the maximum cutaneous vascular territory for the main and first minor pedicle was 35 × 19 cm and 34 × 10 cm, respectively. CONCLUSION: Our findings support the concept that small volume breast reconstructions can be performed on suitable patients, based on septocutaneous perforators from the minor pedicle without the need to harvest any muscle, further reducing donor site morbidity. For large reconstructions, if a 'T' or tri-lobed flap with an extended vertical component is needed, it is important to establish if three territories are present. Flap reliability and size may be optimized following computed tomographic angiography and

  2. Perforator anatomy of the radial forearm free flap versus the ulnar forearm free flap for head and neck reconstruction

    NARCIS (Netherlands)

    Hekner, D.D.; Roeling, TAP; van Cann, EM

    The aim of this study was to investigate the vascular anatomy of the distal forearm in order to optimize the choice between the radial forearm free flap and the ulnar forearm free flap and to select the best site to harvest the flap. The radial and ulnar arteries of seven fresh cadavers were

  3. Reconstruction of totally degloved fingers: a novel application of the bilobed spiraled innervated radial artery superficial palmar branch perforator flap design provides for primary donor-site closure.

    Science.gov (United States)

    Chi, Zhenglin; Yang, Peng; Song, Dajiang; Li, Zan; Tang, Liang; Gao, Weiyang; Song, Yonghuan; Chu, Tingang

    2017-05-01

    To investigate the results of resurfacing completely degloved digits using bilobed innervated radial artery superficial palmar branch (RASPB) perforator flap in a spiral fashion. A detailed anatomic study on 30 adult fresh frozen cadavers preinjected with silicone rubber compound to demarcate arterial anatomy documented locations, numbers, and diameters of arteries and skin perforators with surrounding nerves. The flap-raising procedure was performed using four fresh cadaver specimen. We reviewed the reconstruction of 12 digits by using a bilobed spiraled innervated RASPB free perforator flap after non-replantable degloving injury. Two skin paddles were marked out using standard points of reference. At least two separate cutaneous perforator vessels were identified using a hand-held Doppler and were dissected back to the RASPB in retrograde fashion. The skin paddles were then divided between the two cutaneous perforators to provide two separate paddles with a common vascular supply. The skin paddles were stacked in a spiral fashion on the flap inset, effectively increasing the width of the flap to cover the totally degloved finger while still allowing closure of the primary donor-site. The RASPB was present within the flap in all cadavers. The direct perforator and the musculocutaneous perforator were available in 93.33 and 76.67 %, respectively, with neither of them in 6.67 % of the cases. The constantly present two perforators allowed the design of a new bilobed spiraled innervated radial artery superficial palmar branch perforator flap. We used the proposed flap to reconstruct completely degloved digits in 12 patients (mean age 28.6 years; range 17-35 years). With our proposed flap, no flap failure or re-exploration occurred and the donor site was closed primarily in all cases. All the flaps survived uneventfully. Total active motion ranged from 92° to 140° and 111° to 155° in the cases with and without metacarpophalangeal joint involvement, respectively

  4. Wound Healing and Angiogenesis through Combined Use of a Vascularized Tissue Flap and Adipose-Derived Stem Cells in a Rat Hindlimb Irradiated Ischemia Model.

    Science.gov (United States)

    Yoshida, Shuhei; Yoshimoto, Hiroshi; Hirano, Akiyoshi; Akita, Sadanori

    2016-05-01

    Treatment of critical limb ischemia is sometimes difficult because of the patient's condition, and some novel approaches are needed. The hindlimbs of Sprague-Dawley rats, after 20-Gy x-ray irradiation and surgical occlusion, were divided into four groups: with a superficial fascial flap, 5.0 × 10 adipose-derived stromal/stem cells, and both combined. The rats were tested for laser tissue blood flow, immunohistologic blood vessel density, and foot paw punch hole wound healing. Green fluorescent protein-tagged Sprague-Dawley rats were used for further investigation by cell tracking for 2 weeks. Laser tissue blood flow demonstrated a significant increase in the combined treatment of flap and adipose-derived stem cells at both 1 and 2 weeks. There were no significant differences between the treatment groups treated with flaps alone and those treated with adipose-derived stem cells alone. Wound healing was significantly increased following combined treatment at 1 week, and there was no wound by 2 weeks except for the no-flap and no-adipose-derived stem cell group. The number of vessels depicted by von Willebrand factor showed a significant increase in the combined treatment group, at both 1 week and 2 weeks. In the cell tracking group, at 2 weeks, the green fluorescent protein-tagged adipose-derived stem cells were significantly more positive in the no-flap group than in the flap group. Adipose-derived stem cells may be a potent cell source in irradiated and occluded limbs by enhancing tissue blood flow and blood vessel density. Adipose-derived stem cells may play an important role in some difficult ischemic conditions in terms of wound healing.

  5. Can the green laser doppler measure skin-nutritive perfusion in patients with peripheral vascular disease?

    NARCIS (Netherlands)

    Ubbink, D. T.; Tulevski, I. I.; Jacobs, M. J.

    2000-01-01

    The recently developed green laser (GL; wavelength 543 nm) is thought to measure perfusion derived from a more superficial skin layer than does the standard near-infrared laser (RL; wavelength 780 nm). These lasers were used to investigate the disturbances in the different layers of skin perfusion

  6. Finger island flaps for treatment of dermato-desmogenic flexion contractures of proximal interphalangeal joints

    Directory of Open Access Journals (Sweden)

    T. S. Antonova

    2016-12-01

    Full Text Available Soft tissue defect will form after operative treatment of the dermato-desmogenic flexion contractures of fingers interphalangeal joints of the 2–3 grades after excision of the scar. Using the island flaps (Littler at the central vascular pedicle is one of the classical methods of plastic closure of such defects. Goal. To study the effectiveness of the surgical treatment of dermato-desmogenic flexion contractures of proximal interphalangeal joints of the fingers by using finger island flaps at the central vascular or neuro-vascular pedicle. Materials and methods. 14 operations were carried out on 13 patients for removing dermato-desmogenic flexion contractures of proximal interphalangeal (PIP joints of triphalangeal fingers over a 2-year period (2013–2015. The group included patients with a flexion contracture of the 2–3 grades PIP joints of triphalangeal fingers. Operations were performed on average 5 months after the injury (from 1.5 up to 16 months. Finger island flap in all cases was taken from adjacent finger by using the blood supply of their common finger artery. In all cases the island flap on the central pedicel was used, in 9 cases digital nerve was included in the pedicle (Littler. Closure of donor wound was made with free-skin grafts. Permanent splinting of the hand with extension of the interphalangeal joints and moderate flexion of the metacarpophalangeal joints were performed during 7–8 days after surgery, then exercise therapy was prescribed. Results. The results were estimated 6 and 12 months after surgery. All the results were regarded as excellent. In 5 cases of using the flap on a vascular pedicle flap hypoesthesia was detected, that has not led to dysfunction of the hand. Contracture recurrence during follow-up was not observed. Conclusions. Using the surgery for treatment of dermato-desmogenic flexion contractures of proximal interphalangeal joints of the fingers with the island flaps at the central vascular or neuro-vascular

  7. Omental free-tissue transfer for coverage of complex upper extremity and hand defects--the forgotten flap.

    Science.gov (United States)

    Seitz, Iris A; Williams, Craig S; Wiedrich, Thomas A; Henry, Ginard; Seiler, John G; Schechter, Loren S

    2009-12-01

    Free omental tissue transfer is a versatile reconstructive option for trunk, head and neck, and extremity reconstruction. Its utility is due to the length and caliber of the vascular pedicle and the malleability and surface area of the flap. We report our experience with omental free flap coverage of complex upper-extremity defects. A retrospective analysis of eight omental free-tissue transfers in seven patients with complex upper-extremity defects between 1999 and 2008 was performed. Indications, operative technique, and outcome were evaluated. Patient age ranged from 12 to 59 years with five male and two female patients. Indications included tissue defects due to crush-degloving injuries, pitbull mauling, or necrotizing soft tissue infection. All patients had prior operations including: revascularization, debridement, tendon repair, skin grafts, and/or fixation of associated fractures. One patient sustained severe bilateral crush-degloving injuries requiring free omental hemiflap coverage of both hands. The mean defect size was 291 cm(2) with all patients achieving complete wound coverage. No flap loss or major complications were noted. Laparoscopic-assisted omental free flap harvest was performed in conjunction with the general surgery team in three cases. Mean follow-up was 2 years. The omental free flap is a valuable, often overlooked reconstructive option. The long vascular pedicle and large amount of pliable, well-vascularized tissue allow the flap to be aggressively contoured to meet the needs of complex three-dimensional defects. In addition, laparoscopic-assisted harvest may aid with flap dissection and may result in reduced donor-site morbidity.

  8. The Versatile Naso-Labial Flaps in Facial Reconstruction

    International Nuclear Information System (INIS)

    El-Marakby, H.H.

    2005-01-01

    Surgical excision of tumors from the face may create a defect that is difficult to restore. Skin grafts can only cover superficial defects and has a natural tendency to contract and may not take properly. Also, because of the colour mismatch, it is not cosmetically identical to the face. The use of regional flaps such as the median forehead flaps are usually bulky, can not cover a wide range of facial reconstruction and usually require the donor area to be grafted. The naso-labial flaps are very useful and versatile local flaps, with robust vascularity that can be readily elevated without a delay. The flap can be superiorly based to reconstruct defects on the cheek, side wall or the dorsum of the nose, alae, collumula and the lower eye lid. Inferiorly based flaps can be used to reconstruct defects in the upper lip, anterior floor of the mouth and the lower lip. The flap can be turned over and used as a lining of the nose and the lip. Aim of the Study: In the current study we present our experience with utilization of the nasolabial flaps in facial reconstruction. We evaluated the indications, flap designs, technique, and complications. We will also assess the final functional and aesthetic results. Material and Methods: The study included 20 patients (12 males and 8 females) presented at the surgical department, National Cancer Institute (NCl) Cairo University with skin cancer at different areas of the face. Preoperative assessment includes. Assessment of the stage of the disease, the flap design and patient general condition. The mean age of the patients was 56.3±6 years (range ]6-62 years). Fifteen patients presented with basal cell carcinoma, 2 squamous cell carcinoma, one malignant melanoma, one keratoacanthoma, and one xeroderma pigmentosa. Nasal defects constituted 75% of cases, the rest were lower eye lid (2), one upper lip and one oral commisure beside a case of cheek reconstruction. There was no major complication; only one patient suffered a reactionary

  9. Immediate breast reconstruction with a myocutaneous latissimus dorsi flap and implant following skin-sparing salvage mastectomy after irradiation as part of breast-conserving therapy

    NARCIS (Netherlands)

    van Huizum, Martine A.; Hage, J. Joris; Rutgers, Emiel J.; Hoornweg, Marije J.

    2016-01-01

    Local relapse after breast-conserving therapy including whole breast irradiation is typically treated by salvage mastectomy. Immediate reconstruction by pedicled transfer of a latissimus dorsi flap in combination with implantation of a definitive prosthesis or temporary tissue expander following

  10. Experience with Perforator Based Flaps for Wound Cover of the Leg ...

    African Journals Online (AJOL)

    Background: Open fractures of the distal third of the tibia and fibular offer a challenge to the orthopedic surgeon because of skin coverage. The reconstructive surgeon's help is often required in trying to achieve this. There are several options: - local flap, free flap or a cross leg flap. Local flaps have always had limitations ...

  11. Salvage of Failed Local and Regional Flaps with Porcine Urinary Bladder Extracellular Matrix Aided Tissue Regeneration

    Directory of Open Access Journals (Sweden)

    Gregory J. Kruper

    2013-01-01

    Full Text Available Local and regional flap failure can be a major complication in head and neck surgery, which continue to be prevalent for a number of reasons including poor flap design, improper surgical technique, and poor tissue vascularity. Dealing with these failures can be quite difficult. Surgical debridement, flap revisions, and complex wound regimens are necessitated to reestablish appropriate tissue coverage. Traditional use of wet to dry dressing to enable proper wound granulation and possible closure with additional flaps or skin grafts is a laborious process. Such treatments place great time burdens on the patient, physicians, and nurses. Because the face and neck possess a complex three-dimensional topography, wound dressings are inherently complex to design and change. Many patients also require postoperative treatments such as radiation and chemotherapy to treat aggressive malignancies, and delay in wound healing leads to a delay in adjuvant treatment. Recently, advances in regenerative medicine, specifically xenogeneic extracellular matrix compounds, have been shown to promote tissue growth while limiting scar tissue formation (Badylak 2004. To our knowledge, this paper is the first case series using the porcine extracellular matrix bioscaffold (MatriStem ACell, Columbia, MD, USA to salvage flaps with extensive wound breakdown on the face and neck.

  12. The use of disposable vascular catheters in interstitial brachytherapy of skin cancers

    International Nuclear Information System (INIS)

    Daly, N.J.; Malissard, L.; Douchez, J.; Combes, P.F.

    1978-01-01

    Technical improvements dealing with interstitial brachytherapy (Ir 192 ) of skin cancers are presented. Fine disposable plastic tubes fitted with mandril, which allow loading of light radioactive material in any case are used. Short term results are discussed according to 101 applications [fr

  13. Skin autofluorescence as a noninvasive marker of vascular damage in patients with type 2 diabetes

    NARCIS (Netherlands)

    Lutgers, Helen L.; Graaff, Reindert; Links, Thera P.; Ubink-Veltmaat, Lielith J.; Bilo, Henk J.; Gans, Rijk O.; Smit, Andries J.

    2006-01-01

    OBJECTIVE - Advanced glycation end products (AGES) are thought to have a role in the pathogenesis of diabetes complications. We recently reported the association between skin autofluorescence, as a measure of tissue AGE accumulation, and diabetic neuropathy in a selected diabetic population. In this

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

    Directory of Open Access Journals (Sweden)

    Joseph W. Duncumb

    2016-01-01

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

  15. 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

  16. Current Techniques for Postoperative Monitoring of Microvascular Free Flaps.

    Science.gov (United States)

    Khatri, Nasir; Zhang, Shuhao; Kale, Santosh S

    Free tissue transfer (FTT) is used in patients with complicated reconstructive needs; it can provide stable wound coverage, improved aesthetic appearance, and restore functional deficits. Despite the high success rates of free flaps, vascular occlusion is a significant risk leading to flap failure. Many studies have demonstrated that the salvage rate for flaps is inversely related to the time between onset of a vascular problem and its surgical correction. As a result, ongoing postoperative monitoring of free flaps for adequate perfusion is imperative to allow timely and accurate diagnosis of vascular compromise. Close monitoring and prompt notification of the physician if vascular compromise occurs are typically undertaken by first-line nurses. We conducted an integrative literature to identify and evaluate commonly used techniques for monitoring vascular free flaps during the postoperative period. We searched PubMed and Science Direct electronic databases, using the key words: "free-flap" and "monitoring." This article discusses commonly monitoring modalities, along with their advantages and limitations. Whereas large academic institutions may have an experienced nursing staff specifically trained in effective methods for monitoring free flap patients, this situation may not exist in all hospitals where free flap surgeries are performed. We describe techniques that allow easy and timely detection of flap compromise by nursing staff while reducing interuser variability.

  17. Fibrosis in tubularized skin flaps in rats, using silicon catheters with two different degrees of flexibility: experimental model Fibrose em retalhos tubulizados de pele de ratos usando cateteres de diferentes flexibilidades como molde: modelo experimental

    Directory of Open Access Journals (Sweden)

    Antonio Henrique Rodrigues dos Passos

    2008-06-01

    Full Text Available PURPOSE: Microscopically evaluate the intensity of fibrosis in tubularized skin flaps on the back of Wistar rats, using silicon molds with different degrees of flexibility. METHODS: Twenty rats were submitted to three tubularized skin flaps on their backs. In two tubular flaps, we placed, as a mold, silicon catheters with different degrees of flexibility and removed them on the seventh day after the surgery. They were divided into two groups and euthanized, on the seventh and twenty-first days respectively after the surgery for the collection of the pieces, coloration with Masson tricromic, quantification of the area of each sample and comparison among the groups. RESULTS: Fibrosis was less intense on the tubular flaps where a catheter was not used as a mold. No significant difference was verified among the pieces with the silicon catheters, but there was a tendency of less fibrosis on the tubules with the most flexible catheter. CONCLUSION: There was no significant difference among the two catheter types. Fibrosis was less intense in the flaps where the mold was not used.OBJETIVO: Avaliar microscopicamente a intensidade da fibrose em retalhos tubulares de pele do dorso de ratos Wistar em uso de moldes de silicone de diferentes flexibilidades. MÉTODOS: Vinte animais foram submetidos à confecção de três retalhos tubulizados de pele na região dorsal. Em dois túbulos foram colocados, como molde, cateteres de silicone com flexibilidades diferentes e retirados no sétimo dia após a cirurgia. Foram divididos em dois grupos e sacrificados, respectivamente, no sétimo e vigésimo primeiro dia após a cirurgia para a coleta das peças, coloração pelo tricrômico de Masson, quantificação da área de cada amostra e comparação entre os grupos. RESULTADOS: A fibrose foi menos intensa nos retalhos tubulares em que não se usou cateter como molde. Não se verificou diferença significativa entre os retalhos com os cateteres de silicone, mas sim

  18. Retalho de omento maior para indução de vascularização e consolidação óssea em cão Use of omental flap to induce vascularization and bone healing in a dog

    Directory of Open Access Journals (Sweden)

    Cássio Ricardo Auada Ferrigno

    2010-09-01

    Full Text Available Este trabalho relata o caso de uma cadela da raça whippet, de 10 anos, com união retardada de tíbia e fíbula esquerdas, exposta, cotaminada e com grande perda de massa muscular e óssea e de pele causada por instabilidade óssea decorrente de duas intervenções cirúrgicas realizadas anteriormente. Foi realizado retalho de omento maior em camada simples, alcance ao foco de fratura via túnel subcutâneo e recobrimento por enxerto cutâneo em malha. O objetivo do trabalho foi avaliar a capacidade de indução vascular do omento maior para foco de fratura e consequentemente consolidação óssea, tendo como hipótese a acentuada função de angiogênese do omento maior. A tíbia e fíbula esquerdas foram estabilizadas com fixador circular externo. Após 80 dias, houve consolidação óssea da tíbia, volta do apoio do membro e retirada do implante.This research reports the case of a whippet female dog, 10 years old, with delayed union of left tibia and fibula, exposure of the fracture focus with localized infection, and extensive loss of, muscle, bone and skin after instability caused by two surgical interventions accomplished previously. A flap was made of the greater omentum in a single layer. The fracture site was reached through the subcutaneous tunnel and the coating by mesh skin grafts. The objective of this study was to evaluate the ability of the larger omentum to induce angiogenesis to the fracture site and the subsequent bone healing, considering the strong role of angiogenesis. The left tibia and fibula were stabilized with external circular fixator. After 80 days there was bone healing of the tibia around the support member and removal of the implant. Postoperative complications included partial necrosis of the cutaneous (25% flap and shortening of the tibia with consequent laxity ligament of the member.

  19. [Anatomic study on perforating branch flap of medial vastus muscle and its clinical application].

    Science.gov (United States)

    Guo, Yongqiang; Liang, Xiaoqin; Wang, Jianli; Wang, Chenqi; Guo, Deliang; Wang, Changde; Cui, Lei

    2012-09-01

    To investigate the anatomic features of the perforating branch flap of the medial vastus muscle, so as to provide a new perforating branch flap for repairing the soft tissue defect. Six fresh donated lower limb specimens underwent an intra-arterial injection of a lead oxide and lactoprene preparation. The integument of the thigh was dissected to observe the origin, course, size, and location of the perforating branch of the medial vastus muscle by angiography and photography. Based on the anatomic study, the free perforating branch flaps of the medial vastus muscle (14 cm x 6 cm to 20 cm x 5 cm) were used to repair skin and soft tissue defects (8 cm x 6 cm to 12 cm x 8 cm) of the feet in 4 patients between June 2009 and August 2011. The artery of the medial vastus was sent out constantly from the femoral artery, and then descended in the vastus muscle to lateral patella where it anastomosed with the terminal branches of lateral femoral circumflex artery to form prepatellar vascular network. The artery of the medial vastus sent out 3-5 musculocutaneous perforating branches into the deep fascia and then extended superficially to the overlying skin. Four flaps survived after surgery; wounds at the donor site and recipient site healed by first intention. After follow-up of 6-12 months, the flaps had good appearance and texture. All ankles had normal movement range of plantarflexion and dorsiflexion. The free perforating branch flaps of the medial vastus muscle can be harvested easily, and have the advantage of good texture and abundant donor site.

  20. Degloving injuries and flap viability assessment | Widgerow | South ...

    African Journals Online (AJOL)

    Degloving injuries are associated with major morbidity. The management of these injuries is still not resolved. The method of management used by the authors involves the harvesting of split skin from the surface of the flap and assessment of flap viability based on surface dennal capillary bleeding. The skin grafts are then ...

  1. Vascular aspects of water uptake mechanisms in the toad skin: perfusion, diffusion, confusion

    DEFF Research Database (Denmark)

    Willumsen, Niels; Viborg, Arne L; Hillyard, Stanley D

    2007-01-01

    and declined in parallel with BCF. Water absorption measured during the initial rehydration period did not correlate with BCF and hydrated toads injected with AVT increased water absorption without an increase in BCF indicating the lack of an obligate relation between blood flow and water absorption......Blood cell flow (BCF) in the water absorbing "seat patch" region of toad skin was measured with laser Doppler flow cytometry. BCF of dehydrated toads increased by a factor of 6-8 when water contact was made and declined gradually as toads rehydrated. Water absorption was initially stimulated....... Aquaporins 1-3 were characterized by RT-PCR analysis of seat patch skin. AQP 1 was localized in the endothelium of subepidermal capillaries and serves as a pathway for water absorption in series with the apical and basolateral membranes of the epithelium. Dehydrated toads rehydrated more rapidly from dilute...

  2. Adipose Extracellular Matrix/Stromal Vascular Fraction Gel Secretes Angiogenic Factors and Enhances Skin Wound Healing in a Murine Model

    Directory of Open Access Journals (Sweden)

    Mingliang Sun

    2017-01-01

    Full Text Available Mesenchymal stem cells are an attractive cell type for cytotherapy in wound healing. The authors recently developed a novel, adipose-tissue-derived, injectable extracellular matrix/stromal vascular fraction gel (ECM/SVF-gel for stem cell therapy. This study was designed to assess the therapeutic effects of ECM/SVF-gel on wound healing and potential mechanisms. ECM/SVF-gel was prepared for use in nude mouse excisional wound healing model. An SVF cell suspension and phosphate-buffered saline injection served as the control. The expression levels of vascular endothelial growth factor (VEGF, basic fibroblast growth factor (bFGF, and monocyte chemotactic protein-1 (MCP-1 in ECM/SVF-gel were analyzed at different time points. Angiogenesis (tube formation assays of ECM/SVF-gel extracts were evaluated, and vessels density in skin was determined. The ECM/SVF-gel extract promoted tube formation in vitro and increased the expression of the angiogenic factors VEGF and bFGF compared with those in the control. The expression of the inflammatory chemoattractant MCP-1 was high in ECM/SVF-gel at the early stage and decreased sharply during the late stage of wound healing. The potent angiogenic effects exerted by ECM/SVF-gel may contribute to the improvement of wound healing, and these effects could be related to the enhanced inflammatory response in ECM/SVF-gel during the early stage of wound healing.

  3. Innovation in the planning of V-Y rotation advancement flaps: A template for flap design.

    Science.gov (United States)

    Dölen, Utku Can; Koçer, Uğur

    2018-01-01

    Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2). The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1). The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10). The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19-80 years). All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

  4. Innovation in the planning of V-Y rotation advancement flaps: A template for flap design

    Directory of Open Access Journals (Sweden)

    Utku Can Dölen

    2018-01-01

    Full Text Available Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5, anterior tibia (n=1, posterior axilla (n=1, ischium (n=1, and trochanter (n=2. The template for a bilateral flap was used on the sacrum (n=8, arm (n=1, and anterior tibia (n=1. The causes of the defects were meningocele (n=3, a decubitus ulcer (n=5, pilonidal sinus (n=3, and skin tumor excision (n=10. The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19–80 years. All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

  5. Immediate Breast Reconstruction of a Nipple Areolar Lumpectomy Defect With the L-Flap Skin Paddle Breast Reduction Design and Contralateral Reduction Mammoplasty Symmetry Procedure: Optimizing the Oncoplastic Surgery Multispecialty Approach.

    Science.gov (United States)

    Buller, Mitchell; Heiman, Adee; Davis, Jared; Lee, Thomas J; Ajkay, Nicolás; Wilhelmi, Bradon J

    2017-01-01

    Objective: We describe a modification of the inferior pedicle reduction mammoplasty for oncoplastic reconstruction of a central tumor defect. Our technique involved a deepithelialized L-shaped medial inferior based flap with removal of lateral breast tissue after central lumpectomy with a contralateral Wise-pattern mastopexy with inferior pedicle for symmetry. This technique is ideal for patients with large, ptotic breasts that desire breast conservation with immediate reconstruction. Methods: A 47-year-old woman with size 38 DD breasts presented with a palpable 2-cm subareolar mass of the left breast. Surgical oncology performed a left lumpectomy with nipple-areola complex excision and a sentinel lymph node biopsy. Immediate left breast reconstruction was performed with an inferior pedicle island flap. An additional 30 g of breast tissue was excised laterally for contour, and the neo-nipple-areola complex was rotated into the defect to facilitate inverted-T closure. A standard Wise-pattern mastopexy with inferior pedicle was then performed on the right breast and an additional 205 g of tissue was removed for symmetry. Results: The patient showed excellent symmetry at the conclusion of the procedure. Final pathology demonstrated complete excision of the tumor with negative margins. The entire neo-nipple-areola complex skin island was viable postoperatively. Conclusions: Immediate reconstruction of a nipple-areola complex lumpectomy defect with a L-shaped medial inferior based skin paddle flap and contralateral reduction mammoplasty provides an excellent cosmetic outcome in patients with large, ptotic breasts and central defects following oncologic tumor resection.

  6. The use of the ALT Flap and Lateral Femoral Cutaneous Nerve for the Reconstruction of Carpal Soft Tissue and Ulnar Nerve Defects: a Case Report.

    Science.gov (United States)

    Karonidis, Athanasios; Bouloumpasis, Serafeim; Apostolou, Konstantinos; Tsoutsos, Dimosthenis

    2015-06-01

    The anterolateral thigh (ALT) flap has become one of the workhorse flaps, with indications including diverse reconstructive problems. The lateral thigh area is also a useful donor site for nerve grafts. The lateral femoral cutaneous (LFC) nerve can be dissected along with the ALT flap for a substantial length, depending on the requirements of the recipient site. The LFC nerve can be used as a vascularized or non-vascularized nerve graft. The technique offers advantages and it can find clinical applications, satisfying the functional and aesthetic reconstructive requirements of a complex defect. We report the case of a patient who presented with traumatic soft tissue defect of the volar aspect of the wrist and ulnar nerve defect as a complication of a fracture of distal radius. An ALT flap was used to reconstruct the soft tissue defect. The ulnar nerve was resected due to necrosis and the gap was repaired with non-vascularized grafts of the anterior branch of the LFC nerve. The soft tissues were resurfaced successfully without complications. Functional recovery was good for the superficial branch of the ulnar nerve, whereas it was variable for the deep branch of the ulnar nerve. The anterolateral thigh area offers significant advantages as donor site in the reconstruction of complex soft tissue defects being a large source of vascularized skin, fat, fascia, muscle and nerve. This availability allows for single donor site dissection, minimizing the operating time and the associated morbidity.

  7. Skin-derived precursors from human subjects with Type 2 diabetes yield dysfunctional vascular smooth muscle cells.

    Science.gov (United States)

    Steinbach, Sarah K; Yau, Terrence M; Ouzounian, Maral; Abdel-Qadir, Husam; Chandy, Mark; Waddell, Thomas K; Husain, Mansoor

    2017-08-01

    Objective : Few methods enable molecular and cellular studies of vascular aging or Type 2 diabetes (T2D). Here, we report a new approach to studying human vascular smooth muscle cell (VSMC) pathophysiology by examining VSMCs differentiated from progenitors found in skin. Approach and results : Skin-derived precursors (SKPs) were cultured from biopsies ( N =164, ∼1 cm 2 ) taken from the edges of surgical incisions of older adults ( N =158; males 72%; mean age 62.7 ± 13 years) undergoing cardiothoracic surgery, and differentiated into VSMCs at high efficiency (>80% yield). The number of SKPs isolated from subjects with T2D was ∼50% lower than those without T2D (cells/g: 0.18 ± 0.03, N =58 versus 0.40 ± 0.05, N =100, P <0.05). Importantly, SKP-derived VSMCs from subjects with T2D had higher Fluo-5F-determined baseline cytosolic Ca 2+ concentrations (AU: 1,968 ± 160, N =7 versus 1,386 ± 170, N =13, P <0.05), and a trend toward greater Ca 2+ cycling responses to norepinephrine (NE) (AUC: 177,207 ± 24,669, N =7 versus 101,537 ± 15,881, N =20, P <0.08) despite a reduced frequency of Ca 2+ cycling (events s -1 cell -1 : 0.011 ± 0.004, N =8 versus 0.021 ± 0.003, N =19, P <0.05) than those without T2D. SKP-derived VSMCs from subjects with T2D also manifest enhanced sensitivity to phenylephrine (PE) in an impedance-based assay (EC 50 nM: 72.3 ± 63.6, N =5 versus 3,684 ± 3,122, N =9, P <0.05), and impaired wound closure in vitro (% closure: 21.9 ± 3.6, N =4 versus 67.0 ± 10.3, N =4, P <0.05). Compared with aortic- and saphenous vein-derived primary VSMCs, SKP-derived VSMCs are functionally distinct, but mirror defects of T2D also exhibited by primary VSMCs. Skin biopsies from older adults yield sufficient SKPs to differentiate VSMCs, which reveal abnormal phenotypes of T2D that survive differentiation and persist even after long-term normoglycemic culture. © 2017 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.

  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. 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...

  10. Median forehead flap - beyond classic indication

    Directory of Open Access Journals (Sweden)

    Cristian R. Jecan

    2016-11-01

    Full Text Available Introduction. The paramedian forehead flap is one of the best options for reconstruction of the median upper two-thirds of the face due to its vascularity, color, texture match and ability to resurface all or part of the reconstructed area. The forehead flap is the gold standard for nasal soft tissue reconstruction and the flap of choice for larger cutaneous nasal defects having a robust pedicle and large amount of tissue. Materials and Methods. We are reporting a clinical series of cutaneous tumors involving the nose, medial canthus, upper and lower eyelid through a retrospective review of 6 patients who underwent surgical excision of the lesion and primary reconstruction using a paramedian forehead flap. Results. The forehead flap was used for total nose reconstruction, eyelids and medial canthal reconstruction. All flaps survived completely and no tumor recurrence was seen in any of the patients. Cosmetic and functional results were favorable. Conclusions. The forehead flap continues to be one of the best options for nose reconstruction and for closure of surgical defects of the nose larger than 2 cm. Even though is not a gold standard, median forehead flap can be an advantageous technique in periorbital defects reconstruction.

  11. Lumbar sympathectomy reduces vascular permeability, possibly through decreased adenosine receptor A2a expression in the hind plantar skin of rats.

    Science.gov (United States)

    Zheng, Zhifang; Liu, Yishu; Zhu, Lulu; Tang, Jianbing; Huang, Wenhua; Cheng, Biao

    2018-01-01

    The effect of lumbar sympathectomy for the treatment of lower limb ischemia remains a matter of controversy. Sprague-Dawley rats were subjected to lumbar sympathectomy, after which Evans blue dye was injected into the hind plantar skin. Extravasation of dye was measured and compared with rats undergoing sham operation. Hind plantar skin was processed for HE staining, immunohistochemistry, and Western blot. In sympathectomized rats, blue stained areas in hind plantar skin and concentrations of Evans blue were significantly less than that of sham sympathectomy (control) rats, both 2 weeks and 3 months after surgery. Expression of prostaglandin E2, bradykinin, bradykinin B2 receptor, and adenosine triphosphate were not significantly different between the sympathectomized and control groups. Adenosine receptor A2a expression was significantly reduced in the sympathectomized group both 2 weeks and 3 months after surgery. Vascular permeability in the hind plantar skin of rats decreases following lumbar sympathectomy, possibly via reduced expression of adenosine receptor A2a.

  12. Linezolid and vancomycin in treatment of lower-extremity complicated skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus in patients with and without vascular disease.

    Science.gov (United States)

    Duane, Therèse M; Weigelt, John A; Puzniak, Laura A; Huang, David B

    2012-06-01

    We evaluated drug efficacy and safety among patients with and without vascular disease who were treated with linezolid or vancomycin for a lower-extremity complicated skin and skin structure infection (cSSSI) caused by methicillin-resistant Staphylococcus aureus (MRSA). We pooled data from two randomized clinical trials evaluating the efficacy and safety of linezolid 600 mg intravenously (IV) or orally every 12 h and vancomycin 15 mg/kg or 1 g IV every 12 h for the treatment of cSSSI caused by culture-proved MRSA. There were 477 patients for analysis. Among patients with vascular disease (linezolid n=139, vancomycin n=135), the clinical success rate was 80.4% and 66.7% (p=0.02) for patients treated with linezolid and vancomycin, respectively. Among patients without vascular disease (linezolid n=91, vancomycin n=112), the clinical success rate was 94.5% and 89.4%, respectively (p=0.24). Linezolid-treated patients had fewer IV catheter-site complications and less kidney impairment but more frequent thrombocytopenia than those who received vancomycin, regardless of the presence or absence of vascular disease. Linezolid is an effective treatment for patients with and without vascular disease who have a lower-extremity cSSSI caused by MRSA. The safety data were consistent with the known safety profiles of linezolid and vancomycin given for this indication.

  13. 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.

  14. [Surgical treatment of suppurative axillary hidradenitis: value of a musculocutaneous island flap of the latissimus dorsi. Apropos of 3 cases].

    Science.gov (United States)

    Blanc, D; Tropet, Y; Balmat, P

    1990-01-01

    We report our experience of the surgical management of severe, extensive, medically intractable axillary Hidradenitis suppurativa in three male patients. Under general anaesthesia, all patients underwent large, deep and full excision of the disease prone areas, i. e. zones of apocrine sweat gland distribution and not only of the skin involved at the time of surgery, for the best possible prevention of recurrence. The operation was bilateral in two patients and unilateral in one. In all cases closure was achieved using the latissimus dorsi flap technique. In the two patients with bilateral lesions surgery was carried out in two steps at about two months' interval. At present, after a follow-up of about two years, none of the patients have relapsed and their shoulder mobility is perfectly preserved with a normal abduction allowed by the total absence of axillary scar contracture. The latissimus dorsi flap technique consists of transplanting into the recipient's axillary defect the pedicellated lateral margin of the latissimus dorsi muscle with (2 patients) or without (1 patient) a cover of attached skin palette vascularized by the underlying muscle tissue. Mainly used hitherto for reconstructive mammary surgery, this technique perfectly fits axillary diseases, such as Hidradenitis suppurativa, which can only be cured by creating wide surgical skin defects. It is particularly reliable: covering of the defect is easy and the immediate muscle interposition effectively protects the otherwise widely exposed neurovascular pedicle. The need for a skin palette cover associated with the latissimus dorsi flap is discussed.

  15. Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap.

    Science.gov (United States)

    Karsidag, Semra; Akcal, Arzu; Sirvan, Selami Serhat; Guney, Soner; Ugurlu, Kemal

    2011-02-01

    Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects. Copyright © 2011 Wiley-Liss, Inc.

  16. 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

  17. 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.

  18. Reconstruction for cervical irradiation ulcers with myocutaneous flaps

    Energy Technology Data Exchange (ETDEWEB)

    Strawberry, C.W.; Jacobs, J.S.; McCraw, J.B.

    Radiation-induced skin changes are commonly seen in patients who have been treated for head and neck malignancies. Some of these skin changes can progress into chronic postradiation ulcers, which despite aggressive medical wound management will not resolve spontaneously. Skin grafts and local cutaneous flaps located within the radiation field are unreliable and rarely provide adequate stable coverage. In this article, the authors report a combined experience of 52 patients whose postradiation cervical ulcers were successfully and reliably treated with myocutaneous flaps.

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

    Directory of Open Access Journals (Sweden)

    Mehrotra Sandeep

    2010-01-01

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

  20. The Use of Tensor Fascia Lata Pedicled Flap in Reconstructing Full Thickness Abdominal Wall Defects and Groin Defects Following Tumor Ablation

    International Nuclear Information System (INIS)

    Rifaat, M.A.; Abdel Gawad, W.S.

    2005-01-01

    abdominal wall reconstruction, one case developed ventral hernia, in which bilateral TFL flaps were used without mesh enforcement. There was minimal donor site morbidity in the form of partial skin graft loss in 2 cases. The average follow up period in this study ranged from 6 months to 2 years. Only one patient died of distant metastasis of a see of the groin skin, 8 months postoperatively and another 2 patients with abdominal desmoid tumors developed local recurrence. The tensor fascia lata flap is a reliable and a versatile flap, with minimal donor site morbidity. Problems with the flap's vascularity of its distal part should not be encountered, if the flap is harvested within the safe limits and properly designed and the edges comfortably insetted to the defect. A pedicled flap would be appropriate for lower abdominal wall defects, and is better islanded to achieve extra mobilization and allow a tension free closure, while for groin defects, simple flap transposition should be enough. Nevertheless, reconstruction for full thickness abdominal wall defects by this flap is a static reconstruction. We therefore strongly recommend enforcing the repair with a synthetic mesh primarily to minimize the incidence of ventral hernia. However, further studies with larger number of cases are needed to confirm this observation

  1. Development of a free latissimus dorsi muscle flap in cats.

    Science.gov (United States)

    Nicoll, S A; Fowler, J D; Remedios, A M; Clapson, J B; George, D

    1996-01-01

    Anatomic and experimental evaluation of the feline latissimus dorsi muscle was performed to assess its potential use as a free muscle flap. In the anatomic study, nonselective angiography of the subscapular artery was performed in nine heparinized feline cadavers. The muscle dimensions and vascular anatomy of the dissected latissimus dorsi muscle were recorded. In the experimental study four cats underwent heterotopic transplantation of a partial latissimus dorsi flap, and three cats underwent orthotopic transplantation of a complete latissimus dorsi flap. The mean length and width of the latissimus dorsi muscle was 19.0 and 5.4 cm, respectively. The dominant vascular pedicle was the thoracodorsal artery and vein. The average length and diameter of the thoracodorsal artery was 2.7 cm and 0.6 mm, respectively. Minor vascular pedicles were provided by branches of the intercostal arteries. Numerous choke anastomoses existed between the two pedicle systems. Viability of muscle flaps based on subjective evaluation, angiography, and histopathology, was 66% and 100% in the heterotopic and orthotopic studies, respectively. Flap failure seemed to be caused by both arterial and venous thrombosis. The latissimus dorsi muscle flap met criteria required for application in microvascular reconstruction. The vascular pattern was appropriate and consistent. Donor site morbidity was low, whereas surgical accessibility was high. The muscle satisfied the physical criteria of a free flap. Long-term anastomotic patency and flap viability was shown.

  2. Repair of a soft tissue defect of medial malleolus with cross-leg bridge free transfer of anterolateral thigh muscle flap: a case report

    Directory of Open Access Journals (Sweden)

    ZHANG Gong-lin

    2012-11-01

    Full Text Available 【Abstract】A 38-year-old man sustained a traffic accident injury to his right medial malleolus and leg. It was an open fracture of the right tibia and fibula accompanied by a large soft tissue defect of the right medial malleolus sized 12 cm×4 cm. Doppler examination revealed that the tibialis posterior vessel was occluded due to thrombosis. The anterior tibial artery was patent. Three weeks after injury, the left anterolateral thigh muscle flap was harvested and transplanted to the right medial malleolus defect area for repair of the soft tissue defect, and an end-to-side anasto-mosis was performed between the posterior tibial vessel of the contralateral leg and the muscle flap’s vascular pedicle. A split thickness free skin graft was used to cover the muscle flap and around the flap’s vascular pedicle. The vascular pedicle was cut off after 28 days and the muscle flap sur-vived completely. After 3-year follow-up postoperatively, the right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery of contralateral leg was patent by clinical and Doppler examinations. This tech-nique can be used to preserve the flow and patency of re-cipient arteries. Key words: Surgical flaps; Soft tissue injuries; Leg injuries; Wound healing

  3. 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

    Directory of Open Access Journals (Sweden)

    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

  4. 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

  5. Ação do dimetil-sulfóxido na isquemia de retalhos randômicos de pele em ratos The role of subcutaneous methyl-sulfoxide in a morphological study of random skin flaps in rats

    Directory of Open Access Journals (Sweden)

    Kleder Gomes de Almeida

    2004-12-01

    Full Text Available Objetivo: Avaliar a ação do dimetil-sulfóxido (DMSO na necrose distal de retalhos randômicos isquêmicos em ratos. Métodos: Foram utilizados 30 ratos machos, linhagem Wistar, peso entre 220 e 363g e idade média de 3 meses. O retalho cutâneo dorsal (8x2cm com pedículo cranial foi descolado, reposto em seu leito e suturado com poliamida 4.0. O grupo controle-CT (n=10 não recebeu nenhuma medicação, o grupo simulado-SM (n=10 recebeu o volume de 1mL de solução salina subcutânea, dividida em dez aplicações ao longo do retalho, o grupo experimento-EX (n=10 recebeu a injeção de 1ml de DMSO 5%. Após sete dias foram avaliadas as áreas de necrose distal e colhido material para o estudo histológico. Resultados: As medidas das áreas de necrose (CT=47,99, SM=58,78, EX=41,57 e as porcentagens das áreas de necrose (CT=29,98, SM=36,73, EX=23,99 mostraram-se menores no grupo Ex (pPurpose: To evaluate through the morphologic study (macro and microscopic the effectiveness of DMSO in the genesis of the distal necrosis of random skin flaps in rats. Methods: 30 male rats were used, lineage Wistar, weight between 220 and 363g and 3 months medium age .The skin flap (8x2cm with remained cranial vessels it was unstuck, restored at his bed and sutured with polyamide 4.0. The control-group CT (n=10 don’t received any medication, the simulated group -SM (n=10 it received the volume of 1mL of subcutaneous saline solution, divided in ten applications along the skin flap, the experiment group (n=10 it received the injection of 1ml of DMSO5%. After seven days they were appraised the areas of distal necrosis and picked material for the histology study. Results: The measures of the necrosis areas (CT=47.99, SM=58.78, EX=41.57 and the percentages of the necrosis areas (CT=29.98, SM=36.73, EX =23.99 they were shown smaller in the EX group (p < 0,05. The qualitative histology study showed, in the group EX, larger angiogenic presence, smaller destruction of

  6. [Anterolateral thigh and groin conjoined flap for emergent repair of ultra-long complex tissue defects in forearm and hand].

    Science.gov (United States)

    Wang, Maorong; Gu, Yunfeng; Chen, Fusheng; Li, Jun; Wang, Jiangning; Yin, Yefeng

    2013-08-01

    To evaluate the effectiveness of anterolateral thigh and groin conjoined flap in emergent repair of ultra-long complex tissue defects in forearm and hand. Between February 2009 and October 2011, 6 patients with complex tissue defect of dorsal forearm and hand were in adminsion. There were 5 male and 1 female with an average age of 38.5 years (range, 32-47 years). Injury reasons included machine injury in 5 cases and traffic accident injury in 1 case. Injury to admission time was from 3 to 16 hours (mean, 6 hours). All case were single limb injury, including right forearm and hand injury in 4 cases and left forearm and hand injury in 2 cases. The wound area was from 36 cm x 9 cm to 48 cm x 12 cm. The type of associated injury included elbow dislocation associated with open injury in 2 cases; fractures of the radial, ulnar, and metacarpal bone in 4 cases; defects of wrist dorsal skin and extensor tendons of fingers and wrist in 5 cases; and defects of ulnar artery and ulnar nerve in 1 case. The anterolateral thigh and groin conjoined free flaps were used to repair defects in the forearm and hand in emergency. The area of flap was from 36 cm x 9 cm to 48 cm x 12 cm. Meanwhile the partial functional reconstruction was performed. The donor site was repaired by skin grafts. The anastomotic embolization of vascular pedicle and arteria interossea dorsalis occurred in 1 case, purulent secretion under the flap in 1 case, which were cured after symptomatic treatment; the skin flaps completely survived, and primary healing of the wounds were obtained in the other cases. The donor skin grafts survived in 2 cases, and partial necrosis of the skin graft of lower abdominal occurred in 4 cases, and healed after changing dressing. All of the 6 patients were followed up 3 to 18 months (mean, 10 months). The appearance and texture of the flaps were good. The protective sensation was recovered in 2 cases followed up for more than 14 months; no sensory recovery was observed in the other

  7. [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

    2017-06-01

    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. Eighty-two breast reconstructions by latissimus dorsi flap and prosthesis implantation, with a mean follow-up of 9.5 years were scored from 1 to 5 by a panel of expert and non-expert. The patients scored also their own reconstruction. Various parameters of the reconstructed breast were thus evaluated. We compared the results, according to the positioning of the skin paddle: with additional incision (50 cases); without additional incision (32 cases). The characteristics of the mastectomy scar on the breast area, high or low, horizontal or oblique, defined 6 groups where the results of the 2 surgical options were compared. Only the reconstructions with additional incision get significantly higher results than those without additional incision (P<0.05). This involves the two panels, in the case of high mastectomy scars. In the others cases the additional incision is not essential. If the realization of an additional incision can be perceived like misfit on an area already "mutilated", we plead for this solution in selected cases. This provides a benefit stable in time, in terms of overall results, shape and even rendering scar. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Rectus abdominis myocutaneous flap for primary vaginal reconstruction.

    Science.gov (United States)

    Carlson, J W; Soisson, A P; Fowler, J M; Carter, J R; Twiggs, L B; Carson, L F

    1993-12-01

    Reconstructive procedures are being performed with increasing frequency in conjunction with pelvic exenterations and other radical gynecologic surgeries. The most common reconstructive procedures include continent urinary diversion, rectosigmoid anastomosis, and vaginal reconstruction. Historically, the gracilis myocutaneous flap has been the procedure of choice for vaginal reconstruction. However, the gracilis myocutaneous flap has a history of partial to severe necrosis, a propensity to prolapse, and leaves ipsilateral donor scars on the thigh. In contrast, neovaginal reconstruction using a relatively new procedure, the distally based rectus abdominis myocutaneous flaps, has the advantage of using a large, single flap that can be incorporated into the primary incision. This flap is mobilized on a long vascular pedicle, the rectus muscle. In relation to the underlying rectus muscle, the orientation of the cutaneous portion of this flap may be customized to accommodate the pelvic defect or the surgeon's preference. Depending on their primary orientation, they are referred to as either a vertical or transverse rectus abdominis myocutaneous flap. The versatility and reliability of the rectus flap is demonstrated here through the presentation of a small pilot series of seven patients. The technique was used for vaginal reconstruction, primarily in conjunction with pelvic exenteration. The flaps were mobilized from the supraumbilical area and had a flap viability of 100% for the 2 years that they have been followed. There were no postoperative incisional or flap infections. There was one infraumbilical fascial dehiscence. The advantages of primary pelvic reconstruction along with the description of the operative techniques are presented.

  9. Three cross leg flaps for lower leg reconstruction of Gustilo type III C open fracture

    Directory of Open Access Journals (Sweden)

    Kazufumi Sano

    2016-01-01

    Full Text Available A 60 year old male had Gustilo type III C open fracture of the right lower leg. After radical debridement, the large open defect including certain loss of the bone tissue was successfully augmented and covered, by consecutive three cross-leg flaps, which consisted of the free rectus abdominis musculocutaneous flap, the fibula osteocutaneous flap and the conventional sural flap. Although indication for amputation or preservation is decided with multiple factors in each case, a strategic combination of cross-leg flap, free flap, external fixation and vascular delay could increase the potential of preservation of the lower leg with even disastrous Gustilo type III C.

  10. Decreasing ALT donor site morbidity with the keystone flap.

    Science.gov (United States)

    Turin, Sergey Y; Spitz, Jamie A; Alexander, Karina; Ellis, Marco F

    2018-03-09

    The anterolateral thigh (ALT) flap is a workhorse flap for a variety of wounds. The primary disadvantage of ALT flaps is donor site morbidity associated with large skin paddle defects. We present a strategy of managing the donor site with the Keystone flap to avoid skin grafts in cases where primary closure is not possible. A retrospective, multi-institutional review from December 2015 to March 2017 based on a single surgeon's experience was performed. Inclusion criteria were harvest of an ALT flap and closure of the thigh donor site with a keystone flap. Six patients underwent reconstruction of the ALT donor site with a keystone flap. The average width of the ALT skin paddle was 7.8 cm (range 7-8 cm) and the defects could not be closed primarily or with wide undermining. Surface area of the ALT flaps averaged 96.8 cm 2 (range 64-152 cm 2 ). Mean patient BMI was 24.6 (range 16-37). Keystone flap dimensions averaged 9.5 × 17.8 cm. There were no major donor or recipient site complications, and one ×minor complication of delayed wound healing. No patients exhibited decreased range of motion at the hip or knee. Primary closure of the ALT donor site is preferred, but becomes difficult as skin paddle width approaches 8 cm. Managing the ALT flap donor site with a keystone flap is safe, does not appear to have significant morbidity, and can allow the surgeon to avoid the morbidity and secondary donor site associated with skin grafting. © 2018 Wiley Periodicals, Inc.

  11. Red Grape Skin Polyphenols Blunt Matrix Metalloproteinase-2 and -9 Activity and Expression in Cell Models of Vascular Inflammation: Protective Role in Degenerative and Inflammatory Diseases.

    Science.gov (United States)

    Calabriso, Nadia; Massaro, Marika; Scoditti, Egeria; Pellegrino, Mariangela; Ingrosso, Ilaria; Giovinazzo, Giovanna; Carluccio, Maria Annunziata

    2016-08-29

    Matrix metalloproteinases (MMPs) are endopeptidases responsible for the hydrolysis of various components of extracellular matrix. MMPs, namely gelatinases MMP-2 and MMP-9, contribute to the progression of chronic and degenerative diseases. Since gelatinases' activity and expression are regulated by oxidative stress, we sought to evaluate whether supplementation with polyphenol-rich red grape skin extracts modulated the matrix-degrading capacity in cell models of vascular inflammation. Human endothelial and monocytic cells were incubated with increasing concentrations (0.5-25 μg/mL) of Negroamaro and Primitivo red grape skin polyphenolic extracts (NSPE and PSPE, respectively) or their specific components (0.5-25 μmol/L), before stimulation with inflammatory challenge. NSPE and PSPE inhibited, in a concentration-dependent manner, endothelial invasion as well as the MMP-9 and MMP-2 release in stimulated endothelial cells, and MMP-9 production in inflamed monocytes, without affecting tissue inhibitor of metalloproteinases (TIMP)-1 and TIMP-2. The matrix degrading inhibitory capacity was the same for both NSPE and PSPE, despite their different polyphenolic profiles. Among the main polyphenols of grape skin extracts, trans-resveratrol, trans-piceid, kaempferol and quercetin exhibited the most significant inhibitory effects on matrix-degrading enzyme activities. Our findings appreciate the grape skins as rich source of polyphenols able to prevent the dysregulation of vascular remodelling affecting degenerative and inflammatory diseases.

  12. Reverse-Flow Lateral Tarsal Island Flap for Covering the Great Toe Donor Site of Wraparound Flap.

    Science.gov (United States)

    Jia, Yachao; Xu, Jia; Kang, Qinglin; Zhang, Changqing; Chai, Yimin

    2016-10-01

    Coverage of the great toe donor site of wraparound flap remains a challenge. This report presents the results of using an innervated pedicled reverse-flow lateral tarsal island flap for covering the great toe donor site of wraparound flap. Between 2005 and 2010, 11 reverse-flow lateral tarsal island flaps were used to cover the great toe donor site of wraparound flap in 11 patients. This pedicled flap designed on the lateral tarsal area of foot was based distally on the dorsalis pedis artery; the lateral dorsal pedal cutaneous nerve was incorporated into the reverse-flow lateral tarsal island flap and coapted with the first plantar digital nerve. The donor sites of reverse-flow lateral tarsal island flap were covered with inguinal full-thickness skin grafts. All flaps achieved primary healing except for two that suffered from mild venous insufficiency which was managed by conservative intervention. All skin grafts covering the donor site of reverse-flow lateral tarsal island flap healed uneventfully. The mean follow-up was 24 months (range, 18-48 months). The mean hallux metatarsophalangeal-interphalangeal scale score was 92 points (range, 85-97 points) at 6 months postoperatively. The static 2-point discrimination of the reverse-flow lateral tarsal island flap ranged from 6 to 14 mm (mean 10 mm). None of the patients were restricted in standing or walking during follow-up. The reverse-flow lateral tarsal island flap based distally on the dorsalis pedis artery has a constant pedicle that is sufficiently long. This innervated pedicle flap is a reliable option to cover the great toe donor site of wraparound flap with satisfactory functional and cosmetic results and acceptable donor site morbidity.

  13. Circular local skin flap: a new approach to areola reconstruction Retalho circular de pele local: uma nova abordagem para a reconstrução da aréola

    Directory of Open Access Journals (Sweden)

    Marcelo de Oliveira

    2007-08-01

    Full Text Available PURPOSE: Despite the numerous surgical options available today for nipple-areola reconstruction, the results are often unsatisfactory. The present study proposes a simple and efficient method for areola reconstruction that uses a circular local skin flap. METHODS: We prospectively followed five patients that underwent areola reconstruction using a circular local skin flap. A circle, approximately 5 cm in diameter, was marked on the desired area for the new areola. A thin centripetal undermining of 1.5-2 cm was performed, which created a flap with a central pedicle of approximately 1-2 cm. After hemostasis, the thin flap was fixed in its former position with continuous sutures. RESULTS:The mean procedure time was 20 minutes (± 9. The postoperative results were classified as satisfactory by four of the five patients at six months postoperative. Due to superficial undermining, the resulting scar resembled the appearance of the transition from the mammary skin to the areola. Dermopigmentation was only required in one areola. No complications such as dehiscence, necrosis, hematoma, or infection occurred. CONCLUSION: This technique achieved satisfactory results with low morbidity and few complications, and is thus a potentially promising resource for areola reconstruction.OBJETIVO: A reconstrução da aréola tem sofrido muitas inovações. Apesar do grande número de opções cirúrgicas, os resultados são muitas vezes insatisfatórios. Este estudo descreve um procedimento simples e eficiente para a reconstrução da aréola com um retalho circular de pele local. MÉTODOS: Os autores avaliaram prospectivamente cinco pacientes submetidas à reconstrução da aréola no período de 2004 a 2005. A reconstrução da aréola foi baseada em um retalho circular de pele local. A técnica inicia com a marcação de um círculo de aproximadamente cinco centímetros de diâmetro no local da nova aréola. Um descolamento centrípeto superficial de 1,5-2 cm

  14. Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction

    International Nuclear Information System (INIS)

    Peled, I.J.; Kaplan, H.Y.; Herson, M.; Wexler, M.R.

    1983-01-01

    We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction

  15. Scrotal Reconstruction with a Pedicled Gracilis Muscle Flap after ...

    African Journals Online (AJOL)

    Several scrotal reconstructive options are available including split thickness skin grafts, scrotal advancement flaps, local fasciocutaneous, muscle or myocutaneous flaps, and free tissue transfer. We report a case of a 34 year old African male who presented as a referral from a district hospital with a scrotal defect and ...

  16. Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Peled, I.J.; Kaplan, H.Y.; Herson, M.; Wexler, M.R.

    1983-08-01

    We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.

  17. Gynecologic reconstruction with a rectus abdominis myocutaneous flap: an update.

    Science.gov (United States)

    Carlson, J W; Carter, J R; Saltzman, A K; Carson, L F; Fowler, J M; Twiggs, L B

    1996-06-01

    This series reports the outcomes and significant complications associated with the rectus myocutaneous flap when used for pelvic or inguinal reconstruction in patients with gynecologic cancers. Perioperative variables were retrospectively reviewed to identify social and medical risk factors as well as intraoperative and postoperative complications that predisposed to rectus flap failure. Fifteen patients with gynecologic malignancies underwent reconstructive procedures using a vertically oriented rectus abdominis myocutaneous flap for either vaginal (n = 14) or inguinal (n = 1) reconstruction. The patients' primary cancers were cervical (n = 11), rectal (n = 1), ovarian (n = 1), vulvar (n = 1), and vaginal (n = 1). The median age was 50 years. The median follow-up was 17 months. All flaps were mobilized in conjunction with a radical salvage operation. There were no cases of vaginal prolapse and no abdominal wound infections. However, 4 patients (27%) had major postoperative morbidity in this small series. There was one wound dehiscence and three episodes of necrosis of the subcutaneous and cutaneous portions of the flap. All 4 of these patients required additional operative intervention or debridement. Eleven patients had complete healing of the flap. The rectus abdominis myocutaneous flap is a valuable option for gynecologic reconstructive procedures. Perioperative strategies for improving flap viability include the identification of risk factors that may compromise flap perfusions such as prior abdominal incisions, peripheral vascular disease, and obesity. Meticulous surgical technique is required to preserve the vascular pedicle. These strategies may be useful in preoperative counseling, the perioperative evaluation, and the intraoperative management.

  18. Skin

    International Nuclear Information System (INIS)

    Hunter, R.D.

    1985-01-01

    Malignant disease involving the skin represents a significant work load to the general radiotherapist and can involve interesting diagnostic and therapeutic decisions. Primary skin cancer is also relatively common and there is a need to provide an efficient service in which the first treatment is successful in the majority of patients. The reward for careful attention to technique is very considerable both in terms of clinical cancer control and functional results. Squamous cell carcinoma, basal cell carcinoma, and intra-epidermal carcinoma constitute the majority of the lesions dealt with clinically, but metastatic disease, lymphomas, and malignant melanomas are also referred regularly for opinions and may require radiotherapy. The general principle of the techniques of assessment and radiotherapeutic management to be described are equally applicable to any malignant skin tumour once the decision has been made to accept it for radiotherapy. Dosage and fractionation may have to be adjusted to allow for the nature of the disease process and the intent of the treatment

  19. Use of local muscle flaps to cover leg bone exposures

    Directory of Open Access Journals (Sweden)

    Francisco d'Avila

    Full Text Available Objective: To evaluate the use of the medial gastrocnemius muscle and/or soleus muscle flaps as surgical treatment of the leg bone exposure.Methods: We retrospectively analyzed the medical records of patients undergoing transposition of the medial gastrocnemius and / or soleus for treating exposed bone in the leg, from January 1976 to July 2009, gathering information on epidemiological data, the etiology the lesion, the time between the initial injury and muscle transposition, the muscle used to cover the lesion, the healing evolution of the skin coverage and the function of the gastrocnemius-soleus unit.Results: 53 patients were operated, the ages varying between nine and 84 years (mean age 41; 42 were male and 11 female. The main initial injury was trauma (84.8%, consisting of tibia and / or fibula fracture. The most frequently used muscle was the soleus, in 40 cases (75.5%. The rank of 49 patients (92.5% was excellent or good outcome, of three (5.6% as regular and of one (1.9% as unsatisfactory.Conclusion: the treatment of bone exposure with local muscle flaps (gastrocnemius and/or soleus enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay.

  20. 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.

  1. 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.

  2. Surgeon-Based 3D Printing for Microvascular Bone Flaps.

    Science.gov (United States)

    Taylor, Erin M; Iorio, Matthew L

    2017-07-01

    Background  Three-dimensional (3D) printing has developed as a revolutionary technology with the capacity to design accurate physical models in preoperative planning. We present our experience in surgeon-based design of 3D models, using home 3D software and printing technology for use as an adjunct in vascularized bone transfer. Methods  Home 3D printing techniques were used in the design and execution of vascularized bone flap transfers to the upper extremity. Open source imaging software was used to convert preoperative computed tomography scans and create 3D models. These were printed in the surgeon's office as 3D models for the planned reconstruction. Vascularized bone flaps were designed intraoperatively based on the 3D printed models. Results  Three-dimensional models were created for intraoperative use in vascularized bone flaps, including (1) medial femoral trochlea (MFT) flap for scaphoid avascular necrosis and nonunion, (2) MFT flap for lunate avascular necrosis and nonunion, (3) medial femoral condyle (MFC) flap for wrist arthrodesis, and (4) free fibula osteocutaneous flap for distal radius septic nonunion. Templates based on the 3D models allowed for the precise and rapid contouring of well-vascularized bone flaps in situ, prior to ligating the donor pedicle. Conclusions  Surgeon-based 3D printing is a feasible, innovative technology that allows for the precise and rapid contouring of models that can be created in various configurations for pre- and intraoperative planning. The technology is easy to use, convenient, and highly economical as compared with traditional send-out manufacturing. Surgeon-based 3D printing is a useful adjunct in vascularized bone transfer. Level of Evidence  Level IV. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. Rhomboid flap: An option to medial canthal reconstruction

    Directory of Open Access Journals (Sweden)

    Rafael Corredor-Osorio

    2017-07-01

    Full Text Available Medial canthal defects after wide local excision of basal cell carcinoma can range from small to medium size which can be reconstructed by using full thickness skin-grafts or defect local flaps. This report describes the case of 51-year-old woman with a medial canthal tumor. The large defect after of excision was successfully reconstructed with local rhomboid flap. The result cosmetic was highly satisfactory. Local rhomboid flap reconstruction is a safe, rapid and practical technique for skin defects in the canthal medial region after tumor excisions.

  4. Novel Mechanism for Buffering Dietary Salt in Humans: Effects of Salt Loading on Skin Sodium, Vascular Endothelial Growth Factor C, and Blood Pressure.

    Science.gov (United States)

    Selvarajah, Viknesh; Mäki-Petäjä, Kaisa M; Pedro, Liliana; Bruggraber, Sylvaine F A; Burling, Keith; Goodhart, Anna K; Brown, Morris J; McEniery, Carmel M; Wilkinson, Ian B

    2017-11-01

    High dietary sodium intake triggers increased blood pressure (BP). Animal studies show that dietary salt loading results in dermal Na + accumulation and lymphangiogenesis mediated by VEGF-C (vascular endothelial growth factor C), both attenuating the rise in BP. Our objective was to determine whether these mechanisms function in humans. We assessed skin electrolytes, BP, and plasma VEGF-C in 48 healthy participants randomized to placebo (70 mmol sodium/d) and slow sodium (200 mmol/d) for 7 days. Skin Na + and K + concentrations were measured in mg/g of wet tissue and expressed as the ratio Na + :K + to correct for variability in sample hydration. Skin Na + :K + increased between placebo and slow sodium phases (2.91±0.08 versus 3.12±0.09; P =0.01). In post hoc analysis, there was a suggestion of a sex-specific effect, with a significant increase in skin Na + :K + in men (2.59±0.09 versus 2.88±0.12; P =0.008) but not women (3.23±0.10 versus 3.36±0.12; P =0.31). Women showed a significant increase in 24-hour mean BP with salt loading (93±1 versus 91±1 mm Hg; P salt, and this may be influenced by sex. © 2017 The Authors.

  5. Digital artery perforator (DAP) flaps: modifications for fingertip and finger stump reconstruction.

    Science.gov (United States)

    Mitsunaga, Narushima; Mihara, Makoto; Koshima, Isao; Gonda, Koichi; Takuya, Iida; Kato, Harunosuke; Araki, Jun; Yamamoto, Yushuke; Yuhei, Otaki; Todokoro, Takeshi; Ishikawa, Shoichi; Eri, Uehara; Mundinger, Gerhard S

    2010-08-01

    Various fingertip reconstructions have been reported for situations where microsurgical finger replantation is impossible. One method is the digital artery perforator (DAP) flap. Herein we report 13 DAP flaps for fingertip and finger stump reconstruction following traumatic finger amputations, highlighting modifications to the originally described DAP flap. From October 1998 to December 2007, a total of 13 fingers (11 patients) underwent fingertip and finger stump reconstruction with modified DAP flaps following traumatic finger amputations. We performed six adipocutaneous flaps, three adipose-only flaps, two supercharged flaps and two extended flaps. Flap size ranged from 1.44 to 8 cm(2) (average 3.25 cm(2)). All flaps survived completely with the exception of partial skin necrosis in two cases. One of these cases required debridement and skin grafting. Our initial three cases used donor-site skin grafting. The donor site was closed primarily in the 10 subsequent cases. No patients showed postoperative hypersensitivity of repaired fingertips. Semmes-Weinstein (SW) test result for flaps including a digital nerve branch did not differ from those without (average 4.07 vs. 3.92). Modified DAP flaps allow for preservation of digital length, volume and finger function. They can be raised as adiposal-only flaps or extended flaps and supercharged through perforator-to-perforator anastomoses. The donor defect on the lateral pulp can be closed primarily or by skin grafting. For traumatic fingertip and finger stump reconstructions, DAP flaps deliver consistent aesthetic and functional results. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Three-dimensional analysis and classification of arteries in the skin and subcutaneous adipofascial tissue by computer graphics imaging.

    Science.gov (United States)

    Nakajima, H; Minabe, T; Imanishi, N

    1998-09-01

    To develop new types of surgical flaps that utilize portions of the skin and subcutaneous tissue (e.g., a thin flap or an adipofascial flap), three-dimensional investigation of the vasculature in the skin and subcutaneous tissue has been anticipated. In the present study, total-body arterial injection and three-dimensional imaging of the arteries by computer graphics were performed. The full-thickness skin and subcutaneous adipofascial tissue samples, which were obtained from fresh human cadavers injected with radio-opaque medium, were divided into three distinct layers. Angiograms of each layer were introduced into a personal computer to construct three-dimensional images. On a computer monitor, each artery was shown color-coded according to the three portions: the deep adipofascial layer, superficial adipofascial layer, and dermis. Three-dimensional computerized images of each artery in the skin and subcutaneous tissue revealed the components of each vascular plexus and permitted their classification into six types. The distribution of types in the body correlated with the tissue mobility of each area. Clinically, appreciation of the three-dimensional structure of the arteries allowed the development of several new kinds of flaps.

  7. Structural and mechanism design of an active trailing-edge flap blade

    DEFF Research Database (Denmark)

    Lee, Jae Hwan; Natarajan, Balakumaran; Eun, Won Jong

    2013-01-01

    of excessive hub vibratory loads and noise. The active control device manipulates the blade pitch angle with arbitrary higher harmonic frequencies individually. In this paper, an active trailing-edge flap blade, which is one of the active control methods, is developed to reduce vibratory loads and noise...... of the rotor through modification of unsteady aerodynamic loads. Piezoelectric actuators installed inside the blade manipulate the motion of the trailing edge flap. The proposed blade rotates at higher speed and additional structures are included to support the actuators and the flap. This improves the design....... To select the actuator and design the flap actuation region, the flap hinge moment is estimated via a CFD analysis. To obtain the desired flap deflection of ±4°, three actuators are required. The design of the flap actuation region is validated using a test bed with a skin hinge. However, because the skin...

  8. Effects of Ischemic Preconditioning of Different Intraoperative Ischemic Times of Vascularized Bone Graft Rabbit Models

    Directory of Open Access Journals (Sweden)

    Ahmad Sukari Halim

    2013-11-01

    Full Text Available BackgroundIschemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published.MethodsSixteen rabbits were divided into four groups with ischemic times of 2, 6, 14, and 18 hours. Half of the rabbits in each group underwent ischemic preconditioning. The osteomyocutaneous flaps consisted of the tibia bone, from which the overlying muscle and skin were raised. The technique of ischemic preconditioning involved applying a vascular clamp to the pedicle for 3 cycles of 10 minutes each. The rabbits then underwent serial plain radiography and computed tomography imaging on the first, second, fourth, and sixth postoperative weeks. Following this, all of the rabbits were sacrificed and histological examinations were performed.ResultsThe results showed that for clinical analysis of the skin flaps and bone grafts, the preconditioned groups showed better survivability. In the plain radiographs, except for two non-preconditioned rabbits with intraoperative ischemic times of 6 hours, all began to show early callus formation at the fourth week. The computed tomography findings showed more callus formation in the preconditioned groups for all of the ischemic times except for the 18-hour group. The histological findings correlated with the radiological findings. There was no statistical significance in the difference between the two groups.ConclusionsIn conclusion, ischemic preconditioning improved the survivability of skin flaps and increased callus formation during the healing process of vascularized bone grafts.

  9. Transcriptome analysis of skin fibroblasts with dominant negative COL3A1 mutations provides molecular insights into the etiopathology of vascular Ehlers-Danlos syndrome.

    Science.gov (United States)

    Chiarelli, Nicola; Carini, Giulia; Zoppi, Nicoletta; Ritelli, Marco; Colombi, Marina

    2018-01-01

    Vascular Ehlers-Danlos syndrome (vEDS) is a dominantly inherited connective tissue disorder caused by mutations in the COL3A1 gene that encodes type III collagen (COLLIII), which is the major expressed collagen in blood vessels and hollow organs. The majority of disease-causing variants in COL3A1 are glycine substitutions and in-frame splice mutations in the triple helix domain that through a dominant negative effect are associated with the severe clinical spectrum potentially lethal of vEDS, characterized by fragility of soft connective tissues with arterial and organ ruptures. To shed lights into molecular mechanisms underlying vEDS, we performed gene expression profiling in cultured skin fibroblasts from three patients with different structural COL3A1 mutations. Transcriptome analysis revealed significant changes in the expression levels of several genes involved in maintenance of cell redox and endoplasmic reticulum (ER) homeostasis, COLLs folding and extracellular matrix (ECM) organization, formation of the proteasome complex, and cell cycle regulation. Protein analyses showed that aberrant COLLIII expression is associated with the disassembly of many structural ECM constituents, such as fibrillins, EMILINs, and elastin, as well as with the reduction of the proteoglycans perlecan, decorin, and versican, all playing an important role in the vascular system. Furthermore, the altered distribution of the ER marker protein disulfide isomerase PDI and the strong reduction of the COLLs-modifying enzyme FKBP22 are consistent with the disturbance of ER-related homeostasis and COLLs biosynthesis and post-translational modifications, indicated by microarray analysis. Our findings add new insights into the pathophysiology of this severe vascular disorder, since they provide a picture of the gene expression changes in vEDS skin fibroblasts and highlight that dominant negative mutations in COL3A1 also affect post-translational modifications and deposition into the ECM of

  10. Transcriptome analysis of skin fibroblasts with dominant negative COL3A1 mutations provides molecular insights into the etiopathology of vascular Ehlers-Danlos syndrome.

    Directory of Open Access Journals (Sweden)

    Nicola Chiarelli

    Full Text Available Vascular Ehlers-Danlos syndrome (vEDS is a dominantly inherited connective tissue disorder caused by mutations in the COL3A1 gene that encodes type III collagen (COLLIII, which is the major expressed collagen in blood vessels and hollow organs. The majority of disease-causing variants in COL3A1 are glycine substitutions and in-frame splice mutations in the triple helix domain that through a dominant negative effect are associated with the severe clinical spectrum potentially lethal of vEDS, characterized by fragility of soft connective tissues with arterial and organ ruptures. To shed lights into molecular mechanisms underlying vEDS, we performed gene expression profiling in cultured skin fibroblasts from three patients with different structural COL3A1 mutations. Transcriptome analysis revealed significant changes in the expression levels of several genes involved in maintenance of cell redox and endoplasmic reticulum (ER homeostasis, COLLs folding and extracellular matrix (ECM organization, formation of the proteasome complex, and cell cycle regulation. Protein analyses showed that aberrant COLLIII expression is associated with the disassembly of many structural ECM constituents, such as fibrillins, EMILINs, and elastin, as well as with the reduction of the proteoglycans perlecan, decorin, and versican, all playing an important role in the vascular system. Furthermore, the altered distribution of the ER marker protein disulfide isomerase PDI and the strong reduction of the COLLs-modifying enzyme FKBP22 are consistent with the disturbance of ER-related homeostasis and COLLs biosynthesis and post-translational modifications, indicated by microarray analysis. Our findings add new insights into the pathophysiology of this severe vascular disorder, since they provide a picture of the gene expression changes in vEDS skin fibroblasts and highlight that dominant negative mutations in COL3A1 also affect post-translational modifications and deposition

  11. The use of visible light spectroscopy to measure tissue oxygenation in free flap reconstruction.

    Science.gov (United States)

    Cornejo, Agustin; Rodriguez, Thomas; Steigelman, Megan; Stephenson, Stacy; Sahar, David; Cohn, Stephen M; Michalek, Joel E; Wang, Howard T

    2011-09-01

    The loss of a free flap is a feared complication for both the surgeon and the patient. Early recognition of vascular compromise has been shown to provide the best chance for flap salvage. The ideal monitoring technique for perioperative free flap ischemia would be noninvasive, continuous, and reliable. Visible light spectroscopy (VLS) was evaluated as a new method for predicting ischemia in microvascular cutaneous soft tissue free flaps. In an Institutional Review Board-approved prospective trial, 12 patients were monitored after free flap reconstructions. The tissue hemoglobin oxygen saturation (StO (2)) and total hemoglobin concentration (THB) of 12 flaps were continuously monitored using VLS for 72 hours postoperatively. Out of these 12 flaps 11 were transplanted successfully and 1 flap loss occurred. The StO (2 )was 48.99% and the THB was 46.74% for the 12 flaps. There was no significant difference in these values among the flaps. For the single flap loss, the device accurately reflected the ischemic drop in StO (2) indicating drastic tissue ischemia at 6 hours postoperatively before the disappearance of implantable Doppler signals or clinical signs of flap compromise. VLS, a continuous, noninvasive, and localized method to monitor oxygenation, appeared to predict early ischemic complications after free flap reconstruction. © Thieme Medical Publishers.

  12. Significance of anatomical variations of the lateral circumflex femoral artery for the tensor fasciae latae flapping.

    Science.gov (United States)

    Vuksanovic-Bozaric, A; Radojevic, N; Muhovic, D; Abramovic, M; Radunovic, M

    2015-01-01

    The tensor fasciae latae (TFL) muscle is commonly used in plastic and reconstructive surgery as a transpositional or a free flap, in order to repair different kinds of defects. In most cases its vascularisation is provided by an ascending branch of lateral circumflex femoral artery (LCFA), which gives different numbers of branches and enters the TFL muscle in different manners. The represented study deals with the arterial vascularisation of the TFL muscle: the entrance of the vascular stalk branches; variations of the LCFA bifurcation's angle; and the skin area of vascularisation. The study was performed on both lower limbs of a 100 foetal and 10 adult cadavers. The LCFA was injected with micropaque solution, afterwards fixed and preserved in 10% formalin solution. Microdissection was performed under magnifying glass and surgical microscope. Analysis of adult cadavers was performed to determine the skin area vascularised by perforating blood vessels from the TFL muscle, by injecting methylene-blue dye into the artery, prior to which all branches of the LCFA, besides the ascending branch, were ligated. The research of a 100 foetal cadavers showed that the LCFA with its ascending branch ensured the blood supply to the muscle. In 85% it gave two branches, the ascending and the descending one, with the angle of bifurcation circa 90o in 73% of cases. The ascending branch can give 0 or more terminal branches, or even form an arterial net. Skin area affected with dye ranged from 18 × 22 cm to 23 × 28 cm and is in positive correlation with the LCFA length and diameter. The understanding of the presented variations have an exceptional significance in planning and applying the TFL flap, especially free flap, in successful repairing and covering the defects, as well as in preventing postoperative complications.

  13. Donor-site morbidity of the radial forearm free flap versus the ulnar forearm free flap.

    Science.gov (United States)

    Hekner, Dominique D; Abbink, Jan H; van Es, Robert J; Rosenberg, Antoine; Koole, Ronald; Van Cann, Ellen M

    2013-08-01

    Donor-site morbidity following harvest of the radial forearm free flap was compared with that following harvest of the ulnar forearm free flap. Twenty-eight radial forearm and 27 ulnar forearm flaps were harvested in 55 patients with head and neck defects. Pressure perception was measured with Semmes-Weinstein monofilaments. Cold perception was tested with chloroethyl. Donor-site healing was evaluated. Patients were interviewed about grip and pinch strength and donor-site appearance. In the radial forearm free flap group, pressure perception and cold perception were reduced in the donor hand, whereas in the ulnar group, no differences were observed between the donor and unoperated hands. In the radial forearm group, 15 percent of patients experienced reduced strength in the donor hand, whereas in the ulnar forearm group, none of the patients reported reduced strength in the donor hand. In the radial forearm group, 14 percent had partial or complete loss of the skin graft, whereas in the ulnar forearm group, 4 percent had partial loss of the skin graft. In the radial forearm group, 18 percent of patients were dissatisfied with the appearance of the donor site, and no complaints were reported in the ulnar forearm group. The authors' study shows less donor site-morbidity following harvest of the ulnar forearm free flap than following harvest of the radial forearm free flap. These results emphasize that the ulnar forearm free flap should be considered as an alternative for the radial forearm free flap for reconstruction of soft-tissue defects. Therapeutic, III.

  14. Experimental model for transcutaneous electrical nerve stimulation on ischemic random skin flap in rats Modelo experimental para estimulação elétrica nervosa transcutânea em retalho cutâneo randômico isquêmico em ratos

    Directory of Open Access Journals (Sweden)

    Richard Eloin Liebano

    2003-01-01

    Full Text Available The objective of this paper was to develop an experimental model to be used in the study of Transcutaneous Electrical Nerve Stimulation (TENS on viability of random skin flap in rats. The sample was 15 Wistar-EPM rats. The random skin flap measured 10x4 cm and a plastic barrier was placed between the flap and the donnor site. The animals were submited to TENS for 1 hour immediately after the surgery and on the two subsequent days. On the seventh postoperative day, the percentage of necrotic area was measured and calculated. The experimental model proved to be reliable to be used in the study of effects of Transcutaneous Electrical Nerve Stimulation in random skin flap in rats.Este artigo propõe o desenvolvimento de um modelo experimental para verificar o efeito da Estimulação Elétrica Nervosa Transcutânea (TENS na viabilidade do retalho cutâneo randômico em ratos. A amostra constituiu-se de 15 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. Os animais foram submetido à TENS por 1 hora imediatamente após a operação e nos outros dois dias subseqüentes. No sétimo dia pós-operatório foram calculadas as porcentagens de área de necrose. O modelo experimental mostrou-se factível para estudo dos efeitos da Estimulação Elétrica Nervosa Transcutânea em retalho cutâneo randômico em ratos.

  15. Anatomical Basis and Clinical Application of Synovial Flaps in the Wrist and Distal Forearm.

    Science.gov (United States)

    Colen, David L; Yeh, Jiun-Ting; Colen, Lawrence B

    2017-05-01

    Neuropathic symptoms after median nerve repair at the wrist or secondary to refractory carpal tunnel syndrome may become debilitating. These symptoms develop because of perineural adhesions, intraneural fibrosis, and fixation of the nerve to the transverse carpal ligament after surgery, and often require neurolysis. Interposition of vascularized soft tissue over the median nerve at the time of neurolysis prevents recurrence of such adhesions. The synovial flap, fashioned from the synovial lining of the flexor tendon sheath, is an ideal tissue for this purpose. Previous authors have described the surgical technique of the synovial flap, but the anatomical basis and design of the flap have not been previously discussed. Twenty fresh cadaver upper extremities were injected with Microfil to analyze the arterial anatomy, flap dimensions, and arc of rotation of the flexor tendon synovium mobilized as a flap suitable for coverage of the median nerve at the wrist. The authors determined that both radial and ulnar-based flaps are clinically useful for providing coverage in the wrist and distal forearm. This flap was used in 18 patients with complicated median nerve lesions in this region. All patients had an uncomplicated postoperative course. Of 13 patients treated for posttraumatic median nerve neuromas, all but two had significant resolution of symptoms. When used as a vascularized flap, the flexor tendon synovium provides adequate protection of the median nerve. Flap dimensions and vascularity of this tissue make it an ideal local flap option when performing reoperative surgery on the median nerve.

  16. Usefulness of platysma muscle flap following superficial parotidectomy.

    Science.gov (United States)

    Wang, W H; Zhu, J; Li, M; Xia, B; Xu, B

    2013-01-01

    The purpose of this study was to demonstrate a novel technique of a platysma muscle flap following superficial parotidectomy and to evaluate the impact of using this flap on Frey's syndrome and postoperative appearance. In this retrospective study, there were 55 patients who had had superficial parotid gland tumors removed, 28 patients were restored by the platysma muscle flap, and the remaining 27 patients were not restored by the technique. The area of the flap was measured using Image-Pro plus 6.0 software. The objective starch-iodine test was used to determine the incidence of Frey's syndrome. The postoperative aesthetic outcome of retromandibular contour was evaluated in all the patients. The score in platysma flap group was significantly higher than the scores in the conventionally treated group (P < 0.01). The area of the flap was 1668.7 ± 218.7 square millimeters. Of 28 patients restored by the flap, 2 developed mild Frey's syndrome, and in the remaining 27 patients 10 had Frey's syndrome. There was a statistically significant difference between the two groups (P = 0.007). The technique produced satisfactory aesthetic results with good facial contour. The platysma muscle flap, used as an interposing barrier between the overlying skin flap and the parotid bed following superficial parotidectomy, produced good results in the prevention of Frey's syndrome and resulted in good postoperative facial contour. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  17. Scalping injuries: new technique for stabilization of flaps to the skull.

    Science.gov (United States)

    Schubert, W; Guzman-Stein, G; Hope, R; Ahrenholz, D H; Solem, L D; Cunningham, B L

    1988-05-01

    Extensive scalping injuries offer a unique challenge for tissue coverage because of the wide expanse of bone and lack of deep soft tissue or significant perforating vessels. For smaller injuries, pedicle flaps offer ideal coverage. Larger defects can be covered by omental flaps. Coverage with a free muscle flap followed by split-thickness skin grafting offers optimal long-term coverage. Two new techniques are introduced. The wire-button technique offers stabilization, and the halo frame provides good support and protection for a new free-flap graft and may increase the success rate of flaps in patients with scalping injuries.

  18. The forked flap repair for hypospadias

    Directory of Open Access Journals (Sweden)

    Anil Chadha

    2012-01-01

    Full Text Available Context: Despite the abundance of techniques for the repair of Hypospadias, its problems still persist and a satisfactory design to correct the penile curvature with the formation of neourethra from the native urethral tissue or genital or extragenital tissues, with minimal postoperative complications has yet to evolve. Aim: Persisting with such an endeavor, a new technique for the repair of distal and midpenile hypospadias is described. Materials and Methods: The study has been done in 70 cases over the past 11 years. The "Forked-Flap" repair is a single stage method for the repair of such Hypospadias with chordee. It takes advantage of the rich vascular communication at the corona and capitalizes on the established reliability of the meatal based flip-flap. The repair achieves straightening of the curvature of the penis by complete excision of chordee tissue from the ventral surface of the penis beneath the urethral plate. The urethra is reconstructed using the native plate with forked flap extensions and genital tissue relying on the concept of meatal based flaps. Water proofing by dartos tissue and reinforcement by Nesbit′s prepucial tissue transfer completes the one stage procedure. Statistical Analysis: An analysis of 70 cases of this single stage technique of repair of penile hypospadias with chordee, operated at 3 to 5 years of age over the past 11 years is presented. Results and Conclusion: The Forked Flap gives comparable and replicable results; except for a urethrocutaneous fistula rate of 4% no other complications were observed.

  19. Unexpected outcome of a modification of Bracka repair for proximal hypospadias: High incidence of diverticula with flaps.

    Science.gov (United States)

    Tiryaki, Sibel; Ələkbərova, Vüsalə; Dokumcu, Zafer; Ergun, Raziye; Tekin, Ali; Yagmur, Ismail; Ulman, Ibrahim; Avanoglu, Ali

    2016-12-01

    Various graft and flap techniques have been proposed for urethral reconstruction in proximal hypospadias repair. The Bracka repair involving the transfer of inner prepuce like a Wolfe graft mostly results in satisfactory results besides a high fistula rate. The aim was to decrease the high fistula rate with Bracka repair; we wanted to use the advantages of vascularized skin in the Bracka method. The aim of this study was to evaluate our results with this modification. Our modification involves using a flap instead of a graft. In the first stage, chordee was corrected by transection of the urethral plate and dorsal midline plication when necessary. Instead of a graft as suggested by Bracka, inner preputial skin with ample blood supply was transferred and stitched to the denuded ventral penile surface. In the second stage after 6 months, this flap was tubularized in the Thiersch-Duplay fashion. Hospital records of patients who had undergone two stage modified Bracka repair between June 2007 and July 2012 were reviewed, including complaints, complications, and need for interventions. Thirty-eight patients had undergone this operation. Four patients were lost to follow-up. The main complaint was obstructed urinary flow. Voiding symptoms were first attributed to urethral stenosis, but were, however, found to be due to diverticulum and vortex of the urine in the dilated urethra. Twenty-one patients (61%) had voiding problems and 10 patients (29%) had urinary tract infections. Fistula was observed in 23 and diverticula were observed in 24 patients. Of these, 16 patients had both fistula and diverticula. Only two patients (5%) were free of complications and totally satisfied with the operation, and 23 of the 34 patients had complications requiring intervention (Figure). Inner preputial flaps used in proximal hypospadias repairs are prone to diverticula formation. They become redundant in time requiring reoperation, thus decreasing the success rate. Careful fixation of the

  20. The vastus intermedius periosteal (VIP) flap: a novel flap for osteoinduction.

    Science.gov (United States)

    Maercks, Rian Adam; Runyan, Christopher Michael; Jones, Donna Carlson; Taylor, Jesse Adam

    2010-07-01

    Periosteum's role in fracture healing is widely recognized, and its function in bone tissue engineering shows great potential. Here we introduce a novel periosteal free flap to be used as an abundant source of periosteum in the engineering and repair of bone. The descending branch of the lateral femoral circumflex vessels were isolated on 11 fresh human cadavers, preserving perforators to the vastus intermedius muscle. A cuff of vastus intermedius and approximately 75% of the circumference of the femoral periosteum were harvested from 6 cm proximal to the knee to 8 cm distal to the greater trochanter. Flap pedicle length and periosteal dimensions were measured. The pedicle arteries were injected with radiopaque dye, and radiographs were taken. A musculoperiosteal flap was elevated with visible descending perforators in each case. Mean flap surface area was 128 cm(2) (+/-99-143 cm(2)). Average pedicle length was 8 cm (+/-6-11 cm). Dye injection confirmed that the flaps blood supply was the descending branch of the lateral femoral circumflex artery. This anatomical study confirms the vascular supply of this large musculoperiosteal flap. Future work will test its efficacy as an osteoinductive agent in bone repair and tissue engineering in humans. Thieme Medical Publishers.

  1. scrotal reconstruction with a pedicled gracilis muscle flap after

    African Journals Online (AJOL)

    skin grafting yet eliminating the risks associated with potentially non reliable skin paddle in the myocutaneous flap. INTRODUCTION. Most scrotal defects are related to either trauma or infection particularly Fournier's gangrene (1). Fournier's gangrene is a polymicrobial, acute, rapidly spreading soft tissue necrotizing fasciitis.

  2. A new mucosal propeller flap (deep lingual artery axial propeller): the renaissance of lingual flaps.

    Science.gov (United States)

    Cordova, Adriana; Toia, Francesca; D'Arpa, Salvatore; Giunta, Gabriele; Moschella, Francesco

    2015-03-01

    Lingual flaps provide ideal mucosal coverage for intraoral defects but traditionally require two surgical stages. The authors present an axial mucosal propeller flap for single-stage intraoral reconstruction. The flap includes the mucosa of the lateral side of the tongue, islanded on the deep lingual vessels. Between 2011 and 2013, 23 patients underwent intraoral mucosal reconstruction with a deep lingual artery axial propeller flap after cancer resection in the cheek (n = 16), floor of the mouth (n = 2), retromolar trigone (n = 2), hard palate (n = 2), and soft palate (n = 1). Mean defect size was 19.5 cm. Preoperative and postoperative intraoral function was evaluated with the Functional Intraoral Glasgow Scale. The authors always achieved one-stage reconstruction with primary donor-site closure. The only complications were an infection treated conservatively and a late oronasal fistula caused by radiotherapy. All patients resumed an oral diet after 1 week and none required surgical revision. Mean 12-month postoperative Functional Intraoral Glasgow Scale score was better than the preoperative score (13.5 versus 12.8). The deep lingual artery axial propeller flap combines the advantages of the traditional lingual flap (i.e., reliable axial vascularization and like-with-like reconstruction) with those of a propeller flap (i.e., one-stage transfer of like tissue and extreme mobility) and has wider indications than a conventional lingual flap. The technique is fast and has low morbidity and good functional results, and the authors recommend it as a first-choice technique to reconstruct moderate to large intraoral defects. Therapeutic, IV.

  3. Studies on reconstruction of large skin defects following mammary tumor excision in dogs

    Science.gov (United States)

    Sadhasivan, Sabarish Babu Malli; Shafiuzama, Mohamed; Shammi, Mala; Rao, Ganne Venkata Sudhakar; Souza, Nitin J D; Senthilnayagam, Hemalatha; George, Ravi Sundar; Prabhakar, P. Manoj

    2017-01-01

    Aim: The main objective of the study was to describe the use of skin fold advancement flaps (SFAFs) and other reconstructive techniques for closure of large skin defects following mammary tumor excision in dogs. Materials and Methods: Twelve dogs underwent reconstruction of large ventral skin defects following mammary tumor excision with wide margins. Skin fold flaps (flank fold flap and elbow fold flap) were elevated from the flank and elbow region, respectively, and transposed and sutured onto the large ventral skin defect following mastectomy in all the dogs. In addition to the skin fold flaps, other reconstructive techniques such as undermining, walking sutures, and tension-relieving suture techniques were followed during surgery in the closure of large skin defects without skin tension and compromising limb mobility. The skin flap viability was assessed subjectively by gross observation of the flap such as color, temperature, capillary perfusion, and cosmetic appearance, and scoring (1-4) was done. Tissue samples were collected from a surgical site on days 3, 6, and 12 post-operatively for histopathological evaluation and healing status of the skin flap. Results: All the surgical wounds healed primarily, without any major complications and the skin flap remained healthy throughout the healing process post-operatively. Distal flap necrosis was noticed in one case and necrosis of skin flap between two suture lines was noticed in another case in which the necrotized distal portion healed by secondary intention after 7 days. The mean survival of subdermal plexus flap in the above cases was 98% which was a subjective evaluation based on surface area of the skin defect measured by Image’ J software and the flap dimensions. The average healing of skin flap in days was 14.91±0.86. Conclusion: The SFAFs along with other reconstructive techniques help in the reconstruction of large ventral skin defects following mastectomy in dogs without much compromising limb

  4. Studies on reconstruction of large skin defects following mammary tumor excision in dogs

    Directory of Open Access Journals (Sweden)

    Sabarish Babu Malli Sadhasivan

    2017-12-01

    Full Text Available Aim: The main objective of the study was to describe the use of skin fold advancement flaps (SFAFs and other reconstructive techniques for closure of large skin defects following mammary tumor excision in dogs. Materials and Methods: Twelve dogs underwent reconstruction of large ventral skin defects following mammary tumor excision with wide margins. Skin fold flaps (flank fold flap and elbow fold flap were elevated from the flank and elbow region, respectively, and transposed and sutured onto the large ventral skin defect following mastectomy in all the dogs. In addition to the skin fold flaps, other reconstructive techniques such as undermining, walking sutures, and tension-relieving suture techniques were followed during surgery in the closure of large skin defects without skin tension and compromising limb mobility. The skin flap viability was assessed subjectively by gross observation of the flap such as color, temperature, capillary perfusion, and cosmetic appearance, and scoring (1-4 was done. Tissue samples were collected from a surgical site on days 3, 6, and 12 post-operatively for histopathological evaluation and healing status of the skin flap. Results: All the surgical wounds healed primarily, without any major complications and the skin flap remained healthy throughout the healing process post-operatively. Distal flap necrosis was noticed in one case and necrosis of skin flap between two suture lines was noticed in another case in which the necrotized distal portion healed by secondary intention after 7 days. The mean survival of subdermal plexus flap in the above cases was 98% which was a subjective evaluation based on surface area of the skin defect measured by Image 'J software and the flap dimensions. The average healing of skin flap in days was 14.91±0.86. Conclusion: The SFAFs along with other reconstructive techniques help in the reconstruction of large ventral skin defects following mastectomy in dogs without much

  5. Microvascular Radial Forearm Fasciocutaneous Free Flap for Palatomaxillary Reconstruction Following Malignant Tumor Resection

    International Nuclear Information System (INIS)

    ELSHERBINY, M.; MEBED, A.; MEBED, H.

    2008-01-01

    The aim of this study is to report on the patient's quality of life and outcomes after reconstruction of palatomaxillary defects by microvascular radial forearm fasciocutaneous free flap (RFFF) and dental obturator. Material and Methods: During the period between 2005-2007, 10 patients who had palato maxillary defects were immediately reconstructed using RFFF to restore physiologic oronasal separation. All patients were treated for malignant tumors of hard palate or maxilla and all had preservation of orbital floor. Vascular anastomoses were done with the facial vessels in the neck. All the patients underwent a lateral thigh split-thickness skin graft for closure of the donor site. Outcome measurements included post-operative assessment of flap survival and healing, speech, swallowing and diet evaluation and quality of life. Dental rehabilitation was done 3 months postoperatively for all patients. Results: Flap survival was successful in all cases. In the first 2 weeks post operatively, 80% of patients had very good swallowing, speech and diet ability in the form of soft chewable foods and by the end of 6 months, all patients had very good swallowing and speech function and were able to eat all types of foods. Dental rehabilitation with obturator was easily applied and the presence of the flap did not interfere with its application. The technique improved chewing ability and cosmosis. Complications included, small oronasal fistula in 2 patients (20%) who required secondary sutures and delayed wound healing of donor site in one patient. Conclusion: RFFF for soft tissue reconstruction after maxillectomy is a reliable technique that provides a definitive physiologic separation between oral and nasal cavity. This allows very early improvement of speech and swallowing without being totally dependent on obturator. Dental rehabilitation to improve chewing and cosmoses can be done easily with minimal home care. Subsequently, the quality of life is markedly improved

  6. 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 .

  7. 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.

  8. Clinical application of the internal mammary artery perforator flap in head and neck reconstruction.

    Science.gov (United States)

    Yu, Benny T; Hsieh, Ching-Hua; Feng, Guan-Ming; Jeng, Seng-Feng

    2013-04-01

    The skin texture of the internal mammary artery perforator flap closely resembles that in the face and neck, making it the perfect source of tissue for head and neck reconstruction. In this article, the authors describe their experience in recent application of this flap in head and neck reconstruction and evaluate its pros and cons. A total of 15 patients (three women and 12 men) with a mean age of 58.6 years received an internal mammary artery perforator flap for head and neck defect repair from April of 2007 to August of 2011. There were 11 internal mammary artery perforator pedicle flaps and four internal mammary artery perforator free flaps. Flap size ranged from 5 × 3 cm to 15 × 8 cm, pedicle length ranged from 3 to 6 cm, and 14 of 15 flaps (93.3 percent) had a sizable perforator identified during dissection. In the female patient who had no sizable perforator, the originally intended free flap was transformed to a platysma myocutaneous flap, which served as a backup procedure, extending from the same surgical incision. All of the transfers were successful. The donor sites were closed primarily in all patients except one, who received a split-thickness skin graft for a 15 × 8-cm donor defect. With excellent skin color and tissue texture matching and minimal donor-site morbidity, the internal mammary artery perforator flap is emerging as a potential alternative reconstructive tool for the head and neck region.

  9. Scrotal reconstruction with superomedial fasciocutaneous thigh flap

    Directory of Open Access Journals (Sweden)

    DANIEL FRANCISCO MELLO

    2018-02-01

    Full Text Available ABSTRACT Objective: to describe the use of a superomedial fasciocutaneous thigh flap for scrotal reconstruction in open areas secondary to the surgical treatment of perineal necrotizing fasciitis (Fournier’s gangrene. Methods: retrospective analysis of cases treated at the Plastic Surgery Service of Santa Casa de Misericórdia, São Paulo, from 2009 to 2015. Results: fifteen patients underwent scrotal reconstruction using the proposed flap. The mean age was 48.9 years (28 to 66. Skin loss estimates in the scrotal region ranged from 60 to 100%. Definitive reconstruction was performed on average 30.6 days (22 to 44 after the initial surgical treatment. The mean surgical time was 76 minutes (65 to 90 to obtain the flaps, bilateral in all cases. Flap size ranged from 10cm to 13cm in the longitudinal direction and 8cm to 10cm in the cross-sectional direction. The complication rate was 26.6% (four cases, related to the occurrence of segmental and partial dehiscence. Conclusion: the superomedial fasciocutaneous flap of thigh is a reliable and versatile option for the reconstruction of open areas in the scrotal region, showing adequate esthetic and functional results.

  10. Sudden shrinkage of free rectus abdominis musculocutaneous flap 15 years after maxilla reconstruction

    Directory of Open Access Journals (Sweden)

    Yasushi Mochizuki

    2018-03-01

    Full Text Available A 60-year-old male displayed sudden shrinkage of a left free rectus abdominis musculocutaneous flap, which had been grafted to his left maxilla 15 years previously. No post-reconstructive irradiation had been performed, and no late occlusion of the vascular anastomosis, local infection, recurrence of the maxillary cancer, or body weight loss was observed. However, the shrinkage amounted to approximately 50%. This is considerably more than previously reported cases of shrinkage of various free flaps, which ranged between 10% and 25%. The resultant depression was successfully augmented with a right free deep inferior epigastric artery perforator flap. The residual fat volume of the previously grafted shrunken flap was revealed to be compatible with that of the newly harvested contralateral perforator flap. Thus, the volume of the previously grafted flap may reflect the status of the intact contralateral donor site, although the mechanism of sudden flap shrinkage is unclear.

  11. The Mice Drawer System (MDS) Tissue Sharing Programme: effect of space conditions on skin metabolic activity and vascularization and potential impact of radiations in mice.

    Science.gov (United States)

    Nusgens, Betty; Lambert, Charles; Liu, Yi; Cancedda, Ranieri; Tavella, Sara; Ruggiu, Alessandra; Colige, Alain

    Our aim was to investigate the effect of prolonged microgravity on skin physiology in mice and to identify potentially altered metabolic and vascular parameters. Osteoporosis-induced microgravity is a well documented space flight problem in Man and animals.We have previously demonstrated that fibroblasts from the dermis also sense and react to mechanical forces issued from the surrounding extracellular matrix. Conversely, fibroblasts are able to remodel their environment by a dynamic process of synthesis and degradation. Fibroblasts and cells of the vascular network also react to soluble mediators secreted by the keratinocytes such as IL-1, IL-6, VEGF, .... Skin fibroblasts upon relaxation of mechanical tension adopt a catabolic phenotype and produce significant amount of IL-1 and IL-6, of various matrix metalloproteinases (MMP) while the collagen synthesis is reduced. In microgravity, we have shown that the expression of MMP-1 and IL-6 by dermal fibroblasts is increased indicating that cell might interpret micro-gravity as a mechanical relaxation. This concept is supported by a reduction of the actin stress fibers and focal adhesions in fibroblasts in microgravity. Altogether, microgravity might alter metabolic equilibrium of the skin and perhaps of other soft connective tissues such as tendons or interstitial matrix of internal organs. The Mice Drawer System (MDS) is an Italian Space Agency facility which is able to support mice onboard the International Space Station during long-duration exploration missions by providing living space, food, water, ventilation and light-ing. Details on the mission that took place from August 28, 2009 to November 27, 2009, can be found at the URL indicated below. A similar ground control mission has been performed using the same wild type and transgenic mice overexpressing OSF-1. Upon receiving mice at KSC, the team has collected pieces of skin that were handled for histological, transcriptomic and biochemical analyses. The

  12. E2F1 Hinders Skin Wound Healing by Repressing Vascular Endothelial Growth Factor (VEGF Expression, Neovascularization, and Macrophage Recruitment.

    Directory of Open Access Journals (Sweden)

    Ningning Wang

    Full Text Available Refractory surface of wound and dermal chronic ulcer are largely attributed to poor neovascularization. We have previously shown that E2F1 suppresses VEGF expression in the ischemic heart, and that genetic deletion of E2F1 leads to better cardiac recovery. However, whether E2F1 has a role in dermal wound healing is currently not known.Skin wounds were surgically induced in E2F1-null (E2F1-/- mice and WT littermates. E2F1-/- displayed an accelerated wound healing including wound closure, dermal thickening and collagen deposition, which was associated with an increased endothelial cell proliferation and greater vessel density in the border zone of the wound. Furthermore, more macrophages were recruited to the skin lesions and the level of VEGF expression was markedly higher in E2F1-/- than in WT mice.E2F1 hinders skin wound healing by suppressing VEGF expression, neovascularization, and macrophage recruitment. Strategies that target E2F1 may enhance wound healing.

  13. Galeal flap based on superficial temporal vessels for oral cavity and pharynx reconstruction: an anatomical study

    Directory of Open Access Journals (Sweden)

    Fabio Pinto

    2008-01-01

    Full Text Available PURPOSE: Despite the advances in microvascular free tissue transfer for intraoral reconstruction, this surgery is not recommended for all patients. In specific cases, the pedicled temporoparietal galeal flap may be an option for reconstructive procedures in the head and neck regions. The objective of this paper is to present the anatomical aspects of a galeal flap based on the superficial temporal vessels and to test its potential for reconstructing diverse sites of the oral cavity and pharynx. METHODS: We performed 40 dissections on 34 fresh adult cadavers. The flap vascular anatomy was studied by injecting latex into the superficial temporal vessels. A standardized square-shape flap measuring 10 x 10 cm², pedicled on the superficial temporal vessels, was raised. Oral cavity and oropharynx reconstruction simulations were performed after flap transposition into the mouth by passing it under the zygomatic arch. Hypopharyngeal reconstruction was tested by transposing the flap to the neck under the facial nerve. RESULTS: After latex injection, a rich vascular network over the temporoparietal galea was observed directly from the superficial temporal artery, and a well-vascularized flap based on this vessel was raised. In the reconstruction simulations, the flap was shown to be suitable for the coverage of hypothetical defects in most oral cavity and pharyngeal sites, mainly the retromolar trigone, tonsil area, and buccal mucosa. CONCLUSIONS: A galeal flap based on the superficial temporal vessels presents favorable anatomical characteristics for oral cavity and pharyngeal reconstruction.

  14. Is There an Indication for Digital Subtraction Angiography in the Assessment of Irradiation-Induced Vascular Damage before Free Flap Surgery by the Means of the Internal Mammary Vessels?

    NARCIS (Netherlands)

    Klein, Steven; Hoving, Saske; Werker, Paul; Russell, Nicola

    Secondary breast reconstruction is increasingly performed after postmastectomy radiotherapy. Damage to blood vessel walls is one of the adverse effects of irradiation therapy, which may jeopardize reconstructive free flap surgery. It would be of great importance to be informed about the quality of

  15. A New Option for the Reconstruction of Primary or Recurrent Ischial Pressure Sores: Hamstring-Adductor Magnus Muscle Advancement Flap and Direct Closure.

    Science.gov (United States)

    Burm, Jin Sik; Hwang, Jungil; Lee, Yung Ki

    2018-04-01

    Owing to the high recurrence rates of ischial pressure sores, surgeons should consider the possibility of future secondary flap surgery during flap selection. The purpose of this article is to present a new surgical option for the reconstruction of primary or recurrent ischial pressure sores using a simple hamstring-adductor magnus advancement flap and direct closure. After horizontal fusiform skin excision, complete bursa excision and ischiectomy were performed. The tenomuscular origin of the adductor magnus and the conjoined tenomuscular origin of the biceps femoris long head and semitendinosus were isolated and completely detached from the inferior border of the ischial tuberosity. They were then advanced in a cephalad direction without detachment of the distal tendon or muscle and securely affixed to the sacrotuberous ligament. The wound was directly closed without further incision or dissection. Twelve ischial pressure sores (6 primary and 6 recurrent; 12 patients) were surgically corrected. The follow-up period was 12 to 65 months. All patients healed successfully without early postoperative complications, such as hematoma, seroma, infection, wound dehiscence, or partial necrosis. Late complications included wound disruption 5 weeks after surgery that spontaneously healed in 1 case and recurrence 3 years later in another case. The new surgical option presented herein, which involves hamstring-adductor magnus advancement flap and direct closure, is a simple and reliable method for providing sufficient muscle bulk to fill the dead space and proper padding to the bone stump while preserving the main vascular perforators and pedicles as well as future surgical options.

  16. Intravascular heparin protects muscle flaps from ischemia/reperfusion injury.

    Science.gov (United States)

    Li, X; Cooley, B C; Fowler, J D; Gould, J S

    1995-01-01

    Heparin has been found to decrease ischemia/reperfusion injury in skeletal muscle and other tissue/organ systems. The timing of heparin administration to the muscle vasculature has not been explored. We investigated the use of heparinized blood as a washout solution during ischemia to reduce ischemia/reperfusion injury. A rat cutaneous maximus muscle free flap was subjected to a 10-hr period of room temperature ischemia, then was heterotopically transplanted to the groin via microsurgical revascularization to the femoral vessels. In three experimental groups, flaps were subjected to brief ex vivo perfusion with autologous heparinized blood, at 2, 5, or 8 hr into the 10-hr ischemic interval. In the two other groups, the flaps were not perfused, and the animals were systemically heparinized either before ischemia or before transplantation, respectively. A control group underwent no flap perfusion or systemic heparinization. After transplantation, flaps were given a 48-hr period of in vivo reperfusion, then were harvested for evaluation. Flaps undergoing ex vivo perfusion or preischemic heparinization had no significant differences in weight gain (edema) compared with flaps receiving posttransplant heparinization or no heparinization (controls). The dehydrogenase staining of muscle biopsies was significantly faster (indicative of viable tissue) for perfused flaps and the flaps for which the animals received preischemic heparinization, when compared with flaps for which the animals received posttransplant heparinization or no heparinization. From these results, we conclude that heparin offers protection from ischemia/reperfusion injury when it can be introduced into the vascular network either prior to or during the ischemia period. These findings suggest the possibility of using heparinized washout solutions to enhance survival in amputated extremities.

  17. Supraclavicular flap in the reconstruction of defects of the head and neck (literature review

    Directory of Open Access Journals (Sweden)

    O. A. Saprinа

    2017-01-01

    Full Text Available The article presents a literature review on the use of the displaced skin and fascial supraclavicular flap in the reconstruction of defects of the head and neck. Given that the flap was relatively recently introduced into clinical practice, we have found it necessary to consider the anatomical features, scope, intake flap technique, complications and long-term results.

  18. Temporalis myo-osseous flap: an experimental study

    International Nuclear Information System (INIS)

    Antonyshyn, O.; Colcleugh, R.G.; Hurst, L.N.; Anderson, C.

    1986-01-01

    The present paper investigates the anatomy and vascularization of the temporalis myo-osseous flap. This is a calvarial bone flap that employs temporalis muscle and its distal pericranial extension as a pedicle. In six human cadavers the flap was raised as an island on the anterior deep temporal artery after transecting the zygomatic arch and coronoid process. Maximal mobilization was thus obtained, allowing rotation of the flap into the mouth for intraoral reconstruction. The arc of rotation and potential surgical applications were noted. A comparative study of the temporalis myo-osseous flap and free calvarial bone graft was then conducted in a rabbit model. Vascularization of the calvarial bone flap was confirmed by technetium scintigraphy performed on the first postoperative day. The uptake of fluorochrome labels immediately after transfer verified the adequacy of the periosteal circulation in maintaining viability and new osteoid formation throughout the full thickness of calvarial bone. The transplantation of free calvarial bone grafts was followed by necrosis of most cellular elements. This was demonstrated by an absence of fluorochrome uptake up to 19 days postoperatively and a predominance of empty lacunae and nonviable marrow

  19. Estrogens and aging skin

    OpenAIRE

    Thornton, M. Julie

    2013-01-01

    Estrogen deficiency following menopause results in atrophic skin changes and acceleration of skin aging. Estrogens significantly modulate skin physiology, targeting keratinocytes, fibroblasts, melanocytes, hair follicles and sebaceous glands, and improve angiogenesis, wound healing and immune responses. Estrogen insufficiency decreases defense against oxidative stress; skin becomes thinner with less collagen, decreased elasticity, increased wrinkling, increased dryness and reduced vascularity...

  20. The Use of Keystone Flaps in Periarticular Wound Closure: A Case Series

    Directory of Open Access Journals (Sweden)

    Thomas H. Jovic

    2017-11-01

    Full Text Available The Keystone perforator island flap (Keystone flap, is a Type A fasciocutaneous advancement flap, consisting of two V to Y advancement flaps. Skin cancer excision around joints presents a number of reconstructive challenges. Owing to the mobile nature of joints, the optimal periarticular reconstructive option should possess the ability to provide adequate tissue coverage and withstand regional changes in tensile pressures. We report a single-surgeon series of five cases of periarticular keystone flap between 2014 and 2017. Data were collected from operation notes, clinical photography, histopathology, and outpatient clinic records. The indication for keystone flap was skin cancer in all cases (n = 5. The largest defect size post-excision in was 75 mm × 40 mm × 15 mm. All keystone flaps demonstrate a color and cosmetic appearance comparable to adjacent tissue. There were no major postoperative complications including flap failure or impaired range of joint movement in the follow up period. Superficial wound infection occurred postoperatively in one case. This is the first case series to discuss the use of keystone flaps in periarticular wound closure. Locoregional fasciocutaneous wound coverage offered by keystone flaps may alleviate the risks of graft failure, contour defects, and donor site morbidity associated with alternative reconstructive options, with good functional and cosmetic outcomes. We advocate their use as a robust reconstructive option in periarticular areas.

  1. Gluteus Maximus Turnover Flap for Sacral Osteomyelitis After Radiation Therapy.

    Science.gov (United States)

    Ishiwata, Sho; Yanagawa, Takashi; Saito, Kenichi; Takagishi, Kenji

    2015-07-01

    Developments in radiation therapy modalities offer alternative treatments for unresectable malignant tumors in the pelvis and trunk. However, poor vascularity as a result of radiation therapy makes the treated lesion susceptible to infection, and there are no established treatments for pelvic osteomyelitis with a large dead space after radiation therapy. The authors report 2 cases of sacral osteomyelitis after radiation therapy that were treated successfully with a gluteus maximus turnover flap. To create the flap, the distal portion of the lower third of the muscle was detached from the trochanter. The distal edge of the flap was turned toward the sacral defect and sewn to the remnant of the sacrum, which filled the dead space with the muscle bulk. A 68-year-old man with a recurrent sacral chordoma was treated with carbon ion radiation therapy; however, a sacral infection developed 5 months later. Debridement and a course of antibiotics could not control the infection and did not induce sufficient formation of granulation tissue in the large and deep dead space. The turnover flap with both gluteus maximus muscles cured the deep-seated infection and closed the wound. A 58-year-old woman had sacral osteoradionecrosis with infection. A turnover flap created with the left gluteus maximus muscle controlled the infection and closed the wound after the first operation, a V-Y flap, failed. This study showed that a gluteus maximus muscle turnover flap effectively controlled infectious lesions with large and deep dead space around the sacrum. Copyright 2015, SLACK Incorporated.

  2. The versatility of propeller flaps for lower limb reconstruction in patients with peripheral arterial obstructive disease: initial experience.

    Science.gov (United States)

    Jiga, Lucian P; Barac, Sorin; Taranu, Georgel; Blidisel, Alexandru; Dornean, Vlad; Nistor, Alexandru; Stoichitoiu, Teodora; Geishauser, Max; Ionac, Mihai

    2010-02-01

    In this study, we evaluate the feasibility of propeller flaps, for soft tissue reconstruction in patients with peripheral arterial obstructive disease (PAOD). Five patients (average age, 72 years old), presenting with necrosis of several foot units, were diagnosed with stage IV PAOD and diabetes mellitus. All underwent revascularization, followed by soft tissue reconstruction using propeller flaps. A total of 6 flaps were performed, with dimensions ranging from 4 x 7 cm to 8 x 31 cm. Perforator origin was the peroneal (5 flaps) or the tibial posterior artery (1 flap). Average operative time was 190 minutes. Overall patency was 83.3%; 1 case was complicated with total flap loss followed by below-knee amputation; 1 case developed partial necrosis necessitating skin grafting. All flaps developed mild postoperative edema, which resolved spontaneously. Propeller flaps prove to be useful tools for soft tissue reconstruction in patients with PAOD because of low operative morbidity, easy technique with fast learning curve, and low complications rate.

  3. 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.

  4. Free anterolateral thigh flap harvesting from paralytic limbs in post-polio syndrome.

    Science.gov (United States)

    Changchien, Chih-Hsuan; Chen, Wei-Chen; Su, Yu-Min

    2016-01-01

    We report two cases of poliomyelitis in which an anterolateral thigh myocutaneous free flap was harvested from the paralytic limb for oral reconstruction. We observed a decrease in the pedicle diameter of the anterolateral thigh flap, but the blood supply to the skin paddle was adequate.

  5. Immediate emergency free anterolateral thigh flap after car-tyre friction injury: A case report with eight years follow-up

    Directory of Open Access Journals (Sweden)

    Abdullah Merter

    2017-01-01

    Full Text Available The car-tyre friction injury has differences from other injuries. The components of injury which are burn, crushing, shearing, and degloving occur. Many treatment options can be performed for coverage of wound which are Vacuum Assisted Closure system (V.A.C, skin grafting, free flaps, local flaps and cross leg flap.

  6. Reconstruction of complex thoraco-abdominal defects with extended anterolateral thigh flap

    Directory of Open Access Journals (Sweden)

    Yadav Prabha

    2010-01-01

    Full Text Available Background: The reconstruction of complex thoraco-abdominal defects following tumour ablative procedures has evolved over the years from the use of pedicle flaps to free flaps. The free extended anterolateral thigh flap is a good choice to cover large defects in one stage. Materials and Methods: From 2004 to 2009, five patients with complex defects of the thoracic and abdominal wall following tumour ablation were reconstructed in one stage and were studied. The commonest tumour was chondrosarcoma. The skeletal component was reconstructed with methylmethacrylate bone cement and polypropylene mesh and the soft tissue with free extended anterolateral thigh flap. The flaps were anastomosed with internal mammary vessels. The donor sites of the flaps were covered with split-skin graft. Result: All the flaps survived well. One flap required re-exploration for venous congestion and was successfully salvaged. Two flaps had post operative wound infection and were managed conservatively. All flap donor sites developed hyper-pigmentation, contour deformity and cobble stone appearance. Conclusion: Single-stage reconstruction of the complex defects of the thoraco-abdominal region is feasible with extended anterolateral thigh flap and can be adopted as the first procedure of choice.

  7. TRAM Flap for Immediate Post Mastectomy Reconstruction: Comparison between Pedicled and Free Transfer

    International Nuclear Information System (INIS)

    Bassiouny, M.M.; Maamoun, S.I.; El-Shazly, S.M.; Youssef, O.Z

    2005-01-01

    wall hernia, but abdominal wall weakness was evident in eight patients in the pedicled flap group that gradually improved over 2-3 months. Aesthetic results were comparable in both groups with a slightly better figure for the free flap group. but this was not statistically significant (ρ=0.23). Although free TRAM flap seems to provide several advantages over the pedicled group, namely skin volume available for harvesting, preservation of abdominal wall integrity, and better flap contouring, yet the pedicled TRAM flap is a reliable and easy technique that will produce matching aesthetic results

  8. The anatomy of forearm free flap phalloplasty for transgender surgery.

    Science.gov (United States)

    Kim, S; Dennis, M; Holland, J; Terrell, M; Loukas, M; Schober, J

    2018-03-01

    Transgender surgeries are becoming more frequent and visual interpretation of anatomy is essential for both surgeons and patients. Since the forearm free flap phalloplasty was introduced in 1984, it has been known to provide reliable cosmetic and functional results for transitioning men compared with phalloplasty by different flaps. Surgical text descriptions were enhanced by the creation of new anatomic illustrations. The forearm free flap consists of the anterior forearm skin, subcutaneous tissue, fascia containing the radial artery as the perforator and its venae comitantes, cephalic and basilic veins, and lateral and medial antebrachial cutaneous nerves are demonstrated in relation to the surgically derived flap. Song's forearm free flap phalloplasty requires two surgical stages with a three-month interval between the stages: prelamination of a neourethra and construction of a neophallus. The neophallus created by forearm flap phalloplasty is reported to achieve acceptable aesthetical and psychological satisfaction, appropriate size and shape, and satisfying sexual intercourse. Despite increasing experiences in gender confirming surgery with modifications made by many authors, urethral complications including fistula and/or stricture formation are the leading causes of reoperation. The poor esthetic outcome of the forearm donor site and a decrease in rigidity of the neophallus are the main limitations. Illustrations of anatomy help inform surgical choice and understanding of risks and benefits by patients. The anatomy of the free forearm flap phalloplasty supports creation of a neophallus for transsexual anatomy revision. Clin. Anat. 31:145-151, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

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

    Science.gov (United States)

    Patel, Nakul Gamanlal; Ramakrishnan, Venkat V.

    2016-01-01

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

  10. Subcutaneous tissue flaps for hallux covering.

    Science.gov (United States)

    Vaienti, Luca; Urzola, Victor; Scotti, Andrea; Masetto, L

    2010-03-01

    With the understanding of the extensive vascular supply of the subcutaneous tissue, of its efficacy in the protection of the anatomical structures and of its capability of promoting the adequate functioning of very stressed regions of the human body, the use of subcutaneous adipose flaps has become a valid and sometimes the only reasonable therapeutic weapon in the treatment of small and medium-sized tissue loss. Such a defect represents a common complication of great toe injuries and surgery. Here subcutaneous flap reconstruction is proposed for the treatment of dorsal and medial soft tissue losses of the hallux complicated with infection. Two case are reported. To the best of the authors' knowledge, this application has not been reported in this anatomical site so far. The technique might be worth knowing both for orthopedic and plastic surgeons, as it may represent a safe, less invasive solution for most tegumentary problems of the dorso-medial side of the first ray.

  11. Hand-foot skin reaction with vascular endothelial growth factor receptor tyrosine kinase inhibitors in cancer patients: A systematic review and meta-analysis.

    Science.gov (United States)

    Li, Jing; Gu, Jian

    2017-11-01

    A meta-analysis was conducted to systematically review the risk of hand-foot skin reaction (HFSR) with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) in patients with cancer. The relevant studies of the randomized controlled trials (RCTs) in cancer patients treated with VEGFR-TKIs were retrieved and the systematic evaluation was conducted. EMBASE, MEDLINE, and PubMed were searched for articles published till May 2017. Twenty-one RCTs and 9552 patients were included. The current analysis suggested that the use of VEGFR-TKIs increased the risk of all-grade HFSR (7.04;95%CI, 5.33-9.30;p<0.00001) and high-grade (≥grade 3) HFSR (21.62;95%CI, 15.19-30.78;p<0.00001). On subgroup analyses, the risk ratio (RR) of all-grade HFSR varies significantly according to cancer type, whereas the RR of high-grade HFSR did not. The risk of all-grade and high-grade HFSR did not affect by drug types, treatment line, median age and treatment duration. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Adipofascial Anterolateral Thigh Flap Safety: Applications and Complications

    Directory of Open Access Journals (Sweden)

    Tommaso Agostini

    2013-03-01

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

  13. Dermatosurgery rounds - the island SKIN infraorbital flap

    NARCIS (Netherlands)

    Tchernev, Georgi; Gianfaldoni, Serena; Wollina, Uwe; Lotti, T.; Lotti, Jacopo; França, Katlein; Batashki, Atanas; Maximov, Georgi Konstantinov

    2017-01-01

    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

  14. 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.

  15. T-shaped Pectoralis Major Musculocutaneous Flap for Reconstruction of an Extensive Circumferential Pharyngeal Defect

    Directory of Open Access Journals (Sweden)

    Shimpei Miyamoto, MD

    2014-04-01

    Full Text Available Summary: In the era of free-flap transfer, the pectoralis major musculocutaneous flap still plays a unique role in head and neck reconstruction. We report on a patient with a recurrent hypopharyngeal carcinoma after total pharyngolaryngectomy and adjuvant chemoradiotherapy in whom defects included a circumferential defect of the oropharynx and the entire tongue. The defects were successfully reconstructed with a T-shaped pectoralis major musculocutaneous flap whose skin island included multiple intercostal perforators from the internal mammary vessels. This flap design is effective for reconstructing circumferential pharyngeal defects in vessel-depleted neck.

  16. 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

  17. Blowing Flap Experiment: PIV Measurements

    Science.gov (United States)

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

    2004-01-01

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

  18. The extended abdominal wall flap for transplantation.

    Science.gov (United States)

    Hollenbeck, S T; Senghaas, A; Turley, R; Ravindra, K V; Zenn, M R; Levin, L S; Erdmann, D

    2011-06-01

    Patients with extensive loss of the abdominal wall tissue have few options for restoring the abdominal cavity. Composite tissue allotransplantation has been used for limited abdominal wall reconstruction in the setting of visceral transplantation, yet replacement of the entire abdominal wall has not been described. The purpose of this study was to determine the maximal abdominal skin surface available through an external iliac/femoral cuff-based pedicle. Five human cadaveric abdominal walls were injected with methylene blue to analyze skin perfusion based on either the deep inferior epigastric artery (DIEA; n = 5) or a cuff of external iliac/femoral artery (n = 5) containing the deep circumflex iliac, deep inferior epigastric, and superficial inferior epigastric, and superficial circumflex iliac arteries. Abdominal wall flaps were taken full thickness from the costal margin to the midaxillary line and down to the pubic tubercle and proximal thigh. In all specimens, the deep inferior epigastric, deep circumflex iliac, superficial inferior epigastric, and superficial circumflex iliac arteries were found to originate within a 4-cm cuff of the external iliac/femoral artery. Abdominal wall flaps injected through a unilateral external iliac/femoral segment had a significantly greater degree of total flap perfusion than those injected through the DIEA alone (76.5% ± 4% vs 57.2% ± 5%; Student t test, P DIEA vessel alone. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. [Surgical management of limb prosthetic vascular graft exposure].

    Science.gov (United States)

    Wu, Hao; Wu, Wei-wei; Bai, Ming; Zeng, Rong; Song, Xiao-jun; Chen, Yu; Liu, Chang-wei

    2012-12-01

    To investigate the risk factors and surgical management of limb prosthetic vascular graft exposure. The clinical data of 17 patients suffering from limb prosthetic vascular graft exposure in Peking Union Medical College Hospital from August 2006 to December 2011 were retrospectively analyzed. Among 17 cases, 5 suffered from prosthetic vascular graft exposure after vascular bypass for the lower limb ischemia, whereas 12 were affected after the artificial graft arteriovenous fistula construction in the upper limbs for hemodialysis. The surgical procedures mainly included the local debridement as well as the local flap and transferred muscle-cutaneous flap reconstruction to preserve the prosthetic vascular graft. All 17 patients underwent local flap or muscle-cutaneous flap coverage procedure. After the surgery, the prosthetic vascular graft was successfully salvaged in 14 cases. The total successful rate was 82.4%. The surgery failed in three patients, in whom the prosthetic vascular grafts were finally removed. Local flap and transferred muscle-cutaneous flap reconstruction is an effective surgical management to salvage the exposed grafts.

  20. 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.

  1. Sternocleidomastoid muscle flap preventing Frey syndrome following parotidectomy.

    Science.gov (United States)

    Filho, Wail Queiroz; Dedivitis, Rogério A; Rapoport, Abrão; Guimarães, André V

    2004-04-01

    Frey syndrome is one of the potential sequelae of parotidectomy. Various medical and surgical treatments have been used in an attempt to avoid this embarrassing condition. Recently, interposing barriers between the overlying skin flap and the parotid bed, such as the sternocleidomastoid muscle (SCM) flap, have been used to prevent this condition. The purpose of this study was to evaluate the impact of using this flap on Frey syndrome. A series of 138 patients who underwent subtotal or total parotidectomy from January 1995 to December 2001 were divided into two groups. One group had an SCM flap reconstruction (n = 24), and the other group did not (n = 19). A subjective clinical questionnaire and the objective Minor's starch iodine test were used to evaluate the incidence of this syndrome. The postoperative period varied from 12 to 90 months. The frequency exact test of Fisher and the nonparametric test of Mann-Whitney were applied. The association with the absence of sweating and the presence of the SCM flap was significant (p = 0.0002). There was no association with flushing or pain and the flap. There was a significant association with the starch iodine test and the presence of the flap (p = 0.0016). The only significant association of the epidemiologic and clinical characterization of the patients with a negative or positive Minor's test was between sweating and a positive Minor's test (p = 0.0001). The only significant aspect in the diagnosis of Frey syndrome is gustatory sweating. There is a significant association with a negative Minor's test and the presence of the SCM flap and with sweating and a positive Minor's test. The SCM flap is an efficient method for preventing Frey syndrome following parotidectomy.

  2. Rescate de colgajo muscular de trapecio con isla cutánea en paciente lesionado medular que precisa rehabilitación inmediata Rescue of a pedicled trapezious muscle flap with skin paddle in a patient with spinal cord injury who needded inmediate rehabilitation

    Directory of Open Access Journals (Sweden)

    J.M. Arévalo Velasco

    2011-12-01

    terapias VAC® y VIA® de absoluta indicación en heridas complejas tanto agudas como crónicas porque ahorran tiempo, no sólo en las curas, sino también en términos de estancia hospitalaria total a la vez que evitan tiempos quirúrgicos innecesarios y con alta morbilidad para los pacientes.Negative pressure therapy (subatmospheric is a noninvasive treatment modality included in the armamentarium of any Service of Plastic Surgery and also in General Surgery, Vascular Surgery and Traumatology Services. It can be applied in the treatment of both chronic and acute wounds to decrease the time and number of priests and also to reduce surgeries with high morbidity for the patient. We present a patient with depressive syndrome secondary to an unfortunate postoperative course of a vertebroplasty that produced an spinal cord injury, classified as ASIA C, level D4. The patient suffered a high dorsal ulcer with 6 months of complicated evolution which finally was covered with a pedicled trapezious flap with skin paddle and, again iatrogenicaly, suffered a partial loss of the paddle and a significant seroma at the donor site. In our opinion, this case is interesting because the use of negative pressure therapy with VAC® system allows: 1 Minimize the loss of flap tissue. 2 To decrease the number of cures. 3 To decrease the time in each healing. 4 Allows the patient to move in his wheelchair with two portable VAC® systems to assist to the gym and follow his rehabilitation program. 5 With this unexpected and fast evolution, the patient had a significant clinical improvement of his depressive-anxious state and 6 The final placement of a latest generation VAC-VIA® systems on autografts allowed the patient to go on with his occupational therapy and physiotherapy for the upper extremities. We think that VAC-VIA® therapy is completely indicated to complex acute and chronic wounds because it can save time in terms of total hospital stance and avoid unnecessary surgeries with high risk

  3. Bone scan in breast cancer patients with mastectomy and breast reconstruction with a myocutaneous TRAM flap

    International Nuclear Information System (INIS)

    Morales, Rosanna; Cano, Roque; Delgado, Ricardo; Munive, Carlos

    2014-01-01

    Objectives: To report findings in bone scans for breast cancer patients with mastectomy and breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM). Material and Methods: Inclusion criteria were: confirmed breast cancer, mastectomy, breast reconstruction with TRAM flap and bone scan performed after TRAM. Exclusion criteria were: Absence of bone scan image, breast reconstruction by other approaches. Results: Absence of uptake in TRAM flap in six patients, diminished uptake in skin near TRAM, with peripheral increased uptake in three and increased uptake in TRAM flap, in a patient with cancer recurrence, confirmed by biopsy. Conclusions: Bone scans in breast cancer patients with mastectomy and TRAM flap can have different imaging presentations, procedure details diminish reporting errors. TRAM flap may present fat necrosis areas, which should be differentiated from recurrence in bone scans. Additional imaging and biopsy will be needed to diagnose this finding. (authors).

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

    Science.gov (United States)

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

    2013-03-01

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

  5. Application of Indocyanine Green in Flap Surgery: A Systematic Review.

    Science.gov (United States)

    Li, Ke; Zhang, Zheng; Nicoli, Fabio; D'Ambrosia, Christopher; Xi, Wenjing; Lazzeri, Davide; Feng, Shaoqing; Su, Weijie; Li, Hua; Ciudad, Pedro; Tremp, Mathias; Zhang, Yi Xin

    2018-02-01

     The vascularization of the distal portions of transferred tissue represents the most critical factor in the success of reconstructive surgery. In recent years, indocyanine green (ICG) fluorescence imaging techniques have been applied during surgery to evaluate flap perfusion. However, this investigation has found that there is little consensus regarding the standard dose of ICG as well as the pre-operative requirements of ICG allergy testing. The aim of this study is to summarize the applications of ICG to tissue transfers and safe dosing practices and to provide insight to the possible adverse effects of ICG on flap surgery with the goal of helping clinicians apply ICG safely and efficiently to tissue transfer procedures.  A literature search was performed using, Wiley InterScience, and Springer with the key words, 'Flap,' 'indocyanine green,' 'surgery,' and related mesh words for all publications between 2005 and 2015. Title and abstract screening was performed using predefined in- and exclusion criteria.  Seventy-three articles were included. These were classified as "application of ICG in flap surgery" and "the security of applying ICG in flap surgery".  ICG fluorescence imaging preoperatively facilitates the detection of perforators in tissue flaps with thickness <20 mm, aids in the evaluation of flap microcirculation and perfusion, and allows surgeons to select dominant cutaneous nerves while evaluating the quality of vascular anastomoses and locating thromboses. The literature also concluded that potential allergic reactions to ICG should be taken into consideration. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. A Rapid, Simple, Effective, and Inexpensive Reconstructed Nipple Flap Guard.

    Science.gov (United States)

    Khan, Khurrum; Chevray, Pierre M

    2015-10-01

    Nipple reconstruction is a commonly performed component of breast reconstruction. A nipple reconstructed using local skin flaps requires protection from trauma. Here we describe a novel, effective, simple, rapid, inexpensive, and convenient method to protect a reconstructed nipple in the early postoperative period.

  7. Thoracodorsal artery perforator fasciocutaneous flap: A versatile alternative for coverage of various soft tissue defects

    Directory of Open Access Journals (Sweden)

    Celalettin Sever

    2012-01-01

    Full Text Available Objective: The thoracodorsal artery perforator (TDAP flap has contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous tissue. The optimal reconstruction method should provide thin, and well-vascularized tissue with minimal donor-site morbidity. The indications for the use of this particular flap with other flaps are discussed in this article. Materials and Methods: Thirteen patients underwent soft tissue reconstruction using TDAP flaps between 2009 and 2011. Of those, there were four cases of antecubital burn contracture, three cases of axillary burn contracture, two cases of giant hair cell nevus of upper extremity, two cases of axillary reconstruction following severe recurrent hidradenitis, and two cases of crush injury. All patients were male and their ages ranged from 20 to 23 (average, 21 years. The mean follow-up period was 8 months (range, 4-22 months. Results: All reconstructive procedures were completed without any major complications. Minor complications related to transfered flaps were wound dehiscence in one case, transient venous congestion in two cases. Minor complication related to the donor site was seroma in one case. The success rate was 100%, with satisfactory cosmetic results. Conclusions: The TDAP flap is a safe and extremely versatile flap that offers significant advantages in acute and delayed reconstruction. Although the vascular anatomy may be variable, free and pedicled TDAP flap is a versatile alternative for soft tissue defects. It adapts very well to the soft tissue defects with acceptable donor site scar.

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

    International Nuclear Information System (INIS)

    Schultz, Raymond O.; Lin, Kant; Lovell, Mark; Kelly, Maria

    1997-01-01

    2 and flaps in group three averaged 9.45 cm 2 . Skin elasticity also decreased when compared to non-operated skin. Once again the decrease was greater in the irradiated rats and correlated with the dosage of the radiation. Control flaps had a stiffness of 3.21 N/cm 2 and group three flaps had a stiffness of 4.52 N/cm 2 . Pathology results will also be presented. Conclusion: We conclude that a dose of 3000 rads delivered in 15 fractions will manifest reproducible radiation injury in a myocutaneous flap within eight weeks after exposure and can be delivered without harm to the animal. This model may now be used for a second phase study into the effects of various therapies on the irradiated rats

  9. Retalho venoso unipediculado transposto comparado ao não transposto: estudo experimental em coelhos Evaluation of unipediculated venous flap with and without transposition

    Directory of Open Access Journals (Sweden)

    Alfredo Benjamim Duarte da Silva

    2000-01-01

    Full Text Available Retalhos venosos são aqueles que apresentam em seu pedículo apenas uma veia, diferente dos retalhos convencionais que são caracterizados por entrada de sangue arterial e saída de sangue venoso. O objetivo deste trabalho foi determinar se a transposição do retalho venoso unipediculado modifica a sua área de sobrevida e vascularização. As orelhas de oito coelhos foram submetidas à realização de retalhos venosos. Dissecou-se um retalho de pele de dois por dois centímetros baseado no pedículo distal da veia marginal anterior. Os retalhos foram divididos em dois grupos: no grupo I(n=8, os retalhos venosos foram levantados e suturados na mesma posição; no grupo II (n=8, os retalhos foram levantados e transpostos 90 graus. Estes dois grupos foram comparados entre si e ao grupo III(n=8, no qual foi realizado enxerto de pele com subcutâneo sobre um leito bem vascularizado. A área média de necrose no grupo I (6,5% foi significativamente menor que no grupo II (43,75%, e as áreas de necrose dos grupos I e II foram significativamente menor do que no grupo III (88,75%. O estudo angiográfico não mostrou alterações no padrão vascular comparando-se os grupos I e II. A veia marginal anterior foi importante para a sobrevida do retalho. Houve uma maior área de necrose do grupo II, em que foi realizada transposição, em relação ao grupo I.Conventional flaps are caracterized by arterial blood inflow and venous blood outflow. Venous flaps have only one vein in their pedicle. Determination of survival area and vascularization in transpositioned venous flaps is the aim of this study. A 2x2 cm² skin flap, based in the distal pedicle of anterior marginal vein, was performed in 8 rabbits ears. The flaps were divided in two groups: group I (n=8-the flaps were elevated are fixated in the same position.; group II (n=8-the flaps were elevated and transpositioned in 90°. These two groups were compared in between and with group III (n=8, in which

  10. Radiation Therapy Versus No Radiation Therapy to the Neo-breast Following Skin-Sparing Mastectomy and Immediate Autologous Free Flap Reconstruction for Breast Cancer: Patient-Reported and Surgical Outcomes at 1 Year-A Mastectomy Reconstruction Outcomes Consortium (MROC) Substudy.

    Science.gov (United States)

    Cooke, Andrew L; Diaz-Abele, Julian; Hayakawa, Tom; Buchel, Ed; Dalke, Kimberly; Lambert, Pascal

    2017-09-01

    To determine whether adjuvant radiation therapy (RT) is associated with adverse patient-reported outcomes and surgical complications 1 year after skin-sparing mastectomy and immediate autologous free flap reconstruction for breast cancer. We compared 24 domains of patient-reported outcome measures 1 year after autologous reconstruction between patients who received adjuvant RT and those who did not. A total of 125 patients who underwent surgery between 2012 and 2015 at our institution were included from the Mastectomy Reconstruction Outcomes Consortium study database. Adjusted multivariate models were created incorporating RT technical data, age, cancer stage, estrogen receptor, chemotherapy, breast size, body mass index, and income to determine whether RT was associated with outcomes. At 1 year after surgery, European Organisation for Research and Treatment of Cancer (EORTC) Breast Cancer-Specific Quality of Life Questionnaire breast symptoms were significantly greater in 64 patients who received RT (8-point difference on 100-point ordinal scale, PBREAST-Q (Post-operative Reconstruction Module), Patient-Report Outcomes Measurement Information System Profile 29, McGill Pain Questionnaire-Short Form (MPQ-SF) score, Generalized Anxiety Disorder Scale, and Patient Health Questionnaire-were not statistically different between groups. Surgical complications were uncommon and did not differ by treatment. RT to the neo-breast compared with no RT following immediate autologous free flap reconstruction for breast cancer is well tolerated at 1 year following surgery despite patients undergoing RT also having a higher cancer stage and more intensive surgical and systemic treatment. Neo-breast symptoms are more common in patients receiving RT by the EORTC Breast Cancer-Specific Quality of Life Questionnaire but not by the BREAST-Q. Patient-reported results at 1 year after surgery suggest RT following immediate autologous free flap breast reconstruction is well tolerated

  11. Effect of high frequency transcutaneous electrical nerve stimulation on viability of random skin flap in rats Efeito da estimulação elétrica nervosa transcutânea em alta freqüência na viabilidade do retalho cutâneo randômico em ratos

    Directory of Open Access Journals (Sweden)

    Richard Eloin Liebano

    2006-06-01

    Full Text Available PURPOSE: To determine the effect of high frequency Transcutaneous Electrical Nerve Stimulation (TENS on viability of random skin flap in rats. METHODS: The sample of this study was 75 Wistar rats. The skin flap measured 10 x 4 cm and a plastic barrier was interposed between the flap and donor site. After the operative procedure, animals of all groups were maintained anesthetized one more hour with electrodes positioned in the base of the flap and submitted to treatment according of their respective group. This procedure was repeated on the two subsequent days. G1: sham stimulation (control, G2: TENS (f = 80 Hz and I = 5 mA, G3: TENS (f = 80 Hz and I = 10 mA, G4: TENS (f = 80 Hz and I = 15 mA, G5: TENS (f = 80 Hz and I = 20 mA. RESULTS: The average percentage of necrotic area was 43,11, 34,65, 49,44, 23,52, 45,10 in groups 1, 2, 3, 4 and 5 respectively. CONCLUSION: The amplitude of 15 mA presented a lower necrotic area than control group and Transcutaneous Electrical Nerve Stimulation was efficient in increasing the random skin flap viability.OBJETIVO: Avaliar o efeito da Estimulação Elétrica Nervosa Transcutânea (TENS em alta freqü��ncia na viabilidade do retalho cutâneo randômico em ratos. MÉTODOS: Foram utilizados 75 ratos da linhagem Wistar. O retalho cutâneo apresentava 10 x 4 cm, sendo que entre o mesmo e a área doadora foi realizada a interposição de uma barreira plástica. Após o procedimento operatório todos os animais permaneceram anestesiados por mais uma hora com os eletrodos posicionados na base do retalho e submetidos ao tratamento de acordo com seus respectivos grupos. Este procedimento se repetiu nos outros dois dias subseqüentes. G1: simulação da TENS, G2: TENS (f = 80 Hz e I = 5 mA, G3: TENS (f = 80 Hz e I = 10 mA, G4: TENS (f = 80 Hz e I = 15 mA, G5: TENS (f = 80 Hz e I = 20 mA. RESULTADOS: A porcentagem média de área de necrose foi de 43,11, 34,65, 49,44, 23,52, 45,10 nos grupos 1, 2, 3, 4 e 5

  12. Mastectomy Flap Thickness and Complications in Nipple-Sparing Mastectomy: Objective Evaluation using Magnetic Resonance Imaging.

    Science.gov (United States)

    Frey, Jordan D; Salibian, Ara A; Choi, Mihye; Karp, Nolan S

    2017-08-01

    Ischemic complications after nipple-sparing mastectomy (NSM) have been associated with numerous variables. However, the impact of NSM flap thickness has been incompletely evaluated. NSM flap thickness was determined for all NSMs from 2006 to 2016 with available pre- or postoperative breast magnetic resonance imaging (MRIs). Demographics and outcomes were stratified by those with and without ischemic complications. Of 1,037 NSM reconstructions, 420 NSMs had MRI data available, which included 379 preoperative MRIs and 60 postoperative MRIs. Average total preoperative skin/subcutaneous tissue NSM flap thickness was 11.4 mm. Average total postoperative NSM flap thickness was 8.7 mm. NSMs with ischemic complications were found to have significantly thinner overall postoperative NSM flap thickness compared with those without ischemic complications ( P = 0.0280). Average overall postoperative NSM flap thickness less than 8.0 mm was found to be an independent predictor of ischemic complications (odds ratio, 6.5263; P = 0.026). In NSMs with both pre- and postoperative MRIs, the overall average postoperative NSM flap thickness was 68.2% of preoperative measurements. Average overall postoperative NSM flap thickness was significantly less than average overall preoperative NSM flap thickness ( P < 0.0001). NSMs with ischemic complications were found to have a significantly lower ratio of overall postoperative to preoperative flap thickness (52.0% versus 74.0%; P < 0.0001). Ischemic complications after NSM are significantly associated with thinner postoperative NSM flap thickness. Particularly, NSM flap thickness less than 8.0 mm is a positive independent predictor of ischemic complications. The ratio of postoperative to preoperative NSM flap thickness was significantly lower in reconstructions with ischemic complications.

  13. Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis.

    Science.gov (United States)

    Gong, Xu; Cui, Jianli; Jiang, Ziping; Lu, Laijin; Li, Xiucun

    2018-03-01

    Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis. For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model. Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P < 0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand. Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction. © 2017 Royal Australasian College of Surgeons.

  14. Skin-Reducing Mastectomy in Immediate Reconstruction: How to Limit Complications and Failures.

    Science.gov (United States)

    Pechevy, Lolita; Carloni, Raphael; Guerid, Samia; Vincent, Pierre-Luc; Toussoun, Gilles; Delay, Emmanuel

    2017-06-01

    In hypertrophic and/or very ptotic breasts, skin-reducing mastectomy (SRM) is challenging and the risk of complications is high. Few publications have reported the use of an autologous latissimus dorsi flap (ALDF) in this indication. Most studies opt for implant reconstructions, with a high failure rate. We aimed to identify and present the technical refinements that reduce the risk of reconstruction failure in patients with hypertrophic and/or ptotic breasts with breast cancer or at risk of breast cancer after SRM with immediate breast reconstruction (IBR) utilizing an ALDF. Our retrospective study, covering a period of 18 years, included a series of 60 patients with hypertrophic and/or ptotic breasts who underwent 67 SRM and IBR procedures utilizing an ALDF. The complications were recorded and the risk factors analyzed. Sixty-seven SRMs were reviewed. Forty-nine procedures were performed with an inverted-T scar technique and 18 with a vertical scar technique. The nipple-areola complex (NAC) was preserved in 10 cases. There were eight (11.9%) cases of minor mastectomy flap necrosis after skin-reducing reconstructions, 16 (23.8%) wound dehiscences, no infections, no breast seromas, and no reconstruction failures. Smoking increased the risk of minor mastectomy flap necrosis (P = 0.048) and wound dehiscence (P = 0.002). Previous radiotherapy was associated with minor mastectomy flap necrosis (P = 0.001). The use of an ALDF together with technical refinements that preserve the vascular supply of the skin envelope leads to successful IBR with consistently good aesthetic results. Above all, it avoids failure of the reconstruction in very large or ptotic breasts. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  15. 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

  16. Thoraco-epigastric flap for breast reconstruction in cancer

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhayev,

    2015-01-01

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

  17. Mastectomy skin necrosis after microsurgical breast reconstruction.

    Science.gov (United States)

    Vargas, Christina R; Koolen, Pieter G; Anderson, Katarina E; Paul, Marek A; Tobias, Adam M; Lin, Samuel J; Lee, Bernard T

    2015-10-01

    Mastectomy skin necrosis represents a significant clinical morbidity after immediate breast reconstruction. In addition to aesthetic deformity, necrosis of the native mastectomy skin may require debridement, additional reconstruction, or prolonged wound care and potentially delay oncologic treatment. This study aims to evaluate patient and procedural characteristics to identify predictors of mastectomy skin necrosis after microsurgical breast reconstruction. A retrospective review was performed of all immediate microsurgical breast reconstructions performed at a single academic center. Patient records were queried for age, diabetes, active smoking, previous breast surgery, preoperative radiation, preoperative chemotherapy, body mass index, mastectomy type, mastectomy weight, flap type, autologous flap type, and postoperative mastectomy skin flap necrosis. There were 746 immediate autologous microsurgical flaps performed by three plastic surgeons at our institution during the study period. The incidence of mastectomy skin flap necrosis was 13.4%. Univariate analysis revealed a significantly higher incidence of mastectomy skin necrosis in patients with higher mastectomy weight (P mastectomy type. Multivariate analysis demonstrated statistically significant associations between mastectomy skin necrosis and both increasing mastectomy weight (odds ratio 1.348 per quartile increase, P = 0.009) and diabetes (odds ratio 2.356, P = 0.011). Increasing mastectomy weight and coexisting diabetes are significantly associated with postoperative mastectomy skin necrosis after microsurgical reconstruction. These characteristics should be considered during patient counseling, procedure selection, operative planning, and intraoperative tissue viability assessment. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Denonvilliers' advancement flap in congenital alar rim defects correction

    Directory of Open Access Journals (Sweden)

    Novaković Marijan

    2009-01-01

    Full Text Available Background. Alar rim defects are mostly acquired, resulting from burns, traumas or tumor excision. Sometimes they can accompany craniofacial clefts. However, isolated congenital alar defects are extremely rare. Case report. We presented two cases of congenital isolated alar cleft. The defect was closed by the use of an advancement flap, the technique described by Denonvilliers. We achieved both symmetry and appropriate thickness of the nostrils. Skin color and texture of the alar rim were excellent, with scars not excessively visible. Conclusion. Denonvilliers' z-plasty technique by using advancement flap provides both functionally and aesthetically satisfying outcome in patients with congenital alar rim defects.

  19. Taking care of your vascular access for hemodialysis

    Science.gov (United States)

    ... below as a reminder. What Is a Vascular Access? A vascular access is an opening made in your skin ... access into your body. Know What Type of Vascular Access You Have There are 3 main types of ...

  20. Meniscal repair by synovial flap transfer. Healing of the avascular zone in rabbits.

    Science.gov (United States)

    Cisa, J; Basora, J; Madarnas, P; Ghibely, A; Navarro-Quilis, A

    1995-02-01

    We studied repair of a longitudinal incision of the right medial meniscus in 44 rabbits after the transfer of a pedunculated synovial flap, without immobilization of the knee. The left medial meniscus was used as the control, after creating the same lesion without synovial flap. Healing was analyzed by histologic studies, including India ink perfusion after 8, 12, 24, and 48 weeks. In three quarters of the cases, the meniscus showed healing with vascularization of an originally avascular zone.

  1. Herpes Zoster Lesions on Reconstructed Breast Skin: Rare Objective Proof of Reinervation

    Directory of Open Access Journals (Sweden)

    Laurenz Weitgasser

    2017-01-01

    Full Text Available Blazed up Herpes zoster lesions have been described in very few patients after free and pedicled flap transfer for reconstructive purpose. Although sensory recovery after flap reconstructions has been studied extensively most studies addressed subjective perceptions of sensation. Objective investigations of spontaneous reinervation of free and pedicled flaps are rare. We would like to present a witnessed herpes zoster infection of a latissimus dorsi skin flap 2 years after breast reconstruction.

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

    Directory of Open Access Journals (Sweden)

    Masaki Fujioka

    2014-04-01

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

  3. Combination of Nasolabial V-Y Advancement Flap and Glabellar Subcutaneous Pedicled Flap for Reconstruction of Medial Canthal Defect

    Directory of Open Access Journals (Sweden)

    Hiromichi Matsuda

    2014-02-01

    Full Text Available A 77-year-old woman presented with a 1-year history of a right medial canthal tumor, which was histopathologically diagnosed as a basal cell carcinoma. After removal of the tumor with a 4-mm safety margin, the defect occupied the areas superior and inferior to the medial canthal tendon. We first reconstructed the lower part of the defect using a nasolabial V-Y advancement flap to make an elliptic defect in the upper part. We then created a glabellar subcutaneous pedicled flap to match the residual upper elliptic defect with the major axis set along a relaxed skin tension line. The pedicled glabellar flap was passed through a subcutaneous tunnel to the upper residual defect. At 6 months postoperatively, the patient showed no tumor recurrence and a good cosmetic outcome.

  4. Management of postirradiation recurrent enterocutaneous fistula by muscle flaps

    Energy Technology Data Exchange (ETDEWEB)

    Lui, R.C.; Friedman, R.; Fleischer, A.

    1989-07-01

    Occasionally surgeons have to operate on patients who have had previous abdominal or pelvic operations and irradiations for malignancies. Bowel resection with primary anastomosis under these circumstances is fraught with major complications such as anastomotic breakdown with intra-abdominal sepsis or recurrent enterocutaneous fistula, which are refractory to conventional management. New techniques for using vascularized muscle flaps from a distant nonirradiated field to achieve safe repair of the bowel defects in three such instances are presented.

  5. Effect of ischemia and reperfusion on neutrophil accumulation in equine microvascular tissue flaps.

    Science.gov (United States)

    Scott, W M; Fowler, J D; Matte, G; Allen, A L; Wilkinson, A A; Bailey, J V; Fretz, P B

    1999-01-01

    To investigate neutrophil accumulation after ischemia and reperfusion (IR) in microvascular tissue flaps in horses. Randomized controlled experiment. A total of 8 horses between 1 and 10 years of age, 4 of each sex. Control and experimental myocutaneous island flaps based on the superficial branch of the deep circumflex iliac vessels were dissected on each horse. Atraumatic vascular clamps were applied to the pedicle of the experimental flap for 90 minutes and then removed to allow reperfusion. Based on the assumption that rapid infiltration of neutrophils into affected tissues is a hallmark of IR injury, radiolabeled autogenous leukocytes were used to indirectly quantify neutrophil accumulation in flap tissues. Labeled leukocytes were administered through a jugular catheter 30 minutes before flap reperfusion. Biopsies were collected from each flap over a 6 hour postischemia time period; in group 1 (n = 4) from 0 to 6 hours postischemia, and in group 2 (n = 4) from 24 to 30 hours postischemia. Biopsies were examined scintigraphically and histologically for evidence of neutrophil infiltration. All control flaps survived and 6 of 8 experimental flaps survived. There was no significant evidence of acute neutrophil infiltration into flap tissues after reperfusion in either group. The results of this study suggest that equine myocutaneous flap tissues can survive a 90-minute ischemic period and reperfusion. No significant evidence of the occurrence of IR injury in flap tissues was found. The reasons for the previously reported failures of equine free tissue transfer remain uncertain, but they do not appear to be caused by neutrophil mediated injury associated with ischemia and reperfusion.

  6. Facial contour deformity correction with microvascular flaps based on the 3-dimentional template and facial moulage

    Directory of Open Access Journals (Sweden)

    Dinesh Kadam

    2013-01-01

    Full Text Available Introduction: Facial contour deformities presents with varied aetiology and degrees severity. Accurate assessment, selecting a suitable tissue and sculpturing it to fill the defect is challenging and largely subjective. Objective assessment with imaging and software is not always feasible and preparing a template is complicated. A three-dimensional (3D wax template pre-fabricated over the facial moulage aids surgeons to fulfil these tasks. Severe deformities demand a stable vascular tissue for an acceptable outcome. Materials and Methods: We present review of eight consecutive patients who underwent augmentation of facial contour defects with free flaps between June 2005 and January 2011. De-epithelialised free anterolateral thigh (ALT flap in three, radial artery forearm flap and fibula osteocutaneous flap in two each and groin flap was used in one patient. A 3D wax template was fabricated by augmenting the deformity on facial moulage. It was utilised to select the flap, to determine the exact dimensions and to sculpture intraoperatively. Ancillary procedures such as genioplasty, rhinoplasty and coloboma correction were performed. Results: The average age at the presentation was 25 years and average disease free interval was 5.5 years and all flaps survived. Mean follow-up period was 21.75 months. The correction was aesthetically acceptable and was maintained without any recurrence or atrophy. Conclusion: The 3D wax template on facial moulage is simple, inexpensive and precise objective tool. It provides accurate guide for the planning and execution of the flap reconstruction. The selection of the flap is based on the type and extent of the defect. Superiority of vascularised free tissue is well-known and the ALT flap offers a versatile option for correcting varying degrees of the deformities. Ancillary procedures improve the overall aesthetic outcomes and minor flap touch-up procedures are generally required.

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

    Directory of Open Access Journals (Sweden)

    Sandra Olivia

    2013-07-01

    Full Text Available Flap surgery is treatment for periodontal disease with alveolar bone destruction. Surgical periodontal flap with conventional incision will result in gingival recession and loss of interdental papillae after treatment. Dilemma arises in areas required high aesthetic value or regions with a fixed denture. It is challenging to perform periodontal flap with good aesthetic results and minimal gingival recession. This case report aimed to inform and to explain the work procedures, clinical and radiographic outcomes of surgical papilla preservation flap in the area that requires aesthetic. Case 1 was a surgical incision flap with preservation of papillae on the anterior region of teeth 11 and 12, with a full veneer crown on tooth 12. Case 2 was a surgical incision flap with preservation of papillae on the posterior region of tooth 46 with inlay restoration. Evaluation for both cases were obtained by incision papilla preservation of primary closure was perfect, good aesthetic results, minimal gingival recession and the interdental papillae can be maintained properly. In conclusion, periodontal flap surgery on the anterior region or regions that require high aesthetic value could be addressed with papilla preservation incision. Incision papilla preservation should be the primary consideration in periodontal flap surgery if possible.DOI: 10.14693/jdi.v19i3.144

  8. Reconstruction of fingertip defects with digital artery perforator flap.

    Science.gov (United States)

    Özcanlı, Haluk; Bektaş, Gamze; Cavit, Ali; Duymaz, Ahmet; Coşkunfırat, O Koray

    2015-01-01

    The aim of this study was to present our findings for the use of the digital artery perforator (DAP) flap in the covering of digital pulp defects. The study included 15 patients who underwent reconstruction of the fingertip using a DAP flap between July 2007 and February 2012. The blood supply of the perforator island flap was based on the distal and either radial or ulnar sides of the digit. Donor sites were closed using skin grafting in all cases. Static two-point discrimination (s2PD) and Semmes-Weinstein monofilament (SWM) testing was performed at the final follow-up to determine extension loss and sensorial improvement. Mean follow-up was 22 (range: 7 to 62) months. Flaps size was between 2 x 1 cm and 2.5 x 1.5 cm. Temporary venous congestion was observed in 12 of the 15 patients and was without complication. All patients returned to their normal daily activities and work within an average of 39 (range: 30 to 45) days. Mean two-point discrimination was 5.3 mm and SWM test results were between 3.61 and 4.56 at the final follow-up. The DAP flap appears to be a reliable procedure with several advantages as a single-stage operating procedure, easy to harvest, good sensory recovery and preservation of digital arteries.

  9. Fibular free flap with arteria peronea magna: the role of preoperative balloon occlusion.

    Science.gov (United States)

    Rahmel, Benjamin B; Snow, Thomas M; Batstone, Martin D

    2011-03-01

    The free fibular osteocutaneous flap is a commonly used donor for reconstruction of mandibular defects. Vascular abnormalities and leg trauma are relative contraindications to the use of a fibular free flap. Peroneal arteria magna (PAM) is one such vascular abnormality that may preclude the use of the graft due to the high risk of lower-limb ischemia. Lower-limb angiography is the standard for assessing the lower-limb vascular anatomy; however, the indications remain controversial. Although balloon occlusion has been used to assess the vascular supply in distal bypass surgery, there have no reported cases of balloon occlusion to assess the viability of the distal extremity with PAM. Intraoperative assessment of vascular anatomy with an aborted harvest can lead to significant morbidity and cost. Balloon occlusion provides a relatively safe and minimally invasive technique for assessment of potential lower-limb ischemia in patients with PAM. © Thieme Medical Publishers.

  10. Foot and Ankle Reconstruction Using the Distally Based Sural Artery Flap Versus the Medial Plantar Flap: A Comparative Study.

    Science.gov (United States)

    Mahmoud, Wael Hussein

    Soft tissue defects around the foot and ankle region often present an awkward problem for plastic surgeons. The medial plantar artery flap raised from the non-weightbearing instep of the plantar foot offers a thick, sensorial, durable, and glabrous skin. The reversed sural artery flap offers a reliable option for coverage with the advantages of a wide arc of rotation, adequate dimensions, and a reliable blood supply. The present study compared the outcomes of the medial plantar artery flap and the distally based sural artery flap in foot and ankle reconstruction. The present comparative cross-sectional study included 30 adult patients with soft tissue defects in the foot and around the ankle, who were divided into 2 equal groups. One group underwent reconstruction with the proximally based island medial plantar artery flap (MPAF). The second group underwent reconstruction with the reversed sural artery flap (RSAF). The operative time and complications were carefully recorded. The surgical outcomes in terms of flap survival, durability of coverage, and functional outcome were assessed for all patients. No significant differences were found between the 2 groups in age, sex, etiology, or site of the defect. The defect size was significantly smaller in the MPAF group than in the RSAF group (22 ± 2.7 cm 2 versus 66.2 ± 7.7 cm 2 ; p foot and ankle reconstruction. However, the MPAF offers better functional outcomes with a lower frequency of postoperative complications. Thus, the sensate MPAF is recommended for reconstruction of moderate-size defects of the foot and ankle region. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Simulation-based rhomboid flap skills training during medical education: comparing low- and high-fidelity bench models.

    Science.gov (United States)

    Denadai, Rafael; Saad-Hossne, Rogerio; Raposo-Amaral, Cassio Eduardo

    2014-11-01

    To assess if the bench model fidelity interferes in the acquisition of rhomboid flap skills by medical students. Sixty novice medical students were randomly assigned to 5 practice conditions with instructor-directed Limberg rhomboid flap skills training: didactic materials (control group 1), low-fidelity rubberized line (group 2) or ethylene-vinyl acetate (group 3) bench models; high-fidelity chicken leg skin (group 4) or pig foot skin (group 5) bench models. Pretests and posttests were applied, and Global Rating Scale, effect size, and self-perceived confidence were used to evaluate all flap performances. Medical students from groups 2 to 5 showed better flap performances based on the Global Rating Scale (all P 0.05). The magnitude of the effect was considered large (>0.80) in all measurements. There was acquisition of rhomboid flap skills regardless of bench model fidelity.

  12. [An alternative model of composite tissue transplantation in rat: the femur osteomyocutaneous flap].

    Science.gov (United States)

    Chen, Jianwu; Zhang, Dongliang; Chen, Chen; Su, Yingjun; Wang, Shiping; Guo, Shuzhong

    2014-01-01

    To reconstruct a simpler and reliable composite tissue transplantation model-the femur osteomyocutaneous flap for the replacement of hindlimb transplantation. Ten femur osteomyocutaneous flaps from 5 Lewis rats were transplanted into 10 syngeneic recipients' inguinal region. Their nutrient vessels were anastomosed with recipients vessels. The graft of this model was consisted of the groin flap and partial femur. To verify the feasibility of this model, gross and histological appearance were studied after transplantation to evaluate the viability of grafts. The operative time was (159.0 +/- 8.3) min with the harvesting time of (68.0 +/- 4.8) min and the ischemia time of (55. 8 +/- 6.8) min. The methylene blue injection showed rich blood supply of transplanted femur osteomyocutaneous flap. All the 10 flaps survived completely with pink skin color and hair regrowth. The histologic examination of the flaps also revealed the normal appearance of the viable skin and bone marrow. The femur osteomyocutaneous flap is a simple and reliable model for composite tissue transplantation, and its establishment will provide a new tool for the study of composite tissue allografts.

  13. Innervated digital artery perforator flap.

    Science.gov (United States)

    Ozcanli, Haluk; Coskunfirat, Osman Koray; Bektas, Gamze; Cavit, Ali

    2013-02-01

    To describe a technique for covering defects of the fingertips: the innervated digital artery perforator (IDAP) flap. A total of 17 patients were treated with an IDAP flap. The size of the flaps varied between 2 ×1 cm and 3.5 × 2 cm. Postoperative evaluation of the patients consisted of the Semmes-Weinstein Monofilament test, static 2-point discrimination, patient satisfaction, extension loss, and an investigation into complications. All IDAP flaps survived completely, and no patients required secondary interventions. The mean follow-up period was 7 months (range, 6-10 mo). The Semmes-Weinstein monofilament test results ranged from 3.22 to 3.84. The static 2-point discrimination in the flaps ranged from 2 mm to 4 mm (mean, 3.4 mm) compared with a range of 2 mm to 3 mm (mean, 2.7 mm) on the contralateral hand. There were no joint contractures in the reconstructed fingertips, although 2 patients developed mild hook nail deformity. One patient experienced mild cold intolerance, and 1 patient exhibited mild postoperative hypersensitivity. The advantages of the IDAP flap include minimally invasive surgery; a reliable, versatile flap; and the ease of the technique for different-sized fingertip defect reconstructions with few complications. The IDAP flap may be useful in fingertip amputations when the amputated part is not suitable for replantation. Therapeutic IV. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. Reliability of Free Radial Forearm Flap for Tongue Reconstruction Following Oncosurgical Resection

    Directory of Open Access Journals (Sweden)

    Gaurab Ranjan Chaudhuri

    2015-08-01

    Full Text Available Introduction Primary closure following oncosurgical resection of carcinoma tongue has been found to compromise tongue function in regards to speech and swallowing very badly. In contrast, reconstruction of tongue with free radial forearm flap following oncosurgical resection has shown promising functional outcome. Materials and Methods Thirteen patients (ten male and three female with squamous cell carcinoma involving anterior 2/3rd of tongue had undergone either hemiglossectomy or subtotal glossectomy. Reconstruction was done with free radial forearm flap following oncosurgical resection and neck dissection. All of them received postoperative radiotherapy. Follow-up ranged from 2 months to 2 years. The age of the patients ranged between 32 and 65 years. Flap dimension ranged from 7x6 cm to 10x8 cm. Vascular anastomosis performed in an end-to-end manner with 8-0 Ethilon® under loupe magnifiacation. Results Venous congestion occurred in one patient after 48 hours postoperatively and the flap underwent complete necrosis on postoperative day 5. Postoperative hematoma was found in one patient within first 24 hours of reconstruction. Re-exploration was done immediately, blood clots were removed. No fresh bleeding point was seen and the flap survived. In this series, 12 out of 13 flaps survived completely (92%. Conclusion The free radial forearm flap has become a workhorse flap in head and reconstruction due to its lack of extra bulk, relative ease of dissection, long vascular pedicle, good calibre vessels, malleability and minimal donor site morbidity. Furthermore its low flap loss and complication rate offer the best choice for tongue reconstruction.

  15. Minimising the donor area morbidity of radial forearm phalloplasty using prefabricated thigh flap: A new technique

    Directory of Open Access Journals (Sweden)

    Aditya Aggarwal

    2017-01-01

    Full Text Available Phalloplasty is indicated in various conditions of penile loss or absence. There are numerous techniques for phalloplasty including the pedicle and free flaps with the ultimate goal of micturition in standing position, attaining adequate size, aesthesis and sensations for sexual intercourse. Radial forearm phalloplasty is the gold standard flap to achieve above results but gives a very bad scar on the forearm. We present a technique of using prefabricated thigh flap to reduce the morbidity of donor area. The descending branch of lateral circumflex femoral pedicle was placed in a subcutaneous plane over tissue expander. After attaining an adequate size of flap with tissue expansion, it was delayed 3 weeks before phalloplasty. Prefabricated flap was thin and of large size replicating the radial forearm flap used for phalloplasty. Whole forearm defect was covered with the thigh flap, and the thigh could be closed primarily. This new technique of using prefabricated thigh flap has significantly reduced the donor site morbidity both aesthetically and functionally without the use of skin grafting in the whole procedure.

  16. The prefabricated temporal island flap for eyelid and eye socket reconstruction in total orbital exenteration patients: A new method.

    Science.gov (United States)

    Altindas, Muzaffer; Yucel, Akin; Ozturk, Guncel; Sarac, Mesud; Kilic, Ali

    2010-08-01

    Anophtalmic socket reconstruction is a challenging problem in plastic surgery. We had described a prefabricated superficial temporal fascia island flap and used this technique in >50 enucleation patients with severe socket contraction ending in excellent or good results for 28 years (Altindas- 1 procedure). However, the flap was not suitable for the exenteration patients with complete eyelid loss. The technique was modified and used in exenteration patients (Altindas-2 procedure). In this 2-staged procedure, the temporoparietal fascia is prefabricated with a full-thickness skin graft from the retroauricular area, and a strip of scalp is preserved at the middle of the flap. The flap is transferred to the orbit through a subcutaneous tunnel at the second stage. The prefabricated flap is used for the reconstruction of eyelids and periorbital skin; scalp island is used for the reconstruction of lid margins and eyelashes; and the neighboring bare temporoparietal fascia is used for the augmentation of the periorbital soft tissues. The orbital lining is elevated as a centrally based skin flap and used for the reconstruction of the eye socket, fornicles, and posterior lining of the eyelids. The technique was used successfully in 5 total exenteration patients with complete eyelid loss. In 1 patient, the ipsilateral temporal island flap was used previously, and the flap was prepared from the contralateral site and transferred to the anophtalmic orbit as a free flap 5 weeks later. By this procedure, it is possible to reconstruct a stable eye socket that is suitable for ocular prosthesis, upper and lower fornicles, periorbital skin with good color matching, naturally looking eyelids with eyelashes and lid margins, and medial and lateral canthal areas. It is also possible to improve periorbital soft tissue atrophy, which is an important problem in patients who had radiotherapy previously. Free transfer of the flap provides a new solution for the reconstruction of cases that

  17. Reverse saphenous conduit flap in small animals: Clinical applications and outcomes

    Directory of Open Access Journals (Sweden)

    Ross C. Elliott

    2014-02-01

    Full Text Available Due to the lack of skin elasticity defects of the distal hind limb can be a challenge to close. This article assesses a well-described, but completely under-used technique for closure of wounds on the distal tarsus. The technique was used with good success in six cases presenting to the Bryanston Veterinary Hospital with a wide range of underlying pathology ranging from trauma to neoplastic disease of the tarsus. All six cases were treated with a reverse saphenous conduit flap and two of them underwent radiation therapy with no adverse side effects. All cases showed excellent results with a very low degree of flap necrosis that never exceeded 15% of the total flap area. This skin flap provides an excellent treatment method that is reliable in closure of defects of the distal tarsus with few adverse effects. To the author’s knowledge there has been only one previously published report on the clinical use of this type of skin flap,even though the flap is well described in most texts.

  18. Reconstruction of Anterior Neck Scar Contracture Using A Perforator-Supercharged Transposition Flap

    Directory of Open Access Journals (Sweden)

    Yoshihiro Noda, MD

    2018-02-01

    Full Text Available Summary:. Reconstruction of the anterior neck requires attention to both aesthetic and functional outcomes. In general, skin grafts are not suitable for anterior neck reconstruction in Asian patients, even when artificial dermis is used before skin grafting. Therefore, we have employed various types of thin flaps for anterior neck reconstruction, including the cervico-pectoral flap. However, we have realized that, to fully release neck contractures and therefore achieve the full range of neck extension, the skin pedicle must be sufficiently wide. Therefore, we have started reconstructing anterior neck scar contractures using wide, thin, and long flaps that are harvested from the anterior chest wall. In this article, we describe the case of a 71-year-old man who presented with a neck contracture and tracheal fistula after receiving extensive burns. A transposition flap bearing the internal mammary artery perforator was harvested from the anterior chest wall to repair the neck wounds that were left after removing the scar. At the same time, the tracheal fistula was covered by the flap. The aesthetic and functional results were acceptable. The effectiveness of supercharged transposition flaps from the anterior chest wall for reconstructing anterior neck scar contraction is discussed.

  19. Reverse saphenous conduit flap in small animals: Clinical applications and outcomes

    Directory of Open Access Journals (Sweden)

    Ross C. Elliott

    2014-08-01

    Full Text Available Due to the lack of skin elasticity defects of the distal hind limb can be a challenge to close. This article assesses a well-described, but completely under-used technique for closure of wounds on the distal tarsus. The technique was used with good success in six cases presenting to the Bryanston Veterinary Hospital with a wide range of underlying pathology ranging from trauma to neoplastic disease of the tarsus. All six cases were treated with a reverse saphenous conduit flap and two of them underwent radiation therapy with no adverse side effects. All cases showed excellent results with a very low degree of flap necrosis that never exceeded 15% of the total flap area. This skin flap provides an excellent treatment method that is reliable in closure of defects of the distal tarsus with few adverse effects. To the author’s knowledge there has been only one previously published report on the clinical use of this type of skin flap,even though the flap is well described in most texts.

  20. [Application of skin and soft tissue expansion in treatment of burn injury].

    Science.gov (United States)

    Wang, N Z; Shen, Z Y; Ma, C X

    2000-09-01

    To evaluate the application of skin and soft tissue expansion in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound. From 1988, 83 cases of application of skin and soft tissue expansion were reported. In those patients with deformity due to severe burn of large area and with whole nasal defect, soft tissue expander was used under the forehead skin graft and venter frontalis, followed by reconstruction of nose with the expanded vascularized skin flap and carved cartilago costalis as nasal frame. In patients of severe deep electrical burned scalp and skull with fresh wound, skin and soft tissue expansion were used to repair the wound simultaneously with scalp burn alopecia, anesthetics and antibiotics injected into the extracapsular space of the expander in case of pain and infection. All of the cases were successfully treated with little pain and minimized infection. Skin and soft tissue expansion in a safe and reliable measure in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound.

  1. Terazosin and propranolol as blockers to the deleterious effect of nicotine in a random skin flap, in the rat Terazosina e propanolol como bloqueadores do efeito deletério da nicotina em um retalho cutâneo randômico, no rato

    Directory of Open Access Journals (Sweden)

    Andre V. Fonseca

    2004-06-01

    Full Text Available PURPOSE: To evaluate the effect of Terazosin and Propranolol on the prevention of necrosis induced by nicotine, in a random skin flap. METHODS: This study utilized 32 adult male Wistar-EPM rats divided, at random, into four groups of eight animals each. All the 32 animals received nicotine (2 mg/kg/day subcutaneously, for one week before and one week after flap elevation. CG (Control group received distilled water (0.2 ml/day by gavage and saline (0.5 ml intraperitoneally, for seven days in the postoperative period. TG (Terazosin group received terazosin hydrochloride (3 mg/day by gavage and saline, intraperitoneally, for seven days in the postoperative period. PG (Propranolol group received propranolol (1.5 mg/day intraperitoneally and distilled water, by gavage, following the stablished pattern. TPG (Terazosin + Propranolol group received both drugs. On the seventh postoperative day, the distal necrotic area of the flaps was determined via the paper template method. Blood and skin samples were collected in order to allow determination of Malondialdehyde (MDA levels RESULTS: The control group had a mean value of 39.5 % of necrosis; the Terazosin group 25.1 %; the Propranolol group 34.5 % and the Terazosin + Propranolol group 26.2 % of necrosis. MDA levels in the serum and in the skin samples behave similarly, with an exception regarding Propranolol group in this case. CONCLUSION: Terazosin is effective in the prevention of necrosis in this animal model and Propranolol is not effective in this case.OBJETIVO: O objetivo deste estudo experimental foi avaliar o efeito da Terazosina e do Propranolol na prevenção da necrose induzida pela nicotina, em um retalho cutâneo randômico. MÉTODOS: Este estudo utilizou 32 ratos machos adultos Wistar-EPM divididos, ao acaso, em quatro grupos de oito animais. Todos os 32 animais receberam nicotina (2 mg/kg/dia, por via subcutânea, por uma semana antes e uma semana após a elevação do retalho. O grupo CG

  2. Vascularized fibular graft in infected tibial bone loss

    Directory of Open Access Journals (Sweden)

    C Cheriyan Kovoor

    2011-01-01

    Full Text Available Background : The treatment options of bone loss with infections include bone transport with external fixators, vascularized bone grafts, non-vascularized autogenous grafts and vascularized allografts. The research hypothesis was that the graft length and intact ipsilateral fibula influenced hypertrophy and stress fracture. We retrospectively studied the graft hypertrophy in 15 patients, in whom vascularized fibular graft was done for post-traumatic tibial defects with infection. Materials and Methods : 15 male patients with mean age 33.7 years (range 18 - 56 years of post traumatic tibial bone loss were analysed. The mean bony defect was 14.5 cm (range 6.5 - 20 cm. The mean length of the graft was 16.7 cm (range 11.5 - 21 cm. The osteoseptocutaneous flap (bone flap with attached overlying skin flap from the contralateral side was used in all patients except one. The graft was fixed to the recipient bone at both ends by one or two AO cortical screws, supplemented by a monolateral external fixator. A standard postoperative protocol was followed in all patients. The hypertrophy percentage of the vascularized fibular graft was calculated by a modification of the formula described by El-Gammal. The followup period averaged 46.5 months (range 24 - 164 months. The Pearson correlation coefficient (r was worked out, to find the relationship between graft length and hypertrophy. The t-test was performed to find out if there was any significant difference in the graft length of those who had a stress fracture and those who did not and to find out whether there was any significant difference in hypertrophy with and without ipsilateral fibula union. The Chi square test was performed to identify whether there was any association between the stress fracture and the fibula union. Given the small sample size we have not used any statistical analysis to determine the relation between the percentage of the graft hypertrophy and stress fracture. Results : Graft

  3. An Alternative Posterosuperior Auricular Fascia Flap for Ear Elevation During Microtia Reconstruction.

    Science.gov (United States)

    Li, Yiyuan; Zhang, Ruhong; Zhang, Qun; Xu, Zhicheng; Xu, Feng; Li, Datao

    2017-02-01

    Advances in staged total auricular reconstruction have resulted in improved anterior auricular appearance; however, satisfactory postreconstruction esthetics of the retroauricular fold remain challenging. The postauricular appearance of the reconstructed ear depends largely upon optimizing the covering material. When used as the covering soft tissue for ear elevation, a flap containing primarily the upper portion of the retroauricular fascia has potential advantages over the conventional book cover-type retroauricular fascia flap. We developed a geometrically designed, posterosuperior auricular fascia flap to replace the conventional retroauricular fascia flap for ear elevation. During the second-stage operation, the posterosuperior auricular fascia flap is rotated downward and turned over to wrap around the inner strut and entire posterior auricular surface. Compared to the conventional book cover-type retroauricular fascia flap, the novel posterosuperior auricular fascia flap was easier to harvest and the operative time significantly decreased (110.3 vs. 121.5 min, p fascia flap improves ear elevation. Compared to the conventional book cover-type retroauricular fascia flap, this covering tissue is easier to perform so the surgical time is decreased. It was highly vascularized, well defined, thinner, and yields reliable results. Thus, favorable postauricular surface results can be achieved during auricular reconstruction by using the modified fascia flap. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.

  4. Immediate emergency free anterolateral thigh flap after car-tyre friction injury: A case report with eight years follow-up.

    Science.gov (United States)

    Merter, Abdullah; Armangil, Mehmet; Kaya, Burak; Bilgin, Sinan

    2017-01-01

    The car-tyre friction injury has differences from other injuries. The components of injury which are burn, crushing, shearing, and degloving occur. Many treatment options can be performed for coverage of wound which are Vacuum Assisted Closure system (V.A.C), skin grafting, free flaps, local flaps and cross leg flap. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Skin Autofluorescence in Systemic Sclerosis Is Related to the Disease and Vascular Damage: A Cross-Sectional Analytic Study of Comparative Groups

    Directory of Open Access Journals (Sweden)

    Jolanta Dadoniene

    2015-01-01

    Full Text Available Skin autofluorescence (AF, a relatively simple and time saving procedure, measures the accumulation of advanced glycation end (AGE products. The importance in autoimmune rheumatic diseases, particularly, systemic sclerosis (SSc, has not been evaluated yet. The aim of our study was to examine the skin AF in the context of SSc patients and to analyse the relations between skin AF and other surrogate measures of atherosclerosis. Forty-seven patients with SSc and 47 healthy volunteers were included in this study as controls. Patients and controls underwent common carotid artery wall assessment, arterial stiffness and wave reflection measurements, laser Doppler measurements of capillary flow, assessment of endothelial function by brachial ultrasound, peripheral arterial tonometry, and AGE measurement by skin AF. Wall properties of the common carotid arteries and wave reflection measurements were not affected in these study patients compared to controls while measures reflecting small capillary flow were altered. The accumulation of AGE products measured by skin AF was more prominent in SSc patients than in healthy controls. AGE products’ score was significantly associated with carotid radial pulse wave velocity, intima media/carotid artery diameter ratio, capillary flow percentage change during occlusion, and the disease itself in a multivariate linear analysis model.

  6. Skin Autofluorescence in Systemic Sclerosis Is Related to the Disease and Vascular Damage: A Cross-Sectional Analytic Study of Comparative Groups.

    Science.gov (United States)

    Dadoniene, Jolanta; Cypiene, Alma; Ryliskyte, Ligita; Rugiene, Rita; Ryliškiene, Kristina; Laucevičius, Aleksandras

    2015-01-01

    Skin autofluorescence (AF), a relatively simple and time saving procedure, measures the accumulation of advanced glycation end (AGE) products. The importance in autoimmune rheumatic diseases, particularly, systemic sclerosis (SSc), has not been evaluated yet. The aim of our study was to examine the skin AF in the context of SSc patients and to analyse the relations between skin AF and other surrogate measures of atherosclerosis. Forty-seven patients with SSc and 47 healthy volunteers were included in this study as controls. Patients and controls underwent common carotid artery wall assessment, arterial stiffness and wave reflection measurements, laser Doppler measurements of capillary flow, assessment of endothelial function by brachial ultrasound, peripheral arterial tonometry, and AGE measurement by skin AF. Wall properties of the common carotid arteries and wave reflection measurements were not affected in these study patients compared to controls while measures reflecting small capillary flow were altered. The accumulation of AGE products measured by skin AF was more prominent in SSc patients than in healthy controls. AGE products' score was significantly associated with carotid radial pulse wave velocity, intima media/carotid artery diameter ratio, capillary flow percentage change during occlusion, and the disease itself in a multivariate linear analysis model.

  7. The Pedicled LICAP Flap Combined with a Free Abdominal Flap In Autologous Breast Reconstructions

    Directory of Open Access Journals (Sweden)

    Thomas Sjøberg, MD

    2018-01-01

    Conclusion:. In selected patients with insufficient abdominal flap tissue, a combination of a free abdominal flap and a pedicled LICAP flap is a valuable option to increase breast size and cosmetic outcome. Additional symmetrizing surgery might still be necessary.

  8. Versatility of radial forearm free flap for intraoral reconstruction

    Directory of Open Access Journals (Sweden)

    Jeremić Jelena V.

    2015-01-01

    Full Text Available Introduction. The radial forearm free flap has an important role in reconstruction of the oncologic defects in the region of head and neck. Objective. The aim was to present and evaluate clinical experience and results in the radial forearm free transfer for intraoral reconstructions after resections due to malignancies. Methods. This article illustrates the versatility and reliability of forearm single donor site in 21 patients with a variety of intraoral oncologic defects who underwent immediate (19 patients, 90.5% or delayed (2 patients, 9.5% reconstruction using free flaps from the radial forearm. Fascio-cutaneous flaps were used in patients with floor of the mouth (6 cases, buccal mucosa (5 cases, lip (1 case and a retromolar triangle (2 cases defects, or after hemiglossectomy (7 cases. In addition, the palmaris longus tendon was included with the flap in 2 patients that required oral sphincter reconstruction. Results. An overall success rate was 90.5%. Flap failures were detected in two (9.5% patients, in one patient due to late ischemic necrosis, which appeared one week after the surgery, and in another patient due to venous congestion, which could not be salvaged after immediate re-exploration. Two patients required re-exploration due to vein thrombosis. The donor site healed uneventfully in all patients, except one, who had partial loss of skin graft. Conclusion. The radial forearm free flap is, due to multiple advantages, an acceptable method for reconstructions after resection of intraoral malignancies. [Projekat Ministarstva nauke Republike Srbije, br. 41006

  9. Thiel embalming technique: a valuable method for microvascular exercise and teaching of flap raising.

    Science.gov (United States)

    Wolff, Klaus-D; Kesting, Marco; Mücke, Thomas; Rau, Andrea; Hölzle, Frank

    2008-01-01

    Because of its high requirements on dexterity and microsurgical skills and the need of complete understanding of flap anatomy, microvascular free flap transfer belongs to the most demanding surgical procedures. Therefore, courses for flap raising and microvascular exercise are considered a prerequisite to prepare for clinical practise. To achieve teaching conditions as realistic as possible we used a novel cadaver embalming method enabling tissue dissection comparable to the living body. Thirty cadavers which were offered to us by the Institute of Anatomy for the purpose of running flap raising courses were embalmed in the technique described by Thiel. On each cadaver, nine free flaps were dissected according to a structured protocol by each course participant and afterwards used for microvascular exercise. The conservation of fine vascular structures and the suitability of the embalmed tissue for microvascular suturing were observed and photographically documented. The Thiel embalming technique provided flap raising procedures to be performed under realistic conditions similar to the living body. Vessels and nerves could be exposed and dissected up to a diameter of 1 mm and allowed for microvascular suturing even after weeks like fresh specimens. The Thiel embalming method is a unique technique and ideally suited to teach flap raising and microvascular suturing on human material. (c) 2008 Wiley-Liss, Inc. Microsurgery, 2008

  10. Reconstruction of soft-tissue lesions of the foot with the use of the medial plantar flap

    Directory of Open Access Journals (Sweden)

    Jefferson Lessa Soares de Macedo

    Full Text Available ABSTRACT OBJECTIVE: To study use of the medial plantar flap for reconstruction of the heel and foot. METHOD: The authors share their clinical experience with the use of the medial plantar artery flap for coverage of tissue defects around the foot and heel after trauma. Twelve cases of medial plantar artery flap performed from January 2001 to December 2013 were included. RESULTS: Of the 12 patients, ten were male and two were female. The indications were traumatic loss of the heel pad in ten cases and the dorsal foot in two cases. All the flaps healed uneventfully without major complications, except one case with partial flap loss. The donor site was covered with a split-thickness skin graft. The flaps had slightly inferior protective sensation compared with the normal side. CONCLUSION: From these results, the authors suggest that the medial plantar artery flap is a good addition to the existing armamentarium for coverage of the foot and heel. It is versatile flap that can cover defects on the heel, over the Achilles tendon and plantar surface, as well as the dorsal foot. It provides tissue to the plantar skin with a similar texture and intact protective sensation.

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

    Directory of Open Access Journals (Sweden)

    Durga Karki

    2012-01-01

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

  12. Laparoscopic rectosigmoid flap vaginoplasty.

    Science.gov (United States)

    Kim, Seok Kwun; Jeong, Jae Oo; Kwon, Yong Seok; Lee, Keun Cheol; Park, Ki Jae; Jung, Ghapjoong

    2011-09-01

    Various methods have been developed for vaginoplasty, of which the rectosigmoid flap has its own advantages including sufficient increase in the vaginal length and lower incidence of complications such as contracture or strain after vaginoplasty. Laparoscopic operation can greatly minimise the abdominal scar associated with laparotomy and allow cosmetically superior outcomes. Its minimally invasive procedure can also achieve rapid recovery and shorten the duration of hospital stay. Twelve patients (age range 18-40 years) had vaginoplasty using the rectosigmoid colon. We evaluated the ecological changes of the neovagina from the change of pH in the neovagina, culture of the normal flora, and vaginal wall biopsy taken 6 to 12 months postoperatively. Details of sexual activity were also examined. No patient from interviews developed vaginal narrowing as a result of the contracture that caused painful intercourse, or had smelly discharge or spontaneous bleeding from the vagina. Laparoscopic procedures may need only five-openings of 1-1.5 cm in diameter. Mean operating time was 130 minutes (IQR, 113-140) and duration of hospital stay 8.5 days (IQR, 7-11). Twelve months postoperatively the intravaginal pH was about 6. In one case, the histological test showed that the original columnar cell of the intestinal mucosa had been transformed to stratified squamous cell tissue. The key to the vaginoplasty is that it should give functional satisfaction and a minimal rate of complications. The laparoscopic rectosigmoid flap technique of vaginoplasty allowed less morbidity and excellent aesthetic and functional postoperative outcomes.

  13. Olympic torch flap: one-stop option for simultaneous brow, upper and lower lid reconstruction in post burn patients.

    Science.gov (United States)

    Vathulya, M; Chattopadhyay, D; Koyama, K

    2017-06-30

    Facial units reconstruction in a post burn patient poses tough challenges. Simultaneous brow and lid reconstruction is one of them. This article presents a 45-year-old epileptic male with burn of complete face. The task of reconstructing the brow, upper and lower lids was successfully accomplished using a modification of the Guyuron postauricular fasciocutaneous flap, after initial grafting and radial forearm flap reconstruction of forehead and other parts of the face. The article gives a single-stop solution for simultaneous reconstruction of brow and lids using a random pattern extension of the traditional postauricular flap, thus proving the excellent vascularity and hence durability of the flap in spite of a 180 degrees change in the orientation of the flap with respect to the axis.

  14. Trapezius Rotational Flap for Cervico-thoracic Wound Breakdown in Post-radiotherapy Necrosis : A Case Report

    Directory of Open Access Journals (Sweden)

    MH Ariffin

    2014-07-01

    Full Text Available The management of post-radiation wound breakdown over the posterior cervico thoracic region can be a challenging task for a surgeon. The aim of the treatment is to produce a well vascularized and a low tensile flap which will close a large defect. We describe the use of the lower trapezius flap to reconstruct the wound breakdown and to obtain stable tissue coverage in a patient with postradiation necrosis. This flap minimizes the disruption of the scapula-thoracic function while preserving the range of movement over the shoulder. From the literature review, it was noted that the dorsal scapular artery (DSA and transverse cervical artery (TCA aid in the blood supply to the trapezius muscle and prevent local necrosis during rotation of the flap. The trapezius flap is widely accepted because of the minor donor site morbidity, large arc of rotation and adequate blood supply.

  15. Dynamic Flaps Electronic Scan Antenna

    National Research Council Canada - National Science Library

    Gonzalez, Daniel

    2000-01-01

    A dynamic FLAPS(TM) electronic scan antenna was the focus of this research. The novelty S of this SBIR resides in the use of plasma as the main component of this dynamic X-Band phased S array antenna...

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

    Directory of Open Access Journals (Sweden)

    Charles M Malata

    2015-10-01

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

  17. Active Control of Long Bridges Using Flaps

    DEFF Research Database (Denmark)

    Hansen, H. I.; Thoft-Christensen, Palle

    The main problem in designing ultra-long span suspension bridges is flutter. A solution to this problem might be to introduce an active flap control system to increase the flutter wind velocity. The investigated flap control system consists of flaps integrated in the bridge girder so each flap...... is the streamlined part of the edge of the girder. Additional aerodynamic derivatives are shown for the flaps and it is shown how methods already developed can be used to estimate the flutter wind velocity for a bridge section with flaps. As an example, the flutter wind velocity is calculated for different flap...... configurations for a bridge section model by using aerodynamic derivatives for a flat plate. The example shows that different flap configurations can either increase or decrease the flutter wind velocity. for optimal flap configurations flutter will not occur....

  18. THORACO - ABDOMINAL FLAP FOR RESURFACING LARGE POST MASTECTOMY DEFECTS IN LOCALLY ADVANCED CA. BREAST

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao

    2015-02-01

    Full Text Available Covering of large wounds after mastectomy in locally advanced Ca breast with skin that can withstand radiotherapy is a challenge to the surgeon. Here this study we used a local advancement flap from the adjacent area called Thoraco - A bdominal F la p (TA flap for such giant defects. This is based on superficial and lumbar arteries and is thick to with stand consequent RT . MATERIALS AND METHODS: Of the total 107 cases of LABC 32 had post mastectomy defects of larger than 12 cm and could not be closed by simple approximation. Among the 32 cases 17 cases are covered by split thickness skin grafting. 15 cases are covered by TA flap. These cases are assessed for mean operating time, mean blood loss, post - operative stay, flap necrosis and viability of the f lap after radiotherapy. RESULTS: There is minimal extra time or blood loss in these cases . All the flaps healed well except for small edge necrosis in 4 cases. In all the patients we could start radiotherapy in the fourth week of surgery and all the flaps withstood RT well. After further evaluation probably this can be recommended as procedure for giant post mastectomy defects particularly for those who require RT early

  19. Early Monitoring of the Viability of the Buried Intrathoracic Omental Flap: A Feasibility Study

    NARCIS (Netherlands)

    van Wingerden, Jan J.; Collins, James M. P.; Coret, Elbertus H.; Schröder, Peter J. J.

    2010-01-01

    Purpose. The value of mobile, high-resolution gray-scale and color Doppler ultrasonography (US) in the immediate postoperative, intensive care setting for monitoring the buried flap and vascular pedicle of the laparoscopic or transdiaphragmatic harvested omentum for intrathoracic reconstruction was

  20. Lower abdominal wall reconstructions with pedicled rectus femoris flaps

    International Nuclear Information System (INIS)

    Arashiro, Ken; Nishizeki, Osamu; Ishida, Kunihiro

    2003-01-01

    During the past 10 years, seven pedicled rectus femoris muscle or musculocutaneous flaps were used to repair lower abdominal defects; three recalcitrant incisional hernias with previous radiotherapy, two long-standing wound infections after synthetic mesh reconstruction, one posttraumatic wall defect and one metastatic tumor. There were two flap complications, one skin paddle necrosis and one wound infection. There was no significant disability of the donor limb encountered. During the two-year and seven month average follow-up, there was no recurrence of the problems except for one minor fascial dehiscence in the patient with metastatic abdominal wall tumor. Easy approach, rapid harvest, relatively large and reliable overlying fascia lata, a single dominant neurovascular pedicle, easy primary closure of the donor site, and minimal donor site morbidity all make the rectus femoris flap a good alternative flap for lower abdominal wall reconstruction. It is especially useful in a condition where synthetic mesh would be unsuitable for defects with infection or recurrent incisional hernia after radiotherapy. (author)

  1. Total Lip Reconstruction with Tendinofasciocutaneous Radial Forearm Flap

    Directory of Open Access Journals (Sweden)

    Eldad Silberstein

    2014-01-01

    Full Text Available Introduction. Squamous cell carcinoma is a common tumour of lower lip. Small defects created by surgical resection may be readily reconstructed by linear closure or with local flaps. However, large tumours resection often results with microstomia and oral incompetence, drooling, and speech incomprehension. The goal of this study is to describe our experience with composite free radial forearm-palmaris longus tendon flap for total or near total lower lip reconstruction. Patients and Methods. This procedure was used in 5 patients with 80–100% lip defect resulting from Squamous cell carcinoma. Patients’ age ranged from 46 to 82 years. They are three male patients and two female. In 3 cases chin skin was reconstructed as well and in one case a 5 cm segment of mandible was reconstructed using radius bone. In one case where palmaris longus was missing hemi-flexor carpi radialis tendon was used instead. All patients tolerated the procedure well. Results. All flaps totally survived. No patient suffered from drooling. All patients regained normal diet and normal speech. Cosmetic result was fair to good in all patients accept one. Conclusion. We conclude that tendino-fasciocutaneous radial forearm flap for total lower lip reconstruction is safe. Functional and aesthetic result approaches reconstructive goals.

  2. Bilateral femoral posterior neurocutaneous perforater flap successfully treating Fournier gangrene

    Science.gov (United States)

    Wang, Tao; Zhao, Gang; Rui, Yong-Jun; Mi, Jing-Yi

    2017-01-01

    Abstract Rationale: Necrotizing fasciitis (NF), characterized by widespread fascial necrosis, is a rare disease in clinic. Fournier gangrene (FG) is a special type of NF involved of perineum and scrotum. To our knowledge, no article has reported on bilateral femoral posterior neurocutaneous perforater flap treating for FG. Patient concerns: A 61-year-old Chinese male complained of perineal skin necrosis for 19 days. The patient received treatment in other hospital due to chronic bronchitis on April 15th and body temperature ranged from 38 to 39 °C. Then he received antiinfection therapy. Perianal cutaneous occurred mild necrosis on May 08th. And the necrosis generally deteriorated. He came to our hospital for treating necrosis in area of perineum and scrotum on May 28th. Diagnoses: He was diagnosed with FG and chronic bronchitis. Interventions: The patient underwent debridement on June 2nd and received bilateral femoral posterior neurocutaneous perforater flap on June 29th. Besides, the patient was treated with whole-body nutrition support and antibiotic treatment. Outcomes: One week after the 2nd operation, the flap showed normal color. The result shows good outcome and no recurrence of the clinical symptoms occur till now. Lessons: FG is rare. Bilateral femoral posterior neurocutaneous perforater flap is an effective procedure to treat FG. The outcome of combined therapy is satisfactory. PMID:29145312

  3. The reading man flap for closure of large meningomyelocele defects.

    Science.gov (United States)

    Mutaf, Mehmet; Temel, Metin; Günal, Ertan

    2012-05-01

    Closure of the skin defect in myelomeningocele repair is an essential step that determines the quality of the surgical result. In large myelomeningoceles, however, adequate skin coverage may not be accomplished by direct closure or skin undermining. In such cases, the skin defect is best repaired using flaps. The aim of this study is to evaluate the reading man procedure for closure of large meningomyelocele defect. In this procedure, after neurosurgical repair and closure of the placode, the defect surgically becomes a circle in shape. Then, the circular defect is closed by transposition of two skin flaps designed in an unequal Z-plasty manner. Over 5 years, the reading man procedure was used for closure of large meningomyelocele defects in seven patients (four females and three males), aged between 1.5 and 6 months. The defect size was 10.5×7.25 cm (8.5×5.3 and 12.6×9.5 cm) on average. The localisation of the lesions was thoracolumbar in two patients and lumbosacral in five patients. In all patients, a successful tension-free one-stage closure was obtained without dog-ear formation. Except for one patient with minimal tip necrosis, healing was uneventful without any complications. There was no patient with late breakdown of the wound during 1.5 years (8 months-4 years) of mean follow-up. The reading man procedure enables the surgeon to achieve a tension-free defect closure of considerably large meningomyeleocele defects. Using two well-vascularised fasciocutaneous flaps, it provides a durable coverage and soft tissue padding over the neural tissues with no suture seam at midline. With these advantages, the Reading Man Procedure seems to be a useful and safe alternative for closure of large meningomyelocele defects. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. Pectoralis major myocutaneous flap--still a workhorse for maxillofacial reconstruction in developing countries.

    Science.gov (United States)

    Gadre, Kiran Shrikrishna; Gadre, Pushkar; Sane, Vikrant Dilip; Halli, Rajshekhar; Doshi, Pankaj; Modi, Sachin

    2013-11-01

    To retrospectively evaluate the utility of the pectoralis major myocutaneous (PMMC) flap for head, face, and neck (HFN) reconstruction in the Indian population. The hospital records of 496 patients in whom the PMMC flap was used (saving the deltopectoral flap) for reconstruction of HFN defects from January 1991 to December 2010 were reviewed retrospectively. All the patients were followed up for a minimum period of 6 months, and the utility of the PMMC flap was evaluated for HFN reconstruction. Of the 496 patients, complications developed in 84 patients. The complications included complete flap failure in 12, partial skin paddle loss in 24, wound infection in 12, peripheral wound dehiscence in 16, plate exposure in 12, and donor site morbidity such as infection and a decrease in function in 8. The PMMC flap or its modification was used in 496 cases of reconstruction after resection surgery for malignancy of the HFN region with minimal morbidity and 1 death. This technique is a useful alternative in places with a high incidence of HFN malignancies and microsurgical free tissue transfer is not possible or as a salvage procedure in selected large, full-thickness, oral cavity lesions. In our 19-year experience, the final functional and cosmetic results were satisfactory with this sturdy flap. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Postablative reconstruction of vulvar defects with local fasciocutaneous flaps and superficial fascial system repair.

    Science.gov (United States)

    Al-Benna, Sammy; Tzakas, Elias

    2012-08-01

    Postablative reconstruction of vulvar defects is a difficult challenge because of the functional, locational and cosmetic importance of this region. Local flaps carry a high incidence of delayed wound healing as local flaps may redistribute but not eliminate local wound tension. Repair of the superficial fascial system may avert local complications by minimising tension to the skin and increasing the initial biomechanical strength of wound. The aim of this study was to determine the clinical outcome of local fasciocutaneous flaps used for postablative reconstruction of vulvar defects in which the superficial fascial system was repaired. A retrospective analysis was conducted of patients with vulvar carcinoma in situ or vulvar carcinoma, who underwent ablation and immediate reconstruction with local fasciocutaneous flaps and superficial fascial system repair. Postoperative complications were recorded and clinical outcomes were evaluated. Twelve of the 13 flaps healed primarily. Complications included 2 superficial wound infections, both of which were treated successfully with antibiotic therapy. One flap was complicated by minor wound dehiscence, which healed with conservative treatment. Local fasciocutaneous flaps with superficial fascial system repair provide excellent design flexibility and can be designed and tailored to reconstruct postablative vulvar defects with good outcomes and minimal morbidity.

  6. Interdigitation of the distal anastomosis between tubed fasciocutaneous flap and cervical esophagus for stricture prevention.

    Science.gov (United States)

    Fujiwara, Takashi; Shih, Hsiang-Shun; Chen, Chien-Chang; Tay, Sherilyn Keng Lin; Jeng, Seng-Feng; Kuo, Yur-Ren

    2011-02-01

    Distal end circular stricture is a major complication following circumferential pharyngoesophageal reconstruction with tubed fasciocutaneous free flaps. To reduce the stricture rates, we have incorporated spatulation with interdigitation at the distal anastomosis site. This study investigated whether this procedure could decrease the stricture rate. Retrospective review. There were 51 patients who underwent tubed fasciocutaneous free flap reconstruction following total laryngo-pharyngo-esophagectomy between July 2002 and August 2008. The interdigitation technique was applied in 10 patients; the 41 remaining patients underwent simple circumferential anastomosis. This modification technique consists of incising both distal skin tube and cervical esophagus into three triangular parts, respectively, and interdigitation by interposition of these flaps. Of the 10 patients with this procedure, five patients were reconstructed with an anterolateral thigh flap and five with a radial forearm flap. All 10 patients received postoperative radiotherapy. The mean follow-up period was 30.2 months. Of the 41 patients without any modification, 12 patients (29.3%) developed a stricture; however, in our series of 10 patients undergoing this modification, there was no stricture formation except one (10.0%) who had been reconstructed with a radial forearm flap. The nine remaining patients all achieved a modified or unrestricted full oral diet without complications. Esophagography revealed a wide and patent anastomosis without stricture. This interdigitation technique could prevent circular contracture at the neopharyngoesophageal segment in reconstruction with tubed fasciocutaneous free flaps. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  7. Preservation of bone flap after craniotomy infection.

    Science.gov (United States)

    Delgado-López, Pedro David; Martín-Velasco, V; Castilla-Díez, J M; Galacho-Harriero, A M; Rodríguez-Salazar, A

    2009-04-01

    two operations extending over 4 hours. The interval between the initial surgery and the reintervention ranged from 11 to 227 days. Staphyloccocus spp were cultured in all patients. For bone sterilization povidone scrubbing was used in all patients, autoclave in two and soaking the flap in a sterilizing solution in three. All patients cleared infection and achieved complete wound healing in 2-3 weeks after the re-operation. Follow up ranged from 4 to 18 months. One patient died as a consequence of sepsis in the context of pneumonia some weeks after wound healing. Recent multivariate analyses have demonstrated that the presence of a CSF leak and the performance of repeated operations are the most important independent risk factors for craniotomy infection, with associated odds ratios for infection as high as 145 and 7, respectively. Regular antibiotic administration at anaesthesia induction seems to decrease the rate of craniotomy infection by half, both in the entire population and in low-risk subsets. Organisms involved in craniotomy infections are common pathogens usually contaminating neurosurgical procedures or normal skin flora germs. Auguste and McDermott have recently presented a case series of 12 patients in which successful salvage procedures for infected craniotomy bone flaps were performed using a continuous wash-in, wash-out indwelling antibiotic irrigation system, that needed close observation of the neurological status since obstruction of the outflow system could precipitate brain herniation. The method we present is as effective as theirs and avoids such complication since only small quantities of antibiotic solutions (20 cc) are instilled during each dose administration.

  8. Rhomboid cutaneous flap for defect correction after resection of trichoblastoma on dogs' face

    Directory of Open Access Journals (Sweden)

    Priscilla Bartolomeu de Araújo

    2016-06-01

    Full Text Available ABSTRACT: Surgical excision of neoplasms usually requires a large incision with safety margin, resulting in large cutaneous defects. Skin flaps permit closure of extensive cutaneous defects that would not be closed directly. The rhomboid cutaneous flap can be used in places of the body where a rhomboid defect with internal angles of 60 and 120 degrees can be made. The aim of this paper is to report the her use for reconstruction of the defect created after resection of a tumor on dogs' face . Total removal of the tumor and a safety margin was performed, and then the surgical defect was reconstructed with a rhomboid cutaneous flap. The final result was satisfactory, with an esthetically and functional acceptable scar, a without deformities to the oral commissure or eye. The cutaneous flap was considered a viable alternative for reconstruction of large surgical defects, of relatively simple execution and good functional and cosmetic results.

  9. Risk factors for delayed healing at the free anterolateral thigh flap donor site

    Directory of Open Access Journals (Sweden)

    Yoshiro Abe

    2018-01-01

    Full Text Available Background The free anterolateral thigh (ALT flap has been widely used for various kinds of reconstructions. However, delayed healing at the donor site occasionally occurs due to wound dehiscence or the partial loss of grafted skin at the donor site. The aim of the present study was to identify reliable predictive factors for delayed healing at the donor site after the harvest of a free ALT flap. Methods This study included 52 patients who underwent reconstructive procedures using free ALT flaps. The delayed healing group included patients with wounds at the donor site that had not healed over 3 weeks after surgery, and the normal healing group included patients who showed wound healing within 3 weeks after surgery. Multivariate logistic regression models were created to identify the risk factors for delayed healing at the ALT flap donor site. Results Among the 52 patients, 24 (46.2% showed delayed healing at the donor site, and 6 patients required additional operative treatment. A high preoperative body mass index (BMI, smoking, and skin grafting were found to be significantly associated with delayed healing at the ALT donor site. Of the 37 patients who underwent skin grafting, 23 (62% experienced delayed healing at the donor site. Conclusions A high preoperative BMI, smoking, and skin grafting were risk factors for delayed healing at the free ALT donor site. Skin grafting at the ALT donor site should be avoided in patients with a high BMI or a habit of smoking.

  10. Vascular Cures

    Science.gov (United States)

    ... vascular disease, such as stroke, aneurysm and pulmonary artery disease. Each one has their own unique story about their battle with vascular disease and their road to recovery. SEE PATIENT STORIES Our Supporters Caring ...

  11. Ação da l-arginina na evolução de retalhos cutâneos de ratos sob exposição à nicotina L-arginine action in cutaneous flap evolution under nicotine exposure in rats

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Thomé Nora Guimarães

    2013-02-01

    Full Text Available OBJETIVO: Avaliar se o tratamento com L-arginina influencia a cicatrização de retalhos cutâneos em ratos expostos à nicotina. MÉTODOS: Foram utilizados 40 ratos Wistar pesando 142,4±10,1g separados em quatro grupos: GC- tratamento com solução tampão fosfatos pH 7,4, confecção de retalho cutâneo, observação por 10 dias; GN- exposição à nicotina por quatro semanas, confecção de retalho cutâneo, observação por dez dias; GA- tratamento com solução tampão fosfatos pH 7,4 por quatro semanas, confecção de retalho cutâneo, tratamento com arginina por dez dias; GAN- exposição à nicotina por quatro semanas, confecção de retalho cutâneo, tratamento com arginina por dez dias. Foram avaliadas as áreas de necrose, re-epitelização, reação inflamatória e formação de tecido de granulação, pela coloração HE, a área de deposição total e a diferenciação de colágenos I e III por histometria com a coloração de picrosirius, e, através da marcação imunoistoquímica com anticorpo monoclonal anti-CD34, a densidade vascular cicatricial. RESULTADOS: As porcentagens de áreas de necrose de GN e GNA foram maiores (p0,05 e maiores (pOBJECTIVE: To evaluate whether treatment with L-arginine influences the healing of skin flaps in rats exposed to nicotine. METHODS: 40 male Wistar rats weighing 142.4 ± 10.1 g were separated into four groups: GC: treatment with 7.4 pH phosphate buffer, submitted to skin flap and observation for ten days; GN: exposure to nicotine for four weeks, submitted to skin flap and observation for ten days; GA: treatment with 7.4 pH phosphate buffer for four weeks, submitted to skin flap and arginine treatment for ten days; GAN: exposure to nicotine for four weeks, submitted to skin flap and treatment with arginine for ten days. We evaluated: areas of necrosis, re-epithelialization, inflammatory reaction and formation of granulation tissue by HE stain; the total area of deposition and differentiation

  12. A TRAM flap design refinement for use in delayed breast reconstruction.

    LENUS (Irish Health Repository)

    Patel, A J K

    2009-09-01

    Autologous breast reconstruction following mastectomy is commonly achieved using the free Transverse Rectus Abdominis Myocutaneous (TRAM) flap. Since its first description, refinements and modifications have resulted in improved operative techniques and more aesthetically pleasing reconstructions. Pre-operative flap design, however, is a relatively new concept that has not received much attention in the literature. Patients who undergo breast reconstruction may have large, ptotic contralateral breasts. In these patients there is a tendency to raise a large abdominal flap in an attempt to achieve symmetry, or simply a larger breast. This has the potential to lead to tight closure of the abdomen and the risk of subsequent wound problems. Reconstructions that are too small or have inadequate ptosis commit the patient to contralateral breast surgery to achieve symmetry. Pre-operatively designing the flap, using a template created from the opposite breast, can help achieve a good match, often reducing the need for contralateral breast surgery. Even when contralateral breast reduction surgery is planned in advance, many of these patients still require, and prefer, a large reconstruction in order to achieve a well-proportioned result. We present a design template that addresses these particular issues and in the senior author\\'s hands has proved to be a very effective technique. Our technique allows raising an abdominal flap of less vertical height than traditionally used (thus reducing the risk of tight abdominal closure) and incorporates an inverted V-shaped flap of skin from the inferior mastectomy skin flap into the reconstruction. This allows more flap tissue to be available to fill the upper poles of the reconstructed breast and at the same time produces good ptosis.

  13. PIV Measurements on a Blowing Flap

    Science.gov (United States)

    Hutcheson, Florence V.; Stead, Daniel J.

    2004-01-01

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

  14. Perforator anatomy of the ulnar forearm fasciocutaneous flap.

    Science.gov (United States)

    Mathy, Jon A; Moaveni, Zachary; Tan, Swee T

    2012-08-01

    The ulnar forearm fasciocutaneous flap (UFFF) is a favourable alternative to the radial forearm flap when thin and pliable tissue is required. The precise anatomy of the cutaneous perforators of UFFF has not been previously reported. The position of cutaneous perforators>0.5 mm was recorded while raising 52 consecutive free UFFFs in 51 patients at our Centre. Three (6%) UFFFs in two patients demonstrated direct cutaneous supply through a superficial ulnar artery, a known anatomic variance. There was no cutaneous perforator>0.5 mm in one flap. Among the remaining 48 dissections, an average of 3 (range, 1-6) cutaneous perforators were identified. Ninety-four percent of these forearms demonstrated at least one perforator>0.5 mm within 3 cm, and all had at least one perforator within 6 cm of the midpoint of the forearm. Proximal perforators were more likely to be musculo-cutaneous through the edge of flexor carpi ulnaris or flexor digitorum superficialis, while mid- to distal perforators were septo-cutaneous. UFFF skin paddle designed to overlie an area within 3 cm of the midpoint between the medial epicondyle and the pisiform is most likely to include at least one cutaneous perforator from the ulnar artery, without a need for intra-operative skin island adjustment. This novel anatomic finding and other practical generalisations are discussed to facilitate successful elevation of UFFF. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. WITHDRAWN: The extended abdominal wall flap for transplantation.

    Science.gov (United States)

    Hollenbeck, S T; Senghaas, A; Turley, R; Ravindra, K V; Zenn, M R; Levin, L S; Erdmann, D

    2011-11-01

    Patients with extensive loss of abdominal wall tissue have few options for restoring the abdominal cavity. Composite tissue allotransplantation has been used for limited abdominal wall reconstruction in the setting of visceral transplantation, yet replacement of the entire abdominal wall has not been described. The purpose of this study was to determine the maximal abdominal skin surface available through an external iliac/femoral cuff-based pedicle. Five human cadaver abdominal walls were injected with methylene blue to analyze skin perfusion based on either the deep inferior epigastric artery (DIEA; n = 5) or a cuff of external iliac/femoral artery (n = 5) containing the deep circumflex iliac, deep inferior epigastric, superficial inferior epigastric, and the superficial circumflex iliac arteries. Abdominal wall flaps were taken full thickness from the costal margin to the mid-axial line and down to the pubic tubercle and proximal thigh. In all specimens, the deep inferior epigastric, deep circumflex iliac, superficial inferior epigastric, and the superficial circumflex iliac arteries were found to originate within a 4-cm cuff of the external iliac/femoral artery. Abdominal wall flaps injected through a unilateral external iliac/femoral segment had a significantly greater degree of total flap perfusion than those injected through the DIEA alone (76.5 +/- 4% versus 57.2 +/- 5%; Student t test, P DIEA vessel alone. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. [Osteoplastic flap: our experience].

    Science.gov (United States)

    López Llames, A; Llorente Pendás, J L; Suárez Fente, V; Burón Martínez, G; Suárez Nieto, C

    2003-01-01

    Despite the advances of endoscopic surgical techniques, the frontal sinus obliteration via the osteoplastic flap (OPF) remains the treatment option for frontal sinus pathologies. The aim of this study is to evaluate indications, procedures and results of this technique. Retrospective study of thirty one patients that underwent OPF procedure between 1986 and 1999. The average patient's age was 42 years. The treated pathologies were: 12 mucoceles, 8 fractures, 4 osteomas, 4 sinutisis, 1 frontal abscess, 1 frontal osteomielitis and 1 orbital celullitis. The main clinical symptoms were headache (32%) and nasal obstruction (29%). The surgical approaches es used were: brow incision in 24 patients (78%), bicoronal in 5 (16%) and through the frontal wound in 2 traumatic cases (6%). Endonasal surgical procedures were associated in 8 patients (25%). Frontal sinus obliteration was performed in 23 patients (74%). Surgical revision was necessary in two cases. The were no serious complications. The overall esthetic and functional outcome was good. OPF with fat obliteration is an useful technique in patients who had frontal sinus disease refractary to other methods.

  17. A microneurovascular TRAM flap does not compromise abdominal sensibility more than a conventional one.

    Science.gov (United States)

    Puonti, Helena K; Jääskeläinen, Satu K; Hallikainen, Helena K; Partanen, Taina A

    2012-09-01

    Classic abdominoplasty for a transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction impairs abdominal somatosensory function at the donor site. The aim of this study was to investigate whether the type of surgical procedure has an effect on somatosensory alterations of abdominal skin after TRAM flap breast reconstruction. Sixty patients (mean ± SD age, 50 ± 6.0 years) who underwent microvascular TRAM flap breast reconstruction and 20 healthy subjects (control group; mean age, 46 ± 6.7 years) participated in the study. Twenty patients had bilateral-nerve anastomosis, 20 had single-nerve anastomosis, and 20 underwent no nerve dissection for the TRAM flap. Clinical sensory examination and tactile and thermal quantitative sensory testing were performed and a patient questionnaire was administered at a mean of 2 to 4.5 years after surgery. All surgical techniques produced significant sensory impairment below the umbilicus, but there were no significant differences in total sensibility scores between the groups with single-nerve (mean sensibility score, 21.98 ± 2.7) and double-nerve (mean sensibility score, 20.71 ± 3.6) anastomosis of the TRAM flap. The best sensibility scores were found in the group with single-nerve dissection. Fifteen percent of patients complained of mild pain, and 13 percent felt occasional tactile hyperesthesia in their abdominal skin, mostly around the umbilicus and scars. In this study, unilateral or bilateral nerve dissection when preparing and lifting a TRAM flap did not seem to increase sensory alterations or postoperative pain in the abdominal donor site after breast reconstruction surgery. Cautious microneurovascular dissection techniques may even improve sensory recovery of the abdominal skin after TRAM flap breast reconstruction surgery.

  18. Experimental Study of Wake / Flap Interaction Noise and the Reduction of Flap Side Edge Noise

    Science.gov (United States)

    Hutcheson, Florence V.; Stead, Daniel J.; Plassman, Gerald E.

    2016-01-01

    The effects of the interaction of a wake with a half-span flap on radiated noise are examined. The incident wake is generated by bars of various widths and lengths or by a simplified landing gear model. Single microphone and phased array measurements are used to isolate the effects of the wake interaction on the noise radiating from the flap side edge and flap cove regions. The effects on noise of the wake generator's geometry and relative placement with respect to the flap are assessed. Placement of the wake generators upstream of the flap side edge is shown to lead to the reduction of flap side edge noise by introducing a velocity deficit and likely altering the instabilities in the flap side edge vortex system. Significant reduction in flap side edge noise is achieved with a bar positioned directly upstream of the flap side edge. The noise reduction benefit is seen to improve with increased bar width, length and proximity to the flap edge. Positioning of the landing gear model upstream of the flap side edge also leads to decreased flap side edge noise. In addition, flap cove noise levels are significantly lower than when the landing gear is positioned upstream of the flap mid-span. The impact of the local flow velocity on the noise radiating directly from the landing gear is discussed. The effects of the landing gear side-braces on flap side edge, flap cove and landing gear noise are shown.

  19. [Glandular posterior flap of the breast for oncoplastic surgery].

    Science.gov (United States)

    Ho Quoc, C; Faure, C; Carrabin, N; Istasse, F; Rivoire, M; Delay, E

    2015-06-01

    Breast conservative surgeries, associated with radiotherapy within the framework of conservatives treatments for breast malignant tumors, can occur deformation of the breast in 10 to 15% of cases. The deformity can be more or less important according to the size of the initial lesion and the glandular reshaping reconstruction. Our experience in oncologic and reconstructive surgery of the breast reflects us about difficult cases of breast conservative surgeries in a glandular reshaping to obtain the best aesthetic result. In this approach, the posterior glandular flap of the breast was used in specific indications. The study aims to estimate the efficiency and the tolerance of the posterior glandular flap in difficult cases of breast oncoplastic surgeries. We realized a consecutive serie of 24 breast oncoplastic surgeries. We noticed 15 breast conservative surgeries of superior quadrants. The posterior glandular flap was realized in 15 cases. We used the posterior part of the breast, vascularized by musculo-cutaneous intercostal arteries to give the volume lacking in the breast. We estimated efficiency and tolerance of the posterior glandular flap than one-year operating comment, as well as the oncologic follow-up long-term. In this serie of 15 cases, we did not note acute complications like infection, hematoma or cutaneous necrosis. We listed 13 cases of malignant tumors with indication of radiotherapy, and 2 cases of benign tumors. In one year, we found two patients presenting a cyst of cytosteatonecrosis (1cm and 3cm) in the site of surgery, compared to posterior flap. The glandular total average excision was 333g (30-1200). An oncologic surgical resumption was necessary in 2 cases (a case of preventive mastectomy for BRCA1, and a case of insufficient margins). We realized 12 cases of controlateral surgery at the same time for symmetry. The aesthetic result was judged at one year post-operatory: good or very good in 74% of the cases, correct in 20% of the cases

  20. Pilot study of breast sensation after breast reconstruction: evaluating the effects of radiation therapy and perforator flap neurotization on sensory recovery.

    Science.gov (United States)

    Magarakis, Michael; Venkat, Raghunandan; Dellon, A Lee; Shridharani, Sachin M; Bellamy, Justin; Vaca, Elbert E; Jeter, Stacie C; Zoras, Odysseas; Manahan, Michele A; Rosson, Gedge D

    2013-09-01

    Some sensation to the breast returns after breast reconstruction, but recovery is variable and unpredictable. We primarily sought to assess the impact of different types of breast reconstruction [deep inferior epigastric artery perforator (DIEP) flaps versus implants] and radiation therapy on the return of sensation. Thirty-seven patients who had unilateral or bilateral breast reconstruction via a DIEP flap or implant-based reconstruction, with or without radiation therapy (minimum follow-up, 18 months; range, 18-61 months) were studied. Of the 74 breasts, 27 had DIEP flaps, 29 had implants, and 18 were nonreconstructed. Eleven breasts with implants and 10 with DIEP flaps had had prereconstruction radiation therapy. The primary outcome was mean patient-perceived static and moving cutaneous pressure threshold in nine areas. We used univariate and multivariate analyses to assess what independent factors affected the return of sensation (significance, P sensation (P = 0.041) than did DIEP flaps. However, among irradiated breasts, skin over DIEP flaps had significantly better sensation than did that over implants (static, P = 0.019; moving, P = 0.028). Implant reconstructions with irradiated skin had significantly worse static (P = 0.002) and moving sensation (P = 0.014) than did nonirradiated implant reconstructions. Without irradiation, skin overlying implants is associated with better sensation recovery than DIEP flap skin. However, with irradiation, DIEP flap skin had better sensation recovery than did skin over implants. Neurotization trended toward improvement in sensation in DIEP flaps. Copyright © 2013 Wiley Periodicals, Inc.

  1. Exotic wakes of flapping fins

    DEFF Research Database (Denmark)

    Schnipper, Teis

    We present, in 8 chapters, experiments on and numerical simulations of bodies flapping in a fluid. Focus is predominantly on a rigid foil, a model fish, that performs prescribed pitching oscillations where the foil rotates around its leading edge. In a flowing soap film is measured, with unpreced......We present, in 8 chapters, experiments on and numerical simulations of bodies flapping in a fluid. Focus is predominantly on a rigid foil, a model fish, that performs prescribed pitching oscillations where the foil rotates around its leading edge. In a flowing soap film is measured......, with unprecedented accuracy, the vortex wake structure behind the flapping foil in the space spanned by dimensionless flapping frequency 0 ... fluid. Also, measurements of the swimming speed of a pitching foil in a water tank are presented. Finally, an experimental study of the surprisingly strong fluid-mediated interaction of two tandem flappers is presented. It is shown that a passively flapping flag in general is affected by its downstream...

  2. An Alternative Rhinoplasty Technique: Rotational Spreader Flap ("Rabbit Flap").

    Science.gov (United States)

    Sirin, Ali Ahmet; Erdim, Ibrahim; Erdur, Omer; Sirin, Alperen

    2018-04-01

    In modern rhinoplasty, septal cartilage is the most commonly used graft material. It is a big challenge if septal cartilage is insufficient. We present an alternative technique named the "rabbit flap," created from the cephalic portion of the lower lateral cartilage to show its effectiveness on nasolabial angle, nasal axis deviation, and nasal dorsal line. An alternative flap, called a "rabbit flap," is constituted from the cephalic portion of the lower lateral cartilage (LLC). The key for this flap's success is in not cutting the connection between the lateral and medial crus of the alar cartilage. The flap is rotated and placed between the upper lateral cartilage and the septum to ensure a spreader graft effect; it can also be moved forward and backward to adjust the nasal tip rotation. Patients whose minimum width of LLC was 12 mm were included in this study. We subjectively evaluated the results of this technique for 24 patients who completed the rhinoplasty outcomes evaluation (ROE) questionnaire and objectively by measuring the nasal axis and nasolabial angles in the preoperative and postoperative first-year periods. There were significant improvements in ROE, nasal axis deviation, and nasolabial angle scores when preoperative and postoperative first-year controls were compared (p rotation and a mild nasal axis deviation. Moreover, we can achieve a proper nasal dorsal line and prevent an inverted V deformity. By expanding the internal nasal valve, a functionally effective surgery can be performed. However, the LLC must be strong enough to avoid alar collapse. In light of our results, we believe that the technique we call the "rabbit flap" can be used as an alternative rhinoplasty technique. 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 .

  3. Pedicled Instep Flap and Tibial Nerve Reconstruction in a Cynomolgus Monkey [Macaca fascicularis

    Directory of Open Access Journals (Sweden)

    Ruth Weiss

    2016-01-01

    Full Text Available A male cynomolgus monkey experienced extensive soft tissue trauma to the right caudal calf area. Some weeks after complete healing of the original wounds, the monkey developed a chronic pressure sore on plantar surface of the heel of its right foot. A loss of sensitivity in the sole of the foot was hypothesized. The skin defect was closed by a medial sensate pedicled instep flap followed by counter transplantation of a full thickness graft from the interdigital webspace. The integrity of the tibial nerve was revised and reconstructed by means of the turnover flap technique. Both procedures were successful. This is an uncommon case in an exotic veterinary patient as it demonstrates a reconstructive skin flap procedure for the treatment of a chronic, denervated wound in combination with the successful reconstruction of 2.5 cm gap in the tibial nerve.

  4. Dual Effects of Bisphosphonates on Ectopic Skin and Vascular Soft Tissue Mineralization versus Bone Microarchitecture in a Mouse Model of Generalized Arterial Calcification of Infancy

    Science.gov (United States)

    Li, Qiaoli; Kingman, Joshua; Sundberg, John P.; Levine, Michael A.; Uitto, Jouni

    2015-01-01

    Generalized arterial calcification of infancy (GACI) is an intractable ectopic mineralization disorder caused by mutations in the ENPP1 gene resulting in reduced plasma inorganic pyrophosphate levels. We previously characterized the Enpp1asj mutant mouse as a model of GACI, and we have now explored the potential efficacy of bisphosphonates, non-hydrolyzable PPi analogs, in preventing ectopic mineralization in these mice. These mice were maintained on either basic diet (control) or diets containing etidronate or alendronate in three different concentrations (experimental). Considering low bioavailability of bisphosphonates when administered orally, subsequent studies tested the mice with subcutaneous injections of etidronate. The treatments were initiated at 4 weeks of age, and the degree of mineralization was assessed at 12 weeks of age by quantitation of calcium deposits in the muzzle skin containing dermal sheath of vibrissae and in aorta. We found that bisphosphonate treatments significantly reduced mineralization in skin and aorta. These changes in treated mice were accompanied with restoration of their bone microarchitecture, determined bymicrocomputed tomography. The inhibitory capacity of bisphosphonates, with mechanistic implications, was confirmed in a cell-based mineralization assay in vitro. Collectively, these results suggest that bisphosphonate treatment may be beneficial by a dual effect for preventing ectopic soft tissue mineralization while correcting decreased bone mineralization in GACI caused by ENPP1 mutations. PMID:26763447

  5. Experimental studies of flow separation and stalling on two-dimensional airfoils at low speeds. Phase 2: Studies with Fowler flap extended

    Science.gov (United States)

    Seetharam, H. C.; Wentz, W. H., Jr.

    1975-01-01

    Results were given on experimental studies of flow separation and stalling on a two-dimensional GA(W)-1 17 percent thick airfoil with an extended Fowler flap. Experimental velocity profiles obtained from a five tube probe survey with optimum flap gap and overlap setting (flap at 40 deg) are shown at various stations above, below, and behind the airfoil/flap combination for various angles of attack. The typical zones of steady flow, intermittent turbulence, and large scale turbulence were obtained from a hot wire anemometer survey and are depicted graphically for an angle of attack of 12.5 deg. Local skin friction distributions were obtained and are given for various angles of attack. Computer plots of the boundary layer profiles are shown for the case of the flap at 40 deg. Static pressure contours are also given. A GA(W)-2 section model was fabricated with 30 percent Fowler flaps and with pressure tabs.

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

    Directory of Open Access Journals (Sweden)

    Fikret Eren

    2015-12-01

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

  7. Electromagnetic flowmetry--an experimental method for continuous blood flow measurement using a new island flap model.

    Science.gov (United States)

    Banis, J C; Schwartz, K S; Acland, R D

    1980-10-01

    We describe a reliable experimental method for direct, continuous measurement of the rate of blood flow in an island skin flap, using an electromagnetic flowmeter applied to the artery of the flap. The canine saphenous island flap model, developed as part of this study, is a large (11 x 14 cm) island flap, based solely on the saphenous artery (2 mm in diameter). We describe the anatomy of the flap and the method of raising it. Electromagnetic flowmetry is the only method of blood flow determination that provides immediate, continuous, and quantitative measurement of flow. We describe the principles and pitfalls of the electromagnetic flowmeter and the numerous rules of practice that must be observed to obtain consistent results. A validation study was carried out, in which we simultaneously measured arterial inflow with the flowmeter and venous outflow from the flap using direct collection. This study was based on the assumption that at any point in time the arterial and venous rate of flow were equal. We present the results of the study, which show an extremely close linear relationship between the measured and actual rates of flow. We intend to use this experimental method to study the factors that affect the rate of blood flow in free skin flap transfer.

  8. Extended split superior gluteus maximus musculocutaneous flap and reconstruction after resection of perianal and lower gluteal hidradenitis suppurativa.

    Science.gov (United States)

    Kishi, Kazuo; Nakajima, Hideo; Imanishi, Nobuaki; Nakajima, Tatsuo

    2009-08-01

    Various modifications of the gluteus maximus musculocutaneous flap have been reported. Among them, the split gluteus maximus musculocutaneous flap is easy to prepare and does not leave ambulatory insufficiency. However, the safety of extending the skin portion beyond the margin of the muscle has not yet been clarified. Angiography was performed systemically on 11 fresh cadavers, and the distance the margin of the gluteus maximus muscle could be extended was observed. Based on these anatomical data, reconstruction after total skin resection of perianal and lower gluteal hidradenitis suppurativa was performed with an extended split superior gluteal maximus musculocutaneous flap. Surgery was performed on three sides of two patients. From the anatomical results, we found that it is possible to extend the flap beyond the iliac crest several centimetres superiorly, and to the gluteal fold inferiorly, and several centimetres laterally. We designed the flap such that the extended area is situated in these areas. All flaps took well and did not show any congestion or necrosis. There were no recurrences at least 1 year after surgery. When reconstructing the lower part of the buttock, an extended split superior gluteus maximus musculocutaneous flap is easy to raise and leaves aesthetically satisfactory results. Thus it may be the first choice for reconstruction of the lower buttock.

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

    International Nuclear Information System (INIS)

    Mahmood, F.

    2015-01-01

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

  10. Efficient flapping flight of pterosaurs

    Science.gov (United States)

    Strang, Karl Axel

    In the late eighteenth century, humans discovered the first pterosaur fossil remains and have been fascinated by their existence ever since. Pterosaurs exploited their membrane wings in a sophisticated manner for flight control and propulsion, and were likely the most efficient and effective flyers ever to inhabit our planet. The flapping gait is a complex combination of motions that sustains and propels an animal in the air. Because pterosaurs were so large with wingspans up to eleven meters, if they could have sustained flapping flight, they would have had to achieve high propulsive efficiencies. Identifying the wing motions that contribute the most to propulsive efficiency is key to understanding pterosaur flight, and therefore to shedding light on flapping flight in general and the design of efficient ornithopters. This study is based on published results for a very well-preserved specimen of Coloborhynchus robustus, for which the joints are well-known and thoroughly described in the literature. Simplifying assumptions are made to estimate the characteristics that can not be inferred directly from the fossil remains. For a given animal, maximizing efficiency is equivalent to minimizing power at a given thrust and speed. We therefore aim at finding the flapping gait, that is the joint motions, that minimize the required flapping power. The power is computed from the aerodynamic forces created during a given wing motion. We develop an unsteady three-dimensional code based on the vortex-lattice method, which correlates well with published results for unsteady motions of rectangular wings. In the aerodynamic model, the rigid pterosaur wing is defined by the position of the bones. In the aeroelastic model, we add the flexibility of the bones and of the wing membrane. The nonlinear structural behavior of the membrane is reduced to a linear modal decomposition, assuming small deflections about the reference wing geometry. The reference wing geometry is computed for

  11. The Dorsoulnar Artery Perforator Adipofascial Flap in the Treatment of Distal Radioulnar Synostosis

    Directory of Open Access Journals (Sweden)

    Alessia Pagnotta

    2017-01-01

    Full Text Available Posttraumatic radioulnar synostosis (RUS is a rare event following forearm fractures. Consequences are disabling for patients who suffer from functional limitation in forearm pronosupination. Distal RUS are even more rare and more difficult to treat because of high recurrence rates. The patient we describe in this paper came to our attention with a double distal RUS recurrence and a Darrach procedure already performed. We performed a radical excision of RUS and interposition with a vascularized dorsoulnar artery (DUA adipofascial perforator flap. Four years after surgery, the patient shows the same complete range of motion in pronosupination, and MRI confirms that the flap is still in place with signs of vascularization. Simple synostosis excision has been proven ineffective in many cases. Interposition is recommended after excision, and biological material interposition seems to be more effective than foreign material. Surgeons are increasingly performing vascularized interposition, and the results are very encouraging.

  12. Transabdominal-pelvic-perineal (TAPP) anterolateral thigh flap: A new reconstructive technique for complex defects following extended abdominoperineal resection.

    Science.gov (United States)

    di Summa, Pietro G; Matter, Maurice; Kalbermatten, Daniel F; Bauquis, Olivier; Raffoul, Wassim

    2016-03-01

    Abdominoperineal resection (APR) following radiotherapy is associated with a high rate of perineal wound complications. The anterolateral thigh (ALT) flap, combined with the vastus lateralis (VL) muscle, can cover complex perineal and pelvic anteroposterior defects. This is used for the first time transabdominally through the pelvis and the perineum (TAPP) in the infero-posterior directions; this technique has been described and illustrated in this study. Among over 90 patients who underwent perineal reconstruction between May 2004 and June 2011, six patients presented high-grade tumours invading perineum, pelvis and sacrum, thereby resulting in a continuous anteroposterior defect. ALT + VL TAPP reconstructions were performed after extended APR and, subsequently, sacrectomy. Patients were examined retrospectively to determine demographics, operative time, complications (general and flap-related), time to complete healing and length of hospital stay. Long-term flap coverage, flap volume stability and functional and aesthetic outcomes were assessed. Mean operating time of the reconstruction was 290 min. No deaths occurred. One patient presented partial flap necrosis. Another patient presented a novel wound dehiscence after flap healing, due to secondary skin dissemination of the primary tumour. Following volumetric flap analysis on serial post-operative CT scans, no significant flap atrophy was observed. All flaps fully covered the defects. No late complications such as fistulas or perineal hernias occurred. Donor-site recovery was uneventful with no functional deficits. The use of the ALT + VL flap transabdominally is an innovative method to reconstruct exceptionally complex perineal and pelvic defects extending up to the lower back. This flap guarantees superior bulk, obliterating all pelvic dead space, with the fascia lata (FL) supporting the pelvic floor. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by

  13. Tertiary breast reconstruction using a free contralateral latissimus dorsi myocutaneous flap and contralateral internal mammary recipient vessel anastomosis

    Directory of Open Access Journals (Sweden)

    Toshihiko Satake

    2016-03-01

    Full Text Available Tertiary breast reconstruction after a failed autologous procedure is often performed under various restrictions, posing considerable problems not only in the choice of alternative free flap but also in that of recipient vessels. This is a case report of a free contralateral latissimus dorsi myocutaneous flap combined with a silicone gel implant, with flap pedicle anastomosis to the contralateral internal mammary recipient vessels in a 46-year-old woman with right breast deformity. She underwent a right modified radical mastectomy and failed attempts of reconstruction at another hospital. The deep inferior epigastric artery perforator flap had already been harvested for the failed reconstruction and high-level interruptions of the internal mammary, thoracodorsal, and thoracoacromial vessels were revealed on preoperative three-dimensional computed tomography angiography; therefore, we selected a contralateral latissimus dorsi myocutaneous flap to supply the lower pole skin along with a silicone gel implant for volume in this tertiary breast reconstruction. However, weak blood flow in the ipsilateral internal mammary artery and exhaustion of all recipient ipsilateral vessels in previous attempts to salvage the failing deep inferior epigastric artery perforator flap necessitated the use of the contralateral internal mammary recipient vessels. A contralateral latissimus dorsi myocutaneous flap with contralateral internal mammary recipient vessel anastomosis appears to be a viable option in complicated cases with unavailable deep inferior epigastric artery perforator flap or ipsilateral recipient vessels.

  14. Applied anatomy of the submental island flap and its clinical application in the repair of defects following hypopharyngeal carcinoma resection

    Directory of Open Access Journals (Sweden)

    Xi Chen

    2015-09-01

    Full Text Available Objective: To explore the feasibility of the submental island flap in the repair of hypopharyngeal defects. Methods: We collected wet specimens of fresh cadaveric heads from the Han Chinese adult population for applied anatomy of the submental island flap, and followed five patients with pyriform sinus carcinoma after reconstruction surgery using submental island flaps. Results: We found that the average length and width of the submental island flaps were (65.20 ± 11.69 mm and (46.70 ± 6.59 mm, respectively. The skin flap in all five patients survived after surgery, and tracheal tubes and gastric tubes were removed 7–36 days after surgery. Patients were followed up for 24–42 months, pharyngeal flaps grew well, and speech and swallowing functions were satisfactory. Conclusion: The submental island flap is a preferred material for the repair of hypopharyngeal defects after hypopharyngeal carcinoma resection, because of good blood supply, easy harvesting, and high survival rate. Keywords: Submental island flap, Submental artery, Submental vein, Hypopharyngeal neoplasms, Reconstructive surgical procedures

  15. Contrast-enhanced ultrasonography as a new method for assessing autonomization of pedicled and microvascular free flaps in head and neck reconstructive surgery.

    Science.gov (United States)

    Mueller, Steffen; Wendl, Christina M; Ettl, Tobias; Klingelhöffer, Christoph; Geis, Sebastian; Prantl, Lukas; Reichert, Torsten E; Jung, Ernst Michael

    2017-01-01

    Evaluating vascular autonomization of pedicled and microvascular free flaps for soft tissue reconstruction in the head and neck area by means of postoperative quantitative measurement of dynamic contrast values obtained with contrast-enhanced ultrasound. 8/18 patients underwent lip reconstruction with a pedicle flap, 10 patients reconstruction of other parts of the head with a microvascular free transplant. Ultrasound examinations were conducted within the 1st postoperative week and 4 weeks after surgery. After the intravenous bolus of the ultrasound contrast agent, examinations were carried out for 30 sec without compression followed by 30 sec with compression of the vascular pedicle in bolus and flash kinetics. Digital cine loops were analyzed off-line with a quantification software (VueBox™) to determine the Rise Time (RT) between flap tissue with and without compression. Measurements showed increasing autonomous perfusion, independent of the vascular pedicle. No transplant was lost, but 4/10 patients with a microvascular flap and 1/8 patients with a pedicle flap developed postoperative complications. RT values for the pedicled and microvascular flaps obtained under compression differed significantly between the 1st and the 4th week (p = 0.025). Reliable neovascularization was achieved 4 weeks postoperatively. CEUS showed to be a useful method for assessing the degree of autonomization of pedicle and microvascular free flaps.

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

    Directory of Open Access Journals (Sweden)

    Toshihiko Satake

    2015-11-01

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

  17. Administração tópica de cloridrato de hidralazina na viabilidade de retalho cutâneo randômico em ratos Topical administration of hydralazine hydrochloride on the viability of randon skin flaps in rats

    Directory of Open Access Journals (Sweden)

    Ivaldo Esteves Junior

    2005-04-01

    Full Text Available OBJETIVO: Investigar o efeito da administração do cloridrato de hidralazina, por iontoforese, na viabilidade de retalho cutâneo randômico em ratos. MÉTODOS: Sessenta ratos da linhagem Wistar foram distribuídos aleatoriamente em 4 grupos (n=15, estes animais foram submetidos a retalho cutâneo randômico dorsal, de base cranial, com dimensões de 10X4cm. Os animais do grupo 1 foram utilizados como controle, os do grupo 2 foram submetidos a eletroestimulação com corrente direta 4mA-20' imediatamente após a técnica operatória e nos dois dias subseqüentes. No grupo 3 simulação de estímulo elétrico com Cloridrato de Hidralazina. No grupo 4 iontoforese com Cloridrato de Hidralazina 4mA-20'. A análise dos resultados foi realizada no sétimo dia pós-operatório e interpretada com o Teste não paramétrico de Kruskal-Wallis. RESULTADOS: A media da área de necrose foi: grupo 1 = 45%; grupo 2 = 39%; grupo 3 = 46% e grupo 4 = 41%, sendo que a análise estatística não evidenciou diferença significante entre os grupos (p>0,05. CONCLUSÃO: o Cloridrato de Hidralazina, quando administrado por iontoforese, não é eficaz em aumentar a área de viabilidade de retalho cutâneo randômico em ratos.PURPOSE: Assess the effect of hydralazine hydrochloride, for iontophoresis, on the viability of random skin flaps in rats. METHODS: Sixty Wistar rats was randonly destributed in 4 groups (n=15, these animals was submited as randon dorsal skin flaps as cranial base with measure 10X4 cm. The animals from group 1 was utilized as control, in group 2 was submitted to direct current o 4mA-20' immediately after the surgery and on the two subsequent days. In group 3 the stimulation eletric simulation with hydralazine hydrochloride. In group 4 iontophorese with hydralazine hydrochloride 4mA-20'. The analysis of the results was made on the seventh day post operative and interpreted with test non parametric of Kruskal-Wallis. RESULTS: and the necrotic area

  18. Reducing Postoperative Pterygium Recurrence: Comparison of Free Conjunctival Auto-Graft and Conjunctival Rotation Flap Techniques

    International Nuclear Information System (INIS)

    Akhter, W.; Tayyab, A.; Kausar, A.; Masrur, A.

    2014-01-01

    Objective: To compare the recurrence of pterygium between free conjunctival auto-graft and conjunctival rotation flap following simple surgical excision of pterygium. Study Design: Quasi-experimental study. Place and Duration of Study: Shifa Foundation Community Health Clinic, Shifa College of Medicine, Islamabad, from January to November 2012. Methodology: Fifty seven cases aged above 18 years, with a pterygium corneal encroachment of 2 mm which was responsible for visual disability or was cosmetically undesirable were recruited for the study and randomly assigned to conjunctival auto-graft group and conjunctival rotation flap group. Cases with a history of glaucoma or glaucoma suspect, prior pterygium surgery, pterygium with concurrent ocular surface and lid disease, conjunctival inflammation and scarring, pseudo-pterygium or collagen vascular disease were excluded. After simple pterygium excision conjunctival auto-graft group (n=26) cases received a free conjunctival flap was transplanted, while conjunctival rotation flap group (n=31) cases received a conjunctival rotation flap. All cases were followed-up for 6 months after surgery for recurrence and complications. Frequency distribution and significance of association of recurrence using Fisher's exact test and Mann- Whitney U-test was carried out using Statistical Package for Social Sciences (SPSS) version 20. Results: The median (and inter-quartile range) age and surgery duration in conjunctival auto-graft group and conjunctival rotation flap group were 60 (51.50 - 63.00) and 57 (45.00 - 60.00) years, 28.50 (27.00 - 30.50) and 16.00 (15.00 - 17.00) minutes respectively. Recurrence was seen in 2 (7.96%) and 3 (9.76%) cases in auto-graft and rotation flap groups respectively. No significant difference was seen in postoperative complications between the two groups (p=0.60). Conclusion: The surgical time for conjunctival rotation flap procedure is less as compared to free auto-graft, while their recurrence and

  19. Functional and cosmetic donor site morbidity of the radial forearm-free flap: comparison of two different coverage techniques.

    Science.gov (United States)

    Pirlich, Markus; Horn, Iris-Susanne; Mozet, Christian; Pirlich, Mandy; Dietz, Andreas; Fischer, Miloš

    2018-02-26

    The use of the radial forearm-free flap is a well-established and reliable reconstruction method in head and neck surgery. Usually, the defect of the donor site is covered with full or split-thickness skin grafts. Since 09/2013, a direct closure of the radial forearm donor site has been performed at the ENT University Hospital Leipzig to avoid secondary donor site morbidity. However, few data are available in the literature on long-term cosmetic and functional results compared to the established indirect donor site defect coverage. This study investigated patients with radial forearm-free flap harvest from 01/2012 until 03/2015. A total of n = 39 patients were included, with n = 18 being operated by indirect (group 1) and n = 21 by direct closure technique (group 2). For the validation of surgical revisions and wound healing disorders, we carried out clinical investigations as well as interviews. The "POSAS Observer and Patient Scale" was used for assessing the cosmetic outcome and the "Michigan Hand Outcome Questionnaire (MHQ)" for functional criteria. Group 2 showed an increased rate of wound healing problems, however it was not statistically different compared to group 1. Revision surgery was necessary in both groups only each in one case. Using the POSAS, there were no significant differences between both groups in the observer scale for the items vascularity, pigmentation, thickness, relief, pliability, surface area and even for pain, scar itching, color, stiffness, thickness and relief in the patient scale. The functional results (MHOQ) also showed no significantly inferior results for group 2. The direct closure procedure is quick, simple and can be performed without secondary donor site morbidity. For wound healing, cosmetic and function of the forearm and hand, no inferior results can be measured for the direct procedure compared to the indirect coverage technique.

  20. Chronic Open Infective Lateral Malleolus Bursitis Management Using Local Rotational Flap

    Directory of Open Access Journals (Sweden)

    Yong-Beom Lee

    2017-01-01

    Full Text Available Background. Using a sinus tarsi rotational flap is an uncommon approach to treating chronic open infective lateral malleolus bursitis. Methods. We treated eight patients, including six males, using this approach. First, we debrided all the infected tissues and used a negative pressure wound closure system where needed. After acute infection had been controlled, the local rotational flap was used for cases where the wound could not be closed by a simple suture or bone exposure. The rotational flap was detached with a curved skin incision at the sinus tarsi next to the open wound and sutured to the defect, paying careful attention to the superficial peroneal nerve. The donor site was managed with a split-thickness skin graft. Results. The patients’ mean age was 74.1 years. Six patients had a wound after suppurative infection, but two patients had ulcer-type bursitis. Six patients demonstrated full flap healing, but two patients had venous congestion necrosis. Conclusion. A sinus tarsi rotational flap is a useful method to ensure healing and coverage of chronic open lateral malleolus bursitis, especially for small to medium wounds with cavity and bone exposure.

  1. Early prediction of skin viability using visible diffuse reflectance spectroscopy and autofluorescence spectroscopy.

    Science.gov (United States)

    Zhu, Caigang; Chen, Shuo; Chui, Christopher Hoe-Kong; Tan, Bien-Keem; Liu, Quan

    2014-08-01

    Accurate and early prediction of skin flap viability is vitally important in reconstructive surgery. To the best of the authors' knowledge, this is the first pilot study to evaluate the simultaneous use of both visible diffuse reflectance and autofluorescence spectroscopy on a reverse MacFarlane rat dorsal skin flap model in the early prediction of skin viability. A total of 62 flap measurement sites from 11 Sprague-Dawley rats were monitored for 72 hours. Both statistical analysis using measured spectra and quantification of physiologically relevant tissue parameters using empirical methods were performed. The statistical analysis results suggest that either visible diffuse reflectance spectroscopy or autofluorescence spectroscopy alone can predict the skin viability accurately; however, autofluorescence spectroscopy is more sensitive to tissue changes in the first 2 hours after induction of ischemia. The pilot study shows that it is feasible to predict flap failures in the first 2 hours when using autofluorescence spectroscopy alone; moreover, it is possible to predict flap failures even in the first 15 minutes with high accuracy when using diffuse reflectance and autofluorescence spectroscopy simultaneously. Meanwhile, several physiologically relevant parameters including hemoglobin oxygenation, total hemoglobin concentration, and redox ratio indicators estimated from diffuse reflectance and autofluorescence spectra show distinctively different trends over time for nonviable and viable skin. These findings will be helpful to clinicians for making a precise judgment on flap viability. Furthermore, the authors' results highlight the advantage of using autofluorescence spectroscopy in the early prediction of skin flap viability relative to diffuse reflectance spectroscopy.

  2. Sternocleidomastoid Muscle Flap after Parotidectomy

    Directory of Open Access Journals (Sweden)

    Nofal, Ahmad Abdel-Fattah

    2015-04-01

    Full Text Available Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient dissatisfaction. Objective Assess the functional outcome and esthetic results of the superiorly based sternocleidomastoid muscle (SCM flap after superficial or total parotidectomy. Methods A prospective cohort study for 11 patients subjected to parotidectomy using a partial-thickness superiorly based SCM flap. The functional outcome (Frey syndrome, facial nerve involvement, and ear lobule sensation and the esthetic results were evaluated subjectively and objectively. Results Facial nerve palsy occurred in 5 cases (45%, and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 3 patients (27%, although only 1 (9% subjectively complained of gustatory sweating. The designed visual analog score completed by the patients themselves ranged from 0 to 3 with a mean of 1.55 ± 0.93; the scores from the blinded evaluators ranged from 1 to 3 with a mean 1.64 ± 0.67. Conclusion The partial-thickness superiorly based SCM flap offers a reasonable cosmetic option for reconstruction following either superficial or total parotidectomy by improving the facial deformity. The flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve.

  3. Flap--edge flowfield measurements

    Science.gov (United States)

    Pye, John D.; Cantwell, Brian J.

    1997-11-01

    Recent studies of airframe noise suggest that the wing and flap trailing--edges as well as the flap side--edge are areas of significant noise generation. To identify the fluid dynamic processes associated with these noise sources, we are examining the flow--field around a NACA 63--215 Mod B main element airfoil configured with a half--span Fowler flap. The tests are performed in a low--speed wind tunnel at a Reynolds number of ~ 6.0×10^5. A hot wire traverse system is used to map the mean velocities and turbulence intensities in the near wake region of the flow. Measurements of the pressure fluctuations along the flap side--edge and in the cove of the airfoil configuration are made with pressure transducers mounted inside the airfoil. The experimental data are in good qualitative agreement with the numerical simulation of a slightly higher Reynolds number flow ( ~ 1.5×10^6) around a geometrically similar airfoil configuration.

  4. Oncoplastic surgery for inner quadrant breast cancer: fish-hook incision rotation flap.

    Science.gov (United States)

    Lee, Seokwon; Lee, Jeeyeon; Jung, Younglae; Bae, Youngtae

    2017-10-01

    In oncoplastic breast surgery, the size and location of the defect are two of the major factors affecting the post-operative cosmetic outcome after partial mastectomy. We introduce a modified superior-based dermoglandular rotation flap technique, which can be applied for relatively large tumours and in cases of inner quadrant defects of the breast without surgery of the contralateral breast. Between January 2007 and December 2012, a total of 34 female patients with breast cancer underwent breast-conserving surgery using the 'fish-hook incision rotational flap'. A fish-hook-shaped skin incision line was designed from an axillary site to the tumour, about 2-3 cm below the skin crease of the inframammary fold. After partial mastectomy, a superior-based dermoglandular tissue flap was mobilized off the pectoralis major muscle and the lower abdominal flap was dissected downward. The dermoglandular flap was then rotated and the lower dissected lower abdominal flap was advanced in the upward direction to fill the defect and restore the breast shape. The cosmetic results were self-estimated 12 months after surgery. Mean excised volume of the breast was 23.2 ± 6.1%. The location of the tumours was as follows: upper inner (n = 13, 38.2%) and lower inner quadrant (n = 21, 61.8%). The overall cosmetic satisfaction was self-estimated as follows: excellent (n = 19, 55.9%); good (n = 10, 29.4%); fair (n = 4, 11.8%); poor (n = 1, 2.9%). The 'fish-hook incision rotation flap' is a feasible, effective oncoplastic technique that can be applicable to a relatively large defect located in the inner quadrant of the breast. © 2015 Royal Australasian College of Surgeons.

  5. Post-operative assessment of perfusion of Deep Inferior Epigastric Perforator (DIEP) free flaps via Pulsatility Index (PI) using a portable colour Doppler sonogram device.

    Science.gov (United States)

    Arya, Reza; Griffiths, Louisa; Figus, Andrea; King, David; Ramakrishnan, Venkat; Griffiths, Matthew

    2013-07-01

    PI as an independent indicator of resistance to flow is a widely-accepted alternative index to measurement of flow volume in vessels. This study aimed to determine the normal values and chronological trend of PI of abdominal wall free flaps in breast reconstruction and to revalidate its clinical relevance in post-operative monitoring of these flaps. 47 patients with breast reconstruction using DIEP, MS-TRAM and bi-pedicled DIEP flaps were assessed for PI of the supplying perforator vessels using a hand-held colour Doppler ultrasound device over 6 post-operative days. Triplicate measurements were obtained by one operator once daily concurrently with haemodynamic parameters. DIEP flaps demonstrate a descending trend of PI and resistance to blood flow post-operatively (p=0.005) similar to non-perforator free flaps. MS-TRAM flaps show higher initial PI values and vascular resistance compared to DIEP flaps (p=0.038). PI values show no correlation with haemodynamic parameters (r=0.2, n=38). Flaps with venous insufficiency demonstrate significantly higher values of PI (p=0.03). PI is an objective, non-invasive, efficient, easy-to-measure, reproducible and quickly-responsive indicator of perfusion of DIEP flaps. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Transcutaneous PCO2 Measurement at Low Temperature for Reliable and Continuous Free Flap Monitoring: Experimental and Clinical Study

    Science.gov (United States)

    Abe, Yoshiro; Goishi, Keiichi; Kashiwagi, Keisuke; Yamano, Masahiro; Nakanishi, Hideki

    2013-01-01

    Background: Measurement of transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) has been used for free flap monitoring. Because these values are obtained with sensor probes heated to 44°C, there is potential for low-temperature burns on skin flaps. We measured TcPO2 and TcPCO2 at 37°C in both animals and humans to determine the feasibility and safety of the procedure as a postoperative flap monitoring method. Methods: Twelve epigastric island flaps were elevated in rabbits, and TcPO2 and TcPCO2 were measured at 37°C before and after ligation of the pedicles. In addition, TcPO2 and TcPCO2 at 37°C were measured in healthy men. Subsequently, the method was applied to postoperative monitoring of free flaps in 49 clinical cases. Results: TcPO2 and TcPCO2 values were significantly affected by the experimental flap elevation. A rapid increase in TcPCO2 was observed with both arterial and venous occlusion. In the healthy men, TcPO2 and TcPCO2 were measurable at all skin surface sites. In the clinical cases of free flap transfer, TcPO2 values remained very low for at least 72 hours. TcPCO2 values ranged from 40 to 70 mm Hg for 72 hours in more than 80% of cases. In 2 cases, TcPCO2 values increased to more than 90 mm Hg, and exploration surgery was performed. These compromised flaps were saved by reanastomosis of the veins. Conclusions: Continuous monitoring of TcPCO2 at 37°C can provide objective information and alert doctors and nurses to the need for checking the free flap. PMID:25289213

  7. Evaluation of cutaneous sensibility of the internal pudendal artery perforator (IPAP) flap after perineal reconstructions.

    Science.gov (United States)

    Coltro, Pedro S; Ferreira, Marcus C; Busnardo, Fábio F; Olivan, Marcelo V; Ueda, Thiago; Grillo, Victor A; Marques, Carlos F; Nahas, Caio S; Nahas, Sérgio C; Gemperli, Rolf

    2015-02-01

    In oncological perineal reconstructions, the internal pudendal artery perforator (IPAP) flap is our flap of choice, supplied by perforator vessels from the internal pudendal artery and innervated by branches from the pudendal nerve and the posterior femoral cutaneous nerve. Data related to the evaluation of its cutaneous sensibility are scarce, discrepant, and subject to methodological criticism. The objective of this study was to evaluate the cutaneous sensibility of the IPAP flap 12 months after perineal reconstruction and compare it with the preoperative cutaneous sensibility of the gluteal fold (flap donor area). A prospective study of 25 patients undergoing abdominoperineal excision of rectum (APER) and reconstruction with bilateral VY advancement IPAP flap was conducted. The tactile, pain, thermal, and vibration sensibilities were analyzed in four areas of the gluteal fold preoperatively and in the four corresponding areas of the flap 12 months after surgery. Tactile sensibility was assessed using the Pressure Specified Sensory Device™ (PSSD™), which measures the pressure applied to the skin. The other types of sensibility were analyzed using a needle for pain, hot/cold contact for thermal, and a tuning fork for vibration sensibility. A comparison between tactile sensibility thresholds on the gluteal fold preoperatively and on the flap 12 months after surgery showed no statistically significant difference, with p values>0.05 in all four areas evaluated. All patients had preserved pain, thermal, and vibration sensibility in all four areas, postoperatively. In oncological perineal reconstructions after APER, it is expected that the cutaneous sensibility on the IPAP flap be maintained. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. Delayed flap reconstruction with vacuum-assisted closure management of the open IIIB tibial fracture.

    Science.gov (United States)

    Hou, Zhiyong; Irgit, Kaan; Strohecker, Kent A; Matzko, Michelle E; Wingert, Nathaniel C; DeSantis, Joseph G; Smith, Wade R

    2011-12-01

    Vacuum-assisted closure (VAC) therapy has been shown to be effective at reducing bacterial counts in wounds until definitive bony coverage. However, there is continued debate over timing and type of definitive wound coverage even with VAC therapy application. From 2004 to 2009, 32 patients with Gustilo type IIIB open tibia fractures were initially treated with VAC therapy were included. The number of debridements, length of treatment with VAC dressing, definitive wound coverage management, and length of hospital stay, flap-related complications, and time to radiographic fracture healing were recorded. The mean Injury Severity Score was 17.3 ± 2.0. All wounds closed after being treated with the primary VAC closure. The mean interval between the initial injury and definitive intervention was 10.9 days ± 0.3 days. Twenty of 27 patients (74%) underwent rotational muscle flaps; four received free muscle flaps and three only with split-thickness skin grafts for definitive wound coverage. Nine of 32 patients (28%) underwent below knee amputation, five without flap coverage after several VAC sessions and four after definitive flap coverage. The average time to union was 10.0 months ± 2.0 months. Eight patients developed nonunion and 11 patients developed infections. The average follow-up time is 2.4 years ± 0.2 years. Patients were divided into two groups for analysis according to the interval time. The rate of infection was significantly increased in patients who had an interval of more than 7 days from the time of injury to flap coverage. The VAC therapy may help to reduce the flap size and need for a flap transfer for type IIIB open tibial fractures. However, prolonged periods of VAC usage, greater than 7 days, should be avoided to reduce higher infection and amputation risks.

  9. Success of dental implants in vascularised fibular osteoseptocutaneous flaps used as onlay grafts after marginal mandibulectomy.

    Science.gov (United States)

    Chang, Y-M; Pan, Y-H; Shen, Y-F; Chen, J-K; ALDeek, N F; Wei, F-C

    2016-12-01

    We have evaluated the survival of dental implants placed in vascularised fibular flap onlay grafts placed over marginal mandibulectomies and the effects on marginal bone loss of different types of soft tissue around implants under functional loading. From 2001-2009 we studied a total of 11 patients (1 woman and10 men), three of whom had had ameloblastoma and eight who had had squamous cell carcinomas resected. A total of 38 dental implants were placed either at the time of transfer of the vascularised fibular ostoseptocutaneous flaps (nine patients with 30 implants) or secondarily (two patients with eight implants). Four patients were given palatal mucosal grafts to replace intraoral skin flaps around the dental implants (n=13), and the other seven had the skin flaps around the dental implants thinned (n=25) at the second stage of implantation of the osteointegrated teeth. All vascularised fibular osteoseptocutaneous flaps were successfully transferred, and all implants survived a mean (range) of 73 (33-113) months after occlusal functional loading. The mean (SD) marginal bone loss was 0.5 (0.3) mm on both mesial and distal sides in patients who had palatal mucosal grafts, but 1.8 (1.6) mm, and 1.7 (1.5) mm, respectively, on the mesial and distal sides in the patients who had had thinning of their skin flaps. This difference is significant (p=0.008) with less resorption of bone in the group who had palatal mucosal grafts. Palatal mucosa around the implants helps to reduce resorption of bone after functional loading of implants. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. FREE ANTEROLATERAL FEMORAL FLAP IS THE FIRST CHOICE IN EMERGENCY RECONSTRUCTIVE SURGERY OF THE LOWER LIMB (ANALYSIS OF CLINICAL CASES

    Directory of Open Access Journals (Sweden)

    A. V. Nevedrov

    2015-01-01

    Full Text Available BACKGROUND. Requirements for the graft used in microsurgery are simple retrieval, minimal anatomic variability, the possibility to operate on one surgical area, great length and diameter of flap vessels.PURPOSE OF STUDY. Evaluation of the results and advantages of revascularized free anterolateral muscle flap usage in emergency surgery.MATERIALS AND METHODS. Free muscle flap of the lateral vastus muscle on a vascular pedicle of the descending branch of the lateral femoral circumflex artery (anterolateral flap was used to replace the defect in 2 patients. In one case, a patient had open fractures of the lower leg, complicated with primary defects of soft tissue, and in the other case a patient had incomplete traumatic amputation of the left foot. All the victims underwent soft tissue defects restoration within the first hours after the injury, next to fixation of the fracture.RESULTS. All grafts have completely healed, total necrosis of muscle flaps hasn’t been observed. All patients had primary wound healing after the transfer. Cases of deep purulent infection after the surgery haven’t been noted.CONCLUSION. The transfer of a free anterolateral muscle flap is the best method for emergency plastic and reconstructive surgery of the lower limbs. The advantages are simple and prompt retreival, no need to turn the patient to the lateral position, large amount of the flap, great length and caliber of vessels. 

  11. Effects of Remote Ischemic Conditioning Methods on Ischemia-Reperfusion Injury in Muscle Flaps: An Experimental Study in Rats

    Directory of Open Access Journals (Sweden)

    Durdane Keskin

    2017-09-01

    Full Text Available Background The aim of this study was to investigate the effects of remote ischemic conditioning on ischemia-reperfusion injury in rat muscle flaps histopathologically and biochemically. Methods Thirty albino rats were divided into 5 groups. No procedure was performed in the rats in group 1, and only blood samples were taken. A gracilis muscle flap was elevated in all the other groups. Microclamps were applied to the vascular pedicle for 4 hours in order to achieve tissue ischemia. In group 2, no additional procedure was performed. In groups 3, 4, and 5, the right hind limb was used and 3 cycles of ischemia-reperfusion for 5 minutes each (total, 30 minutes was applied with a latex tourniquet (remote ischemic conditioning. In group 3, this procedure was performed before flap elevation (remote ischemic preconditoning. In group 4, the procedure was performed 4 hours after flap ischemia (remote ischemic postconditioning. In group 5, the procedure was performed after the flap was elevated, during the muscle flap ischemia episode (remote ischemic perconditioning. Results The histopathological damage score in all remote conditioning ischemia groups was lower than in the ischemic-reperfusion group. The lowest histopathological damage score was observed in group 5 (remote ischemic perconditioning. Conclusions The nitric oxide levels were higher in the blood samples obtained from the remote ischemic perconditioning group. This study showed the effectiveness of remote ischemic conditioning procedures and compared their usefulness for preventing ischemia-reperfusion injury in muscle flaps.

  12. Effects of Remote Ischemic Conditioning Methods on Ischemia-Reperfusion Injury in Muscle Flaps: An Experimental Study in Rats.

    Science.gov (United States)

    Keskin, Durdane; Unlu, Ramazan Erkin; Orhan, Erkan; Erkilinç, Gamze; Bogdaycioglu, Nihal; Yilmaz, Fatma Meric

    2017-09-01

    The aim of this study was to investigate the effects of remote ischemic conditioning on ischemia-reperfusion injury in rat muscle flaps histopathologically and biochemically. Thirty albino rats were divided into 5 groups. No procedure was performed in the rats in group 1, and only blood samples were taken. A gracilis muscle flap was elevated in all the other groups. Microclamps were applied to the vascular pedicle for 4 hours in order to achieve tissue ischemia. In group 2, no additional procedure was performed. In groups 3, 4, and 5, the right hind limb was used and 3 cycles of ischemia-reperfusion for 5 minutes each (total, 30 minutes) was applied with a latex tourniquet (remote ischemic conditioning). In group 3, this procedure was performed before flap elevation (remote ischemic preconditoning). In group 4, the procedure was performed 4 hours after flap ischemia (remote ischemic postconditioning). In group 5, the procedure was performed after the flap was elevated, during the muscle flap ischemia episode (remote ischemic perconditioning). The histopathological damage score in all remote conditioning ischemia groups was lower than in the ischemic-reperfusion group. The lowest histopathological damage score was observed in group 5 (remote ischemic perconditioning). The nitric oxide levels were higher in the blood samples obtained from the remote ischemic perconditioning group. This study showed the effectiveness of remote ischemic conditioning procedures and compared their usefulness for preventing ischemia-reperfusion injury in muscle flaps.

  13. Comparison of vancomycin and linezolid in patients with peripheral vascular disease and/or diabetes in an observational European study of complicated skin and soft-tissue infections due to methicillin-resistant Staphylococcus aureus.

    Science.gov (United States)

    Eckmann, C; Nathwani, D; Lawson, W; Corman, S; Solem, C; Stephens, J; Macahilig, C; Li, J; Charbonneau, C; Baillon-Plot, N; Haider, S

    2015-09-01

    Suboptimal antibiotic penetration into soft tissues can occur in patients with poor circulation due to peripheral vascular disease (PVD) or diabetes. We conducted a real-world analysis of antibiotic treatment, hospital resource use and clinical outcomes in patients with PVD and/or diabetes receiving linezolid or vancomycin for the treatment of methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections (MRSA cSSTIs) across Europe. This subgroup analysis evaluated data obtained from a retrospective, observational medical chart review study that captured patient data from 12 European countries. Data were obtained from the medical records of patients ≥ 18 years of age, hospitalized with an MRSA cSSTI between 1 July 2010 and 30 June 2011 and discharged alive by 31 July 2011. Hospital length of stay and length of treatment were compared between the treatment groups using inverse probability of treatment weights to adjust for clinical and demographic differences. A total of 485 patients had PVD or diabetes and received treatment with either vancomycin (n = 258) or linezolid (n = 227). After adjustment, patients treated with linezolid compared with vancomycin respectively had significantly shorter hospital stays (17.9 ± 13.6 vs. 22.6 ± 13.6 days; p MRSA-active antibiotics at discharge were 43.2% and 12.4% of patients in the linezolid and vancomycin groups, respectively (p MRSA cSSTIs if treated with linezolid compared with vancomycin. Copyright © 2015. Published by Elsevier Ltd.

  14. Systematic Review and Comparative Meta-Analysis of Outcomes Following Pedicled Muscle versus Fasciocutaneous Flap Coverage for Complex Periprosthetic Wounds in Patients with Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    James M. Economides

    2017-03-01

    Full Text Available BackgroundIn cases of total knee arthroplasty (TKA threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA.MethodsA systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis.ResultsA total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05 and limb salvage (89.8% vs. 100%, P=0.14 were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78, the rates of persistent infection (16.4% vs. 0%, P=0.14 and recurrent infection (9.1% vs. 4%, P=0.94 tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported.ConclusionsRates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.

  15. Pedicle Anterolateral Thigh Flap Reconstruction after Pelvic Tumor Resection: A Case Report

    Directory of Open Access Journals (Sweden)

    Robert M. Whitfield

    2010-01-01

    Full Text Available A 47-year-old female with a locally advanced urologic malignancy previously managed with resection, diversion, and postoperative radiation therapy presented for management of her recurrent cancer that had eroded through the soft tissues of the left inner thigh and vulva. On all staging studies the tumor involved the left common femoral artery, and vein, both above and below the inguinal ligament. The difficulty with such tumors is the availability of tissue to reconstruct the defect. The patient had a history of deep venous thrombosis in the femoral venous system. A local flap was the most logical type of reconstruction. The patient had a right lower quadrant ureterostomy with a large parastomal hernia which further limited the local flap options. An anterolateral thigh flap from the opposite thigh was used to reconstruct the soft tissue deficit in this patient. This resurfaced the defect and provided coverage for the vascular reconstruction.

  16. Modification of the sinus tarsi approach for open reduction and plate fixation of intra-articular calcaneus fractures: the limits of proximal extension based upon the vascular anatomy of the lateral calcaneal artery.

    Science.gov (United States)

    Femino, John E; Vaseenon, Tanawat; Levin, David A; Yian, Edward H

    2010-01-01

    The treatment of displaced calcaneal fractures remains controversial. Early surgical management to restore articular congruence and the structural function of the calcaneus is widely accepted as the best way to avoid the negative consequences of malunion. Concerns remain however regarding the best approach for reducing and maintaining reduction of these complex fractures, while minimizing the risk of surgical complications. The potential for serious wound complications is a major concern, particularly breakdown of the lateral calcaneal skin flap with the extensile lateral approach. Various approaches have been developed to try and balance the need for direct reduction of the articular surface while minimizing the potential for wound complications. Palmer originally described a laterally based approach through the sinus tarsi for direct visualization of the articular surface for reduction. He and others have found this approach to be useful and reasonably safe. At times, however, it may be necessary to extend the limits of a small incision over the sinus tarsi to treat adjacent fractures or to aid reduction in more complex fractures. In addition, a limited sinus tarsi incision without elevation of the lateral calcaneal skin flap does not allow for plate fixation, a notable advantage of the extensile lateral approach, particularly in gaining reduction of the body of the calcaneus. The authors have used an extended sinus tarsi approach to include placement of plate percutaneously beneath the lateral calcaneal skin flap through a sinus tarsi approach, and to treat adjacent fractures and soft tissue injuries. A clinical series of 13 patients (including 7 chronic smokers and 1 with diabetes and vascular disease) with closed displaced intra-articular calcaneal fractures (Sanders types II and III) were treated by open reduction and internal fixation via this approach. Adjacent fractures were treated through the same incision. Two patients developed wound complications. No

  17. MODIFICATION OF THE SINUS TARSI APPROACH FOR OPEN REDUCTION AND PLATE FIXATION OF INTRA-ARTICULAR CALCANEUS FRACTURES: THE LIMITS OF PROXIMAL EXTENSION BASED UPON THE VASCULAR ANATOMY OF THE LATERAL CALCANEAL ARTERY

    Science.gov (United States)

    Femino, John E.; Vaseenon, Tanawat; Levin, David A.; Yian, Edward H.

    2010-01-01

    The treatment of displaced calcaneal fractures remains controversial. Early surgical management to restore articular congruence and the structural function of the calcaneus is widely accepted as the best way to avoid the negative consequences of malunion. Concerns remain however regarding the best approach for reducing and maintaining reduction of these complex fractures, while minimizing the risk of surgical complications. The potential for serious wound complications is a major concern, particularly breakdown of the lateral calcaneal skin flap with the extensile lateral approach. Various approaches have been developed to try and balance the need for direct reduction of the articular surface while minimizing the potential for wound complications. Palmer originally described a laterally based approach through the sinus tarsi for direct visualization of the articular surface for reduction. He and others have found this approach to be useful and reasonably safe. At times, however, it may be necessary to extend the limits of a small incision over the sinus tarsi to treat adjacent fractures or to aid reduction in more complex fractures. In addition, a limited sinus tarsi incision without elevation of the lateral calcaneal skin flap does not allow for plate fixation, a notable advantage of the extensile lateral approach, particularly in gaining reduction of the body of the calcaneus. The authors have used an extended sinus tarsi approach to include placement of plate percutaneously beneath the lateral calcaneal skin flap through a sinus tarsi approach, and to treat adjacent fractures and soft tissue injuries. A clinical series of 13 patients (including 7 chronic smokers and 1 with diabetes and vascular disease) with closed displaced intra-articular calcaneal fractures (Sanders types II and III) were treated by open reduction and internal fixation via this approach. Adjacent fractures were treated through the same incision. Two patients developed wound complications. No

  18. Distal phalanx amputation with delayed presentation and successful reconstruction with reposition and flap after 2 weeks

    Directory of Open Access Journals (Sweden)

    Jefferson Braga-Silva

    2016-01-01

    Full Text Available Traumatic finger amputations are common, causing significant functional and cosmetic deficits. Microsurgical replantation techniques are the mainstay of treatment for most such injuries although they require adequate conservation of the amputated segment for a successful result. In distal finger amputations, replantation is the procedure of choice, as long as the amputated fragment is viable. If replantation is not an option, reposition + flap using a neurovascular flap can be an efficient option, as this offers improved skin coverage. To the best of our knowledge, this case illustrates the longest cold ischaemic time with a successful outcome.

  19. The cost of infection in severe open tibial fractures treated with a free flap

    DEFF Research Database (Denmark)

    Olesen, Ulrik Kähler; Pedersen, Nicolas Jones; Eckardt, Henrik

    2017-01-01

    of treatment, and to determine the effect of delayed skin closure on this cost. METHODS: We reviewed all records of patients treated with a free flap in our institution for an open tibial fracture from 2002 to 2013. We calculated direct costs based on length of stay (LOS) and orthopaedic and plastic surgical...... rate from 60 to 27 %. CONCLUSIONS: Severe open tibial fractures covered with free flaps, cause over a year of absenteeism. Infection increases direct cost of treatment over 60 % and roughly doubles LOS. Early soft-tissue cover and correct antibiotics have been shown to improve outcomes...

  20. Reconstruction of irradiated mandible after segmental resection of osteoradionecrosis-a technique employing a microvascular latissimus dorsi flap and subsequent particulate iliac bone grafting

    DEFF Research Database (Denmark)

    Hillerup, Soren; Elberg, Jens Jorgen; Thorn, Jens Jorgen

    2014-01-01

    The fibula osteocutaneous flap has revolutionized the options of mandibular segmental defect bridging in osteoradionecrosis (ORN). In selected cases, however, the fibula flap is not an option because of atherosclerosis or other features that compromise the vascularity of the lower leg and foot....... The aim of this study is to present an alternative method of mandibular segmental reconstruction employing a latissimus dorsi (LD) flap and subsequent particulate iliac free bone graft reconstruction. In 15 patients with ORN, a mandibular segmental defect was bridged with a reconstruction plate......, and the defect site was primed with a LD musculocutaneous flap wrapped around the reconstruction plate to bring in vascularized tissue and optimize healing conditions for a subsequent particulate iliac free bone graft reconstruction. The management of defect closure was successful in all 15 patients. Twelve...

  1. Head and neck reconstruction with pedicled flaps in the free flap era.

    Science.gov (United States)

    Mahieu, R; Colletti, G; Bonomo, P; Parrinello, G; Iavarone, A; Dolivet, G; Livi, L; Deganello, A

    2016-12-01

    Nowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to microvascular free flap reconstruction in terms of complications, functionality and prognosis. The records of consecutive patients who underwent free flap or pedicled flap reconstruction after head and neck cancer ablation from 2006 to 2015, from a single surgeon, in the AOUC Hospital, Florence Italy were analysed. A total of 93 patients, the majority with oral cancer (n = 59), were included, of which 64 were pedicled flap reconstructions (69%). The results showed no significant differences in terms of functional outcome, flap necrosis and complications in each type of reconstruction. Multivariate regression analysis of flap necrosis and functional impairments showed no associated factors. Multivariate regression analysis of complicated flap healing showed that only comorbidities remained an explaining factor (p = 0.019). Survival analysis and proportional hazard regression analysis regarding cancer relapse or distant metastasis, showed no significant differences in prognosis of patients concerning both types of reconstruction. In this retrospective, non-randomised study cohort, pedicled flaps were not significantly inferior to free flaps for reconstruction of head and neck defects, considering functionality, complications and prognosis. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

  2. Why Do Elephants Flap Their Ears?

    Science.gov (United States)

    Koffi, Moise; Jiji, Latif; Andreopoulos, Yiannis

    2009-11-01

    It is estimated that a 4200 kg elephant generates as much as 5.12 kW of heat. How the elephant dissipates its metabolic heat and regulates its body temperature has been investigated during the past seven decades. Findings and conclusions differ sharply. The high rate of metabolic heat coupled with low surface area to volume ratio and the absence of sweat glands eliminate surface convection as the primary mechanism for heat removal. Noting that the elephant ears have high surface area to volume ratio and an extensive vascular network, ear flapping is thought to be the principal thermoregulatory mechanism. A computational and experimental program is carried out to examine flow and heat transfer characteristics. The ear is modeled as a uniformly heated oscillating rectangular plate. Our computational work involves a three-dimensional time dependent CFD code with heat transfer capabilities to obtain predictions of the flow field and surface temperature distributions. This information was used to design an experimental setup with a uniformly heated plate of size 0.2m x 0.3m oscillating at 1.6 cycles per second. Results show that surface temperature increases and reaches a steady periodic oscillation after a period of transient oscillation. The role of the vortices shed off the plate in heat transfer enhancement will be discussed.

  3. [Clinical effects of repair of wounds in fingers after electrical burn with wrist perforator free flaps].

    Science.gov (United States)

    Di, H P; Xia, C D; Xing, P P; Li, Q; Han, D W; Xue, J D; Cao, D Y

    2017-09-20

    Objective: To explore the clinical effects of repair of wounds in the fingers after electrical burn with wrist perforator free flaps. Methods: Twelve patients (13 fingers) with electrical burn were hospitalized in our burn ward from January 2016 to January 2017. After radical debridement, the size of wounds ranged from 5.0 cm×2.0 cm to 10.0 cm×7.0 cm. Wounds with size below or equal to 6.0 cm ×2.5 cm were repaired with free flaps based on the superficial palmar branch of radial artery, with flap area ranging from 2.5 cm×2.2 cm to 6.0 cm×4.5 cm. The superficial palmar branch of radial artery, subcutaneous vein, and palmar cutaneous branch of the median nerve underwent end-to-end anastomosis with digital proper artery, dorsal superficial vein, and digital proper nerve in the finger, respectively. The donor sites were sutured directly. Wounds with size larger than 6.0 cm×2.5 cm were repaired with free flaps based on the dorsal carpal branch of ulnar artery, with flap area ranging from 4.5 cm×3.0 cm to 12.0 cm×8.5 cm. The dorsal carpal branch of ulnar artery, subcutaneous vein, and medial antebrachial cutaneous nerve underwent end-to-end anastomosis with digital proper artery, dorsal superficial vein, and digital proper nerve in the finger, respectively. The donor sites were sutured directly or covered by full-thickness skin graft from abdomen. Results: Five free flaps based on the superficial palmar branch of radial artery and 8 free flaps based on the dorsal carpal branch of ulnar artery were used in the patients. In one week after surgery, 12 flaps survived completely, while one free flap based on the dorsal carpal branch of ulnar artery suffered from slight infection, after depressing change, it survived in the end. After the follow-up of half a year, the flaps were full in shape and the distance of two-point discrimination of ranged from 4.0 to 7.0 mm. The fingers showed good functional recovery and no deformity. The grade of function of the fingers was

  4. Cost analysis of postmastectomy reconstruction: A comparison of two staged implant reconstruction using tissue expander and acellular dermal matrix with abdominal-based perforator free flaps.

    Science.gov (United States)

    Tran, Bao Ngoc N; Fadayomi, Ayotunde; Lin, Samuel J; Singhal, Dhruv; Lee, Bernard T

    2017-09-01

    Two staged tissue expander-implant with acellular dermal matrix (TE/I + ADM) and deep inferior epigastric perforator (DIEP) flap are the most common implant and autologous methods of reconstruction in the U.S. Implant-based techniques are disproportionally more popular, partially due to its presumed cost effectiveness. We performed a comprehensive cost analysis to compare TE/I + ADM and DIEP flap. A comparative cost analysis of TE/I + ADM and DIEP flap was performed. Medicare reimbursement costs for each procedure and their associated complications were calculated. Pooled probabilities of complications including cellulitis, seroma, skin necrosis, implant removal, flap loss, partial flap loss, and fat necrosis, were calculated using published studies from 2010 to 2016. Average actual cost for successful TE/I + ADM and DIEP flap were $13 304.55 and $10 237.13, respectively. Incorporating pooled complication data from published literature resulted in an increase in cost to $13 963.46 for TE/I + ADM and $12 624.29 for DIEP flap. The expected costs for successful TE/I + ADM and DIEP flap were $9700.35 and $8644.23, which are lower than the actual costs. DIEP flap breast reconstruction incurs lower costs compared to TE/I + ADM. These costs are lower at baseline and when additional costs from pooled complications are incorporated. © 2017 Wiley Periodicals, Inc.

  5. The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy

    OpenAIRE

    Butterworth, C. J.; Rogers, S. N.

    2017-01-01

    This aim of this report is to describe the development and evolution of a new surgical technique for the immediate surgical reconstruction and rapid post-operative prosthodontic rehabilitation with a fixed dental prosthesis following low