Groin flap design and versatility

Resurfacing deep wound of upper extremities with pedicled groin flaps

A total of 29 axial pedicled groin skin flaps were applied clinically with satisfactory result excepting for one flap which tailed on transplantation. These cases included severe scar contracture of the dorsum of hands in 20 patients, deeply burned wounds with infection and exposure of deep structure in upper extremities in nine patients, such as electrical burns and hot-crushing injuries. The flap is supplied by two groups of nutrient vessels with abundant vascularization and located in a hidden area. Therefore, the pedicled groin skin flap is still valuable due to its advantages as safe, easy operation and strong antiinfective ability although the free groin flap is more widely used today.

Combined ischemic preconditioning and laser Doppler measurement for early division of pedicled groin flap

OBJECTIVES

The main disadvantage of the pedicled groin flap for hand reconstruction is the long period of immobilization required. Early division of the pedicled groin flap is desirable for both patients and surgeons. The aims of this study were to investigate whether ischemic preconditioning can effectively accelerate the neovascularization of the junction between the donor and recipient sites in the pedicled flap, and the most objective method of judging the timing of early division of the pedicled groin flap. This report is the first prospective study to use ischemic preconditioning for early division of pedicled cutaneous flap combined with laser Doppler measurement.

METHODS

The severe hand injuries of 12 patients were reconstructed by using the pedicled groin flap method. The ischemic preconditioning program was prospectively performed as scheduled for 5 to 7 days postoperatively. The pedicled groin flap was monitored with laser Doppler when the flap was elevated, inset, with clamping and nonclamping postoperatively.

RESULTS

Eleven of the 12 pedicled groin flaps were divided safely and survived completely. Only one pedicled groin flap with a simultaneous harvest of iliac bone graft had partial flap loss, giving a success rate of 90.1%.

CONCLUSION

With ischemic preconditioning, the pedicled groin flap can be safely divided postoperatively at a mean period of 8.4 days according to the laser Doppler measurement, especially when the perfusion unit ratio of clamping over nonclamping reaches more than 36.6%.

The sartorius muscle: anatomic considerations for reconstructive surgeons

To evaluate the sartorius muscle as an alternative donor site for functional transfer, the neurovascular anatomy of the muscle was studied in 42 human sartorius muscle specimens (22 fresh and 20 preserved). Eleven adult fresh cadavers were injected with a mixture of lead oxide, gelatin and water (200 ml/kg) through the common carotid and femoral arteries. The sartorius muscle with its neurovascular pedicles was dissected, and radiographed. The sartorius muscle was also dissected out in 10 preserved cadavers. The neurovascular anatomy was thus analyzed in 42 sartorius muscles. The results show that each nerve supplying the sartorius muscle is accompanied by one vascular pedicle, forming a neurovascular hilum. Within the muscle, most of the nerves and vessels divide early, and their branches run parallel to each other and to the muscle fibers. Many of the vessels anastomose with each other to form an intricate vascular network. We conclude that it is possible to subdivide the muscle into functional units to harvest a segmental muscle flap with a neurovascular pedicle for transfer.

Arterialised venous groin flap: case report

A defect of the right cheek, mastoid and inferior auricular region in a 16-year-old female after resection of a squamous cell carcinoma was covered with a free arterialised venous groin flap. As the conventional groin flap did not include the superficial circumflex iliac artery, one of the two superficial circumflex iliac veins was arterialised and the other was used as the draining vein. Part of the flap underwent full-thickness necrosis; however, the area that survived was enough to cover the defect.

Complications of free flap donor sites

A variety of free tissue transfers are available for microsurgical reconstruction. To date little attention has been placed on the donor site, both from the potential for acute complications as well as long-term morbidity. In this review the various types of tissue transfers in different anatomical locations have been assessed for potential problems at the donor site. An assessment system is proposed to better evaluate this problem as well as to allow comparison of the different donor sites.

Morbidity of the pedicled groin flap. A retrospective study of 44 cases

Forty four pedicled groin flaps, raised between 1986 and 1990 for the coverage of soft tissue defects of the hand and forearm, were retrospectively evaluated. Thirty eight (86%) were emergencies, roller injuries with skin avulsion being the main mechanism of injury. Local complications such as partial flap necrosis, infection, and seroma, developed in 11 patients (25%). Subsequent defatting was required in 38 (86%) of the flaps and four patients (9%) had secondary revisions of the donor sites. The median duration of hospital stay was 26 days (range 8-81), and 12 patients (27%) were discharged from hospital before division of the pedicle. General complications, including pneumonia (n = 2) and pulmonary embolism (n = 1) developed in five patients (11%), four of whom were 55 years old or more. One patient died of a myocardial infarction 15 days postoperatively. Our results indicate that other methods for skin coverage should be chosen for patients older than 50 years.

Closure of an ischial pressure sore with a sartorius musculocutaneous flap

A method for the reconstruction of ischial defects is outlined, citing some particular advantages of the technique.

Experience of 73 free groin flaps

The free groin flap has gradually lost its popularity due to the disadvantages relating to the pedicle and the plethora of new donor sites. The purpose of this article is to re-evaluate this time-honoured free flap and to demonstrate its reliability and versatility through a review of 73 free groin flaps performed between 1985 and 1990. 7% of free transfers (total 1096 cases) in our institution were free groin flaps. The complication rate was 8% (three complete failures and three partial failures). This result is acceptable and not so high as other reports have described. The artery discrepancy is the main cause of the complication rate. Two special techniques to gain additional diameter of vessel size to overcome the pedicle disadvantages are stressed. The groin flap has proved to be useful and still deserves consideration in reconstructive procedures.

State-of-the-art breast reconstruction

Many breast reconstruction procedures have been performed with success and satisfaction. These methods can be categorized as implant reconstruction, local tissue with implant, autologous tissue, and free flaps. Implant reconstruction, immediate or delayed, has been the easiest and most fulfilling experience for the surgeon and the patient. Local tissue with implant and autologous tissue are usually available to those patients with anterior chest tissue deficiency or those who prefer autologous tissue without the fear of implant material. Free flap reconstruction is often selected when no other procedures are appropriate for the patient. Individual procedures must be familiar to the patient and the surgeon. Other factors such as time involved, cost of hospital stay, recovery time, and associated complications are discussed in this article. Refinement and nipple areolar reconstruction are an intimate part of breast reconstruction, but these are usually the decisions made by the patient that must be respected.