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Zhang SL, Xu N, Bo Dou C, Mao L, Ma SR, Jia J, Yu ZL. Reconstructive strategies following surgical resection of malignant sublingual gland tumors: a single institution experience. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101908. [PMID: 38703996 DOI: 10.1016/j.jormas.2024.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To investigate the characteristics and treatment modalities of malignant tumors originating from the sublingual gland, as well as evaluate the therapeutic outcomes following free flap reconstruction. METHODS A retrospective statistical analysis was conducted on the clinical data of nine patients diagnosed with malignant neoplasms of the sublingual gland. RESULTS The aggregate of nine instances of malignant neoplasms arose from the sublingual glandular tissue, encompassing eight instances of adenoid cystic carcinoma (ACC) and a single case of a bipartite differentiated carcinoma-a hybrid of epithelial-myoepithelial carcinoma and adenoid cystic carcinoma. In addition, there were four instances where anterolateral thigh flaps were employed (of which three were thin flaps), and five instances utilized forearm flaps. The flap incisions varied in size, with dimensions spanning from 2.5 cm × 6 cm to 4 cm × 9 cm. The vessels chosen for anastomosis were the superior thyroid artery in seven cases, the facial artery in a singular case, and the lingual artery in another. Among the eight patients who underwent dissection of cervical lymph nodes, not a single one exhibited metastasis. A duo of patients underwent adjuvant radiotherapy as an integral component of their treatment regimen. Upon postoperative follow-up, recurrence was absent in all of the patients documented. CONCLUSION The thinning of the anterior external thigh flap can be employed for postoperative repair and reconstruction of malignant sublingual gland tumors, minimizing patient trauma.
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Affiliation(s)
- Shi-Long Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 430079 Wuhan, China; Dongfeng Stomatological Hospital, Hubei University of Medicine, 442000, Shiyan, China
| | - Ning Xu
- Department of Oral and Maxillofacial Surgery, Jining Stomatological Hospital, 272000, Jining, China
| | - Chun- Bo Dou
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 430079 Wuhan, China; Dongfeng Stomatological Hospital, Hubei University of Medicine, 442000, Shiyan, China
| | - Liang Mao
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 430079 Wuhan, China; State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 430079 Wuhan, China
| | - Si-Rui Ma
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 430079 Wuhan, China; State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 430079 Wuhan, China
| | - Jun Jia
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 430079 Wuhan, China; State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 430079 Wuhan, China.
| | - Zi-Li Yu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 430079 Wuhan, China; State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 430079 Wuhan, China.
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Akita S, Nakaguchi T, Tokumoto H, Yamaji Y, Arai M, Yasuda S, Ogata H, Tezuka T, Kubota Y, Mitsukawa N. The usefulness of a free thinned deep inferior epigastric artery perforator flap and measurement of the vascular pedicle length: A thin flap with a long pedicle. J Plast Reconstr Aesthet Surg 2021; 75:1579-1585. [PMID: 34973933 DOI: 10.1016/j.bjps.2021.11.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/28/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The thinned deep inferior epigastric perforator (DIEP) flap branching from the main trunk to the superolateral direction may be useful because of its long vascular pedicle. DIEP flap is used as an axial-pattern adipose flap. The vascular pedicle length of the thinned DIEP flap was investigated using originally developed software. The clinical application of the thinned DIEP flap was verified in a case series. METHODS In 40 patients with enhanced computed tomography (CT) data, the vascular pedicle length of the longest thinned DIEP flap was simulated using the software. A free thinned DIEP flap was used in 10 clinical cases of facial or breast reconstruction. RESULTS In all simulated cases, the vascular pedicle of the DIEP branching to the superolateral direction was the longest, and the vascular pedicle could be lengthened up to 34.8% by dissecting the vessels on the fascia as a vascular pedicle. In all the clinical cases, the reconstruction of a complex form defect or reconstruction requiring a long vascular pedicle could be achieved in one stage without any perioperative complications. The intraclass correlation coefficient between simulated pedicle length and dissected pedicle length was 0.99. CONCLUSION Thinned DIEP flaps with long vascular pedicles could be elevated safely. Multiple adipose or muscle flaps could be combined without complications. The length of the winding vascular pedicle could be measured using imaging data using the software first developed in the present study. This software would be useful in the planning of a thinned DIEP flap and other free flaps.
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Affiliation(s)
- Shinsuke Akita
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Toshiya Nakaguchi
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Hideki Tokumoto
- Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, Chiba, Japan
| | - Yoshihisa Yamaji
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Minami Arai
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Saori Yasuda
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideyuki Ogata
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takafumi Tezuka
- Department of Dermatology and Plastic and Reconstructive Surgery, Akita University Graduate School of Medicine and Faculty of Medicine, Akita, Japan
| | - Yoshitaka Kubota
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Subdermal Dissection for Elevation of Pure Skin Perforator Flaps and Superthin Flaps: The Dermis as a Landmark for the Most Superficial Dissection Plane. Plast Reconstr Surg 2021; 147:470-478. [PMID: 33620945 DOI: 10.1097/prs.0000000000007689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pure skin perforator and superthin flaps have been reported and are becoming popular, as they allow one-stage thin skin reconstruction even from a thick donor site. However, currently reported elevation procedures use proximal-to-distal dissection requiring free-style perforator selection and primary thinning procedures. With distal-to-proximal dissection using the dermis as a landmark for dissection plane, it is expected that elevation of pure skin perforator or superthin flaps can be simplified. METHODS Patients who underwent pure skin perforator or superthin flap transfers with the subdermal dissection technique were included. Flaps were designed based on location of pure skin perforators visualized on color Doppler ultrasound, and elevated just below the dermis under an operating microscope. Medical charts were reviewed to obtain clinical and intraoperative findings. Characteristics of the patients, flaps, and postoperative courses were evaluated. RESULTS Thirty-six flaps were transferred in 34 patients, all of which were elevated as true perforator flaps (superficial circumflex iliac artery perforator flap in 29 cases, other perforator flaps in seven cases). Mean ± SD flap thickness was 2.24 ± 0.77 mm (range, 1.0 to 4.0 mm). Skin flap size ranged from 3.5 × 2 cm to 27 × 8 cm. Time for flap elevation was 27.4 ± 11.6 minutes. All flaps survived without flap atrophy/contracture 6 months after surgery, except for two cases of partial necrosis. CONCLUSION The subdermal elevation technique allows straightforward and direct elevation of a pure skin perforator or superthin flap within 30 minutes on average without the necessity of primary thinning. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Expeditionary Plastic Surgery: Reconstruction Pearls for the Non-plastic Surgeon Managing Injured Host Nationals. CURRENT TRAUMA REPORTS 2021. [DOI: 10.1007/s40719-021-00212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Evaluation of Primary and Secondary Free Flap Desyndactylization Techniques in Hand and Digit Reconstruction: A Systematic Review. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2020. [DOI: 10.1055/s-0040-1721705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractObjective Injuries of the hand often require free flap reconstruction. To minimize flap loss, evidence exists to surgically syndactylize digits when repairing multiple injuries, with delayed flap division, or desyndactylization. However, evidence suggests that division of the flap at the time of inset can be accomplished with minimal negative effect. The purpose of this study was to evaluate outcomes, following hand reconstruction with free flaps utilizing either acute or staged desyndactylization techniques.Methods A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Articles that described the use of a free flap for surgically syndactylized digits or multilobed flaps for coverage of multiple digits were included.Results One hundred sixty-one articles were reviewed with 34 fulfilling inclusion criteria. One hundred seventeen patients underwent 145 free flap reconstructions. Traumatic avulsions (49%) were the most common injuries, followed by burns (11%). Twenty-one (62%) papers described surgical syndactylization of digits, which were later desyndactylized and five (15%) papers included reconstruction of more than one digit with multilobed free flaps. Eight papers (24%) described both techniques. Overall, 100% of included flaps survived. Total complication rate was 6%, with six complications (67%) occurring in flaps with primary syndactylization.Conclusion Hand defects often require free flaps for reconstruction. Although free flaps for the reconstruction of digital defects is technically demanding, they result in better outcomes. With available evidence indicating complications rates less than those of staged desyndactylization, multidigit reconstruction with multilobed free flaps may be a more desirable technique.
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Anatomical Understanding of Target Subcutaneous Tissue Layer for Thinning Procedures in Thoracodorsal Artery Perforator, Superficial Circumflex Iliac Artery Perforator, and Anterolateral Thigh Perforator Flaps. Plast Reconstr Surg 2019; 142:521-534. [PMID: 29889740 DOI: 10.1097/prs.0000000000004619] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thinned perforator flaps, reported techniques, and degree of thinning differ by study. This study investigated the anatomy of subcutaneous tissue according to the varying fattiness and identified which component and how much of the subcutaneous tissue layer needed to be excluded to meet target flap thickness using computed tomography. METHODS Three stratified fattiness groups consisting of 30 donors were formed for thoracodorsal artery perforator, superficial circumflex iliac artery perforator, and anterolateral thigh flaps. Thickness of the superficial fat and the deep fat layers was measured at specific points in donor sites of the three flaps and the proportion of superficial and deep fat layers to exclude to reach the target flap thickness (4, 6, and 8 mm) was calculated. RESULT The median proportion for the superficial fat layer varies depending on donor fattiness. The estimated percentage reduction of thickness after thin flap elevation along superficial fascia was approximately one-third of the whole layer. A variable proportion of each fat layer needs to be excluded to obtain required thinness and in very thick groups, part of the superficial fat layer must be removed to reach any of the target thicknesses for the three flaps. CONCLUSIONS The present study demonstrated the frequent need for superficial fat layer manipulation when obtaining a thin perforator flap. To cope with various combinations of donor-site fattiness and different required thicknesses effectively, an appropriate thinning method should have increased adaptability, including the ability to control superficial fat layer thickness.
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Luca‐Pozner V, Boissiere F, Rodriguez T, Karra A, Herlin C, Chaput B. Complex abdominopelvic reconstruction by combined tensor fascia latae and superficial circumflex iliac artery perforator flaps. Microsurgery 2018; 40:25-31. [DOI: 10.1002/micr.30391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/24/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022]
Affiliation(s)
- V Luca‐Pozner
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - F Boissiere
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - T Rodriguez
- Department of Orthopedic and Trauma Surgery, Upper Limb and Spine Surgery UnitCHU Lapeyronie Montpellier France
| | - A Karra
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - C Herlin
- Department of Plastic and Reconstructive Surgery, Burns and Wound Healing UnitsCHRU Lapeyronie Montpellier France
| | - B Chaput
- Department of Plastic, Reconstructive, Aesthetic Surgery and BurnsCHRU Rangueil Toulouse France
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Abdelrahman M, Zelken J, Huang RW, Hsu CC, Lin CH, Lin YT, Lin CH. Suprafascial dissection of the pedicled groin flap: A safe and practical approach to flap harvest. Microsurgery 2017; 38:458-465. [DOI: 10.1002/micr.30238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 07/06/2017] [Accepted: 08/25/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Mohamed Abdelrahman
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Jonathan Zelken
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Ren-Wen Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, School of Medicine; Chang Gung University; Taoyuan Taiwan
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Song D, Li Z, Zhou X, Xie S. [Repair of the donor defect after wrap-around flap transfer with free thinned innervated anterolateral thigh perforator flap]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:987-991. [PMID: 29806438 DOI: 10.7507/1002-1892.201703122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the feasibility of harvesting free thinned innervated anterolateral thigh (ALT) perforator flap for repairing the donor defect after wrap-around flap transfer. Methods Between May 2011 and December 2013, free thinned innervated ALT perforator flap was used to repair the donor defects after wrap-around flap transfer in 9 patients. There were 8 males and 1 female, with a mean age of 31.2 years (range, 19-42 years). The interval time between injury and admission was 3-12 hours (mean, 6.5 hours). Injury causes included machine crush injury (4 cases), traffic accident injury (3 cases), and twisting injury (2 cases). The wrap-around flaps were transferred to reconstruct thumb defects. And the size of donor site defect ranged from 3 cm×2 cm to 8 cm×5 cm. A branch of the lateral femoral cutaneous nerve was carried to make innervated ALT perforator flap for donor site repair. The size of innervated ALT perforator flap ranged from 3.0 cm×2.0 cm to 8.5 cm×5.0 cm. The thickness of innervated ALT perforator flap before defatting ranged from 2.0 to 4.5 cm (mean, 3.2 cm); the thickness after defatting ranged from 0.4 to 0.6 cm (mean, 0.5 cm). The defect at the anterolateral thigh was primarily closed in all cases. Results All reconstructed thumbs and ALT perforator flaps survived. All patients were followed up 6-30 months (mean, 15.8 months). The ALT perforator flaps had good appearance and color, with no further flap revision or defatting procedures. The static two-point discrimination was 8-15 mm (mean, 10.5 mm). All patients could walk and run normally without postoperative skin erosions or ulcerations. Conclusion The free thinned innervated ALT perforator flap is pliable and thin. It is suitable for repairing the donor site defects after wrap-around flap transfer for thumb reconstruction.
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Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Xiao Zhou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Songlin Xie
- Hand Surgical Centre, Nanhua Hospital, Nanhua University, Hengyang Hunan, 421001,
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Study of the Medial Superficial Perforator of the Superficial Circumflex Iliac Artery Perforator Flap Using Computed Tomographic Angiography and Surgical Anatomy in 142 Patients. Plast Reconstr Surg 2017; 139:738-748. [DOI: 10.1097/prs.0000000000003147] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dast S, Vaucher R, Rotari V, Assaf N, David E, Christian H, Sinna R. Les lambeaux cutanés minces dans la prise en charge des pertes de substance cutanée de la main et du membre supérieur. ANN CHIR PLAST ESTH 2017; 62:69-78. [DOI: 10.1016/j.anplas.2016.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
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Hand Allograft Saved by an Ultrathin Groin Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e869. [PMID: 27757334 PMCID: PMC5055000 DOI: 10.1097/gox.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 05/04/2016] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. We report a case of a young double-hand allotransplant patient who presented with a full-thickness skin necrosis of the dorsum of the left hand after vascular compromise of the allotransplantation. Considering the lack of viable dorsal tissue overlying the extensor tendons and the need for early hand rehabilitation, an ultrathin pedicled groin flap was used for the coverage. This procedure resulted in salvaging the allotransplantation, and the patient was able to successfully return to work after his surgery. To our knowledge, this is the only case of an upper extremity allotransplant salvaged by a pedicled flap.
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Xie S, Deng X, Chen Y, Song D, Li K, Zhou X, Li Z. Reconstruction of foot and ankle defects with a superthin innervated anterolateral thigh perforator flap. J Plast Surg Hand Surg 2016; 50:367-374. [PMID: 27224035 DOI: 10.1080/2000656x.2016.1184158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND An anterolateral thigh (ALT) perforator flap can be thinned to an extent to which it is vascularised only by the subdermal plexus. This study presents an innervated flap thinning technique and its application for dorsal foot and ankle resurfacing. METHODS A superthin innervated ALT perforator flap was used to repair the dorsal foot and ankle of 12 patients. The perforators were classified according to their variations in the adipose layer, and the corresponding microdissection technique was then applied. The branch of the lateral femoral cutaneous nerve and its accompanying vessels were adopted to construct a sensory flap. RESULTS The flap thickness before defatting, which was measured immediately after flap elevation, ranged from 25-45 mm. The average flap thickness after defatting was 4.55 mm (range = 3-6 mm). A total of 11 flaps completely survived, and one flap presented superficial necrosis within a small area (2 cm ×2 cm) in the distal part of the flap. No further flap revision or defatting procedures were required for these patients during an average follow-up period of 16.5 months (range = 10-24 months). In the transferred flap, protective sensibility existed in all cases, and the static two-point discrimination was 13-16 mm. CONCLUSIONS The superthin innervated ALT perforator flap may be considered as an ideal strategy for foot and ankle reconstruction.
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Affiliation(s)
- Songlin Xie
- a Department of Orthopedics , Xiangya Hospital of Central South University , Changsha , PR China.,b Hand Surgical Centre, Nanhua Hospital, Nanhua University , Henyang , PR China
| | - Xiangwu Deng
- b Hand Surgical Centre, Nanhua Hospital, Nanhua University , Henyang , PR China
| | - Yanmin Chen
- b Hand Surgical Centre, Nanhua Hospital, Nanhua University , Henyang , PR China
| | - Dajiang Song
- c Department of Head and Neck Surgery, Department of Oncology Plastic Surgery , Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University , Changsha , Hunan , PR China.,d Department of Orthopedics , Changzheng Hospital, the Second Military Medical University , Shanghai , PR China
| | - Kanghua Li
- a Department of Orthopedics , Xiangya Hospital of Central South University , Changsha , PR China
| | - Xiao Zhou
- c Department of Head and Neck Surgery, Department of Oncology Plastic Surgery , Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University , Changsha , Hunan , PR China
| | - Zan Li
- c Department of Head and Neck Surgery, Department of Oncology Plastic Surgery , Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University , Changsha , Hunan , PR China
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Abstract
BACKGROUND The groin flap represents a milestone in the history of flap development, since it was the first successful free cutaneous flap. Once widely used, it is currently less popular owing to the variations in vascular anatomy and the small, short pedicle. To enhance the clinical applications of the groin flap, its merits need to be promoted and its faults improved, including making some useful innovations. METHODS From February 2010 to February 2014, we successfully treated 35 patients with soft tissue defects in the extremities (28 patients), buttock (1 patient), and head (6 patients) using new designs in groin flaps: axial free (34 patients) or pedicle (1 patient) groin flaps. RESULTS All types of axial groin flaps survived successfully in the 2 to 38 months' (mean, 15.6 months) follow-up. The branches of the superficial circumflex iliac artery used for the axial flap design were 2 to 4 (mean, 3.09). The flap size ranged from 1×1.5 cm to 11×30 cm. No significant complications developed in any of the patients, with the exception of 2 mildly bulky flaps. CONCLUSIONS This axial design of freestyle groin flaps not only preserves the earlier merits of the groin flap but also creates many new advantages: (1) reliability is greater, (2) ability to tailor the dimensions and flap paddles to the lesions, (3) options available to "lengthen" flap pedicles, and (4) local anesthesia usable with free flaps for reconstruction.
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Chao WN, Wang PH, Chen BR, Chen SC. Chimeric groin free flaps: Design and clinical application. Microsurgery 2015; 36:206-15. [DOI: 10.1002/micr.22442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 05/10/2015] [Accepted: 05/28/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Wai-Nang Chao
- Institute of Medicine & School of Medicine; Chung Shan Medical University; Taichung Taiwan
- Division of Plastic Surgery, Department of Surgery; Changhua Christian Hospital; Changhua Taiwan
- Chienkuo Technology University; Changhua Taiwan
| | - Po-Hui Wang
- Institute of Medicine & School of Medicine; Chung Shan Medical University; Taichung Taiwan
| | - Bing-Ren Chen
- Division of Plastic Surgery, Department of Surgery; Liouying Chi-Mei Hospital; Tainan Taiwan
| | - Shiuan-Chih Chen
- Institute of Medicine & School of Medicine; Chung Shan Medical University; Taichung Taiwan
- Department of Family and Community Medicine; Chung Shan Medical University Hospital; Taichung Taiwan
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Abstract
A total of eight cases with multiple skin defects of the hand and digits were resurfaced using a free iliac flap. The lesions involved both the hand and multiple digits in five patients and multiple digits in three patients. The average skin flap size was 89.3 cm(2). In three, a piece of of vascularized iliac bone was included. There was no flap loss. Flap debulking was performed in five patients at 10-12 weeks post-surgery during the operation for flap separation and inset. Secondary flap debulking was performed in one patient at 6 months post-surgery. The average static 2-point discrimination was 15.4 mm in five patients, whereas the remaining patients only exhibited sensation to pressure. This procedure may require additional refinement; however, the free iliac flap with technical refinements is a viable option for the treatment of multiple skin defects of the hand and digits.
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Affiliation(s)
- Z-H Pan
- Orthopaedics Institute of Chinese PLA, Weifang, Shandong Province, China
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Poon SW, Wei FC. Discussion for the article “Clinical Application and Refinement of the Microdissected Thin Groin Transfer Operation” by Kimura and Saitoh. J Plast Reconstr Aesthet Surg 2009; 62:1517-8. [DOI: 10.1016/j.bjps.2008.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 06/09/2008] [Indexed: 10/21/2022]
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Kimura N, Saitoh M, Hasumi T, Sumiya N, Itoh Y. Clinical application and refinement of the microdissected thin groin flap transfer operation. J Plast Reconstr Aesthet Surg 2009; 62:1510-6. [DOI: 10.1016/j.bjps.2008.06.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
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Rozen W, Murray A, Ashton M, Bloom R, Stella D, Phillips T, Taylor G. The cutaneous course of deep inferior epigastric perforators: implications for flap thinning. J Plast Reconstr Aesthet Surg 2009; 62:986-90. [DOI: 10.1016/j.bjps.2008.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 12/24/2007] [Accepted: 01/05/2008] [Indexed: 11/26/2022]
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Iglesias M, Butrón P, Chávez-Muñoz C, Ramos-Sánchez I, Barajas-Olivas A. Arterialized venous free flap for reconstruction of burned face. Microsurgery 2009; 28:546-50. [PMID: 18683867 DOI: 10.1002/micr.20525] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this study, a forearm arterialized venous free flap (23 cm x 14 cm) was used in a 25-year-old male with facial burns sequels to reconstruct both cheeks, chin, lips, nose, columnella, nasal tip, and nostrils. It was arterialized by the facial artery to an afferent vein anastomosis. The venous flow was drained by four efferent vein to vein anastomoses. Although it developed small inferior marginal necrosis in the lower lip, the rest of the flap survived with good quality of the skin in both texture and color, with self-delimitation of the different esthetics units of the center of the face such as the nasogenian folds, nostrils, and upper lip filtrum, without the need of additional thinning surgical procedures. From all of the above, the arterialized venous free flap is an alternative reconstructive option for the treatment of burn sequels especially those that include the centrofacial region.
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Affiliation(s)
- Martín Iglesias
- Plastic Surgery Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF, México.
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del Piñal F, García-Bernal FJ, Studer A, Ayala H, Cagigal L, Regalado J. Super-thinned iliac flap for major defects on the elbow and wrist flexion creases. J Hand Surg Am 2008; 33:1899-904. [PMID: 19084199 DOI: 10.1016/j.jhsa.2008.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 08/22/2008] [Accepted: 09/20/2008] [Indexed: 02/02/2023]
Abstract
Four free iliac flaps were used to treat or prevent flexion contracture at the elbow or wrist flexion crease. Flap size ranged from 13 x 6 cm to 18 x 8 cm. Two flaps were used for primary coverage, and the other 2 flaps were used to treat established flexion contractures. All flaps survived without vascular complications. Full range of motion was obtained at the elbow and 40 degrees of active extension was obtained at the wrist. The flap has a very thin dermis with minimal panniculus that can be thinned as required, making it ideal to cover flexion creases. Despite the fact that anatomic variations are common in the inguinal region, the flap can be expeditiously and safely elevated. If needed, pedicle length can be up to 8 to 10 cm. The donor site is comparable with that of a full-thickness skin graft harvested from the groin. The donor artery, however, can be very small.
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Kimura N, Saitoh M, Itoh Y, Sumiya N. A comprehensive protocol of general burn treatment with microdissected thin flaps—a preliminary report. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-008-0264-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dabernig J, Watson S, Hart A. Free Microdissected Thin Groin Flap Design with an Extended Vascular Pedicle; Thin Anterolateral Thigh Perforator Flap Using a Modified Microdissection Technique. Plast Reconstr Surg 2007; 119:2327-2328. [PMID: 17519754 DOI: 10.1097/01.prs.0000261086.77699.c9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jörg Dabernig
- Canniesburn Plastic Surgery Unit, Glasgow, United Kingdom
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