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Zhang Y, Shi J, Zhang Z, Gupta A, Xiao M, Wang L. Mandibular reconstruction using an iliac bone flap with perforator-supported external oblique abdominal muscle island: a pilot study. Int J Oral Maxillofac Surg 2024:S0901-5027(23)00933-5. [PMID: 38185542 DOI: 10.1016/j.ijom.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
The deep circumflex iliac artery (DCIA) flap is one of the bone flaps commonly used for mandibular reconstruction. Observation of the skin paddle and Doppler ultrasound are methods that are usually used to monitor DCIA flaps after mandibular reconstruction surgery. The aim of this study was to introduce a novel DCIA flap with a perforator-supported external oblique abdominal muscle (EOAM) island for postoperative flap monitoring. This study included five patients who underwent mandibular reconstruction using this modified technique. The DCIA flap and the EOAM island supplied by the ascending branch of the DCIA were harvested during the surgery. After mandibular reconstruction, the EOAM island was placed in the submandibular region to monitor the blood supply to the DCIA flap after surgery. The blood supply to the DCIA flap was monitored by observing the colour, texture, and bleeding condition of the EOAM island. After the monitoring period, the EOAM was removed and the ascending branch of the DCIA was ligated. The outcome was successful in all patients. The EOAM island supported by the ascending branch of the DCIA is reliable and safe, thus providing a robust option to monitor the blood supply to the DCIA flap.
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Affiliation(s)
- Y Zhang
- Department of Oral and Maxillofacial Surgery - Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Shi
- Department of Oral and Maxillofacial Surgery - Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Z Zhang
- Department of Oral and Maxillofacial Surgery - Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - A Gupta
- Department of Dentistry, Government Medical College and Hospital, Chandigarh, India
| | - M Xiao
- Department of Oral and Maxillofacial Surgery - Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - L Wang
- Department of Oral and Maxillofacial Surgery - Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Stomatology, Fengcheng Hospital, Fengxian District, Shanghai, China.
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Lin M, Zuo X, He F, Fu Q, Li D, Zuo Z. Clinical application of an expanded reverse- island flap with two dorsal metacarpal arteries and dorsal metacarpal nerves in index- and middle-finger-degloving injury repair and amputation reconstruction. J Plast Reconstr Aesthet Surg 2023; 77:309-318. [PMID: 36610276 DOI: 10.1016/j.bjps.2022.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022]
Abstract
The dorsal metacarpal artery flap (DMAF) is irrefutable as an effective way of repairing long finger defects, and hand surgeons might consider using it for long finger reconstruction or degloved injury repair. Unfortunately, the DMAF containing a single dorsal metacarpal artery (DMA) hinders the treatment effect. The sensory restoration of long fingers and the reconstruction of phalangeal joints and tendon grafts are unsolved challenges as well. We reported our experience in reconstructing the index and middle finger by a reverse-island flap with two DMAs and dorsal metacarpal nerves (DMNs) with blood supply. We reviewed ten patients with finger-crush injuries affecting eight index fingers and two middle fingers. Degloving injuries occurred in two patients, and finger amputations occurred in eight others. Two patients received simple flap reconstruction, and eight received finger reconstruction, including seven from abandoned phalangeal joints and tendon grafts of the severed finger and one from the iliac crest bone graft. All patients underwent finger reconstruction by an expanded reverse-island flap consisting of two DMAs and DMNs up to a maximal size of 9 × 8 cm2. Postoperative follow-up evaluation showed a satisfactory appearance and functional recovery of the reconstructed fingers. We posit that the expanded reverse-island flap involving two DMAs and DMNs constitutes a feasible and safe option for restoring a severely damaged index or middle finger, particularly for patients who are unwilling to undergo toe-to-finger transplantation to reconstruct the injured long fingers.
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Affiliation(s)
- Mei Lin
- Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Xi Zuo
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Fen He
- Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Qiuyuan Fu
- Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Degui Li
- Department of Plastic Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Zhongnan Zuo
- Department of Plastic Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, China.
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Shin J, Kim SA, Rhie JW. Perineal perforator switch flap for three-dimensional vulvovaginal reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:3208-3216. [PMID: 35717498 DOI: 10.1016/j.bjps.2022.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/12/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Vulvovaginal reconstruction is challenging. In this study, we evaluated the outcomes of vulvovaginal reconstruction with "perineal perforator switch flap" (PPSF) and compared it with other conventional flaps. In addition, the long-term esthetic results were compared with the perineal perforator propeller flap (PPPF), which we previously used. METHODS We retrospectively reviewed the clinical data of 16 patients (27 flaps) who underwent vulvovaginal reconstruction with PPSF. After tumor resection, perineal perforators close to the genitofemoral sulcus were identified. The flap was designed as an island with the perforator at the center. The flap was elevated while preserving the soft tissue surrounding the pedicle, and transferred to the defect via the subcutaneous tunnel without pedicle skeletonization. RESULTS All flaps survived and no major surgical complications were observed. The total follow-up period was 16.13±3.38 months. The mean operation time was 79.38±19.65 min, and the initiation of walking and the length of hospitalization were 1.69 ± 0.79 and 5.69 ± 0.79 days, respectively. Perineal function was well preserved. Comparison of esthetic results with PPPF showed that PPSF showed better results in symmetrical and labial shape (2.29 ± 0.73 vs. 3.13 ± 0.81; p=0.015, 2.43 ± 1.02 vs. 3.25 ± 0.68; p=0.031, respectively), and in total score. (10.29 ± 2.16 vs. 12.31 ± 1.82; p=0.017). CONCLUSION PPSF was technically simple and significantly reduced the duration of operation and the overall recovery time. PPSF also prevented delay in radiation. Therefore, PPSF is a promising method for vulvovaginal reconstruction.
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Affiliation(s)
- Jongweon Shin
- Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Tongil-ro 1021, Eunpyeong-gu, Seoul, Republic of Korea.
| | - Seong Ae Kim
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Won Rhie
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Su Z, Fan J, Liu L, Tian J, Gan C, Jiao H, Yang Z, Zhang T, Zeng Y, Chen Y, Huang R. The application of a retrograde postauricular island flap in reconstructing periorbital region defects. J Plast Reconstr Aesthet Surg 2021; 75:761-766. [PMID: 34789431 DOI: 10.1016/j.bjps.2021.09.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 07/10/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reconstruction of periorbital region defects is thought to be one of the most challenging areas in reconstructive plastic surgery. This paper describes our experiences with the application of retrograde postauricular island flaps in reconstructing periorbital region defects. METHODS Between November 2008 and June 2019, 16 patients with periorbital region defects underwent treatment using a retrograde postauricular island flap. The flap is designed with two portions: 1) the pedicle segment only with the superficial temporal fascia and 2) the flap segment in the posterior auricular region with non-hair-bearing full-thickness tissue. Intraoperatively, the vascular networks between the postauricular and the superficial temporal vessels were preserved. The flap was then transferred to the receipt area after passing through a subcutaneous tunnel. The donor site was directly closed in the postauricular sulcus by advancing the posterior scalp flap. RESULTS All the periorbital region defects were reconstructed in one-stage surgery. All the flaps survived without venous congestion. The size of the harvested flaps varied from 5.0 × 2.5 cm to 7.5 × 5 cm. The colour of the transferred flaps matched the surroundings of the receipt region, and the eyelids functioned well. CONCLUSION A retrograde postauricular island flap is a good choice for the reconstruction of periorbital region defects. The flap can be useful for the reconstruction of the periorbital region, since it uses similar colours and textures. In addition, it permits a "one-stage" reconstruction with less conspicuous donor site scars behind the auricle.
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Affiliation(s)
- Zhiguo Su
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China
| | - Jincai Fan
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China.
| | - Liqiang Liu
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China
| | - Jia Tian
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China
| | - Cheng Gan
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China
| | - Hu Jiao
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China
| | - Zengjie Yang
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China
| | - Tiran Zhang
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China
| | - Yan Zeng
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China
| | - Yihua Chen
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China
| | - Rong Huang
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing, China
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Amouzou KS, Mokako JL, El Youssoufi A, El Harti A, Diouri M. A thin superficial temporalis artery revealed by total necrosis of an island scalp flap, a case report. Int J Surg Case Rep 2021; 81:105708. [PMID: 33721824 PMCID: PMC7970353 DOI: 10.1016/j.ijscr.2021.105708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/02/2022] Open
Abstract
Total necrosis of a scalp flap based on the STA is rare. Extensive exploration of the vascular supply of the scalp before pedicled flap is not a common rule. Impact of anatomic variations on scalp flap surgery is not well documented. Anatomical variation may impact negatively the outcome of single pedicled scalp flaps.
Introduction and importance The superficial temporalis artery (STA) counts as one of the most reliable blood supplies capable of supporting the vascularization of the entire scalp. Therefore, total necrosis of a scalp flap based on the superficial temporalis artery is a rare complication. Case presentation A 43-year-old woman with a history of hypertension and cerebral stroke presented to our consultation for fronto-parietal scalp alopecia. The scar was the result of spontaneous healing of a chemical burn that occurred eight months earlier. We performed the first step of scalp expansion and raised a parietal expanded goblet island flap based on the right STA. In the postoperative period, the flap developed progressive necrosis. Despite the release of tension and stab incisions, the flap failed in a week. An angio-MRI revealed a thin STA on the right compared to the left side. After debridement, the necrosis was superficial, deep galea, and some subcutaneous tissues were viable. We performed a split-thickness skin graft that achieved a total wound closure. Clinical discussion An extensive exploration of the vascular supply of the scalp before raising a scalp flap is not a common rule. The anatomical variation that we discovered as a thin superficial temporal artery may have explained the total failure of this flap surgery. Conclusion Surgeons should keep in mind the possible existence of a detrimental anatomical variation when planning a single pedicled scalp flap.
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Affiliation(s)
- Komla Séna Amouzou
- University, Faculty of Medicine and Pharmacy, Casablanca, Po Box 2000, Morocco.
| | | | - Ahlam El Youssoufi
- University, Faculty of Medicine and Pharmacy, Casablanca, Po Box 2000, Morocco.
| | - Amine El Harti
- University, Faculty of Medicine and Pharmacy, Casablanca, Po Box 2000, Morocco.
| | - Mounia Diouri
- University, Faculty of Medicine and Pharmacy, Casablanca, Po Box 2000, Morocco.
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Tomás-Velázquez A, Redondo P. Island Flap for Upper-Lip Reconstruction: Analysis of Key Aspects and a Case Series. Actas Dermosifiliogr (Engl Ed) 2020; 112:171-175. [PMID: 32931753 DOI: 10.1016/j.ad.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/29/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022] Open
Abstract
Upper-lip reconstruction after Mohs micrographic surgery is challenging for dermatologic surgeons. We describe a series of 15 patients (7 men and 8 women; mean age, 65.6 years) with skin cancer on the upper lip treated with Mohs surgery: 10 were basal cell carcinomas, 2 were melanomas, and 3 were squamous cell carcinomas. The resulting defects measured between 3 and 7.6cm. We used island flaps to reconstruct the defects in all cases, hiding the incisions in the nasolabial fold, at the line where the skin meets the vermillion border of the lip, and in the relaxed skin tension lines. We explain key aspects of the surgeries and design of the reconstructions, with emphasis on the importance of occasionally sacrificing small areas of healthy skin. Cosmetic and functional outcomes were satisfactory in all patients, and there were no postsurgical complications.
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Affiliation(s)
- A Tomás-Velázquez
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona y Madrid, España.
| | - P Redondo
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona y Madrid, España
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Affiliation(s)
- Kyle S Ettinger
- Section of Head & Neck Oncologic Surgery and Reconstruction, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Mail Code: RO_MA_12_03E-OS, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Rui P Fernandes
- Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine - Jacksonville, 653-1 West 8th Street 2nd FL/LRC, Jacksonville, FL 32209, USA
| | - Kevin Arce
- Section of Head & Neck Oncologic Surgery and Reconstruction, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Mail Code: RO_MA_12_03E-OS, 200 First Street Southwest, Rochester, MN 55905, USA
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Rauchenwald T, Dejaco D, Morandi EM, Djedovic G, Wolfram D, Riechelmann H, Pierer G. The Pectoralis Major Island Flap: Short Scar Modified Muscle-Sparing Harvesting Technique Improves Aesthetic Outcome in Reconstructive Head and Neck Surgery. ORL J Otorhinolaryngol Relat Spec 2019; 81:327-337. [PMID: 31698360 DOI: 10.1159/000503008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pectoralis major flap reconstruction is often associated with large unappealing scars in head-neck surgery. We recently established an alternative harvesting technique that improves aesthetic outcome. OBJECTIVES The objective of this study was to demonstrate a modified surgical technique that harvests the pectoralis major muscle as an island flap and focuses on minimizing incision lines and applying a muscle-sparing approach. METHODS A retrospective analysis covering the period 2008-2018 was conducted. Patients who underwent pectoralis major island flap reconstruction for fistula prophylaxis after salvage laryngectomy at the Medical University of Innsbruck were included. Flap harvesting was performed subcutaneously using two small incision lines, thereby sparing the clavicular and upper sternocostal aspects of the pectoralis muscle. RESULTS Twenty-three patients with squamous cell carcinoma of the larynx (n = 19) or pharynx (n = 4) underwent salvage laryngectomy and consecutive reconstruction using a pectoralis major island flap and our muscle-sparing technique. Mean overall operation time was 147 ± 48.6 min. The majority (70%) of patients had an uneventful course of recovery and showed satisfying aesthetic results and low donor site morbidity as compared to traditional harvesting techniques. Six (26%) patients had major complications that required surgical revision. Three (13%) cases were complicated with fistulas. CONCLUSION The pectoralis major island flap is shown to be reliable in otolaryngeal surgery. This surgical technique minimizes scarring and preserves thoracic wall architecture by taking a less invasive approach, thereby improving aesthetic outcome and reducing overall patient morbidity.
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Affiliation(s)
- Tina Rauchenwald
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria,
| | - Evi M Morandi
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Djedovic
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Ben Slama N, Adnot J, Trost O. Management of an extended bone-invasive basal cell carcinoma of the median forehead. J Stomatol Oral Maxillofac Surg 2019; 121:296-299. [PMID: 31325622 DOI: 10.1016/j.jormas.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
We report the case of a 35-year-old male patient managed for extended basal cell carcinoma of the median forehead, invading the frontal bone. Bone reconstruction was performed by a splitting of calvaria and skin reconstruction was performed using two frontal flaps dissected into complete vascular island, covering a skin defect of about 8cm in diameter (including safety margins). Wound healing was achieved after 4 weeks despite a median area of suffering and a temporary leak of cerebrospinal fluid of favorable evolution. The result at 5 years was excellent, with the patient's return to normal daily life and total satisfaction.
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Affiliation(s)
- N Ben Slama
- Department of Oral and Maxillofacial Surgery, Rouen Normandy University, 1, rue de Germont, 76031 Rouen, France
| | - J Adnot
- Department of Oral and Maxillofacial Surgery, Rouen Normandy University, 1, rue de Germont, 76031 Rouen, France; LIMICS UMR-1142,French National Institute for Health (INSERM), 76000 Rouen, France
| | - O Trost
- Department of Oral and Maxillofacial Surgery, Rouen Normandy University, 1, rue de Germont, 76031 Rouen, France; LIMICS UMR-1142,French National Institute for Health (INSERM), 76000 Rouen, France; Laboratory of Anatomy, Rouen Faculty of Medicine, Rouen Normandy University, Rouen, France.
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Tchernev G, Wollina U, Temelkova I. High-Risk Basal Cell Carcinomas of the Head and Neck: Selected Successful Surgical Approach in Three Bulgarian Patients! Open Access Maced J Med Sci 2019; 7:1665-1668. [PMID: 31210819 PMCID: PMC6560301 DOI: 10.3889/oamjms.2019.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/18/2019] [Accepted: 05/26/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Regarding localisation, basal cell carcinomas are classified in three risk groups, designated as H for high-, M as medium-, and L as low-risk area. In patients with high-risk basal cell carcinomas (BCCs), as a first-line of treatment are mentioned, different types of surgical approaches and radiotherapy. Depending on the location of the tumour, the choice of surgical technique should vary and be consistent with the patient's will for a most aesthetically acceptable result. CASE REPORT Three cases of patients with BCCs defined as high-risk about two different indicators-localisation and relapse after radiation therapy are presented. For the recovery of the occurred defects, three different types of surgical approaches (primary closure/undermining surgical approach, island flap and advancement flap) were used, tailored to the high-risk factors in each patient, which at the same time provided a perfect clinical outcome. CONCLUSIONS High-risk BCCs are a challenge for every dermatosurgeon and require serious training and knowledge both in terms of anatomy and in terms of the possibilities for reconstruction of the defects that occurred. Operations usually run in three phases, namely: 1) removal of tumour tissue, 2) intraoperative plan for reconstruction according to the size of the defect and the condition of the surrounding tissues as well as phase 3) undermining of surrounding tissues and adaptation of the wound edges.
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Affiliation(s)
- Georgi Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, General Skobelev 79, 1606 Sofia, Bulgaria.,Onkoderma - Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606 Sofia, Bulgaria
| | - Uwe Wollina
- Department of Dermatology and Allergology, Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Ivanka Temelkova
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, General Skobelev 79, 1606 Sofia, Bulgaria.,Onkoderma - Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606 Sofia, Bulgaria
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11
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Zhang JF, Wang L, Hao RZ, Huo YX, Yang HY, Hu YC. Treatment of fingertip avulsion injuries using two periposition pedicled flaps. J Plast Reconstr Aesthet Surg 2019; 72:628-635. [PMID: 30655243 DOI: 10.1016/j.bjps.2018.12.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
We described a treatment of fingertip avulsion injury by two periposition pedicled flaps, the reversed pedicle island flap of dorsal branch of proper digital artery and the cross-finger flap. From February 2009 to January 2017, 22 patients (22 fingers) with fingertip avulsion injury were treated with two periposition pedicled flaps, 14 male and 8 female, aged from 17 to 47 years (mean 32 ± 9 years). All of the patients were followed up more than 6 months after operations (mean 9.6 ± 2.6 months). All flaps survived completely. Compared with the traditional abdominal flaps, two periposition pedicled flaps had less pedicle division time. At last follow-up, the 2PD of the palmar part of the flaps, the TAM of the injured finger and the MHQ summary score of the two periposition pedicled flaps were much better than the traditional abdominal flaps. The reconstruction using two periposition pedicled flaps is a versatile treatment with better functions, less morbidity and better aesthetics. Level of evidence: Therapeutic, level III.
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Affiliation(s)
- Jian-Feng Zhang
- Graduate School, Tianjin Medical University, No.22 Qixiangtai Road, Tianjin 300070, China; The Department of Hand Surgery, The Second Hospital of Tangshan, No.21 Jianshe Road, Tangshan 063000, China
| | - Lei Wang
- The Department of Trauma, The Second Hospital of Tangshan, No.21 Jianshe Road, Tangshan 063000, China
| | - Rui-Zheng Hao
- The Department of Hand Surgery, The Second Hospital of Tangshan, No.21 Jianshe Road, Tangshan 063000, China
| | - Yong-Xin Huo
- The Department of Hand Surgery, The Second Hospital of Tangshan, No.21 Jianshe Road, Tangshan 063000, China
| | - Huan-You Yang
- The Department of Hand Surgery, The Second Hospital of Tangshan, No.21 Jianshe Road, Tangshan 063000, China
| | - Yong-Cheng Hu
- The Department of Bone Oncology, Tianjin Hospital, No.406 Jiefang Road, Tianjin 300211, China.
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12
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Tchernev G, Temelkova I, Mangarov H, Stavrov K. Comparative Analysis of the Applicability of Island Flap in Primary and Recurrent Basal Cell Carcinomas of Similar Localization. Open Access Maced J Med Sci 2018; 6:1077-1080. [PMID: 29983805 PMCID: PMC6026405 DOI: 10.3889/oamjms.2018.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Basal cell carcinoma belongs to non-melanoma skin cancers and is the most prevalent neoplasia that shows a tendency to increase over the last few decades. It occurs most often in skin areas exposed to sunlight. It is characterised by slow progression, low tendency to metastasising and good prognosis when the right choice of treatment has been made. The difficulty in the treatment of basal cell carcinomas is determined by their localisation and puts to the test the aesthetic potential of dermatosurgeons. Complete surgical excision is the standard approach in most uncomplicated cases. In relapsing basal cell carcinoma or carcinoma with aggressive or unfavourable histopathological characteristics, the clinician faces the dilemma of identifying the most appropriate method of treatment. To find the decision, help comes from the individualisation of each case and the related risk factors. CASE REPORT: Two cases of basal cell carcinoma of similar localisation are presented, where the carcinomas are removed using island flaps. In spite of the desire to observe the recommended field of surgical security (by the desire for the ultimate esthetic effect for the patient), one of the tumours was not completely removed, and as an alternative, reoperation was proposed using Mohs micrographic surgery (MMS). CONCLUSION: The choice of a surgical technique, which would guarantee a better outcome and could be applied depending on the individual risk factor in each patient, is discussed.
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Affiliation(s)
- Georgi Tchernev
- Medical Institute of the Ministry of Interior, Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, General Skobelev Nr 79, Sofia, Bulgaria.,Onkoderma, Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26, Sofia, Bulgaria
| | - Ivanka Temelkova
- Medical Institute of the Ministry of Interior, Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, General Skobelev Nr 79, Sofia, Bulgaria
| | - Hristo Mangarov
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology and Dermatologic Surgery, General Skobelev 79, 1606 Sofia, Bulgaria
| | - Konstantin Stavrov
- Medical Institute of the Ministry of Interior, Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, General Skobelev Nr 79, Sofia, Bulgaria
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Huang Y, Xie H, Lv Y, Yu L, Sun L, Li X, Chen Y, Sun H, Chen F. One-stage repair of proximal hypospadias with severe chordee by in situ tubularization of the transverse preputial island flap. J Pediatr Urol 2017; 13:296-299. [PMID: 28359778 DOI: 10.1016/j.jpurol.2017.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/15/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To investigate a modified transverse preputial island flap repair which is performed in an attempt to reduce the complications following one-stage repair of proximal hypospadias with chordee. METHODS Briefly, the two ends of the flap were trimmed into V shape and anastomosed with the spatulated urethra proximally and urethral plate distally before tubularization. Then the in situ tubularization of the flap was performed. The procedure was performed in our hospital on 32 patients (mean age = 11 months). They were followed for 12-38 months. RESULTS The length of the urethral defect ranged from 4.0-6.0 cm after chordee correction. Urethrocutaneous fistulae occurred in 6 (18.7%) cases. No urethral strictures or meatal stenoses were observed. 29/32 families were satisfied with the cosmetic results. CONCLUSION This procedure seems straightforward and reliable, leading to good result after a short-term follow-up.
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Affiliation(s)
- Yichen Huang
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Hua Xie
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Yiqing Lv
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Ling Yu
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Li Sun
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Xiaoxi Li
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Yan Chen
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Huizhen Sun
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Fang Chen
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China.
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González-García JA, Chiesa-Estomba CM, Sistiaga JA, Larruscain E, Álvarez L, Altuna X. Utility and versatility of the supraclavicular artery island flap in head and neck reconstruction. Acta Otorrinolaringol Esp (Engl Ed) 2017; 69:8-17. [PMID: 28506450 DOI: 10.1016/j.otorri.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/22/2017] [Accepted: 03/12/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The supraclavicular island flap is a rotational pedicled flap and may have some advantages in head and neck reconstruction compared with free-tissue transfer when this kind of reconstruction is not affordable or recommended. MATERIAL AND METHODS We present our experience during the year 2016 in the application of the supraclavicular island flap in five cases as an alternative to microvascular reconstruction in several defects after resection of head and neck tumours. In two patients, the flap was used to close the surgical pharyngostoma after total laryngectomy with partial pharyngectomy. In one patient, it was used in lateral facial reconstruction after partial resection of the temporal bone. In one case, it was used to close a skin defect after total laryngectomy with prelaryngeal tissue extension. And in the last case to close a neck skin defect after primary closure of a pharyngo-cutaneous fistula. There were no flap complications, and the result was satisfactory in all cases. RESULTS The supraclavicular artery island flap is useful and versatile in head and neck reconstruction. Operating room time in aged patients or those with comorbidities will be reduced compared to free flaps. The surgical technique is relatively easy and can be used for skin and mucosal coverage. CONCLUSION The supraclavicular island flap could be a recommended option in head and neck reconstruction, its use seems to be increasing and provides a safe and time-saving option to free flaps in selected patients.
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Affiliation(s)
- José A González-García
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España.
| | - Carlos M Chiesa-Estomba
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España
| | - Jon A Sistiaga
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España
| | - Ekhiñe Larruscain
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España
| | - Leire Álvarez
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España
| | - Xabier Altuna
- Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, Donostia-San Sebastián, Gipuzkoa, España
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15
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La Padula S, Abbate V, Di Monta G, Schonauer F. Levator alae nasi muscle V-Y island flap for nasal tip reconstruction. J Craniomaxillofac Surg 2016; 45:432-435. [PMID: 28108241 DOI: 10.1016/j.jcms.2016.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/17/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022] Open
Abstract
Nasal tip reconstruction can be very challenging. It requires close attention to skin texture, colour and thickness matching, with the respect of the nasal aesthetic units and symmetry. Flaps are usually preferred to skin grafts where possible. Based on different donor areas, various flaps have been described for reconstruction of this region. Here we present a new V-Y myocutaneous island flap based on the levator alae nasi muscle (LAN muscle) blood supply. This flap may represent an alternative to the nasalis myocutaneous sliding V-Y flap previously described by Rybka. As its pivot point it is located more cranially than the nasalis flap, and it can advance more medially than the Rybka flap, with the possibility of covering larger defects of the nasal tip area, up to 1.8 cm in diameter. Over the past 5 years, 24 patients received nasal tip reconstruction with this flap following the resection of basal cell carcinomas. Good tip projection was maintained, and the aesthetic outcome was satisfactory, with well healed scars. We recommend this technique as an alternative to other flaps for nasal tip defects, especially if paramedian.
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Affiliation(s)
- Simone La Padula
- Department of Plastic and Reconstructive Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy.
| | - Vincenzo Abbate
- Department of Maxillofacial Surgery, A.O.U. Federico II, 80131 Naples, Italy
| | - Gianluca Di Monta
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", Istituto Nazionale dei Tumori Fondazione Pascale Napoli, 80131 Naples, Italy
| | - Fabrizio Schonauer
- Department of Plastic and Reconstructive Surgery, A.O.U. Federico II, 80131 Naples, Italy
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Aksam E, Aksam B, Demirseren ME, Yavuz HSO. Saphenous artery-based flap models in rats: new flap designs for experimental studies. J Surg Res 2016; 206:355-362. [PMID: 27884329 DOI: 10.1016/j.jss.2016.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/29/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Ersin Aksam
- Plastic Reconstructive and Aesthetic Surgery Department, Akhisar State Hospital, Manisa, Turkey.
| | - Berrak Aksam
- Plastic Reconstructive and Aesthetic Surgery Department, Turgutlu State Hospital, Manisa, Turkey
| | - Mustafa Erol Demirseren
- Plastic Reconstructive and Aesthetic Surgery Department, Yildirim Beyazit University Ataturk Training and Research Hospital, Ankara, Turkey
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Ibañez N, Abrisqueta J, Luján J, Hernández Q, Parrilla P. V-Y advancement flaps for extensive perianal defect repair. Cir Esp 2016; 94:525-530. [PMID: 27554330 DOI: 10.1016/j.ciresp.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/26/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Some perianal pathologies require aggressive surgery that will need techniques to allow to re-establish the integrity of the perianal region. The purpose is to analyze short and long term results after perineal reconstruction with V-Y flaps. METHODS A retrospective review of prospectively collected database was conducted at Virgen de la Arrixaca's Hospital in Murcia (España) between January 2000 and December 2013. The study includes all patients who underwent a perineal reconstruction with V-Y flaps. Demographic and surgical data and short-/long- term morbidity was recorded. RESULTS 10 patients were included, 6 males and 4 females. The average age was 58,1±17,4 years. Surgical indication included both malignant and benign pathologies. Operating time was 143,5±41,3min. R0 resection was performed in all cases although histopathological analysis showed involvement of the deeper margin in 3 cases. Length of hospital stay was 7,8±7,6 days. Regarding complications: 6 patients had partial dehiscence of the flap. None of the patients lost the flap completely. The most frequent late complication was anal stenosis (n=4). Follow up showed total continence in 7 patients. Two patients had variable fecal and/or flatus incontinence. A colostomy was made in one case due to severe incontinence. CONCLUSIONS V-Y flaps are an effective and feasible technique to cover large perianal defects after aggressive surgeries. However, this technique is not free of postoperative morbidity.
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Affiliation(s)
- Noelia Ibañez
- Departamento de Cirugía General y Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - Jesús Abrisqueta
- Departamento de Cirugía General y Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Juan Luján
- Departamento de Cirugía General y Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Quiteria Hernández
- Departamento de Cirugía General y Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Pascual Parrilla
- Departamento de Cirugía General y Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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Chang JW, Lee JH, Choi MSS. Perforator-based island flap with a peripheral muscle patch for coverage of sacral sores. J Plast Reconstr Aesthet Surg 2016; 69:777-782. [PMID: 27068663 DOI: 10.1016/j.bjps.2016.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/22/2016] [Accepted: 03/06/2016] [Indexed: 11/26/2022]
Abstract
Despite numerous therapeutic advances, the treatment of pressure sores remains a challenge. The increased use of perforator flaps enables surgeons to minimize donor-site morbidity by sparing the underlying muscle. In the presence of focal deep spaces, however, the inclusion of muscle would be beneficial. The goal of this study was to introduce a method for including a muscle patch at the periphery of a perforator-based island flap for coverage of sacral pressure sores. Between March 2010 and February 2015, 26 patients with stage IV sacral sores underwent perforator-based island flap reconstruction with a peripheral muscle patch. Patient characteristics, including sex, age, defect size, and postoperative complications, were recorded. All flaps survived without major complications. No flap necrosis was noted. The present study shows that a muscle patch incorporated into the periphery of a perforator-based flap can be transferred safely. This can be a good surgical option in cases where infection control or more volume is needed.
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Affiliation(s)
- Jung Woo Chang
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jang Hyun Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Matthew Seung Suk Choi
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.
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Izadi F, Ghanbari H, Zahedi S, Pousti B, Maleki Delarestaghi M, Salehi A. An Island Flap Technique for Laryngeal Intracordal Mucous Retention Cysts. Iran J Otorhinolaryngol 2015; 27:337-42. [PMID: 26568936 PMCID: PMC4639685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Mucous retention cysts are a subtype of intracordal vocal cysts that may occur spontaneously or may be associated with poor vocal hygiene, and which require optimal treatment. The objective of this study was to present a new laser-assisted microsurgery technique for treating intracordal mucous retention cysts and to describe the final outcomes. MATERIALS AND METHODS In this prospective study, we assessed the pre-operative and post-operative acoustic analysis, maximum phonation time (MPT), and voice handicap index (VHI) of four patients with a diagnosis of mucous retention cyst. The island flap technique was applied to all patients without any complications. In this procedure, we favored the super-pulse mode using a 2-W power CO2 laser to remove the medial wall of the cyst, before clearing away the lateral wall margins of the cyst using repeat-pulse mode and a 2-W power CO2 laser. Indeed, we maintained the underlying epithelium and lamina propria, including the island flap attached to the vocal ligament. RESULTS There was a statistically significant improvement in the MPT (pre-op,11.05 s; post-op,15.85 s; P=0.002) and the VHI (pre-operative, 72/120; post-operative,27/120; P=0.001) in all patients. Moreover, jitter and shimmer were refined after surgery, but there was no statistically significant relationship between pre-operative and post-operative data (P=0.071) (P=0.622). In the follow-up period (median, 150 days), there was no report of recurrence or mucosal stiffness. CONCLUSION The island flap procedure in association with CO2 laser microsurgery appears to be a safe and effective treatment option for intracordal mucous retention cysts, but needs further investigation to allow comparison with other methods.
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Affiliation(s)
- Farzad Izadi
- Department of Otorhinolaryngology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Hadi Ghanbari
- Department of Otorhinolaryngology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author Department of Otorhinolaryngology and ENT&HNS Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Tel: +98 21 66504294, Fax: 98 21 66511011, E–Mail:
| | - Sahar Zahedi
- Department of Otorhinolaryngology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Behzad Pousti
- Department of Otorhinolaryngology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Mojtaba Maleki Delarestaghi
- Department of Otorhinolaryngology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Abolfazl Salehi
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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Kang IG, Jung JH, Kim ST, Kim YJ. Reconstruction of a columellar defect with a nasolabial island flap. Clin Exp Otorhinolaryngol 2014; 7:142-4. [PMID: 24917913 DOI: 10.3342/ceo.2014.7.2.142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 02/17/2012] [Accepted: 03/16/2012] [Indexed: 11/09/2022] Open
Abstract
Columellar skin defects may be caused by excision of cutaneous malignancy, trauma, or tissue necrosis associated with surgery. Although columellar skin necrosis rarely occurs following rhinoplasty, this condition might be more common when using an external approach than a closed approach. Columellar skin incision performed with exaggerated tip augmentation may cause columellar necrosis. The nasolabial island flap, used unilaterally to cover columellar skin defects, is used for a single-stage reconstruction procedure and is generally not associated with the need for secondary surgeries. This technique is well suited for repairing columellar skin defects. We experienced a patient with columellar skin necrosis occurring after rhinoplasty which was reconstructed using a unilateral single-stage nasolabial island flap.
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Classen DA. Alternative techniques for pedicle transfer of an island flap and a free flap. Can J Plast Surg 2005; 13:77-81. [PMID: 24223010 DOI: 10.1177/229255030501300201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Alternative techniques for pedicle transfer of a reverse radial forearm flap for hand coverage, and a latissimus dorsi myocutaneous free flap for pelvic wound coverage, are illustrated. Exteriorization of the vascular pedicle of a reverse radial forearm flap allows a greater arc of movement of the flap for more distal coverage, and avoids the potential vascular compromise of tunnelling under a tight skin bridge. Two-stage transfer of a latissimus dorsi myocutaneous free flap on a wrist carrier pedicle may be useful in circumstances when local recipient vessels are inadequate for free flap transfer. Although both of these vascular pedicle modifications have drawbacks, they may be of value in limited circumstances. Their advantages and limitations are discussed.
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Affiliation(s)
- Dale A Classen
- Division of Plastic Surgery, Department of Surgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan
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