Adipofascial Turnover Flap Research Articles

Aesthetic Outcomes of the Adipofascial Turnover Flap for Nasal Defects

A retrospective review was conducted of patients who underwent either a forehead flap or an AFT flap for nasal reconstruction between January 2016 and January 2021. Aesthetic outcomes were compared via patient surveys and photographic analysis by plastic surgeons. All photographs were standardized and masked to conceal which reconstructive technique was utilized. Wilcoxon rank-sum tests and t-tests were performed to determine significance. Ten forehead flaps and 22 AFT flaps were performed between January 2016 and January 2021. Seven forehead flap patients and 18 AFT flap patients participated in the aesthetic outcome survey. Seven forehead flap postoperative photographs and 20 AFT flap postoperative photographs were available for analysis. Patients who underwent forehead flap reconstruction reported higher satisfaction for color match of the reconstruction to the surrounding nasal skin (P = 0.005). Otherwise, there was no statistical significance between the two patient groups. There was no statistical difference in the photographic analysis of the two groups. The single-stage AFT flap with full thickness skin grafting provides similar aesthetic outcomes compared with the two-stage forehead flap when reconstructing large defects of the nasal tip, which is supported by both patient-reported outcome measures and standardized photographic analysis by a panel of plastic surgeons.

Reconstruction of Soft-Tissue Defects of the Thumb Using Reverse-Flow Homodigital Flaps: A Systematic Review

IntroductionSoft-tissue thumb defects are common reconstructive challenges, the main goals being restoration of tactile sensibility, range of movement, pulp padding, length, and cosmesis. The reverse-flow dorsoulnar and dorsoradial collateral artery flaps are homodigital flaps used to cover both distal dorsal and volar thumb defects. These flaps can be used as compound flaps including skin, fat, and/or nerves. As there is no critical analysis of these studies, this study aims to create a synthesized comprehensive systematic review. MethodsSystematic review was performed using the databases PubMed, Embase, and Medline. Eligible studies followed the inclusion criteria: English language and all studies published to date. The primary outcome was flap survival. Other data collected included anatomical area of the defect, flap constituents and dimensions, donor-site closure and complications, transfer method, reoperation, revision, and functional outcomes. ResultsA total of 19 articles incorporating 189 flaps met the inclusion criteria. These flaps were categorized and analyzed as dorsoradial (50%), dorsoulnar (39%), and turnover flaps (11%). Dorsoradial flaps were used in fasciocutaneous fashion alone. Partial flap failures occurred in five cases. Dorsoulnar flaps were used as fasciocutaneous or as osteocutaneous flaps. Complete flap failure was reported in one patient alone, whereas partial necrosis was reported in four patients. Adipofascial turnover flaps had two partial flap failures reported but no complete failures. The overall complete and partial flap failure rates were 0.5 and 6.5%, respectively. ConclusionReverse-flow homodigital random or axial-based flaps provide a reliable means of reconstruction for soft-tissue defects with reasonable success rate and good functional outcomes. They have a consistent anatomy with a good potential for personalization and therefore increased versatility.

Reconstruction of Lateral Malleolar Defects: Adipofascial Turnover Flap Based on the Peroneal Artery Perforator

Background: Lateral malleolar defects are a commonly encountered clinical issue, with several treatment options available from local flaps to microsurgical reconstruction. However, ankle defects are difficult to manage, especially in patients with comorbidities. We report here our experience of lateral malleolar reconstruction using adipofascial turnover flaps based on the peroneal artery perforator.Methods: A total of nine patients who underwent peroneal artery perforator-based adipofascial turnover flap coverage from December 2011 to February 2016 were retrospectively evaluated. Data were collected on the patients’ age, sex, etiology, comorbidities, anesthesia type, combined surgery, presence of osteomyelitis, bacterial profiles, vascular status, defect size, flap size, flap elevation time, follow-up period, and complications.Results: The mean age of the patients was 66.4 years. The most common cause of the wound was pressure injury. Seven patients had one or more comorbidities, and four patients were current smokers. Three patients were diagnosed with chronic osteomyelitis. Percutaneous transluminal angioplasty was performed in two patients. The mean defect size was 8.4 cm<sup>2</sup>, and the mean follow-up period was 30.7 months. All nine flap transfers were successful without major complications. However, in one case, partial skin graft loss occurred, requiring additional skin grafting.Conclusion: The peroneal artery perforator-based adipofascial turnover flap is a safe and reliable method to reconstruct lateral malleolar defects. The operative technique is simple and convenient to perform and hence a useful option for reconstructing lateral malleolar defects. This is especially true for patients with comorbidities who are typically not indicated for more complex procedures.

Response to Comment on "Li et al, Distally Based Sural Adipofascial Turnover Flap for Coverage of Complicated Wound in the Foot and Ankle Region".

Response to Comment on "Li et al, Distally Based Sural Adipofascial Turnover Flap for Coverage of Complicated Wound in the Foot and Ankle Region".

Multi-dorsal metacarpal artery perforator adipofascial turnover flap for index to little finger reconstruction: Anatomical study and clinical application

Reconstruction of the dorsum of the hand and fingers is one of the main challenges in hand surgery. Regional flaps from the forearm, free flaps, or pocket procedures are options when multiple digits are injured with tendon damage and bone exposure. These procedures can be technically demanding and are often plagued by a texture mismatch. We conducted an anatomical study of 20 fresh frozen hands. The second, third and fourth intermetacarpal spaces were analyzed with the aim of defining the vascular foundation of dorsal hand adipofascial-turnover flaps based on dorsal metacarpal artery (DMA) perforators, analyzing their potential for reconstruction procedures on the dorsum of the hand. In three cases, the 4th intermetacarpal space lacked the DMA. A mean of 3.5 arterial communications were found between the DMA and palmar arterial system. Each hand had 11 ± 2 dorsal skin perforators, which were equally distributed among different intermetacarpal spaces. At least one perforator was present in each one-third of the space. The most distal perforators were the largest in all spaces but missing in two hands. A clinical case of multiple index finger to little finger reconstruction with this new multi-dorsal metacarpal artery perforator (mDMAP) adipofascial turnover flap is presented. Our anatomical study confirmed previous descriptions of the anatomy of the dorsum of the hand. It supports the safety of the mDMAP adipofascial turnover flap based on all distal arterial perforator for the simultaneous reconstruction of index to little finger injuries. Similarly, adipofascial turnover flaps can be raised from more proximal perforators arising from DMAs if more than one intermetacarpal space is included.

Distally Based Sural Adipofascial Turnover Flap for Coverage of Complicated Wound in the Foot and Ankle Region.

Distally based perforator propeller flap from the lower leg region is a versatile local reconstructive technique for the foot and ankle defects. However, flap venous congestion remains a tough nut to crack. We hypothesize that raising an adipofascial flap with turnover mode of transposition can improve venous drainage and enhance flap safety. Based on the 2 rows of septocutaneous perforators in the posterior distal third of the lower leg, distally based adipofascial flap was raised from medial sural region nourished by 1 perforator bundle from the posterior tibial artery or from the lateral sural region from the peroneal artery. The superficial dissection was performed in subdermal plane and deep in to the subfascial space. The flap was nourished by perforator-plus-adipofascial pedicle and turned over 180 degrees upside down to reach the distal wounds. One week later, a split-skin graft was used to cover the exposed fascial flap. Postoperatively, flap survival, complications, and patient functional recovery were evaluated. Distally based sural turnover adipofascial flaps were used in 12 cases with complicated wounds of the distal third lower leg, foot, and ankle region. All wounds were caused by trauma and experienced fracture implants fixation and 5 with osteomyelitis. The comorbidities include diabetes in 9 cases and smoking in 7. There were 8 medial ural flaps and 4 lateral sural flaps. The adipofiscial flaps measured from 6.0 cm × 5.0 cm to 17.0 cm × 6.0 cm (mean, 61.3 cm). Postoperatively, all flaps survived uneventfully without any complication such as flap ischemia and/or necrosis. Two minor donor site complications were encountered, one was postoperative hematoma, and another was hyperproliferative scar. After a mean of 14.6 months of follow-up, the adipofascial flap plus skin graft showed a durable esthetic coverage, with normal shoe wearing and walking. Distally based sural adipofascial turnover flap is a simple and reliable wound coverage technique. It avoids venous congestion as usually seen in distally based fasciocutaneous flaps.

Single-stage Adipofascial Turnover Flap as an Alternate Option for Large Nasal Defects Usually Requiring 2-stage Forehead Flap

Single-stage Adipofascial Turnover Flap as an Alternate Option for Large Nasal Defects Usually Requiring 2-stage Forehead Flap

Abstract: Fingertip Reconstruction with Adipofascial Island Flap

INTRODUCTION: The fingertip reconstruction requires durable coverage, with good color and contour, so that, adequate coverage of the fingertip wounds is often a demanding problem for hand surgeons.1 Fingertip defects with bone exposure should be covered as promptly because of its chance of infection and bone desiccation.2 Adipofascial flap is one of the methods covering soft tissue defect at fingertip. This study is designed to introduce the new method of fingertip reconstruction using a pedicled adipofascial island flap. MATERIALS AND METHODS: From August 2014 and June 2015, 8 patients with bone-exposed fingertip soft tissue defect were treated. At first, we dissected subdermal layer of undamaged area and elevated adipofascial flap based on branches from terminal arch of digital arteries. After that, we sacrificed one side of terminal arch of digital artery, which becomes island flap pattern with comparatively longer pedicle, and transposed the flap onto the bone exposure area. The remaining skin layer of the donor site was sutured primarily. 3 weeks after the surgery, split thickness skin graft was performed on the adiopofascial flap as the second stage of the procedure. RESULTS: The 8 patients ranged in age from 30 to 62 years old; seven males and one female with injuries at fingertip. Mean follow-up period was about 8 months. All the adipofascial island flaps survived completely and provided excellent soft tissue coverage, and all the skin grafts were taken well. There were no complications, such as infection or re-exposure of bone. And the donor site showed no significant morbidities, such as hematoma and dehiscence. During the follow-up period, there was no atrophy and the appropriate soft tissue padding was provided. All patients were satisfied with round fingertip contour. CONCLUSION: The adipofascial island flap provides an excellent option because of the simplicity of procedure. Other advantages are constant anatomic pedicle of the flap, minimal donor site morbidity and one operative field. This flap can be performed within one digit, which benefits covering the defect with bone exposure immediately without any preparation of other donor site. We consider that the adipofascial island flap is another reliable and useful method for the fingertip reconstruction. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Joshua A. Lemmon, Jeffrey E. Janis, Rod J. Rohrich. Soft-Tissue Injuries of the Fingertip: Methods of Evaluation and Treatment. An Algorithmic Approach. Plast. Reconstr. Surg. 2008; 122: 105e. 2. Jefferson Braga-Silva, Carlos R. Kuyven, Walter Albertoni, Flávio Faloppa. The Adipofascial Turn-Over Flap for Coverage of the Dorsum of the Finger: A Modified Surgical Technique. J Hand Surg. 2004; 29A:1038–1043.

Early outcomes of reconstructing complex distal leg defects in Lagos, Nigeria

Background: Complex defects in the distal third of the leg are often difficult problems for the reconstructive surgeon. Objective: This study aims to identify the early outcomes of reconstruction for complex defects of the distal leg. It explores basic demographics and presentation challenges associated with these defects. It further highlights various methods of reconstruction, complications, and outcomes. Materials and Methods: Between 2008 and 2013, all patients with lower leg and ankle defects that had definitive flap cover were prospectively studied. Age, sex, duration of defect, cause of defect, comorbidity, size of defects, and the reasons for delay in intervention were obtained for each patient. The type of flap used, complications, duration of hospital stay, early outcome, and ambulation status at 6 months were noted. Results: Twenty five patients were studied during the period with a male to female ratio of 3:2. Sixty eight percent (17) of the defects were trauma related. The inability to pay for treatment was the commonest cause of intervention delay. The mean size of the defects was 31 cm 2 . Diabetes and peripheral vascular disease were the commonest comorbidities. Perforator-based fasciocutaneous flaps were the most commonly used (48%;12), while muscle flaps (24%;6) and adipofascial turnover flaps (20%;5) were less utilized. Two patients died and one underwent a below-knee amputation. Late infection persisted in 16%(4) of the patients seen. Conclusion: Trauma-related defects predominated in this study, and financial issues delayed definitive intervention in many cases. Inspite of this, successful coverage was obtained in 84% of the patients. There was, however, a trend toward increasing infection and mortality among older patients.

Double adipofascial turnover flaps in repairing stage IV ischial pressure scores

To report our therapeutic effect of double adipofascial turnover flaps in repairing stage IV ischial pressure scores. During the period of May 2009 to February 2013, we treated 11 cases of stage IV ischial pressure scores with double adipofascial turnover flaps and proper drainage. Based on the conditions of pressure scores and abundant blood supply of adipofascial flaps, we designed two adipofascial flaps on each side of lesion. The two flaps were overlaped to cover the pressure score, following with negative pressure drainage. All pressure scores healed primarily. The follow-up period ranged from 11 to 36 months with satisfactory results and no recurrence. Double adipofascial turnover flaps and proper drainage is a safe and simple method for the treatment of stage IV ischial pressure scores with satisfactory results.

Application of split gluteus maximus muscle--adipofascial turnover flap and subcutaneous tension-reducing suture technique in repair of decubitus ulcers.

The purpose of this study was to study the clinical effect of split gluteus maximus muscle-adipofascial turnover flap and tension-reducing suture in the treatment of decubitus ulcers. Thirty-one cases of sacrococcygeal decubitus ulcers were repaired by split gluteus maximus muscle-adipofascial turnover flap. The surface of flaps ranged from 5×6 cm to 7×8 cm. The skin was then closed, primarily using subcutaneous tension-reducing suture. Eighty-eight percent of the flaps (27 of 31) healed primarily. The split gluteus maximus muscle-adipofascial turnover flap and tension-reducing suture technique was found to be a highly efficient method of repairing decubitus ulcers with a relatively low ratio of recurrence.

Adipofascial turnover flap for the coverage of the dorsum of the thumb: an anatomic study and clinical application

The purpose of this report is to show how our anatomical findings have influenced the design of the dorsal homodigital adipofascial turnover arterial flap to the thumb. Thirty-six thumbs from 18 fresh cadavers were dissected at the Fèr à Moulin Laboratoire (Paris, France) between January 1998 and March 1999. All branches of the proper digital artery (PDA) were identified. During the clinical study, from 2002 to 2008, 12 patients with dorsal thumb skin defects were treated with adipofascial turnover flaps. The dorsal branches of the PDA typically emerge at the level of the metacarpophalangeal and interphalangeal joints, 10 mm apart from the joint line. Based on the anatomical study, the flap could be designed predictably and reliably. The main advantages of dorsal adipofascial turnover flaps include their simplicity; the possibility of a one stage procedure; avoiding the use of tissue from elsewhere on the limb/body; minimal donor-site deformity; and avoidance of damage to the volar digital arteries.

Dorsal forearm adipofascial turnover flap among the elderly

We have assessed the results of soft tissue cover on the back of the hand using an adipofascial turnover flap. From 2004 until 2007, 14 patients (mean age: 62 years) underwent reconstruction of extensive defects in the dorsum of the hand, using a forearm adipofascial turnover flap based on the perforators of the anterior interosseous artery covered with a split skin graft. The pivot point of the flap is typically 4-6 cm proximal to the level of the radial styloid process. In 93% of patients, the reconstruction healed without any problem. The adipofascial turnover flap is a useful and reliable method of reconstruction of the dorsum of the hand even in elderly patients.

Treatment of Ischial Pressure Sores With Double Adipofascial Turnover Flaps

Despite a variety of flap reconstruction options, the ischium remains the most difficult pressure sore site to treat. This article describes the authors' successful surgical procedure for coverage of ischial ulcers using double adipofascial turnover flaps.After debridement, the adipofascial flaps are harvested both cephalad and caudal to the defect. The flaps are then turned over to cover the exposed bone in a manner so as to overlap the 2 flaps. The skin is then closed with sutures in 2 layers. A total of 15 patients with ischial sores were treated using this surgical procedure.The follow-up period ranged from 11 to 159 months, with a mean of 93.6 months. Overall, 86.7% of the flaps (13 of 15) healed primarily. One patient had a recurrent grade II ischial pressure sore again 11 months after the operation. The other 14 patients did not have a recurrence.Treatment of ischial pressure sores with adipofascial turnover flaps provides an easy, minimally invasive procedure, with preservation of future flap options, and a soft-tissue supply sufficient for covering the bony prominence and filling dead space. This technique is a reliable and safe reconstructive modality for the management of minor ischial pressure sores.

Coverage of Clavicular Area by a Pectoralis Minor Pedicle Flap

As the data in the literature concerning the vascularization of the pectoralis minor were conflicting, we conducted a new anatomic study on cadavers preliminary to clinical application of a pedicle flap for clavicular coverage in 3 patients. Twenty flaps were dissected, yielding numerous anatomic variations. In all cases, the principal arteries penetrated the muscle in its upper part, either posteriorly or posterolaterally. This anatomic study justified the use of the pectoralis minor as a pedicle flap, with turnover just below the coracoid process. Accordingly, 3 cases of clavicular defects were treated successfully. Reports in the literature propose an adipofascial turnover flap or a pectoralis major flap for clavicular coverage. The pectoralis minor pedicle flap is easy to dissect and reproducible, involving minor esthetic sequelae and no functional complications. This flap, which has never been described in this application, would appear to be suitable for first-line treatment in this indication.

Car tire injuries: a review of 35 patients

During the period from October 2001 to March 2007 (66 months), 35 patients, all pedestrians, were treated at the King Khalid Civil Hospital, Tabuk, Saudi Arabia for injury to the foot and ankle due to road traffic accidents. The injuries share common features and are grouped in a distinct entity known as "car tire injuries". The victim is always a pedestrian, usually a child, who while trying to escape from the car, gets his foot caught undl der the car tire when the driver is trying to stop the car. The resultant injuries are usually severe due to a combination of friction burns, crushing, shearing, and degloving. Language: en

A New Flap for Reconstruction of Pilonidal Sinus

"Adipofascial turnover flap" is a well-known procedure, but it is generally not used for the surgical treatment of pilonidal sinus disease. The "lumbar adipofascial turnover flap" has been used in this study for the reconstruction of uncomplicated pilonidal sinus disease. Ten cases (8 male and 2 female patients) were operated on by this technique. The reconstruction was performed with the lumbar adipofascial turnover flap. The flap sizes ranged from 4 x 7 cm to 5 x 9 cm (mean, 4.5 x 8 cm), and they were elevated with length-to-base ratio below 2:1. The follow-up period was 14 to 26 months. Postoperative magnetic resonance imaging, computed tomography scan, and power Doppler ultrasound examinations revealed viability of the flaps in all patients. There was no distortion of anatomic landmarks in any of the cases. The esthetic results were satisfying for all patients as well. There was no recurrence in any cases. The hospital stay and mean time off work were shorter compared with other methods of reconstruction and there was no recurrence. We advocate that the lumbar adipofascial turnover flap is an excellent choice for reconstruction of cases with uncomplicated pilonidal sinus disease.

Anatomic Basis of Dorsal Finger Skin Cover

This study describes the anatomy of the dorsal cutaneous vascular system of 180 digits (36 thumbs, index, middle, ring, and little fingers) from 18 pairs of fresh human cadaver hands. The aim of this paper is to incorporate the anatomic data into the current way of designing the homodigital adipofascial turnover flap for cutaneous coverage of the dorsum of the finger. We have carried out an anatomic study in preserved cadaver hands to define the distance between the joint and the origin of the dorsal cutaneous branches of the proper palmar digital artery in the proximal and middle phalanx of the long fingers and for the thumb to metacarpal and interphalangeal joint. All branches of the proper digital artery that ran to the dorsal skin were then identified, and their diameters and the distances of their origins from the proximal interphalangeal joint were measured. We showed that 2 constant branches in the proximal and middle phalanx from each proper digital artery have consistent sites of origin at predictable distances from the proximal interphalangeal joint for the long fingers and the metacarpal and interphalangeal joint for the thumb. The flap survival was excellent, and no donor site complications were observed. We showed that these branches have consistent sites of origin at predictable distances from the proximal interphalangeal joint. The adipofascial turnover arterial flap has appeared as an excellent alternative to achieve early coverage of cutaneous wounds at the dorsal aspect of the fingers.

De-epithelialized Cross-Finger Flaps Versus Adipofascial Turnover Flaps for the Reconstruction of Small Complex Dorsal Digital Defects: A Comparative Analysis

To compare the results of 2 reconstructive options (the de-epithelialized cross-finger flap vs the adipofascial turnover flap) for coverage of small complex dorsal digital defects. A total of 73 patients with small complex dorsal digital defects were included in the study and were classified into 2 groups: group 1 (n = 31) had reconstruction using the de-epithelialized cross-finger flap and group 2 (n = 42) had reconstruction using the adipofascial turnover flap. The type of complication and patient dissatisfaction with the appearance of the donor site were documented in each study group. All flaps in both groups survived with no infection or hematoma. Specific complications were found in group 1 patients and included flap dehiscence (1 patient), considerable skin graft loss (2 patients), stiffness of the donor finger (5 patients), and inclusion cyst (1 patient). The only specific complication for group 2 patients was the occasional epidermolysis of the skin of the donor site, which was observed in 6 patients. Patient dissatisfaction with the appearance of the donor site was documented in 10 patients in group 1 and none in group 2. The elective flap division in the cross-finger-flap group was considered a disadvantage in children because it required general anesthesia. The versatility of both flap techniques in digital reconstruction is confirmed; however, considering the type of complication and the need for general anesthesia in children for cross-finger-flap division, the adipofascial flap was determined to be superior in the following specific groups: children, older patients, and patients with osteoarthritis and multiple defects of adjacent border digits.

The use of adipofascial turnover flaps for coverage of complex dorsal ring finger defects caused by electric burns

This paper describes a unique occupational electrical injury that results in a complex defect on the dorsal aspect of the ring finger. The injury was seen in seven electricians working while wearing a ring on the ring finger. All patients were treated successfully using random adipofascial turnover flaps. The electric current was found to cause a zone of subcutaneous necrosis adjacent to the skin burn. This zone of subcutaneous necrosis varied in size but never exceeded 5 mm and it was easy to recognize the extent of this zone intraoperatively because of the presence of the thrombosed dorsal subcutaneous veins within the necrotic subcutaneous tissue. These observations suggested that adequate debridement and then location of the base of the adipofascial flap proximal to the edge of the debrided area was an appropriate procedure. Other technical considerations were described to ensure a successful outcome. It was concluded that adipofascial turnover flaps were not only reliable in these electrical injuries, but also had several advantages when compared with other flaps commonly used to reconstruct dorsal digital defects.