Artery Flap Research Articles

Short and Extra Short Dental Implants in Osseous Microvascular Free Flaps: A Retrospective Case Series.

There is limited information regarding implant and prosthetic survival after osseous microvascular free flap (OMFF). This case series aims to describe the placement of short and extra short implants in osseous microvascular free flaps to support prostheses, and present an up to 40-month retrospective follow-up. Short and extra short dental implants were placed in six fibula free flaps (FFF) and in two microvascular deep circumflex iliac artery (DCIA) flaps. In total, 27 short and extra short dental implants have been placed into two different types of free flaps. Kaplan-Meyer (K-M) survival analyses were performed to evaluate the survival and success outcomes of implants and prostheses. Out of the eight patients reconstructed with free flap, five were rehabilitated with prostheses, one patient has a temporary prosthesis, and two patients are in the process of prosthetic rehabilitation. Twenty-seven implants were followed up for up to 40 months, and K-M analyses showed 100% implant survival probability (95% confidence interval: 100%), while the implant success probability was 91.0% (95% confidence interval: 68.6-97.7%). Short and extra short dental implants placed in OMFF presented high survival and success rates in a retrospective case series after up to 40 months.

Supraclavicular Artery Flap for Head and Neck Reconstruction

Reconstruction of various defects following head and neck surgery is crucial for restoring both function and aesthetics. Over the years, various flap techniques have been developed to meet these demands. The supraclavicular artery flap is a versatile option readily accessible within the same surgical field during head and neck surgery. Its similarity in texture, color, and contour to the facial region makes it particularly useful for reconstructing defects in the neck and lower face. Additionally, its thin and pliable nature, coupled with a moderate volume, renders it suitable for a wide range of applications, including intraoral defects, pharyngeal defects, and contour refinement in facial surgery. In this paper, we present a method for reconstructing defects in the head and neck region using the supraclavicular artery flap, and discuss its utility, advantages, and limitations.

Full-thickness nasolabial facial artery flap: A modified surgical approach for reconstruction of lower lip defects.

Reconstruction of large lower lip defects remains challenging in terms of aesthetics, function and safety. The aim of this study is to explore a modified nasolabial flap to repair large lower lip defects. The full-thickness nasolabial facial artery flap was used for reconstruction of defects in lip squamous cell carcinoma (LSCC) patients after tumor ablation. The postoperative recovery of patients was obtained through clinical review and follow-up in the first and sixth month. There were four LSCC patients who received tumor ablation at the Beijing Stomatological Hospital of Capital Medical University from November 2022 to March 2023, were included in our study. All patients did not suffer from postoperative infection, orocutaneous fistula, flap necrosis, and flap loss. One patient had the trapdoor deformity. These patients achieved better lip closure function. One patient developed cervical lymph node metastasis 2 months after surgery. The modified nasolabial flap could achieve good outcomes in terms of aesthetics, function, and safety. It provided a supplementary strategy for the using of nasolabial flap in larger defects of lower lip.

"Boot-on-Donut" procedure for anterior and large septal perforation.

Surgical closure of large nasoseptal perforation (NSP) is challenging. The use of an extended anterior ethmoidal artery (eAEA) flap to reconstruct NSP may present with difficulties for NSPs which have their upper edge in a high position. We propose adding a "donut-shape" flap from surrounding septal tissue to the eAEA flap. Thus, the inverted edges of this flap allow to cover the uppermost aspect of the NSP. A series of 18 patients with complete closure of NSPs was included. This novel "Boot-on-Donut" technique consisting of the eAEA flap (Boot) and inverted edges (Donut) is a feasible procedure that allows to reconstruct large NSP located superiorly.

Effect of corticosteroids on ischemia-reperfusion injury of deep inferior epigastric perforator flap after re-exploration for anastomosis thrombosis: A prospective randomized trial

Patients undergoing breast reconstruction with the deep inferior epigastric perforator (DIEP) flap are at risk of arterial and venous thrombosis, necessitating flap salvage surgery. However, this carries the risk of ischemia-reperfusion injury (IRI) and potential significant partial or complete flap loss. The objective of this study was to evaluate the potential benefit of corticosteroids in reducing IRI related complications in DIEP flaps that are returned to the operation theater for attempted salvage after venous or arterial failure.A double-blinded prospective randomized study was conducted between January 2012 and January 2023 on patients scheduled for secondary unilateral breast reconstruction using the DIEP flap technique. Patients were included if they developed post-operative venous or arterial flap thrombosis and experienced DIEP flap IRI following operative take-back and anastomosis revision. The treatment group (TG) received a 5-day course of corticosteroids, while the control group (CG) did not receive any specific treatment. Forty-six patients were enrolled in the study. In the CG, two cases of total flap loss and eight cases of partial flap necrosis were observed, while the TG had only 1 case of partial flap necrosis (p < 0.05). The complete resolution of clinical signs of IRI occurred within 13 ± 2.1 days for the TG and 21 ± 3.5 days for the CG (p = 0.00001). The TG had a significantly shorter hospital stay (11.13 ± 0.38 days) compared with the CG (15.47 ± 1.27 days; p < 0.0001). Targeted corticosteroid therapy following a salvage procedure for vascular thrombosis in DIEP flaps has shown promise as an effective treatment for subsequent IRI. This approach may be considered as a viable option for managing IRI in free flaps. However, further studies involving a larger number of patients are required to substantiate our hypothesis.

The first dorsal metacarpal artery flaps versus reverse homodigital dorsal flaps for thumb reconstruction: a systematic review and meta-analysis.

This review was performed to systematically compare the effectiveness and safety of the first dorsal metacarpal artery flaps (FDMAF) and reverse homodigital dorsal flaps (RHDF) for thumb reconstruction. All literatures, which compared FDMAF versus RHDF for thumb reconstruction, were acquired through a comprehensive search in multiple databases from inception until 31st August 2022. A meta-analysis was performed using the Cochrane Collaboration's RevMan 5.4 software. A total of 19 articles were retrieved, comprising 396 patients in the FDMAF group and 423 patients in the RHDF group. The pooled estimates suggested that there were no significant differences in venous congestion, complications about flap necrosis and reduced range of motion (ROM) of thumb, static 2-point discrimination (S-2PD) between the two groups. On the other hand, patients in the RHDF group had less vascular crisis (odds ratio [OR] = 3.15, 95%CI, 1.31-7.56), complications about poor cortical reorientation (OR = 440.02, 95%CI, 91.97-2105.27) and higher satisfaction rate (OR = 0.56, 95% CI, 0.33-0.96) than those in the FDMAF group. The two surgical procedures were both safe and reliable since no significant differences were found in flap necrosis between the two groups. However, the patients in the RHDF group had less complications about vascular crisis, poor cortical reorientation and higher satisfaction rate. Accordingly, we thought RHDF may be more superior for thumb reconstruction than FDMAF.

Perforator Dissection Porcine Abdominal Model: A Novel Simulator to Improve Microsurgical Training.

Perforator dissection and flap elevation are routinely performed for microsurgical reconstruction; however, there is a steep learning curve to mastering these technical skills. Though live porcine models have been utilized as microsurgical training models, significant drawbacks limit their use. We recently developed a latex-perfused, nonliving, porcine abdomen perforator dissection simulation and described its anatomic similarity to the human deep inferior epigastric artery flap. The purpose was to assess the change in resident confidence in performing key operative steps of flap elevation and perforator dissection and obtain feedback on model realism and utility. Seventeen plastic and reconstructive surgery resident physicians (postgraduate years 1-6) at a single institution participated in a perforator dissection session utilizing the simulation model. Each resident completed pre- and postactivity surveys to assess interval change in confidence in operating. The postactivity survey also asked residents to answer questions regarding their perception of the model's anatomic and surgical realism and utility in microsurgical training. Following a practice session using the latex-perfused, nonliving porcine abdomen, resident confidence was significantly increased in performing all key operative steps and the procedure overall (p = 0.001). All residents (n = 17, 100%) believed the model would improve "trainees' ability to perform perforator dissection in the operating room." Perforator, fascial, and pedicle anatomy were reported to be "Very" similar to human anatomy, with a median Likert score (MLS) of 4. Additionally, six out of the eight surgical steps were noted to be "Very" realistic, with only "Flap Design" and "Fascial Closure" found to be "Moderately" realistic with an MLS of 3. The latex-infused porcine abdominal model is a novel, realistic simulation for microsurgical trainee perforator dissection practice. This model offers a suitable substitute for perforator dissection practice, as its implementation within a microsurgery training course improves resident comfort and confidence.

Clinical outcomes of reposition flap transfer for fingertip amputation.

This study aimed to describe the reposition flap for reconstructing fingertip amputation when replantation is not possible. This study retrospectively reviewed the records of patients with reposition flap transfers and investigated postoperative clinical outcomes and patient satisfaction. Sixteen patients with fingertip amputations treated with a reposition flap from 2016 to 2020. The mean age at injury was 46years (range, 26-70years). Ten cases were treated with oblique triangular advancement flaps, 3 with retrograde-flow digital artery flaps, and 3 with thumb palmar advancement flaps. Postoperative outcomes, including wound healing period and the IP/PIP extension angle, and the presence of grafted bone absorption and patient satisfaction were evaluated as of 3years after surgery. The average reduction in passive extension angle of the IP/PIP joint was 19°. The average time for complete wound healing was 28days (range, 18-41days). The reduction in passive extension angle of the IP/PIP joint was significantly correlated with the wound healing period (r = 0.66, p = 0.01). The absorption of the grafted bone was observed in 3 cases. In these cases, the distal tip of the flap became thin due to flap retraction and an insufficient flap volume. All patients were highly or fairly satisfied with the results of surgery. Our findings show that IP/PIP flexion contracture can occur due to delayed wound healing after reposition flap transfer, but the patient satisfaction level was generally high. Therefore, reconstruction using a reposition flap gives acceptable clinical outcomes and high patient satisfaction as a result of medium to long-term.

Topographical landmarks for lateral calcaneal artery sensate flap- A cadaveric study

The lateral calcaneal artery (LCA) flap is used for treating skin defects of the foot. We aim to study the relationship between the LCA and the Sural Nerve (SN) with the lateral malleolus (LM) to delineate the topographical landmarks for identifying LCA and SN while designing the LCA flap. The foot was dissected to identify LCA and SN in 32 formalin-fixed lower limbs. The LCA and SN were identified and separated from the superficial fascia of the foot. Measurements such as the distance between the LCA and LM, SN and LM, and LCA and SN were taken in (a) horizontal plane, (b) 45º oblique plane passing, (c) vertical plane from the most prominent point on LM, including the luminal diameter of LCA.In the horizontal plane, the LCA and SN were present at a mean distance of 24.56±5.2 mm and 22.64±6.26 mm from the LM, respectively. In a 45° oblique plane, LCA and SN were present at a mean distance of 29.10±6.12 mm and 22.68±7.05 mm from the LM, respectively. In the vertical plane, the SN was present at a mean distance of 26.59± 8.87 mm from the LM.LCA was present in the horizontal plane and 45 oblique plane and was absent in the vertical plane in relation to LM; hence, the LCA flap should not extend beyond the 45 oblique plane, and the internal diameter of LCA should not be less than 1.02mm.

(183) Radial Artery Free Flap Urethroplasty

Abstract Introduction Urethroplasty is an essential component of gender-affirming phalloplasty for transgender individuals who desire the ability to stand to void through a neophallus. Objective We demonstrate the creation of a neourethra using a radial artery free flap for transmasculine individuals with an existing neophallus using live surgical footage. Methods The patient was a 36 year old transmasculine individual who had undergone abdominal phalloplasty 6 months prior, and desired the ability to stand to void. Two teams may simultaneously work; one will harvest a radial forearm flap from the non-dominant upper extremity following a preoperative Allen's test. The flap is tubularized over a catheter. The other team will open the existing neophallus and groin site to prepare the flap recipient site. Following microvascular anastomosis, a micro-Doppler is used to confirm perfusion. The donor site is covered with a skin graft and negative pressure wound dressing. Results The patient had an uneventful recovery after 48 hours of bedrest with head of bed maintained at 30 degrees, and scheduled flap checks. They were discharged on postoperative day 5 after removal of the negative pressure forearm dressing. He has recovered well and has satisfactory orthotopic voiding on follow-up visits. Conclusions This technique of radial artery flap urethroplasty is a safe and effective option for patients who desire a neourethra with their neophallus. Disclosure No.

The sucker-like end-to-side arterial anastomosis for free flap in extremities reconstruction: a retrospective study of 78 cases

BackgroundThe application of end-to-side (ETS) anastomosis for flap transfer poses challenges, particularly in cases of significant size discrepancy between the donor and flap arteries. Herein, a novel ETS anastomosis technique, termed “sucker-like ETS anastomosis”, is developed to mitigate and rectify such vessel discrepancies. This study aims to evaluate the efficacy of this technique in tissue defect reconstruction through free flap transfer.MethodsBetween September 2018 and March 2023, the medical records and follow-up data of 78 patients who underwent free flap transfer using sucker-like ETS anastomosis for significant artery size discrepancies were collected and retrospectively analyzed.ResultsAmong the 78 cases that received free flap transfer, the range of artery size discrepancy (flap artery vs donor artery) was 1:1.6–1:4 (mean: 1:2.5). Following anastomosis with the sucker-like ETS technique, 75 cases achieved flap survival without requiring additional surgical intervention, yielding a one-stage success rate of 96.2%. Three cases experienced post-operative venous crises, with two cases surviving after vein exploration and one case undergoing flap necrosis, necessitating a secondary skin graft. Seven cases faced delayed wound healing but eventually achieved complete healing following dressing changes. No arterial crisis was observed during hospitalization. With an average follow-up of 13 months, the surviving flaps exhibited excellent vitality without flap necrosis or pigment deposition. Overall, the application of sucker-like ETS arterial anastomosis for flap transfer resulted in a high overall surgical success rate of 98.7% (77/78).ConclusionThe application of sucker-like ETS anastomosis for free flap transfer is highly effective, particularly in cases with significant size discrepancy between the recipient and donor arteries.

Technical Details of a Novel Surgical Procedure of Anomalous Left Coronary Artery from the Pulmonary Trunk in a Child Using Autogenous Aortic and Pulmonary Arterial Flaps (UKC’s Modification): A Video Presentation

A 18-months-old male child diagnosed with anomalous origin of left coronary artery from the left posterior pulmonary sinus underwent the modification of the “trapdoor” technique, wherein the anomalous left coronary artery was detached from the pulmonary arterial sinus, and combined aortic and pulmonary arterial flaps were used to augment its length. The postoperative recovery was uneventful.

Local Flaps in Breast-Conserving Surgery in Early Breast Cancer Patients: Armamentarium for Breast Surgeon.

To describe the technique and outcome of local perforator arteries advancement flap in breast-conserving surgeries (BCS) in patient of early breast cancer as our initial experience and review of literature on it. Patients who underwent (BCS) with local perforator artery flap reconstruction were reviewed in terms of their clinical, surgical, and post-operative follow-up details after taking written and informed consent. We have described 4 patients of early breast cancer out of which one patient was post-NACT while 3 were for upfront BCS. We have performed LICAP in 2 patients, AICAP in 1 patient, and IMAP in one patient, depending on the location of primary tumors. None of the patients had any major or minor surgical complications in the post-operative period and drains were removed on post-operative day 2. All patients received post-operative radiotherapy and tolerated well without any loco-regional complications. Patients are in routine follow-up with cosmetic satisfaction without any local recurrence over 1year. The main advantages of pedicled perforator flaps are well-vascularized tissue, spares underlying muscle leading to lesser donor site morbidity like muscle function and seroma formation, easily reach the breast area with good match in terms of skin and subcutaneous tissue, faster recovery, and shorter learning curve in comparison to free flaps. Knowledge and skill about these flaps will help surgeon to give better surgical outcomes and satisfaction to patients.

Outcomes of V-Y dorsal metacarpal artery perforator artery flap for web space reconstruction in simple syndactyly

outcomes of V-Y dorsal metacarpal artery perforator artery flap for web space reconstruction in simple syndactyly

Mandibular reconstruction using an iliac bone flap with perforator-supported external oblique abdominal muscle island: a pilot study

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.

Coverage of large soft tissue defects of the lower limb and foot with superficial inferior epigastric artery flap.

Large soft tissue defects of the lower limb and foot are common occurrence in clinical practice and a considerable number of flaps have been used to treat them. However, there have been few reports using the superficial inferior epigastric artery (SIEA) flap. This review aims to present the experience of using the SIEA flaps for the repair of large soft tissue defects of the lower limb and foot. A retrospective review of data from 11 patients who underwent coverage of lower limb and foot defects exceeding 120 cm2 (15 × 9 cm) using SIEA flaps from March 2018 to July 2022 were retrospectively reviewed. The average size of the defects was 18 × 11 cm2 (range 15 × 9 cm2-32 × 16 cm2). Flap survival rates, surgical complications and overall long-term outcomes were recorded. All 11 flaps survived. One flap was partially necrotic at the edge and healed after several changes of dressing. Additionally, one flap presented with mild venous congestion. The mean follow-up period was 18 months (ranging from 12 to 30 months). The mean size of the flaps was 20 × 12 cm2 (range 17 × 9 cm2-34 × 18 cm2). The flaps were observed to be aesthetically pleasing and exhibited a well-defined texture. The donor wounds were successfully closed primarily, with only linear scarring remaining. The SIEA flap is characterised by concealed donor area, superficial vascular location, easy access and primary closure, which results in favourable aesthetic outcomes. It is an appropriate choice for the repair of large soft tissue defects of the lower limb and foot.

Efficacy of Bi-lobed Second Dorsal Metacarpal Artery Flap in Pediatric Electric Hand Burns

Background: Bi-lobed second dorsal metacarpal artery (SDMA) flap is a viable option for the reconstruction over electrical burns of hand in the pediatric patients. The purpose of this study is to evaluate of the success rate and donor site range of motion after SDMA flap. Methods: A prospective observational cohort study was undertaken in all patients who underwent reconstruction with SDMA flap at institution from March 2016 to March 2018. Data was collected regarding flap success rate and active motion arcs of metacarpophalangeal joint (MCPJ) and proximal interphalangeal joints (PIPJ) of donor area. Results: Among 32 patients, survival rate of flap is 96.87 percent (n=31) with only partial loss of 3.12 percent (n=1). At mean follow up of 12 months, donor finger movements at MCPJ and PIPJ were almost similar to that on opposite side. Conclusion: Second dorsal metacarpal artery flap is useful and reliable flap in complex reconstruction of burn hands in pediatric group in terms of survival and range of motion. Key words: Second dorsal metacarpal artery flap, Metacarpophalangeal joint, Hand burn, Pediatric

Outcome and Utility of First Dorsal Metacarpal Artery Flap for Finger Defects

Background: The First Dorsal Metacarpal Artery (FDMA) Flap or Foucher’s flap is an island pedicle flap proximally based on the first dorsal metacarpal artery and veins. A branch of radial sensory nerve is incorporated in the flap to make it a sensate flap. Objective: The aim of our study was to evaluate the functional and aesthetic outcomes of the seven FDMA flaps done over a period of four years for reconstruction of the distal thumb soft tissue defects and one defect over proximal phalanx of the index finger. Methods: This prospective study was performed between 2018 and 2022 at the Clinic of Reconstructive and Plastic Surgery. We present a series of six cases of distal thumb soft tissue defects and one patient with defect over the dorsal aspect of the index finger that were reconstructed with the FDMA flap. Results: In six patient donor site was grafted by full-thickness skin graft harvested from the groin and in one case was closed primary. All flaps survived and one case that was closed primary had donor site complication that was related to primary closure of the skin. All the patients had good fine touch and average two-point discrimination of 8.7 mm. Conclusion: FDMA flap is a useful and reliable flap to cover the defects of the dorsal aspect and to a certain extent the volar aspect of the thumb. We showed that can be used to cover the defects over proximal phalanx of the index finger. The flap provides adequate soft tissue coverage and good aesthetic results.

Free medial plantar flap connection with a posterior tibial artery flap and its modification for combined dorsal and plantar foot defects - two case reports.

Reconstruction of large soft tissue foot defects were considered a difficult issue due to weight-bearing function of the foot. The reconstruction becomes more difficult when both plantar and dorsal soft tissues are involved. The options for the reconstruction were variable, in 2016 Hao Wu et al. presented a combined flap for coverage of combined fore-foot plantar and dorsal soft tissue defects. We used combined flaps in two cases and present our experience in this article.

Complex Heel Defect: A Comprehensive Study On Combined Regional Flaps For Sensate And Stable Coverage.

BACKGROUND: Heel defect has remained a challenging situation for reconstructive surgeons. In large post traumatic defects, the goal is to provide a sensate and stable soft tissue coverage, especially for the weight-bearing part of the heel. The paucity of local tissue options makes the scenario difficult to deal with. OBJECTIVE: This study is aimed to reconstruct large defect, involving both the weight-bearing and non-weight-bearing part of the heel by combining two regional flaps. METHODS: A retrospective study, comprising of 11 patients from January 2016 to December 2019 with large traumatic heel defects, operated in our setup with combined medial plantar and reverse sural artery flap within 72 hours of injury. Follow up period was 6 months postoperatively. RESULT: All flaps survived well except one reverse sural flap, which was congested and later debrided and 2 had distal edge necrosis which were managed conservatively. All the reverse sural flaps were noted to have lymphedema, but only 3 patients opted for debulking surgery. The functional outcome was excellent, with all the patients being able to walk normally, both barefoot and with footwear. The weight-bearing area was sensate, a clear advantage of utilizing instep skin. CONCLUSION: In our experience, the combined strategy of utilizing local tissue for large heel defects, not only provides a sensate, stable, and reliable coverage but also avoids the lengthy procedure of free tissue transfer that in the end would not be able to give similar results.