Conventional Flap Research Articles

Comparison of the Postoperative Outcomes of the Mini-Flap Bilateral Axillo-Breast Approach (BABA) and Conventional BABA Robot-Assisted Thyroidectomy.

The bilateral axillo-breast approach (BABA) for robot-assisted thyroidectomy has some advantages over other minimally invasive thyroidectomies. However, some people do not consider this as a minimally invasive thyroidectomy because of the wider surgical skin flap. Thus, we devised mini-flap BABA robot-assisted thyroidectomy and analyzed the postoperative outcomes. The clinical records of 44 patients undergoing BABA robot-assisted thyroidectomy using a conventional flap or mini-flap were evaluated retrospectively. There were no significant group differences in clinicopathological characteristics. The operating and flap making times were shorter in the mini-flap group (206.18 ± 31.09 vs. 178.90 ± 34.43 min, p = 0.009; 38.85 ± 2.73 vs. 32.21 ± 8.62 min, p = 0.003, respectively). The total drainage amount was smaller in the mini-flap group (196.57 ± 81.40 vs. 150.74 ± 40.80 mL, p = 0.027). The numeric rating scale score and number of analgesics were lower at 2 h postoperatively in the mini-flap group (5.52 ± 0.87 vs. 4.57 ± 1.31, p = 0.006; 0.95 ± 0.22 vs. 0.65 ± 0.49, p = 0.012, respectively). There was no significant group difference in immediate oncological outcomes (p = 1.000). Mini-flap BABA robot-assisted thyroidectomy minimized the surgical flap and improved surgical outcomes. Therefore, it is a form of minimally invasive thyroidectomy. However, long-term follow-up of oncological outcomes is needed.

Retrograde Free Venous Flaps for Extremity Reconstruction: A Roadmap.

Background and Objectives: Retrograde free venous flaps represent a separate entity among free venous flaps: their physiology is still unclear, but they provide an immediate visible refill after reconnection, with a similar behaviour to conventional flaps. Therefore, the dimensions and the indications of these flaps can be extended beyond what was previously believed, and they can be easily customized, including with respect to tendons and nerves. Nevertheless, they are still debated and regarded as unsafe. Materials and Methods: From 2012 to 2019, we performed 31 retrograde free venous flaps on 31 patients to reconstruct hands, digits, and in one case the heel. All the flaps were arterialized in a retrograde manner; the donor site was the forearm in 28 cases, the foot in 2 cases, and the calf in 1 case. We recorded the size, vein architecture, donor site, donor artery, donor morbidity, function for composite and non-composite flaps, immediate complications, late complications, survival rate, and the number of revisions. We recorded the hand function when appropriate. A total of 10 flaps were also intraoperatively studied with indocyanine green to monitor their hemodynamical behaviour. Results: All the patients were followed for an average of 8 months (6–15). The flap dimensions ranged from 6 cm2 to 136 cm2. All the flaps, except two that had complete necrosis, survived. Two flaps had partial necrosis. There was no correlation between necrosis and the size of the flap, with one case of necrosis and one of partial necrosis in the small flaps (<10 cm2). None of the cases with partial necrosis needed a new flap. Two flaps developed a late arterio-venous shunt that was ligated. Conclusions: The retrograde free venous flaps proved to be a useful tool for complex reconstructions of the hand and extremities. They can provide a large island of pliable skin and composite tissue with tendons and nerves, but surgeons must be aware of some caveats.

Flap Monitoring Using Interstitial Fluid Glucose Measurements.

Background: Various flap monitoring techniques have been used in the early detection of anastomotic thrombus; however, the use of automatic and continuous monitoring methods is presently uncommon. The purpose of this study was to investigate trends in interstitial fluid glucose concentration (IFG) in flap monitoring by measuring IFG automatically and continuously. Methods: Nine patients underwent unilateral breast reconstruction using a transverse rectus abdominis myocutaneous flap with vascular anastomosis. Two IFG measuring devices were attached to each patient. One device was attached to the flap (flap IFG) and the other to the healthy breast (control IFG). In each case, flap IFG, control IFG, and IFG ratio (flap IFG/control IFG) were recorded in the initial 72 h post-surgery (first half) and also in the subsequent 72 h (second half). In all of the cases, the mean values recorded in the first half and those in the second half were compared. Results: All flaps survived. The flap IFG didn't fall below 40 mg/dL in the first half. The minimum flap IFG and IFG ratio were 42 mg/dL and 0.55 in the first half. The flap IFG was significantly higher in the first half than in the second half in all cases, and the IFG ratio was similar in 8 cases. Furthermore, mean flap IFG and mean IFG ratio in all cases in the first half were significantly higher than in the second half. Conclusions: IFG measurements may complement conventional flap monitoring, particularly in the early postoperative period.

Comparison of clinical outcomes of non-surgical adjunctive use of the 980-nm diode laser to conventional periodontal flap procedure-a randomised controlled split-mouth clinical trial.

Lasers have been found to be effective as an adjunctive in periodontal therapy. The objective of the study was to compare the outcomes of non-surgical adjunctive use of 980-nm diode laser to that of conventional flap surgery in terms of clinical outcome measures and radiographic osseous defect depths. This study was designed as a double-blinded split-mouth randomised controlled clinical trial. A total of fifteen patients (30 quadrants) with generalised periodontitis stage III grade B were randomly assigned test group (diode laser) and control group (conventional flap surgery). Both test and control groups had 15 quadrants each. At 3months, the probing pocket depth (PPD) was 3.46 ± 0.19mm (test) and 4.20 ± 0.20mm (control), with a statistically significant difference between the groups (p = 0.01). Similarly, at 6months re-evaluation, PPD was 1.46 ± 0.12mm (test) and 2.33 ± 0.13mm (control) with a highly significant statistical difference (p = 0.001). Plaque index showed a difference between both test and control groups at baseline, 3months and 6months (p = 0.001) while gingival index, modified sulcular bleeding index and radiographic osseous defect depth showed a difference at 3months and 6months (p = 0.001). Within the study's limitations, 980-nm diode laser can result in significant improvements in the clinical and radiographic parameters and is very well tolerated by the subjects.

Aerodynamics of a three-dimensional bionic morphing flap

Avian wings are characterized by intricate feather movements to manipulate airflow and enhance aerodynamic performance. The wing trailing-edge undergoes continuous gradual transformations to enact camber reflexes. A three-dimensional bionic flap inspired by the avian wings is proposed. The flap undergoes spanwise morphing to generate seamless wave-like deformations at the trailing-edge. The performance of S809 airfoil fitted with various spanwise morphing flaps, and conventional flaps, is studied. Comprehensive investigations are performed to analyze the aerodynamic forces, pressure-fields, and velocity evolution across the airfoils fitted with different flaps, subjected to various deflection angles and angles of attack, at the Reynolds number of 106. The analyses exhibit significance of variable mean airfoil-camber on the aerodynamic performance. Comparative analyses demonstrate the superiority of morphing flaps over the conventional ones with regards to- lift increment, drag reduction, and enhanced glide ratio. Further, flow-field visualization and surface-flow measurements reveal unique 3D-evolution of the inflow in streamwise and spanwise directions. The spanwise morphing significantly delays flow separation and aids turbulence suppression. The downstream wake-velocity profiles are also found to be considerably reformed by the spanwise morphed flap topology. Overall, the study establishes supremacy of spanwise morphing over the conventional design in terms of achieving optimal aerodynamic performance.

Evaluation of Crestal Bone Loss in Flap vs Flapless Implant Placement Technique: An In Vivo Comparative Study

The aims of the study were to assess the technique with-flap and flapless implant placement and to compare crestal bone heights around the implant in flapless and conventional flap technique using digital radiovisiograph, in 3 and 6 months after the surgery. A total of 20 implants were placed by flap and flapless implant technique; each patient received two implants, except for two patients who received four implants. A radiovisiograph was taken at implant placement, as well as 3- and 6-month intervals. Crestal bone level was compared between flapless and flap during these intervals and compared between intervals for each group. On evaluating the distribution, it was found to be asymmetric and hence lacked normality (K-S = 0.382; p <0.001). On mesial side, bone loss values in group I ranged from 0.40 to 1.10 units with a mean value of 0.71 and a standard deviation of 0.26 units. The median value was 0.70. On evaluating the data for normality, it was found to be symmetric and normal (K-S = 0.166; p = 0.200). This study concluded that there are not any significant differences in the crestal bone with both flap and flapless techniques. Comparatively, the flapless approach showed a lesser crestal bone height reduction, which was statistically significant. Implant dentistry is nonetheless behind when advances are concerned, we have seen the inclination toward minimal invasive implant techniques to yield better esthetic as well as improved results, thus taking care of patients' discomfort.

Perineal perforator switch flap for three-dimensional vulvovaginal reconstruction

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. 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. 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). 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.

Application of the Jigsaw Puzzle Flap Based on Freestyle Perforators to Repair Large and Deep Ulcers on the Buttocks.

BackgroundDecubitus ulcers are common skin injuries in plastic and burn surgery departments, usually occur in patients with a long disease course and poor underlying health. Designing a reconstruction procedure with safety blood supply to a large volume soft tissue and resulting in minimal trauma is a priority for surgeons.MethodsThe free-style perforators on the potential donor sites surrounding the ulcers were detected by Doppler, and the area of the ulcer was divided into several sections based on the location of pre-design perforator flaps. According to the insertion point of the perforators, small V-Y advancement flaps, propeller flaps and rotation flaps pedicled with freestyle perforators were formed and moderately modified during surgery. All of the small flaps were transplanted from donor sites to the defect and reassembled into a new composite flap to repair the ulcer. The donor sites were directly closed. The area of the flaps ranged from 7.0 × 10.5 cm to 8.0 × 22.0 cm and the diameter of the pedicle perforators ranged from 0.5 to 4.0 mm.ResultsIn 30 patients, 65 flaps were constructed, and all of the flaps survived with direct closure of all donor sites. One case with effusion healed 1 month postoperatively through draining and application of a mild pressure dressing. After a 3–24 months follow-up period, all of the patients were satisfied with post-operative function and appearance, and only one case had a local recurrence 6 months postoperatively.ConclusionThe jigsaw puzzle flap based on freestyle perforators can repair the large skin and soft tissue defects caused by decubitus ulcers on the buttocks, with direct donor flap area closure. This method is easy to perform with a safe blood supply and minimal trauma resulting from the avoidance of microvascular anastomosis and the conventional myocutaneous flap.

Filling the Upper Pole with the Pectoralis Major Muscle Flap in Profunda Femoris Artery Perforator Flap Breast Reconstruction.

Background and Objectives: Among many donor site options for autologous breast reconstruction, the use of the profunda femoris artery perforator (PAP) flap has become common in patients who are not suitable for the gold standard procedure, the deep inferior epigastric artery perforator flap. However, its limited volume has precluded its wide use in breast reconstruction. The aim of this report was to demonstrate the effectiveness of a method in which the anatomical position of the pectoralis major muscle was adjusted to augment the volume of the superior pole of the breast during PAP flap transfer. A comparison was made with a conventional PAP flap breast reconstruction. Materials and Methods: Fifty-nine consecutive cases where unilateral autologous breast reconstruction was performed using the vertically designed PAP flap were retrospectively reviewed. Conventional PAP flap transfer was performed in 36 patients (Group 1), and PAP flap transfer with pectoralis major muscle augmentation was performed in 23 patients (Group 2). Results: The patient satisfaction at 12 months postoperatively was statistically greater in Group 2, with the pectoralis major muscle augmentation, than in Group 1 [23/36 (64%) vs. 22/23 (96%), p = 0.005]. There were no significant differences in postoperative complication rates at the reconstructed site [2/36 (5.6%) vs. 0/23 (0%), p = 0.52]. Conclusions: Higher patient satisfaction could be achieved with pectoralis major muscle augmentation in PAP flap breast reconstruction without increasing the postoperative complication rate at the reconstructed site.

The Effects of a Morphed Trailing-Edge Flap on the Aeroacoustic and Aerodynamic Performance of a 30P30N Aerofoil

This paper presents initial results on the aeroacoustic and aerodynamic effects of morphing the trailing-edge flap of the 30P30N aerofoil, over five flap deflections (5–25°), at an 8° angle of attack and a Reynolds number of Re=9.2×105. The Ffowcs-Williams–Hawkings acoustic analogy estimates the far-field noise, whilst the flow field is solved using URANS with the four-equation Transition SST model. Aerodynamic and aeroacoustic simulation data for the 30P30N’s full configuration compare well with experimental results. A Courant number (C) ≤ 1 should be used for resolving tonal noise, whilst a C of up to 4 is sufficient for broadband noise. Sound pressure level results show an average 11% reduction in broadband noise across all flap deflections and frequencies for the morphed configuration compared with the conventional, single-slotted flap. The morphed flap eliminates the multiple tonal peaks observed in the conventional design. Beyond 15° flap deflection, the morphing flap achieves higher stall angles, but with increased drag, leading to a maximum reduction of 17% in Cl/Cd ratio compared with the conventional flap. The methodology reported here for the 30P30N is a quick tool for initial estimates of the far-field noise and aerodynamic performance of a morphing flap at the design stage.

Numerical assessment of the scale effects on the propulsive performance of a ship with gate rudder system

Several energy-saving methods have been implemented on ships to improve propulsion efficiency, reducing fuel consumption and carbon dioxide emissions. The Gate Rudder System, as a novel energy-saving and maneuvering device, reduces fuel consumption by up to 14% compared to the conventional flap rudder system, as confirmed by the sea trial test of a container ship with a gate rudder system. The power savings achieved by the ship with the Gate Rudder system exceeded projections based on model tests. With the motivation of evaluating this discrepancy, this research aims to investigate the propulsive performance of a cargo ship with a gate rudder system as well as the scale effects on its performance, considering two different models of 3 m and 6 m in length, as well as a full-scale ship of 69 m in length. RANSE-based CFD analyses with the Shear Stress Transport (SST) k-ω turbulence model were performed to investigate the ship's propulsive performance and power savings at full load and sea trial conditions with both conventional and gate rudder arrangements. For multi-phase flows, the volume of fluid method (VOF) was used to account for free surface effects, and the model was unconstrained by heave and pitch. Grid convergence, verification, and validation studies were carried out to ensure the accuracy of the numerical studies. Improved propulsive performance and more than 12% power savings for the ship with the gate rudder system have been achieved at both loading conditions compared to the conventional rudder for the selected cargo ship. The study also observes scale effects, which reveal that the gate rudder of the larger model generates more thrust compared to the smaller one.

One-stage coverage of multi-digital pulp defects with sensate flaps from the foot

BackgroundThe reconstruction of the digital pulp defects was a mix of the sensation, function, and aesthetics. As the conventional flaps became out of date, the sensate flaps were increasingly utilized in covering such defects. In this report, we present our experience with some novel flaps design, located on the foot. MethodFrom April 2015 to September 2018, nine patients received the free sensate flaps to resurface soft tissue defects in the multi-digital pulps. And all flaps were harvested from each aspect of the foot, which dimensions were tailored to the defects. The cutaneous nerve was preserved within the flap. Standardized assessment of outcome in terms of sensory, functional, and esthetic scores of the reconstructed pulps was completed. ResultsNineteen flaps survived completely without significant complications, and mild venous congestion was observed in one flap. The free sensate flaps were performed for digital pulp reconstruction in 9 patients: 6 male and 3 female patients with a mean age of 49 years (ranged, 16 to 72 years). The defects involved 3 thumbs, 6 index fingers, 5 long fingers, 3 ring fingers, and 2 little fingers. All flaps were available for a mean follow-up of 30 months (ranged, 24 to 36 months). The functional and esthetic outcomes were satisfied for all flaps, as well as the sensory restoration. ConclusionThe sensate flap from the foot is a remarkable alternative for digital pulp reconstruction with less morbidity and better outcomes. Furthermore, the foot region presents a sensitive, glabrous skin with the proper bulkiness and allows for easy dissection.

Comparative evaluation of postoperative pain and tissue response in patients undergoing conventional flap surgeries with or without 940 nm diode laser exposure - A randomized clinical study.

Over the past few years, a growing body of evidence has allowed us to ascertain that the initiation of periodontitis stems from the existence of oral microbial biofilm and that this requires definitive treatment. Owing to its exceptional usability, affordability, and antibacterial activity, the "diode laser" (DL) has increasingly become a popular and important tool in a dentist's armamentarium. However, there is a scarcity of scientific evidence on the utility and advantages of using "diode laser" in periodontal flap surgery. The study aimed to determine the efficacy of 940 nm diode laser exposure in combination with conventional periodontal flap surgery for the treatment of chronic periodontitis to evaluate postoperative discomfort and clinical parameters. A total of 10 subjects (7 males and 3 females) with generalized chronic periodontitis were recruited and completed the study without any dropouts. For this split-mouth study, 40 sample sites with pocket probing depth (PPD) 5-7 mm post periodontal Phase I therapy were selected. The quadrants were randomly allocated to Groups A, B, C, and D using the fish bowl lottery method. Kirkland flap surgery with laser and modified Widman flap (MWF) with laser were performed in Group A and C, respectively, while Kirkland flap surgery and MWF surgery were performed in Group B and Group D. Clinical parameters including visual analog scale (VAS) score and gingival inflammation were determined at 3rd and 7th day postoperatively while PPD, clinical attachment level (CAL), and sulcus bleeding index (SBI) were recorded at baseline and 6 months following treatment. Wilcoxon signed-rank test and Kruskal-Wallis test were used for intra-group and inter-group comparison of parameters, respectively. Statistically significant difference was attained with postoperative discomfort in laser-assisted groups on 1st and 3rd day postoperatively (P < 0.001). There was no significant difference in the proportion of subjects with gingival inflammation. A statistically significant reduction in mean PPD at 6 months postoperatively was seen among all study groups (P < 0.05) but the inter-group difference was not statistically significant. SBI score reduced significantly from baseline to 6 months follow-up among all four groups (P < 0.05). However, we did not find the inter-group difference to be statistically non-significant. Diode laser as an adjunct to the surgical procedure can demonstrate appreciable benefits by increasing the CAL and minimizing the postoperative pain and the probing pocket, but such additional effects were not observed with gingival inflammation.

Clinical Observation of Flapless Implantation in the Posterior Tooth Area under the Guidance of the Fully Guided Template.

Objective Compared with the conventional flap implantation, the postoperative effect of flapless implantation of a single posterior tooth under the guidance of the fully guided template was observed. Materials and Methods 67 cases were divided into the template group (n = 35) and the flap group (n = 32) according to the wishes and actual situation of the patients. In the template group, the fully guided template was made by rapid prototyping technology, and the flapless implantation was performed under the guidance of the template in the posterior tooth area. The flap group underwent routine flap implantation. After the operation, the template group took CBCT (cone beam computed tomography) again and fitted it with that before the operation. Neck deviation, apical deviation, depth deviation, and axial angle deviation in buccolingual and mesiodistal directions were measured to observe the accuracy of the fully guided template. At the same time, the postoperative reactions of the two surgical methods were compared by recording the operation time, pain degree 24 hours after the operation, swelling degree 72 hours after the operation, and postoperative satisfaction of patients. Results Whether in buccolingual or mesiodistal directions, the maximum values of neck deviation, apical deviation, and depth deviation were less than 2 mm. The axial angle deviation was 0.07°∼5.93° in the buccolingual direction and 0°∼4.12° in the mesiodistal direction. The guiding effect of the template was relatively reliable, and the implantation site and depth were well controlled. Although there were small deviations, the accuracy of the template could meet the clinical needs. The operation time and the VAS (visual analogue scale) score 24 hours after the operation in the template group were lower than those in the flap group (P < 0.05), and the swelling degree rating 72 hours after the operation and postoperative satisfaction of the patients were better than those in the flap group (P < 0.05). Conclusion Compared with the conventional flap implantation, the flapless implantation in the posterior tooth area under the guidance of the fully guided template could improve the accuracy of the operation, shorten the operation time, and reduce the degree of postoperative pain and swelling, which had a certain positive clinical significance.

Comparison of Laser-assisted and Conventional Flap Surgery with Hydroxyapatite Crystals in the Treatment of Intrabony Defects under Magnification- A Randomised Clinical Trial

Introduction: Achieving regeneration of the lost periodontal structures after surgical approach plays a major role. This healing can be interrupted due to the presence of invasive bacteria which is present in the periodontal tissues. Aim: To compare laser-assisted and conventional flap surgery using microsurgical instruments and under surgical operating microscope with hydroxyapatite graft in the treatment of intrabony defects. Materials and Methods: This prospective randomised split-mouth clinical study was conducted in Department of Periodontology at Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, from June 2020 to December 2021. A total of 24 bilateral intrabony defects were selected for the study. Control sites (n=12) received the graft after conventional open flap debridement. In the test group (n=12), graft placement was done followed by laser irradiation with diode laser (980 nm, power: 3.0 W; frequency 2.5 KHz) for 30 seconds. The entire flap surgery procedure was performed under Surgical Operating Microscope (SOM). Clinical parameters such as plaque index, gingival index, probing depth, relative attachment level, were assessed at 3 months and 6 months. Healing index was assessed after 7 days of surgery. Radiographic parameters were assessed at baseline and 6 months using Cone Beam Computed Tomography (CBCT). Descriptive statistics, Independent samples t-test, repeated measures analysis of variance and Paired t-tests were used in data analysis. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software. Results: Intragroup comparison showed statistical significance in all clinical and radiographical parameters (p-value&lt;0.001). Intergroup comparison between the test and control group did not show any statistical significance in terms of plaque index, gingival index, relative Clinical attachment level, probing depth (p-value≥0.05). Intragroup comparison of the depth of defect was statistically significant in both test (p-value=0.011) and control groups (p-values=0.002). Intergroup comparison did not show any statistical significance in linear bone fill (p-value=0.1). Intergroup comparison did not show any statistical significance in defect angle (p-value=0.773). No statistical significance was obtained in percentage fill (p-value=0.074). Intergroup comparison did not show any statistical significance in the clinical and radiographical parameters. Conclusion: The additional laser irradiation at the test site did not exhibit any significant benefits in the bone regeneration. All the outcomes were similar in test and control group.

An In-Vivo Comparative Study of the Soft Tissue Response and Esthetics of the Titanium Implant with Titanium Collar by Flapless and Conventional Flap Technique.

Background:These days, patients want quick results for tooth replacement and esthetic results. However, there is no direct correlation between the achievement of osseointegration and the outcome of successful treatment always. It is vital to sustaining peri-implant soft tissue health for extensive tenure success of the implant.Aim:The purpose of this trial was to determine, estimate, and compare the soft tissue retort and esthetics of the titanium implants with titanium collar at periodic intervals by flapless and conventional flap technique before and after prosthesis placement.Results:The difference in soft tissue indices namely, gingival index, plaque index, and the modified sulcular bleeding index was insignificant between the two implants placed by flapless and open flap technique 2. There was a significant difference amid the probing depths of the two implants after 3 months of prosthesis positioning where the implant placed by flapless technique showed lesser values as compared to the implant placed by the open flap technique 3. The esthetics of the soft tissues surrounding the titanium implant with titanium collar, when compared, presented a significant difference between the two techniques of implant placement.Conclusion:In conclusion, in recent advancements in dentistry, the flapless technique is becoming prominent because of procedure of minimally invasive surgery in implantology. There are advantages of early re-epithelialization and less inflammation around the soft tissue of the implant in the flapless procedure, provided that the prospective for the establishment of a fully functioning along with aesthetically desirable peri-implant soft tissue collar. The flapless technique accomplishes high degrees of gratification by the patients by shortening the surgery time and minimum invasion to both bone and soft tissue.

Minimally invasive medial gastrocnemius flap harvesting technique: A case report

The gastrocnemius muscle flap remains a workhorse for lower extremity reconstruction. It provides ample vascularized tissue, is extremely reliable, and can be dissected with ease. However, conventional flap harvest requires additional incisions which increase morbidity. Endoscopic techniques have been described in the harvest of various muscle flaps but none have yet described an effective, minimally-invasive technique for medial gastrocnemius muscle harvest in a clinical case. We present a minimally invasive technique for the harvest of a medial gastrocnemius muscle flap without additional incision, thereby minimizing donor site morbidity and cosmetic deformity. • Aesthetic outcomes of medial gastrocnemius flap reconstruction may be suboptimal. • A minimally-invasive medial gastroc flap harvest can be achieved using an endoscope. • This alternative reduces perioperative morbidity and improves aesthetic outcomes.

Single-port transaxillary robotic thyroidectomy (START): 200-cases with two-step retraction method

BackgroundThis study aims to report the results of a pioneering clinical study using the single-port transaxillary robotic thyroidectomy (START) for 200 patients with thyroid tumor and to introduce our novel two-step retraction method.MethodsSTART was performed on consecutive 200 patients using the da Vinci Single-Port (SP) robot system from January 2019 to September 2020 at the Yonsei University Health System, Seoul, Korea. The novel two-step retraction technique, in which a 3.5 cm long incision is made along the natural skin crease, was used for the latter 164 patients. The surgical outcome and invasiveness of the SP two-step retraction method were analyzed.ResultsAmong the 200 cases who underwent START, 198 were female and 2 were male, with a mean age of 34.7 (range: 13–58 years). Thyroid lobectomy was performed for 177 patients and total thyroidectomy was performed for 23 patients. Ten patients had benign thyroid nodules, whereas the other 190 had thyroid malignancy. The mean body mass index (BMI) was 22.2 ± 3.7 kg/m2 (range: 15.9–37.0 kg/m2). All of the operations were performed successfully without any open conversions, and patients were discharged on postoperative day 3 or 4 without significant complication. The mean operative time for thyroid lobectomy with the two-step retraction method was 116.69 ± 23.23 min, which was similar to that in the conventional robotic skin flap method (115.33 ± 17.29 min). We could minimize the extent of the robotic skin flap dissection with the two-step retraction method.ConclusionsSTART is a practical surgical method. By employing the new two-step retraction method, we can maximize the cosmetic and functional benefits for patients and reduce the workload fatigue of surgeons by increasing robotic dependency.

Reconstruction of Foot and Ankle Defects Using Free Lateral Arm Flap: A Retrospective Review of Its Versatile Application.

Background Successful reconstruction of the feet and ankles remains challenging due to limited quantities of soft tissue and laxity. The free lateral arm flap (LAF) is an alternative to conventional flaps and has been widely used due to advancements in its flap characteristics. This study is aimed at utilizing the advantages of this flap to validate its increased applications for foot and ankle defects. Methods Twenty patients with various LAF types between May 2011 and May 2020 were enrolled. Clinical data was retrospectively collected, and defect sites were classified according to the subunit principle. We utilized various LAF types, such as LAFs with sensate, extended, osteomyocutaneous, or myocutaneous flaps, as necessary. A two-point discrimination test was performed, and results were statistically compared between flaps. Results Among the diverse etiologies of skin defects, chronic inflammation was the most common cause of defects. Various LAF types, including LAFs with fasciocutaneous, extended fasciocutaneous, musculocutaneous, and osteomyocutaneous flaps, were used. The versatility of free LAF helped successfully cover various defects in all cases. Results of the two-point discrimination test were statistically significant between groups. Conclusions Free LAF is a unique soft tissue free flap that is more versatile than other flaps, allowing flaps to be continuously modified and applied to various foot and ankle defects under different clinical conditions.

Flap vs flapless technique for impacted third molar removal: A split mouth prospective randomized control study

The aim of this study was to compare the post-operative sequelae of removal of impacted third molars in participants treated with conventional flap elevation technique or with a minimally invasive flapless technique.Participants with bilaterally impacted mandibular third molars were included. They were divided into two sites constituting 2 groups. One group was operated by using conventional flap design and elevation and other with flapless technique. Objective clinical parameters were recorded and compared in the post-operative period like mouth opening, swelling, surgical time, and pocket depth. Subjective parameters including pain were also assessed and statistically analyzed.The sites operated in Group II (Flapless technique) had better results (p≤0.05) in terms of pain, swelling, trismus, and pocket depth distal to second molar when compared to Group I (Flap).The flapless technique gives better surgical results and improved healing process after third molar removal and so should be recommended in routine clinical practice.