Distal Flap Research Articles

Different reverse points of forward lateral malleolus perforator flap in the repair of skin and soft tissue defect of ankle or dorsal foot

Objective To discuss the clinical effects of forward lateral malleolus perforator flap in the repair of skin and soft tissue defect of ankle or dorsal foot. Methods From November, 2014 to June, 2017, 16 cases of skin and soft tissue defect in ankle or dorsal foot had been repaired, which were 11 males and 5 females, aged from 25 to 58 years old(average, 32.5 years). The rotation points were on proximal 5 cm of the lateral malleolus in 11 cases and on the level of tarsal sinus in 5 cases. The largest flap was 10.0 cm×18.0 cm and the smallest flap was 6.0 cm×4.0 cm. The color, thickness, texture, sensation, appearance, donor site shape and functional were followed-up after operation. Results All the 16 patients were followed-up from 1 to 24 months. The distal flap appeared dark in 1 case 2 days after operation, and blood supply was improved after stitches; One case was superficial necrosis and healed after dressing. All the flaps had good appearance and texture, no pigmentation, scar contracture, and so on. Conclusion The forward lateral malleolus perforator flaps have perforator constantly and the color, thickness are similar with the receiving areas, the rotation point could on proximal 5 cm of the lateral malleolus and on the level of tarsal sinus, which is a good method to repair skin and soft tissue defect of ankle or dorsal foot. Key words: Forward lateral malleolus perforator flap; Dorsal foot; Ankle; Skin and soft tissue defect; Repair

Reconstruction of Skull and Skull Base Defects Using Titanium, Collagen, Polyesterurethane and Other Alloplastic, Allogeneic, Xenogeneic and Autogenic Materials

We present our experience in the reconstruction of 12 defects of the skull and lateral skull base following the resection of advanced stage malignant tumors. The reconstruction was performed using three pectoralis major flaps and six temporalis muscle flaps, local skin flaps in two cases and one skin graft. For three dural defects, the plasty was performed using synthetic substitutes. In two cases titanium mesh was utilized for protection of the soft tissues. In one patient a gold plate was used to counteract the effects of facial nerve paralysis on eyelid closure. The advantages and disadvantages of the reconstructive methods are discussed, together with a literature review listing frequently used methods of skull base defect restoration, including autogenous tissues in the form of local, regional or distant flaps, as well as allogeneic, xenogeneic and alloplastic materials.

Versatility of Dorsal Metacarpal Artery Flaps for Hand Burns.

Burns to the hands can be devastating injuries and early debridement and coverage can prevent these chronic problems. Reconstructive options for these defects include skin grafts; local, regional, and distant flaps; and free flaps. In this series, they set out to demonstrate the versatility, durability, and effectiveness of dorsal metacarpal artery (DMCA) flaps for primary soft tissue coverage. This study involves a review of all consecutive patients who underwent acute soft tissue coverage using DMCA flaps at their institution from December 2014 to December 2017. Four patients were identified, two underwent reverse DMCA flaps, and two others underwent first DMCA flaps. Three patients were males and one female whose age ranged from 33 to 74 (mean 48 years old). Follow-up ranged from 6 to 43 days. One of the four flaps had de-epithelialization of the distal flap with loss of the most distal tip left to heal by secondary intention. The remainder of the flaps survived without incident, and a full thickness skin graft had 100% take onto the index finger donor site. At the final follow-up, all flaps had healed completely and patients had return of almost complete active range of motion. Flaps based on the DMCA have been proven to be versatile and reliable methods for primary hand burn reconstruction.

Combined Approach of Vasodilators and Surgical Reconstruction in Diabetic Foot Ulcer: Experience in a Tertiary Care Hospital

Background: Diabetic patients frequently suffer from chronic non-healing ulcer on the sole of foot as a result of combined peripheral neuropathy and arterial insufficiency. Many of them end up in amputation. The aim of this study was to see the outcome of diabetic patients presenting with ulcers that showed no signs of healing in sole of the foot for 3 months or more treated with combination of peripheral vasodilators and surgical reconstruction.Methods: A cross sectional study of 249 patients who presented to Plastic surgery department in BIRDEM fromJanuary 2013 toDecember2015 was done. The patients who had existing associated chronic medical illness like Chronic Kidney Disease (CKD) requiring dialysis, malignancy, Status Asthmaticus and foot ulcer withWagner grade 4 and 5 and patients receiving drugs that cause immunosuppression like chemotherapeutic agents, steroids, and methotrexates were excluded from the study.Results: All patients presented with non-healing ulcerations average size of which was 1.48 cm (range, 0.68 to 4 cm) of more than 3 months in various parts of sole of the foot complicated by peripheral neuropathy and/or arterial insufficiency. After the use of peripheral vasodilators, these patients underwent a variety of surgical reconstructions such as simple skin graft, local flaps, regional flaps and distant flaps. In follow up of 3 to 36 months, 194 patients (77.91%) achieved good results, 55(22.08%) patients’ required secondary procedure such as flap revision, debridement or Split thickness skin graft (STSG) due to post operative complications.Conclusion: We conclude that chronic non-healing ulcers in diabetic patients can be successfully treated by combined approach of surgical reconstruction and peripheral vasodilators.Birdem Med J 2018; 8(2): 108-113

Application of vacuum wound therapy with split thickness skin grafts in the head and neck area

In vacuum wound therapy (VAC) a negative pressure can continuously clean effusions and enhance the formation of granulation tissue significantly. In visceral, trauma and burns surgery this technique is used frequently in critical wounds. In the head and neck area there is limited experience and publications. Especially in the combined use of split-thickness-skin grafts (STSG) and VAC there is no published evidence. A retrospective database analysis was done and resulted in 36 single VAC therapies in 13 patients. They were treated between 2012 and 2017 in the Department of Otorhinolaryngology of the University Medical Center Ulm, Germany. A data analysis was performed relating to indications, diagnoses, comorbidities as well as the clinical course and outcome with special focus on STSG. Besides classical indications as pharyngo-cutaneous fistulas and troublesome would healing after flap surgery, 7 cases of VAC use with split-thickness skin grafts were identified. The median treatment duration was 11 days, the VAC dressing was changed twice in average, the median negative pressure was 70 mmHg. Wound closure was successful in 13/13 cases, in 7/13 cases wound closure was achieved by split-thickness skin graft with synchronous VAC therapy, 4/13 cases showed healing by secondary intention, in 2/13 cases a local or distant flap was used. We first describe the successful use of VAC therapy in combination with STSG in the head and neck area. This was effective in radiated patients and in critically ill patients with sepsis and necrotizing fasciitis.

Application of embryonic equivalents in male-to-female sex reassignment surgery

Introduction:The feeling of incongruence between phenotypic sex and psychological recognition of self-gender is termed gender dysphoria. Transsexualism is the most extreme form of this disorder.Aims and Objectives:The aims and objectives of the study are to evaluate the esthetic and functional outcome of embryonic equivalents-based male-to-female sex reassignment surgery in transwomen using the institutional scoring system.Materials and Methods:Thirty transwomen who had undergone male-to-female embryonic equivalents-based sex reassignment surgery (MFEEbSRS) from October 2012 to March 2016 were retrospectively studied. The outcome was evaluated by two independent plastic surgeons, based on interview with the individuals, visual assessment, and measurements.Surgical Technique:Clitoris was created from reduced glans on dorsal penile pedicle mounted on the crura of the conjoined corpora cavernosa. De-gloved unfurled proximal penile skin formed the introitus, hood for clitoris and labia minora. Neo-external urethral meatus was fashioned from the distal portion of the bulbar urethra. Distal de-gloved inverted penile tube flap was used for the creation of neovagina. Reduced scrotal flaps formed the labia majora.Observation and Results:The maximum length of neovagina in the study was 12 cm, and the average length was 9.8 cm. Based on our institutional scoring system for the assessment of esthetic and functional outcome, we got excellent results in all transwomen.Conclusion:The esthetic and functional outcome in all the patients was good. All patients were relieved of their primordial feminine tension and satisfied with the surgery. Their personality, lifestyle, and self-esteem improved remarkably following surgery.

A New Technique for Coronaplasty in Penile Reconstruction

BackgroundThe coronaplasty is an important step of the phalloplasty procedure as it creates a prominent coronal ridge and a constricted coronal sulcus, resulting in the transformation of a regular skin flap into a flap resembling a circumcised penis. AimThe aim of this article is to describe our new coronaplasty technique that exploits opposing contracting forces of 2 different skin grafts to hold the shape of a thick, distally based skin flap, resulting in a natural looking neo-phallus. MethodsA distally based flap is raised at the junction of the middle and distal thirds of the neo-phallus. The dissection continues until adequate mobilization is obtained, so the flap can stand almost perpendicular to the axis of the shaft. 2 separate full-thickness skin grafts are harvested and placed: the first at the raw undersurface of the flap, the second at the flap's donor site. To make the sulcus deeper and to define the ridge, the lower part of the graft placed on the undersurface of the distal flap is sutured with tacking sutures. Depending on the type of flap used this procedure can be done during the phalloplasty procedure itself (axial flaps) or at least 1 week later (perforator flaps). OutcomesThe new technique that we developed shows a more distinct coronal sulcus and coronal ridge, long-lasting results, and a more aesthetically pleasing and natural-appearing glans penis. ResultsThe harvested distal flap is progressively thicker and not folded, resulting in a more naturally looking ridge. The donor site is deeper than other techniques, creating a well-defined sulcus. By using 2 skin grafts the opposing force vectors increase the projection of the ridge and the deepness of the sulcus. Clinical TranslationThis technique results in a more prominent glans penis and is an important step in creating an almost naturally looking neo-phallus. ConclusionsThis procedure can be applied to all different kind of flaps used for phalloplasty, both in an immediate or delayed fashion. As grafts are used, partial or complete graft lost can appear. Furthermore, attention must be paid not to incise the distal flap too deep so vascularity to the distal part of the flap will not be impaired. A continuous search to optimize the aesthetic outcome of the phalloplasty procedure is necessary and with this new coronaplasty technique we hope to raise attention and take another step toward creating “the real thing.”Sommeling CE, De Wolf EJ, Salim A, et al. A New Technique for Coronaplasty in Penile Reconstruction. J Sex Med 2018;15:920–923.

Pedicled Flaps for Reconstruction of Head and Neck Region

There has been a consistent increase in the number of publications on pedicled flaps for the reconstruction of post ablation defects in the oropharyngeal area. In principle, tissue is lifted from a donor site and moved to a recipient site without disruption of blood supply. The donor site is an exact anatomically defined region of tissue that is capable of sustaining its own blood supply. The benefits of pedicled flaps include lower technical demands that obviate the need for microsurgical anastomosis and shorter operating times. For this reason, they are mostly indicated in elderly and at risk patients. The aim of this paper is to describe our experience with the regional (pedicled) (submental, supraclavicular) flaps with a focus on reliability, function, cosmesis, donor site morbidity, and oncological safety. Reconstructive techniques using distal flaps are described in 12 patients. A submental flap for reconstruction was used in 7 patients. In 5 patients, we used the supraclavicular flap. A total of 9 patients were treated primarily for squamous cell carcinoma of the orofacial region, and 3 for low-grade adenocarcinoma of the small salivary gland. In 5 patients, there was successful engraftment of the submental flap. Ischemia and necrosis of the edges of the flap occurred in 1 case. In one patient, the 3rd day after surgery, the flap was almost totally necrotised. The supraclavicular flap in 4 patiets healed completely, 1 time during the postoperative period it was infected with partial loss of the outer part of the flap from the pre auricular region. In one case there was necrosis of the terminal part of the flap in the reconstructed part of the tongue, the defect was healed by granulation tissue. In all patients, after reconstruction using supraclavicular and submental flaps, the donor site closed primarily with minimal morbidity. Regional (pedicled) flaps are thin, and pliable with good cosmetic and functional results. Reconstruction using these flaps can be accomplished in one-stage with minimum morbidity of the donor site.Key words: pedicled flap - surgical flap - head and neck cancersSubmitted: 11. 5. 2017Accepted: 5. 11. 2017 The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Propeller facial artery perforator flap for repairing defect after resection of skin malignant tumor at upper lip

To explore the effectiveness of propeller facial artery perforator flap to repair the defect after resection of skin malignant tumor at upper lip. Between July 2012 and January 2017, 17 cases with skin malignant tumor at upper lip underwent tumor resection and the remained defect was repaired with propeller facial artery perforator flap. Among the 17 patients, 3 were male and 14 were female, with an average age of 57 years (range, 35-82 years). There were 5 cases of squamous cell carcinoma and 12 cases of basal cell carcinoma. The disease duration ranged from 4 months to 11 years with an average of 20 months. The tumor size ranged from 1.4 cm×0.3 cm to 3.1 cm×1.4 cm. The extended resection of the tumor tissue was performed according to the characters of tumor. According to the location, size, and shape of the defect and the position of facial artery perforator explored with Doppler ultrasonography, the propeller facial artery perforator flap was designed to repair the defect and partial donor site. The flap size ranged from 5 cm×2 cm to 7 cm×3 cm. The length of the perforator pedicle was 0.5-1.0 cm with an average of 0.8 cm. The defect at donor site was directly closed. Cyanosis occurred in 3 cases of the distal flap after operation, then healing after symptomatic treatment. The remaining flaps survived successfully and the wound healed by first intention. Primary healing was obtained in the donor site. All the patients were followed up 6-36 months with an average of 18 months. The shape of the patient's upper lip was good and the scar on the donor site was unconspicuous. There was no lip deformity, ala nasi deflection, facial tension, entilation dysfunction, or recurrence of tumor during follow-up. At last follow-up, the results of self-evaluation were very satisfactory in 13 cases and satisfactory in 4 cases. Based on multiple advantages of good blood supply, large rotation range, aesthetic outcome, and slight injury of the donor site, propeller facial artery perforator flap is not only an optimal choice for repairing upper lip defect after resection of skin malignant tumors, but also can achieve good functional and cosmetic effectiveness.

Reconstruction of the plantar toe with a distal reverse instep sensory island flap

Plantar toe ulcers are a challenging surgical problem. There are several methods for reconstruction, but no attention has been given to the preservation of sensation. This report proposes a method to provide protective sensation for the reconstructed area. The ulcers of seven patients ranged from 2 × 3 to 7 × 3 cm with defects of the plantar first toe and distal metatarsus, including four burns, a trauma, a diabetic ulcer, and a neuropathy injury reconstructed with a distal reverse instep sensory island (DRISI) flap. The patients were 21-38 years old. The second metatarsus medial nerve was co-opted using the end-to-side method to the adjacent lateral nerve, then its proximal stump provided the donor nerve for the sensation of the flap. Patients were assessed in terms of protective sensory functions, including touch, pain, dermatomeric somatosensory-evoked potentials (SEP), thermal sensation and Semmes-Weinstein monofilament (SWM) light touch. The flaps ranged from 2 × 3 to 7 × 3 cm. All transferred flaps to the plantar first toe survived. No complications were observed at the donor and flap sites. Patients were followed-up 8-24 months. Except for two cases, all nerves of the donor and flap sites exhibited protective sensation, including positive SEP responses between 44 and 50 ms and positive SWM responses ≤ 3.84. The DRISI flap can be used for the reconstruction of various plantar first toe defects with acceptable protective sensation. End-to-side neurorrhaphy provides a sensory nerve end to subsequent end to end co-optation to the flap nerve for protective sensation.

The clinical features and surgical treatment of facial basal cell carcinoma

Objective:To investigate the clinical features and reasonable surgical treatment of facial basal cell carcinoma (BCC). Method:The clinical features of primary facial BCC from 37 patients were analyzed.All patients were cured by standard surgical excision with intraoperative frozen section examination and ensuring margins negative,the defects were reconstructed by using adaptive flaps after resection. Result:The patients were followed up for 12 to 36 months after operation.Two cases of 37(2/37,5.41%) with unclear margin developed local recurrence during 4-6 months after resection,the cure rate was 94.59% (35/37). Except 4 cases were suffered with distal skin flap necrosis, the others were well developed. Conclusion:The clinical feature of primary facial basal cell carcinoma was various. The complete resection of primary nidus with clear margin is the key to a successful treatment of facial basal cell carcinoma, and satisfactory therapeutic effects can be obtained after repairing defects by using adaptive flaps after resection.

Management of distal limb skin defects in dogs and cats

Skin defects on the lower limb are common and their management is usually challenging. All trauma patients should be initially assessed for concurrent injuries and stabilized. Debridement and cleansing is performed in all wounds. The most important factors for decision making on wound closure are the wound size, the extent of soft tissue damage, the presence of contamination and impaired perfusion. Primary closure is the preferred choice although; it is seldom applicable in wounds on the distal limbs. Delayed primary closure, secondary closure or second intention healing can be undertaken under certain circumstances in such wounds. When these options are not feasible local pedicle flaps, axial pattern flaps, distant flaps, grafts, muscle or myocutaneous flaps and microvascular free tissue transfer can provide coverage.

Clinical analysis of repairing the defect of hand with reverse island skin flap of upper carpal cutaneous branches of ulnar artery

To investigate the clinical effect of repairing soft tissue defect after hand wound using reverse island skin flap of upper carpal cutaneous branches of ulnar artery. From June 2010 to November 2016, 12 patients with hand soft tissue defects were repaired by reverse island skin flap of upper carpal cutaneous branches of ulnar artery, including 9 males and 3 females with an average age of (35.2±9.4) years old ranging from 22 to 58 years. The defect area varied from 7.0 cm×3.0 cm to 12.0 cm×7.0 cm. Time interval from injury to operation ranged from 3 to 15 days with an average of (8.4±2.6) days. The flap was designed beforehand according to the size of the defect, sharply dissected the aponeurotic fascia from the proximal to the distal, abscised the communicating branch between the flap and the ulnar artery at the wrist epithelial branch, repairing the defect of flap with method of metastasis retrograde. The sensation, shape of the flap and hand function were observed, and the upper extremity function was evaluated according to the standard of hand surgery branch from Chinese Medical Association to assessment of functional recovery. The flaps in 10 patients obtained primary healing, the healed time was 14 to 18 days with an average of(15.0±1.5) days. Two patients occurred distal flap necrosis, and wound surface healed after change dressing and skingrafting cover. All patients were followed up from 3 to 15 months with an average of(7.0±3.8) months. According to the upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, 2 cases got excellent results, 7 good, 2 fair and 1 poor. Reverse island skin flap of upper carpal cutaneous branches of ulnar artery for the treatment of soft tissue defect caused by hand wound has advantages of concealed donor area, no need sacrifice the main blood vessel, flap thin and no need repair it for thick and thin.

The Vascularity and Osteogenesis of a Vascularized Flap for the Treatment of Scaphoid Nonunion: The Pedicle Volar Distal Radial Periosteal Flap.

Background: Vascularized periosteal flaps from the distal radius have been previously proposed. The purpose of this study was to investigate the vascularity and osteogenic potential of a vascularized volar distal radial periosteal flap for the treatment of scaphoid nonunion. Methods: In 5 fresh frozen cadavers, a rectangular periosteal flap was elevated from the distal radius with the pedicle just proximal to the watershed line. Latex dye was injected into the radial artery proximally and the vascularity of the flap characterized by microscopic evaluation. Patients with scaphoid nonunion were then treated with open reduction, internal fixation, and distal radius cancellous bone graft. Two groups of patients with midwaist nonunion scaphoid were then evaluated. The first group received the vascularized periosteal flap and the second group received a nonvascularized periosteal flap. A third group of proximal pole nonunions also received the vascularized flap. Results: Cadaveric dissections revealed that all of the injected flaps demonstrated vascularity to the distal edge of the flap. Vascularized flaps formed visible bone on imaging in 55% of cases. None of the nonvascularized flaps formed visible bone. In group 1, 12/12 midwaist nonunions united. In group 2, union was achieved in 6/6 of patients who completed the follow-up. In group 3, 6/7 proximal pole fractures united. Conclusions: Previously proposed vascularized periosteal flaps from the distal radius appear to possess notable osteogenic potential that may be of interest to surgeons treating scaphoid nonunion.

RADICAL BREAST RESECTION WITH SKIN-MUSCULAR LATISSIMUS DORSI FLAP GRAFTING

The oncological breast surgeries with single-stage replacement of the lost volume by means of autogeneous tissue using distant flaps grafting (particularly by skin — muscular flaps of the latissimus dorsi ) allow obtaining satisfactory and stable aesthetic results without the decrease of indices of relapse-free and general survival. The early results of the application of the skin-muscular flaps of the latissimus dorsi for single-stage breast reconstruction after radical breast resection are presented in this work in 3 patients with breast cancer. The technique allows performance of the extensive radical resection with single-stage grafting in patients with breast cancer and obtaining an objective clinical response against the background of neoadjuvant therapy with subsequent applying radiation therapy and systemic treatment.

Case Report: New Surgical Approach option for Keloid in Ear

Introduction: Crossing centuries, great inquiries are still portrayed in medicine. Abnormal healing becomes one of these mysteries not completely unraveled. Keloid and hypertrophic scars are characterized by abnormal responses to the healing process. They present intense production and deposition of collagen and glycoproteins in the dermis, with consequent development of a pathological scar. Keloid and hypertrophic scars arouse an important aesthetic and psychological appeal, especially when present in regions such as the face, causing embarrassment and changes in social relationships. Due to this, when carrying out a review of the literature, there are many papers talking about the subject keloid, being at experimental or clinical level, however there is no consensus on which method is best done in its handling and treatment. Objective: Describe a new approach to keloid resection preserving its epithelium and dermis as cover in cases where transplantation would be necessary. Method: Report three cases of keloid in ear in young patients, one in the lobe and two in the ear helix, all with low or absent clinical activity (hyperemia, pain and/or pruritus and absence of growth). In the first case, the patient was previously treated with intralesional corticoid injections, surgical resection and radiotherapy, but recurred with keloid formation predominantly in the ear lobe. On this time, it was treated with the technique described by Kim DY et al. as keloid fillet flap added to adjuvant beta-therapy, with no signs of recurrence until the present moment of follow-up and with a tension-free primary closure. In the second case, the patient presented keloid formation in the upper extremities of ears after performing otoplasty. Such patient was treated with intralesional injections of corticoid (triamcinolone acetonide) followed by surgical procedure, also with cited technique, and adjuvant beta-therapy, providing a primary closure of the lesion without tension. The third case, reports about a keloid recurrence in upper auricular helix after two procedures of excision and local skin grafting. In this case it was also made intralesional injections of triamcinolone acetonide, followed by a surgical approach with the keloid fillet flap technique and beta-therapy adjuvant also carried out tension-free primary closure. Results: In the short follow-up period, no recurrences, suture dehiscence, hematomas / seromas, or areas of tissue necrosis were observed. Patients remain without clinical signs of keloid activity. Conclusion: Cases where clinical signs of keloid activity, hyperemia, pruritus, local pain and growth are not observed, as well as areas where there is no possibility of primary closure after complete resection, including large masses, conservative surgical approach provides a very pertinent alternative. Techniques that cause minor morbidities to the patients and preserve the local anatomy after resection of the lesions and that do not increase the rates of recurrence and/or complications, are portrayed as ideal. Thus, these reports corroborate a new approach to some forms of keloid lesions with the objective of better patient outcomes and without the need for skin grafts or distant flaps.

Wide excision and microvascular reconstruction for maxillomandibular ameloblastomas: local control, functional, and esthetic outcomes

Introduction: Ameloblastomas are benign but aggressive odontogenic tumors with have a high propensity for bony destruction. They require to be excised completely to avoid local recurrence, and these resections involve significant functional and esthetic disturbances. With the advent of microvascular reconstruction, they can be excised, and defects are reconstructed with preservation of form and function. This paper presents our experience with wide excision and microvascular reconstruction for maxillomandibular ameloblastomas, and to describe the planning, resection, microvascular reconstruction, and rehabilitation of these patients. Materials and Methods: A retrospective review of records for patients treated with wide excision and microvascular reconstruction for maxillomandibular ameloblastomas at Amrita Institute of Medical Sciences Kochi between 2003 and 2015 was performed. Clinical and pathological features were described, and a literature review was performed. Results: A total of 48 patients were identified with equal sex distribution and mean age at presentation of 35 (range 16–71) years. Half of these patients had primary lesions, and the remaining half had the recurrent disease (range 1–4 previous surgeries). Forty patients (83%) had mandibular lesions and the remaining had the maxillary disease. All patients had wide excision with a gross bony margin of 1 cm and reconstruction with microvascular flaps (fibula free flap = 41, distal circumflex iliac artery flap = 3 and scapular free flap = 2, anterolateral thigh flap = 1 and radial forearm free flap = 1). Mean tumor size was 4.73 (2–14) cm. At a median follow-up of 21 months, all patients were free of recurrence. Successful dental rehabilitation was achieved in 40 patients (83%). Conclusion: This approach leads to results in excellent local control, functional, and esthetic outcomes. Although managing these patients is challenging, multidisciplinary expertise and planning are crucial for successful management.

The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice.

Background:The finger skin and soft-tissue defects are reconstructive challenges due to their nature and the intricate extensor apparatus and flexors it protects. The reverse dorsal metacarpal artery (RDMA) is a time-tested option for the reconstruction of the same.Materials and Methods:A total of 14 cases of RDMA flap for finger defects involving proximal to distal phalanx were performed. Thirteen of these patients were male and one patient female and the most common mode of injury was occupational in nature followed by road traffic accident. The overall appearance was assessed for the flap and the donor site. The associated injuries and the range of motion were noted.Results:All but one flap survived completely. One patient had partial distal flap loss, which was tackled with split-thickness skin grafting. The flap size varied from 3.5 cm × 1.5 cm to 9 cm × 2 cm with mean of 6.64 cm × 1.72 cm. The mean age of the patients was 33.4 years. All the patients had acceptable aesthesis. The donor site had no complications and healed with linear scar.Conclusions:RDMA flap is a reliable flap for finger defects reconstruction. The range of movement mainly depends on the associated injury rather than flap transfer alone and to prove this we require doing analysis of range of movement in patients with flap done alone or with associated injuries.

Repair soft-tissue defect in forefoot with reversed lateral soleus muscle flap

To summarize clinical application results of repair soft tissue defect in forefoot with a reversed lateral soleus muscle flap on peroneal artery pedicle. From January 2005 to January 2013, 8 patients with soft-tissue defect on forefoot were underwent reconstruction with a reversed lateral soleus muscle flap on peroneal artery pedicle. There were 6 males and 2 female, aged from 16 to 48 years with an average of 26.8 years old. The reversed lateral soleus muscle flap was transposed to the forefoot defect area, then immediate coverage of the muscle flaps were performed by a meshed split-thickness free skin graft. The donor site was closed directly. The muscle flap survey was observed after the repair of the forefoot. All muscle flaps had survived completely. No clinical vascular deficiency was found on muscle flaps postoperatively. One case occurred recipient area sustained insignificant superficial infection, one patient developed distal muscle flap small skin graft necrosis, and spontaneous heal by 2 weeks' change dressing. Follow-up period was ranged form 2.5 to 5.5 years with an average of 3.5 years postoperatively. A good contour was confirmed at the recipient area. According to Cedell questionnaire, 6 patients obtained good results and 2 fair. When the local skin flap or muscle flap application is limited, lateral soleus muscle flap survey is satisfactory after repair and very suitable for repair of soft tissue defect of forefoot.

Studies on reconstruction of large skin defects following mammary tumor excision in dogs

Aim:The main objective of the study was to describe the use of skin fold advancement flaps (SFAFs) and other reconstructive techniques for closure of large skin defects following mammary tumor excision in dogs.Materials and Methods:Twelve dogs underwent reconstruction of large ventral skin defects following mammary tumor excision with wide margins. Skin fold flaps (flank fold flap and elbow fold flap) were elevated from the flank and elbow region, respectively, and transposed and sutured onto the large ventral skin defect following mastectomy in all the dogs. In addition to the skin fold flaps, other reconstructive techniques such as undermining, walking sutures, and tension-relieving suture techniques were followed during surgery in the closure of large skin defects without skin tension and compromising limb mobility. The skin flap viability was assessed subjectively by gross observation of the flap such as color, temperature, capillary perfusion, and cosmetic appearance, and scoring (1-4) was done. Tissue samples were collected from a surgical site on days 3, 6, and 12 post-operatively for histopathological evaluation and healing status of the skin flap.Results:All the surgical wounds healed primarily, without any major complications and the skin flap remained healthy throughout the healing process post-operatively. Distal flap necrosis was noticed in one case and necrosis of skin flap between two suture lines was noticed in another case in which the necrotized distal portion healed by secondary intention after 7 days. The mean survival of subdermal plexus flap in the above cases was 98% which was a subjective evaluation based on surface area of the skin defect measured by Image’ J software and the flap dimensions. The average healing of skin flap in days was 14.91±0.86.Conclusion:The SFAFs along with other reconstructive techniques help in the reconstruction of large ventral skin defects following mastectomy in dogs without much compromising limb mobility.