Dorsi Flap Research Articles

Evaluation of Effects of Losartan on Random Pattern Skin Flap Model of Rats

Losartan, a drug with antiinflammatory properties, has been shown to prevent ischemic injury in various organs. The purpose of the present study was to investigate the effects of losartan on ischemic skin flaps and on flap survival. A 3x9 cm dorsal flap was elevated in 24 Sprague-Dawley rats. Rats received the following treatment for seven days: Group I (n=8): 10 mg/kg losartan; Group II (n=8): 40 mg/kg losartan; and Group III (n=8): nonionized water. At the end of the seventh day, the viable flap areas were calculated, and histological analysis was conducted to count cells and capillaries in microscopic fields. Mean flap survival was 61%, 56% and 60% in Groups I, II and III, respectively. Comparison of flap survival between groups did not yield any significant difference (p>0.05). Ischemic zones of the flaps in all groups demonstrated an increase in number of neutrophils, fibroblasts and capillaries (p<0.05), whereas no difference was seen in mast cells. The cell counts in the viable areas of the flaps showed a significant decrease in fibroblasts in the group treated with 40 mg/kg losartan (p<0.05). The number of neutrophils, mast cells and capillaries was not influenced by treatment. Losartan does not improve skin flap survival but it has a significant antiproliferative effect on fibroblasts.

Treatment of Thumb Tip Degloving Injury Using the Modified First Dorsal Metacarpal Artery Flap

Treatment of Thumb Tip Degloving Injury Using the Modified First Dorsal Metacarpal Artery Flap

Anatomical Study of the Ulnar Dorsal Artery and Design of a New Retrograde Ulnar Dorsal Flap

Anatomical Study of the Ulnar Dorsal Artery and Design of a New Retrograde Ulnar Dorsal Flap

Accelerated delay of random flaps in a rat model

Random flaps have been supplanted by more immediate and reliable reconstructive methods because the former require two or more procedures and a period of delay. This study was designed to test the hypothesis that a random flap can be elevated, delayed, and safely divided within 4 days. Ninety-two Sprague–Dawley rats were operated by elevating an 8 cm × 4 cm cranially based dorsal flap with its underlying panniculus carnosus muscle. The rats were divided into four groups, one control and three experimental, with 23 rats in each. In the control group, the flap was elevated and its caudal end divided at the same time without delay. In the experimental groups, we tested three delay procedures and all flaps had their caudal end divided 4 days after elevation. The number of flaps showing total viability compared to the flaps showing any amount of necrosis was as follows: control group 1:22, mini delay group 18:5, progressive craniocaudal elevation group 19:4, and the accelerated delay group 22:1. The extent of necrosis, expressed as mean percentage area of necrosis in each group, was as follows: control group 45.9%, in the mini delay group 2.3%, progressive craniocaudal elevation group 2.5%, and the accelerated delay group 0.1%. Delay of this random flap can be accomplished safely in 4 days. In terms of total flap survival and mean percentage necrosis, all three experimental delay procedures were effective in improving total viability and reducing the extent of necrosis significantly. We believe the observed difference in total viability and mean percentage necrosis in the accelerated delay group to be clinically significant.

The application of the improved interosseous dorsal antidromic artery flap in the emergency treatment of hand trauma

Objective To introduce the clinical application of the improved interosseous dorsal antidromic artery issular flap in the emergency treatment of the soft tissue defects in hand trauma. Methods 16 patients were received the interosseous dorsal antidromic artery flap for soft tissue defects in the hand with emergency treatment. Results All 14 flaps survived, tip necrosis occurred in 2 cases which healed without complications. Conclusion It was simple technical and shorten time in hospital with improvement of the emergency operative procedure of interosseous dorsal antidromic artery flap, and could reduce the impact of frequency of anatomic variations and vascular complications. Key words: Surgical flaps; Interosseous dorsal antidromic artery; Cutaneous artery; Emergency

Preliminary outcomes of the modified first dorsal metacarpal artery island flap for soft tissue defects of the thumb

Objective To explore the survival rate and early-term effects of sensory reconstruction of the modified first dorsal metacarpal artery (FDMCA) flap in treatment of thumb distal soft tissue defect.Methods From March 2004 to October 2007, 65 patients with soft tissue defects of the thumb underwent the FDMCA flap in our department. Forty-nine cases with complete data were included in the study. There were 37 males and 12 females, with an average age of 32 years (ranged, 18-65 years). The conventional surgical methods were used in 18 cases while the improved surgical methods were in 31 cases. The distal necrosis, the vascular crisis rate and the sensory recovery were recorded. Results The mean follow-up period was 2 years (ranged, 20 months to 3 years). Forty-six flaps survived completely. Vascular crisis occurred in five cases harvested by the conventional methods. Eventually, three of them had a partial distal necrosis.Improved FDMCA flap survived well in all 31 patients. Flaps in these patients with nerve anastomosis restored satisfied sense and all sense were located in the thumb. Eighteen cases of nerve transfer group had different levels of mixed feelings (33%) or ectopic sensory (62%). Sense was located in the thumb completely in 1 case. Conclusion The modified FDMCA flap significantly increased the survival rate. Neurorrhaphy could make the sense of the flap locate in the thumb; however it had not been proved that its impact on the recovery of two-point discrimination and stereognosis. Key words: Hand injury; Thumb; Surgical flaps; Microsurgery

One-stage repair of soft tissue and nerve defect of the fingers using dorsal island flap

Objective To report the treatment outcomes of repairing soft tissue and nerve defect of the fingers using dorsal island flap carrying dorsal cutaneous branch of the proper digital nerve. Methods The skin and nerve defects in 18 fingers of 16 patients were repaired by dorsal island flap carrying dorsal cutaneous branch of the proper digital nerve. The size of the flaps ranged from 10 mm × 7 mm to 24 mm × 20 mm. The length of the nerve defect ranged from 9 to 22 mm. Results Postoperatively all the flaps in the 18 fingers of 16 patients survived. The average follow-up was 5 to 25 months. The appearance and function of the involved fingers were satisfactory. Sensation of the finger pulp returned to S3+ and two-point discrimination ranged between 4 to 7 mm. Conclusion Using dorsal island flap carrying dorsal cutaneous branch of the proper digital nerve can achieve simultaneous repair of both skin and nerve defects. The treatment outcomes were satisfactory. It is an optimal procedure for repairing combined soft tissue and nerve defect of the fingers. Key words: Surgical flaps; Finger injuries ; Repair

Repair of finger pulp defect using free digital artery dorsal branch flap

Objective To introduce the techniques of using free digital artery dorsal branch flap to repair finger pulp defect, and evaluate the clinical outcomes. Methods Free digital artery dorsal branch flap was transferred to repair finger pulp defect in 6 fingers of 6 patients. The area of flaps ranged from 1.0 cm× 1.0 cm to 2.0 cm× 2.5 cm. The donor sites were dorsoradial or dorsoulnar aspect of the proximal phalanx of the injured finger or the adjacent finger. The donor areas were covered with full-thickness skin graft. Results All 6 flaps survived postoperatively. Follow-up period ranged fiom 6 to 18 months, with an average of 12 months. The texture and appearance of the flaps were satisfactory. Finger function recovery was good, with 0° to 60° range of motion of the distal interphalangeal joint. Two-point discrimination of the flaps was 6 to 11 mm. Primary healing was achieved in the donor area wound. Long-term follow up showed that the skin grafts were wearable. There was no ulceration, and the movement of the donor finger was not impaired. Conclusion Free digital artery doral branch flap transfer is an ideal procedure for repair of finger pulp defect. The technique is relatively straightforward. The reconstructed finger pulp is full, aesthetic and sensate. Key words: Surgical flaps; Finger injuries; Dorsal side flap of digital artery

Controlled muscle division during flap surgery: a simple technique

Tissue transfer for breast reconstruction surgery using latissimus dorsi and transverse rectus abdominis myocutaneous flaps requires a degree of muscle cutting. Whether free or pedicled flaps are performed, muscles are divided and cauterised to obtain the desired tissue volume. Standard techniques of muscle cutting include monopolar or bipolar diathermy, whose electrical impulses mimic action potentials causing excessive muscle twitching. This can lead to irregular planes of dissection, potential damage to delicate perforating vessels, and difficult haemostasis. We propose localised infiltration of 0.25% bupivicaine into the muscle prior to diathermy division. This technique reliably prevents excess muscle twitching and permits controlled dissection in the desired plane. Comparative video clips of this technique are available as supplementary material. Although the ideal method for tissue transfer in breast reconstruction is to avoid muscle cutting altogether by using free tissue transfer of perforator flaps, in units where these methods are not standard it may become necessary to convert to a muscle-sparing or pedicled-flap technique, thereby necessitating a degree of muscle cutting. Whether division of muscle is preferable or not, it is occasionally unavoidable, and our proposed technique will make the process of muscle division simpler and more controlled.

Dorsal Metacarpal Artery Flap for Resurfacing of Fourth-Degree Electrical Burns of Fingers

Dorsal Metacarpal Artery Flap for Resurfacing of Fourth-Degree Electrical Burns of Fingers

Clinical application of muliplefoliated flap combined with tendon graft from dorsal foot for repairing soft tissue defects of multi-fingers

Objective To summarize clinical experience of application of muliplefoliated flap combined with tendon graft from dorsal foot for repairing soft tissue defects of multi-fingers. Methods Based on the results of microdissection researches, muliplefoliated flap including medial foot flap, the first metatarsal dorsal flap, lateral foot flap, extensor pollicis brevis of toe and extensor proprius of the fifth toe pedicled by anterior tibial vessels and dorsal pedis vessels as trunk, anterior medial malleolus vessels, the first metatarsal vessels and anterior lateral malleolus vessels as branches respective was designed for repairing soft tissue and tendon defects of multi-fingers. Results In all 12 cases, total survival of flap was 11 cases , 1 case had partial necrosis of distal flap and it was healed by dress changing. Conclusion Transplantation of muliplefoliated flap combined with tendon graft from dorsal foot is a good method to repair soft tissue and tendon defects of multi-fingers. Key words: Flap of dorsal foot; Hand; Foot; Tendon; Transplantation; Microsurgery

Dosimetric analysis of radiation dose to latissimus dorsi myocutaneous flap in women undergoing adjuvant radiotherapy for early breast cancer—short report

Breast reconstruction following mastectomy often involves the use of regional myocutaneous flaps such as the latissimus dorsi (LDM) and transverse rectus abdominus flaps. A history of previous radiation to the skin paddle of the myocutaneous flap planned for breast reconstruction may cause the plastic surgeon to consider using an alternative muscle flap which has not received radiation. To aid decision-making in the setting of previous radiation, we prospectively assessed the dose given to the latissimus myocutaneous flap of a small series of seven women who were to undergo adjuvant 3-D conformal radiation therapy after breast conservation surgery (four) or mastectomy (three). The skin paddles of this flap were marked using wires prior to the planning CT scan required for 3-D conformal therapy. Radiation dose to the skin paddles was minimal but the LD muscle dose averaged 888 cGy. The thoracodorsal artery received the highest doses of radiation averaging 2,750 cGy with 55.5% of the artery receiving at least 2,500 cGy and 25.3% of the artery receiving at least 4,500 cGy which was almost a prescription radiation dose to the whole breast. The clinical implications of this level of radiation dose to the arterial pedicle are likely minimal because it is a peripheral small blood vessel. The surgeon and the radiation oncologist should be aware of this as a potential factor and its possible effects on breast reconstruction outcome particularly in the midst of other predictors of poor vascularity such as smoking, diabetes, or peripheral vascular disease. We plan to study further the dose to LDM flap in a larger series of women. However, information about dose to planned myocutaneous flap in the setting of history of previous breast radiation can be easily obtained from the radiation plan and should be ascertained prior to breast reconstruction.

The use of reverse-flow dorsal metacarpal artery flaps after postburn metacarpophalangeal joint flexion contracture release

Abstract When thermal injuries of the hand are managed inappropriately, complex hand contractures are inevitable. Patients with hand contractures may have many difficulties in their daily life because of this deformity. These patients are challenging to reconstructive surgeons. In this study we evaluated reverse-flow dorsal metacarpal artery flaps for the defects occurred after metacarpophalangeal joint contracture release of different fingers. Nineteen patients with defects on the volar surface of metacarpophalangeal joint were reconstructed by the reverse-flow dorsal metacarpal artery flaps. All operations were successful and flap losses were not seen. The DMCA flaps provide one stage coverage and permit primary closure of the recipient site. The aesthetic and functional results are satisfactory without sacrificing main arteries. The only drawback is the residual scar on the dorsum of the hand, which can be treated by conservative means and may improve over time.

Syndactyly correction: an aesthetic reconstruction

Various flaps have been used with and without skin grafts to separate digits with syndactyly. Dorsal flap techniques with and without grafts result in dorsal and thus more visible scars. Some of the recent techniques which use no grafts are only applicable for some simple syndactylies. The technique described in this paper uses a combination of techniques which have been described previously. A shaped palmar flap is used to create the web space; narrow V-flaps and full-thickness skin grafts are used to resurface the lateral defects on the fingers and reciprocal pulp flaps are used to create aesthetically pleasing nail folds. This technique allows the full thickness grafts to be hidden on the radial and ulnar sides of the fingers and palm. It increases the span of the hand in conditions where there is shortage of palmar skin. A retrospective review has been undertaken of 102 patients in whom 221 webs were reconstructed through 176 surgical procedures. There were 54 cases of simple syndactylies (53%) and the rest were complex. Complications were encountered in 11 operations (6%) and web creep was noted in 12 web spaces (5%). Re-operation for web creep has been carried out in seven web spaces (3%).

Biomechanical Analysis of Surgical Correction of Syndactyly

The dorsal rectangular flap technique has been widely used for the correction of syndactyly. In this method, however, the linear scar along the palmar border of the webspace may lead to secondary contracture and web creep. Some modifications have been advocated for breaking these linear scars. In this study, these modifications were evaluated biomechanically with the finite element method. Based on computed tomography findings of seven adult hands, three scar models were created: the dorsal rectangular flap, the dorsal flap with palmar-based triangular flap, and the dorsal flap with V-shaped tip. Forced displacements were applied to mimic the hand-opening motion, and scar stresses and web displacement were investigated. The maximal stress of the scar was significantly greater in the dorsal rectangular flap group than in the other groups (dorsal flap with palmar-based triangular flap, p = 0.046; dorsal flap with V-shaped tip, p = 0.018). The web was displaced most distally in the dorsal rectangular flap group compared with the other groups (dorsal flap with palmar-based triangular flap, p = 0.043; dorsal flap with V-shaped tip, p = 0.043). There was no significant difference between the dorsal flap with a palmar-based triangular flap group and the dorsal flap with a V-shaped tip group. The authors' results indicate that both the palmar-based triangular flap and the V-shaped tip flap work well. It is strongly recommended that any break should be made in the palmar edge of the webspace for prevention of web creep.

Effect of Low-Level Laser Therapy with Output Power of 30 mW and 60 mW in the Viability of a Random Skin Flap

To assess the effects of low-level laser therapy (LLLT) with output power of 30 and 60 mW in the viability of a random skin flap in rats. Output power values in LLLT are not well defined. Controlled, single-blind experimental study. Thirty-six animals were randomly distributed into three groups: sham group (SG), 30-mW output power (30G), and 60-mW output power (60G). In both treated groups, a fluency of 3 J/cm(2) was used. Two minutes after elevation of a random-pattern cranially based dorsal flap (4 x 10 cm), laser irradiation was applied and repeated on the first, second, third, and fourth postoperative days. Percentages of flap necrosis were calculated on the seventh postoperative day. Also, four fragments of each flap were collected to allow determination of the percentages of vascular density according to the bidimensional method of the morphometric analysis of blood vessels. Statistical analysis included the Wilcoxon test and Kruskal-Wallis variance analysis. A significance level of 5% was elected (p < 0.05). Laser-treated animals presented significantly less necrosis than the sham group (SG, 53%; 30G, 24%; p < 0.05) (60G, 25%; p < 0.05). Also, laser-treated animals presented significantly more vascular density than the sham group (SG, 37%; 30G, 57%; p < 0.05) (60G, 59%; p < 0.05). LLLT (660 nm) with 30-mW and 60-mW output power was efficient in the increase of skin flap viability, but there was no difference between them.

A new design of a dorsal flap in the rat to study skin necrosis and its prevention

The Mcfarlane flap or dorsal pedicled flap has become the standard model for pedicled rat skin flap study but its reliability has been called to question. In the past, there were possible confounding variable with the McFarlane flap and various methods were used to adjust these variables. We have developed a new model for studying skin flap necrosis and its prevention that eliminates these confounding variables. The flap is a significant modification of the McFarlane flap where we form a blind ended pedicled tube using a 3 cm x 9 cm dorsal flap. Survival area is measured using digital photography and computer assisted analysis. This new flap is compared with the standard McFarlane flap with n=25 in each group. The mean survival area of the new flap (15.673 cm(2)+SD3.37) is comparable with the McFarlane flap (18.904 cm(2)+SD3.79). The relative merit lies in the elimination of the confounding variable of the graft bed influence on our flap without a significant reduction in the survival area. A new rat model is presented that may be used in studying the effect of various treatment modalities on pedicled skin flaps. This model has the benefit of eliminating graft bed effect without the risk of flap and wound infection or desiccation that have been encountered using other models. The new flap also has better demarcation of necrosis area in this study.

First record of the percophidid fish Osopsaron formosensis (Percophidae: Hemerocoetinae) off Jeju Island, Korea

A specimen of Osopsaron formosensis was collected at the southeastern part of Jeju Island in June 2008. This specimen is to be distinguished from congeneric species using the key characters such as the eye with dorsal iris flap, cheek with scales, elongated dorsal spine, the length and the numbers of the first dorsal spines, and black pigmentation of the dorsal fin membrane. This report was the first record of O. formosensis from Korea. We named it ‘No-ran-tti-nun-tung-ii’ in Korean.

Effect of Recombinant Human Growth Hormone on Random Pattern Flaps in Rats

Recombinant human growth hormone, a very potent anabolic hormone, plays a significant role in growth regulation, bone metabolism, and wound healing. This study evaluates its effect on random flap survival. Rats were randomly divided into 2 groups. A dorsal random flap, cephalically based, was used. One group received 5 mg/kg subcutaneous injection of recombinant human growth hormone 1 hour before surgery and a repeat dosage every 24 hours for 1 week. The others served as controls. At the end of 1 week, average weight and flap survival was evaluated. There was no difference in flap survival between the groups. Treated rats had gained significantly more weight. Recombinant human growth hormone had no beneficial effect on flap survival. The lack of a deleterious effect of the hormone on random flap survival and its significant effect on rat weight and well being supports its safe use during flap surgery.

Chronic Upregulation of the Endogenous Opioid System Impairs the Skin Flap Survival in Rats

Recent studies suggest a detrimental role for long-term opioid receptor stimulation in different tissues. In this study, we investigated the effect of chronic over production of endogenous opioids on skin tolerance to ischemia in a rat model of cholestasis. Sixty-six rats were randomly divided into 11 groups, 6 animals each. First group served as surgical control. In first experiment, 1, 2, and 3 weeks bile duct ligation (BDL) rats and SHAM-operated controls underwent random-pattern skin-flaps by elevating a caudally based dorsal flap (2 x 8 cm). BDL was performed by midline laparotomy and ligating the common bile duct under general anesthesia. Flap survival was assessed after 7 days (14-, 21-, and 28-day cholestatic rats, respectively). In another experiment, the first effective duration of BDL on flap survival (21 days) was chosen to receive either chronic (20 mg/kg/day) or acute (20 mg/kg, 30 minutes before flap surgery) intraperitoneal naltrexone (NTX). In the first experiment, flap survival was 56.6% +/- 2.6% (mean +/- SEM) in control group and 50.2% +/- 3.9%, 37.4% +/- 3.4%, and 35.4% +/- 6.9% in groups of 14-, 21-, and 28-day cholestatic rats, which were significantly impaired in 21- and 28-day group. In the second experiment, skin flap survival was completely reversed to their SHAM control level after chronic and acute NTX treatment (63.6% +/- 7.6% and 61.9% +/- 5.6% vs. 55.1% +/- 4.2% and 54.9% +/- 4.3%, respectively, P < 0.05). Chronic cholestasis (longer than 2 weeks) decreases the skin flap survival, which is reversed by systemic NTX. This study provides evidence, for the first time, that long-term elevated opioidergic tone impairs the skin tolerance to ischemia.