Fasciocutaneous Transposition Flap Research Articles

Treatment of Trigeminal Trophic Syndrome using Scalp Based Flap Reconstruction: Case Report

Trigeminal trophic syndrome, or trigeminal neurotrophic ulceration, is an uncommon cause of persistent or recurrent facial ulceration, paresthesia, and anesthesia following self-manipulation of the skin, most commonly affecting the maxillary branch of the trigeminal nerve in the ala nasi region. We present a case of a 63-year-old with chronic ulceration of the right frontoparietal scalp involving the ophthalmic branch of the trigeminal nerve following herpes zoster infection. The patient was successfully treated with a fasciocutaneous transposition flap and splitthickness skin graft; these procedures allowed us to avoid the diseased ophthalmic nerve distribution. This patient’s postoperative course was uneventful, and the flap and skin graft healed without further ulceration of the involved area at 1 year follow-up.

Surgical Treatment of Sacrococcygeal Pilonidal Sinus with a Leaf Flap

Background: Pilonidal sinus, occurring in 7% of the population, is a disease found in the cleavage of the buttocks, typically in young males after puberty. This study explored the utility of the leaf flap, a unilobed fasciocutaneous transposition flap, as a reconstructive method for treating pilonidal sinus on the sacrococcygeal area.Methods: We present cases of eight patients with pilonidal sinus who underwent unilobed fasciocutaneous transposition flap surgery. Patients complaining of an abscess in the sacrococcygeal region were initially treated with a minimal incision to drain the abscess, and 14 days of antibiotics administration. Afterwards, the patients were re-evaluated at the outpatient clinic and scheduled for a leaf flap procedure 4 weeks after drainage. Hospitalization, the time required for full activity, and complication rates were recorded.Results: Minor postoperative complications were observed in one patient (12.5%). The patient required re-suturing of his wound due to an infection and wound dehiscence. The mean hospitalization was 10 days (range, 5–23 days), and the period required to return to daily activities was 4 weeks.Conclusion: The leaf flap procedure is recommended because it is a relatively easy method for surgeons, and also because the flap has abundant perfusion. This surgical method was used as the first treatment of choice for sacrococcygeal pilonidal sinus, with the advantages of less patient discomfort, fast healing of the site and short hospitalization. Our results support the leaf flap surgery as a favored treatment for pilonidal sinus.

Treatment of Trigeminal Trophic Syndrome Using Scalp Based Flap Reconstruction: Case Report

Introduction: Trigeminal trophic syndrome (TTS) is a rare cause of ulcerative lesions in the trigeminal sensory nerve distribution secondary to repeated mechanical manipulation of the affected area. The classic lesion described in TTS is a painless ulceration on the cheek beside the ala nasi associated with trigeminal nerve dysfunction. Case presentation: 63-year-old male presented with chronic ulceration on the right frontoparietal scalp. Seven months prior to presentation, the patient developed burning pain in the V1 distribution diagnosed as shingles. As the patient’s discomfort worsened, the patient developed a 6 centimeter x 6 centimeter lesion with exposed calvarium after repeated mechanical manipulation. Management and Outcome: To make a tissue diagnosis, an excisional biopsy with bone biopsy of the exposed calvarium was performed. After excluding other diagnoses, the patient was diagnosed with TTS. A fasciocutaneous transposition flap based on the parietal branch of the superficial temporal artery with split thickness skin graft of the flap donor site was performed. In consultation with Neurology, the patient was given carbamazepine to decrease his neuropathic pain and urge to scratch. Postoperatively, the patient did not have any discomfort over the site of the flap reconstruction which healed completely. Discussion: The goal of the scalp based flap reconstruction was to design flap coverage based on a different sensory nerve distribution. Utilizing a flap from the V3/C2 distribution, the previously diseased V1 nerve distribution was avoided. Postoperatively, the patient has not disrupted the reconstruction and is pleased with the overall outcome.

Alternative Methods to Local Flap Applications in Large Tissue Losses Caused by Gunshot Injuries in the Syrian War.

In gunshot injury (GSI), the distance, ballistic properties, and the site of injury of lead or scattering gain importance. The authors investigated alternative methods to local flap applications in large tissue losses on facial regions caused by GSI in the Syrian War at the light of our approaches and outcomes. The study was designed as a cross-sectional retrospective clinical cohort analyze. The authors analyzed data describing the distribution and comparisons of 187 Syrian patients who injured in the war due to GSI and transferred to our medical center from Jan 2011 and June 2018. The study included data of the patients with demographics, mechanisms of a war injury, clinical data, treatment, and outcomes. 131(70%) of all the patients were soldiers, while the rest 56 was civilians. 58% (n = 108) of the GSI was female while remaining was males (42%; n = 79). The rate for children was 32% in all the patients as the most common soft tissues of the face were around the maxilla-zygoma (38.4%), orbita-nose region (29.3%), mandibula-teeth (18.5%). The authors performed a fascio cutaneous transposition flap that was planned from the cervical region (58%), interpolation flap that was planned from the frontotemporal region (28%), and forehead rotation flap (14%). The authors did not lose any patients due to plastic reconstruction. The fasciocutaneous transposition flap, interpolation flap, and forehead rotation flap that The authors apply to these patients are extremely rare flaps today. These flap applications have achieved tremendous outcomes, even without any sign of necrosis in war surgery.

Buried island transposition flap for joint Plastic-Neurosurgical management of spinal wound dehiscence – a technical note and single Centre experience

Introduction Spinal surgical wound infection can lead to tissue voids between the spine and skin that can be difficult to reconstruct. Previously described techniques include myocutaneous flaps or perforator based fasciocutaneous flaps. However, these procedures can be time-consuming and surgically challenging. Aims This study aimed to assess the effectiveness of a novel technique employing a buried island transposition (BIT) flap, for the repair of non-irradiated dehisced spinal wounds. Methods Fifteen patients with failed conservative management of infected midline posterior spinal wounds, underwent wound repair using a local buried islanded de-epithelialized double-breasted fasciocutaneous transposition flap, performed by joint input from the neurosurgical and plastic surgical teams. Results Mean age was 58 years (range, 31–76 years) with male-to-female ratio of 8:7. The BIT flap was used to repair four wounds in the cervical spine with underlying fixation; four wounds in the thoracic spine with underlying fixation; and seven wounds in the lumbar-sacral spine, of which three had underlying fixation. Pre-operatively, each of the wounds were either dehiscent with exposed hardware, or had large defects unsuitable for primary closure following debridement. There was no procedure-related mortality. All patients demonstrated good wound healing with no subsequent repeat surgery or removal of spinal fixation at mean 24-month follow-up. Conclusion We successfully used a novel buried island transposition flap that has not previously been described in repair of spinal wounds. This technique, which led in all cases to good wound healing and prevented removal of metalwork, has comparable efficacy but increased ease of use compared to traditional techniques. It requires redundant skin at the wound site.

Lambeau fasciocutané sous fessier fiabilisé par une perforante de l’artère fémorale profonde en reconstruction d’escarre ischiatique

The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers. A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily. A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory. Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size.

A Wise Surgical Approach for Reconstruction of Postburn Axillary Contractures and Versatility of Perforator Flaps.

Postburn axillary adduction contractures should essentially be released for adequate shoulder function. Many methods have been described for this purpose. However, use of perforator flaps prevents harm to the underlying muscle and provides thin, pliable skin flaps. Despite the major advantages offered by perforator flaps, certain shortcomings of perforator flap surgery restrict their widespread use by inexperienced surgeons, including anatomic variations of perforator vessels. In order to rule out these shortcomings, we devised a new surgical approach with an initial incision that provides access to possible perforator systems on the dorsolateral thoracic area. The approach can easily be converted to a fasciocutaneous transposition flap when attempts for identification of a proper perforator fail. Nevertheless, a proper perforator can easily be reached through the exposure provided by this initial incision. With the intention of using perforator-based flap for reconstruction, we used this surgical approach for coverage in 14 cases of postburn axillary contractures. In 3 cases, conversions of the initial incision to local transposition flap (parascapular flap) were required. There was only 2 tip necrosis observed, which healed with secondary intention. Our current surgical approach may offer taking the advantages of using a true perforator flap for reconstruction while avoiding a second stress on the patient when an operative plan for perforator flap harvest fails.

Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

BackgroundBreast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer.MethodsFrom September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons.ResultsThe average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15), the lower lateral quadrant (n=2), and the central lateral area (n=3). Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes.ConclusionsPartial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

Sacrococcygeal Pilonidal Sinus Treated by a New Fascio-Cutaneous Flap

This study reported the technical details and preliminary clinical outcomes of a new fascio-cutaneous transposition flap for the surgical treatment of pilonidal sinus. Fifty-two patients with pilonidal sinus were surgically treated. During the surgical procedure, an inferiorly pedicled, fascio-cutaneous flap with specific geometric characteristics was prepared and transposed. Postoperative pain, complications, duration of hospital stay, and time off worked were assessed. Patients were followed for eighteen months after surgery. The mean hospital stay was 2 days. Drains and sutures were removed after 3 and 12 days, respectively. No flap ischemia, wound dehiscence or major complications were observed. Tension on suture lines and pain after surgery were negligible. Wound infections occurred in 4 patients (7.7 percent) and were managed by removing a few sutures. Seroma was detected in 6 patients (11.5 percent). The mean time patients missed work was 7 days. No recurrence was observed during the follow-up period of 18 months. With no disease recurrence, minimal complication rate, time off work, and acceptable aesthetic outcome, this fascio-cutaneous transposition flap technique is a safe and effective method for surgically treating pilonidal sinus.

A fasciocutaneous transposition flap for coverage of defects of the lower extremity.

During a three-year period, eleven fasciocutaneous transposition flaps were used in ten patients to cover a defect in the lower extremity that was due to trauma or infection. The patients were subsequently evaluated with respect to survival of the flap, sensation in the flap, healing of the donor site, and postoperative morbidity. Two cases are presented for illustration. Coverage with a fasciocutaneous transposition flap proved to be safe and simple. This technique offers several advantages compared with reconstruction using microvascular free muscle transfer, and it may be preferable for many patients who have a defect distal to the knee.

The rationale of using the rhomboid fasciocutaneous transposition flap for the radical cure of pilonidal sinus.

A simple, safe technique for complete excision of pilonidal pathology and immediate fasciocutaneous rhomboid flap closure is presented. Twenty-five patients were treated. All wounds healed by first intention, with no patient remaining in the hospital for more than 10 days. Earlier cases were followed up for 2 years. No recurrence has yet been encountered.

The lateral thoracodorsal flap in breast reconstruction.

A fasciocutaneous transposition flap, the lateral thoracodorsal flap, has been used in 114 cases of breast reconstruction. This flap is raised from the lateral and dorsal aspects of the thoracic wall at the level of the submammary crease, and the size may be varied from 12 to 22 cm in length and 6 to 12 cm in width. The lateral thoracodorsal flap is used with an implant and forms the lateral part of the reconstructed breast. A natural ptotic breast shape is achieved in a single-stage procedure. Complications such as partial necrosis and infection have occurred in 3.5 and 2.5 percent of cases, respectively. The procedure is simple and has at our unit largely replaced the use of the latissimus dorsi musculocutaneous flap in extensive postmastectomy defects. In less disfiguring defects, the lateral thoracodorsal flap has taken the place of direct implantation because the reconstructed breast obtains a more pleasing shape by augmentation of the lower lateral pole.