Appearance Of Flaps Research Articles

Application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar

To investigate the application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar. The proximal end of the plantar fasciocutaneous perforator flaps were at the edge of defects. The deep fascia was cut off at the both sides of flaps. The plantar fascia should be included into the flaps. Then the flaps were rotated to cover the defects, containing two or three perforators. If necessary, the original supplying vessels could be cut off to facilitate the advancement of flaps. From Jan. 2010 to Oct. 2012, 7 cases with plantar defects were treated with the horn shaped perforator flaps. The defects size ranged from 1.5 cm x 2.0 cm to 4.0 cm x5. 0 cm with the size of the flaps ranging from 7 cm x 3 cm to 13 cm x 7 cm. All the flaps survived completely with primary healing both on donor and recipient sites. The flap color, texture, function and appearance were satisfactory during the follow-up period of 3-24 months. The plantar horn shaped perforator flap can reconstruct the defects at plantar weight-bearing area with the similar thick skin tissue, which facilitates the functional reconstruction. No skin graft is necessary for the defect at donor site.

The application of hallux dorsal artery flap for repairing f＇mger pulp defect

Objective To investigate the clinical efiqcacy of repairing finger pulp defect with hallux dorsal artery flap. Methods Finger pulp defect in 11 cases was treated with free transplantation of hallux dorsal artery flap. Flap sizes ranged from 2.0 cm × 1.5 cm to 3.5 cm× 2.5 cm. Results Flap survival was uneventful in 10 cases. Vascular crisis occurred in 1 flap. Surgical exploration and reanastomosis of the vessels rescued the flap that survived. The patients were follow-up for 1 month to 2 years. The appearance and texture of 10 flaps were satisfactory. Two-point discrimination was 5 to 8 nun. All affected fingers had normal pinch. Bulkiness and stiffness of the flap was treated with plastic surgery which greatly improved flap appearance in 2 cases. Walking of the donor foot was normal. Conclusion Hallux dorsal artery flap transplantation leads to good clinical results and is an ideal flap for repairing of finger pulp defects. Key words: Finger injuries; Surgical flaps; Microsurgery

Application of lateral thoracic flap in maxillofacial defect reconstruction: Experience with 28 cases

Lateral thoracic (LT) flaps are primarily used as pedicle flaps for reconstructing limb and chest wall defects and have rarely been applied for head and neck reconstruction. We aimed to present our surgical techniques and experience using free LT cutaneous, myocutaneous and conjoint flaps for oral and maxillofacial reconstruction. From 2006 to 2010, we reconstructed 28 cases of oral and maxillofacial soft tissue defects using LT flaps. Controls were 54 cases reconstructed with anterior forearm flaps during same period. Flap size and pedicle length were recorded intraoperatively. Patients were monitored for flap survival in hospital until discharge and then followed regularly for 3-38 months, assessing for tumor recurrence, flap appearance, donor site function and cosmesis. All patients had free flaps except for one LT pedicle flap. LT flap patients were significantly younger than controls (45.5 vs. 54.8 years, p=0.004) and had greater flap size than controls (55.2 cm2 vs. 40.3 cm2, p=0.001). Of 28 LT flaps transferred, 26 survived completely; 1 failed (total necrosis due to venous insufficiency), and 1 suffered tip necrosis. No significant differences were observed in flap survival between groups. Follow-up was shorter in LT flap patients than in controls (20.3 months vs. 26.9 months, p=0.02). Application of the LT flap is a reliable technique for reconstruction of maxillofacial defects with minimal donor site morbidity and favorable aesthetic outcomes.

Reconstruction of thenar eminence defects using modified medial pedis flap combined with abductor hallucis muscle transfer

Objective To explore the surgical technique of functional myocutaneous flap transfer for reconstruction of the appearance of the thenar eminence and thumb opposition, and to improve the design and harvest of medial podis myoculaneous flap. Methods From November 2010 to January 2012, 6 cases with skin and muscle defects of the thenar eminence were treated by modified medial pedis flap combined with abductor hallucis muscle transfer using microsurgical techniques. Functional exercises and physical therapy were initiated 3 weeks postoperatively. Electromyogram （EMG） of the thenar muscles was performed at 6 and 12 months after the transfer. Grip strength, pinch strength, British Medical Research Council （BMRC） muscle strength and sensory recovery grading were performed during the follow-up periods. Results Flaps in all cases survived well. The appearance of the flaps was similar to the normal skin of the hand. All cases had more than 12 months＇ followup. In all cases, voluntary abduction of the thumb by the transferred abductor hallucis was achieved and confirmed by EMG. EMG of the thenar muscles at 6 months showed a mixed pattern upon maximum voluntary contraction and an interference pattern at 12 months. Pain and touch perception returned at 6 months, while twopoint discrimination was 7.5 to 11.2 mm （mean, 7.9 nun） at 12 months. BMRC sensory grading was S3＋, while muscle power recovery was M3 to M4. Conclusion As a new myocntaneous flap, the modified medial pedis flap combined with abductor hallucis muscle transfer is effective for repairing thenar eminence defects. The flap had not only good appearance and sensory reinnervation, but also the transplanted hallucis abductor muscle results in satisfactory opposition fimction of the thumb once it is innervated. Key words: Surgical flaps; Clinical research; Medial pedis flap; Hallucis abductor muscle; Thenar eminence

Cosmetic Tattooing of Free Flaps following Head and Neck Reconstruction

Free flap reconstruction of the head and neck is a widespread procedure. The aesthetic outcome is frequently compromised by color mismatch between the donor site skin and the complex pigmentation of the face. Various surgical procedures have been described to improve the appearance of external skin paddles. Medical tattooing is commonly used for nipple pigmentation in breast reconstruction and cosmetic procedures such as permanent makeup. This article describes the technique and its application to head and neck reconstruction. Medical tattooing can be used to improve the cosmetic appearance of head and neck free flaps. There is no donor site morbidity and subtle changes in color can be replicated. The article describes the technique of medical tattooing with the use of illustrative cases. Medical tattooing is a viable alternative for improving the appearance of cutaneous skin paddles following head and neck reconstruction with free flaps. Its advantages include no donor site morbidity, availability of an infinite range of colors, no requirement for general anesthesia, and the ability to use multiple colors in the one flap for complex pigmentation requirements. Its disadvantages include the need for specialized skills and equipment and the fading of color over time.

Adoptive Transfer of Ex-Vivo Donor Alloantigen-Stimulated Regulatory T Cells Delays Composite Tissue Allotransplantation Rejection

Introduction: Great efforts from teams around the world have made composite tissue allotransplantation (CTA, or vascularized composite allotransplantation, VCA in short) a clinical reality. However, chronic application of immunosuppresants is still critical for long-term survival of the allografts. To circumvent this, major research efforts have been focused on establishing the allograft-specific tolerance. A specific subset of T cells termed regulatory T cells (Treg), with expression of CD4+CD25+Foxp3+, was found to be involved in suppressing the immune response. Tregs have been increasingly documented to suppress alloantigen-driven rejection especially in organ transplantation studies. However, less is known about functions of Tregs in composite tissue allotransplantation. Methods: The hindlimb osteomyocutaneous flap allotransplantation was performed on a rat model with BN donors and LEW recipients. The recipients were conditioned with two doses of antilymphocyte serum (ALS) in addition to daily injection of cyclosporine A for 7 days. CD4+CD25+ splenocytes were collected from the recipients with MACS magnetic microbeads technique in two steps. Firstly, splenic CD4+ cells were sorted out using negative selection by antibodies against non-CD4 cells. Secondly, CD25+ cells were sorted from CD4+ cells using positive selection. The in vitro suppressive potential of sorted CD4+CD25+ cells were assayed with mixed lymphocyte reaction. The in vivo effects were evaluated by adoptive transfer to allotransplantation receipients. Flap appearance was observed daily to monitor the rejection. Blood cell population was characterized with flow cytometry. Results: Two-step sorting greatly increased the purity of CD4+CD25+ cells from 7% to 91%. Out of these CD4+CD25+ cells, 61% expressed Treg marker Foxp3, in contrast to 6% in whole splenocyte population. When added into the coculture of Lewis and BN splenocytes, Tregs suppressed alloantigen-stimulated proliferation of LEW splenocytes in a dose-dependent manner. The in vivo effects of Tregs were evaluated by adoptive transfer to the allotransplantation recipients. Without conditioning by ALS and cyclosporine A, fresh-isolated CD4+CD25+ -infused rats showed signs of rejection sooner than controls. However, after alloantigen-stimulation, via coculture with BN splenocytes for 72 hours prior to infusion, the Tregs greatly delayed the onset of rejection in combination with ALS and cyclosporine A. One third of the allotransplantation recipients with alloantigen-stimulated Treg infusion had the allografts survive longer than 150 days. Conclusion: The protocol to isolate Tregs from rat splenocytes was developed with good purity. Isolated Tregs showed immnunosuppressive function in vitro. In vivo, alloantigen-stimulated Tregs in combination of ALS and cyclosporine A prolonged the survival of allotransplanted grafts.

Application of distal biperforator based island flap of the first web dorsal space for repairing soft tissue defects of the thumb or index finger

Objective To introduce the clinical experience of the application of distal bipefforator based island flap of the first web dorsal space.Methods Fifteen cases of expansive soft tissue defect of the thumb or index finger were treated by distal biperforator based island flap of the first web dorsal space.Results The average postoperative follow-up period was 3 to 6 months.All flaps survived uneventfully.Both appearance and function of the flaps were satisfactory.The opening angle of the first web space was augmented up to more than 80°.There was no impairment of the opposition and pinch function of the thumb and index finger.Conclusion Transfer of the distal biperforator based island flap of the first web dorsal space is an ideal way to repair expansive soft tissue defect of the thumb or index finger. Key words: Surgical flaps; Finger injuries; Treatment outcome

Modification of VY Flap to Preserve Fingertip Contour

VY flap is a reliable treatment for fingertip amputation injuries. Insetting the flap to replicate fingertip contour can be challenging with the conventional method of using sutures. We propose a modification of inset technique with K-wire to simplify contouring during flap inset. Seven patients underwent VY flap reconstruction with the modified inset technique for fingertip defects ranging from 10 × 15 to 20 × 15mm. The flaps were advanced between 6 and 10mm and inset with K-wires. The donor site is allowed to heal by secondary intention. At 6months, static two-point discrimination, sensitivity, and flap appearance were assessed. All flaps healed uneventfully, and each patient returned to work between 8 and 10weeks. Fingertip and nail contour were satisfactory in every case. This modification simplified contouring during flap inset and provided a viable alternative to flap inset and contour adjustment.

Design and clinical application of "exclamation mark" shaped pedicle flaps

Objective To investigate effects of pedicle processing methods on the survival and appearance of the pedicle flaps. Methods The study involved 17 patients with soft tissue defects of extremities treated with the “exclamation mark” shaped pedicle flaps from October 2009 to January 2011.The traditional pedicled rotation flaps was designed to be a tennis racket-like shape,then the rotational pedicle was designed to small round tension reduction flap and pedicled rotation flaps,which contributed to formation of the “exclamation mark” shaped pedicle flaps.The soft tissue defects was located at the upper extremity in three patients and at lower extremity in 14,with defect areas of 4.0 cm× 7.2 cm-5.8 cm × 14.0 cm.There used two superficial radial nerve vasotrophic flaps,one ulnar artery supra-carpal cutaneous flap,eight sural neurocutaneous vasotrophic flaps and six saphenous nerve vasotrophic flaps.Results All flaps survived at Ⅰ stage except that one flap had partial distal necrosis postoperatively,which was cured after dress change.The follow-up ranged from six months to one year,which showed unobvious swelling of the survived flaps and good appearance of the rotation point of the pedicle. Conclusion The “ex(c)lamation mark” shaped pedicle flaps can reduce entrapment of the distal pedicle,promote venous drainage,improve survival and modify the appearance of the flaps. Key words: Soft tissue injuries; Surgical flaps; Tension reduction flap

Perforator flap in the middle segment of posterolateral forearm for dorsal defects at the lower forearm

To discuss the feasibility of perforator flaps in the middle segment of posterolateral forearm for dorsal defects at the lower forearm. 30 specimens of adult upper limbs, perfused with red latex, were dissected. The course, origin, distribution and branches of major perforator artery in the middle segment of posterolateral forearm were observed and measured. 8 cases with dorsal defects at the lower forearm were treated with the perforator flaps. All the 8 flaps survived completely with primary healing. The patients were followed up for 2-28 months with good flap texture, color and appearance. The perforator flap in the middle segment of posterolateral forearm has constant and rich blood supply which is originated from the main artery. It is suitable for defects at the dorsal side of lower forearm.

Clinical applications of superficial radial nerve nutrient vessel flaps in the forearm

Objective To summarize the clinical results of retrograde transfer of forearm superficial radial nerve nutrient vessel flaps to repair skin and soft tissue defects in the hand. Methods From June 1999to December 2010,forearm superficial radial nerve nutrient vessel flaps were retrogradely transferred to cover soft tissue defects of the hand in 15 cases.The projection of the course of superficial radial nerve in the forearm was used as the axis of the flap.The flap was designed along the axis and dissected sharply beneaththe deep fascia.It was then rotated distally to reach the defects in the hand.If a sensate flap was needed,the cutaneous nerve included in the flap was coapted to the cutaneous nerve of the recipient site. Results Of the 15 flaps,2suffered from subcutaneous blood stasis in the distal 1/3 of the flap.Skin necrosis of 1.5 cm× 1.0 cm at the tip of the flap was debrided and healed after dressing changing in one case.The rest of the flaps survived uneventfully.The appearance and function of the flaps were satisfactory through 4 months to 8 years of follow-up.Conclusion This flap is easy to harvest,causes minor donor site morbidity,offers flexible transfer options and can be transferred as a sensate flap.It has good appearance with matching skin color of the recipient site.It is an ideal method in the repair of soft tissue defects of the palm,dorsum of the hand and the first web space. Key words: Surgical flaps; Radial nerve; Superficial branch

Anatomy of the free descending genicular artery perforator flap and its clinical application for soft-tissue defects at extremities

To investigate the feasibility of free descending genicular artery perforator flaps in the soft tissue defects at extremities. Ten fresh cadavers were injected with lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized volume-rendering software ( Materiaise's interactive medical image control system, MIMICS). The origin, course and distribution of the perforators in the thigh and leg region were observed. 11 patients with skin defects at the distal part of extremities were treated. The flap size ranged from 5 cm x 8 cm to 6 cm x 15 cm. Six flaps were pedicled with the descending genicular artery and the others were pedicled with the perforator of the descending genicular artery. All flaps were transferred by end to end anastomosis. RESULTS The follow-up period ranged from 6 to 18 months. All the flaps survived. The appearance and texture of the flaps were good with sensory recovery of S3. Free descending genicular artery perforator flap has a reliable blood supply and suitable thickness for the treatment of soft tissue defects at extremities. The technique is easily performed with reliable results.

Tissue defect repair and functional reconstruction of the limb with free flap by inverted-Y-shape microvascular anastomosis

Objective To discuss the clinic application and surgical technique of the free flap by inverted-Y-shape microvascular anastomosis in tissue defect repair and functional reconstruction of the limb.Methods Twenty-two flaps in 18 patients were involved in the study between June 2006 and September 2010 ( 12 cases for soft tissue defect repair with exposure of the tendons, bones or joints, and 6 cases for functional reconstruction; five cases were around the elbows and 13 cases were around the extremity of the lower limb). Before free flap graft, twelve cases with infective tissue defect were debrided extensively and covered with vacuum sealing drainage from 1 to 2 times and each time last 5 to 7 days until the granulation tissue growing well.Designed the free anterolateral thigh flaps with the transverse and descending branches of the lateral femoral circumflex vessels or free latissimus dorsi flaps with the subscapular and circumflex scapular vessels forming a inverted-Y-shape pedicle to repair the tissue defect or to reconstruct the limb function.The recipient artery was sectioned and the arterial tree of the flap was anastomosed to the recipient vessel by two end-to-end anastomoses.This inverted-Y-shape microvascular anastomosis could supply blood for both the free flap and the extremity of the limb.Not all of the veins of the recipient limb need to be cut off.Observed the circulation of the limb extremity, and evaluated the quality of flaps' survival. Results Complete flap survival was achieved in 21 flaps and without vaso-occlusive crisis; while partial flap loss in 1 case, which healed after changing dressings.The mean follow-up was 16.2 (6-36) months postoperatively,appearance of the flaps and the functions of limbs were satisfactory, and no obvious complication was found in the donor site. Conclusion The free flap by inverted-Y-shape microvascular anastomosis is a new choice for the tissue defect repair and functional reconstruction of the limb,especially for the wound around elbow or extremity of the lower limb with one major artery destroyed. Key words: Surgical flap ; Anastomosis ; Tissue transplantation ; Limb ; Functional reconstruction

Stair‐step flap for secondary lower lip revision after lip and cheek composite defects reconstruction

Free flap reconstruction is a common procedure for through-and-through lip and cheek complex defects after cancer ablation. However, oral incompetence with unacceptable bulky flap appearance invariably occurs and needs a secondary revisionary procedure. The purpose of this article was to present our method to improve the oral competence and cosmetic appearance by the stair-step technique of flap revision. Fourteen patients who had undergone flap folding reconstruction of the lip and cheek complex defect resulting in oral incontinence were involved in this study. Thirteen patients had been treated with an anterolateral thigh flap and 1 patient had been treated with a fibular osteocutaneous flap. This revisionary stair-step technique was combined with simultaneous liposuction of the bulky flap in all cases. Adequate oral continence and good contour was achieved in 12 patients. The remaining 2 patients still had mild drooling, which was managed successfully with a second stair-step flap. This technique is a valuable option for revision of lower lip deformity.

Applied anatomy of the lateral tarsal artery pedicle flap on front and lateral compartment of leg and clinical application

Objective To explore an anatomical basis for the lateral tarsal artery pedicle flap on front and lateral compartment of leg and the feasibility of repairing skin defects on forepart of feet. Methods The branches, course and anastomosis of the lateral tarsal artery, perforator of peroneal artery up external malleolus, superficial peroneal artery were studied in 20 legs of adult cadavers.The flap was designed on these grounds. 8 cases repaired by lateral tarsal artery pedicle flap on front and lateral compartment of leg, 5 cases of skin defects on dorsum of foots, 3 cases of skin defects on footplates.The area of defect on forepart of foot was 5 cm× 4 cm-cm × 5 cm. The donor sites were resurfaced with skin grafts or sutured directly. The lateral tarsal artery, perforator of peroneal artery up external malleolus, perforator of anterior tibial artery superficial peroneal artery were anastomosed each other, formed single band blood vessel axle on lateral foot, fore external malleolus, front and lateral compartment of leg. The area of flap was 6 cm × 4 cm - 10 cm × 6 cm.Results All of the flaps survived completely. All cases were followed up, followed up 6- 12 months, averaged 8 months. The color, appearance and texture of the flaps were good, without ulcer on the flap. The patients can walk freely. Conclusion The flap on front and lateral compartment of leg should be designed according to the lateral tarsal artery. Blood supply of flap was reliable, little trauma. The flap's vessel pedicle is enough long. It could repair any defect on forepart of foots. Key words: Surgical flaps; Feet; Lateral tarsal arteries; Vascular anastomosis

Application of snuff-box flap in repairing skin defects of the hand

Objective To explore the surgical technique and clinical outcomes of pedicled snuff-box flap to repair skin defects in the hand of small to medium sizes. Methods From July 2005 to May 2009 , the snuff-box flap was used to repair soft tissue defects of the hand in 22 cases. The survival rate, texture, colour and sensation of the flaps were evaluated. Results All 22 flaps survived except the partial distal necrosis in 1 case. Postoperative follow-up period ranged from 6 to 24 months. The texture, colour and appearance of the flaps were good. There was no bulkiness and atrophy of the flap. Flap sensation was good. Conclusion The snuffbox flap based on perforator of the radial artery has constant vascular anatomy. It is an effective procedure to repair small to medium size defects of the hand. Key words: Surgical flaps; Hand injuries; Snuff-box flap

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

Transplantation of the chimerical osteocutaneous perforator flap with superficial circumflex iliac artery for repair of bone and skin defect in limbs

Objective To investigate the applied methods and effects of the chimerical osteocuta-neous perforator flap with superficial circumflex iliac artery for reconstruction of bone and skin defect in limbs. Methods From February 2008 to April 2009, five patients in whom bone and skin defect in limbs were reconstructed with free chimerical osteocutaneous perforator flaps using superficial circumflex iliac vessel, in-cluding 4 males and 1 female with an average age of 31.2 years. Of 5 patients, 2 were used for the recon-struction of composite metacarpal bone and soft-tissue defects, 2 for foot reconstruction, and 1 for fibula re-construction. The area of cutaneous deficiency was about 5 cm×2 cm to 16 cm×5 cm. The size of osseous flaps ranged from 2 cm×1 cm×0.8 cm to 8 cm×2 cm×0.5 cm, and the size of cutaneous flaps ranged from 6 cm×3 cm to 18 cm×6 cm. All the arteries were reconstructed by end-to-end anastomoses between the donor iliac artery and the recipient artery, except one, which was performed using an end-to-side method. The bone flaps were fixed with the aid of plate and screw (4 cases), and Kirschner wire (1 case). Results One hap-pened arterial crisis during the 2-day postoperative period. The other flaps were fully survival by first intention, and all wounds of the donor site healed within 8 to 27 days. All the cases were followed up for 8 to 19 months, the appearance of flaps was satisfactory and no special protection was needed. All bone defects healed during a period time of 3 to 6 months. No patient complained of pain at the donor site. The function of hand prehension was completely recovered, and thumb opposition was partly recovered. Patients who re-ceived repairing of lower limb were able to ambulate with self-weight bearing. Conclusion The chimerical os-teocutaneous superficial circumflex iliac free perforator flap can minimize the donor site complication and is suit-able for the reconstruction of small area of bone defect, especially combined with a large area of soft tissue defect. Key words: Surgical flaps; Bone transplantation; Transplantation, autologous; Microsurgery

Anatomical study and clinical application of the vascularized composite fibula perforating osteoseptocutaneous flap

Objective To report the anatomical study and clinical application of the vascularized composite fibula perforating osteoseptocutaneous flap. Methods Latex injection studies were performed on 24 adult cadaveric lower limbs. The presence, prevalence, and location of the peronel artery and its perforators in the distal leg were documented. 16 vascularized fibul osteoseptocutaneous flaps were performed for reconstruction of composite soft-tissue defect of limbs. The flap areas ranged from 6 cm×4 cm to 16 cm× 8 cm. Results A mean of 5.3 perforating vessels of the peroneal artery was noted in the specimen. 40.6% of them were muscularcutanous perforators, and the other were septacutanous perforators. The perforating vessels were all located within 3.1 cm from the postlateral fibula. The average diameter was 1.1 mm at the deep fascial level, and the interval of them was 4-8 cm. There were two constant perforators which located about 15-25 cm and 4-7 cm from the lateral maleolar respectively. All of the 16 clinical cases survived uneventfully and the time to union of the graft-host junction site were 3 to 5 months. The appearance of flaps and the function of the limbs were satisfied during 10 to 36 months following up. Conclusion It is the anatomic basis that there are pedorating vessels of the peroneal constantly. The vnscularized compound fibula perforating osteoseptocutaneous flap has the advantage of flexible design. It is the safe and suitable choice in the cases when compound bone and soft tissue defects of the limbs are required for reconstruction. Key words: Surgical flaps; Fibula osteoseptocutaneeus flap; Transplantation; Microsurgery

The MR Imaging Appearance of the Vascular Pedicle Nasoseptal Flap

Recently, surgeons have used an expanded endonasal surgical approach (EENS) to access skull base lesions not previously accessible by minimally invasive techniques. Reconstruction of the large skull base defects created during EENS is necessary to prevent postoperative CSF leaks. A vascular pedicle nasoseptal mucoperiosteal flap based on the nasoseptal artery, (Hadad-Bassagasteguy flap) is becoming a common reconstructive technique. The purpose of this study was to review the expected MR imaging appearance of these flaps and to discuss variations in the appearance that may suggest potential flap failure. We retrospectively reviewed 10 patients who underwent EENS for resection of sellar lesions with skull base reconstruction by multilayered reconstruction including the Hadad-Bassagasteguy flap. All patients had preoperative, immediate, and delayed postoperative MR imaging scans. Flap features that were evaluated included flap configuration, signal intensity characteristics on T1-weighted and T2-weighted images, enhancement patterns, location, and flap thickness. All patients had detectable postoperative skull base defects. All patients had C-shaped configuration flaps within the operative defect, which were isointense on T1-weighted and T2-weighted images on both immediate and delayed postoperative MR imaging scans. On the immediate scans, 8 of 10 patients had enhancing flaps and 2 of 10 had minimal to no enhancement. There were 9 of 10 patients who had enhancing flaps on delayed scans, and 2 of 10 patients had flaps that increased in enhancing coverage on the delayed scans. Vascular pedicle nasoseptal flaps have a characteristic MR imaging appearance. It is important for the radiologist to recognize this appearance and to evaluate for variations that may suggest potential flap failure.