Flap Dimensions Research Articles

Using Freestyle Skin Flap in Closure of Defects in Upper Limb

Background: Defects in upper limb may result from primary open trauma, postoperative wound infection, raw area after burns or post burn scar excision, tumor excision, radiation injury. Some defects require skin flap for proper coverage and restoration of function. One of the methods recently used for reconstruction of defects in upper limb is local freestyle skin flap. This flap is based on a perforator which provides blood supply for flap and acts as pivot point when the flap is rotated. Objectives: To evaluate using freestyle flap for reconstruction of defects in upper limb and assess the post-operative results for restoring function and cosmoses. Patients and Methods: This is a prospective study carried out in Plastic & Reconstructive Surgery Department & Emergency Unit, Zagazig University Hospitals in the period from January to July 2018 including 12 patients with soft tissue loss in upper limb managed by freestyle skin flap. Results: 50% of the cases had soft tissue defect after contracture scar release, while 25% were due to traumatic cause and the remaining 25% were post malignancy resection. flap dimensions ranged from 6 - 96 cm². we had no complications in 58.3% of our cases, while minor complications like flap congestion and distal partial necrosis occurred in 33.4% which were resolved within 1 week. Unfortunately, we experienced 1 flap loss (8.3%) which managed later by debridement of necrotic tissue and skin grafting the remaining soft tissue. Conclusion: Freestyle skin flaps are a reliable option for coverage of small to moderate sized defects

Enhancement thermoelectric generators output power from heat recovery of chimneys by using flaps

This study proposes a new and effective way to improve waste heat recovery from chimneys using thermoelectric generators cooled by natural convection heat sinks. A modified heat sink equipped with a flap fixed at the top of its base is used instead of only the conventional heat sink. A three-dimensional model is presented and solved by using ANSYS Fluent and ANSYS Mechanical for the complete setup. The model simulates completely the heat transfer phenomenon surrounding the first three heat sinks as part of a column of thermoelectric generator modules covering a vertical chimney wall. Also, it simulates the thermal-electric phenomenon inside the thermoelectric generator to predict the thermoelectric generators output power at different operating conditions. The impact of flap's dimensions and material (conductive and non-conductive) on the thermoelectric generator performance is studied. The flap's depth varies from 14 to 50 mm and height from 20 to 35 mm. This modified heat sink achieves about 64% increase in the thermoelectric generators cooling rate, yielding an increase in their output power by 129%. Results prove that sing the proposed modified heat sink in cooling thermoelectric generators (passively) maintains the system simplicity with no running cost and performs more than double its performance.

Oncoplastic Volume Replacement for Breast Cancer: Latissimus Dorsi Flap versus Thoracodorsal Artery Perforator Flap.

Background:Volume replacement oncoplastic breast techniques have become one of the standard lines in the treatment of early breast cancer. They have better cosmetic outcome and patient satisfaction. Latissimus dorsi (LD) flap is one of the most commonly used flaps for these techniques. Although it shows satisfactory surgical outcomes, postoperative shoulder dysfunction is an obvious drawback. The aim of this study was to compare LD flap with thoracodorsal artery perforator (TDAP) flap after breast-conserving surgery regarding surgical outcomes, patient satisfaction, and impact on shoulder function.Methods:The study included 42 adult female patients with early breast cancer who were eligible for conservative breast surgery and immediate breast reconstruction. Patients were divided into 2 equal groups: group A where patients underwent immediate reconstruction using LD flap and group B where patients underwent reconstruction using TDAP flap. Follow-up was designed for 12 months for early outcome, patient satisfaction, and shoulder functions.Results:The mean age of the included patients in group A and group B was 40.95 ± 5.06 and 40.33± 5.25 years, respectively. There was no significant difference in flap dimensions, postoperative complications, or cosmetic outcome in both groups. However, significantly less shoulder dysfunction was documented in cases of TDAP compared to LD flap at 3, 6, and 12 months postoperatively.Conclusions:TDAP flap is as reliable a technique as LD flap regarding the feasibility, postoperative complications, and the cosmetic outcome with significantly better functional outcome of the shoulder.

Successful application of modified keystone flaps following skin tumor ablation.

Skin cancer and precancerous skin lesions cause significant soft-tissue defects following tumor ablation. Recently, keystone flaps have gained popularity due to their simplicity, versatility, and reliability.We evaluated the efficacy of modified keystone flaps for soft-tissue reconstruction following skin tumor ablation in 2 medical centers.We reviewed the medical records of patients who received modified keystone flaps following the removal of skin tumors from January 2017 to December 2017. The diagnosis, site, flap size, and complications were recorded.Forty-one modified keystone flaps were evaluated, and the wound dimensions ranged from 1 cm × 1 cm to 18 cm × 9.5 cm, with an average size of 9.8 cm × 6.4 cm. With our selection strategy, specific modified keystone flaps were designed for the soft-tissue defects. The flap dimensions ranged from 2.2 cm × 1 cm to 26 cm × 10 cm, with an average size of 14.3 cm × 7.5 cm. Two patients developed minor wound dehiscence (4.9%), and 1 patient developed partial flap loss (2.4%), but all of these patients healed after local wound care without the need for surgical intervention.Our selection strategy for modified keystone flaps is a feasible and reliable option for reconstruction following skin tumor excision.

Comparisons of fascio‐cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction

The anterolateral thigh (ALT) flap is considered a workhorse reconstructive option; however, it is encumbered by its bulkiness that can result in poor final outcome and need for revision surgery. The aim of the present study was to compare the standard cutaneous ALT free flap and sandwich fascial ALT (SALT) free flap, raised harvesting between the Scarpa's fascia and the crural fascia, for distal extremity soft tissue reconstruction, including pre- intra- and post-operative considerations and outcomes. A retrospective review of medical records from 2013 to 2018 of 24 patients who underwent distal extremity reconstruction with standard fascio-cutaneous ALT flap (13 patients) and SALT flap (11 patients) was performed. The mean defect dimensions were 12 × 6.5 cm in group 1 and 12 × 6 in group 2. Surgical outcomes and quality of life were assessed (through the upper extremity functional scale and the lower extremity functional scale questionnaires. The mean flap dimensions were 13.1 × 7.1 in group 1 and 14.1 × 7.8 in group 2, the overall flap success rate was 100% (one microvascular venous thrombosis occurred in group 1), no statistically significant difference was recorded regarding microvascular thrombosis (one patient in group p = .369) and infections (one patient in group 1, p = .36) while a statistically significant difference was presence regarding the number of secondary/debulking procedures (6 patients vs. 0) (p = .0076) and the quality of life perception showed an overall better perception in group 2 with statistical significant difference (p = .03). The SALT flap represents a valid option, as showed through our preliminary data, when a thin and robust reconstruction is required when dealing with distal extremities soft tissue reconstruction.

The Versatility of the Superficial Circumflex Iliac Artery Perforator Flap: A Single Surgeon's 16-Year Experience for Limb Reconstruction and a Systematic Review.

The superficial circumflex iliac artery perforator (SCIP) flap is a versatile option of free tissue transfer for small to large defects. In this study, we examine the advantages of the SCIP flap, its cadaveric anatomy, and clinical subtypes. Ten cadavers were dissected and the corresponding pedicles of the SCIP and groin flaps were identified. A retrospective review of 20 clinical cases of free SCIP flap reconstruction was undertaken. The indication for reconstruction, flap dimensions, and survival were analyzed. A systematic literature review was conducted including articles that have previously reported the use of the SCIP flap. The SCIP pedicle was present in all our cadaveric dissections. The starting point of its pedicle ranged from 1.5 to 4.5 cm along the superficial circumflex iliac artery. The median diameter of the perforator and its concomitant vein was 1mm (range 0.8-2 mm). A cutaneous vein (1.3-2.3 mm) could be included in the flap if the concomitant vein was too small. Twenty consecutive patients had free SCIP flaps between 2002 and 2018. The indications were for finger defects (n = 8), thumb reconstruction (n = 1), lower limb compound fractures (n = 3), iatrogenic wounds (n = 2), upper limb large defects (n = 2), and scar contractures (n = 4). Flap dimensions ranged from 2 × 4 cm to 14 × 25cm, and the longest pedicle was 8cm. All flaps survived. The systematic literature review identified 34 previous reports using the SCIP flaps, most of these published by Asian units. The SCIP flap is useful for reconstruction throughout the body due to its ease of dissection, thinness, adjustable pedicle length, and flap dimension ranging from tiny to large, as well as the feasibility of raising a compound flap incorporating an adipofascial or vascularized bone component if necessary.This is a level of evidence therapeutic IV study.

Propeller perforator flaps for coverage of soft tissue defects in the middle and distal lower extremities

The middle and distal leg coverage is demanding procedure for reconstructive surgeon until evolution of local perforator flaps which becomes as valuable options in lower limb reconstruction. The goal of our study was to assess the results, reliability, safety, and possible complications of the local propeller perforator flaps in lower extremity reconstruction. We demonstrate a case series of 11 patients in whom we cover small-to-medium soft-tissue defects of the middle and distal leg by application of local propeller perforator flaps. The site of soft tissue defects were in the distal third in 9 cases (81.8%) and 2 cases (18.1%) in the middle third. Flap dimensions ranged from 48 to 192cm2, with an average size of 88.9 cm2. The flap rotation was 180 degrees in (63.6%) of cases. The flaps were based on a single perforator of the posterior tibial artery in 8 (72.7%) cases and peroneal artery perforator in 3 (27.2%) cases. Complications were present in 18% of the perforator flaps which were based on peroneal artery perforator, one partial necrosis and one flap with a superfacial epidermolysis. The donor area is covered by split thickness skin graft in 63.6% of our cases and primary closure of in 36.3% of cases. The perforator propeller flaps are safe, relatively simple procedure and consider as an ideal option in reconstructing small-medium defects of the middle and distal third of the leg which provide similar skin texture with low donor site morbidity.

Penoscrotal reconstruction with superficial circumflex iliac artery perforator propeller flap.

Successful penoscrotal reconstruction requires proper resurfacing of the defect and maintenance of the original shape of the penis and scrotum. We examined the feasibility of using the superficial circumflex iliac artery perforator (SCIP) propeller flap to effectively reconstruct penoscrotal defects. Eleven male patients with an average age of 62.2 years were retrospectively evaluated. The average defect size was 21.3 × 10.5 cm2 (range: 10 × 8-24 × 16 cm2 ). An eccentrically located elliptical flap was constructed using a handheld Doppler device after detecting the perforator as the pivot point. The medial branch of the superficial circumflex iliac artery was used for all cases. Flaps were designed to cover 70-80% of the defect area and the average rotation arc was 165°. The average flap dimension was 19.7 × 7.7 cm2 . Two cases showed partial necrosis in the flap tip area. There were no instances of total flap loss or lymphorrhea, or complications such as scar contracture, urination problems, erectile dysfunction, or discomfort during intercourse. The SCIP flap is an effective and ideal method for penoscrotal reconstruction considering the loose, elastic, and thin nature of the tissue. Elevation is easily facilitated, and the thickness of the SCIP flap can be adjusted without microsurgery.

Head and neck reconstruction: The supraclavicular flap: technical note

Defects reconstruction after oncologic resection is challenging and complex in head and neck tumors. The aim of this retrospective study is to evaluate the use of the supraclavicular artery island flap (SCAIF) in head and neck reconstruction, in particular, when traditional free flaps is not recommended. We reviewed our two years' experience of the use of SCAIF on a total of 15 cases. In 10 cases, it was used as an alternative to free flaps after head and neck tumors resection. In 5 cases, SCAIF was used for revision surgery after a free flap failure. The indications for flap use have been defects due to resection of stage II-IV cancer in the head and neck region. The operative site, time, complications and functional outcomes were assessed. We identified 15 patients with a total of 16 SCAIF. One patient had received bilateral SCAIF. Out of the patients, 10 were men and 5 were women. Head and neck oncologic patients underwent tumor resection followed by immediate reconstruction using SCAIF. Among those 15 patients, 10 received previous radiotherapy in the head and neck region. All the patients had undergone multiple surgical procedures. Mean flap dimensions were 6.0cm (range, 5-7cm) wide and 22.0cm (range, 14-26cm) long. The proximal part of the flap was de-epithelialized to match the defect, resulting in a mean skin paddle length of 8.0cm (range, 5-12cm). After an average follow-up duration of 13 months (range 3-20 months), the flap survival rate was 90%. Two patients had had a partial loss of the flap. All the flaps were harvested in less than one hour. The donor sites were closed primarily and did not require any additional surgery. No donor site wound dehiscence had been reported. No infection or cellulitis were observed. None of the patients reported any functional donor site morbidity. The supraclavicular flap provides a safe option for head and neck reconstruction of oncologic defects when traditional free flap is not recommended. It is also an excellent alternative to radial forearm free flap (RFFF) in head and neck soft tissue reconstruction, especially in vessel-depleted neck.

Use of an anteriorly based ventral tongue flap to reconstruct the lower vermilion following early-stage cancer ablation.

Reconstruction of lower vermilion defects is surgically challenging. This study evaluated whether lower vermilion defects can be repaired using tongue flaps, and the reconstructive outcomes. We evaluated 11 patients with early-stage lower vermilion cancers who underwent lower vermilion reconstruction using anteriorly based ventral tongue flaps following cancer ablation. We treated eight males and three females aged 54-67years (median, 59.8years). The defect/tongue flap dimensions ranged from 1.8×3.5 to 2.0×4.5cm (median, 1.87×3.81cm). No major complication developed in any patient. The postoperative esthetic results, orbicularis oris functions, and speech functions were excellent in six, eight, and nine patients, and satisfactory in five, three, and two, respectively. The patients were followed up for 13-36months (median, 21.7months); two local recurrences developed, and these patients underwent salvage surgeries. An anteriorly based ventral tongue flap is a safe and feasible option for reconstruction of lower vermilion defects.

Continuous Video-Rate Laser Speckle Imaging for Intra- and Postoperative Cutaneous Perfusion Imaging of Free Flaps.

Success of free tissue transfer depends on standardized intraoperative flap design, microsurgical technique, and postoperative monitoring. We sought to investigate whether laser speckle imaging (LSI) is suitable for optimization of intraoperative flap design and postoperative monitoring of free flaps with skin paddles. Skin perfusion was assessed with LSI in 27 free flaps after dissection at the donor site, after anastomosis at the recipient site, after inset and on postoperative days (POD) 1, 5, and 10. Skin perfusion of the whole flap (ROI [region of interest]-1) and the area over the pedicle (ROI-2) were compared between patients with and without postoperative complications (POC+ and POC - , respectively). A receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff for perfusion during LSI-guided microsurgery. In flaps without or only minor POC, intraoperatively measured perfusion over ROI-2 was significantly higher compared with ROI-1, whereas no significant differences were found for flaps with major POC. Perfusion of ROI-1 and 2 intraoperatively and on POD 1 was significantly lower in the POC+ compared with the POC- group (p < 0.05). ROC analysis yielded a threshold of 107 perfusion units (PU) at ROI-2 with an area under the curve (AUC) of > 0.8 for identification of flaps with major POC. LSI is an easy to use, noninvasive technique for identification of malperfused areas in free flaps, thus allowing for intraoperative decision-making on flap dimensions and postoperative monitoring. LSI therefore is a valuable tool for perfusion assessment with a high potential to become an established part of microsurgical practice.

Inferior pole breast reconstruction by TDAP flap in post-burn breast contracture

Post-burn breast deformities are not an uncommon condition after severe second-degree or third-degree burn and present as severe asymmetry of the breast as compared to the opposite side, displacement of nipple-areola complex, obliteration of inframammary fold, and reduced breast projection. Based on deformities especially for lower pole breast contracture, we propose a new classification to describe breast contracture. There is no tailor-made approach described to deal such deformities. Various options are available ranging from skin graft to different flaps. We present reconstruction by TDAP flap after the release of breast contracture grades I and II. This study aimed to classify the lower pole breast contracture according to its severity and to evaluate the outcome of TDAP flap reconstruction and augmentation of the lower pole of the breast in terms of symmetry and aesthesis. This is a descriptive retrospective study of 10 patients with 15 post-burn contracted breast affecting the inferior pole of the breast and inframammary fold within a period of January 2012 to March 2016 in Kasralainy hospital, Cairo. All cases were evaluated according to flap vascularity, donor site morbidity, symmetry, and esthetic outcome. All flaps survived completely. Flap dimension ranged from 18 × 10 to 22 × 12 cm. The muscle sparing design had been used in three patients due to lack of reliable perforators. Patients were evaluated for their satisfaction, and all of them were satisfied. It is essential to classify the grade of post-burn lower pole breast contracture according to the proposed classification. TDAP is a valuable option in case of grade I and II deformities only. For severe grade III breast contracture, more volume restoring procedure is advisable. Level of Evidence: Level IV, therapeutic study.

Is the Medial Sural Artery Perforator Flap a New Workhorse Flap? A Systematic Review and Meta-Analysis.

The medial sural artery perforator flap offers thin, pliable tissue with a relatively long pedicle and low donor-site morbidity. This study explores the characteristics and uses of the medial sural artery perforator flap along with postoperative outcomes and complications. A systematic literature review was performed using PubMed, Embase, and Cochrane Central Register of Controlled Trials to identify all cases of medial sural artery perforator flap reconstruction. Descriptive and meta-analyses were performed on pooled outcomes. Multivariate logistic regression identified factors associated with increased complication rates. Thirty-five studies encompassing 526 medial sural artery perforator flaps were included for analysis. The most common reasons for surgery were oncologic (47.6 percent) and traumatic injuries (31.8 percent). The oral cavity was the most common recipient location (45.5 percent). Average flap dimensions were 6.0 ± 2.3 cm × 9.8 ± 3.6 cm, with an average pedicle length of 10.1 ± 6.6 cm. Meta-analysis revealed an overall complication rate of 14.3 percent (Q value = 22.16; p = 0.877; I(2)= -39.9). Use of chimeric medial sural artery perforator flaps was associated with significantly higher rates of complications (OR, 3.92; p = 0.039; 95 percent CI, 1.10 to 13.89). The majority of flap donor sites were closed primarily (68 percent) versus 32 percent that were covered with split-thickness skin grafts. A flap width greater than 5.75 cm had an odds ratio of 5.3 (95 percent CI, 1.3 to 21.8; p = 0.014) of having a donor-site complication if closed primarily. The medial sural artery perforator flap offers thin, pliable tissue with a relatively long pedicle and has minimal donor-site morbidity when the donor site is managed appropriately. As such, it should be considered a workhorse flap for both head and neck and extremity reconstruction.

Anatomical Study of a Chimeric Fascio-Osteomyocutaneous Fibula Flap for Free Microvascular Tissue Transfer.

Functional restoration in reconstructive surgery can require complex and adaptable approaches. In this anatomical study, the combined angiosome of the septofasciomyocutaneous vessels originating from the fibular artery was defined as basis for a chimeric flap of the lateral lower leg. Methylene blue injection into the fibular artery was performed in 10 legs of fresh cadavers for visualization of the angiosome on the skin, fibula, and adjacent muscles as the lateral hemisoleus (HS) muscle. With regards to clinical specifications a maximum-size flap containing cutaneous, osseous, and muscular elements was raised. During dissection, the distribution pattern, number and size of stained septofasciomyocutaneous vessels at the lateral border of the proximal, middle, and distal thirds of the fibula length, as well as the flap dimensions were evaluated. In all specimens, vessels originating from the fibular artery and supplying the resected fibular bone, the fasciocutaneous flap and dorsally located muscles were found. The mean number of vessels to the skin was 4.2 per leg with a mean diameter of 1.1 ± 0.5 mm (range: 0.4-2.5 mm) and to the HS muscle 3.4 vessels with a mean diameter of 1.2 ± 0.7 mm (range: 0.3-3.0 mm). A total of 88.4% vessels occurred in the proximal and middle thirds of the legs. The resected fibula graft had a mean length of 23.8 ± 3.9 cm (range: 19.9-31.0 cm) and the skin paddle had a mean size of 23.8 ± 3.9 cm (range: 19.9-31.0 cm) × 7.0 cm. The flexor hallucis longus (FHL) muscle had a mean volume of 37.2 ± 15.8 cm3 (range: 18-58 cm3) and the lateral HS muscle 77.1 ± 23.3 cm3 (range: 48-105 cm3). Our results and anatomical descriptions indicate that chimeric fibula flaps can meet the specific reconstructional requirements of complex and large sized defects representing a promising basis for further studies.

Reconstruction of Large Soft Tissue Defects of the Extremities in Children Using the Kiss Deep Inferior Epigastric Artery Perforator Flap to Achieve Primary Closure of Donor Site.

The closure of massive skin defects remains challenging, particularly in children. In this report, we describe a technique to achieve primary donor site closure using the kiss deep inferior epigastric perforator (DIEP) flap for the reconstruction of large soft tissue defects located in the extremities of children. From May 2011 to May 2016, a retrospective analysis was conducted on 10 pediatric patients with extensive soft tissue defects and reconstruction with double-skin paddle DIEP flap. After harvesting the flap, the skin paddle was divided into 2 separate paddles with a common vascular supply, and then the 2 paddles were sutured side by side through translating 2 paddles or rotating one of the paddles by 90 or 180 degrees, effectively doubling the width of the flap and rejoining it at the recipient site. Data on patient age, medical history, defect size, flap dimensions, recipient vessels, donor site closure, complications, and follow-up were reviewed retrospectively. Nine children had major soft tissue defects of the lower limb, and the remaining one had an upper limb defect. Only 1 case was complicated by partial necrosis of 1 paddle. Primary donor site closure was accomplished in all cases. The flaps were well matched on texture and contour, except that the 2 flaps were bulky at postoperative follow-up. There was no donor site breakdown, with only a slightly noticeable linear scar. The kiss DIEP flap could be an alternative for reconstruction of large soft tissue defects of the extremities in children, with lower morbidity and improved cosmetic of the donor site.

Capsulorhexis flap dimensions between manual continuous curvilinear capsulorhexis and zepto-assisted capsulotomy: A prospective study

Purpose: The purpose of this study is to compare rhexis flap dimensions between manual continuous curvilinear capsulorhexis (CCC) and zepto-assisted capsulotomy. Methods: A prospective study including consecutive 10 patients of CCC and consecutive 10 patients of zepto capsulotomy. Two methods were used to compare the CCC and zepto capsulotomy flaps. In the first method, digital caliper was used to compare the vertical and horizontal dimensions of the CCC and zepto flaps under microscope. In the second method, New Eyes software was used to measure the rhexis flap dimensions from the postoperative slit-lamp photo. Dilated slit-lamp photograph is captured and capsulorhexis size, shape, continuity, and intraocular lens (IOL) optic coverage was evaluated. Results: The t-test was used for the statistical analysis. The mean difference between the flap dimensions in the two groups is not statistically significant. The coefficient of variation is more in manual than the Zepto method for all the parameters, i.e., DC_VL (10.0% vs. 0.6%); SW_VL (12.5% vs. 0.8%); DC_HL (14.2% vs. 0.3%); and SW_VL (19.0% vs. 0.3%). Discussion: Zepto-assisted capsulotomy is very precise and has a good predictability and repeatability. Complications can be related to technique. Both methods ensure optimal IOL-optic coverage, but the repeatability of rhexis dimensions is more with zepto than CCC.

Pedicled thoracodorsal artery perforator flap for reconstruction of post burn contracted neck

Background: The thin and pliable skin of the neck is a region with multidirectional activity, and postburn contractures forms there easily. Different methods of reconstruction were described. In our study the thoracodorsal artery perforator flap (TDAP) is used to reconstruct the post burn contracted (PBC) neck. Its main vascular supply is the thoracodorsal artery, and can be harvested as an island flap. Aim of the work: to evaluate the aesthetic and function outcome of TDAP flap as a new technique for reconstruction of PBC neck. Patients and Methods: this study included a total of 10 TDAP flaps. Were studied prospectively for their efficacy in reconstruction of PBC neck in 10 patients. Also donor site morbidity, patient satisfaction, and complications were evaluated. Between November of 2017 and January of 2019, this study was preceded by preserved cadaveric dissection. All were island flaps. The range of flap size was 18 ± 5 cm in length, and 9 ± 2 cm in width. Primary closure of donor site was performed in all cases. Results: 8 of the 10 flaps survived completely, two cases of distal necrosis not exceeding 2 cm (20%), and no total flap necrosis. Most of the patients were satisfied with both the functional and aesthetic results. Conclusion: PBC neck affects function, and appearance. In our view, the island TDAP flap is a good option for neck resurfacing regarding a wide arc of rotation, a relatively larger flap dimensions, a reliable pedicle length, and acceptable donor site morbidity

Pedicled thoracodorsal artery perforator flap for reconstruction of post burn contracted neck

Background: The thin and pliable skin of the neck is a region with multidirectional activity, and postburn contractures forms there easily. Different methods of reconstruction were described. In our study the thoracodorsal artery perforator flap (TDAP) is used to reconstruct the post burn contracted (PBC) neck. Its main vascular supply is the thoracodorsal artery, and can be harvested as an island flap. Aim of the work: to evaluate the aesthetic and function outcome of TDAP flap as a new technique for reconstruction of PBC neck. Patients and Methods: this study included a total of 10 TDAP flaps. Were studied prospectively for their efficacy in reconstruction of PBC neck in 10 patients. Also donor site morbidity, patient satisfaction, and complications were evaluated. Between November of 2017 and January of 2019, this study was preceded by preserved cadaveric dissection. All were island flaps. The range of flap size was 18 ± 5 cm in length, and 9 ± 2 cm in width. Primary closure of donor site was performed in all cases. Results: 8 of the 10 flaps survived completely, two cases of distal necrosis not exceeding 2 cm (20%), and no total flap necrosis. Most of the patients were satisfied with both the functional and aesthetic results. Conclusion: PBC neck affects function, and appearance. In our view, the island TDAP flap is a good option for neck resurfacing regarding a wide arc of rotation, a relatively larger flap dimensions, a reliable pedicle length, and acceptable donor site morbidity

Posterior intercostal artery perforator flap for posterior trunk reconstruction: Perforator mapping with high-resolution ultrasound and clinical application

BackgroundPedicled perforator flaps have progressively been used for reconstructive purposes of the anterior trunk. However, reports regarding perforator flaps for local reconstruction of the posterior trunk are sparse. The aim of this study was to investigate the vascular basis of perforator flaps based on the posterior intercostal arteries and to highlight the clinical versatility of these flaps for local posterior trunk reconstruction. MethodsThe posterior intercostal artery perforators (PICAP) between the 4th and 12th intercostal space were investigated using high resolution ultrasound in ten healthy volunteers. The location, diameter, suprafascial length and course of the individual perforators was measured. PICAP flaps were used in a series of ten cases for defect reconstruction of the posterior trunk to demonstrate their clinical versatility. ResultsA total number of 100 perforators was investigated. The mean diameter was 0,7 ± 0,24 mm with an average length until arborisation of 0,8 ± 0,8 cm. Perforators were located at 2,4 ± 1,8 cm from the midline on average. Only 16% of all measured perforators were identified as major perforators (diameter ≥ 1 mm). In ten patients (mean age at surgery 61,7 years, f:m = 3:7) a PICAP flap was used for defect reconstruction at the back with a mean follow-up of 2,9 years. Flap dimensions ranged from 7 × 3 to 16 × 7 cm. In three cases, a complication was observed (one seroma, one hematoma, one marginal tip necrosis). ConclusionIn the present study, a reliable vascular basis of the posterior intercostal artery perforator flap could be demonstrated. Clinically these flaps replace “like with like” and may be transposed in a propeller – or V to Y – fashion. The donor site can be closed primarily in most cases, thus resulting in a favorable donor side morbidity.

Is the caudal auricular axial pattern flap robust? A multi-centre cohort study of 16 dogs and 12 cats (2005 to 2016).

To determine the frequency and type of healing complications arising after the use of the caudal auricular axial pattern flap to close defects on the head in dogs and cats. Multi-centre retrospective cohort study. Centres were recruited by the Association for Veterinary Soft Tissue Surgery Research Cooperative. Medical records of 11 centres were reviewed, and data from all dogs and cats treated with a caudal auricular axial pattern flap were retrieved. The following data were recorded: signalment, reason for reconstruction, flap dimensions, anatomic landmarks used, histological diagnosis, flap healing and whether revision surgery was required. Twenty-eight cases were included: 16 dogs and 12 cats. Flap length: width ratio was approximately 3:1 and flap length extended to the scapular spine in most cases. Optimal wound healing occurred in five of 16 (31%) dogs and six of 12 (50%) cats. Wound dehiscence without flap necrosis occurred in one of 16 (6%) dogs and one of 12 (8%) cats. Wound dehiscence with flap necrosis occurred in 10 of 16 (63%) dogs and five of 12 (42%) cats. Revision surgery was performed in eight of 16 (50%) dogs and three of 12 (25%) cats. The caudal auricular axial pattern flap can provide full thickness skin coverage for large defects on the head in dogs and cats. Partial flap necrosis is a common complication, and revision surgery may be required in order to achieve final wound closure.