Flap In Terms Research Articles

Sinus Laser Closure (SiLaC) with pit excision versus Limberg Flap in pilonidal disease: A prospective, randomized study

BackgroundPilonidal disease is a chronic suppurative condition of the natal cleft associated with significant morbidity primarily affecting the working population causing daily discomfort and activity limitation. Although several treatment modalities have been suggested for the management of this condition, the gold standard continues to be undefined. We conducted a randomized prospective study on the treatment of Pilonidal disease by Sinus Laser Closure (SiLaC) compared with Limberg Flap. Materials and methods100 patients with primary Pilonidal disease were randomized to undergo either SiLaC or Limberg Flap. The primary objective of our study was to establish the advantage of SiLaC over Limberg Flap in terms of the operative time, postoperative pain, duration of hospital stay, healing time, cosmesis and recurrence rates over a period of 2 years. The patient satisfaction and return to normal activities were also documented. ResultsWe analysed a total of 50 cases that underwent SiLaC and 50 that underwent Limberg Flap with similar demographic characteristics. Significantly lower operative time was noted in the SiLaC group. SiLaC was associated with decreased postoperative pain and duration of hospital stay with faster healing and better cosmetic outcome. The patient satisfaction and return to normal activites were also reported to be better in the SiLaC group. Recurrence was reported in 4 patients in SiLaC group versus 6 patients in Limberg Flap group. ConclusionOur study reports SiLaC as superior to Limberg Flap with shorter operative time, lower pain scores, length of hospital stay, faster healing time, decreased recurrence rates and good cosmetic satisfaction.

Biomechanical explanation of W-plasty effectiveness using a finite element method approach

The finite element method has often been used to assist analyzing local flaps in terms of deformation and stress measurements as it takes into account complex skin properties. We, herein, present an isotropic two-dimensional finite element skin model applied to the W-plasty method to demonstrate that the good outcomes of W-plasty should be attributed to the geometry itself, as it generates lower stresses. The skin was modeled as a two-dimensional (2D) planar geometry. The model was created and solved as a plane stress problem. The model was based on simulation of the loading and stitching of W-plasties of various angles. Each central triangular flap was segmented in nine triangular elements. The stitching was modeled with one suture at the top of each triangular flap with the center of the opposite corner. X- and Y-axis stresses and shearing stresses Txy in the elements involved in the broken stitching line, show lower stresses than the elements behind the stitching line. Interestingly, in the triangular flaps, the stresses were clearly lower than those of their neighboring areas. The maximum compressive stresses in the 2D model we used, correspond to the dog ears. We conclude that the effectiveness of W-plasty should be attributed not only to the scar orientation in relation to the relaxed tension skin lines but also to the special design of the triangular flaps used. This finding assists the general understanding of the method and should be taken into account by the clinician during flap designing.

Abdominal function and appearance of patients after repairing the extensive skin and soft tissue defects in the limbs with two types of lower abdominal tissue flaps

Objective: To study the abdominal function and appearance of patients after repairing the extensive skin and soft tissue defects in the limbs with two types of lower abdominal tissue flaps. Methods: A retrospective clinical controlled study was conducted. From June 2016 to October 2022, 17 patients with extensive skin and soft tissue defects in the limbs who met the inclusion criteria were admitted to the Department of Bone Hand Microsurgery of Shandong Wendeng Orthopedic Hospital, including 2 males and 15 females, aged 21-60 years, with a defect ranging from 15.0 cm×10.0 cm to 23.0 cm×15.0 cm. According to the applied repair method, the patients were divided into deep inferior epigastric perforator (DIEP) flap group (9 cases) with the defect wound being repaired by the DIEP flap and muscle sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap group (8 cases) with the defect wound being repaired by the MS-TRAM flap. On post surgery day (PSD) 1, 3, 5, 7, and 14, the blood supply of the tissue flaps was evaluated using a self-made tissue flap blood supply evaluation scale. At 12 months after surgery, the patients' satisfaction with the efficacy of tissue flap repair was evaluated using the satisfaction score standard for flap efficacy. Before surgery and at 3 and 12 months after surgery, a self-made abdominal wall strength evaluation scale was used to evaluate the strength of abdominal wall. At 12 months after surgery, a self-made abdominal appearance evaluation scale was used to evaluate the condition of abdominal scars, degree of abdominal symmetry, the appearance and restoration of umbilicus, abdominal protrusion during dressing, and formation of folds on both sides of the abdomen. Data were statistically analyzed with analysis of variance for repeated measurement, independent sample t test, paired sample t test, and Fisher's exact probability test. Results: On PSD 1, 3, 5, 7, and 14, there was no significant change in the blood supply score of tissue flaps of patients in the two groups, and there was no statistically significant difference between the two groups (P>0.05). At 12 months after surgery, the satisfaction ratio of patients in DIEP flap group with tissue flap repair efficacy was 8/9, which was close to 7/8 in MS-TRAM flap group (P>0.05). The preoperative abdominal wall strength of patients between the two groups was similar (P>0.05), while the abdominal wall strength of patients in DIEP flap group was significantly stronger than that in MS-TRAM flap group at 3 and 12 months after surgery (with t values of 3.09 and 3.02, respectively, P<0.05). Compared with the preoperative strength within each group, the abdominal wall strength of patients in DIEP flap group at 3 months after surgery and in MS-TRAM flap group at 3 and 12 months after surgery decreased significantly (with t values of 6.04, 9.71, and 2.91, respectively, P<0.05), which did not change significantly in DIEP flap group at 12 months after surgery (P>0.05). At 12 months after surgery, the scores of abdominal scars, degree of abdominal symmetry, the appearance and restoration of umbilicus, abdominal protrusion during dressing, and formation of folds on both sides of the abdomen of patients were similar between the two groups (P>0.05). Conclusions: Free transplantation of DIEP flap and MS-TRAM flap to repair the extensive skin and soft tissue defects in the limbs can achieve good repair results, including good blood supply of tissue flap and abdominal shape, and the patients' high degree of satisfaction with the efficacy of tissue flap repair. However, DIEP flap is superior to MS-TRAM flap in terms of long-term postoperative abdominal wall strength recovery, showing a broader prospect of application.

Comparative evaluation of nasolabial flap and buccal fat pad flap in the surgical management of oral submucous fibrosis: a systematic review and meta-analysis.

Oral submucous fibrosis (OSMF) is a chronic, potentially malignant condition affecting any part of the oral cavity and is prevalent in Southeast Asia and the Indian subcontinent. The aim of this study is to compare the efficacy of buccal fat pad flap with the nasolabial flap in the management of OSMF. We systematically compared two commonly used constructive techniques in the management of OSMF: the buccal pad of fat flap and the nasolabial flap. We performed a comprehensive search in four databases for all articles published between 1982 and November 2021. We assessed the risk of bias using the Cochrane Handbook and Newcastle-Ottawa Scale. We used the mean difference (MD) for pooling the data with 95% confidence intervals (CIs) and evaluated the heterogeneity between pooled studies using χ2 and I2 tests. Out of 917 studies, six were included in this review. The meta-analysis significantly favored conventional nasolabial flap over buccal fat pad flap in improving the maximal mouth opening (MD, - 2.52; 95% CI, - 4.44 to - 0.60; P = 0.01; I2 = 0%) after OSMF reconstructive surgery. Conversely, when it comes to esthetic outcomes, these studies favored buccal fat pad flap. Our meta-analysis found that nasolabial flap was better than buccal fat pad flap in terms of mouth opening restoration after OSMF reconstructive surgery. Also, the included studies found better results, favoring nasolabial flap over buccal fat pad flap in terms of oral commissural width restoration. Also, these studies reported better outcomes in terms of esthetics, favoring buccal fat pad flap. Further studies with larger sample sizes and different populations/races are needed to confirm our findings.

Comparison between Partial Newmann Flap Versus Modified Partial Newmann Flap in Mandibular Third Molar Surgery

Aim: To compare the outcomes of two different flap techniques, namely the Partial Newmann Flap (FNP) and the Modified Partial Newmann Flap (MPNF), in surgical extraction of mandibular third molars. Methods: This randomised clinical study included 186 participants, 93 each group. The research comprised male and female patients aged 20–45 with lower mesioangular impacted third molar till 18–21. Patients with vertically impacted wisdom teeth, disto-angular impaction, horizontal impaction, pregnancy, trismus, pericoronitis, and oral submucous fibrosis were excluded. The student t-test compared mouth opening across groups, whereas the chi-square test compared discomfort and edoema. Results: The mean age of the participants was 32.17±8.30 years. On the first day, the MPNF group reported significantly less moderate pain (34.41%) compared to the NPF group (56.99%) (p=0.001). On the third day, the MPNF group reported significantly more mild pain (55.91%) and less severe pain (1.08%) compared to the NPF group, which reported less mild pain (49.46%) and more severe pain (7.53%) (p=0.028). Similarly, mouth opening was significantly higher in the MPNF group than the NPF group on the 1st, 3rd, and 7th day. Swelling was significantly less in the MPNF group than the NPF group on the 1st and 3rd day. Conclusion: The Modified Partial Newmann Flap may be a better alternative compared to the Partial Newmann Flap in terms of pain, swelling, and mouth opening during the disimpaction of lower third molars. Keywords: Partial Newmann Flap, Modified Partial Newmann Flap, Mandibular Third Molar

Efficacy of platysma flap in oral submucous fibrosis: Preliminary study

: Efficacy of platysma flap in terms of esthetics, function (mouth opening) &amp; postoperative compliance of the patient.: Eight cases are included, seven men and one women, 40 - 50 years old, after resection of fibrous bands. All of them were reconstructed with a platysmaflap.No local complications occurred with this technique. Overall aesthetic and functional results were acceptable in all the patients. Of 8 patients, six had no postoperative complications. The remaining two developed venous congestion, with limited skin loss. All flaps remained viable. The platysma flap is a good method to reconstruct buccal mucosa after resection of bands in oral submucous fibrosis. It is a versatile, portable, and thin flap, is easy to perform with a primary closure of the donor site.

Utility of Single-Stage Nasolabial Flap Reconstruction for Oral Cavity Defects Following Surgery for Oral Cancers and Premalignant Lesions: A Clinical Audit.

An inferiorly based nasolabial flap (NLF) is a versatile flap for various oral cavity defects. However, it generally necessitates a second stage procedure to release the base at 3weeks following the initial surgery. Reconstruction for oral cavity defects can be done with the inferiorly based nasolabial flap as a single-stage procedure. In this retrospective clinical audit, we analyzed patients who underwent an inferiorly based NLF reconstruction for oral cavity defect from January 2016 to September 2021. We analyzed the various defects for which this flap was used along with the associated complications and the safety of performing this flap in terms of its flap-related complications and the histopathological features such as margins. Forty-four patients underwent this inferiorly based single-stage NLF. The median age of the patients in the cohort was 56years, with the majority being men (n = 38, 86.4%). Buccal mucosa and lip were the most common sites of the primary. Twenty-nine patients were per primam and 15 were recurrent cancers. Most had T1 (n = 14, 31.8%) and T2 (n = 19, 43.2%) cancers. The median closest margin was 6mm and the base was 7mm. There were no flap losses; however, 6 patients had minor wound breakdown for which secondary suturing was needed. Single-stage NLF is a safe flap that could be considered in select patients for appropriate oral cavity defects.

Use of a Fibula Free Flap for Mandibular Reconstruction in Severe Craniofacial Microsomia in Children with Obstructive Sleep Apnea.

This is a retrospective study describing a multi-stage protocol for the management of severe mandibular hypoplasia in craniofacial microsomia (CFM) with accompanying obstructive sleep apnea (OSA). Patients with severe mandibular hypoplasia require reconstruction functionality and esthetical features. In the cohort, reconstructions based on free fibular flaps (FFF) may be the most effective way. Patients aged 4-17 years with severe mandibular hypoplasia were treated with FFF, which initially improved the respiratory function assessed on polysomnography (AHI). In the next stages of treatment of cases with respiratory deterioration, it was indicated to perform distraction osteogenesis (DO) of the mandible and the structures reconstructed with FFF. All surgeries were planned in accordance with virtual surgery planning VSP. The aim of the study was to prospectively assess the effectiveness of multi-stage mandibular reconstruction in craniofacial microsomia with the use of a free fibula flap in terms of improving respiratory failure due to obstructive sleep apnea (OSA). The FFF reconstruction method, performed with virtual surgical planning (VSP), is proving to be an effective alternative to traditional methods of mandibular reconstruction in patients with severe CFM with OSA.

Comparison of the free thinned anterolateral thigh perforator flap and the free medial sural artery perforator flap for reconstructing head, neck and extremity defects

BACKGROUNDThe free anterolateral thigh (ALTP) and free medial sural artery perforator (MSAP) flaps are time tested donor for head and neck, and extremities defect reconstruction. Proponents of either flap have concluded each as workhorse flap in their large cohort studies. However, we could not find any literature comparing the donor morbidities, or recipient site outcomes of these flaps, objectively.METHODSRetrospective data, such as demographic details, flap characteristics and post operative course, from patients who underwent free thinned ALTP (25 patients) and MSAP flap (20 patients) were included. At follow-up, donor site morbidity and recipient site outcomes were assessed, using previously defined protocols. These were compared in-between the two groups. RESULTSFree thinned ALTP (tALTP) flap had significantly more pedicle length and vessel diameter and harvest time than free MSAP flap (p value&lt;.00). The differences in incidence of hyperpigmentation, itching, hypertrophic scar, numbness, sensory impairment and cold intolerance at the donor site in-between the two groups, were not significant statistically. Scar at free MSAP donor site was considered a significant social stigma (p value=.005). Recipient site cosmetic outcome was comparable (p value=.86), measured using aesthetic numeric analogue.CONCLUSIONSThe free tALTP flap is superior to free MSAP flap in terms of pedicle length, vessel diameter, donor site morbidity, while the latter takes lesser time for harvest.

Comparison of Pedicled Adductor Longus and Pedicled Sartorius Flap in Inguinal Reconstruction, a Fresh Cadaver Study.

Reconstruction surgeries in the inguinal area are challenging for vascular surgeons, oncologists, orthopedists, and others. The pedicled sartorius flap is the most commonly used flap for reconstruction. The pedicled adductor longus is reported as a new method to reconstruct the inguinal region. The related anatomic study is rare. This work aims to make a comparison of pedicled adductor longus and pedicled sartorius on cadavers for better use. Out of the 12 thighs in the 6 cadavers analyzed, the author compares two surgical methods in terms of surgical details, exposure of vascular and nerve pedicle, flap harvesting, flap transposition and flap volume, etc. Through the course of this study, it is showed that the adductor longus flap had a sizable advantage over the sartorius flap in terms of exposure, harvesting, and flap volume.

Low Donor Site Morbidity Supports the Use of Infraumbilical Flaps for Head and Neck Reconstruction: A Retrospective Cohort Study

Background: Currently, the standard design of the skin component of abdominal soft-tissue flaps recommended for head and neck reconstruction encompasses the upper and lower periumbilical region to include the maximum number of myocutaneous perforators. Yet, this flap design precludes the harvest of bilateral flaps and the use of the contralateral area in case of flap failure. Aim: We aimed at proving the long-term safety of infraumbilical abdominal free flaps in terms of abdominal wall integrity. Methods: Consecutive subjects who underwent reconstruction of composite cervico-facial defects with infraumbilical free flaps between 2008 - 2020 were enrolled. After surgery, patients were followed up at three-month intervals to evaluate the incidence of any complications at the donor site. Results: 25 patients underwent reconstruction with free flaps from the lower abdomen. A total of 35 abdominal flaps were performed; ten patients underwent bilateral flap harvest. Marginal abdominal skin necrosis occurred in 3 patients. Abdominal bulge occurred in one case; neither hernia nor abdominal wall weakness was encountered at a median follow-up of 12 months. Conclusions: The infraumbilical region is a safe donor area of free flaps for head and neck reconstruction that preserves abdominal wall firmness and provides a satisfactory cosmetic result at the donor site.

The Effect Of Small Bone Window Craniotomy Removal on Lactic Acid and CRP in Patients with Hypertensive Intracerebral Hemorrhage in the Basal Ganglia.

Hypertensive intracerebral hemorrhage (HICH) seriously endangers the quality of life of patients and can even lead to death. Craniotomy is a common treatment method for HICH. The aim of this study was to investigate the efficacy of two different sizes of craniotomy in patients with HICH, as well as to evaluate their effects on C-reactive protein (CRP) and blood lactate levels. A total of 72 patients with HICH in the basal ganglia were operated on in our hospital from February 2017 to March 2019 and randomly divided into two groups: the small bone window (SBW) group (n = 37) and the large bone flap group (n = 35). The curative effects of the two kinds of operations were evaluated by the length of operation, the days of hospitalization, the rate of hematoma clearance, the rate of rebleeding, and the incidence of complications. Additionally, the levels of CRP and lactate were compared between the two groups. The results showed that the average intraoperative time, hospital stay, rebleeding rate, and postoperative complications of patients in the SBW group were less than those in the large bone flap group. Moreover, the number of patients in the SBW group with good postoperative recovery, including class V and class IV, was higher than that in the large bone flap group. Minimally invasive craniotomy with SBW reduced the lactic acid and CRP levels more quickly than the large bone flap group. An SBW was superior to a large bone flap in terms of the operative effect and lactate and CRP levels. It is concluded that an SBW has significant advantages over a large bone flap.

Comparison of “complications” and functional outcome of anterolateral thigh flap and sural neurofasciocutaneus flap for foot and ankle reconstruction: A single center cohort study

BackgroundSkin and soft-tissue defects around the foot and ankle remain a challenge for orthopedic and plastic surgeons. Anterolateral thigh (ALT) flap and sural neurofasciocutaneous (NFC) flap are both used to reconstruct lower-extremity soft-tissue defects. The purpose of this study was to compare outcomes of the two flaps and attempt to provide an optimal strategy. MethodsA retrospective study was conducted, reviewing data from 93 patients who underwent reconstruction of wounds around the foot and ankle with ALT flap (42 cases) or NFC flap (51 cases) from January 2014 to January 2020. Patients’ demographics, characteristics of the defect, complications, cosmetic appearance, and functional outcome were analyzed, and statistical analysis was performed. ResultThere was no difference in gender and etiology; however, NFC flaps were more frequently used in elderly patients. Mean size of the flap in the ALT group was significantly larger in comparison with the NFC group. The ALT group had longer operation and hospitalization time than the NFC group (P < 0.05). The incidence of partial necrosis in ALT group was significantly lower than that in NFC group, while its general complications rate was higher. In long-term follow-up, esthetic appearance of the reconstructed site was comparable in both groups, the ALT group had a higher ratio of revision surgery. Moreover, the ALT group showed better overall esthetic outcomes in the donor site. ConclusionsThe study showed that anterolateral thigh flaps in wound coverage of foot and ankle achieved better outcomes than neurofasciocutaneous flaps in terms of recipient benefits and donor-site compromise with a special indication for larger and more distally located defects.

Morbidity of the Donor Site and Complication Rates of Breast Reconstruction with Autologous Abdominal Flaps: A Systematic Review and Meta-Analysis

Background Numerous studies have evaluated the use of autologous abdominal tissue for breast reconstruction; nevertheless, complications and donor site morbidity rates vary significantly. The study aims to compare the literature regarding morbidity of the donor site and complication rates of breast reconstruction with autologous abdominal flaps. Methods The databases of MEDLINE, EBSCO, Scopus, Wiley Library, and Web of Sciences were searched for studies that compared different flaps in terms of complications and donor site morbidity. The procedures studied included pedicled transverse rectus abdominis myocutaneous flap (pTRAM), free TRAM (fTRAM), deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery perforator (SIEA) flaps. A total of 34 studies were included. Of these, 28 were retrospective studies and 9 were prospective cohort studies. Results When compared to DIEP, fTRAM flaps were found to have a decreased incidence of flap fat necrosis, hematoma, and total thrombotic events, yet a higher risk of donor site hernia/bulging. pTRAM flaps were also associated with an increased risk of hernia/bulging at the donor site, as well as wound infection, yet flap hematoma was less common. On the other hand, SIEA flaps showed the lowest risk of donor site hernia/bulging while still having a high risk of wound infection. Conclusion fTRAM procedures comparatively had the least complications. However, regarding flap choice, patients would benefit most from a case-by-case analysis, taking into consideration individual risk factors and preferences.

Long-Term Donor Site Morbidity and Flap Perfusion Following Radial versus Ulnar Forearm Free Flap-A Randomized Controlled Prospective Clinical Trial.

This clinical prospective randomized controlled study aimed to investigate the differences between Radial (RFFF) and Ulnar (UFFF) Forearm Free Flap in terms of success, performance, and donor site morbidity. Thirty patients with reconstruction of the head and neck region were included. For the first time, this study assessed flap-perfusion characteristics, donor-site-wound-healing dynamics and hand perfusion using hyperspectral imaging. Further, subjective (Likert-scale, DASH-score) and objective (grip/pinch-strength) parameters of donor site morbidity were analysed. Postoperative follow-up was performed until 6 months after index surgery. With 100% of patients, RFFF and UFFF were equally successful. Compared to surrounding reference, UFFF revealed significant lower tissue oxygenation saturation (StO2) than RFFF. Compared with UFFF, blood flow in both the thenar and hypothenar region were significantly reduced 6 months following RFFF transfer. After four weeks, 27% more patients demonstrated impaired wound healing following RFFF transfer. After 6 months, epithelial-surface continuity was restored in all patients of both groups. After 6 months, overall rates of both subjective and objective donor site morbidity were comparable between RFFF and UFFF. RFFF and UFFF both demonstrate similar success rates and HSI-perfusion dynamics following transfer. After 4 weeks, wound-healing disorder appeared significantly more often in RFFF than in UFFF; however, they became equal after 6 months. RFFF and UFFF can be considered as mutual alternatives.

Dual-Perforator Flap With Wide Pedicle Versus Sural Neurocutaneous Flap With Peroneal Artery Perforator in the Treatment of Soft Tissue Defects of Foot and Ankle

How to deal with large soft tissue defects around the foot and ankle is still controversial. The aim of this study was: (1) to display a new pedicled flap, also named the dual-perforator flap with wide pedicle (DPFWP), and (2) to compare it with the sural neurovascular flap with peroneal artery perforator (SNFPAP) in foot and ankle reconstruction. According to different surgical methods, 82 patients were divided into 2 groups: the DPFWP group (42 cases) and the SNFPAP group (40 cases). All cases underwent a flap surgery after radical debridement. The 2 groups were homogeneous in terms of age, sex, body mass index (BMI), etiology, location, and follow-up duration. Operation indexes were compared, including flap length, flap width, operation time and blood loss. Complications, cosmetic appearance, and functional outcome were analyzed, and statistical analysis was performed. The DPFWP group had larger flap length (24.5 ± 4.6 cm vs 16.3 ± 3.8 cm), and flap width (10.5 ± 2.7 cm vs 7.8 ± 1.7 cm) than the SNFPAP group. In postoperative follow-up, DPFWP group showed a lower complication rate and better cosmetic, functional outcomes than SNFPAP group. In conclusion, this study showed that a DPFWP flap brought better results than a SNFPAP flap in terms of complications, cosmetic appearance, and functional outcomes for patients undergoing reconstruction of foot and ankle defects.

Efficacy of pedicled anterolateral thigh flap for reconstruction of regional defects - a record analysis.

The anterolateral thigh (ALT) flap was described as the fasciocutaneous flap. It can be harvested as apedicled and/orfree flap. Majority of the free flaps are harvested as afasciocutaneous flap. Their use in head and neck reconstruction and limb trauma is well established. Apart from these advantages, this flap has various applications which are less utilized. ALT flap can be used as amyocutaneous flap along with vastus lateralis muscle. When muscle and fasciocutaneous flaps are required, both can be harvested as achimeric flap which can cover two different regions of the wound. Moreover, harvest of the pedicled flap procedure is less time-consuming than that of afree flap. Since it has along vascular pedicle, when used as pedicled flap, it can reach up to the gluteal region. To evaluate these less applied advantages of pedicled ALT flap, our study was undertaken. This study aimed to evaluate the efficiency of ALT flap in terms of the surface area of coverage, arc of rotation and the advantages of including vastus lateralis muscle as part of the flap. Aretrospective record analysis of all pedicled ALT flap reconstruction of trochanteric, upper thigh, gluteal and flank regions from 2016 to 2018 was undertaken; 7 patients with 8 defects were included. All the flaps healed successfully. There was no major necrosis of the flap and minor complications like wound gapping were found in three patients. The ALT-vastus lateralis flap dimensions can be very large and can be easily harvested in avery short time. Vastus lateralis muscle harvested can be used to fill the defect or can be used as chimera to cover the defect. The use of muscle over long standing infective pressure sores can sterilize the wound bed and help in preventing recurrence. The vascularity of this flap is robust and highly reliable. Even after amaximum arc of rotation (up to 170°) all the flaps survived without any major complications.

Quantification and Further Refinement of Lateral Calcaneal Artery Flap for Complicated Heel Defect Reconstruction.

Background:Reconstruction of posterior heel defects requires tissues with adequate blood supply, good elasticity, and sensate; because of the traumatic origin in the young population, it ends up with morbidity. The lateral calcaneal artery is the arterial supply of the lateral calcaneal artery flap. This is one of the viable choices for coverage of hind foot soft-tissue defects. The objective of this study was to determine the outcome of the lateral calcaneal artery flap in terms of function, donor site morbidity, and duration of surgery.Method:This was a descriptive case series. Patients with complicated heel defects of small to medium size were included. The follow-up period was 6 months to 1 year of posttreatment. Outcome measures were noted and assessed in all patients in terms of function, donor area morbidity, and total duration of surgery. Significance was determined by assessing the gait, donor site pain, physical appearance at the surgical site, and time needed for surgery.Results:Twelve patients [men: eight (62.5%), women: four (37.5%)] were selected for this study, with their mean age being 14.4 ± 7.4 years. Mean defect size was (4.4 ± 0.5) cm. Mean flap size was 3.5–5.5 cm (P < 0.001). There was a near-normal gait in all patients, with a pain score of (0–2) on the visual analogue scale score, physical appearance by Vancouver scar scale score (0–3), and the mean duration of surgery was 45 ± 4.5 minutes.Conclusion:The lateral calcaneal artery flap is more effective for reconstruction of posterior heel and tendon Achilles defects in terms of function, donor area morbidity, and duration of surgery.

Safety and efficacy of anterior intercostal artery perforator flaps in oncoplastic breast reconstruction.

Partial breast reconstruction based on the anterior intercostal artery perforators (AICAP) has been suggested to avoid the unsightly 'bird's beak' deformity for lower pole breast cancers. The aims of this study were to evaluate the initial clinical experience of AICAP flaps in terms of safety and efficacy in oncoplastic breast reconstruction. Between October 2013 and April 2020, AICAP flaps were offered to 30 patients with lower pole breast cancers. Hand-held Acoustic Doppler assessments were undertaken to confirm adequate perforators. Surgical results were evaluated in terms of safety and efficacy. Patients were invited to complete sections of the Breast-Q questionnaire at least 12 months postoperatively to assess patient satisfaction in terms of cosmetic outcome, physical and psychosocial wellbeing. Median operating theatre time for AICAP flap harvesting and positioning was 20 min (range 15-28 min). The median weight of resected breast specimens was 41 g (range 10-127 g). Total tumour size ranged from 7 to 35 mm (median 16 mm; three cases exhibited multifocal disease). Clear radial resection margins were achieved in 29 cases (96.7%). The median post-operative stay was two days (range 2-3 days). There were two postoperative complications comprising delayed wound healing/fat necrosis, which resolved with monitoring and inadine dressings. Based on the Breast-Q results, patients reported high levels of satisfaction with the physical appearance of their reconstructed breast, psychosocial and physical wellbeing. AICAP flaps appear to be safe in restoring breast contour after wide excision of lower pole breast cancers, with high levels of patient satisfaction reported postoperatively.

The Rectus Abdominis Perforator Turndown Flap for Preserving Rectus Continuity: A DIEP Alternative?

Background:The deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction has been popularized over the transverse rectus abdominis myocutaneous (TRAM) flap, as it spares rectus abdominis muscle and has low donor site morbidity. This progression to muscle preservation, however, has been associated with an increased difficulty in vascular dissection, perfusion-related complications, and lengthier surgical times. We pilot a technique that may achieve the benefits of the TRAM flap in terms of ease of dissection and vascularity, with the benefits of the DIEP flap in terms of maintaining rectus abdominis continuity.Methods:A cohort of six consecutive patients underwent a free TRAM flap for reconstructive surgery. All patients underwent a segmental, periumbilical harvest of rectus abdominis muscle as part of flap design, and the segmental defect was reconstructed with an innervated rectus abdominis perforator turndown (RAPT) flap harvested supraumbilically. Postoperative assessment of rectus continuity was performed clinically, with muscle electromyography and ultrasound.Results:In all six cases, there was successful TRAM flap transfer, with no flap-related complications. Rectus abdominis muscle reconstruction with the RAPT flap was achieved, with continuity and function of the rectus muscle confirmed.Conclusions:We describe the innervated RAPT flap for reconstitution of rectus continuity after TRAM flap harvest. This technique may achieve the benefits of the TRAM flap in terms of ease of dissection and flap vascularity, and the benefits of the DIEP flap in terms of maintaining rectus abdominis continuity.