Flap Method Research Articles

A New Method of Orbital Septal Fat Flap in Transconjunctival Approach

A New Method of Orbital Septal Fat Flap in Transconjunctival Approach

Clinical comparison study of square flap method and five-flap Z-plasty technique for correction of post-burn axillary contractures: Analysis of length gain and evaluation of functional outcome

IntroductionWhile there is no consensus on the best surgical procedure for post-burn axillary contractures, it is crucial to consider the elongation rate along the scar axis as a useful measurement index for determining the optimal surgical approach. The square flap and five flap z-plasty techniques are commonly employed scar lengthening procedures to address scar contractures in the axilla. These approaches successfully disrupt the linear scar, leading to significant elongation while reducing transverse tension. Our study aims to compare the increase in band length and functional results of these two approaches for treating post-burn contractures in the axilla. MethodsA retrospective study was carried out utilizing data from 34 patients with mild-to-moderate band-like contractures located on the anterior or posterior axillary lines who underwent surgical correction through either the square flap method or five-flap z-plasty technique. The effectiveness of surgical methods was evaluated using two objective indices: improvement in contracture band length and improvement in abduction angle at the shoulder joint. ResultsAll patients achieved complete contracture release. There is no statistically significant difference between the two groups regarding the improvement in the degree of abduction postoperatively. Although there was a significant increase in the length of the contracture band postoperatively in both groups, the average increase in length for cases treated with a square flap was significantly greater than those managed with a five-flap Z-plasty (87.7 ± 44.8 % vs. 38.80 ± 11.119 %,) respectively. ConclusionThe square flap technique is considered a better alternative to the commonly used 5-flap Z-plasty method because it can achieve higher elongation in the contracture band, restore joint function, and create optimal shape when dealing with single linear band contractures over the axilla.

Effectiveness of vacuum-assisted wound closure and mesh-mediated fascial traction in open abdomen management.

To determine the effectiveness of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in patients undergoing open abdomen management (OAM). Data from cases with OAM for at least five days who were admitted to our institution between January 2011 and December 2020 were included. We compared the patient's age, sex, medical history, indication for initial surgery, APACHE II scores, indication for OAM, operative time, intraoperative blood loss, intraoperative transfusion, success of primary fascial closure (rectus fascial closure and bilateral anterior rectus abdominis sheath turnover flap method), success of planned ventral hernia, duration of OAM, and in-hospital mortality between patients undergoing VAWCM (VAWCM cases, n = 27) and vacuum-assisted wound closure (VAWC) alone (VAWC cases, n = 25). VAWCM cases had a significantly higher success rate of primary fascial closure (70% vs. 36%, p = 0.030) and lower in-hospital mortality (26% vs. 72%, p = 0.002) than VAWC cases. A multivariate logistic regression analysis showed that VAWCM was an independent factor influencing in-hospital mortality (odds ratio, 0.14; 95% confidence interval: 0.04-0.53; p = 0.004). VAWCM is associated with an increased rate of successful primary fascial closure and may reduce in-hospital mortality.

Intraoperative Puncture of the Retina. Clinical Case

Clinical case present of a complication of retrobulbar anesthesia and a method of its treatment in the practice of a vitreoretinal surgeon. A technique for closing a retinal defect caused by a needle puncture during retrobulbar anesthesia with a flap of the internal limiting membrane is presented. Stages of the operation: A vitrectomy was performed in full, with the closure of the macular hole using the inverted flap method and punctures of the retina with the inner boundary membrane, previously stained with the Vitreocontrast suspension, were detected. The operation was completed by successive replacement of physiological saline with a gas­air mixture 20% С3F8 (3 ml). As a result of successful surgical treatment, the macular hole and retinal punctures were closed with an internal limiting membrane.

Comparison of postoperative topical interferon-α2b versus intraoperative mitomycin C for pterygium recurrence prevention: a randomized clinical trial.

To evaluate the effect of postoperative interferon-alpha 2b (IFN-α2b) ophthalmic drops versus intraoperative mitomycin-c (MMC) on preventing pterygium recurrence. This prospective randomized clinical trial was conducted on patients who were candidates for pterygium surgery. A total of 75 patients were included in the study from December 2021 to December 2022, of which 64 patients (one eye each) were examined and analyzed based on the inclusion criteria. Then the patients were randomly assigned to control groups, intra-operative MMC (32 patients) and the intervention group, IFN-α2b drops after the operation (32 patients). All patients underwent pterygium surgery using the rotational conjunctival flap method. In terms of pterygium grading, 8 (12.5%), 25 (39.06%), and 31 (48.44%) eyes were in grades 1, 2, and 3, respectively. The average size of the pterygium was 3.6 ± 0.7mm. The grade and size of pterygium had the same distribution in the two groups. There was no statistically significant difference between the two groups in the level of post-operative clinical inflammation. The present study showed no significant difference in complications between the two groups (p = 0.999). The recurrence rate in the control group was 9.4% (3 eyes), and 0% (no recurrence) in the intervention group (p = 0.119). interferon-alpha 2b group did not show a statistically significant difference in preventing pterygium recurrence compared to the mitomycin C group. The post-surgery administration of IFN-α 2b drops can effectively prevent pterygium recurrence with a comparable and even more compelling effect than MMC during surgery.

Treatment of gum recession by the method of a coronally displaced flap and application of phytoextract

BACKGROUND: Owing to the widespread prevalence of gum recession in the morbidity structure of the population, the search for optimal treatment tactics for patients with this pathology is crucial in dentistry. AIM: To evaluate the effectiveness of treatment of patients with gum recession using the coronally displaced flap method and application of a phytoextract. MATERIALS AND METHODS: Overall, 123 patients diagnosed with gum recession were clinically examined. During examination, all patients revealed a defect such as exposed roots in the area of the frontal group of teeth. Moreover, the size of the defect was measured, and the Miller class was determined. Then, complex treatment was performed, including conservative treatment and, if required, surgical intervention, as well as orthopedic treatment. RESULTS: In the surgical treatment of gum recession, flap operations were performed. On postoperative day 2, to achieve the best healing and regeneration of the gums, a phytoextract was applied. Over a 3-year period after treatment of patients with gum recession, the effectiveness of treatment was monitored, and relapses of the disease were detected. The following complications were identified after treatment of patients diagnosed with gum recession: transition from class I to II to Miller, 15% of cases; class II to III according to Miller, 19.5%; temporomandibular joint diseases during recession, 16.5%; and occlusal deformation during recession, 19.8%. Stabilization in class I recession occurred in 45.0% of patients, class II in 33.4%, and class III in 8.5%. CONCLUSION: The etiology and pathogenesis of gum recession requires long term treatment and observation and early diagnosis and an integrated approach. Therefore, new treatment methods that will be most effective and can be used in all age groups are required. One of these methods is the method developed by the authors for the treatment of gum recession using a coronally displaced flap and the application of a phytoextract, which has shown high effectiveness in the long term.

Reverse circumcision foreskin advancement flap for reconstructing penile shaft skin defects in adults with burn injuries in the perineal region

AimGenital burns are rare injuries. Reconstruction of penile skin defects should consider cosmetic and functional outcomes. Skin grafts can develop scar contractures and carry hair follicles, causing unwanted results. These downsides remain unsolved issues. This work aimed to describe a new foreskin advancement flap method for completely reconstructing penile shaft skin defects in severely burned patients. Materials and methodsFrom 2021 to 2023, four patients with third-degree burns in the genital area were enrolled in this investigation. We describe a series of cases with deep burns to the penile shaft and surrounding area that needed debridement and reconstruction using a novel technique called “reverse circumcision,” which consists of tangential excision of the penis and a foreskin advancement flap without longitudinal cuts with less morbidity, preservation of function, and a better aesthetic appearance. The patients had an average follow-up of nine months. ResultsThe reverse circumcision technique was established for patients with severe burns in the genital area. The four patients were satisfied with the postoperative results and the aesthetic results of the procedure without reporting any complications. No scarring or contractures were observed on the glans or penile shaft after surgery. ConclusionsCompared with other flap methods, the use of a reverse circumcision foreskin advancement flap was more straightforward, feasible, and effective. In adults, the foreskin tissue completely covers the penile shaft skin defect. It is a viable reconstructive surgical technique that is easily reproducible and has excellent aesthetic and functional results. For this surgical technique, tissue transfers, bulky regional flaps, or skin grafts were not needed.

Excision of basocellular carcinoma in the face with the rieger flap and A-T flap methods: a narrative review

Excision of basocellular carcinoma in the face with the rieger flap and A-T flap methods: a narrative review

PERANCANGAN TATA LETAK RELOKASI LANTAI PRODUKSI DENGAN METODE SYSTEMATIC LAYOUT PLANNING, BLOCPLAN, DAN FLAP

In the development of the industrial revolution 4.0, in carrying out production at small, medium, and large levels, there has been a fairly large and significant increase. Factors that influence the goal of successful production are not only about investment, capital, suppliers, machines, skills, and distributors but also one that must be observed is the layout planning and placement of factory facilities. PT. Eworx Indonesia is a company engaged in the processing industry, especially manufacturing in the metal processing sector. PT. Eworx Indonesia intends to relocate the production floor in order to increase production productivity. In this study, the proposed layout design on the new production floor was carried out using the SLP, Blocplan, and FLAP methods. The design is done by collecting direct observation data and interviews with the operator on duty. It was found that the initial layout had problems with operator movement that was not optimal and the placement of several machines and facilities that did not pay attention to material flow resulting in a slowdown in production time. Therefore, in order to get the best layout, a comparison is made on the results of the three alternative layouts with the smallest displacement distance comparison so that the production process will run more optimally. The best proposed layout is the systematic layout planning (SLP) method with the smallest material displacement distance of 147.4 meters and material handling costs Rp. 223,958 per day. Flexsim simulations show this layout can increase production output by 15%-34%.

Myomucosal composite graft: A simple technique for full-thickness vermilion defects of the lower lip.

Reconstruction of vermillion defects of the lower lip requires careful consideration of functional and aesthetic aspects. Traditionally, various local flap methods involving tissue advancement from the corner of the mouth, lateral chin, and medial cheek have been commonly employed to fill lower lip defects. However, these approaches have inherent limitations, which include technical complexity, disruption of the orbicularis oris muscle, lip tightening, microstomia, and visible scarring. To overcome these limitations, we employed a free myomucosal composite graft from the lower lip to reconstruct small to medium vermilion defects. Our technique is based on a simple and reproducible surgical approach that facilitates natural volume rearrangement of tissues. Moreover, this method enables precise inset and tension-free repair, prevents lip tightening, and offers excellent aesthetic outcomes with no vertical scarring and appropriate color matching with surrounding tissues.

Closure of Full-thickness Macular Hole after Pars Plana Vitrectomy (23G) with Cataract Phacoemulsification, Artificial Intraocular Lens Implantation, and Silicone Oil Administration Due to Rhegmatogenous Retinal Detachment in the Right Eye in a 67-year-old Patient – a Case Report

Macular holes pose a significant threat to central vision, necessitating precise diagnosis and intervention with an occurrence of 1 per 1000 patients over the age of 55. This manuscript presents a case study of a 66-year-old man with a retinal detachment in the right eye and full-wall macular hole. The patient underwent a multi-step surgical intervention involving pars plana vitrectomy, internal limiting membrane peeling with silicone oil tamponade, retinal endophotocoagulation, and administration and removal of the perfluorocarbon liquid DK-line in the first step. The second stage of treatment comprised silicone oil removal via posterior access vitrectomy, injection of 25% SF6 into the right eye, and treatment of intraoperatively found macular hole with an inverted flap method. The case underscores the association between macular hole and rhegmatogenous retinal detachment, with potential iatrogenic causes during vitrectomy. The inverted internal limiting membrane flap technique emerged as a superior strategy for managing full-thickness macular holes, demonstrating high closure rates and improved visual acuity postoperatively. This case study contributes to the evolving understanding of macular hole pathogenesis and reinforces the significance of tailored surgical approaches for optimal patient outcomes.

‘’Comparative outcome study between simple closure and flap technique in Pilonidal sinus disease’’

I have read the interesting article ‘’Comparative outcome study between simple closure and flap technique in Pilonidal sinus disease’’ by Dr. Ram Magar and Dr. Rupali Magar published in your journal on 15th March 2022. According to this valuable study; Limberg flap method has has been found to have better outcome with less wound infection, wound disruption, postoperative discharge and recurrence rate compared to simple closure group. And as stated, it is safe and easy procedure. So it is recommended that Limberg flap method should be used in the treatment of pilonidal sinus disease over other modalities.[1]
 In our 767 patients study group results, we had recommended Limberg Flap Repair Technique for surgical treatment of pilonidal sinus disease. This technique had an acceptable “short” ‘Return to Work Outcome’ when compared with open techniques. Also had the smallest postoperative infection rate and low recurrence rate.
 Still in our daily surgical practice, earlier healing, shorter return to work, lower rates of infection and recurrence are the major factors that make us to use Limberg Flap Repair Technique mostly. Moreover, it is easy, fast, and practical to apply.[2]

Cross-leg flaps: A nonmicrosurgical alternative treatment method in complex lower extremity trauma reconstruction.

This study aimed to present our experiences with cross-leg flap surgery, which demonstrates successful outcomes in lower limb soft tissue defects without the necessity of microsurgical intervention. The retrospective study included 26 patients (18 males, 8 females; mean age: 35.6±12.2 years; range, 18 to 65 years) between January 2015 and September 2019. A fasciocutaneous cross-leg flap was applied to the recipient extremity, and the extremities were immobilized by a tubular external fixator. Flap divisions were performed on the 21st postoperative day. At least two years of clinical outcomes were presented. Twenty-five flaps survived and recovered completely without any complication at the donor site, flaps, or the recipient area. In one diabetic patient, partial flap loss was encountered, which granulated with secondary healing. All patients demonstrated stable wound coverage, with none demanding additional soft tissue surgeries. All patients resumed normal ambulation and physical activity without any residual joint stiffness. Cross-leg flap method is an effective and respectable option for extremity salvage as a good alternative to free flaps for the management of traumatic complex lower limb defects. This method is simple, provides abundant blood supply to the wound, and does not require microsurgical experience or a good working recipient artery.

Perineal hernia repair following tailgut cyst excision: A case report and literature review of optimal management strategies

Perineal hernias, categorised as primary or secondary, pose a clinical challenge necessitating surgical intervention. Herein we present the surgical management of a postoperative perineal hernia of the retrorectal space. A 42-year-old female patient presented to the clinic with symptoms such as perineal discomfort, bulging, and constipation after previous surgical tailgut cyst excision. Diagnosis involved MRI, confirming rectal herniation into the retrorectal space. The surgical approach featured a perineal intervention using a unilateral inferior gluteal flap to reinforce the posterior rectal space, avoiding mesh complications. The patient experienced a successful recovery, highlighting the importance of tailored interventions based on symptoms and complications. Secondary perineal hernias, often postoperative, present diverse challenges influenced by multiple factors such as pelvic surgeries. Surgical repair options include perineal and abdominal approaches, mesh usage, and flap methods, each with variable outcomes. This case study contributes to the evolving understanding of perineal hernias, emphasising the need for multidisciplinary approaches and ongoing research to enhance management strategies in this complex clinical scenario.

Marginal Tension Release Method of Nasoseptal Flap During Reconstruction of Skull Base Defect

The successful reconstruction of anterior skull base defects following transcribriform or transsphenoidal surgery is pivotal in mitigating the communication between the external environment and the cranial cavity. This intervention is crucial to prevent potential complications, including cerebrospinal fluid leakage and meningitis. The ideal reconstructive flap should possess sufficient vascularity and be of ample size to adequately cover vital nerves and vessels. Predominantly, the nasoseptal flap is employed for the repair of skull base defects. This flap is vascularized by the posterior division of the sphenopalatine artery, ensuring sufficient coverage of the defects. A significant advantage of the nasoseptal flap is its rotational capability, allowing for mobilization and repositioning to effectively cover the defect. Nonetheless, the rotational tension on the nasoseptal flap running from the nasal cavity to the skull base may affect the distal margin of the flap. Alleviation of this tension can be achieved through the insertion of multiple minuscule incisions in the vertical axis of the flap’s border. This report introduces and elaborates on this technique.

The Square-Plus Flap: A Modification to Release Long Postburn Scar Contractures.

The square flap method has been successful in releasing contracture bands at various body regions. However, the original square flap method alone may not be efficient in releasing long contracture bands. We, therefore, proposed an extended design to the traditional design, which is called the "square-plus flap." A 4-year-old girl presented with a postburn web-like contracture band over the right axilla. We marked a square flap technique at the center of the contracture band and then two additional Z-plasties were placed on both edges of the flap. After the release and securing of the square flap, the adjacent distal Z-plasty was then transposed and sutured in their new locations. We do not need to incise the proximal Z-plasty as we could achieve complete relaxation of the contracture band. This novel modification can be added to the plastic surgeon's armamentarium for releasing long postburn contracture bands involving distinct body regions.

Intraoesophageal pressure in patients receiving proximal gastrectomy with hinged double flap method for gastric cancer: a retrospective cohort study

Background: Objective functional assessment of esophagogastric anastomosis in patients who underwent proximal gastrectomy with the hinged double flap method for gastric cancer has not been well investigated. This study aimed to perform a functional analysis of reconstruction using high-resolution impedance manometry (HRIM). Materials and methods: The authors enroled 25 patients who underwent proximal gastrectomy for gastric cancer between May 2015 and April 2020 and subsequently underwent HRIM postoperatively. Eligible questionnaires [Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37)] were retrieved from 16 patients. The association between HRIM data and PGSAS-37 was analyzed. Results: The amplitudes of distal oesophageal peristaltic waves, contractile front velocity, and distal latency assessed by HRIM were almost normal after surgery. Most patient’s lower oesophageal sphincter (LES) resting pressure created by the hinged double flap was within normal limits. Conversely, LES residual pressure values during swallowing-induced relaxation were abnormally high in most patients, and the lower the values, the more severe the reflux and diarrhoea symptoms (P=0.038, P=0.041, respectively). In addition, even when the integrated relaxation pressure (IRP) was normal, lower values corresponded to more severe reflux symptoms (P=0.020). The required LES pressure may be higher after proximal gastrectomy because of the relatively higher intragastric pressure due to the reduced volume of the remnant stomach. This also suggests that swallowing-induced relaxation of the LES was considered a trigger for oesophageal reflux in post-proximal gastrectomy patients. Conclusion: LES residual pressure and IRP values in HRIM correlated with reflux symptoms in patients after proximal gastrectomy.

Evaluation of the Effect of the Modified Myocutaneous Flap Method Combined with Orbital Septum Fixation in Blepharoplasty

Objective: To explore the clinical efficacy of modified myocutaneous flap method combined with orbital septum fixation in treating patients with eye bags. Methods: The selected surgical plan divided 60 patients with eye bags into two groups. One group served as the control group and adopted the traditional myocutaneous flap method, while the other group was the observation group that implemented the modified myocutaneous flap method combined with orbital septum fixation. The general clinical observation indicators, treatment effect-related observation indicators, postoperative complication rates, and disease recurrence rates were compared between the two groups. Results: The total treatment time and postoperative recovery time of the observation group were significantly shorter than those of the control group. The degree of postoperative eye bag ptosis and lower eyelid skin wrinkle scores of the observation group were significantly lower than those of the control group. The nasolacrimal groove, skin glossiness, and White Aesthetics Score (WES) of the observation group were significantly higher than those of the control group. The total incidence of complications and disease recurrence rate in the observation group were significantly lower than those in the control group (P < 0.05). Conclusion: The modified myocutaneous flap method combined with orbital septum fixation for patients with eye bags can shorten the treatment and postoperative recovery time, improve the aesthetics of the eyes and face, and reduce the occurrence and recurrence rates of postoperative complications, thus it is worthy of promotion.

Functional Outcome of Distal Humerus Intra-articular Fractures Treated with Pre-contoured Anatomical Locking Plates

Introduction: The most difficult therapeutic challenge is treating humerus fractures, which might result in a subpar functional outcome. It is anticipated that early mobilization, anatomic reduction, and internal fixation will enhance the functional results. The purpose of this study is to assess the functional result, intercondylar fixation rate, and anatomically pre-contoured locking plate treatment of a distal humerus fracture. Material and Method: This prospective research included patients with type 13-C2 distal humerus fractures, regardless of sex, who were hospitalized. Using the modified triceps tongue flap method, all patients received open reduction and internal fixation with anatomic pre-contoured locking plates and screws. Patients underwent 6 months of follow-up after surgery. They had follow-up evaluations using the Mayo Elbow Performance Score (MEPS) for clinical, radiological, and functional assessments. The Chi-square test was used to analyze the outcomes. Observations: Males accounted for the majority of injuries (66.7% vs. 33.3%). The age distribution was 36.93 ± 14.67. Traffic accidents were the most common cause of injuries (66.7%). The most frequently affected side was the right upper limb (76.7%). Eighty percent of the patients had MEPS scores that were excellent or good overall. At the fracture site, the radiological union took an average of 10.2 ± 2.11 weeks. In the 6th week, the mean extension-flexion arc was 32.06°–104.06°, and in the 6th month, it was 11.55°–124.16°. Early superficial infection (3.3%), malunion (3.3%), ulnar neuropraxia (3.3%), and chronic osteomyelitis (3.3%) were the consequences. In conclusion, the functional result of the elbow was effectively preserved in distal humerus fractures treated with anatomic pre-contoured locking plates. Keywords: Elbow joint, distal humerus intra articular fractures, bone plates, articular range of motion, osteomyelitis, MEPS, pre-contoured anatomical locking plate.

Which method is successful in closure of acute oroantral communication? A retrospective study.

This study's purpose is to retrospectively evaluate the success of surgical methods used in treating Oroantral Communication (OAC). This study was designed as a retrospective cohort study on patients who developed OAC after surgery maxillary posterior region. The records of patients previously treated with OAC were scanned through the hospital registry software. A data set was created by recording patients' age, gender, systemic disease, etiological reasons, and surgical methods. The primary predictor variable was the surgical method used to treat OAC. Other variables were age, gender, systemic disease and etiological reasons. The primary outcome was oroantral fistula development after the first surgical intervention. The patients who were positive in clinical examination and Valsalva test on control days were considered unsuccessful. One-way analysis of variance and Kruskal-Wallis tests were used for quantitative variables in more than two groups. Pearson chi-square test was used to compare categorical data. This retrospective cohort study was completed with 605 patients who met the study criteria among 95,883 patients who underwent surgery in the maxillary posterior region. The incidence of OAC was 0.63%. The patients consisted of 238 female and 367 male patients. The mean age was 41.06±14.48 years. Buccal flap and Buccal Fat Pad methods were used most frequently in the treatment. While treatment was completed with the first surgical intervention in 592 (97.85%) patients, OAF developed in 13 (2.15%) patients. No statistically significant relation existed between surgical technique and OAF development (p>0.005). The success rate of the Buccal Flap method was 98.7%, and the Buccal Fat Pad method was 95.8%. The results of this study showed that noninvasive methods in openings smaller than 5 mm and surgical treatment methods in openings larger than 5 mm have a high success rate with the limitations of present study.