Flap Reconstruction Techniques Research Articles

Outcomes of flap reconstruction techniques in abdominal wall defects following oncologic resections

Outcomes of flap reconstruction techniques in abdominal wall defects following oncologic resections

Case Report: Radical Vulvectomy V-Y Flap Surgical Procedure in a Woman with Vulva Cancer

Introduction: Vulva cancer is one of the relatively rare malignancies, accounting for only 4% of all malignancies in gynecologic organs. Vulva cancer is often asymptomatic. Surgery is the basic management in patients with earliest-stage vulvar cancer and frequently requires a combined radical vulvectomy followed by inguinal LN dissection through a separate incision. Therefore, the author hopes this case can add insight into the knowledge related to early detection and comprehensive management of vulva cancer. Case Presentation: A woman, 67 years old, referred from Gambiran General Hospital Kediri with a vaginal biopsy result of vulva cancer, came to the Saiful Anwar General Hospital oncology clinic. The patient complained of pain in the pubic area accompanied by tissue growth around the pubic area since August 2023. History of weight loss (+) 10 kg in the past year. History of menopause since 18 years ago. The examination results obtained vital signs: BP 132/79 mmHg, pulse 128x/min, RR 20x/min, temperature 36.5C, height 155 cm, weight 40kg, and BMI 16.64 kg / m2 (underweight). Physical examination of external genitalia revealed a 12x8 cm mass on the right vulva, odour (+). The results of the vulvar biopsy examination on 25/08/2023 were found to be squamous cell carcinoma, well differentiated. The patient is planned for elective-wide excision. The management performed was radical vulvectomy with V-Y flap reconstruction surgery. Conclusion: In this case, it can be concluded vulva cancer is a relatively rare malignancy. The subtype often found is SCC (90-95%). This patient planned for radical vulvectomy using the V-Y flap reconstruction technique with SAB.

Various Free Flap Reconstruction Techniques after Hand and Foot Melanonychia Ablation: A Case Series.

(1) Purpose: The management of melanonychia is highly controversial. With growing melanonychia, in case of doubt, the entire lesion should be examined. It may appear similar to nail melanoma or may turn into melanoma. Here, we present surgical cases of nail bed total removal and free flap reconstruction. (2) Methods: Between 1 January 2020 and 31 December 2022, eleven patients were operated on for growing melanonychia, involving the hand and foot. After complete resection of the nail root and plate, immediate reconstruction was performed using a fasciocutaneous free flap. The authors describe the procedures in detail with a few illustrations and clinical photographs depicting the techniques. (3) Results: All patients underwent complete nail unit removal around the anatomic boundaries of the nail. Histology showed a nevus and no malignancy in all cases. We used three onychocutaneous flaps, three hypothenar flaps and five venous flaps. All flaps survived, with one case of partial necrosis which spontaneously healed with secondary intention. In the follow-up periods, there was no recurrence or nail regrowth. (4) Conclusions: These free flap techniques are very useful for total nail bed defect reconstruction after melanonychia lesion total ablation.

Local flap reconstruction techniques after frontal sinus drainage typeII andIII according to Draf

Extended endonasal endoscopic frontal sinus surgery is characterized by bone resection beyond the lamellae of the frontal sinus and is currently classified according to Draf as typeIIa, typeIIb, modified typeIII (also referred to as typeIIc), and typeIII. This approach is indicated when the surgical goal cannot be achieved through complete removal of the anterior ethmoidal cells. Numerous studies indicate restenosis rates ranging from 7to 36%, despite creation of maximal openings. Exposed bone, which tends to epithelize slowly with significant crusting and the risk of uncontrolled wound healing depending on the local environment and other factors, is considered acontributing factor. Covering the exposed bone with mucosa can significantly reduce the risk of restenosis. Avariety of flap techniques for frontal sinus drainage in DrafIII procedures are presented, including some variants that were part of presentations at the 2023 Congress of the European Rhinologic Society in Sofia, Bulgaria. These include combinations of free mucosal grafts, pedicled mucosal flaps, and hybrids combining both techniques. Additionally, the results of current studies are presented. The results and achieved opening areas in contemporary DrafIII surgeries are significantly improved and larger compared to the early stages of these procedures. Amultitude of published studies consistently demonstrate that outcomes are markedly improved with mucosal coverage. Depending on the prevailing anatomy, mucosal conditions, and the extent of the surgical intervention, the most suitable technique should be selected. Therefore, proficiency in various methods is crucial. The use of aflap technique (free, pedicled, or combinations thereof) should be defined as the standard when performing extended frontal sinus surgery (Draf IIb, IIc, III, or endonasal frontal sinus surgery [EFSS] 4-6).

Dufourmentel Rhomboid Flap versus the Karydakis and Bascom Flap Reconstruction Following Wide Excision of Pilonidal Sinus Disease

Abstract Background: Primary closure of the defect following radical excision of pilonidal sinus disease often has high complication rates. Objectives: This study aims to compare the outcomes of the Karydakis and Bascom off-midline flap closure techniques with the more recently described Dufourmentel rhomboid flap technique. Design: Retrospective cohort study. Setting: Patients who underwent elective pilonidal sinus excision with flap reconstruction at a tertiary referral center from January 2019 to January 2023. Patients and Methods: De-identified data of patients who underwent elective pilonidal sinus excision with flap reconstruction at a tertiary referral center from January 2019 to January 2023 were analyzed. Patients who underwent pilonidal sinus surgery without flap reconstruction were not included in the analysis. Institutional ethical committee review was waived for this study. Main Outcome Measures: Wound healing time, postoperative complications, disease recurrence, operative duration, and length of hospital stay. Sample Size: Forty-four patients. Results: Over a 4-year duration, 44 patients had elective pilonidal sinus surgery, of whom 44 (36 men, eight women) underwent flap reconstruction of the defect. Mean age and body mass index was 25.6 years and 26.6 kg/m2, respectively. The overall mean complete wound healing time was 10.8 weeks, with the Dufourmentel group having the quickest healing time compared to the Karydakis and Bascom groups (6.1 weeks versus 10.8 weeks versus 13.9 weeks, respectively; P = 0.206) At a mean follow-up duration of 8 months, 18 (40.1%) patients developed postoperative wound complications. Overall wound complication rate was lowest in the Dufourmentel group (9.1% versus 52.9% versus 56.3%, respectively; P = 0.030). This was largely contributed by the reduced wound dehiscence rate (9.1% versus 35.3% versus 56.3%, respectively; P = 0.043). The rates of wound infection, sinus recurrence, and reoperation were low and statistically comparable across all three groups. Conclusion: Our findings suggest the superiority of the Dufourmentel flap reconstruction technique compared to the Karydakis and Bascom closure techniques following elective pilonidal sinus excision. Limitations: Retrospective study with a small sample size and short follow-up duration. Conflict of Interest: The authors have no conflict of interest to declare.

Multifactor analysis of the technique in total laparoscopic gastric cancer.

Esophageal gastric anastomosis is a common surgical technique used to treat patients with gastric cancer who undergo total gastrectomy. However, using simple anastomosis techniques alone may not meet the needs of patients in some cases and can lead to complications such as anastomotic stenosis and ulceration. In order to overcome these issues and improve patient prognosis, muscle flap reconstruction technique has emerged. Muscle flap reconstruction is a method of improving gastric-esophageal anastomosis by transplanting muscle tissue. By covering the anastomotic site with muscle tissue, it not only enhances the stability of the anastomosis site but also increases blood supply, promoting healing and recovery of the anastomosis. Therefore, the use of muscle flap reconstruction technique in esophageal gastric anastomosis during total gastrectomy for gastric cancer is increasingly widely applied. To determine the effectiveness of esophagogastric anastomosis using the muscle flap reconstruction technology in total abdominal gastrectomy for gastric cancer and perform follow-up experiments to understand the factors affecting patients' prognosis. The study subjects were 60 patients with gastric cancer who were admitted to our hospital between October 2018 and January 2022. All patients underwent esophagogastric anastomosis using the double muscle flap reconstruction technology in total abdominal gastrectomy. Perioperative indicators were determined, and patients were followed up for 1 year. Furthermore, patient outcomes were observed within 1 year, followed by patient classification based on different outcomes. Moreover, clinicopathological parameters were observed and relevant factors affecting patient prognosis were analyzed. The operation time was 318 ± 43 min, the formation time of esophageal double muscle flap anastomosis was 110 ± 13 min, the number of lymph node dissections was 26 ± 6, the incision length was 3 ± 0.6 cm, intraoperative bleeding volume was 48 ± 15 mL, first anal exhaust time was 5.3 ± 1.8 d, first meal time was 6.0 ± 1.6 d, length of hospital stay was 11.8 ± 2.5, and treatment cost was 5.8 ± 0.7 thousand yuan. The patient experienced three postoperative complications: 2 cases of pulmonary infection and 1 case of respiratory discomfort. During 1-year follow-up, 50 patients survived and 10 died. Univariate analysis revealed that histological types, tumor size, tumor-node-metastasis staging, vascular invasion, and postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting the prognosis of surviving patients. Furthermore, Cox regression analysis revealed that postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting patient prognosis. The survival time of the survival group was significantly higher than that of the death group (P < 0.05). Esophagogastric anastomotic using muscle flap reconstruction exhibits good effects on patients who undergo total abdominal gastrectomy for cancer. Postoperative adjuvant radiotherapy and chemotherapy are the main factors affecting patient prognosis.

Surgical management of mandibular and maxillary central giant cell granuloma

BackgroundCentral giant cell granuloma is a benign intraosseous lesion of bone. It frequently affects the head and neck region, particularly the maxillary and mandibular bones. Despite the availability of various nonsurgical treatment options, surgery is still the most effective treatment option for granulomas that do not respond to medical treatment, cause significant bone deformities, or result in extensive bleeding. In this article, we aimed to show the importance of surgery in certain patients by sharing our experience with five patients who were operated on in our clinic.Case presentationIn this case series, five patients who attended our clinic with central giant cell granuloma disease and underwent surgical treatments were retrospectively evaluated utilizing the hospital database records. Demographic and medical information, symptoms at admission, the results of CT and MRI imaging, pathologic results, previous treatments, and the surgical therapy performed at our clinic were all considered. Surgical procedures were performed in five patients; marginal mandibulectomy in two, segmental mandibulectomy in one, and partial maxillectomy in the other two. The granulation tissues in the cavity were removed using curettage and a diamond burr. Primary suture, secondary healing, palatal obturator repair, and free fibula flap reconstruction techniques were performed.ConclusionsThe objective of surgical therapy for central giant cell granuloma is to remove the mass with appropriate surgery and repair it properly with the least amount of morbidity and risk of recurrence possible.

Bilobed Flaps: An Esthetic Method of Reconstructing Circular Defects.

Local flap reconstruction is an important skill used to excise and repair many cutaneous defects in various anatomical regions of body. In this article, the authors have described the bilobed flap reconstruction technique useful in the resection of various circular and semicircular defects, especially over nose tip and lateral wall of the nose. The authors have highlighted various indications, procedural techniques, and complications related to the surgery which will help in better esthetic outcome.

CLINICAL CHARACTERISTICS AND RESULT OF LOCAL FLAP RECONSTRUCTION FOR FINGERTIP INJURY IN ADULTS

Background: Fingertip injury at different levels is a common injury and management varies with variable outcomes. Local flap reconstruction techniques are the most commonly used method of treatment with satisfactory results in most. The current study aimed to analyze the clinical characteristics and results of different local flap reconstruction techniques in the treatment of fingertip injuries. Methods: This was a retrospective observational study of 31 fingertip injuries in 24 patients treated with one of the three local flap reconstruction techniques; V-Y advancement flap, thenar flap, and Moberg flap, performed by a single orthopedic surgeon in a tertiary care teaching hospital over 2 years period. The variables analyzed were demographic and injury characteristics, flap take-up function, and cosmesis of the finger and nail using descriptive statistics. Results: There were a total of 31 fingertip injuries at different levels and morphology with a mean age of 35.79 years (range 18-55). Household tools or machine-related injury was the most common mode of injury. A total of 23 (74%) fingertip amputations at a different level were treated with V-Y advancement local flap, 5 cases with thenar flap, and 3 cases of thumb tip amputation and laceration with Moberg flap. All the flaps survived well with preservation of sensation, function, and acceptable cosmesis. Conclusions: Local flap reconstruction techniques can give rise to consistently good results in the management of fingertip injury. They are technically simple, and reliable and should be practiced by all orthopedic trauma surgeons whenever it is indicated.

Horse-Shoe Flap Reconstruction Technique in Breast Surgery: From The Smallest Defect to The Biggest—A Case Series

Chest wall resections and reconstructions are routinely performed to close defects after primary breast tumor resections. Depending on the size of primary breast tumors, the reconstructive technique requires more challenging approaches. In this study, we would like to introduce a novel technique which can be applied as a method in covering various sizes of skin defects after mastectomy termed as “horse-shoe flap technique.” We conducted a series of case reports of patients who underwent chest wall coverage after primary breast tumor resections between October 2018 and November 2019 and selected five cases of breast cancer patients. These patients were treated with the horse-shoe flap technique which relies on shape as its main concept. All chest defects must form a circular shape, based on the principle that adequate safe tumor margins are best achieved with a circular incision. The donor flap was drawn and taken from the outer circle area with a larger arc, depending on the defect's diameter size. Five post-mastectomy chest wall defect cases had been successfully closed with this technique. Patients were all female, ranging from 36 to 55 years of age. The smallest chest defect was 4 cm in diameter, and the largest was 26 cm. All the defects were closed using a 120-degree horse-shoe flap design. One patient experienced marginal necrotic skin, and one case had formed postoperative seroma. The horse-shoe flap technique proves to be an excellent option for closing chest skin defects which can be applied for various sizes of skin defects with minor complications.

Reconstruction of Large Anterior Skull Base Defects After Resection of Sinonasal Tumors With Intracranial Extension by Using Pedicled Double Flap Techniques.

The use of surgical resection for large anterior skull base (ASB) tumors and sinonasal malignancies with intracranial extension will result in a large skull base defect. Reconstruction of large ASB defects using traditional techniques is high risk and may lead to postoperative cerebral spinal fluid (CSF) leakage, meningitis, and an increase in mortality rate. The use of a pedicled double flap technique to reconstruct the ASB defect may decrease complications. This study presents the clinical outcomes of patients who underwent double flap reconstruction techniques after resection of their sinonasal malignancies with significant intracranial extension at Cho Ray hospital in Vietnam. The case series study was conducted at Cho Ray hospital from September 2010 to September 2020. All patients with large sinonasal malignancies that invaded intracranially underwent transnasal endoscopic surgery and subfrontal craniotomy. Reconstruction of large skull base defects (>2cm) were followed up by using the pedicled double flaps technique. This study was performed in line with the principles of the Declaration of Helsinki. Approval of the study was granted by the Independent Ethics Committee of Cho Ray Hospital (Date: March 3, 2014/No: 11/BVCRHĐĐĐ). During September 2010 to September 2020, there were 75 patients who underwent a modified multilayer, double flap reconstruction technique after the resection of their ASB tumor. Skull base defects were commonly seen along the horizontal plate of the ethmoid bone and the ethmoid roof (98.6%). Large skull base defects (>2cm) accounted for 81.3% of cases. Overall, the risk of postoperative CSF leakage and meningitis after double flap repair was considerably low. Of all participants, only 1 experienced postoperative CSF leakage and 1 experienced postoperative meningitis. Despite the complications, these patients improved significantly and remained stable. The use of double vascularized pedicled flaps may decrease the incidence of postoperative CSF leakage and meningitis. This technique is an effective method for the reconstruction of ASB tumors with large defects.

Donor Site Morbidity and Quality of Life after Microvascular Head and Neck Reconstruction with a Chimeric, Thoracodorsal, Perforator-Scapular Flap Based on the Angular Artery (TDAP-Scap-aa Flap).

Extensive defects in the head and neck area often require the use of advanced free flap reconstruction techniques. In this study, the thoracodorsal perforator-scapular free flap technique based on the angular artery (TDAP-Scap-aa flap) was postoperatively evaluated regarding the quality of life and the donor site morbidity using the standardized SF-36 and DASH questionnaires (short form health 36 and disabilities of the arm, shoulder and hand scores). Over a five-year period (2016–2020), 20 selected cases (n = 20) requiring both soft and hard tissue reconstruction were assessed. On average, the harvested microvascular free flaps consisted of 7.8 ± 2.1 cm hard tissue and 86 ± 49.8 cm2 soft tissue components. At the donor site (subscapular region), only a mild morbidity was observed (DASH score: 21.74 ± 7.3 points). When comparing the patients’ postoperative quality of life to the established values of the healthy German norm population, the observed SF-36 values were within the upper third (>66%) of these established norm values in almost all quality-of-life subcategories. The mild donor site morbidity and the observed quality of life indicate only a small postoperative impairment when using the TDAP-Scap-aa free flap for the reconstruction of extensive maxillofacial defects.

Lateral Thoracic Flap in Axillary Hidradenitis SuppurativaA Prospective Interventional Study

Introduction: Hidradenitis Suppurativa (HS) is a chronic socially debilitating disorder of unknown aetiology. Surgical treatments include simple incision and drainage; excision followed by healing by secondary intention or split-skin grafting, and the more recent method of excision followed by local-flap reconstructions. In this study, the use of a lateral thoracic fasciocutaneous island flap based on vessels arising from the thoracodorsal or thoracic lateral vessels is described. Aim: To describe the benefit and outcomes of lateral thoracic flap reconstruction technique in treatment of axillary hidradenitis suppurativa. Materials and methods: This prospective interventional study was conducted at the Plastic Surgery Department at Amala Institute of Medical Sciences, Thrissur, Kerala, India (tertiary care center), from January 2017 to June 2018. The study included 36 patients with chronic axillary hidradenitis, who underwent lateral thoracic flap surgery on one or both axillae. These patients were studied closely preoperatively during surgery and during postoperative follow-up period. The basic demographic details, clinical parameters and Hurley stage; along with postoperative outcomes were recorded. Data was summarised using descriptive statistics. Results: The study sample consisted of 36 patients with a mean age of 38.33±13.11 years. There were 20 females and 16 males. Eleven patients were having co-morbidities in the form of type 2 diabetes mellitus or hypertension. The mean duration of illness was 3.17±1.44 years. Six patients had bilateral axilla involvement and underwent bilateral axillary reconstructions. Out of these 36 patients; 30 patients only had antibiotic treatment previously and five patients underwent excision of affected axillary skin previously without flaps; one patient was treatment naïve. Twenty four patients were Hurley stage 2 and 12 were stage 3. These patients were taken up for repair with a lateral thoracic flap. The mean postoperative hospitalisation was 6 days. There was no impairment of shoulder movement in the early or late postoperative period. There were no surgical complications in terms of vessel damage or flap viability. All flaps healed without complications and there was no recurrence of disease or scar contracture during the follow-up period. Conclusion: Lateral thoracic flap reconstruction for axillary hidradenitis suppurativa is without doubt the strategy for treating axillary HS due to its lower recurrence rates.

Hypotrophic Clavicle Pseudoarthrosis Treatment: a Case Report

Background. The treatment of post-traumatic of the clavicle false joint remains a subject of discussion regarding the technology of the surgical intervention. Recently, the use of vascularized fibular flap reconstruction technique has been popularized, but the potential of the external osteosynthesis remains relevant. Clinical case description. A 70-year-old patient got a fracture of the middle third of the left clavicle diaphysis as a result of a fall. He underwent four surgical treatment options: plate osteosynthesis; plate osteosynthesis + bone autoplasty; plate osteosynthesis + vascularized fibular flap reconstruction; external osteosynthesis. A month after the fourth attempt of surgical treatment, fusion, improvement of the function of the right upper limb and the quality of life of the patient were achieved. Technological inaccuracy, namely, the lack of the fragments fixation stability due to the incorrectly chosen length of the plate, as well as an incomplete assessment of the anamnesis and the identified cognitive behavioral features of the patient, are considered as possible reasons for the treatment failure. Conclusion. Attempts of surgical treatment using plates in combination with bone autoplasty, including vascularized skin-bone flaps, do not always ensure the achievement of clavicle fractures fusion. In such situations, it is advisable to use the potential of external osteosynthesis with the reasonable planning.

Muscle Flap Reconstruction Based on Muscle Tension Line Groups to Repair the Philtrum of Patients With Microform Cleft Lip or Secondary Cleft Lip.

The muscle flap reconstruction technique was developed based on the concept of muscle tension line groups, which elucidates how nasolabial muscle tension helps maintain the shape of the philtrum. To investigate the operative effect, we reviewed 43 patients with microform cleft lip and 102 patients with secondary cleft lip treated with muscle flap reconstruction between January 2018 and June 2020. The patients were scanned using the digital three-dimensional stereophotogrammetry face system pre- and post-operatively, and comparative analysis of three-dimensional (3D) images was used to highlight variations of the philtrum. Visual analog scales were used to assess surgical outcomes. More than 6 months after the surgery, comparative 3D images of 37 patients (86.04%) with microform cleft lip and 86 patients (84.31%) with secondary cleft lip showed visible improvement in the prominence of the affected column. In addition, visual analog scale scores showed that 38 microform cleft lip patients (88.37%) and 89 secondary cleft lip patients (87.25%) had a good appearance. The postoperative prominence of the philtral column in both groups improved significantly compared to before surgery (P < 0.001 and P < 0.001, respectively). There was no significant difference in scores for philtrum prominence pre- and post-operatively between the 2 groups (P > 0.05). Muscle flap reconstruction is an effective means to create the 3D configuration of the philtrum. The biomechanical properties of muscles play a vital role in the morphological maintenance of the philtrum.

RECONSTRUCTION OF LARGE ANTERIOR SKULL BASE DEFECTS AFTER RESECTION OF SINONASAL TUMORS WITH INTRACRANIAL EXTENSION BY USING PEDICLED DOUBLE FLAP TECHNIQUES

Background: Surgical resection of a large anterior skull base (ASB) tumor and sinonasal maglinancies with intracranial extension will result a large skull base defect. Reconstruction of large ASB defects by using traditional techniques may result in high risk of postoperative CSF leakage, meningitis and increase mortality rate. The use of pedicled double flap technique to reconstruct the anterior skull base defect may decrease the complications. In this study, we examine the clinical outcomes of patients who underwent this double flap reconstruction technique after the resection of sinonasal malignancies with significant intracranial extension at Cho Ray hospital, Vietnam. Methods: Case series study was conducted at Cho Ray hospital from 09/2010 to 09/2020. All patients with large sinonasal malignancies with intracranial invasion underwent combined transbasal - EEA approach. Reconstruction of large skull base defect ( &gt; 2 cm ) was followed by using the pedicled double flap technique. Results: There were 75 patients who underwent the modified multi-layer with double flap reconstruction technique after the resection of ASB tumor from 09/2010 to 09/2020. The skull base defects were commonly seen at the horizontal plate of the ethmoid and the roof of the ethmoid ( 98.6%). The large skull base defects ( &gt; 2cm) accounted for 81.3%. The risk of postoperative CSF leakage after double flap repair was very low. In this study, we had 1 patient with postoperative CSF leakage and 1 patient had postoperative meningitis. Conclusion: The use of two vascularize pedicled flap may decrease the incidence of postoperative cerebral spinal fluid (CSF) leakage and meningitis. This technique is an effective method for the reconstruction of the ASB with large defect.

Flap Reconstruction of Perineal Defects after Pelvic Exenteration: A Systematic Description of Four Choices of Surgical Reconstruction Methods.

The treatment of locally advanced or recurrent anorectal cancer requires radical surgery such as extralevator abdominoperineal resection and pelvic exenteration. Larger defects require flap reconstruction. The authors evaluated outcomes of different perineal reconstruction techniques. A systematic search was performed in the PubMed, Embase, and Cochrane databases. Studies reporting outcomes on perineal flap reconstruction in patients with anal or colorectal cancer were included. Data on patient characteristics, surgical details, perineal and donor-site complications, revision surgery, mortality, and quality of life were extracted. Articles were assessed using the Group Reading Assessment and Diagnostic Evaluation approach. The authors included 58 mainly observational studies comprising 1988 patients. Seventy-three percent of patients had rectal cancer. The majority of 910 abdominoperineal resection patients underwent reconstruction with rectus abdominis flaps (91 percent). Dehiscence (15 to 32 percent) and wound infection (8 to 16 percent) were the most common complications. Partial flap necrosis occurred in 2 to 4 percent and flap loss occurred in 0 to 2 percent. Perineal herniation was seen in 6 percent after gluteal flap reconstruction and in 0 to 1 percent after other types of reconstruction. Donor-site complications were substantial but were reported inconsistently. Clinical outcome data on perineal reconstruction after exenterative surgery are mostly of very low quality. Perineal reconstruction after pelvic exenteration is complex and requires a patient-tailored approach. Primary defect size, reconstruction aims, donor-site availability, and long-term morbidity should be taken into account. This review describes the clinical outcomes of four flap reconstruction techniques. Shared clinical decision-making on perineal reconstruction should be based on these present comprehensive data.

Treatment and Outcomes for Cutaneous Periauricular Basal Cell Carcinoma: A 16-Year Institutional Experience.

ObjectiveTo report a single institutional experience with the surgical management of cutaneous periauricular basal cell carcinoma.Study DesignRetrospective chart review.SettingTertiary academic center.MethodsRetrospective chart review of 71 patients diagnosed with periauricular basal cell carcinoma managed surgically from 2000 to 2016. Data were analyzed with descriptive statistics.ResultsThe median age at diagnosis was 73.0 years (interquartile range, 13.0). Of all lesions, 2.8% (n = 2) were preauricular, 80.3% (n = 57) auricular, and 16.9% (n=12) postauricular. Auricular subsites included conchal bowl (36.6%, n = 26), helix (21.1%, n = 15), antihelix (1.4%, n = 1), peritragus (5.6%, n = 4), triangular fossa (1.4%, n = 1), external auditory canal (2.8%, n = 2), and lobule skin (1.4%, n = 1). Surgical approach included wide local excision (80.3%, n = 57), partial auriculectomy (8.5%, n = 6), and total auriculectomy or other combinations of surgical methods (11.3%, n = 8). Due to aggressive pathology, 3 cases required concurrent parotidectomy, neck dissection, ear canal sleeve resection, or mastoidectomy. In sum, 52.1% (n = 37) of cases had clear margins on first pass in the operating room; 25.4% (n = 18) required further resection; and 12.7% (n = 9) demonstrated final positive/overturned margins read as negative from the frozen sections. Reconstruction included full-thickness (25.4%, n = 18) or superficial-thickness (29.6%, n = 21) skin grafts and local flap reconstruction (25.4%, n = 18), while 5.6% (n = 4) required combinations of free flap and/or other reconstruction techniques; 14.1% (n = 10) did not undergo formal reconstruction.ConclusionPeriauricular basal cell carcinoma occurs in anatomically diverse locations in and around the ear, and multiple surgical methods are required for successful treatment.

Make Your Own Deep Inferior Epigastric Artery Perforator Flap: Perforator Delay Improves Deep Inferior Epigastric Artery Perforator Flap Reliability.

Background:Abdominal-based autologous breast reconstruction remains a conflict between blood supply and donor site complication. Optimizing esthetics and minimizing recovery and postoperative pain add further complexity. We present a 2-stage technique of deep inferior epigastric artery perforator flap reconstruction to (1) reliably harvest single-vessel flaps while minimizing fat necrosis, (2) decrease abdominal wall morbidity, and (3) improve breast and donor site esthetics.Methods:Female subjects presenting between August 2017 and January 2019 to the senior surgeon for abdominal-based breast reconstruction were included. After mastectomy, the subjects underwent subcutaneous placement of tissue expanders and in situ selection of a low, centrally located perforator based on preoperative computed tomographic angiography imaging through an infraumbilical “T” incision with ligation of all other perforators and superficial system. Subjects underwent tissue expander explant and flap transfer at a second stage.Results:One hundred thirty-five subjects undergoing 215 free flaps met criteria. Mean age and body mass index were 52.1 years and 29.3 kg/m2, respectively. Seven perforator complications (3.3%) occurred with 2 (0.9%) total and 5 (2.3%) partial flap losses. There were 20 (14.8%) readmissions and 26 (19.3%) reoperations. Breast complications included arterial thrombosis (0.5%), venous congestion (1.9%), and fat necrosis (5.1%). The mastectomy skin flap necrosis rate decreased from 14.9% to 2.3% following staged reconstruction. Abdominal donor site complications included delayed healing (11.1%), seroma (5.9%), and hematoma (2.2%).Conclusions:The 2-stage delayed deep inferior epigastric artery perforator flap technique represents a safe, efficacious modality to allow for reliable harvest of single-vessel flaps with low rates of fat necrosis while improving donor site esthetics and morbidity.

Complication des lambeaux en reconstruction mammaire

Flap reconstruction techniques are increasingly desired by French's patients and it represents almost half of breast reconstruction indications in 2017. The main reasons of this statistics are the growing concerns of the patients with breast implant of developing BIA-ALCL, as well as their desire of having a more natural reconstruction results without having any foreign bodies. The multiplication of autologous reconstruction techniques, especially microsurgical techniques which has been popularized in the recent years, makes possible to propose a reconstruction to the majority of patients without an implant. This type of reconstructions is associated with a significant number of complications; thus, a proper selection of patient should be done and a good knowledge of the surgical technique by the surgeon to reduce the complication. Our proposed study is divided into two main parts, the complications of the flap and the complications at the donor site. Based on the experience of our plastic surgery department in immediate and delayed breast reconstruction, the objective of this article is to describe and to analyze the possible complications of breast reconstruction by a flap and their surgical management in intra and post operatively. Our goal is to provide an algorithm for our young colleagues in order to obtain better understanding of this type of interventions difficulties and to provide an appropriate care in the event of complication, also to provide optimal care to the patients who wish to undergo autologous flap reconstructions.