Flap Technique Research Articles

Success Rate of Temporal Inverted ILM Flap Versus ILM Peel in Macular Hole Larger Than 400 µm in Size: A Non Randomized Clinical Study

Objective: To compare the efficacy of the temporal inverted ILM flap technique versus ILM peeling for better visual outcomes and closure of macular holes larger than 400 µm. Methodology: This was a non randomized controlled study conducted in the Department of Eye Unit 3, Institute of Ophthalmology, Mayo Hospital Lahore from January 2019 to December 2019. Twenty eyes with large macular holes were included; ten eyes were treated with the Temporal Inverted ILM Flap technique, and ten eyes were treated with ILM Peeling. Preoperatively all macular holes in both groups were assessed for visual acuity and size of macular hole on Optical Coherence Tomography (OCT). Postoperatively, one week, one month, three months, and six months, best corrected visual acuity (BCVA) was measured using the logarithm of the minimum angle of resolution (logMAR) scale and macular hole (MH) closure was assessed on OCT. The chi-square test was applied taking p-values < 0.05 a significant. Results: Initially, both groups had an average BCVAof 0.54 ± 0.1 logMAR. After 6 months, the group that underwent Temporal Inverted ILM Flap surgery showed a notable enhancement in BCVA(0.30 ± 0.08 logMAR) in comparison to the group that underwent ILM Peeling surgery (0.40 ± 0.08 logMAR, p = 0.012). There was a higher rate of Type 1 closure (90% compared to 60%, p = 0.011) and better continuity of the ellipsoid zone (100% compared to 80%, p = 0.12) in the group that utilized the temporal inverted flap method as compared to simple ILM peel. Conclusion: Temporal Inverted ILM Flap approach is more effective than ILM peeling in terms of better visual acuity, higher type 1 closure rate, and better continuity of the ellipsoid zone. Keywords: ILM Peeling, Macular Hole, Retinal Surgery, Temporal Inverted ILM Flap, Visual Acuity

Anterior Skull Base Reconstruction in Multiportal Approaches: Insight into Vascularized Flap Techniques

Anterior Skull Base Reconstruction in Multiportal Approaches: Insight into Vascularized Flap Techniques

A minimally invasive modified revolving-door flap for surgical reconstruction of concha and antihelix defects

Skin cancers affecting the concha and antihelix are quite common, because of anterior auricular projection from the head and subsequent actinic exposure, leading to the need for effective ear reconstruction post-surgery. Various methods such as skin grafts, free tissue transplantation, and local flaps have been used. This study introduces a refined technique for concha-antihelix defect reconstruction, based on a minimally invasive modification of the revolving-door flap procedure. Here, a fasciocutaneous flap technique involving minimal posterior auricular muscle contribution is used, particularly suitable for anterior skin and cartilage defects. The study included 75 patients with nonmelanocytic skin carcinoma on the ear's anterior surface, in which we evaluated patient's and surgeon's satisfaction with a visual analogue scale and discussed the surgical technique and its advantages and indications. The technique demonstrated excellent cosmetic and functional outcomes, effectively hiding donor-site deformities and ensuring patient and surgeon contentment. This approach allows for one-stage reconstruction under local anesthesia, reducing costs, surgery time, and recovery period. The procedure provides high-quality tissue for reconstruction with low complication risks, making it an optimal choice for wide conchal and antihelix defect repairs due to its proximity to the affected area and the reliable, swift nature of the method.

ASSESSMENT OF NASAL BREATHING FUNCTION AND TIP DEFINITION AFTER THE IMPLEMENTATION OF THE CEPHALIC LATERAL CRURAL ADVANCEMENT FLAP TECHNIQUE.

Cephalic trimming of the lower lateral cartilage can result in the collapse of the internal and external nasal valves, pinched nose, and alar retraction. The cephalic lateral crura advancement flap (CLCAF) technique is introduced as a method to prevent these complications by avoiding grafts in the lower lateral cartilage (LLC). A retrospective study was conducted on 126 open approach rhinoplasties (82 female and 44 male) employing the CLCAF technique between January 2021 and March 2022. Preoperatively, 20 patients exhibited collapse of the internal nasal valve. CLCAF was performed in all patients following cephalic incision, leaving 7-8 mm horizontally and caudally of LLC, and preserving the scroll ligament. The CLCAF was advanced onto the lateral crura to reinforce it and tension the scroll ligament. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to assess the technique. The average postoperative follow-up period was 14 months. Overall, 114 patients (90.5%) experienced improved nasal breathing on the NOSE scale, and the overall NOSE score significantly decreased from a mean of 30.4 to 14.0 (P<0.001). A statistically significant reduction in NOSE scores was observed in groups with moderate, severe, and extreme obstruction (P<0.001), with greater improvement seen in the patients with more severe preoperative nasal breathing obstruction. Post-intervention, no patient exhibited collapse of the internal valve, and all patients with preoperative collapse of the internal nasal valve showed an increase of at least 40 points in the NOSE scale. Two patients required revision due to tip asymmetry related to CLCAF. Pinched nose or alar retraction was not observed postoperatively in any patient. The implementation of CLCAF, combined with other techniques, enhances nasal breathing function, prevents the collapse of the internal nasal valve, and leads to optimal nasal tip definition, resulting in a better-shaped and functioning nose.

An unusual occurrence: Treacher Collin syndrome with nasal dermoid cyst

Treacher-Collins syndrome (TCS), characterized by autosomal dominant inheritance, affects craniofacial development and presents with diverse clinical manifestations, including facial bone hypoplasia, ear malformations, and ocular abnormalities. The syndrome's association with nasal dermoid cysts is rare and poorly documented in the literature. We present a case report of a 10-year-old male with TCS who presented with a nasal dermoid cyst, a noteworthy and atypical finding within this patient population. The patient exhibited typical features of TCS, including facial asymmetry, malar and mandibular hypoplasia, and microtia. The diagnosis was confirmed through clinical evaluation and diagnostic imaging, which revealed additional anomalies such as conductive hearing loss and absence of the external auditory canal. Surgical excision of the nasal dermoid cyst was performed, utilizing the V-Y advancement glabellar flap technique for closure. This case underscores the importance of comprehensive multidisciplinary care in managing complex conditions like TCS, where treatment strategies must address both medical needs and cosmetic outcomes. Further exploration of rare associations like nasal dermoid cysts in TCS contributes to a broader understanding of the syndrome's phenotypic variability and informs optimal clinical management strategies.

Reconstructing through-and-through cheek defects using transposing cervicofacial and anterolateral thigh flaps-comparative analysis of aesthetic and functional outcomes

Despite extensive efforts to restore through-and-through cheek defects caused by oral cavity malignancies, surgeons continue to explore optimal approaches to achieving satisfactory cosmetic and functional outcomes. In this prospective randomized controlled study, we share our experience with a modified flap technique, involving the transposition of cervicofacial and anterolateral thigh flaps to repair through-and-through cheek defects. A total of 41 patients with oral squamous cell carcinoma involving the cheek underwent radical excision of buccal carcinoma and reconstruction with a chimeric anterolateral thigh bi-paddles flap. The patients were randomly divided into 2 groups: the "flap transposing" group (n=21) and the "traditional surgery" group (n=20). The research data was collected through physical examinations and questionnaires, with postoperative assessments including flap-biting evaluation, the Medical Outcome Study Short Form 36 (MOS SF-36), and the Teacher Drooling Scale. The "flap transposing" group demonstrated significantly higher MOS SF-36 scores for social function, role emotion, mental health, and vitality compared to the "traditional surgery" group. In addition, improved salivation control and decreased flap-biting were observed in the "flap transposing" group. In conclusion, for the repair of through-and-through cheek defects using a chimeric anterolateral thigh bi-paddles flap, transposing the cervicofacial flap to the cheek defect while positioning the flap lobe for skin defects in the submandibular region may significantly enhance esthetic outcomes and improve patients' quality of life.

Can 3 Stages Forehead Flap Provide Longer Flap Length?

This article discusses the use of the forehead flap technique in nasal reconstruction, specifically examining the effect of the 3-stage forehead flap procedure in providing longer flap length. Traditionally performed in 2 stages, the forehead flap technique often requires additional operations due to the thickness of the forehead skin. The 3-stage procedure, however, allows for better control of the flap thickness and improved reconstruction of nasal subunits. In this study, 17 patients who underwent this procedure for nasal defect repair were evaluated. Despite minor complications such as bleeding and venous congestion in some patients, the overall outcomes were successful. The 3-stage forehead flap is highlighted as an effective method for achieving both functional and aesthetic results in nasal reconstruction. This technique is particularly beneficial for addressing complex nasal defects and achieving optimal tissue matching between the flap and the recipient site.

Outcomes of Mucous Cystectomy and Osteophytectomy Using a Random Nonadvancement Flap Technique.

The purpose of this study was to determine the clinical outcomes of mucous cystectomy and osteophytectomy using a random nonadvancement flap technique. This was a therapeutic outcomes study of patients who underwent mucous cystectomy under local anesthesia by 1 of 2 hand fellowship-trained surgeons between 2012 and 2022. The key features of the surgical technique include designing a random nonadvancement flap with the cyst at its base; transecting the cyst pedicle as the flap is elevated; resecting the cyst wall from the undersurface of the reflected flap; decompressing the distal joint by removing marginal osteophytes; and insetting the flap without advancement. Patient demographic and disease-specific data were extracted from medical records and compiled in an electronic database. At minimum 1-year follow-up, patients were queried by telephone regarding wound complications, cyst recurrence, and satisfaction with outcome. The study cohort included 64 cysts in 61 patients, mean age 63 ± 10 years. The index or middle finger was affected in 63% of cases. At early postoperative follow-up, digital pain improved or resolved in 97% of cases. There were no complications of wound dehiscence or infection. At median 5-year follow-up in 34 cases, all patients except 1 were satisfied with the surgical outcome. There were 2 cyst recurrences in the study cohort (3%) and only 1 secondary procedure. Our study demonstrated that mucous cystectomy and distal joint osteophytectomy using a random nonadvancement flap is an effective surgical technique with low procedure complication and cyst recurrence rates and high patient satisfaction.

[Translated article] Medial tab-type fasciocutaneous flap as an alternative for the management of soft tissue defects of the leg

BackgroundSelecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity. ObjectiveDemonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps. Materials and methodsCohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group (1) medial tab flap, and group (2) conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively. Outcome variables: surgical time in minutes, healing, healing time in days, complications. ResultsThe patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2±11.2 days in the tab flap and 16.1±11.2 days in conventional flaps, no statistically significant differences were found between the groups (p=.89).The surgical time for tab flaps was 225.2±117.8min, and 191.3±117.2min for the comparison flaps (p=.65), there were no statistically significant differences. There were no complications in the medial tab flaps. ConclusionThe findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.

Abbe Flap for Upper Lip Reconstruction.

Lips are complex structures that are part of the facial esthetics. Their integrity may be affected by congenital diseases, trauma, burns, and cancers, among other pathologies. The reconstruction of the upper lip subunit can be a challenge for the surgeon. The purpose of this paper is to review the Abbe flap technique with the help of tips from the primary surgeon (surgical tips) and present a series of cases as experience in upper lip reconstruction. A retrospective study at Chilean centers Fundación Gantz and Clínica Alemana de Santiago from 2003 to 2023. The surgical technique was described, and different variables were assessed. The Strasser scale was used as an objective method for assessing the results. Sixteen surgery patients, 50% female and 50% male. Fourteen patients (87.5%) with cleft lip and palate. In total, 85.71% of the total number of patients with follow-up had a good score of 1 to 4 on the Strasser scale. There were no mediocre results comparable to results described in other series. There were no complications relating to the technique. The Abbe flap technique continues to be an excellent option in upper lip reconstruction, especially in patients with a condition of the middle third of the lip. Knowledge of the anatomy, the surgical technique, the function of the lip, and facial esthetics leads to acceptable results for the patient and their environment with this technique.

Olfactory outcomes in skull base surgery.

This review examines the impact of skull base surgery on olfactory function, a critical yet often overlooked aspect of postoperative quality of life. As surgical techniques continue to evolve, understanding their impact on olfaction is key to optimizing patient outcomes. The relationship between skull base surgery and olfactory function continues to be debated in the literature. With the adoption of transnasal surgical approaches, a significant concern has been its impact on olfaction. Prior studies have shown evidence of olfactory dysfunction following transnasal skull base surgery, though these findings are not universal. A particular area of discussion involves the use of the pedicled nasoseptal flap, which has demonstrated potentially negative short-term olfactory impacts. Additional concerns surround flap design (olfactory strip preservation) and technique of flap harvest (cold knife versus electrocautery). Evidence suggests that olfactory strip preservation may effectively maintain postoperative olfactory performance, while cold knife techniques offer no clear advantage over electrocautery. The inconsistencies in the literature underscore the need for standardized, large-scale studies that directly compare surgical techniques to better understand the impact of transnasal skull base surgery on olfaction. This is essential to optimizing surgical outcomes and improving patient quality of life postoperatively.

086. Combination of Mustarde Flap and Paramedian Forehead Flap in Nasal Non-Melanoma Basal Cell Carcinoma: A Case Report

Background: Basal cell carcinoma (BCC) is a non-melanocytic skin cancer, specifically an epithelial tumor originating from basal cells. The National Comprehensive Cancer Network (NCCN) states that the primary goal of treating BCC is to eliminate the tumor to prevent its locally invasive and damaging characteristics while preserving function and aesthetic appearance as much as possible. This case report details a patient who experienced a defect on the nose due to surgery. Case: A sixty-year-old male patient came to our center with a lump on the right side of his nose, which had developed about 1.5 years prior to his admission. Over the last year, the initially small lump progressively enlarged in both size and depth, becoming ulcerated and necrotic. Clinical examination showed multiple lumps on the right side of the nose with a necrotic edge and ulceration, but without any signs of bleeding. Laboratory tests showed normal results. Conclusion: Facial defects caused by BCC may require various reconstruction approaches depending on the size and location. A combination of skin flap techniques, such as the paramedian forehead flap and Mustardé flap, shows outstanding functional and cosmetic outcomes.

The Vascular Anatomical Basis for a Well-Designed Reconstruction of the Ala Nasi by a Microsurgical Preauricular Flap Technique

Background: A microsurgical auricular flap represents a single-step technique for the reconstruction of full-thickness defects of the ala nasi. To achieve the best surgical outcomes, it is essential to have an exhaustive knowledge of the vascular network to improve the management of the surgical flap. This study aimed to provide an anatomical and surgical guide for a well-designed reconstruction of the ala nasi using a free preauricular flap. Methods: In this study, three fresh-frozen and two formalin-fixed human head specimens injected with red silicone rubber to enhance the arterial facial system were used. The reconstruction of the full-thickness defect of the ala nasi was performed using a microsurgical auricular flap technique, with the dimensions of the ala nasi and the preauricular flap duly noted. In addition, anatomical dissections were conducted, during which the positions and diameters of the main donor and recipient vessels were measured. Results: A presurgical evaluation was performed to define the flap design. A comparison of the shape and mean dimensions of the ala nasi defect (height 9.66 ± 1.40 mm; thickness 3.52 ± 0.53 mm) and the preauricular flap (height 8.50 ± 2.68 mm; thickness 3.92 ± 1.29 mm) indicated that this flap was an optimal option for the reconstruction of the ala nasi. The surgical procedure involved the full-thickness removal of the ala nasi, and the harvesting and insertion of the preauricular flap. The anatomical measurements demonstrated that the facial artery and veins were the optimal recipient vessels, with a diameter of &gt;1 mm (2.08 ± 0.56 and 2.85 ± 0.74 mm), suitable for anastomosis with the superficial temporal artery and vein (1.86 ± 0.58 and 1.66 ± 0.15 mm). In addition, the postsurgical evaluations indicated a slight mean difference in the thickness (1.14 ± 0.65 mm) and height (1.68 ± 1.18 mm) between the ala nasi and helix and a satisfactory VAS score (7.9 ± 0.57). Conclusions: Our surgical and anatomical data provide compelling evidence in favour of free preauricular flap reconstructions of the ala nasi. This procedure allows for the correct choice of recipient vessels and the creation of a well-designed surgical flap.

Comparative study on the short-term clinical effects of distal incision flap technique in the extractions of mesially/horizontally impacted mandibular third molar with high or medium position

ObjectiveThe extraction of impacted mandibular third molars (M3Ms) often lead to postoperative complications such as pain, swelling, and trismus. Flap design during surgery plays a critical role in determining the severity of these complications. This study aimed to compare the impact of three surgical flap types—modified triangular flap (MTF), modified envelope flap (MEF), and distal incision flap (DIF)—on surgery duration and postoperative complications. Study DesignPatients aged 18–30 years with mesially/horizontally impacted M3Ms in Class I, II and Position A, B from June 2023 to June 2024 were included. The primary predictor variable was the surgical flap type (MTF, MEF, or DIF), and the primary outcome variables were surgery duration and postoperative complications, including pain, swelling, and trismus. Covariates included patient demographics and M3M positions. Descriptive statistics, one-way ANOVA, and Pearson correlation analyses were used, with significance set at P < .05. ResultsA total of 135 patients were included. The DIF technique resulted in the shortest surgery duration and the lowest postoperative pain, swelling, and trismus on the 3rd and 7th days. ConclusionWhile limited in its applicability, the DIF is a safe and effective technique, reducing surgery duration and postoperative complications. Long-term studies are needed to confirm these findings.

Columellar lengthening with V-Y advancement flap in aesthetic rhinoplasty

Achieving a harmonious nasal shape requires balance from the frontal, lateral, and basal views. A short columella can lead to inadequate tip projection and drooping. While various methods have been used to lengthen a short columella in cleft lip and palate cases, adapting these techniques for aesthetic surgery presents challenges. This report outlines the design and surgical considerations for this issue. Ten patients with a short columella at risk of skin resistance or retraction were evaluated. The V-Y flap technique was employed, featuring a V-shaped design starting at the midpoint between the columellar footplate and the lowest point of the nostril sill. Standard techniques included a columellar graft to prevent narrowing. The rhomboid flap was trimmed and sutured in place. Results showed that the V-Y flap provided adequate tip projection, reduced columellar flaring, and improved nostril shape. Scarring was comparable to an inverted-V incision, with improvements in the columellar base and philtrum and high patient satisfaction. The technique effectively addressed tip projection challenges in patients with short columella.

Multilayered Inverted Internal Limiting Membrane Flap Technique in Optic Disc Pit Maculopathy.

To evaluate the anatomical and visual outcomes of the multilayered inverted internal limiting membrane (ML-ILM) flap technique in the treatment of optic disc pit maculopathy (ODPM). In this retrospective interventional case series, medical records and macular spectral-domain optical coherence tomography images of patients who underwent combined pars plana vitrectomy with ML-ILM flap surgery for ODPM were analyzed. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) at postoperative 6 months were compared with baseline findings. Intraoperative and postoperative complications, fluid resolution time, and recurrence during follow-up were recorded. Five eyes of 5 patients with ODPM were included in the study. According to the preoperative macular fluid characteristics, 2 patients had only intraretinal fluid, while 3 patients had intraretinal and subretinal fluid. The preoperative median BCVA was 1.0 logarithm of the minimum angle of resolution (logMAR) (range, 1.0-1.3 logMAR), and the CMT was 560 μm (range, 452-667 μm). At the 6-month postoperative follow-up, the median BCVA was 0.40 logMAR (range, 0.1-0.7 logMAR), and CMT was 315 μm (range, 265-326 μm) (p=0.042 and p=0.043, respectively). During the 6-month follow-up period, no recurrence or full-thickness macular hole formation was observed. The ML-ILM flap technique is a preferable surgical option to achieve both high anatomical and functional success and flap stabilization.

Surgical outcomes of inverted internal limiting membrane flap technique for primary rhegmatogenous retinal detachment coexisting with a macular hole.

This retrospective study aimed to evaluate the visual outcomes and foveal restoration in eyes with rhegmatogenous retinal detachment (RRD) and macular hole (MH) following surgery using the inverted internal limiting membrane (ILM) flap technique. We collected data on eyes with coexisting RRD and MH that underwent surgery using the inverted ILM flap technique between January 2016 and December 2018. The primary outcome measures were visual acuity (VA) and optical coherence tomography findings. Of 308 eyes with MH originating from various causes, 8 (2.6%) eyes diagnosed with coexisting RRD and MH treated using the inverted ILM flap technique were included. The average patient age and axial length were 65.00 ± 12.01 years and 23.66 ± 0.77 mm, respectively. The mean preoperative best-corrected VA (BCVA) was 1.84 (spherical equivalent [SE], counting finger) ± 0.32 logMAR and the mean final BCVA had improved significantly to 1.05 (SE, 20/223) ± 0.67 logMAR (P = .017). The primary retinal reattachment, MH closure, and secondary retinal attachment rates were 75% (6/8), 87.5% (7/8), and 100% (7/7), respectively. The inverted ILM flap technique led to significant improvements in anatomical and visual outcomes in patients with coexisting RRD and MH.

Root Coverage Techniques: Coronally Advancement Flap vs. Tunnel Technique: A Systematic Review and Meta-Analysis.

Gingival recession, characterized by the apical displacement of the gingival margin, presents challenges to oral health. This study compares the effectiveness of the coronally advanced flap (CAF) and the tunnel technique (TT) for treating gingival recessions. Bibliographical searches included PubMed, Embase, Web of Science, Cochrane, Scopus, and the grey literature, with keywords "root coverage" "coronary advanced flap", and "tunnel". A systematic coreview was performed that included 26 studies evaluating root coverage, and 14 articles were included for the meta-analysis. Three groups were analyzed: Group 1 compared TT with connective tissue graft (CTG) versus CAF with CTG; Group 2 examined TT with CTG and/or other biomaterials versus TT with CTG alone; Group 3 compared TT with CAF, regardless of complementary biomaterials. Meta-analysis assessed mean root coverage (MRC), complete root coverage (CRC), and keratinized tissue gain (KTG). In Group 1, TT with CTG demonstrated superior MRC compared with CAF with CTG (-8.68 CI95% -17.19 to -0.17; p = 0.0457). In Group 2, TT with CTG and/or other biomaterials showed similar MRC (4.17 CI95% -17.91 to 26.26; p = 0.7110) and CRC (0.37 CI95% -1.14 to 1.89; p = 0.6269) to TT with CTG alone, with variations in keratinized tissue gain. Group 3 indicated higher potential MRC for TT compared with CAF (5.73 CI95% -8.90 to 13.55; p = 0.685) but without statistically significant differences. This study suggests that TT with CTG might offer better root coverage than CAF with CTG; however, biomaterial selection requires consideration.

Evaluation of esophagogastric anastomosis with additional mechanical anti-reflux barrier after proximal gastrectomy

The application of proximal gastrectomy for suitable upper gastric cancer and AEG patients is increasing along with the promotion of the concept and technology for function-preserving partial gastrectomy. The following problems such as postoperative reflux esophagitis and anastomotic stenosis naturally become the focus of academic field. Based on the understanding of the anti-reflux structure and function of the esophagogastric junction, scholars have successfully established some representative esophagogastric anastomosis methods with additional mechanical anti-reflux barrier, including gastric tube reconstruction, side overlap esophagogastrostomy, and double flap technique. Subsequently, a series of improved esophagogastric reconstruction methods have been derived. At present, the recognized ideal reconstruction method has not yet been established, and there are also misunderstandings in related concepts and cognition. Based on the literatures and the authors' own practical experience, this paper draws on the research results in the field of surgical treatment for reflux esophagitis, and discusses the theoretical basis, key details and anti-reflux effect of the above-mentioned digestive tract reconstruction methods after proximal gastrectomy, as well as the possible problems in the exploration of innovative surgical methods at home and abroad.

P-65853023-1399 - Total Reconstruction of the Lower Lip using Different Local Flap Techniques Simultaneously. Case Report

P-65853023-1399 - Total Reconstruction of the Lower Lip using Different Local Flap Techniques Simultaneously. Case Report