Flap Technique Research Articles

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

Introduction: 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. Methods: 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). Results: 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. Conclusions: 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

Treatment of Multiple Soft Tissue Maxillofacial Wounds: A Case Report

Introduction: Trauma to the maxillofacial area is a frequent problem in medical emergencies, including injuries caused by external forces such as traffic accidents. These injuries can result in damage to the soft tissues, especially the face, which plays an important role in a person's expression, appearance, aesthetics, and identity. Prompt and appropriate treatment is essential to prevent serious complications, including infection and long-term damage. Case Report: A 21-year-old male patient suffered facial bleeding due to a traffic accident. This incident caused lacerations to the frontal region dextra, palpebra dextra, zygoma dextra, and mental, as well as multiple abrasions to the face. Radiographic examination showed no bone fracture, but the wounds required debridement and suturing of the lacerated soft tissues. Management: The patient was diagnosed with multiple lacerations to the maxillofacial area. Initial measures included Tetagam as anti-tetanus protection, followed by Ceftriaxone as prophylactic antibiotics, Omeprazole to reduce gastric irritation, and Ketorolac for analgesic and anti- inflammatory effects. Wound cleansing and debridement were performed to reduce the risk of infection and preserve healthy tissue. The wound was then sutured with the transpositional flap technique, which allows a change in wound direction to reduce the risk of infection and ensure aesthetic and functional wound closure. Conclusion: Multiple soft tissue wounds of the maxillofacial area due to physical trauma require prompt and appropriate management to prevent serious complications. Debridement, wound cleansing, and the use of transpositional flap technique in the treatment of laceration wounds in this case showed optimal wound healing results without complications. Keywords: Transpositional Flap, Maxillofacial, Soft tissue trauma, soft tissue wound, debridement

A Comprehensive Analysis of Flapless and Conventional Flap Technique in Dental Implant Surgery - A Comparative Study

A Comprehensive Analysis of Flapless and Conventional Flap Technique in Dental Implant Surgery - A Comparative Study

Efficacy of the U‐shaped flap technique in preventing reflux after minimally invasive proximal gastrectomy for proximal gastric and esophagogastric junction cancer

Efficacy of the U‐shaped flap technique in preventing reflux after minimally invasive proximal gastrectomy for proximal gastric and esophagogastric junction cancer

Clinical effects of different types of flaps selected according to local conditions in the treatment of diabetic foot defects

BackgroundThe repair of diabetic foot defects (DFD) is a major challenge in clinical practice. The purpose of this study was to investigate the difference in clinical efficacy of different flap techniques in repairing DFD wounds, and to compare the difference in clinical efficacy of anterolateral thigh perforator flap (ALTP) in repairing DFD and non-DFD.MethodsThis study is a retrospective clinical study of different types of flap reconstruction in patients with DFD admitted to our hospital from January 2010 to December 2021. A total of 40 patients with DFD and 43 patients with non-DFD were included in this study. Detailed preoperative basic information, intraoperative details, postoperative complications and long-term follow-up results were collected.ResultThe comorbidities, wound infection and wound duration of DFD group were more serious than those of non-DFD group. In addition, the incidence of complications was higher in DFD group, the wound healing time was longer, the aesthetic evaluation, the functional recovery rate of ankle joint and the sensory recovery effect of flaps were worse.ConclusionIn this study, it is concluded that different flap techniques can obtain better clinical efficacy in repairing DFD wounds. Compared with non-DFD wounds, the postoperative risk of DFD wounds using free ALTP flaps is higher, but the risk can be reduced by reasonable preoperative vascular examination. Free flap can deal with various irregular wounds and provide more options for clinical repair.Level of evidenceIII, Case–control study.

Root Coverage in Miller's Class 3 Gingival Recession using a Laterally Positioned Flap with Advanced PRF: A Two-year Follow-up Case Report

Introduction: Gingival recession, marked by the apical migration of gingival tissue, presents aesthetic and functional challenges. The laterally positioned flap (LPF) technique, often used for localized root coverage, remains effective, particularly when combined with advanced platelet-rich fibrin (A-PRF). Case Report: A 23-year-old male presented with Miller Class III gingival recession on tooth 41, with clinical attachment loss of 4.5 mm and high frenum attachment. A treatment plan involved the revised LPF technique, A-PRF membrane application, and frenectomy. Surgical Procedure: Following patient consent and scaling, a sulcular incision was made, and flaps were elevated. A-PRF was prepared and placed over the exposed root, with the flap secured by sutures. Post-operative Care: The patient received antibiotics and analgesics, with follow-up at 2 years showing a 4 mm gain in clinical attachment level and complete root coverage. Results: The combination of the LPF technique and A-PRF effectively managed Miller Class III gingival recession, restoring both function and aesthetics. Conclusion: This case underscores the efficacy of using A-PRF with the LPF technique for treating gingival recession, offering a reliable approach for restoring the keratinized gingival zone.

Combination of the Endoscopic Septonasal Flap Technique and Bioabsorbable Stents for Repair of Congenital Choanal Atresia in Neonates and Infants: A Prospective Study

Background: Choanal atresia and stenosis are the most common craniofacial abnormalities of the nose and often require more than one corrective surgery or can lead to life-threatening airway obstruction. Objectives: To evaluate the long-term outcomes of the endoscopic septonasal flap technique combined with silicone stents for the repair of congenital choanal atresia and to determine independent predictors of surgical success. Methods: This study was designed as a review of prospectively collected data. The study included 40 patients diagnosed with choanal atresia due to congenital nasal obstruction at our hospital's otolaryngology clinic. The demographic characteristics and hospital information of the cases were recorded. Patients with congenital choanal atresia were operated on using the endoscopic septonasal flap technique combined with silicone stents. The surgical results were evaluated. Results: Out of the 40 patients, 23 (57.5%) were female and 17 (42.5%) were male, with a mean age of 90 days, ranging from 2 days to 1650 days. The atretic plate was bilateral in 23 patients (57.5%) and unilateral in 17 (42.5%). The types of atresia among the cases were 14 (35%) bony, 17 (42.5%) membranous, and 9 (22.5%) mixed atresia. Postoperative restenosis developed in 7 (17.5%) of the cases. Revision was needed in 10% (n = 4) of the operated bilateral choanal atresia cases and 7.5% (n = 3) of the unilateral choanal atresia cases. In cases diagnosed with bilateral choanal atresia, oxygen need, malnutrition, follow-up time in the intensive care unit, and follow-up time in the ward were significantly longer (P < 0.05). Conclusions: The Septonasal flap technique combined with silicone stents may be effective in preventing potential complications and restenosis after surgery.

Surgical Reconstruction in Malignant Eyelid Tumors.

To report the histopathological subtypes of malignant eyelid tumors treated surgically in the author's clinic and to present the author's graft and flap preferences in the reconstruction of the eyelid defect after surgical excision. This retrospective study included 33 patients who underwent malignant eyelid tumor excision, followed by eyelid reconstruction. A frozen section was performed during surgery to assess surgical margins in all patients. Demographic characteristics, histological classification, localization, and size of the tumor, postoperative defect size, follow-up period, complications, and recurrence rate were recorded. Of the patients with a mean age of 66.6 ± 15.3 (range: 23-94), 15 (45.5%) were females and 18 (54.5%) were males. The lower eyelid was the most commonly involved site in 27 (81.8%) patients. Basal cell carcinoma was the most frequently diagnosed type of malignant cancer in 81.8% (n = 27) of the cases. Among the tumor subtypes, nodular type basal cell carcinoma was the most frequently observed subtype in 10 (30.3%) patients. Wide excision with different flap and graft techniques was performed in 26 (78.8%) patients with defect sizes of 40% or larger. In the author's study, the most preferred flap technique for anterior lamella reconstruction was the Tenzel semicircular flap (30.3% n = 10). The most frequently preferred flap for posterior lamella reconstruction was the Hughes tarsoconjunctival flap (30.3% n = 10). There were no flap or graft failures in any of the author's cases. In the treatment of malignant eyelid tumors, different local flap and graft techniques selected according to the size of the defect have successful anatomical results in reconstructive surgery after frozen section controlled excision.

Embracing Robotics in Microsurgery: Robotic-Assisted Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

The integration of robotic-assisted surgery (RAS) has transformed various surgical disciplines, including more recently plastic surgery. While RAS has gained acceptance in multiple specialties, its integration in plastic surgery has been gradual, challenging traditional open methods. Robotic-assisted deep inferior epigastric perforator (DIEP) flap breast reconstruction is a technique aimed at overcoming drawbacks associated with the traditional open DIEP flap approach. These limitations include a relatively large fascial incision length, potentially increasing rates of postoperative pain, abdominal bulge, hernia rates, and core weakening. The robotic-assisted DIEP flap technique emerges as an innovative and advantageous approach in fascial-sparing abdominal autologous breast reconstruction. While acknowledging certain challenges such as increased operative time, ongoing refinements are expected to further improve the overall surgical experience, optimize results, and solidify the role of robotics in advancing reconstructive microsurgical procedures in plastic surgery. Herein, the authors provide an overview of robotic surgery in the context of plastic surgery and its role in the DIEP flap harvest for breast reconstruction.

Hug Flap and Hamdi Hammock: Two Innovative Techniques for Enhancing Aesthetic Outcomes in Deep Inferior Epigastric Artery Perforator Breast Reconstruction.

Achieving optimal aesthetic outcomes in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction remains a challenge, often necessitating additional procedures for refinement. This study presents two innovative techniques (the hug flap and Hamdi hammock) aimed at enhancing breast projection and inframammary fold (IMF) definition in DIEP flap reconstruction. The hug flap technique uses de-epithelialized caudal mastectomy skin to augment breast projection, whereas the Hamdi hammock uses a percutaneous purse-string suture to define the IMF. A retrospective review of 782 patients who underwent DIEP flap breast reconstruction between 2007 and 2023 was conducted. The hug flap group required significantly less additional fat grafting compared to other techniques (11% versus 27% and 22%). No total flap losses occurred in the hug flap group, and fat necrosis rates were low. The Hamdi hammock was used in 405 patients with a mean of two lipofilling sessions. Complications were minor and no stitches required removal. The hug flap and Hamdi hammock techniques offer effective and safe methods for enhancing breast projection and IMF definition in DIEP flap reconstruction. These techniques may reduce the need for additional procedures and improve aesthetic outcomes.

Combined use of coronally positioned flap and tunnel technique

Combined use of coronally positioned flap and tunnel technique

Outcomes of the Lateral Caval Flap and Conventional Techniques for Repair of Right-Sided Partial Anomalous Pulmonary Venous Connection in Adults

Outcomes of the Lateral Caval Flap and Conventional Techniques for Repair of Right-Sided Partial Anomalous Pulmonary Venous Connection in Adults

Apically Positioned Flap Technique for Crown Lengthening Procedure

Apically Positioned Flap Technique for Crown Lengthening Procedure

Changes in practices concerning urethral stricture surgery: Analysis of French data for the period 2013–2022

IntroductionThe prevalence of urethral stricture is estimated at 0.9%. American, European and French recommendations have reduced the place of endoscopic treatments due to their poor outcomes, especially in the case of repeated procedures. Urethroplasty is the new reference treatment for urethral stricture. Our aim was to assess the evolution of national practices from 2013 to 2022. Material and methodsWe collected national CCAM coding data for all procedures involving urethral stricture surgery using the Scansanté internet platform produced by the Technical Agency for Information on Hospitalization, which prospectively collects all procedures coded according to CCAM coding from public, liberal and ESPIC healthcare structures. ResultsThe overall number of urethral surgical procedures has been steadily increasing over the past 10 years. Endoscopic procedures remain largely predominant in 2022, totaling 23,982, but have remained stable over the decade. Urethroplasties have been on the rise since 2019, reaching 1600 cases in 2022 compared with 1100 cases in 2020. Although urethrotomies currently outnumber urethroplasties by a factor of 10, this ratio has been consistently decreasing since 2016. The most significant contributor to the 10-year increase is urethroplasty by augmentation, particularly free flap techniques on the anterior urethra. Resection-anastomosis and urethrostomy techniques have remained stable. DiscussionIn 2022, endoscopic treatments remain by far the majority, but urethroplasties are on the increase. A significant number of patients can benefit from initial endoscopic treatment because short bulbar localization is the most common presentation, but long-term success rates are poor compared to urethroplasty, which boasts approximately 80% success rates. Urethroplasty should no longer be considered a last-resort surgery but rather a reference technique in treating urethral stricture.

Meningomyelocele defect report: surgical technique selection

Aims: Surgical repair of meningomyelocele is important in terms of infection, cerebrospinal fluid (CSF) leakage, and preservation of neural structures. While there are numerous techniques available for repair, there are few guidelines on when flap repair should be performed. In this study, we employed a method to select the surgical technique. Methods: Thirty-two patients with meningomyelocele who underwent surgery were included in the study. The decision to use or not to use a flap was based on the ratio of defect height to width and the ratio of the axillary line to defect width. Results: Fasciocutaneous transposition flap (FTF) repair was performed in 17 patients, whereas primary repair was performed in 15 patients. There was no statistically significant difference between the groups in terms of preoperative characteristics of the patients. In the FTF group, one patient experienced necrosis at the wound site, and one patient developed a cerebrospinal fluid fistula. In the primary repair group, necrosis was observed in one patient, CSF fistula developed in two patients, and central nervous system infection developed in one patient. No statistically significant difference was found between the groups in terms of complications. Conclusion: The results obtained in the present study suggest that the shape of the defect and the ratio of intact tissue to defect size are more important than the size of the defect itself in achieving appropriate tension during repair. By employing the patient selection guidelines we achieved successful outcomes using a different flap technique.

Our 40 Years' Experience on Face and Neck Lift Procedures with High-SMAS Flap Techniques: How to Manage Secondary and Tertiary Surgeries.

Facial aging drives a growing demand for esthetic procedures, with nonsurgical options often falling short in longevity compared to surgery. Despite primary face and neck lift techniques receiving substantial attention, revision procedures have been relatively overlooked in terms of their unique surgical management, complication incidence, and preventive strategies. The authors present a 40-year experience with revision face and neck lifts, comprising 283 cases. The primary focus was on the high-SMAS flap technique in revision surgeries, with data collected on complications compared to primary procedures and existing literature. Secondary analysis investigated the time-lapse between primary and revision surgeries in the author's series (secondary and tertiary rhytidectomy) compared to the literature findings. Out of 283 cases, 232 were secondary and 51 were tertiary procedures. Overall complication rates in secondary cases mirrored those of primary procedures, with no statistically significant difference observed (p > 0.05). The mean interval between procedures was 9.0years (range: 3.4-28.8years), with a significant statistical difference (p < 0.05) observed between the first and second procedures (10.7years, range: 3.8-18.8years) and the second and third procedures (7.8years, range: 3.5-10.8years). Results indicate that high-SMAS flaps yield consistent and satisfying outcomes, even in secondary and tertiary cases. Complication rates are comparable to primary surgeries, underscoring the importance of meticulous attention to detail in managing the complexities associated with previous surgeries and the aging process. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .