Hinge Flap Research Articles

Hinge Flaps in Facial Reconstruction

Hinge Flaps in Facial Reconstruction

Hinge Flaps in Facial Reconstruction

Hinge Flaps in Facial Reconstruction

Corneal Hysteresis, Resistance Factor, Topography, and Pachymetry After Corneal Lamellar Flap

To measure prospectively the early changes in corneal hysteresis, topography, and pachymetry after the creation of a stromal flap cut without laser photoablation. A 37-year-old man was referred for a bioptic procedure to correct for compound myopic astigmatism in the left eye. A 159-microm-thick 8x8.5-mm superior hinged flap was created with a mechanical microkeratome in the left cornea. Changes in the corneal hysteresis, corneal resistance factor, Goldmann correlated intraocular pressure (lOP), corneal compensated IOP, anterior and posterior topography, and optical and ultrasound pachymetry were monitored prospectively before and at 1 hour, 1 day, 5 days, and 25 days after flap creation. The right eye served as a control. In the left eye, corneal hysteresis and corneal resistance factor decreased immediately after the flap cut and remained lower than preoperatively at 1 hour, 1 day, 5 days, and 25 days. Corneal compensated IOP varied significantly less than Goldmann correlated IOP in both eyes. Central flattening of the horizontal meridians was observed on the difference topography maps. The values of the left eye posterior best fit sphere increased after the flap cut. Increased central corneal thickness occurred immediately after the flap cut and decreased over time without returning to its preoperative value. The creation of a stromal flap can modify the biomechanical properties of the cornea, including a reduction in corneal hysteresis. The topographic changes were consistent with previously reported cases of flap cut in normal corneas.

LASIK Flap Characteristics Using the Moria M2 Microkeratome With the 90-µm Single Use Head

To evaluate the accuracy and consistency of corneal flap thickness, horizontal diameter, and hinge size with the Moria M2 90-microm single use head. Fifty-two myopic patients (104 eyes), mean age 32.6 years, underwent bilateral LASIK with a superior hinged flap using the Moria M2 microkeratome (90-microm single use head). Prospective evaluation included flap thickness (subtraction method), diameter, hinge size, interface particles, intraoperative complications, and visual recovery. The mean preoperative spherical equivalent refraction was -5.72 +/- 2.59 diopters (D) (range: -2.88 to -10.75 D) and -5.84 +/- 2.73 D (range: -3.13 to -9.38 D) for right and left eyes, respectively. The mean preoperative central corneal thickness was 548 +/- 24 microm and 547 +/- 25 microm for right and left eyes, respectively. The mean preoperative steepest K was 44.12 +/- 1.28 D and 44.41 +/- 1.27 D for right and left eyes, respectively. Corneal diameter (white-to-white) was 12 +/- 0.4 mm and 11.9 +/- 0.4 mm for right and left eyes, respectively. The mean postoperative flap thickness was 109 +/- 18 microm (range: 67 to 152 microm) and 103 +/- 15 microm (range: 65 to 151 microm) for right and left eyes, respectively. The mean postoperative flap diameter was 9.4 +/- 0.3 mm (expected mean according to the nomogram given by the company was 9.5 mm). The mean postoperative hinge chord was 4.4 +/- 0.4 mm (expected mean 4.2 mm). No interface particles were detected on slit-lamp examination. The Moria M2 90-microm single use head is safe with reasonable predictability for LASIK flap creation.

Surgical Pearl: Peripheral crescentic excision with hinge flap for treatment of pilar cysts

Pilar cysts are frequently encountered benign neoplasms of the scalp and are a common reason for referral to dermatologists.1 In lesions that are not inflammed and small, simple extraction is usually performed through the use of a small overlying elliptical incision or through access using a 3 mm to 4 mm punch.2 Larger cysts, especially those greater than 1.5 cm to 2.0 cm, often act as tissue expanders, creating overlying skin redundancy requiring removal in order to achieve a smooth contour. To ameliorate this redundancy, a larger ellipse is often required, extending well beyond the margins of the cyst resulting in removal of normal surrounding tissue, and subsequently, a larger scar.

Surgical closure of the larynx for intractable aspiration, using double hinged flaps of the vocal folds and false vocal folds

We report a new surgical procedure to treat intractable aspiration: closure of the larynx, using double hinged flaps of the vocal folds and false vocal folds. The anterosuperior portion of the thyroid cartilage is ablated. A small horizontal incision is made just above the anterior commissure and is continued posteriorly along the laryngeal ventricle; these incisions are continued across the posterior wall of the glottis. Incisions are made into the bilateral vocal folds and false vocal folds in order to create the hinged flaps. The glottis and the supraglottis are closed by approximating the bilateral vocal folds and false vocal folds hinged flaps. Superiorly or inferiorly based sternohyoid muscle pedicles are then inserted into the dead space between the approximated bilateral vocal folds and false vocal folds hinged flaps. The removed lamina of the thyroid cartilage is obliterated between both sternohyoid muscle flaps to enforce the closure of the larynx.

Post-Traumatic Reconstruction of the Enucleated Contracted Eye Socket

Contracted eye socket is a constant cosmetic embarrassment to the patient. It does not only render patients unable to maintain eye prosthesis, but it becomes a source of chronic discharge and irritation. Traumatic injuries to the orbit and neighboring soft tissue lead to a contracted eye socket. To evaluate the use of full thickness and thick split thickness skin graft in the reconstruction of contracted eye socket with achieving satisfactory cosmetic results we used bilateral fish tail incision in continuity with the transverse incision on the back of the eye socket for rising of two unipedicle hinge flaps for creation of upper and lower fornices. Fixation of full-thickness and thick split-thickness skin graft to the created raw area by stitch and splint (non-adherent tulle and eye prosthesis).Twenty-six patients with contracted eye sockets treated with above method from February, 2004 to March, 2005. Eye sockets with adequate size were created in 22 patients and the results were satisfactory, four patients had unsatisfactory results due to partial loss of the full thickness skin graft. We believe that thick split thickness skin graft can be effectively used well than full thickness skin graft in the reconstruction of the contracted eye socket with uncomplicated problems.

The Incidence and Risk Factors for Developing Dry Eye After Myopic LASIK

To determine the incidence of dry eye and its risk factors after myopic laser-assisted in situ keratomileusis (LASIK). Single-center, prospective randomized clinical trial of 35 adult patients, aged 24 to 54 years, with myopia undergoing LASIK. setting and study population: Participants were randomized to undergo LASIK with a superior or a nasal hinge flap. They were evaluated at 1 week and 1, 3, and 6 months after surgery. intervention: Bilateral LASIK with either a superior-hinge Hansatome microkeratome (n = 17) or a nasal-hinge Amadeus microkeratome (n = 18). main outcome measures: The criterion for dry eye was a total corneal fluorescein staining score > or =3. Visual acuity, ocular surface parameters, and corneal sensitivity were also analyzed. Cox proportional-hazard regression was used to assess rate ratios (RRs) with 95% confidence intervals. The incidence of dry eye in the nasal- and superior-hinge group was eight (47.06%) of 17 and nine (52.94%) of 17 at 1 week, seven (38.89%) of 18 and seven (41.18%) of 17 at 1 month, four (25%) of 16 and three (17.65%) of 17 at 3 months, and two (12.50%) of 16 and six (35.29%) of 17 at 6 months, respectively. Dry eye was associated with level of preoperative myopia (RR 0.88/each diopter, P = .04), laser-calculated ablation depth (RR 1.01/microm, P = 0.01), and combined ablation depth and flap thickness (RR 1.01/microm, P = 0.01). Dry eye occurs commonly after LASIK surgery in patients with no history of dry eye. The risk of developing dry eye is correlated with the degree of preoperative myopia and the depth of laser treatment.

じょく創用軟膏が有効であった喉頭全摘術後咽頭皮膚ろう例

Pharyngocutaneous fistula is one of the most critical complications of total laryngectomy. When we see this complication, we have to drain saliva out of the fistula. One month later, the fistula is closed by surgery using a hinge flap and deltopectoral flap. In this paper we reported a patient, whose pharyngocutaneous fistula could be closed by conservative therapy only. Bucladesine sodium, that is used for pressure ulcers, was administrated for the treatment. We think this conservative therapy is useful for the treatment of cases of pharyngocutaneous fistula whereby it is difficult to re-operate because of a poor general state.

Effect of hinge location on corneal sensation and dry eye after laser in situ keratomileusis for myopia

To evaluate the effects of a superior or nasal hinge location on corneal sensation and dry eye after laser in situ keratomileusis (LASIK). Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. This prospective randomized masked study included 47 patients having bilateral myopic LASIK surgery. The first eye was randomly assigned to have a nasal or superior hinge flap; the fellow eye had the alternate location. Visual acuity, contrast sensitivity, corneal sensation, basic secretion test, tear film breakup time, conjunctival and corneal staining, and a subjective questionnaire were evaluated preoperatively and postoperatively at 1 week and 1, 3, and 6 months. The Wilcoxon signed rank test and paired t test were used for comparison. Dry eye occurred with the same frequency in both groups. However, eyes with the nasal hinge had significantly better nasal sensation than those with the superior hinge (P<.05) at 1 month. Better nasal corneal sensation was found at 1 month in the nasal hinge group but there was no difference in any other parameters measured.

Does Hinge Position Affect Dry Eye after Laser in situ Keratomileusis?

Purpose: To evaluate the effect of corneal flap hinge position on dry eye after laser in situ keratomileusis (LASIK). Methods: In a prospective double-masked randomized controlled clinical trial, 212 consecutive eyes of 106 myopic patients underwent LASIK; in each patient, one eye was randomly assigned to the superior hinge and the other eye to the nasal hinge procedure. The patients were examined pre-operatively and 1 week, 1 month, 3 months and 6 months after surgery for visual acuity, fluorescein tear film breakup time and Schirmer’s baseline tear secretion test; a subjective evaluation of dry eye symptoms was accomplished by the Ocular Surface Disease Index (OSDI^®) questionnaire at the 1-month, 3-month and 6-month postoperative visits. Results: Tear film breakup time was not significantly different with the nasal or superior hinge flap technique at the preoperative, 1-week, 1-month, 3-month and 6-month visits (p > 0.05 for all comparisons between two groups). No significant difference between the two groups was found for the amount of Schirmer’s baseline tear secretion test at pre- and postoperative visits (p > 0.05 for all comparisons between two groups). Subjective evaluation of symptoms also showed no significant difference at the 1-month, 3-month and 6-month postoperative visits. Conclusions: The nasal and superior hinge flap methods do not affect signs and symptoms of dry eye after LASIK. We recommend that selecting the hinge position should be done according to the surgeon’s preference and ease.

Flap-induced and Laser-induced Ocular Aberrations in a Two-step LASIK Procedure

To identify aberrations created by making a laser in situ keratomileusis (LASIK) flap and treating the refractive error with laser ablation at a later date. Twenty-two eyes (11 patients) underwent a two-step LASIK procedure with the Alcon LADAR-Vision laser (Alcon Laboratories, Ft Worth, Tex). In the first step, a flap was created, and 1 month later the flap was lifted and laser ablation performed. Aberrations were measured with the LADARWave wavefront measurement device preoperatively, after making the flap (1 day, 1 week, 1 month) and after laser treatment (1 week and 3 months). Two different microkeratomes were used (Moria M2 [Moria; Antony, France] and SKBM [Alcon]). With the SKBM, all flap hinges were nasal; with the Moria M2, the flap hinge was randomly selected as superior in one eye and nasal in the other. A slight hyperopic shift was seen in the manifest and wavefront refractions at 1 week and 1 month after flap creation for the Moria M2, but not for the SKBM. Statistically significant change in manifest sphere with the Moria M2 showed a mean shift at 1 month of +0.50 +/- 0.08 diopters (D) whereas the SKBM showed no mean shift, but less reproducibility, +0.06 +/- 0.17 D. Higher order aberrations after flap creation were statistically significantly higher for all except coma with both microkeratomes, but with no predictable trends observed. Although higher in magnitude, post flap aberrations were less than one quarter the increase noted in post laser aberrations, except for "other terms." Creating a LASIK flap induces changes in lower and higher order ocular aberrations. The change in lower order terms is microkeratome dependent. Higher order aberrations increase to a much larger degree after laser than after flap, making a two-step procedure unnecessary in conventional LASIK.

Temporal hinge laser in situ keratomileusis: Maximizing treatable stromal bed area

To compare the treatable stromal bed area created by a temporal versus superior hinge laser in situ keratomileusis (LASIK) flap. Assil Sinskey Eye Institute, Santa Monica, California, USA. A randomized retrospective case review was performed of 2 subgroups (each with 12 eyes) of a cohort having LASIK for the correction of hyperopic astigmatism between August 2001 and March 2002. In 1 group, superior hinge LASIK was performed using the standard surgical technique for the 9.5 mm Hansatome suction ring. In the other group, the keratome was rotated 90 degrees such that a temporal hinge LASIK was performed with the 9.5 mm Hansatome suction ring. Corneal curvature (central mean keratometric value), flap diameter (arc length), and treatable stromal bed area were measured in each eye, and mean values were compared between the 2 groups. A treatable stromal bed area was defined as the circle centered over the entrance pupil, tangent to the hinge (devoid of hinge interference). The mean keratometry and mean flap diameter in the superior and temporal hinge groups measured 42.3 diopters (D) and 9.68 mm and 42.2 D and 9.69 mm, respectively. These differences were not significant (P=.882 for average keratometry and P=.943 for flap diameter). The mean treatable stromal bed area in the superior versus temporal hinge group measured 44.14 mm(2) and 62.25 mm(2), respectively. The difference between the 2 groups was highly significant (P<.0001). A large diameter, temporal hinge LASIK flap yielded a significantly greater area of treatable corneal stromal bed than a superior hinge flap. There are several clinical and theoretical advantages of optimizing stromal bed exposure for any given flap diameter.

Anatomic correction of polysyndactyly of the fifth toe fused with the fourth toe

A new surgical technique for correction of polysyndactyly with the fifth toe fused with the fourth toe was devised. The technique consists of the creation of a dorsal rectangular flap on the dorsum of the syndactyly web for the new fourth web, making a medially based plantar rectangular flap on the plantar surface of the fifth toe, and a sixth toe-tip-based rectangular hinge flap to reconstruct the lateral side of the fourth toe and medial side of the new fifth toe, respectively. All suture lines are intended to be located in the transition of the plantar and dorsal surfaces of the web and digit. This technique is characterised by accurate anatomic reconstruction, which produces better aesthetic results with no wasting of any skin components.

Réparation par laryngotrachéoplastie cutanéochondromyocutanée d'une perte de substance trachéale antérieure induite par un tube de Montgomery

A 37-year old patient was referred in 2000 for reconstruction of the anterior tracheal wall eroded by a Montgomery T-tube. A four-layer laryngotracheoplasty was proposed to the patient. The endotracheal plane was reconstructed by a bilateral random pattern quadrangular skin hinge flap raised from both sides of the defect. The chondral plane was realized with conchal cartilage. This cartilage graft was covered with an inferiorly based sternocleidomastoid flap. The fourth layer was a mesh split-thickness skin graft. Satisfactory and lasting results were observed during a three-year follow-up. Few articles deal specifically with tracheal reconstruction after anterior wall erosion induced by a Montgomery-T tube. We found no mention of the described four-layer flap in the literature.

Computational Study of the Risø-B1-18 Airfoil with a Hinged Flap Providing Variable Trailing Edge Geometry

A comprehensive computational study, in both steady and unsteady flow conditions, has been carried out to investigate the aerodynamic characteristics of the Risø-B1-18 airfoil equipped with variable trailing edge geometry as produced by a hinged flap. The function of such flaps should be to decrease fatigue-inducing oscillations on the blades. The computations were conducted using a 2D incompressible RANS solver with a k-w turbulence model under the assumption of a fully developed turbulent flow. The investigations were conducted at a Reynolds number of Re = 1.6 · 106. Calculations conducted on the baseline airfoil showed excellent agreement with measurements on the same airfoil with the same specified conditions. Furthermore, a more widespread comparison with an advanced potential theory code is presented. The influence of various key parameters, such as flap shape, flap size and oscillating frequencies, was investigated so that an optimum design can be suggested for application with wind turbine blades. It is concluded that a moderately curved flap with flap chord to airfoil curve ratio between 0.05 and 0.10 would be an optimum choice.

Corneal flap thickness and topography changes induced by flap creation during laser in situ keratomileusis

To determine the corneal flap thickness profile produced by 3 microkeratomes and the topographic changes induced by flap creation in laser in situ keratomileusis (LASIK). Cornea and Refractive Surgery Unit, Instituto de Microcirugia Ocular de Barcelona, Autonoma University, Barcelona, Spain. In this prospective consecutive nonrandomized comparative study, patients were divided into 2 groups. In Group 1 (75 eyes), 3 microkeratomes were used: Moria LSX One, Moria M2, and Amadeus (AMO); 25 eyes per microkeratome. Pachymetry was measured with a DGH pachymeter in the center of the cornea and 3.0 mm from the center at 4 cardinal points (superior, inferior, nasal, and temporal; 3 measurements at each point) before and after the cut. The flap thickness in each sector was calculated by subtracting the mean post-flap corneal thickness from the mean pre-flap corneal thickness. In Group 2 (33 eyes), the M2 microkeratome with a 130 microm plate was used to create a superotemporal hinged flap (9 eyes) or a superonasal hinged flap (24 eyes). The topographic change induced by the microkeratome cut was evaluated using 4 sequential data acquisitions by the Keratron Scout topographic unit (Optikon) before and immediately after the cut (before laser ablation). Cardinal and oblique astigmatism and change in the axis were calculated by vectorial analysis of the simulated keratometry. Topographic Zernike analysis was performed in a subgroup. With the LSX One microkeratome, the mean flap thickness was 151.7 microm centrally, 161.9 microm superiorly, 151.4 microm inferiorly, 156.1 microm temporally, and 167.5 microm nasally. There was no statistically significant difference between the areas studied (P<.05). With the M2, the mean flap thickness was 131.7 microm centrally, 155.5 microm superiorly, 146.7 microm inferiorly, 143.7 microm temporally, and 160.5 microm nasally. There was a statistically significant difference between flap thickness centrally and in the other areas (P>.05). With the Amadeus microkeratome, the mean flap thickness was 140.0 microm centrally, 152.5 superiorly, 128.5 microm inferiorly, 145.0 microm temporally, and 147.0 microm nasally. Statistically significant differences (P>.05) were found in the 4 sectors of the flap. With vectorial analysis, there was no statistically significant difference between superonasal and superotemporal hinge placement in the cardinal and oblique components but there was a statistically significant difference in the axis change with both placements (P>.05). The LSX One microkeratome was the most predictable. A significant difference was noted in all sectors except superiorly with the M2 and in all sectors with the Amadeus. No differences between nasal and superior hinge placement were found with the M2. Topographic Zernike analysis demonstrated a difference in the orientation of the induced coma as a function of hinge position.

Repair of Pharyngocutaneous Fistulas with the Submental Artery Island Flap

Pharyngocutaneous fistulas after total laryngectomy are difficult to manage and are a cause for significant morbidity to the patient. When fistulas fail to close with conservative measures, debridement and flap closure are indicated. Although a number of techniques to repair pharyngocutaneous fistulas are described, each of these procedures has its drawbacks. The authors have used the submental island flap to close postoperative pharyngocutaneous fistulas in nine male patients during the past 4 years. The mean patient age was 65 years (range, 57 to 75 years). The submental island flap is based on the submental artery, a branch of the facial artery. The inner aspect of the fistula was initially formed using hinge flaps on the skin around the fistula. Once a watertight closure of inner side was created, the skin defect was closed with the submental island flap. The maximum flap size was 6 x 3 cm and the minimum size was 4 x 2 cm (average, 4.8 x 2.7 cm) in this series. Direct closure was achieved at all donor sites. Patients were followed for 6 months to 4 years. No major complication was noted in the postoperative period. All patients have successfully recovered their swallowing function. The submental island flap is safe, rapid, and simple to elevate and leaves minimal donor-site morbidity. The authors believe that this technique is a good alternative in the reconstruction of pharyngocutaneous fistulas. Application of the technique and results are discussed.

Expression of Neurotransmitter Receptors in Normal and Inflamed Human Conjunctival Epithelium

To report the time course for the return of corneal sensation following laser in situ keratomileusis (LASIK).University-based retractive surgery practice.Twenty-eight eyes of 18 patients having LASIK were evaluated. Preoperative and postoperative corneal sensation at the nasal flap hinge, at the central cornea, and within the temporal flap edge were measured before and after LASIK for a 3 week period using the Cochet–Bonnet esthesiometer (Luneau).Corneal sensation initially decreased in all 3 positions of the flap measured after LASIK; the greatest decrease was in the central cornea. Near preoperative corneal sensation returned by 3 weeks. The degree of sensation loss did not appear to correlate with the ablation depth.Corneal sensation is significantly decreased for approximately 2 to 3 weeks after LASIK, centrally greater than nasally at the flap hinge or temporally within the flap edge, but it generally returns to near the preoperative level by 3 weeks postoperatively.

The effect of hinge position and depth plate on the rate of recovery of corneal sensation following LASIK

To evaluate and compare the effect of hinge position and flap thickness on recovery rate of corneal sensation after (LASIK). Prospective, randomized clinical study. Forty eyes of 40 patients underwent LASIK to correct myopia ranging from -1.00 to -2.50 diopters. Corneal sensitivity was measured preoperatively and each month after surgery until recovery to preoperative level. The nasal-hinged ACS microkeratome (NH) with depth plates of 130 and 160 microm and the superior-hinged Hansatome microkeratome (SH) with depth plates of 160 and 180 microm were used for corneal flap creation. The eyes were divided into four groups according to the hinge position and depth plate (DP): group 1, NH and 130 microm DP; group 2, NH and 160 microm DP; group 3, SH and 160 microm DP; group 4, SH and 180 microm DP. Corneal sensitivity returned to preoperative level after 3.7 (+/- 0.4), 4.4 (+/- 0.6), 5.4 (+/- 0.8), and 5.8 (+/- 0.9) months, respectively, in groups 1, 2, 3, and 4. Statistically significant differences were found between groups 1 and 2, but not between groups 3 and 4. Corneal sensitivity gradually returned to preoperative levels in all groups. Sensitivity of the hinge area was higher than other areas at every time point. The results suggest that after LASIK, hinge position and flap thickness seem to be important factors in the rate of return of corneal sensitivity. A thin flap with a nasally placed hinge is associated with the most rapid recovery of corneal sensitivity.