Ideal Donor Site Research Articles

The Effect of Adding Stromal Vascular Fraction (SVF) to Hydrocolloid Dressing to Enhance Healing of Donor Sites of Split Thickness Skin Grafts

Abstract Background Wound healing is complex process, which requires suitable environment to enhance the healing process. With the advancement in technology, many new wound dressings have been introduced for use on split-thickness skin graft donor sites to treat different types of wounds by targeting various aspects of healing process. An ideal donor site wound dressing can reduce pain, lower the risk of infection, encourage hemostasis, and accelerate the healing process. This dressing would also be simple to manage, simple to apply in the operating room, and affordable. The use of hydrocolloid dressing to promote healing of donor site of STSG is a well-established technique. Aim of the Work The main aim of this study was to evaluate the effect of adding Stromal Vascular Fraction (SVF) to Hydrocolloid Dressing to enhance reepithelization and quality of scars of donor Sites of Split Thickness Skin grafts. Patients and Methods Twenty-seven post burn and post traumatic patients admitted to plastic, burn and maxillofacial department in Ain Shams University hospitals which need coverage with STSG were included in this study. A prospective comparative interventional self-controlled clinical study was conducted on donor sites of STSG, In which donor sites of STSG were divided into two equal halves where the upper half was injected intradermally with SVF with application of hydrocolloid dressing (group A), and the other half was covered with hydrocolloid dressing only (group B).follow up of reepithelization at donor sites were evaluated at day 10th, 15th, 21th and 1 month post harvesting of STSG also Vancouver scar scale was used to assess the quality of the scar after 1 month. Results The result showed that among the studied population 51.9% were males and 48.2% were females with mean age of the study population was 33.37 ± 9.55 years ranged from 18 to 52 years. 85.2% of patients had burn raw areas, while only 14.8% had post-traumatic raw areas. The comparison between (group A) and (group B) according to time for reepithelization by days, we found that (group B) needed more time for healing by (18.56 ± 4.69) compared to (group A) which need (11.33 ± 1.92) days and this difference was statistically significant as p-Value <0.05. Also using Vancouver scar scale to assess the quality of scar, there was statistically significant difference between both (group A) and (group B) as (p-value = <0.001). Among study cases, there were only two cases (7.41%) where complicated by superficial infection, which settled in both halves of each case, was improved on repeated dressing. Conclusion The intradermal injection of SVF in donor site resulted in significant reduction in healing time, increased epithelium thickness and a significant improvement in scar quality with low rate of infection.

Bilateral Lumbar Artery Perforator Flaps for Breast Reconstruction: A Perforator Classification System.

Autologous breast reconstruction is continually evolving, with focus on the ideal donor site. This study presents 108 consecutive simultaneous lumbar artery perforator (LAP) flaps and a perforator classification system. A retrospective review of all LAP flaps was completed, and appropriate data were recorded. All simultaneous bilateral LAP flaps were included, and perforator patterns were assessed using CT angiography (CTA). Fifty-four patients (108 flaps) were included in the final review. The mean patient age was 50.7 years, and the mean body mass index was 26.6. Mean ischemia times for all flaps and grafts were 130 ± 64.5 and 300.6 ± 97.3 minutes, respectively. The average pedicle length was 4.6 ± 1.5 cm, and the average composite graft length was 6.2 ± 1.7 cm. Donor-site complications consisted of seromas (10 patients [19%]), hematomas (6 patients [11%]), procedural wounds (4 patients [8%]), and infections (2 patients [4%]). The total flap loss rate was 2.8%. Perforators were classified into categories based on pedicle pattern, lumbar spine level, and clusters, all in relation to posterior iliac bone as seen per CTA. Vascular pedicle patterns were categorized as type 1 (43.9%), 2 (45.6%), 3 (8.8%), or 4 (1.8%). Perforators were dissected at lumbar spine level L3 in 51.8% of patients, L4 in 46.5%, and L5 in 1.8%. The authors present a CTA-directed anatomic perforator classification system to assist in preoperative planning, dissection, and choice of the composite graft best suited for particular perforator patterns or calibers. Simultaneous LAP flaps can be performed successfully with excellent outcomes in cases unsuitable for other flaps. Therapeutic, IV.

Assessment of palatal mucosal thickness and location of the greater palatine foramen using cone-beam computed tomography: a retrospective study.

This study aimed to measure the palatal mucosal thickness and examine the location of the greater palatine foramen using cone-beam computerized tomography (CBCT). In this study, cone-beam computed tomography (CBCT) images of the maxillary posterior region of 120 subjects were evaluated. The palatal mucosal thickness (PMT), palatal width and depth, and location of the greater palatine foramen (GPF) were determined on CBCT. The differences in the palatal mucosal thickness according to gender and palatal width/palatal depth were analyzed. The location of the GPF related to the maxillary molars was noted. The mean palatal mucosal thicknesses from the canine to the second molar teeth were 3.66, 3.90, 4.06, 3.76, and 3.92mm, respectively. The mean PMT at the second premolar was statistically thicker than at other regions (p < 0,001). There was no relationship between PMT and gender. However, the palatal depth and width of the males were greater than females. (p = 0.004 and p = 0.014, respectively) PMT in the low palatal vault group had statistically higher compared to the high palatal vault group. (p = 0.023) Greater palatine foramen was mostly observed between second and third molar teeth. (48%). According to our results, first and second premolar regions can be preferable in soft tissue grafting procedures for safe and successful treatment outcomes. The measurement of the thickness of the palatal mucosa and the evaluation of the greater palatine foramen location before the surgical procedures are essential steps to harvest from the ideal donor site and to achieve optimal surgical outcomes.

Scrotal flap phalloplasty as temporary neophallus in infants and children with penile agenesis: Multi-institutional experience and long-term follow-up

Aphallia is a rare congenital disorder pertaining to genotypic males. Early surgical creation of a neophallus is recommended to reinforce the child's male gender-identity, favoring proper psychosexual development. Modern microsurgical techniques used to create a neophallus in adults are not recommended in children due to the invasiveness and complexity of the procedures, along with high complication rates. Scrotal flap phalloplasty is a simple and reproducible technique to create a temporary neophallus in prepubertal boys with aphallia. We present a multi-institutional experience, ten years after the initial description of the scrotal flap phalloplasty (SFP) technique, in which a flap from the well-developed scrotum is used to build a temporary neophallus, without obvious scars in patients with aphallia. The records of surgical neophalloplasty for aphallia patients from 4 centers between 2011 and 2021 were reviewed. All patients had at least one year follow-up to assess for short and long-term complications. Age at initial operation, associated anomalies, and other related surgical procedures were analyzed. The post-operative aesthetic result in all patients was satisfactory and has been maintained in the long-term follow-up, with all patients presenting a cylindrical structure resembling an uncircumcised penis, without evidence of significant contraction or loss of length. (Summary Figure) DISCUSSION: Non-microsurgical neophalloplasty techniques in patients with penile agenesis are temporary procedures that help to establish the body image and preserve the psychosexual development of the patient with aphallia. These techniques do not involve tissue transplant from a distant region, and are simpler to perform, with less scarring at the donor sites. Due to significant donor scars and considerable morbidity and complexity associated with the definitive phalloplasty techniques, we created a simple, reproducible and straightforward procedure to serve as a temporary neophallus in young boys with aphallia. As affected patients usually have a well-formed scrotum with normal and orthotopic testicles, it is the ideal donor site for a temporary neo-phallus in childhood. Furthermore, other donor sites are preserved for a definitive phalloplasty. There are limitations to this study, as quality of life could not be assessed and psychological or gender-identity investigations have not been carried out. None of these children have reached puberty, and hence decision and outcomes of definitive neophallus reconstruction has not been considered to date. Scrotal flap phalloplasty is a minimally invasive, simple and reproducible technique used to create a temporary neophallus in boys with aphallia, while waiting for definitive reconstructive surgery after puberty.

Evaluation of the outcomes of using iliac bone graft for reconstruction of traumatic orbital floor fractures.

Orbital floor fracture is common in facial trauma patients. Although treated through surgical repair, the orbital floor fractures are associated with risk of persisting sensibility disorders, enophthalmos, and permanent diplopia due to complex anatomy of the orbit, time of surgery, and the reconstructive material used for such repairing.Failure of early recognition and treatment of these traumatic injuries may result in functional and cosmetic problems. Autogenous bone grafts are the gold standard for reconstruction of maxillofacial defects. The iliac crest is also considered the most ideal donor site for bone grafting when a large amount of bone is needed. To assess the outcome of early repair of orbital floor fractures regarding enophthalmos, double vision, extrusion, and gait disturbance. A total of 15 patients, all with orbital floor fracture, were enrolled, of which 12 of them were having pure blow-out fractures and 3 patients had impure blow-out fractures. All had undergone primary surgical reconstruction of the orbital floor by autogenous anterior iliac crest within 5-14 days of the injury. The results were as follows: Postoperative complications at recipient site included diplopia (13.3%), enophthalmos (6.7%), and extrusion (6.7%). At the donor site, one patient had pain and the other had gait disturbances, both relieved within 1 month after treatment. Less complications were reported postoperatively with the use of nonvascularized autogenous iliac bone graft.

Correction of hand deformities after burns

Hand burns can lead to deformities even after successful primary healing. They are the most common cause of skin contracture involving the hand. This review article discusses ways to correct claw deformity, flexion contracture in the palm and finger, and web space contracture, which are post-burn hand deformities commonly encountered in clinical practice. Loss of skin is the end result in many cases of hand deformities after burns. Therefore, reinforcing the lost skin is the principle of corrective surgery. Even if the skin is thicker than the full-thickness skin, it will engraft if damage to the tissue and blood vessels of the recipient is minimized. The thicker the skin, the less re-contraction and growth occur. The foot is an ideal donor site for skin grafts on the hand. In particular, the instep or the area below the malleolar is a very good donor site. The first web space of the hand is very important for hand function, and it must be reconstructed with Z-plasty, a skin graft, and a free flap step by step according to the degree of contraction.

Parametric Multi-Scale Modeling of the Zygomaticus Major and Minor: Implications for Facial Reanimation.

Facial paralysis can severely impact functionality and mental health. Facial reanimation surgery can improve facial symmetry and movement. Zygomaticus minor (Zmin) and zygomaticus major (Zmaj) are 2 important perioral muscles, that function to elevate the upper lip, contributing to the formation of a smile. The objective of this study was to analyze the morphology in three-dimensional (3D) and quantify architectural parameters of Zmin and Zmaj. In ten formalin-embalmed specimens, Zmin and Zmaj were serially dissected and digitized at the fiber bundle level. The 2 muscles were modeled in 3D to construct high fidelity models. The 3D models were used to assess muscle morphology and quantify architectural parameters including mean fiber bundle length, physiological cross-sectional area, and line of action. Zygomaticus minor fiber bundles were oriented horizontally or slightly obliquely and had a muscular attachment to the medial modiolus. Zygomaticus minor was found to either have no partitions or medial and lateral partitions. Specimens with partitions were divided into type 1 and type 2. Type 1 consisted of a medial partition with fiber bundles attaching to the zygomatic bone at the inferior margin of the orbit. The type 2 medial partition attached to the lateral margin of the orbit to attach to the zygomatic bone. Zygomaticus major had obliquely oriented fiber bundles with most specimens having inferior and superior partitions attaching to the inferior aspect of the zygomatic bone. Zygomaticus major was found to have a greater mean fiber bundle length and physiological cross-sectional area than Zmin. The direction of the line of action of Zmin and Zmaj was closely related to fiber bundle arrangement. Detailed 3D anatomical understanding of Zmin and Zmaj, at the fiber bundle level, is critical for reconstructive surgeons performing dynamic facial reanimation. This data can be used to assist with selecting the ideal donor site for reconstruction.

The Ideal Donor Site Dressing: A Comparison of a Chitosan-Based Gelling Dressing to Traditional Dressings.

Donor site wound management is critical in split-thickness skin graft surgeries. These sites typically recover in 7 to 14 days due to the dermal-imbedded keratinocytes that promote skin regeneration. An ideal donor site dressing can help to mitigate pain, reduce infection risk, promote hemostasis, and accelerate healing times. Additionally, this dressing would be easy to apply in the operating room, easily managed, and cost-effective. Chitosan-based gelling dressings (CBGD) possess many of these qualities that make an ideal donor site dressing. We conducted a retrospective chart review of patients who received CBGD as part of their postoperative wound care plan. We collected data on infections, hemostasis, dressing failure, and hospital course over a 14-month period where CBGD was used as the donor site dressing. One hundred and fourteen patients were evaluated. We found an infection rate of 7%, a bleed-through rate of 1.8%, and a re-application rate of 9.6%. The average CBGD cost per patient was $75.15. CBGD has acceptable infection rates, and pain scores as traditional donor site dressings. However, it possesses several qualities of a suitable donor site dressing notably swift healing rates, impressive hemostatic property, and low cost. Our study supports the idea that CBGD is a suitable donor site dressing for split-thickness skin graft surgeries.

BEARD-A Potential Donor Site in Grade 6 and Grade 7 Alopecia: A Case Series.

Autologous hair transplantation has been the convention in cases of androgenic alopecia. Routinely, the occipital area serves as an ideal donor site. The advent of follicular unit extraction (FUE) has made body and beard hair harvest a possibility. Beard hair, in particular, has been far more sought after than other parts of the body. A case series of 20 patients have been documented wherein cases with Grade 6 and 7 androgenic alopecia have been treated with beard hair as an adjunct donor site. The local anatomy, procedural technicalities and method of harvesting have been emphasized. The pre, intra and postoperative records have been maintained. The advent of FUE paved way for minimal downtime, better cosmesis and less scarring facilitating the possibility of using non-scalp hair in hair restoration, thus increasing the overall donor graft availability. Beard hair has its characteristic differences when compared to the scalp hair. Alongside there exists an array of advantages and disadvantages. Minimal complications and potential advantages have encouraged the usage of beard graft in the recent past. In hindsight, beard to scalp transplantation is a worthwhile alternative in cases demanding an expanded source of donor hair which demands further literary contribution.

The vascular exploration of the proximal femoral artery perforator region, an ideal donor site to choose cutaneous flaps of thin, supple, and glabrous skin: A cadaveric study

The thigh region is a well-known area for harvesting cutaneous flaps for microsurgery replacement, given the characteristics of the skin: thin, flexible, and glabrous. We investigated the vascular pattern of 32 cadaveric anteroproximal thighs for the possibility of an extended harvesting area, which we call the proximal femoral artery perforator region. We injected colored, radio opaque latex in the external iliac artery and investigated the perforator branches from the superficial circumflex iliac, femoral common, superficial, and deep femoral (profunda femoris) arteries to the skin of the proximal femoral artery perforator region. This region was divided into 3 equal subregions (superior, medial, and lateral), and their perforators were counted and measured. There was no significant difference in the number of arterial pedicles across the three subregions: 30 superior, 35 inferolateral, and 27 inferomedial. The perforators had a cutaneous path in 81% of the cases, while 6% were musculocutaneous and 5% septocutaneous, without a significant difference in their proportion in the three subregions. The mean length and diameter of the pedicles were 5.39 ± 2.1 cm and 1.07 ± 0.4 mm, respectively, without significant differences in the three subregions. The proximal femoral artery perforator region is a suitable area to generate flaps of various sizes and shapes, as needed by the surgeon. All perforators were constant and possessed a sufficient diameter and length for a successful anastomosis during the surgical procedure. The donor site retains all technical advantages to successfully replace areas of glabrous skin.

Free neurosensory flap based on the accompanying vessels of lateral sural cutaneous nerve: anatomic study and preliminary clinical applications

Background The posterior aspect of the leg is an ideal donor site for flap surgery. In this study, the anatomy was investigated of the lateral sural cutaneous nerve (LSCN) and its accompanying artery, superficial lateral sural artery (SLSA), and a lateral sural neurocutaneous flap was designed. Methods Five fresh adult cadaver legs perfused with red latex were dissected to observe the course and relationship between LSCN and SLSA. The outer diameter of SLSA at its origin was measured. Then a lateral sural neurocutaneous flap was designed and used to repair soft tissue defects in six patients. Results The anatomic results showed that the SLSA gave rise to branches that followed the LSCN and ramified into terminals at the ramification of the nerve. It originated directly from the popliteal artery 4.2 ± 0.2 mm above the fibular head, where its outer diameter was 0.96 ± 0.23 mm. Several perforators penetrated from the crural fascia and anastomosed to the SLSA, creating a fine anastomotic network. The clinical results showed that the size of the flap ranged from 12 × 6 cm to 25 × 8 cm. All six flaps survived completely without complications. Follow-up ranged from 6 to 18 months with 11 months on average. The overall contour and sensory recovery of the flap were satisfied. Conclusion A free innervated flap may be elevated safely based on the LSCN and its accompanying vessels. It provides an alternative in reconstruction of soft tissue defects where sensory recovery is important.

In search of ideal donor site wound dressings

Background: Split skin grafting (SSG) is a commonly used reconstructive technique for wound cover. Donor site wounds (DSW) after split-skin graft harvesting are rather clean wounds. Depending on the thickness of the SSG, the DSW should re-epithelialize completely in 7 to 21 days. This study was initiated with a background to look for an ideal dressing for the management of DSW. Aim of the study was to compare efficacy of Cellulose acetate mesh, Collagen sheet, Hydrocolloid dressings and chlorhexidine tulle for donor site wound management after harvesting split thickness skin graft.Methods: 100 patients with 100 donor site wounds were included in the study. Patients were randomized into four different groups of 25 each, depending upon the type of dressings used to cover the wound. Data regarding time to complete wound healing and pain at the donor site were recorded on visual analogue scale (VAS). Requirement of pain killers during post-operative period were recorded. Complications like infection or hyper-granulation were also recorded.Results: The study included 72 males and 28 females. The primary objective was to observe the effectiveness of wound dressings in the treatment of DSWs and time to complete wound healing. In this context, collagen dressing was found to be the most effective in current study (p&lt;0.07) and also the least pain was experienced by the patients where collagen dressings were used.Conclusions: The study concluded that collagen dressings was best amongst the various dressings studied with average healing time of 9 days with least pain score over DSW.

Mandibular reconstruction using the deep circumflex iliac artery free flap: effect of the length of bone harvested on donor site morbidity

The aim of this study was to assess the amounts of pain and morbidity that are associated with the length of the harvested anterior iliac bone graft (cm), and their effect on the contour of the donor site and activities of daily life. A total of 62 patients who had mandibular reconstruction using an iliac bone graft were enrolled in this study at the Wuhan University Hospital. The same surgical standards were used throughout. We divided the patients into two groups depending to the length of the graft (<9cm or 9cm or more). The amount and duration of the pain, the time necessary to walk normally, abnormalities of sensation, contour of the donor site, length of the scar, and the patients’ satisfaction with the donor site were evaluated, and outcomes in the two groups compared. The worst pain after operation (p=0.001) the length of the scar (p=0.001), and the time needed before the patients were able to walk (p=0.001) differed significantly between the two groups. There was no significant difference between the two groups regarding other complications. The anterior iliac crest might still be considered to be an ideal donor site for large mandibular defects.

Technical refinements of the free medial sural artery perforator (MSAP) flap in reconstruction of multifaceted ankle soft tissue defects

BackgroundPeri-ankle defects are difficult to reconstruct due to sharp contours, thin skin, aesthetic value, function and footwear impact. The medial sural artery perforator flap (MSAP) is increasing in popularity as a thin and pliable flap. This study aims to demonstrate its versatility in reconstructing defects around the ankle area and our approach to insetting these flaps in difficult areas around the ankle without the need for subsequent flap revisions. MethodsA retrospective review of the senior author’s series of peri-ankle reconstructions using the MSAP flap was undertaken. ResultsBetween 2011–2015, 15 patients underwent peri-ankle reconstruction with the MSAP flap. There were 4 dorsal foot, 4 medial malleolar, 4 lateral malleolar, and 3 tendo-achilles defects. All flaps in this series survived. There was one episode of partial flap necrosis in one patient and no incidences of donor site dehiscence. All patients returned to full ambulation and none required subsequent flap revision. ConclusionsThe MSAP flap offers the benefits of a fasciocutaneous flap, whilst providing a thin, pliable, single stage and robust reconstruction for peri-ankle defects, with a cosmetically ideal donor site.

Mesoappendix as potential donor site for vascularized lymph node transfer: anatomic study

BackgroundThe standard of care for treatment of lymphedema is manual lymphatic drainage and compression therapy, which is time intensive and requires a life-long commitment. Autologous lymph node transfer is a microsurgical treatment in which a vascularized lymph node flap is harvested with its blood supply and transferred to the lymphedematous region to assist with lymph fluid clearance. An ideal donor lymph node site minimizes the risk of iatrogenic lymphedema and other donor site morbidity. To address this, we have used jejunal mesentery lymph nodes and omental flaps and hypothesize that the mesoappendix, as a “spare part,” may be an ideal autologous lymph node transfer donor site. MethodsIn this Institutional Review Board–approved study, 25 mesoappendix pathology specimens resected for benign disease underwent gross pathologic examination for the presence of lymph nodes and measurement of the appendicular artery and vein caliber and length. ResultsA single lymph node was present in two of 25 specimens (8%). Mean arterial and vein calibers at the point of ligation were 0.87 ± 0.44 mm and 0.86 ± 0.48 mm (range 0.30-2.2 mm and 0.25-2.2 mm), respectively. Mean arterial and vein length was 1.70 ± 1.06 cm and 1.84 ± 1.09 cm (range 0.8-4.5 cm for each), respectively. ConclusionsThe mesoappendix rarely contains a lymph node. The artery and vein calibers of 46% of the specimens were greater than 0.8 mm, the minimum caliber preferred for microsurgical anastomosis. If transplantation of a vascularized lymph node for the treatment of lymphedema is desired, the mesoappendix is inconsistent in providing adequate lymph nodes.

Reexploring the Anatomy of the Distal Humerus for its Role in Providing Vascularized Bone

Background:The lateral arm flap is used for composite defects in need of vascularized soft tissue, skin, and bone. From its original description, the distal humeral metaphysis can be included with the flap, supplied by the periosteal extensions of the posterior branch of the radial collateral artery. We sought to reexplore the anatomy of the lateral arm to determine its utility as a donor site for vascularized bone.Methods:Twelve fresh, silicone-injected cadaver dissections were performed. Arteriovenous anatomy, pedicle length and diameter, and anatomic variability as well as photo documentation was recorded.Results:The distal extent of the deltoid, lateral intermuscular septum and lateral humeral epicondyle were identified before the dissection. A septocutaneous perforator was consistently located 10 cm proximal to the lateral humeral epicondyle, which could be used for a skin paddle to monitor. Harvest of a 1.5 cm × 2 cm corticocancellous bone graft was performed. Average pedicle length was 9.1 ± 1.1 cm, and average pedicle diameter was 1.74 ± 0.52 mm. The inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm were consistently identified and preserved.Conclusion:The predictable anatomy of the lateral distal humerus make it an ideal donor site for small segments of vascularized bone.

A new surgical technique for congenital distichiasis

ABSTRACTPurpose: To describe a new technique to treat congenital distichiasis.Methods: Case series of three distichiatic patients undergoing a novel surgical technique combining splitting of the lid margin with the distichiatic lashes, marginal tarsectomy in the affected area, and tarsoconjunctival graft obtained from the upper region of the tarsus. The graft was sutured at the exposed region of the marginal tarsectomy.Results: Good cosmesis was obtained in all cases and the lids margins healed completely with good surgical outcome and no lashes contacted the cornea postoperatively.Conclusions: The split lamellae with a composite tarsoconjunctival graft results in satisfactory functional and cosmetic outcomes. The upper tarsal region represents an ideal donor site.

Lateral arm free tissue transfer for parotid reconstruction: A pictorial essay.

The goals of parotid reconstruction are to provide accurate volume reconstruction of the defect while minimizing ptosis, optimize color match to surrounding facial skin, maintain anatomic position of the auricle, and to perform facial nerve rehabilitation in cases in which the facial nerve is removed. For many complex parotid defects, the lateral arm free tissue transfer achieves these reconstructive goals and is the ideal donor site for microvascular reconstruction. In this pictorial essay, we describe the anatomy, harvest, inset, and reconstructive advantages of the lateral arm free tissue transfer in complex parotid reconstruction. The lateral arm donor site provides well-compartmentalized adipose tissue that resists ptosis, favorable color match to facial skin, and the posterior cutaneous nerve to the forearm may be used as a nerve graft for facial nerve rehabilitation. These reconstructive advantages make the lateral arm donor site our primary reconstructive option for complex parotid defects. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1015-1019, 2017.

Mucoperosteum of the Palate – An Ideal and Versatile Reconstructive Tool

Background: Palate is a complex structure separating oropharynx and nasopharynx. However reconstruction of the defects of palate is much simpler because of the available versatile mucoperiosteal flaps. Here we present our experience of palatal mucoperiosteal flap used in different situation. Methods: 10 patients of palatal as well as buccal mucosa defects were reconstructed using either free or pedicled mucoperiosteum. Results: All patients recovered well. No flap loss or secondary procedures were required. Conclusion: Palate is a complex structure both functionally and anatomically. Success in Reconstruction of the palatal defects depends on creation of good nasal as well as buccal mucosal lining. The rich vascular macronet in the palatal mucosa makes it an ideal donor site for local reconstruction. The mucoperiosteum harvested either as a free graft or as pedicled flap serves the purpose well leaving no donor site deformity.

Expanded Cheek-Shaped Flap for Aesthetic Cheek Reconstruction in the Cervicoperiauricular Area.

The cervical area is well acknowledged as an ideal donor site for aesthetic reconstruction of the cheek, and tissue expansion may play an important role for maximally achieving such a purpose. However, the conventional design of the expanded cervical flap generally results in unsightly morbidity of the donor site. The aim of this study is to evaluate the results of using an improvised cervical expanded flap in aesthetic reconstruction of the cheek. From July 2004 to October 2012, a total of 23 burn sequelae patients (30 cheeks) underwent cheek reconstruction with an expanded flap that originated from the cervicoperiauricular area. The procedures were initially carried out with the insertion of a round tissue expander in the cervicoperiauricular area, followed by serial inflation of the expander, and finally, transplantation of the expanded flap to the cheek in a rotation advancement fashion. The donor site closure was along the auricular sulcus. The average area of the harvested flaps was 9.7 × 8.1 cm. All the flaps completely survived, only one major complication occur-a dome exposure of the tissue expander after the expansion was completed. The flap was salvaged, and the transfer stage was done without intact. Minor complications after flap transfer include: widened scar at the donor site, a "dog-ear" needing additional minor surgery, distal part of the flap transient congestion. The patients achieved very satisfactory results functionally and aesthetically. Using the expanded cheek-shaped flap technique can provide a safe, thin, and color-matched flap in aesthetic reconstruction of the cheek with minimal donor site morbidity.