Island Flap For Reconstruction Research Articles

Evaluation of moving and static two point discriminations of volar forearm skin before and after transfer as a sensate radial forearm island flap in reconstruction of degloving injury of the thumb

In degloving injury of the thumb the large skin defect needs cover with sensate, glabrous and pliable skin. Although coverage of this defect with a sensate free flap from the foot is the best choice, most commonly, cover is achieved using a non-sensate distant pedicle flap. Between 2001 and 2003, degloving injuries of the thumb in eight patients were reconstructed using a sensate radial forearm flap in the sensory territory of the lateral ante-brachial nerve of the forearm which was repaired to the digital nerve of the thumb (six cases) or to a branch of the sensory radial nerve (two cases). Follow-up period ranged from 17 to 41 months (mean: 29.9 months). Sensory evaluation was performed using the moving two point discrimination (M-2PD) and static two point discrimination (S-2PD) of the volar forearm skin. These altered significantly after transfer and their values approached those of the contra-lateral thumb but never reached normal sensation (p<0.01). Sensate radial forearm island flap is a reliable option to cover a large defect of the thumb such as degloving injury and the sensation produced is acceptable.

Temporalis Muscle-Coronoid Swing and Forehead Skin Island Flap Reconstruction of the Orbit after Maxillectomy

The use of local regional flaps is often the most practical and easy means of reconstruction in the management of head and neck tumors. The temporalis muscle coronoid swing has been used to reconstruct the orbital floor and is described in literature as early as 1983. Difficulty is encountered when the medial wall and orbital floor are completely removed and a temporalis muscle-coronoid swing is rendered insufficient for orbital reconstruction.&#x0D; &#x0D; Objective: To describe a combination of forehead island flap and temporalis muscle-coronoid swing in orbital reconstruction.&#x0D; &#x0D; Design: Surgical Innovation/ Case Report.&#x0D; &#x0D; Subject: 12-year-old female with recurrent maxillary chondroblastic osteosarcoma one year after chemotherapy.&#x0D; &#x0D; Methods: The course of tumor excision and defect reconstruction is described.&#x0D; &#x0D; Results: There was no diplopia or other morbidity. There was minimal added operative time for reconstruction with acceptable results.&#x0D; &#x0D; Conclusion: Local flaps can be combined in order to repair the orbital floor. Acceptable function with minimal cosmetic deformity can be achieved with less extensive surgery.&#x0D; &#x0D; Keywords: Forehead flap, temporalis muscle, coronoid, orbit, reconstructive surgical procedures, maxillectomy&#x0D;

Island Rotation Flap for Nasal Reconstruction

Nasal reconstruction options are often dictated by size and location of the defect. Local flaps are often considered of little utility for larger or more complex defects. The authors' modification of the island rotation flap allows increased versatility and single-stage reconstruction for many more defects of varied sizes and locations. A retrospective review of all cases of nasal reconstruction using the island rotation flap over a 3.5-year period was undertaken. Ninety-two island flap reconstructions were performed for defects ranging from 0.8 to 4.0 cm. For defects smaller than 2.5 cm, there were no cases of flap loss. Five percent of the patients required a second procedure, whereas 95 percent were reconstructed in a single stage. Five percent required treatment for prominent scars. Follow-up was over 2 years. The laterally based blood supply of the nasal island rotation flap is reliable and robust. Patients treated with this flap had good healing and good symmetry and required minimal revision. Single-stage reconstruction with this flap requires both proper flap design and extensive undermining of the entire nasal soft-tissue cover. Nasal symmetry is maintained despite the defect and donor flap being on the same side of the nose. The authors present their technique for the island rotation flap for nasal reconstruction and information on its reliability and acceptance.

Reconstruction of facial defect with submental island flap

目的 探讨颏下岛状瓣修复面部组织缺损的应用效果.方法6例面部病变患者,其中男4例,女2例;最小年龄44岁,最大78岁.病变部位:左面部2例,左腮腺区1例,右腮腺区1例,右面部2例.病变性质:皮样囊肿感染伴皮肤坏死1例,皮脂腺囊肿感染伴皮肤坏死1例,皮肤上皮瘤恶变1例,鳞状细胞癌3例.良性病变切除后,恶性病变扩大切除同期行颈淋巴清扫术后,面部缺损均以颏下岛状瓣即时修复.组织缺损范围最小4.0 cm×3.0 cm,最大6.0 cm×6.0 cm.组织瓣最小面积4.5 cm×3.0 cm,最大6.0 cm×4.5 cm.组织瓣以颏下动脉为蒂3例,颏下动脉联合面动脉为蒂3例.蒂的长度:6 cm 3例,9 cm 2例,11cm 1例.结果6例组织瓣均存活良好,肤色与面部无明显差异;未发生任何并发症.供区伤口Ⅰ期愈合,平视位时,供区瘢痕不显露.结论颏下岛状瓣修复面部组织缺损是一种可供选择的良好方法。

Homodigital reverse flow island flap for reconstruction of neuropathic great toe ulcers in diabetic patients

Diabetic ulcers located in the plantar surface of the great toe resist conservative treatment modalities including skin grafts and usually require flap coverage for a stable reconstruction. Free tissue transfer is not feasible in these patients, because these defects are closely associated with peripheral vascular disease and local flap alternatives are extremely limited in this region. Reported here is the use of homodigital reverse flow island flap for reconstruction of neuropathic great toe ulcers in diabetic patients with encouraging results.

DORSAL PENTAGONAL ISLAND FLAP: A TECHNIQUE OF WEB RECONSTRUCTION FOR SYNDACTYLY THAT FACILITATES DIRECT CLOSURE

Though many techniques have been described for the correction of syndactyly, current methods result in skin deficiency that requires skin grafting, especially at the finger bases. We discuss the technical aspects and document our experience with the dorsal pentagonal metacarpal island flap for reconstruction of the web commissure in a series of 12 patients (22 webs) with syndactyly of varying complexity. In appropriately selected cases, this technique can improve reconstruction of the web commissure, facilitating direct closure, minimising the need for skin grafts and offers the potential for continued growth. This reduces operative time significantly and simplifies post-operative wound care. In this series, all our cases healed primarily in two to three weeks with minimal donor site morbidity. There were no post-operative complications, although the prominent dorsal scar remains a concern. At an average follow-up of 33.7 months, no cases of contracture or web creep after correction were noted.

Use of the peroneal island flap in reconstruction of feet. (Turkish)

Use of the peroneal island flap in reconstruction of feet. (Turkish)

Temporal artery island flap in reconstruction of the eyelid.

The temporal artery island flap, based on the anterior branch of the superficial temporal artery, was used in full thickness eyelid reconstructions of 11 patients (in four for both lids, in two for the upper lid and in five for extensive lower lid defects). The skin island was taken from the upper lateral frontal skin in front of the hairline to leave minimal scaring and create a long vascular pedicle. Mucosal or chondromucosal graft was used for the inner lining. In seven patients the arterial pedicle surrounded by a 0.5 cm wide band of subcutaneous tissue containing the corresponding veins, was tunnelled under the skin in a one stage procedure. In four cases, the pedicle was temporarily left above the skin to shorten the operating time. The temporal artery island flap is a reliable way of reconstructing both lids, or the lower lid in cases where the local flaps have been used in earlier operations. Because of the risk of bulging and for functional reasons, we do not recommend the flap for upper eyelid reconstructions.

The first dorsal intermetacarpal island flap in reconstruction of hand defects: Anatomical and clinical study

The first dorsal intermetacarpal island flap in reconstruction of hand defects: Anatomical and clinical study

FASCIOCUTANEOUS ISLAND FLAPS FOR ORTHOPAEDIC MANAGEMENT IN LOWER LIMB RECONSTRUCTION USING DERMATOMAL PRECINCTS

This paper describes a technique of fasciocutaneous island flaps used in reconstruction of the lower limb. It is very versatile and some 26 individual flaps in 22 patients have been used to reconstruct skeletal and soft tissue problems from the popliteal fossa to the ankle joint. These longitudinally designed flaps made up of a trilaminate of skin, subcutaneous fat and fascia are aligned within the dermatomal precincts. The most important location for such flap design is along the peroneal compartment sitting within the L5 dermatome and incorporating the superficial peroneal nerve. It can be lengthened as far as the lateral malleolus and is an excellent reconstructive method to close defects over the lower third of the tibia. The medial compartment of the leg employing the saphenous nerve (L4 dermatome) is another area for fasciocutaneous island flap reconstruction, but use is restricted to the upper two-thirds of the tibial area. Posteriorly the island flap design sits along the S2 dermatome, this time incorporating the sural nerve to reconstruct defects of the calf and can be extended to include problems of the popliteal fossa. In the overall flap technique, the age of the patient is not a contraindication and cases with peripheral vascular disease have been treated successfully. The flaps may extend up to a 5:1 ratio in dimension. The operating time can be considerably shortened.

One‐stage Hypospadias Repair: Experience of 367 Cases

Over a 6 1/2-year period we performed 374 primary hypospadias repairs, all but 7 as single-stage procedures. We usually employed the MAGPI, tubed preputial island flap and Mathieu reconstructions. Complications were comparatively few, with an overall incidence of 5% fistulae, 3% anastomotic strictures and 7% meatal retraction or stenosis. The cosmetic results were superior to those of staged procedures in that it was almost always possible to obtain a glanular meatus which was both terminal and realistic.

Reverse flow forearm island flap in reconstruction of the hand. (Japanese)

Reverse flow forearm island flap in reconstruction of the hand. (Japanese)

Utilization of the medial plantar fasciocutaneous island flap for reconstruction of the heel. (Japanese)

Utilization of the medial plantar fasciocutaneous island flap for reconstruction of the heel. (Japanese)

A clinical study of the use of musculocutaneous island flaps for reconstruction in head and neck surgery

A clinical study of the use of musculocutaneous island flaps for reconstruction in head and neck surgery

Latissimus dorsi musculocutaneous island flap for reconstruction of soft tissue defects of the upper arm

Latissimus dorsi musculocutaneous island flap for reconstruction of soft tissue defects of the upper arm

工作機械によるきょう部全層欠損 Ｄ‐Ｐ皮弁，前頭島状皮弁による再建の１例

Nowadays, facial trauma is getting much more complicated and severed along with the social factors.Progress in surgical, anesthetical and medical ambulatory care has made it possible to save severely injured patients. Such life-threatening forces also cause severe facial trauma and cases needing more complex treatment plans arc increasing.In this paper, a case of a 44 year old male treated with multiple reconstructive procedures is presented.The patient was caught in to an iron-work machine by his left forearm and had an abulsed right malar area. After first aid for life was given, he was transfered to our department. The extent of injury was confirmed to be a rt. cheek full-thichness defect, partial loss and fractures of maxilla and mandible, multiple facial lacerations and burns through the first operation included wound debridement and primary maxillary and mandiblar reduction and fixation.One month later, the facial defect settled to 6 × 9 cm and segmental loss of rt. mandible was evident. D-P flap and forehead island flap reconstruction for cheek defect, mandibular repair with Vitallium® cast splint and iliac bone graft, transposition of parotid duct to oropharynx were performed.Through 4 separate operations over 20 hours, good functional and cosmetic reconstruction was aquired.

Neurovascular island flap reconstruction following high pressure injection injuries of the hand

Adequate, satisfactory treatment of high pressure paint or grease injection of the hand invariably requires wide wound excision. This results quite often in a mutilated, disabled digit or hand, with loss of soft tissue and sensation. We report two such cases, each with a neurovascular island flap used in order to restore adequate soft tissue and sensation.

眼瞼部のIsland Flapについて

眼瞼部のIsland Flapについて

The neurovascular island flap in reconstruction of the thumb

Thumb reconstruction by skin flap, bone graft and neurovascular island flap is not without its problems, but the results are sufficiently encouraging to persist with the method as an alternative to pollicisation.