Island Pedicle Research Articles

Multi-flap Cheek Reconstruction: Merging Triple Advancement, Island Pedicle, and Rotation Flaps for Optimal Aesthetic and Functional Outcomes After Mohs Micrographic Surgery

Multi-flap Cheek Reconstruction: Merging Triple Advancement, Island Pedicle, and Rotation Flaps for Optimal Aesthetic and Functional Outcomes After Mohs Micrographic Surgery

Dermatosurgical rounds: shark island pedicle flap for skin defect of the alar crease area after basal cell carcinoma removal

A 67-year-old female presented to the Dermatology Department with a tumor formation located on the left lateral side wall of the nose, measuring 1,5/1,2 cm in size, which had been slowly growing over the past few years. The tumor exhibited a shiny, pink-colored surface with a dome-shaped appearance, irregular borders, and superficial telangiectasias, raising clinical suspicion for basal cell carcinoma. Additionally, there was no reported history of skin cancer in any family member or painful sunburns during childhood. The patient was recommended surgical excision under local anesthesia for the suspected lesion.

Penoscrotal transposition: Long-term outcome in 29 patients.

Penoscrotal transposition (PST) is a rare anomaly of the external genitalia characterized by malposition of the penis in relation to the scrotum. This transposition may be partial or complete and may be associated with hypospadias, chordee, and other anomalies. We have reviewed our experience with the surgical repair of PST utilizing a modified Glenn-Anderson technique. Twenty-nine patients with a median age of 5.6 years (8 months -15 years) underwent surgical repair of PST at our institution between 2004-2022. Of those, 20 (69%) had complete PST, while 9 (31%) had partial PST. All children were divided into three groups. In the first group of 8 (28%) children, repair of PST was an integral part of one-stage male genitoplasty; in the second group of 18 (62%) children, repair of PST was an isolated last stage of the staged hypospadias repair and the remaining 3 (10%) children underwent PST repair without the presence of hypospadias. All patients underwent modification of the Glenn-Anderson technique involving utilization of bilateral rotational advancement scrotal flap, complete de-tethering of the testis from the internal part of the scrotum when indicated, and relocation of the scrotal compartment in a normal dependent position. The follow-up ranged from 6 months to 18 years. In the first group, five children (62%) underwent Onlay Prepucial Island Pedicle Flap (OIF) hypospadias repair, and three (38%) underwent Long Tubularized Incised Plate Repair (TIP). In the second group, 8 (44%) underwent OIF hypospadias repair, 2 (12%) had Long TIP repair, and the remaining 8 (44%) underwent staged hypospadias repair. Post-operative Clavien Dindo grade III presented among three patients in group I and only one patient in group II. In the third group, no postoperative complications were observed. Our data show that penoscrotal transposition correction utilizing the Glenn-Anderson technique is a reliable and durable surgery in the pediatric population. These children require careful monitoring till adolescence to ensure that no re-operation is needed.

Transposition Island Pedicle Flap to Repair the Nasal Ala.

Reconstruction of the nasal ala presents surgical challenges, including loss of the nasofacial junction and vasculature compromise, in addition to achieving a cosmetically satisfactory result. The reconstructive surgeon has a variety of closure techniques to employ, but few allow for acceptable cosmesis in a single-stage procedure. The objective of this study is to discuss a novel approach to alar reconstruction using a melolabial-based transposition island pedicle flap, an alternative to traditional interpolated melolabial flaps and inferiorly based interpolated paranasal flap methods. Our reconstruction method utilizes an island pedicle flap harvested from the nasolabial fold and rotated 165˚ medially and superiorly into a surgical defect on the adjacent ala. The pedicle is placed within the alar facial sulcus for a slight trap-dooring effect, recreating the sulcus. The harvest site is closed linearly, resulting in a fusiform scar line to take advantage of the nasolabial fold. Although delicate care is required while dissecting and positioning the flap, it is an otherwise straightforward procedure. The ideal candidate for this technique presents with loss of the alar subunit with an intact alar rim. The only limitation to this style of flap is that the patient has undergone prior procedures involving the ipsilateral nasolabial fold. The transposition island pedicle flap is a well-tolerated alternative to patient cases that require grafting or more involved multi-step reconstructions to efficiently repair nasal alar defects. This technique provides the patient with a presentable cosmetic result using local tissue with minimal post-surgical complications and alar compromise.

Repair of a Medial Cheek Skin Defect with an Island Pedicle Flap

Repair of a Medial Cheek Skin Defect with an Island Pedicle Flap

Analysis of thumb pulp reconstruction based on different local flaps: A systematic review

BackgroundThe reconstruction of the thumb's pulp is challenging when considering that there is no consensus on which local flap will provide better prognosis and less financial impact. The aim of this study was to analyze the outcomes of the most used flaps for the trauma to the volar substance of the thumb, validating the main indications. MethodsThis systematic review adhered to PRISMA guidelines and electronic searches were conducted in multiple databases (MEDLINE/PubMed, Virtual Health Library, Embase and Scopus) with studies published in the last ten years - until April 2022. ResultsThe search resulted in the screening of 573 records, and twenty studies were included. Among the flaps analyzed and compared by outcomes and prognostic factors, there are First Dorsal Metacarpal Artery (FDMCA), modified (MFDMCA), Moberg flap, Heterodigital Neurovascular Island, Neurovascular Island Pedicle and Modified Littler. ConclusionThrough this literature review, we can analyze different flaps widely used in the daily life of hand surgeons. The flaps that were also positive in a global context, but with few criticisms, are the MFDMCA, Moberg Flap, Neurovascular Island pedicle flap and FDMCA. However, it is important for the surgeon to consider different prognostic factors when choosing the flap, since these aspects directly impact the return to daily activities after the procedure.

DS09 Nasalis myocutaneous island pedicle flap for nasal defects after Mohs surgery: a case series and video demonstration

DS09 Nasalis myocutaneous island pedicle flap for nasal defects after Mohs surgery: a case series and video demonstration

Variations of the Island Pedicle Flap for Reconstruction of Nasal Defects.

Variations of the Island Pedicle Flap for Reconstruction of Nasal Defects.

Outcome and Utility of First Dorsal Metacarpal Artery Flap for Finger Defects

Background: The First Dorsal Metacarpal Artery (FDMA) Flap or Foucher’s flap is an island pedicle flap proximally based on the first dorsal metacarpal artery and veins. A branch of radial sensory nerve is incorporated in the flap to make it a sensate flap. Objective: The aim of our study was to evaluate the functional and aesthetic outcomes of the seven FDMA flaps done over a period of four years for reconstruction of the distal thumb soft tissue defects and one defect over proximal phalanx of the index finger. Methods: This prospective study was performed between 2018 and 2022 at the Clinic of Reconstructive and Plastic Surgery. We present a series of six cases of distal thumb soft tissue defects and one patient with defect over the dorsal aspect of the index finger that were reconstructed with the FDMA flap. Results: In six patient donor site was grafted by full-thickness skin graft harvested from the groin and in one case was closed primary. All flaps survived and one case that was closed primary had donor site complication that was related to primary closure of the skin. All the patients had good fine touch and average two-point discrimination of 8.7 mm. Conclusion: FDMA flap is a useful and reliable flap to cover the defects of the dorsal aspect and to a certain extent the volar aspect of the thumb. We showed that can be used to cover the defects over proximal phalanx of the index finger. The flap provides adequate soft tissue coverage and good aesthetic results.

How We Do It: Shark Island Pedicle Flap for Alar Crease Defects.

How We Do It: Shark Island Pedicle Flap for Alar Crease Defects.

Response to "How We Do It: Modification of the Island Pedicle Flap-The Catapult".

Response to "How We Do It: Modification of the Island Pedicle Flap-The Catapult".

Narrative Review: Submental Artery Island Pedicled Flap, Indications, Tips, and Pitfalls.

Narrative review. To describe the advantages, challenges, and potential indications of the submental artery island flap as a local pedicled flap for head and neck reconstruction. We conducted a comprehensive review of the literature to describe the submental artery island flap's surgical technique, indications, and outcomes. Data sources included peer-reviewed articles, case reports, and clinical studies on using the submental flap in head and neck surgery reconstruction. The submental artery island flap, while offering advantages such as minimal donor site morbidity, and good cosmetic outcomes, presents challenges related to the pedicle dissection and patient selection. This flap is particularly suitable for defects in the oral cavity, oropharynx, parotid bed, and midface or neck skin. Simultaneous neck dissection is feasible but should be approached with caution in patients with a history of prior neck surgery. The submental artery island flap is a valuable option for selected cases. When performed in the right patient with a correct technique, this flap can reconstruct defects in the oral cavity, oropharynx, parotid bed, and skin of the midface or neck with a minimally visible scar of the donor site.

Island Pedicle Flap Pada Dinding Hidung Dengan Karsinoma Sel Basal

A flap is a tissue unit that is transferred from one area (donor site) to another area (recipient site) while still maintaining its blood circulatory system. The island pedicle flap, also known as the V-Y flap, is a modified advancement flap. This flap is a very useful reconstruction option for small to intermediate-sized defects. A 69-year-old Acehnese woman with a history of working as a farmer came with complaints of a non-painful nodule on the wall of her left nose for the last 6 months. Based on the history and physical examination, the patient was provisionally diagnosed with nodular type Basal Cell Carcinoma. An excisional surgical was performed, then a pedicle island flap was performed to close the defect. Anatomical pathology examination results concluded basal cell carcinoma. The island pedicle flap technique is one of the surgical techniques that can be an option to close tumor excision defects. This technique offers a one-stage reconstruction with excellent cosmetic results for defects in the nasal wall. The color and texture of the skin after surgery are almost perfect because the flap originates from the skin immediately adjacent to the defect.

Modified island pedicle advancement cheek flap for optimal reconstruction of cutaneous defects after excisional biopsy of basal cell carcinoma right lower eyelid

A 64-year male came for treatment of a lesion on his eyelid. Approximately 10 years earlier, he had developed a small blackish mass on his right lower eyelid, which was gradually increasing in size along the infra-orbital crease. It is associated with blackish discharge. Laboratory tests were normal; medical history and family history were unremarkable. Incisional biopsy shows strings of stratified squamous epithelium, proliferative basal cells, and scattered melanin pigmentation. The tumor was completely excised, and the defect is reconstructed with modified island pedicle advancement cheek flap and sent for HPE examination. It is a powerful technique for reconstruction with minimal complication.

How We Do It: Modification of the Island Pedicle Flap-The Catapult.

*All authors are affiliated with the Department of Dermatology, University of California, San Francisco, San Francisco, California Address correspondence and reprint requests to: David J. Rosenfeld, MD, 731 W Melrose, Unit 2, Chicago, IL, 60657, or e-mail: [email protected] The authors have indicated no significant interest with commercial supporters.

D139. Aesthetic and Functional Outcomes following Reconstruction of Mohs Defects of the Lip: Analysis of 417 Cases

PURPOSE: Vermilion lip defects secondary to Mohs micrographic surgery (MMS) present significant challenges to the reconstructive surgeon. The association of reconstructive method with aesthetic and functional outcomes of the lip remains uncertain. METHODS: A retrospective review of patients who underwent MMS involving the vermilion lip between 2008-2022 was performed. Outcomes assessed included satisfactory appearance and function within 12 months, as reported at postoperative visits, complications, and revisions. Patients were stratified by the proportion of vermilion lip excised. Outcomes were analyzed using multivariable logistic regressions adjusting for patient-associated factors and with Chi-square tests. RESULTS: Four hundred seventeen patients were included. The mean defect area was 3.1±5.0 cm2 with 9.6% (n=40) of patients with defects involving >25% of the vermilion lip. Fifty-eight percent (n=244) were reconstructed with advancement flaps, 26% (n=108) with island pedicle flaps, and 10% (n=43) underwent complex reconstruction. Median follow-up duration was 89 days. Aesthetic and functional outcomes did not differ between patients with <25% versus 26-50% of the vermilion excised. Patients with >50% vermilion excised were significantly less likely to have satisfactory function (63.6% vs 99.4%, p<.001) and appearance (50.0% vs 91.5%, p=.004). Involvement of >25% vermilion was predictive of increased complications [OR=4.2, 95% CI: (1.6-11.0)] and revisions [OR=3.8, 95% CI:(1.5-9.4)]. Reconstructive method was not associated with any effect on aesthetics or function. CONCLUSION: Large MMS defects of the vermilion remain challenging to treat and were associated with greater rates of impaired function, appearance, complications, and revisions. Reconstructive method was not associated with alterations in function or appearance.

Tunneled island pedicle flap reconstruction for upper lateral cutaneous lip defects

Esthetic upper lateral cutaneous lip reconstruction preserves the apical triangle, nasolabial fold symmetry, and free margin position. The tunneled island pedicle flap (IPF) is a novel single-stage reconstruction to achieve these goals. Describe the technique and patient and surgeon-reported outcomes for the tunneled IPF reconstruction of upper lateral cutaneous lip defects. Retrospective chart review of consecutive tunneled IPF reconstruction following Mohs micrographic surgery (MMS) at a tertiary care center between 2014 and 2020. Patients rated their scars using the validated Patient Scar Assessment Scale (PSAS), and independent surgeons rated scars using the validated Observer Scar Assessment Scale (OSAS). Descriptive statistics were generated for patient demographics and tumor defect characteristics. Twenty upper lateral cutaneous lip defects were repaired with the tunneled IPF. Surgeons rated scars with a composite OSAS score of 11.83±4.29 (mean, SD) [scale of 5 (normal skin) to 50 (worst scar imaginable)] and an overall scar score of 2.81±1.11 [scale of 1 (normal skin) to 10 (worst scar imaginable)]. Patients rated their scars with a composite PSAS score of 10±5.39 [scale of 6 (best possible score) to 60 (worst)] and with an overall score of 2.2±1.78 [scale of 1 (normal skin) and 10 (very different from normal skin)]. One flap was surgically revised for pincushioning, but none experienced necrosis, hematoma, or infection. The tunneled IPF is a single-stage reconstruction for upper lateral cutaneous lip defects with favorable scar ratings by patients and observers.

Shark island pedicle flap: a series of two cases

Shark island pedicle flap: a series of two cases

Clinical effects of resurfacing fingertip amputations in long fingers using homodigital dorsal neurofascial broaden pedicle island flaps

The use of homodigital dorsal neurofascial broaden pedicle island flaps (HDNBPIF) to treat fingertip amputations is an ongoing research topic. Here, we evaluated the clinical effects of resurfacing fingertip amputations in long fingers using HDNBPIF. Seventeen patients with 18 long fingers were treated with HDNBPIF from December 2018 to May 2021. Total active motion (TAM) scores, Semmes Weinstein monofilament (SWM) test, static 2PD test, visual analogue scale (VAS), Vancouver scar scales (VSS), and quick DASH scores were evaluated at 12–25 months postoperation. The aesthetic satisfaction of the patients was estimated subjectively using a 5-point Likert scale. The mean defect size was 1.11 × 1.13 cm and mean flap size was 1.32 × 1.32 cm. All flaps survived and the mean TAM of injured fingers was 255.6° (Contralateral side: 268.4°, p < 0.05). Mean SWM score in the flap was 3.90 g, and 3.22 g in the donor zone. Mean static 2PD discrimination in the flap was 5.61 mm and 4.33 mm in the donor zone. Mean quick Dash scores were 5.81 whereas Mean VAS score in the flap was 0.7 and 0.2 in the donor site. Vancouver scar scales at the donor and recipient sites ranged from 0 to 2. At the end of the follow-up, all patients reported good aesthetic appearance and curative effects. These results show that HDNBPIF is a promising strategy that achieves good curative effects and recovery of fingertip functions. Type of Study and Level of Evidence: Therapeutic IV

How We Do It: Melolabial Drawbridge Island Pedicle for Reconstruction of Nasal Ala and Perialar Cheek.

How We Do It: Melolabial Drawbridge Island Pedicle for Reconstruction of Nasal Ala and Perialar Cheek.