Island Pedicle Research Articles

Treatment of Basal Cell Carcinoma Involving the Medial Canthus by Multiple Local Flaps: A Case Report

Introduction: Basal cell carcinoma (BCC) is a skin malignancy that commonly appears on the face. Although surgical resection remains the therapeutic gold standard, it always produces a skin defect. Fine aesthetic reconstruction is a persisting challenge for all dermatologists. We herein present a case of BCC affecting the patient’s medial canthus. Case presentation: A 61-year-old woman presented with BCC of her right medial canthus. After lesion excision, a 2.5- × 3.5-cm skin defect remained in her canthal area. We used three local flaps to cover the defect according to aesthetic subunits. The defect over the nasal dorsum was covered by a glabellar flap, the upper eyelid defect was covered by a rotation advancement flap, and the lower eyelid defect was covered by a subcutaneous island pedicle flap. The result remained both functionally and aesthetically satisfactory throughout 2 months of follow-up. Discussion: Skin malignancies can occur in areas that require special treatment. The medial canthus is a fundamental element of the “facial triangle.” Restoration of color, texture, and thickness of the soft tissue is essential in this area. Full-thickness skin grafts and single flaps seem unsuitable for large defects in this region. Instead, a combination of local flaps according to aesthetic subunits can give desirable results. Conclusion: Defects in the medial canthus are difficult to reconstruct. This case provides a novel technique for the treatment of BCC in the medial canthus. Multiple local flaps were used to cover the defect with low tension, giving both a good cosmetic appearance and effective structural reconstruction.

The submental island pedicled flap and supraclavicular artery island flap in a free flap practice

Reconstruction of head and neck defects is a delicate endeavor that poses numerous intrinsic and extrinsic challenges, which are currently magnified by rising health care costs and limitations in system resources. Current trends in the United States heavily favor the use of free tissue transfer over locoregional pedicles flaps (LRPF); however, the latter group is often undervalued, offering high utility, practicality, and cost-efficiency whilst providing equivalent results. The submental island flap and supraclavicular artery island flap are two LRPF that should be in the arsenal of the modern reconstructive surgeon.

Eyelid Reconstruction: An Algorithm Based on Defect Location.

Eyelid reconstruction is a complex topic. This review looks at articles from 1990 to 2018 on eyelid reconstruction that had at least 10 patients and a mean 6 month follow-up. The authors present the results of our findings and propose an algorithm to guide the surgeon in choosing the best technique based on location, size, and lamella. Defects less than 1/3rd of the upper or lower eyelid may be closed primarily. Anterior and posterior lamella defects of the lower eyelid greater than 1/3rd in size should be reconstructed with a double mucosal and myocutaneous island flap. Those greater than 50% in size should be recreated with a Tripier flap for the anterior lamella and conchal chondroperichondral graft for the posterior lamella. For total lid reconstruction, a Fricke flap is best for the anterior lamella and the tarsoconjunctival free graft/lateral orbital rim periosteal flap is best for the posterior lamella. Fullthickness defects between 1/3rd and 2/3rd in size of the upper eyelid should be reconstructed with a myotarsocutaneous flap and those greater than 2/3rd should be reconstructed with a Cutler-Beard flap for the anterior lamella and auricular cartilage for the posterior lamella. For the medial canthal region, the island pedicle and horizontal cheek advancement flap is recommended for the anterior lamella and a composite upper lid graft for the posterior lamella. For the lateral canthal region, a bilobed flap is recommended for the anterior lamella and a periosteal flap for the posterior lamella.

Hypospadias treatment by tubulated pedicled preputial island flap according to the DUCKETT technique: single-center experience in sub-Saharan Africa

BackgroundHypospadias is the second most frequent congenital condition in boys after cryptorchidism, with an incidence of 0.3–0.7% compared to 2–4% for cryptorchidism. Since the 1980s, single-stage operations, such as the one described by Duckett, have been adopted by some authors. To assess the results of hypospadias surgery by tubed pedicled preputial island flap (DUCKETT’s procedure) in a West African reference hospital.MethodsThis is a retrospective and descriptive study that includes 41 patients with hypospadias who underwent DUCKETT procedure by a tubed pedicled preputial island flap during a period of 12 years. After penile degloving, the curvature has been corrected by skin bridging with or without Nesbit’s plication. The urethroplasty was done according to the DUCKETT procedure.ResultsThe patients mean age was 11 ± 8.5 years. All of them had posterior foreskin and a ventral curvature of the penis. The urethral meatus was posterior in 37%. Six of them had a previous hypospadias repair. The complication rate was 58.5%. Wound infection and meatal stenosis occurred in 14.6% and 19.6% of cases, respectively. After a mean follow-up of 20 ± 9 months, total success, relative success and failure rates were 63%, 27% and 10%, respectively.ConclusionThe DUCKETT procedure is associated with a high complication rate in our daily practice.

An island pedicle advancement flap – effective technique for the repair of nasolabial defects

An island pedicle advancement flap – effective technique for the repair of nasolabial defects

Postoperative Outcomes of Local Skin Flaps Used in Oncologic Reconstructive Surgery of the Nasal Ala: A Systematic Review.

Despite numerous options for nasal ala reconstruction, advantages and disadvantages of each method are unclear. To summarize reported outcomes of local flaps without the use of grafts for nasal ala oncologic reconstructive surgery. A nasal ala-specific protocol was adapted from a previous head- and neck-specific PROSPERO submission (CRD42017071596). The search was conducted in MEDLINE, EMBASE, and CENTRAL on December 23, 2017 and updated on May 10, 2019. Two reviewers screened 9,313 results from head and neck literature. Study bias was evaluated with the ROBINS-I tool. Subunit-based categorization of included studies identified 12 nasal ala-specific publications. Complications (flap necrosis, hematoma, wound infections, trapdoor deformities, and dehiscence), functional (nasal valve or respiratory dysfunction), and cosmetic (alar rim distortion/asymmetry/notching, secondary/revisionary procedures, and patient satisfaction) outcomes were extracted. Generally favorable outcomes are seen in all flaps. Careful consideration of donor sites for interpolation flaps is needed for optimal cosmetic outcomes. Transposition flaps, including laterally based bilobed and trilobed flaps, created good outcomes, although melolabial transposition flaps may produce poorer outcomes compared with melolabial island pedicle advancement flaps. Caution is needed for rotation flaps to prevent nasal valve/respiratory dysfunction due to alar crease contracture or ridge elevation. Further research is needed.

Crab claw island pedicle flap for reconstruction of nasal ala and perialar combined large defects

Crab claw island pedicle flap for reconstruction of nasal ala and perialar combined large defects

Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps.

Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. A retrospective review was conducted of all patients who underwent vulvar-perineum reconstruction between 2011 and 2018 by the senior author, and oncologic and reconstructive outcomes and complications were analyzed. Thirty-three patients underwent 55 soft tissue reconstructions for vulvar-perineum defects during the study period. The mean follow-up time was 27.6 ± 28.9 months. Squamous cell carcinoma was the most common cancer (45.5%). For 11 patients (33.3%), the procedures were performed for the treatment of recurrent cancer. The average defect size was 39.8 ± 34.3 cm2. The overall survival rate was 90.3%. Profunda artery perforator flaps were the most commonly applied flap for reconstruction in both the primary and recurrent groups. Poor wound healing was the most common complication which occurred in 10 of the 55 flaps (18.2%). Perforator flaps presented fewer complications than myocutaneous flaps or traditional random flaps. Similarly, Island pedicle flap design also presented fewer complications than traditional rotation flaps. With proper reconstruction, previous surgery or radiotherapy did not contribute to an increase in complications. In our experience, perforator flaps can provide satisfactory reconstruction for perineum reconstruction with low postoperative complications while preserving other donor sites in the event of disease recurrence for repeat resection and reconstruction. Previous surgery or radiotherapy did not increase the complications or preclude its usage. A redefined reconstructive ladder was created to help selecting the best state-of-the-art technique for reconstruction to achieve better results.

Nasal Reconstruction Using a Myocutaneous Island Pedicle Flap Based on the Nasalis Muscle With Bilevel Undermining: Review of 57 Cases.

Nasal reconstruction after Mohs resection of skin cancer commonly uses local flaps, many of which present limitations concerning their movement and skin color/texture match. In this article, the use of a myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining for the management of defects at challenging locations on the nose is described as a versatile and cosmetically appropriate flap option. In addition, a novel mathematical sizing methodology for this flap is presented. Between March 2013 and May 2016, 57 patients having undergone Mohs resection of skin cancer underwent nasal reconstruction using a myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining at our clinic. During the postoperative follow-up, patients were monitored for complications and received proper wound care. The mean age was 68.4 (range, 34-94) years. The mean follow-up was 10.1 (range, 3.0-34.9) months. The mean defect size was 1.99 (range, 0.70-5.25) cm2. No complete losses of flap occurred. Incidence of minor complications (pin cushion effect, minor delayed healing, etc) was minimal (4/57; 7.0%). Two of the cases in this series involved the utilization of cartilage grafts in combination with the myocutaneus island pedicle flap. The myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining can be used as a versatile flap for the closure of defects of various sizes and locations on the nose because of its rich blood supply, ease and convenience of use, and highly acceptable cosmetic outcome.

Myomucosal island flap of the buccinator Muscle: An anatomical study

IntroductionDespite its ease of dissection and accessibility, the buccinator muscle has received little attention in the surgical literature as an island flap. This study aimed to clarify the detailed anatomy of the buccinator muscle and the important related structures for planning to use it as a myomucosal island flap. Materials and methodsThe study was carried out on 30 hemifaces from 15 adult cadavers (12 males and 3 females). The cadavers were injected with red latex through the external carotid artery. The buccinator muscle was carefully dissected, and the vessels and nerves reaching its surface, and their origins and points of entry into the muscle were observed. The facial vessels were separated from the superior and inferior labial as well as from the angular branches. Then, the buccinator muscle with its vascular pedicles was delivered alone. The extent of the pedicle was then evaluated for its potential reach. The distance of the vessels and nerves related to the muscle together with the parotid duct was measured in relation to two reference points, the labial commissure (LC) and the upper point of the zygomatic arch (Z) just in front of the auricle, and the dimensions of the muscle were estimated. ResultsThe present study showed that the anterior part of the muscle had an arterial supply from the facial artery and its venous blood drained into the facial vein. The posterior part of the muscle was supplied by the buccal and posterior superior alveolar arteries, and its venous blood drained into the pterygoid venous plexus. The nerve supply of the muscle was through the lower ramus of the buccal branch of the facial nerve. The mandibular rami of the facial nerve were found to lie superficial to the facial vein, but interlacing with the facial artery (superficial, deep, or superficial and deep). From the valuable measurements obtained, the facial artery crossed the reference line (LC-Z) at the meeting of the medial ¼ with the lateral ¾ of that line, and the facial vein was 0.8 cm posterior to the artery. It was also found that the buccinator island pedicle after its harvest reached the upper ends of the trachea and esophagus. In addition, rotation of the pedicle downward and forward until 180° did not form kinks of the pedicle. ConclusionsAccording to the present study, the buccinator island flap is safe, reliable, and provides mucosa; however, it has no sensation or motility.

In Response to Versatility and Reliability of Islanded Pedicled Nasolabial Flap in Head and Neck Cancer Reconstruction

In Response to <i>Versatility and Reliability of Islanded Pedicled Nasolabial Flap in Head and Neck Cancer Reconstruction</i>

Laterally Based Island Pedicle Flap Reconstruction of Distal Nasal Defects.

Laterally Based Island Pedicle Flap Reconstruction of Distal Nasal Defects.

Commentary on Tunneled Island Pedicle Flap for a Conchal Bowl Defect.

Commentary on Tunneled Island Pedicle Flap for a Conchal Bowl Defect.

Comparison of Clinical Results and Quality-of-Life in Tongue Cancer Patients Undergoing Submental Island Flap and Radial Forearm Free Flap Reconstruction

Our goal was to compare the clinical results and quality-of-life (QoL) in tongue cancer patients undergoing submental island pedicled (SIP) flap and radial forearm free (RFF) flap reconstruction. Patients undergoing SIP or RFF flap reconstruction for primary tongue squamous cell carcinoma were prospectively enrolled and were asked to complete the University of Washington Quality-of-Life (UW-QOL) questionnaire, version 4, at 12months after the operation. The study's main interest was QoL as well as locoregional recurrence control. A total of 190 patients were enrolled for analysis, and the SIP and RFF groups showed significant differences in patient age, American Society of Anesthesiologists classification, and hospital cost. In the survival analysis, locoregional recurrence occurred in 35 patients in the SIP group and 48 patients in the RFF group; the difference was not significant (P=.440). In the QoL analysis, compared with patients in the SIP group, those in the RFF group had higher scores in the domains of activity and recreation. No significant differences were found with respect to the other domains. The SIP flap and RFF flap have comparable survival control in tongue squamous cell carcinoma patients. The RFF flap might lead to better QoL, but the SIP flap imposes fewer limitations on patients' health status and is associated with lower hospital cost.

Versatility and Reliability of Islanded Pedicled Nasolabial Flap in Head and Neck Cancer Reconstruction.

Reconstruction of head and neck cancer ablative defects is challenging. A modification of the nasolabial flap (islanded pedicled nasolabial flap [ipNLF]) is an easy and reliable option for reconstruction of small- to medium-sized defects of the head and neck, especially in resource-constrained and high-volume centers. We present the retrospective analysis of 27 consecutive patients reconstructed with ipNLF at two high-volume cancer centers, Homi Bhabha Cancer Hospital, Varanasi, India; and Army Hospital Research and Referral, New Delhi, India. The functional outcomes measured were duration of weaning of feeding and tracheotomy tubes and speech assessment (speech intelligible rating score [SIR]) postsurgery. Complications assessed were flap loss, orocutaneous fistula, donor site wound dehiscence, oral incompetence, and angle of mouth deviation. The most common ablative defect was of the oral cavity (22 patients), followed by the oropharynx (4 patients) and hypopharynx (1 patient). The mean operating time for flap harvesting and insetting was 57.7 minutes. The mean durations for postoperative feeding tube and tracheotomy removal were 10 and 5 days, respectively. Twenty-four subjects had SIR scores of I or II. None of the subjects had flap loss, orocutaneous fistula, or donor site wound dehiscence. Twenty-five subjects had no oral incompetence, and 26 subjects had no or minimal angle of mouth deviation. This is the largest series of ipNLF to date and emphasizes the versatility, reliability, reproducibility and excellent functional and acceptable cosmetic outcomes of this flap for the reconstruction of judiciously chosen head and neck ablative defects. 2C Laryngoscope, 130: 1967-1972, 2020.

Gaining Large Coverage With Small Island Pedicle Flaps in Tight Cosmetic Subunits: Taking Advantage of Rotation and Pincer Principles on the Nasal Ala.

Island pedicle flaps (IPFs) are widely used in reconstructive surgery due to their versatility, tissue efficiency, and excellent clinical outcomes. While IPF rotations and 'pincer flap' modifications have previously been sparsely described, they are not often discussed in the literature. We demonstrate the use of both rotating IPFs and pincer techniques for defects traditionally considered too large for classic IPF design on the nasal ala. Forty-four patients underwent alar repair using the rotation or combined rotation with pincer modification to the standard IPF technique from August 2014 to May 2017. Our technique is described and case examples are presented with photographs. Forty-four patients with an average alar defect size of 1.2 cm underwent repair using rotation only or rotation with pincer modification of the classic IPF approach. Reconstruction of large defects in small facial cosmetic subunits such as the nasal ala can be performed using principles of both rotating IPFs and the 'pincer flap' technique. The degree of rotation is directly related to the length of coverage. Modifications to the flap are straightforward to perform. Using these techniques, larger defects that previously would have been reconstructed using flaps that cross cosmetic boundaries can now be reconstructed within the same cosmetic unit, thus, improving aesthetic outcomes.

Myomucosal island pedicle flap repair for lower lip defects

A 69-year-old man had undergone surgery for a squamous cell carcinoma (Fig 1), resulting in a partial-thickness myomucosal defect involving 40% of the lower lip. Defects over 30% of the transverse width are commonly repaired with local flaps, which should aim to preserve the shape, symmetry, and oral sphincter function. 1 Isik D. Garca M.F. Durucu C. Goktas U. Atik B. Reconstruction of lower lip with myomucosal advancement flap. Head Neck. 2012; 34: 1562-1569 Crossref PubMed Scopus (4) Google Scholar

Shark island pedicle flap for large reconstruction of the upper lip

Shark island pedicle flap for large reconstruction of the upper lip

Difficult-To-Treat Periprosthetic Hip Infection: Outcomes of Debridment

Purpose of the study — to compare management efficiency for difficult-to-treat periprosthetic hip joint infection (PJI) during resection arthroplasty with grafting by vastus lateralis pedicle island flap in comparison with insertion of an antimicrobial-loaded cement spacer. Material and Methods. 132 patients were included into the retrospective study who underwent treatment from 2012 until 2018 including removal of orthopaedic implant, radical surgical debridement of infection focus, resection arthroplasty with grafting by vastus lateralis pedicle island muscle flap (PMF group — 57 patients) or insertion of antibacterial-loaded cement spacer (AMS group — 75 patients). The authors examined medical histories, nature of infection process, infection agent type, laboratory data in respect of systemic inflammation, size of bone defects, follow up status and remission of PJI in the late period. Results. 89.4% of patients (n = 51) who underwent grafting by vastus lateralis pedicle island flap had a history of 3 and more prior surgical procedures in the same area. At the same time the share of such patients in the spacer group was only 38.6% (n = 29) (p0.0001) while the share of patients with two and more recurrences was 78.9% (n = 45) and 25.3% (n = 19), respectively (p0.0001). No significant variances were observed between the groups in respect of type composition of PJI microbial infection agents. The infection in a vast majority of patients in both groups was caused by microbial association: 77.2% and 72.0% in PMF and AMS groups, respectively. In the early postoperative period secondary revision of surgical site was performed in 35% and 28% of cases in PMF group (n = 20) and AMS group (n = 21), respectively, including due to recurrent infection in 15.8% and 28% of cases, respectively. Stable remission of difficult-to-treat PJI in PMF group was 96.5% and 45.3% in AMS group. Conclusion. Despite some cases that required secondary revisions in early postoperative period the resection arthroplasty in combination with pedicle muscle flap can be considered a surgery of choice for management of recurrent difficultto-treat PJI with feasible re-implantation of prosthesis against the stable remission of infection.

Repair of Anterior Ear Defects Using Transcartilage Island Pedicle Flaps.

Surgical reconstruction of the anterior surface of the ear (concha, antihelix, scapha, and triangular fossa) is complicated by the paucity of mobile local skin. This is a retrospective study of the transcartilage island pedicle flap for reconstruction of surgical defects of the anterior ear. Two hundred thirty-two Mohs micrographic surgery defects were included in the study. The technique involves circumferential incision of the flap in the postauricular sulcus, transfer of the flap to the anterior ear through a surgically created cartilage slit, suturing of the flap on the anterior surface of the ear, and repair of the secondary postauricular defect. Preoperative, intraoperative, and postoperative details of each case were tabulated and analyzed. The mean defect size was 1.9 × 1.5 cm. Complications included flap edema (n = 6, 2.6%), postoperative bleeding (n = 4, 1.7%), partial thickness flap necrosis (n = 2, 0.9%), pinning back of the ear (n = 2, 0.9%), and central flap dimpling (n = 2, 0.9%). There was 1 acute staphylococcal abscess and 1 sterile abscess that developed 13 months postoperatively. All complications resolved with medical or surgical management. Transcartilage island pedicle flaps may be considered for single-stage surgical reconstruction of defects involving the anterior ear.