Island Pedicle Research Articles

Nasal root island pedicle flap for lateral nasal sidewall defect: A case report

Nasal root island pedicle flap for lateral nasal sidewall defect: A case report

Observation of effect of red lip defect repair using orbicularis oris muscles pedicle island flap disc

Objective To explore the effect of red lip defect repair using orbicularis oris muscles pedicle island flap disc. Methods 100 cases of unilateral pure red lip defect 1/3-2/3, lip lines full of patients were selected as the research subjects. They were randomly divided into two groups, 50 cases in each group. Group A treated with debridement surgery to repair. Group B received red lip flap to promote repair treatment. The treatment effect of the two groups, satisfaction, lip survival rate and the degree of obvious scars were compared. Results he operation effect of the two groups was good. The satisfaction rates of group A and group B were 94.00% and 96.00%, respectively.For the lip shape treatment satisfaction, the difference was no statistically significant (P>0.05). The patients of the two groups with lip all alive, and 1 patient in group A with obvious scar, the scar was not obvious in group B. Conclusion For patients with red lip defect, take orbicularis oris muscles pedicle island flap of the oral mucosa or red lip flap to promote repair treatment has relatively significant clinical efficacy, with easy operation, less influence on the patients with facial form, it is worthy of popularizing. Key words: Oral mucosal flap; Red lip defect; Repair; Orbicularisoris muscles island

Evaluating Surgical Delay Using Infrared Thermography in an Island Pedicled Perforator Flap Rat Model

Background The aim of this study was to examine the usefulness of infrared (IR) thermography in visualizing the dilation of the choke vessels in a delayed pedicled perforator flap rat model. Methods A three-territory island flap was designed and harvested on one side of the rat dorsum. The flap was divided into five regions. In the normal group (n = 8), IR thermal imaging was correlated with the postmortem arteriography for the location of angiosomes, linking patterns, perforator diameter, and temperature on each region. The delay group (n = 35) was divided into seven groups according to various delay periods. At different time intervals, the delay group was compared with the normal group according to link pattern and temperature on each region. Results IR thermal imaging showed that a white hotspot existed on the surface of each angiosome; the true anastomotic vessels manifested a continuous white band linking the white hotspots on angiosomes, whereas the choke vessels presented a red zone in between adjacent hotspots. After delay, the dilation of the choke vessels manifested itself as the replacement of the red zone between adjacent hotspots by the white band on IR thermography. In addition, the delayed flap presented a phenomenon of rise and fall in temperature over time. Conclusion IR thermography can accurately visualize the process of the dilation of choke vessels after a surgical delay. The chronological change in the IR thermal imaging combined with the temperature change in the delayed flap might be useful to determine the optimal delay period.

Reconstruction of Heel Soft Tissue Defects Using Medial Plantar Artery Island Pedicle Flap: Clinical Experience and Outcomes Analysis

We report our clinical experience with 11 cases of heel soft tissue defects treated with a medial plantar artery island pedicle flap. We also evaluated the functional outcomes of reconstruction. We enrolled 11 patients (10 [90.9%] males and 1 [9.1%] female), who received a medial plantar artery island pedicle flap for heel soft tissue defects from August 2010 to July 2014. The cause of the defects included trauma (post-traumatic heel skin necrosis) in 2 (18.2%) patients, infection (calcaneal osteomyelitis with overlying soft tissue infection) in 2 (18.2%) patients, and tumor (stage IA melanoma) in 7 (63.6%) patients. The mean average size of the defect was 3.7 cm × 4.4 cm (range 3.1 cm × 4.0 cm to 4.5 cm × 5.5 cm). The mean follow-up period was 19.6 (range 8 to 35) months, and all flaps survived within that period. The mean static 2-point discrimination was 34.4 (range 29 to 40) mm at the heel and 17.2 mm at the distal sole. The mean visual analog scale score for the aesthetic appearance of the reconstructed heel was 9 (range 8 to 9.5). The average revised Foot Function Index score was 25.8 (range 21 to 37). The medial plantar artery island pedicle flap is a versatile and effective method for reconstructing heel soft tissue defects.

Umbilicus Reconstruction After Melanoma Excision.

An 81-year-old woman was admitted with a nodular cutaneous melanoma of the abdominal wall involving the umbilicus. After performing wide excision with 2 cm margin of the melanoma, umbilical reconstruction and defect closure were planned. After careful consideration, we decided to use an island pedicle flap which allowed closure of the defect and reconstruction of the umbilicus.

Reconstruction of auricular conchal defects with local flaps.

Reconstruction of the auricular conchal cavity is relatively difficult because of its unique structure, shape, and location. We compared different methods of repair of the auricular concha to determine the method that would cause the least injury to the donor site.The method selected was based on the location and size of the defect. If the defect was located in the upper part of the concha, or if the defect was >15 mm in diameter, we used a post-auricular subcutaneous pedicle island flap that was pulled through a post-auricular sulcus tunnel to cover the wound. If the defect was located in the lower part of the concha and was <15 mm in diameter, we used a pre-auricular translocation flap that was passed through the intertragic notch to cover the wound. The donor site was closed primarily. All flaps survived well and any scars associated with the surgery were unnoticeable. No tumor relapse or metastasis was observed over a mean follow-up period of 35 months. All patients were satisfied with the outcome.The periauricular flap technique chosen for reconstruction of skin defects in the auricular concha depends on the size and location of the defect. With appropriate flap selection, excellent functional, and aesthetic outcomes are achieved.

Thumb Tip Defect Reconstruction Using Neurovascular Island Pedicle Flap Obtained From Long Finger.

Thumb tip reconstruction has been a very challenging issue for hand surgeons. Varieties of reconstructive options have been described or modified to obtain satisfactory sensory recovery. However, none has yielded entirely satisfactory results. This study reports a retrospective review of clinical data records of patients treated with a neurovascular island pedicle flap obtained from the medial aspect of the long finger. We enrolled 15 patients (9 men and 6 women), who received neurovascular island pedicle flaps for thumb tip amputations between December 2011 and December 2015. The average size of the flap was 2.8×2.2cm(2) (range 2.5×1.8cm(2) to 3.5×2.5cm(2)). At the final follow-up visits, static two-point discrimination, visual analogue scale, Michigan hand outcome questionnaire and return-to-work time were used to evaluate surgical outcomes. All flaps survived well. The follow-up period was 18months. The mean static 2PD values at the reconstructed thumb tip and donor finger pulp (medial side) were 5.3mm (range 4-8mm) and 3.2mm (range 3-4mm), respectively. The average VAS scores for the aesthetic appearance of the donor site and recipient site were 9.1 (range 8-10) and 9.0 (range 8-9.5), respectively. The average Michigan Hand Outcome Questionnaire (MHOQ) score for hand function (reconstructed hand) was 8.2 (range 6-16). The average RTW time was 8.4weeks (range 7-12weeks). Neurovascular island pedicle flap obtained from the medial aspect of long finger is a very reliable alternative technique for thumb tip defect reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Surgical Repair of Mid-shaft Hypospadias Using a Transverse Preputial Island Flap and Pedicled Dartos Flap Around Urethral Orifice.

To evaluate the effects, particularly the incidence of anastomotic fistula, of a pedicled dartos flap around the urethral orifice in the treatment of urethroplasty of mid-shaft hypospadias. A total of 46 cases of congenital mid-shaft hypospadias were included in this study. The patients ranged in age from 0.7 to 25.4years and the average was 5.8years. The patients received penis chordee correction. A transverse preputial island flap was developed for urethral reconstruction. The proximal dartos of the urethral orifice was used to develop a pedicled dartos flap, which was transposed to cover and strengthen neourethral anastomosis. The ventral penile skin defect was repaired by another flap. The 46 patients were examined during follow-up visits for 6months to 3years. An anastomotic fistula was observed in one case (2.2%). Scar healing without fistula was observed in another patient due to poor blood supply to part of the ventral penile skin. No other incidences of fistula, urethral rupture, flap necrosis, wound infections, urinary tract (meatal) stenosis, or urethral diverticulum were observed in the patients. A pedicled dartos flap around the urethral orifice can take advantage of well-vascularized local tissue to add a protective layer to the proximal aspect of the neourethral anastomosis for reducing the incidence of anastomotic fistula in mid-shaft hypospadias repair using a transverse preputial island flap. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator.

Background:The purposes of this article are to introduce and assess the results of a long-term follow-up of using anterograde pedicle flap based on the dorsal branches of proper digital neurovascular bundles from the dorsum of the middle phalanx for the fingertip defect.Methods:Between February 2011 and December 2012, 31 patients underwent reconstruction of fingertip defects using a homodigital flap based on the dorsal perforator in the middle phalanx. The defect size ranged from 1.3 cm × 1.5 cm to 2.4 cm × 3.0 cm. During surgery, the flap was designed on the dorsal middle phalangeal region. The pedicle was a neurovascular bundle consisting of an artery, vein, and sensory nerve; the rotation of pedicle was <90 degrees.Results:The clinical results were satisfactory after 3 to 9 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors. The sensory recovery was excellent, 2-point discrimination was 4.96 ± 1.47 mm, and the recovery of range of motion of the interphalangeal joints was very good.Conclusions:The anterograde island flap based on the dorsal branches of proper digital neurovascular bundles is an ideal aesthetic reconstruction method for fingertip defect. A 90-degree rotated island pedicle flap was very versatile, easy to design, and had good survival. This technique is simple with less damage to the donor site, without sacrificing the branch of the digital artery and nerve. The reliable source of blood supply and satisfactory recovery of sensation can be achieved without affecting the interphalangeal joint activity.

Undermining the opposition: Ballistic tips for improving the island pedicle flap

SURGICAL CHALLENGE The island pedicle flap is one of the staples of facial reconstructive surgery, particularly useful for repairing wounds on the medial aspect of the cheek and upper cutaneous lip. With the rich vasculature at the base of the pedicle, excellent cosmetic results can be achieved. One of the challenging aspects of the repair is ensuring the tip of the pedicle is juxtaposed to its receptacle to facilitate an optimal scar andmanipulating the leading edge of the flap into the defecteagain aiming to optimize the aesthetics of the scar. We present 2 modifications to the traditionally taught island pedicle flap.

Profunda artery perforator flap for isolated vulvar defect reconstruction after oncological resection.

Isolated vulvar reconstruction using profunda artery-based perforator flaps have good functional as well as quality of life restoration. Surgical techniques, complications, and final evaluation using questionnaires are presented. Vulvar reconstruction remains a great challenge to reconstructive surgeons. A local fasciocutaneous flap from the medial thigh is a good option with multiple choices of the donor arteries. Here, we extended the clinical application of a profunda perforator artery (PAP) flap with the design of an island pedicle flap. From 2012 to 2015, 12 female patients with vulvar cancer received tumor ablation and immediate reconstruction using a PAP flap. The flaps (n = 19) were divided into V-Y advancement perforator flap (group I, n = 4) and island pedicle perforator flap (group II, n = 15). All of the demographic data were collected and analyzed. All of the flaps were transferred successfully, and all of the donor sites were closed without morbidities. Group II was superior to group I because of the smaller required flap size (P = 0.004), the smaller defect size/flap size ratio (P = 0.001), and a lower rate of post-op debridement (P = 0.037). The other parameters were not statistically significant. PAP flap is a good choice for vulvar reconstruction. We preferred an island pedicle setting for its thin and pliable fasciocutaneous component and robust flap circulation. The favorable functional and aesthetic results can be achieved with limited donor site morbidities. J. Surg. Oncol. 2016;113:828-834. © 2016 Wiley Periodicals, Inc.

Huge abdominal wall reconstruction with island pedicle anterolateral thigh flap with tensor fascia lata plus vastus lateralis muscle

Full-thickness abdominal wall defects may result from trauma, tumor resection, or infection. Management of these defects poses a significant challenge. Few studies have been conducted on using the pedicle anterolateral thigh (ALT) flap to reconstruct a defect of over half the anterior abdominal wall. We report a large abdominal wall reconstruction with island pedicle ALT flap with tensor fascia lata plus vastus lateralis muscle. An 80-year-old man with a large recurrent abdominal wall tumor had undergone two tumor resections after 2010. The pathology report demonstrated fibromatosis in 2010. Recently, computed tomography revealed a large, lobulated mass measuring approximately 11.8 cm × 5.3 cm × 8.8 cm, with heterogeneous enhancement, located at the left abdominal wall with cutaneous and subcutaneous involvement and adjacent omentum thickening. Wide excision and subsequent reconstruction of the abdominal wall defect with a pedicle ALT flap was conducted. The permanent histology report confirmed fibrosarcoma. Partial skin necrosis was noted after reconstruction surgery, and a second operation was performed to debride the necrotic skin. Wound healing was optimal, without any recurrence. Large primary abdominal fibrosarcoma is rare; thus, reconstruction of the postoperative defect is particularly challenging for plastic surgeons. In this case, we successfully used the pedicle ALT flap with tensor fascia lata plus vastus lateralis muscle to reconstruct the abdominal wall defect in the patient. This is an effective yet simple single-stage reconstructive procedure for defect repair.

Long-term result of meatoplasty using inferiorly based retroauricular island pedicle flap for external auditory canal stenosis.

To characterize the long-term outcomes of meatoplasty using our new technique, inferiorly based retroauricular island pedicle flap for external auditory canal (EAC) stenosis. A long-term clinical analysis of meatoplasty for nine patients (mean age, 33 years; age range, 8-64 years) with stenotic EAC was performed. The follow-up period after meatoplasty ranged from 5 years to 14 years, with a mean duration of 8.4 years. We compared preoperative and postoperative otoscopic findings, high-resolution computed tomographic (CT) images of the EAC, and hearing levels. Otoscopic examinations demonstrated widened EAC in eight of the nine patients. There was a significant increase in the size of the EAC on postoperative CT examinations when compared with the preoperative state. The hearing outcome in all patients was variable. The postoperative air-bone gap (ABG) was closed to 10dB or less in two cases, while the other seven cases showed ABG ranging from 15.0dB to 57.5dB. We performed meatoplasty using inferiorly based retroauricular island pedicle flap for nine patients with EAC stenosis and eight of the nine patients demonstrated satisfactory patent EAC during a mean follow-up of 8.4 years.

Clinical experience with the supraclavicular flap to reconstruct head and neck defects

To evaluate the efficacy of pedicled supraclavicular artery island flaps for head and neck reconstruction. Reconstructive surgeries for head and neck oncologic defects were performed with the pedicled supraclavicular artery island flaps in 10 patients from May 2013 to December 2014 and the cases were review. Among them, 6 were performed for hypopharyngeal cancer, 2 for oral tongue cancer, 1 for oral base cancer and 1 for cervical esophageal cancer. The size of the flaps was measured in (5-8) cm × (6-12) cm. Seven flaps survived, one flap failured and two flaps had partial necrosis. Donor sites were closed primarily without morbidity. The pedicled supraclavicular artery island flap is an easy harvesting and reliable for head and neck reconstruction, especially suitable for otolaryngo-head and neck surgeon and maxillofacial surgeon in the local hospital.

Dorsal hand coverage

Dorsal hand coverage

Reconstruction algorithm for nasal basal cell carcinoma with skin involvement only: analysis of 221 cases repaired by minor surgery.

Basal cell carcinoma (BCC) often occurs on the nose. Reconstruction of the nose should yield excellent aesthetic and functional outcomes. We propose a technical algorithm for the reconstruction of surgical defects, based on our analysis of 221 cases of nasal BCC with skin involvement only, which could be repaired by minor surgery. The aesthetic and functional outcomes for various reconstruction techniques were analysed according to defect location and size. A reconstruction algorithm was proposed with the aim of obtaining the best surgical results. Defect location and size were key considerations. Primary closure was the first option for small defects (<10mm), with scores of 3.4 for objective aesthetic outcome (OAO), 3.2 for subjective aesthetic outcome (SAO) and 3.3 for subjective functional outcome (SFO). The first option for medium defects (1-20mm) was the island pedicle flap, with scores of 3.5 for OAO, 3.2 for SAO and 3.7 for SFO. The first option for large defects (>20mm) was the transposition flap for the upper nose (scores of 2.0 for OAO and SAO and 3.0 for SFO) and the interpolation flap for the lower nose (2.8 for OAO and 2.9 for SAO and SFO). We have proposed an algorithm to select the optimal technique for repairing nasal BCC surgical defects according to their size and location.

"Sensory Switching" in Elbow Reconstruction.

In the treatment of the soft tissue defect of the elbow, flap reconstruction is necessitated in many cases because of thinness of soft tissue at this region. In addition, reacquirement of tactile sensation is desirable because of the anatomical and specific functions of the elbow. Of three cases treated for elbow defects, one was reconstructed with a pedicled island forearm flap containing the lateral cutaneous nerve of the forearm, another was reconstructed with a venoneuro-accompanying artery fasciocutaneous flap (VNAF flap) containing the basilic vein, and the third with the VNAF flap containing the cephalic vein. The three cases demonstrated a sudden change of sensory territory 4 to 6 months after surgery, which was confirmed by touching the reconstructed region with patients' eye-closed: from its original territory to the elbow in a "switching"-like action. Here we describe and discuss the concept of "sensory switching."

Experimental study of survival of pedicled perforator flap with flow-through and flow-end blood supply.

Flap viability after transfer depends on blood flow from the arterial blood supply below the fascia. This study evaluated survival of a pedicle flap with a perforator lateral branch and flow-through blood supply, compared with that of a flap with a flow-end blood supply and perforator terminal branch. Forty Sprague-Dawley rats, 20 in each group, were assigned to transfer of a superficial epigastric artery pedicle island flap with a flow-through or flow-end configuration of blood supply. Laser Doppler imaging was used to evaluate flap perfusion 2 h, 3 days and 5 days after surgery. The rats were killed on day 5, and lead oxide-gelatine-enhanced flap angiography and histology with haematoxylin and eosin staining was performed. Dorsal midline tissue was excised for quantification of vascular endothelial growth factor by western blot assay. On day 5 after surgery, the flow-through group exhibited a significantly greater mean(s.d.) flap survival area (97·8(3·5) versus 80·8(10·2) per cent; P = 0·003), microvascular density (303(19) versus 207(41) per mm(2) ; P < 0·001) and perfusion (8·64(0·14) versus 5·95(0·14) perfusion units; P < 0·001) than the flow-end group. The flow-through group exhibited more angiosomes connected by dilated vascular anastomoses between the skin and subcutaneous fasciae. The flow-through blood supply improved pedicle perforator flap survival. Surgical relevance Perforator flap failure is mainly the result of impaired blood supply, as a flow-end blood configuration is nourished only by the perforator terminal branch of the artery. This work showed that the flow-through blood supply nourished by the perforator lateral branch improved flap survival, with dilatation of collateral vascular anastomoses and increased neoangiogenesis. The use of a flow-through configuration improves perforator flap survival and could therefore minimize morbidity resulting from flap necrosis.

A salvage maneuver for the caudal part of the pectoralis major muscle in the reconstruction of superior thoracic wall defects: The pectoralis kite flap

The pectoralis major muscle flap is the most commonly used option for chest wall reconstruction. However, its utilization should be avoided in chest wall tumors infiltrating the muscle. This article presents the utilization of the caudal part of the pectoralis major muscle as a pedicled flap in cases requiring the resection of the cranial part of the muscle due to tumor infiltration. Fourteen patients with a mean age of 60.3 years were operated for malignant thoracic wall tumors between 2011 and 2014. All tumors were located on the upper thoracic area with a mean defect size of 16.6×12cm. During tumor resection, the thoracoacromial vessels and pectoral branch were preserved and dissected until reaching the pectoralis muscle. After the resection of the cranial part of the muscle, the caudal part is prepared as a pedicled island flap and used for the coverage of the resultant defect. The mean postoperative follow-up period was 10.9 months. All flaps survived without any partial or total flap loss. A case of local recurrence, two cases of hematoma requiring drainage, and two cases of local wound-healing problems were the encountered complications. The pectoral kite flap is a versatile and reliable option for the coverage of small to medium upper chest wall defects with minimal morbidity, and it gives the reconstructive surgeon the opportunity to use the non-infiltrated caudal part of the pectoralis muscle instead of an unnecessary resection of the whole muscle.

Phalloplasty with an Innervated Island Pedicled Anterolateral Thigh Flap in a Female-to-male Transsexual : A Case Report

Phalloplasty with an Innervated Island Pedicled Anterolateral Thigh Flap in a Female-to-male Transsexual : A Case Report