Island Pedicle Research Articles

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

Double island pedicle or V-Y flap repair for partial-thickness combined defects of the cutaneous and mucosal lip

Removal of skin cancer at or near the vermilion border may result in a partial-thickness combined cutaneous and mucosal lip defect for which repair has potential for poor cosmetic and functional outcomes. We sought to describe the closure and results from repair of combined lip defects using 2 island pedicle or V-Y flaps, 1 for the cutaneous lip and 1 for the mucosa. A retrospective review of all patients with combined defects of the lip who underwent double island pedicle or V-Y flap repair from June 2008 to December 2013 was performed. Ten patients (6 female, 4 male; ages 35-89 years, mean age 60 years) had defects on the upper lip in 8 cases and on the lower lip in 2 cases. Follow-up was for 3 months or longer with good or excellent outcomes in all cases. This was a nonrandomized, unblinded clinical case series with a limited sample size. Double island pedicle or V-Y flap repair is an elegant closure with good to excellent results and may avoid potential problems inherent in other repair options.

The clinical classification of sigle pedicled double island free anterolateral thigh flaps

To summarize the anatomic characteristic of sigle pedicled double island free anterolateral thigh flaps and to evaluate its application and classification. Between January 2010 and March 2013, 76 patients underwent free femoral anterolateral double island flap reconstruction of the defects in oral and maxillofacial region. Summarized the anatomic features of perforators, such as the number and origin of the perforators. According to the anatomic features and regularity of perforators, 76 cases of femoral anterolateral double island flaps were divided into 3 types: trunk type (type I), 15 cases (20%), in which the perforators of two flaps originated in descending branch and transverse branch of lateral femoral circumflex artery respectively; branch type (type II), 55 cases (72%), in which both the perforators originated in lateral femoral circumflex artery descending branch or lateral femoral circumflex artery transverse branch; bifurcation type (type III), 6 cases (8% ), in which two perforators originated in the two bifurcation of one perforator. Among the 76 cases, 75 survived and 1 showed partial necrosis. According to the anatomic features and regularity of perforators, femoral anterolateral double island flaps can be divided into 3 types: trunk type (I type), branch type (II type), bifurcation type (III type).

Lessons from 28 cases of reconstruction by lenticular island pedicle flap at a single institution.

Lenticular island pedicle flap (LIPF) has been reported to be one of the most useful techniques for reconstructing middle cheek skin defects. LIPF may have been used all over the world on a daily basis; however, no reports have examined a large number of LIPF cases at a single institution. A total of 28 cases of reconstruction by LIPF at the Hokkaido University Hospital from 2005 to 2013 were analysed. We examined the tumour type, location, area of defect and presence/absence of antithrombotic treatment and complications, including transient circulatory impairment, damage to facial nerves and eyelid ectropion. We found that nine patients had transiently impaired circulation. This complication was statistically more frequent in the patients without antithrombotic treatment than in the patients with antithrombotic treatment (0/8 vs. 10/20, P=0.0292; Fisher's exact test). We revelled that LIPF have been safely performed even under antithrombotic treatment, so, when patients are taking antithrombotic agents, we should choose LIPF rather than conventional flap including cheek flap, island pedicle flap and so on.

Full-thickness skin grafts for surgical defects of the nasal ala - a comprehensive review, approach and outcomes of 186 cases over 9 years

Skin cancers of the nasal ala are commonly encountered in dermatological surgery. Various techniques have been described to reconstruct surgical defects of the ala, including melolabial transposition flaps, interpolated melolabial flaps, bilobed and trilobed transposition flaps, island pedicle flaps and spiral flaps. Full-thickness skin grafts have received little attention in the reconstructive literature. We present our experience with full-thickness skin grafts for the reconstruction of partial thickness defects of the nasal ala in the largest series to date. A retrospective analysis of the Mohs micrographic surgery database over a 9-year period was performed. All cases of full-thickness skin grafts for reconstruction of the nasal ala were identified. Defect location, size and any postoperative complications were noted. All patients were reviewed at the time of suture removal, at 3 and 6weeks postoperatively and at 1year. There were 186 cases in total in 181 patients (88 men and 93 women). Their ages ranged from 31 to 88years with a mean of 65years (median 66). Defect size varied from 0·3×0·4cm to 2·0×2·7cm, with the average defect size measuring 1·0-1·2cm in diameter. Thirty-six per cent (67 of 186) of cases underwent postoperative dermabrasion, and 8% (14 of 186) received postoperative intralesional triamcinolone. The incidence of graft failure and infection was low. Good-to-excellent cosmetic results were seen in all patients and postoperative complications were uncommon and minor. The use of full-thickness skin grafts for defects of the nasal ala is a simple and versatile reconstructive option with excellent functional and aesthetic outcomes.

Comparison of ischaemic preconditioning with surgical delay technique to increase the viability of single pedicle island venous flaps: An experimental study

The aim of the present study was to investigate the effect of ischaemic preconditioning compared with the surgical delay procedure in an effort to increase the survival rate of single pedicle island venous flaps. Eighteen male Wistar albino rats (250–350 g) were included. A 3 × 4 cm flap was planned at the right lower abdomen of the rat. Superficial epigastric vein constituted the pedicle of the flap. The rats were divided into three groups, each consisting of six rats. In the control group, a single pedicle venous island flap was elevated on each rat and no other surgical procedure was performed. In the ischaemic preconditioning group, ischaemic preconditioning was performed and, in the surgical delay procedure group, the surgical delay technique was performed before flap elevation. The mean necrosis areas were 56.85 ± 14.60%, 28.73 ± 15.60%, and 12.08 ± 3.65% in the control, ischaemic preconditioning, and surgical delay procedure groups, respectively. The necrosis areas were significantly smaller in the ischaemic preconditioning group and surgical delay procedure groups compared to the control group (p = 0.004 and p < 0.001, respectively). The necrosis areas were similar in the ischaemic preconditioning and surgical delay procedure groups. Histopathological parameters including necrosis, abscess formation, and skin ulceration scores were significantly lower in the ischaemic preconditioning group than in the control group, whereas the study groups were similar. In conclusion, ischaemic preconditioning may serve as an adjuvant technique in increasing venous island flap viability.

Combined Vestibular Mucosal Advancement and Island Pedicle Flaps for the Repair of a Defect Involving the Cutaneous and Vermilion Upper Lip

Combined Vestibular Mucosal Advancement and Island Pedicle Flaps for the Repair of a Defect Involving the Cutaneous and Vermilion Upper Lip

An unexpected course after simultaneous urethral repair and reimplantation of penile prosthesis in a patient with a urethral stricture.

We experienced the growth of urethral hair along the urethral stricture six years after simultaneous urethral repair and reimplantation of penile prosthesis (RPP) in a patient with a urethral stricture. We detected hair in the urethra with a stricture on the bulbous urethra. Further, we performed hair removal by using a pair of cystoscopic forceps and internal urethrotomy. Then, we performed RPP, and the patient voided well; the prosthesis worked very well and without any complications. One-stage urethroplasty with a pedicle island of the penile skin and RPP in a simultaneous stage may be an option for treating the long-segment urethral stricture in the penile prosthesis patient. However, we should pay attention to the urethral hair growth that can occur after urethral repair performed using a skin graft.

Local Flaps: Cheek and Lip Reconstruction

The reconstruction of cutaneous defects of the cheek and lip is a foundational topic for facial plastic and reconstructive surgeons. Facial defects have a significant impact on patient quality of life that has been well demonstrated. To review new findings that have an impact on the planning and understanding of local flaps for the reconstruction of cutaneous defects of the cheek and upper lip; recent research in facial soft-tissue anatomy and vascular anatomy is integrated into a discussion of local flap reconstruction. A Medline search of scientific literature was conducted, with an emphasis on 1980 to the present. Search terms included cheek; lip; reconstruction; vascular anatomy, soft-tissue anatomy, aging face, outcomes, and perforator flap. Cadaveric studies were specifically sought for anatomic review, and comparison group outcome studies are preferentially cited over clinical case series. Reconstruction of large medial defects of the cheek and upper lip is particularly challenging, and the V-Y subcutaneous tissue pedicle island advancement flap is valuable for repair of these defects. Outcomes analyses for local flap reconstruction are in high demand. Pedicled perforator flaps will likely see increased application for facial reconstruction in the near future. Detailed knowledge of the soft-tissue anatomy of the cheek and lip is critical to accurate surgical planning in local flap reconstruction.

Staged Island Pedicle Flap and Tube Flap to Repair a Full-Thickness Defect of the Upper Third of the Ear

Staged Island Pedicle Flap and Tube Flap to Repair a Full-Thickness Defect of the Upper Third of the Ear

Crescentic Alar Myocutaneous Island Pedicle Flap for Reconstructing Columellar Defects

Crescentic Alar Myocutaneous Island Pedicle Flap for Reconstructing Columellar Defects

Medial Eyebrow Defects

Medial Eyebrow Defects

Delay of the reverse pedicled venous island flap: Clinical applications

In patients with hand or foot injuries, the delay procedure of the reverse pedicled venous flap was applied, including the loose areolar tissue around the pedicle vein. As preliminary clinical observations, five patients were treated with delay and the results compared with those of four patients without delay. The delay procedures were two types: type 1 was circumferential incision with ligature of the proximal vein, and type 2 was a bipedicled flap without ligature of the pedicle vein. Two weeks later, the flap was transferred to the defect. In the patients treated without delay, the maximum limit of the perfectly survived flap sizes was 4.0 × 2.0 cm. However, in the patients treated with delay, the perfectly survived sizes were 5.0 × 3.0 cm and 10 × 4.0 cm in type 1 delay and 12 × 5.0 cm in type 2 delay. The delay procedure appeared to stabilise the reverse pedicled venous flap and to expand its clinical applications.

Management of Infected Groin Wounds after Vascular Surgery

Management of an infected groin wound after vascular surgery may be a challenge. We report a retrospective series of cases of the management of groin defects and an algorithm for their management based on our own experience and related literature. We conducted a retrospective chart review from June 2008 to February 2012 of patients with infected groin wounds after vascular surgical procedures. The review disclosed six patients with a history of femoral cannulation or extracorporeal membrane oxygenation (ECMO), one patient with a femorofemoral bypass, one patient with an intra-aortic balloon pump (IABP), and one patient with a thoracoabdominal aneurysm following stent implantation. Exposure of femoral vessels was noted in seven of these nine patients, and wound cultures of all nine patients yielded positive results. The mean age of the nine patients (five males and four females) was 54.6 years (range 17-79 years). The mean follow-up was 13.6 months (range 8-30 months). Four of the patients were treated with a pedicled gracilis flap; one with a local flap; one with a myocutaneous flap of the anterolateral thigh (ALT) combined with a partial tensor fascia lata (TFL) flap; one with primary closure; and two with a myocutaneous island pedicle flap of the ALT. No donor-site complications were noted. There was partial skin cyanosis in the patient treated with a myocutaneous flap of the ALT combined with a TFL flap, which resolved after one week. The scheduled follow-up of the patients showed that all of their groin wounds had healed well. A pedicled flap of gracilis muscle is an ideal and effective option for covering infected groin wounds of <10 cm with exposure of femoral vessels. According to a literature review, a sartorius muscle flap is another option for accomplishing this. A myocutaneous island flap of the ALT is indicated for infected groin wounds>10 cm with exposure of femoral vessels. The literature indicates that myocutaneous flaps of rectus abdominis (RA) muscle and flaps of rectus femoris (RF) muscle are also suitable for groin wounds larger than 10 cm. Bilateral flaps of ALT and bilateral myocutaneous flaps of RA or RF muscle are suggested for the reconstruction of bilateral groin wounds. For infected groin wounds without exposure of femoral vessels, a local flap or primary closure are suggested, depending on the size of the defect.

The Auricle's Cavum conchae Composite Graft in Nasal Reconstruction

Autologous transplants consisting of skin and cartilage, so-called composite grafts (CGs), are useful in nasal reconstruction of multilayered defects. A CG from the auricle's cavum conchae serves both functional and esthetic demands. This article outlines the indications and the requirements of the CG, making special considerations to improve wound healing, and discusses our results in consideration with recent publications. A retrospective case-control study assessing the functional and esthetic long-term results in the donor and recipient site is presented. Between 2005 and 2011, 91 patients received differently sized CGs of the auricle for nasal reconstruction. In 85/91 cases the donor site defect was closed using a retroauricular pedicled island flap. Six of 91 defects were closed primarily. Indications were multilayered defects of the nasal vestibule, the nasal floor, the inner nasal valve, and the lateral sidewall. The main indication for surgery was skin malignancies. One of 91 major and 14/91 minor complications were observed. Seventy-seven of 91 patients received a custom-made prosthesis to prevent stenotic scarring. The 2.5-year follow-up showed excellent results of stability and shape at the donor and recipient site. The auricular inner lining CG is a versatile and reliable autologous transplant, which is ideal for multilayered nasal reconstruction because of easy harvesting, little donor site morbidity, and its convex shape. Septal splints and custom-made prosthesis secure healing and prevent stenotic scarring.

Reconstruction of the Inner Canthus Region Using Combined V-Y Island Pedicle Flaps

Harceaga, Olimpiu I. MD1; Baican, Corina I. MD, PhD1; Cosgarea, Rodica MD, PhD1 Author Information

両側口唇裂術後に見られるwhistlingdeformityに対する筋茎粘膜弁(muscularpedicleislandflap)による修正法

両側口唇裂術後に見られるwhistlingdeformityに対する筋茎粘膜弁(muscularpedicleislandflap)による修正法

Medial eyebrow defects: Reconstruction with whole eyebrow subcutaneous island pedicle

Medial eyebrow defects: Reconstruction with whole eyebrow subcutaneous island pedicle

Crescentic Apical Triangle Island Pedicle Flap for Repair of the Medial Upper Lip

Crescentic Apical Triangle Island Pedicle Flap for Repair of the Medial Upper Lip

Island flaps in the repair of medial canthus: Report of 8 cases

Reconstruction of the medial canthus following skin cancer excision is often challenging because of the complex anatomy and the cosmetic relevance of that region. The island pedicle advancement flap is an extremely versatile flap, which is commonly used to close defects in different body areas, including face, trunk, and extremities. We report our favourable experience with the use of island flaps, mobilized from the nasal saddle or lateral nasal side wall in 8 patients who had skin defects on the medial canthus region after Mohs micrographic surgery for basal cell carcinomas.