Island Flap Research Articles

Improved Reverse Postauricular Island Flap for Repair of Lower Conjunctival Fornix Retraction.

Repair of lower conjunctival fornix retraction is a great challenge for plastic surgeons in the aspects of orbital prosthesis retaining and cosmetic appearance. Hereby, a 25-year-old woman, suffering from lower conjunctival fornix retraction after the removal of retinoblastoma and radiotherapy, was undertaking the treatment with an improved reverse postauricular island flap for expansion of the lower conjunctival fornix, and volume augmentation of the anophthalmic socket in one stage. The flap was based on the parietal branch of the superficial temporal artery and its vascular architecture to the postauricular vascular system, and successfully transferred by passing through a subcutaneous tunnel. The satisfactory result indicated that the mentioned technique may be a good option in surgical rehabilitation of the stable depth of the lower conjunctival fornix, not only from the reliable blood supply and the suitable thickness of the flap but also from the less donor morbidity without an exposed unsightly scar. Level V.

Keystone design perforator island flap: our experience for coverage of lower limb defects

The fusion of concept of perforasome and trapezoid design made Keystone design Perforator Island flap (KDPIF). This flap was first introduced by Behan in 2003 and since then many modifications were done. Keeping the principles of KDPIF, two modifications were done in this study. Aims: to determine reliability and advantages of KDPIF for lower limb defect coverage. Materials and Methods:15 cases were done in Plastic surgery department of Rajshahi Medical College Hospital from October 2020 to September 2022. Results: The largest wound measuring 11X 10 cm2 on thigh defect following wide local excision of sarcoma was covered by the largest dimension flap measuring 16X 11 cm2. In most of the cases (7 cases), Type IIA KDPIF was done. With co-morbidities, 14 flaps survived without any complications. Range operating time was 35-110 minutes. Conclusion: Due to its reliable vascularity and easy execution and good outcomes, KDPIF is one of the best choices for lower limb defect coverage. Bangladesh Journal of Medical Science Vol. 22 No. 04 October’23 Page : 920-925

Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve for Repairing of Finger Pulp Defect and Sensory Reconstruction: Is It Deserving?

Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve for Repairing of Finger Pulp Defect and Sensory Reconstruction: Is It Deserving?

To study the usefulness of islanded tongue flap reconstruction for carcinoma buccal mucosa defect

Background: Carcinoma buccal mucosa is very prevalent among the Indian population. The mainstay of treatment is surgical excision, which leaves tissue defects requiring reconstruction. Various techniques and flaps have been used for reconstruction of such defects, and research is still underway for better cosmesis and functional outcomes. Aims and Objectives: The aims of this study were to assess the usefulness of an islanded tongue flap in buccal mucosa cancer defect reconstruction after segmental mandibulectomy. Materials and Methods: The present hospital-based observational study was conducted on patients with carcinoma buccal mucosa, with an age greater than 20 years and both sexes included after obtaining written and informed consent. The patients underwent islanded tongue flap reconstruction after wide local excision of tumor and segmental mandibulectomy. Results: Twenty-four patients underwent the procedure and were included in this study. The outcome of the surgery was compared in terms of deglutition and difficulty in speech on a scale of good, satisfactory, and poor. The cosmetic outcome was also compared in the same way. During the post-operative period, eight (33.33%) patients developed early complications of hematoma and pus discharge. Three (12.5%) developed wound dehiscence. Two (8.33%) of these patients also developed flap necrosis. All these complications were managed conservatively. Overall, the surgery had a good cosmetic outcome with minimal difficulty in deglutition or speech. Conclusion: Based on results, an islanded tongue flap can be regarded as a good alternative for small and medium-sized buccal mucosa cancer defect reconstruction after segmental mandibulectomy.

Dorsal V-Y Advancement Flap for Lateral Finger Defect Based on Dorsal Skin Branch of Proper Digital Artery.

Managing lateral soft tissue defects, distal to the proximal interphalangeal joint, of the finger can be challenging. The use of antegrade homodigital island flap can be limited due to the length of the defect. Using a heterodigital island flap can be precluded by an injury in the adjacent fingers. Using the locoregional flap from the hand can result in a more extensive soft tissue dissection, which can create additional donor site morbidity. We present our execution technique of the homodigital dorsal skin advancement flap. The pedicle of the flap is based on dorsal branches of the digital artery perforator; hence the proper digital artery and nerve are unharmed. The operation is limited only to the injured digit, which can reduce donor site morbidity.

Tracheoesophageal Fistula Closure in a Pediatric Patient Using a Supraclavicular Artery Island Flap.

Acquired tracheoesophageal fistulas can lead to large defects with fatal complications. Surgical management is challenging but necessary to prevent respiratory infections and poor weight gain. Therefore, a reliable and pliable flap like the pedicled supraclavicular artery island flap with its wide arc of rotation and robust vascularization is needed for reconstruction. We highlight the surgical technique and postoperative measures in managing a tracheoesophageal fistula due to button battery ingestion in a 9-month-old boy with the supraclavicular artery island flap. In summary, the supraclavicular artery island flap is a safe and successful tool for closure of large acquired tracheoesophageal fistulas in pediatric patients.

Tunnelized Facial Artery Myomucosal Island Flap: A Modification of the FAMM Flap that Enhance its Reconstructive Versatility

Tunnelized Facial Artery Myomucosal Island Flap: A Modification of the FAMM Flap that Enhance its Reconstructive Versatility

Letter to the Editor about the article published in Clinical Oral Investigations titled "The contralateral-based submental artery island flap: feasibility and oncological safety in oral cancer-related defect reconstruction" (Ma J, Zhai X, Huang M, Li P, Liang Y, Ouyang D, Su YX, Yang WF, Liao G, Zhang S. Clin Oral Investig, https://doi.org/10.1007/s00784-023-05103-1).

Letter to the Editor about the article published in Clinical Oral Investigations titled "The contralateral-based submental artery island flap: feasibility and oncological safety in oral cancer-related defect reconstruction" (Ma J, Zhai X, Huang M, Li P, Liang Y, Ouyang D, Su YX, Yang WF, Liao G, Zhang S. Clin Oral Investig, https://doi.org/10.1007/s00784-023-05103-1).

The double-face onlay-tube-onlay transverse preputial flap: An advantageous alternative to the two-stage hypospadias repair?

To compare the surgical outcomes and complications of boys who underwent double-face onlay-tube-onlay transverse preputial island flap (DFOTO) one-stage repair vs. two-stage repair for proximal hypospadias. Males with proximal hypospadias who underwent DFOTO or two-stage repair at a single institution from 2008 to 2021 were identified. Patients who had prior hypospadias surgery were excluded. Outcomes were surgical complications, number of surgical procedures, operative time, and post-operative uroflowmetry results. Fifty-three males who underwent DFOTO and 39 who underwent two-stage repair were included. Median age at surgery was 1.1 years (IQR 0.83-1.6) and median follow-up was 3.0 years (IQR 1.2-6.8). Although not statistically significant, the DFOTO group had higher rates of urethrocutaneous fistula (30% vs. 15%, p=0.10), urethral stricture (15% vs. 3%, p=0.07) and urethral diverticulum (8% vs. 3%, p=0.39). Although the unplanned re-operation rate was higher in DFOTO (58% vs. 33%, p=0.02), the mean number of procedures and median total surgical time were lower in DFOTO (1.8±0.9 vs. 2.4±0.8, p=0.0004; 337min [IQR 278-460] vs. 468 min [IQR 400-563], p=0.008). There were no significant differences between groups for mean peak flow rates and post void residuals. In males who underwent DFOTO, 42% achieved completion of their proximal hypospadias repair with one operation, while the remainder had largely minor complications. Accounting for reoperation rates, the mean number of procedures per patient was lower in the DFOTO group. Comparable results can be achieved with both techniques; the risks of higher unplanned operation rates in the DFOTO group should be considered with the benefit of fewer total procedures.

Perforator flap for burn reconstruction

BackgroundMajority of burn patients in Bangladesh are treated at home and tend to develop scar and scar contracture. Other than physical limitations there are also stigmatization, loss of marriageability or divorce particularly for women. Skin grafts are prone to contraction and need prolonged splintage and physiotherapy. Flaps are often too bulky. Local flaps have the advantage of increased positional comfort as compared to distant flaps like the abdominal or the groin flaps. Free flaps are technically demanding and facilities are not universally available. Advances in knowledge of blood supply of the skin have increased the potentials for perforator based skin flaps. MethodologyA total of 72 patients who could complete a minimum one year follow up were included in the study. All flaps were rotated around the axis of the perforator ranging from 90 degrees to 180 degrees. Skin pedicles were kept when possible, complete island flaps were designed when rotation was maximum. ResultsAmong the 72 cases 54 cases were electric burn wounds and18 were post burn scar contracture, 59 were male and 13 were female. 44 cases were done on leg. Smallest flap was 5 cm in length and the largest was 16 cm. Immediate complications include total flap loss, tip loss, margin loss, wound infection and hematoma under the flap was noted. In one case emergency exploration was required to control hemorrhage. Contour defect, dependent edema in legs, sensorineural deficit, limitation of joint movement was also observed. ConclusionA single perforator may safely supply its proper angiosome and up to the half of vascular territory of the adjacent perforator. This possibility is favored by vascular adoption directed toward the periphery that occurs by means of increased vascular pressure in the perforator artery after ligature of collateral subcutaneous and intramuscular arterial branches. The authors percept is, usually perforation is along the intermuscular septum, the portion of the flap that crosses beyond the adjacent intermuscular septum are at risk. Not required to go that far as residual wounds can be grafted with split thickness skin.

Reverse Sural Flap for Lower Limb Reconstruction: A Literature Review

Soft tissue reconstruction of the lower third of the leg, the ankle, and the foot is challenging for reconstructive surgeons. The options for reconstruction are limited. Reverse sural flap is relatively easy to perform and considered a good option for reconstruction. The complication rates are variable in studies. These defects commonly occur as a result of trauma, infection and tumor excision. Sural artery neurovascular island flap is a relatively thin, pliable and insensate flap with minimum donor-site morbidity and acceptable aesthetic outcome.

Versatility of the Supraclavicular Artery Island Flap in Neck Reconstruction

Versatility of the Supraclavicular Artery Island Flap in Neck Reconstruction

Preservation of the Nerve to the Mylohyoid Muscle During Submental Island Flaps: An Anatomic Feasibility Study for Facial Nerve Reanimation Procedures.

The submental island flap is an axial pattern pedicle flap widely used in head and neck surgery because of its ease and success. Indications of the submental island flap range from reconstruction for the malignant tumor resection to loss of temporal bone and facial skin due to trauma. Whereas, intraoperative facial nerve injury is not uncommon. We verified whether it was possible to localize the nerve to the mylohyoid muscle and reanimate the facial nerve during submental island flap procedures by preserving the mylohyoid muscle using human fresh cadaveric specimens. Six cadaveric heads were dissected and the position of the nerve to the mylohyoid muscle identified to the mylohyoid triangle documented. We identified the nerve to the mylohyoid muscle on all sides within the mylohyoid triangle and were able to separate the nerve from the submental island flap completely. Our results suggest that facial nerve reanimation using the nerve to the mylohyoid muscle can be used while reconstructing with a submental island flap in cases of intraoperative facial nerve injury.

A modified induced membrane 2-stage technique using a thoracodorsal artery perforator free flap followed by vascularized or non-vascularized free fibular transfer for the treatment of complex bone infection with concomitant severe soft tissue lesion–A case series of 9 cases

Treatment of post-traumatic complex bone infection is very challenging. The two principal bone reconstruction approaches are the single-stage vascularized bone graft technique and the two-stage induced membrane technique (IMT). Here we introduce a modified 2-stage induced membrane technique (MIMT) for complex long bone infection with a major bone defect and a concomitant severe soft tissue lesion. The 2-stage procedure consists of bone debridement, placement of a PMMA spacer and soft tissue reconstruction with a thoracodorsal artery perforator free flap (“Tdap”) at stage 1. At stage 2, the thoracodorsal artery perforator flap is elevated and a fibular strut graft (either vascularized of non-vascularized) is placed for bone reconstruction.We retrospectively analyzed the extents of lower extremity, long bone, post-traumatic bone infection treated via MIMT from 2008 to 2020. There were nine such cases (eight males) of mean age 59.8 (range 31 to 79) years. The osteomyelitis durations ranged from 3 to 360 months (mean 53 months). The cortical bone defect sizes was ranged from 9 to 14 cm (mean10.7 cm). All skin resurfacing employed Tdap. Vascularized fibular grafts were placed in six patients and non-vascularized grafts were placed in three. The fibular graft size ranged from 12.5 to 19 cm (mean 16.2 cm). Non-vascularized iliac bone grafts served as the fibula docking sites.Unfortunately, all patients suffered complications before bone union was achieved. One case of plate stress fracture and one case of screw fracture required plate and screw change. In three cases of cellulitis, one resolved by use of intravenous antibiotics, others required plate and screw removal. Wound disruption required re-suture and distal skin flap partial necrosis was covered by perforator-based island flap. One case of fibular stress fracture needed cast for 4 weeks. A peroneal nerve palsy patient recovered spontaneously. Bone union was achieved after 6 months in five patients and after 8 months in three (mean 6.9 months). All patients were able to walk unaided. The follow-up period ranged from 2 to 14 years (mean 6.2 years).MIMT saves the limbs in cases with difficult post-traumatic bone infection. It is valid treatment option for complex bone infections with severe soft tissue lesions. However, even with this technique potential complication must be considered.

Primary Cutaneous Adenoid Cystic Carcinoma Of The Chest Wall With Axillary Lymph Node Metastases And Its Management: A Case Report.

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of adenoid cystic carcinoma (ACC) arising commonly from the salivary gland. Less often they originate outside the head and neck region, with the scalp being the commonest cutaneous site in 40% of the cases. The presentation on the chest wall is rare, with no reports to date on axillary lymph node metastases. Here we report a case of a 65-year-old female with previously operated PCACC of the chest wall at a different center, showing uptake on positron emission tomography imaging at the site of surgical scar that w as inconclusive on needle biopsy metastasized to the axillary lymph node confirmed by needle biopsy managed with wide local excision, axillary lymph node dissection, and chest wall reconstruction with keystone island flap. The postoperative outcome was uneventful with no recurrence or axillary complications at one year's follow-up. She was advised to receive adjuvant radiotherapy; however, she refused. To conclude, though PCACC is rare, they can have an aggressive presentation, and a multidisciplinary approach is necessary for a better outcome.

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.

Hook nail deformity correction by the combination of the antenna procedure and reverse-flow homodigital island flap: Description of clinical cases

BACKGROUND:Hook nail deformity is one of the widespread post-traumatic deformities of distal phalanges. The affected finger has decreased function and loses its characteristic appearance. Onlyafew publications explored this problem in children. In this study, we presentasurgical correction technique for this deformity by the combination of two existing reconstructive methods, i.e., the antenna procedure and the reverse-flow homodigital island flap.
 CLINICAL CASES:Aseries of clinical cases of patients aged 3, 5, and 17 years who underwent hook nail deformity correction was analyzed. These children underwent the combination of the antenna procedure and reverse-flow homodigital island flap. In all three cases, the deformities were corrected, andanacceptable appearance, and function of the fingers were achieved.
 DISCUSSION:Various methods of hook nail deformity correction have proven themselves and affirmed by literature data. The method described herein may be considered reliable, as demonstrated by the clinical cases.
 CONCLUSIONS:We consider the combination of the antenna procedure and reverse-flow homodigital island flap asajustified method. However, issues raised in this technique require further investigation.

Reconstruction of Hand Dorsum Defect Using Double Perforators-Based Anterior Interosseous Artery Island Flap: A Case Report and Description of a New Anterior Interosseous Artery Perforator.

The anterior interosseous artery (AIA) perforator flap is not commonly used in hand dorsum reconstruction compared with alternatives. However, it is a versatile flap with several advantages. Literature on the AIA perforator flap is based on the dorsal septocutaneous branch (DSB), which branches from the AIA and passes through fascia between the extensor pollicis longus (EPL) and extensor pollicis brevis muscles. In the described case, the authors reconstructed a hand dorsum defect in a 78-year-old man using an AIA perforator flap with double perforators supplied by the DSB and a new perforator branching from the distal than DSB. No complication was encountered, and the flap survived completely. A retrospective computed tomography review revealed the presence of the new perforator in 14 of 21 patients. Two types of new perforator were observed. One passed through the ulnar side of the extensor indicis proprius (EIP) muscle and penetrated fascia between the extensor digitorum minimi and extensor digitorum communis tendons, whereas the other passed between the EPL and EIP muscles. This report describes the anatomical location and clinical application of the new AIA perforators. The double perforators-based AIA flap provides a straightforward, reliable means of reconstructing hand dorsum defects.

Effectiveness of penile ventral curvature correction and the trend of hypospadias repair: a prospective study of the national center in China

BackgroundHypospadias repair is a complex surgical procedure that involves correcting penile ventral curvature (VC) and performing urethroplasty. This study aims to evaluate the effectiveness of different strategies for VC correction...

Indocyanine Green (ICG)-Guided Onlay Preputial Island Flap Urethroplasty for the Single-Stage Repair of Hypospadias in Children: A Case Report

First described by Duckett in 1981, and initially employed for the surgical correction of mid-penile hypospadias, the onlay preputial island flap urethroplasty has progressively gained increasing popularity, extending its indication to proximal forms. However, with the complexity of the penile anomaly, the rate of postoperative complications related to poor tissue perfusion (including skin and glans dehiscence, urethral stenoses, and fistulas) has also increased. Conventionally, the visual assessment of the onlay preputial island flap is the only option available to establish the appropriate tissue vascularization during surgery. To this end, we have first introduced the EleVision IR system (Medtronic Ltd., Hong Kong, China) to assess the vascular perfusion of the preputial island flap in a 13-month-old boy undergoing the onlay urethroplasty for the surgical correction of a mid-shaft hypospadias. This was possible 80 s after the intravenous injection of indocyanine green (ICG, 0.15 mg/kg, Diagnostic Green GmbH, Munich, Germany). ICG-based laser angiography helped define the proximal resection margin of the preputial flap, and proved to be safe, effective, and easy to employ. This innovative intraoperative imaging modality can be considered a useful adjunct for tissue perfusion evaluation and intraoperative decision-making during the onlay preputial island flap urethroplasty in children.