Lateral Advancement Flap Research Articles

Reconstruction of full thickness lower eyelid defects using a lateral advancement flap with Z-plasty and periosteal strip

ABSTRACT Purpose To describe a single stage technique of reconstruction of full thickness lower eyelid defects using a lateral advancement flap and Z-plasty combined with a lateral periosteal strip. Methods A retrospective case series of six patients who underwent reconstruction using this technique is presented documenting surgical technique, clinical photographs and postoperative outcomes. Results All six patients demonstrated good eyelid position and cosmesis following reconstruction. Conclusion A lateral advancement flap with Z-plasty combined with a periosteal strip is an effective technique to close lower eyelid defects of up to eighty percent of eyelid width, providing a good structural and aesthetic outcome.

Long-Term Results of the Murawski Unilateral Cleft Lip Repair.

In 1968, Ralph Millard published his "Millard II" method for repair of wide, complete unilateral cleft lip and nose deformity. In 1979, Murawski published a major modification of the Millard II procedure in Polish. This motif was taken up 8 years later by Mohler and 22 years later by Cutting. The Murawski variation on the Millard II procedure has become a dominant motif in unilateral cleft lip repair worldwide. This brief report intends to introduce the method to the English language literature and present long-term results. The Murawski method alters the Millard II procedure by changing the upper medial curve into a point in the columellar base. This creates a broad C flap used to fill the entire defect produced by downward rotation of the medial lip. Millard's lateral advancement flap becomes unnecessary. A lateral approach to primary nasal reconstruction allows the lateral C flap to be used to construct the nasal floor and sill. The method is described using a physics-based surgical simulator. Long-term results of the method are demonstrated with four patients with 15 to 25-year follow-up. None of these patients had any revisions to the lip or nose. The Murawski repair was the first to modify the Millard II repair by sharpening the medial columellar incision, eliminating the need for a lateral advancement flap. This motif was put forth in the years to follow by Mohler and Cutting. Long-term results of the method are presented.

Reconstruction of Medial Canthal Defects by Local/Loco-Regional Flaps.

To describe a series of medial canthal defect reconstruction by local/loco-regional flaps following excision of basal cell carcinoma. A series of 35 medial canthal defects following excision of basal cell carcinoma was reconstructed by local/loco-regional flaps. For smaller defects, glabellar lateral advancement flap or Limberg's flap from the nasolabial area were used to resurface the defects. For larger defects extending to the upper and lower eyelid or to the nose, a combination of flaps, that is, forehead and cheek rotation flaps or glabellar and cheek rotation flaps were used. In all the cases, the aesthetic and functional results were highly satisfactory except in one, where punctum and lower canaliculi were also excised with the tumor for clearance. This patient complained of watering from the affected eye. Two patients had developed webbing after the operation. It was corrected by Z plasty after 6 months. Medial canthal defects are best managed by local/ loco-regional flaps. For smaller defects in the upper part, the glabellar flap is the choice of the flap and in the lower part, flaps from the nasolabial region give the best result. For larger defects not amenable to single flap, a combination of flaps (glabellar/forehead flap and cheek rotation flap) can close the defects with the good aesthetic and functional results.

The Reconstruction of the Central Tubercle in Bilateral Cleft Lips: Bilateral Lateral Mucosal Advancement Flap With Reinforcement of the Orbicularis Oris Muscle.

There are various methods to correct the whistle deformity in bilateral cleft lip. In case of the central deficiency with concomitant lateral excess, local tissue rearrangement can be used to reposition the lateral tissue. We designed bilateral lateral advancement flap with reinforcement of the orbicularis oris muscle. Thirteen bilateral cleft lip patients with whistling lip deformity from July 2009 to February 2017 underwent our method of tubercle formation. Vertical upper lip measurements of upper lip were recorded. Augmentation percentage was documented using follow-up measurements compared with preoperative measurements. The average follow-up period was 16.2 months (range, 9-26 months). The axis of the flap and central incision were placed on the red line (wet-dry vermilion border). Dissection was performed through the submucosal plane. After entire dissection, inter-orbicularis oris muscle suture on both medial edge of the flap was performed. In case it was necessary, back-cutting incision on both curvature of the central orbicularis oris could facilitate central augmentation. Elevated superior and inferior trap-door flaps were trimmed to make natural central lip line along with the lateral mucosal flaps. Both lateral parts of vermilions were closed in V-Y advancement fashion. The vertical height of central tubercle (T) had a mean increase of 136.9%, which was significantly different from preoperative measurement (P < 0.05). There were no surgical complications. Our surgical method is safe, useful, and effective to correct the whistle deformity of the central deficiency with concomitant lateral excess.

Fascio-Adipo-Cutaneous Lateral Advancement Flap for Treatment of Pilonidal Sinus: A Modification of the Karydakis Operation-Cohort Study.

Pilonidal sinus is a common chronic disease affecting young adults. Many surgical procedures have been developed for its treatment, but an optimal one has still not been achieved. This study presents a modification to the Karydakis operation. A total of 265 patients with chronic pilonidal sinus between May 2008 and May 2015 were included in this study and submitted to fascio-adipo-cutaneous lateral advancement flap as 1-day case surgery. Any Septic complication was treated firstly. Follow-up examinations were conducted during the first three postoperative months at the outpatient clinic at regular intervals and thereafter by phone calls or direct examination to check for recurrences. Males constituted 93.6% with a mean age of 21.6±7.7year. The median disease duration was 15months. Twenty-eight patients had recurrent disease. The mean operative time was 41.4±12.7min. The mean time out of work was 11.6±4.6days. Complications occurred in 19 patients (7.1%) in the form of seroma in six patients (2.2%), superficial wound infection occurred in nine patients (3.3%), cuticular wound disruption occurred in four patients (1.5%). All patients completed 3-months follow-up, but 48 patients were lost at variable intervals with the remaining 217 patients completed follow-up throughout the period of the study with a median follow-up of 43months. No reported recurrence and 96.7% of the patients were satisfied about their wound. This modification is simple with low complication rate, no recurrence, and excellent patient satisfaction.

Lateral advancement flap for sacrococcygeal pilonidal sinus: reassessment study

Background: Sacrococcygeal pilonidal sinus disease is treated better with various flaps and primary closure. This study was aimed to describe the lateral advancement flap in surgical treatment of sacrococcygeal pilonidal sinus disease in an effort to redefine the results of this technique. It is a fascio-adipo-cutaneous flap which is advanced from one buttock to opposite across the natal cleft and providing the off midline closure with cleft lift.Methods: The results of this technique were assessed in 65 patients. The technique consists of adequate excisions of sinus, tracts and surrounding inflamed tissue till depth of presacral fascia. The defect was covered with a thick lateral advancement flap and produce an off midline closure and cleft lift.Results: The sixty patients were hirsute males and five were hairless females. The maximum length and breadth covered was 7x5cm. The operative time taken was 40±10 minutes. The average hospital stay was 5 to 7 days. The surgical site infection in 4 patients and wound dehiscence occurred in one patient only. No recurrence was recorded in follow up period of one year.Conclusions: The lateral fascio-cutaneous advancement flap is gaining popularity for its ease of designing and harvesting. The short hospital stay, minimum postoperative complications, no recurrence and acceptable aesthetic results make this a uniformly acceptable technique for surgical primary closure of pilonidal sinus disease.

Comparison of modified Limberg flap transposition and lateral advancement flap transposition with Burow’s triangle in the treatment of pilonidal sinus disease

BackgroundAlthough many options exist for surgical treatment of pilonidal sinus disease (PSD), consensus has not yet been achieved, as all surgical methods have various rates of complications, postoperative infection, and recurrence. MethodsThis study was a prospective, randomized, clinical trial, and was conducted with consecutive 100 patients admitted to Ankara Military Hospital General Surgery Service for treatment of PSD from May 2013 to August 2013. This study compared two surgical treatments for PSD: modified Limberg flap transposition and lateral advancement flap transposition with Burow's triangle.The patients received surgical treatment with either modified Limberg flap transposition (n = 50) or lateral advancement flap transposition with Burow’s triangle (n = 50).Clinical healing period, length of hospital stay, operative time, postoperative complications including recurrence, wound dehiscence, and surgical site infection, as noted during postoperative follow-up period; Visual Analog Scale scores for pain. ResultsThe mean follow-up period was 12 months. No significant differences were observed between the 2 groups in length of hospital stay (P = .515), operative time (P = .175), wound dehiscence (P = .645), and Visual Analog Scale pain scores (P = .112). The mean operative times were 42.5 minutes in the modified Limberg group and 40.0 minutes in the lateral advancement group. ConclusionsAlthough lateral advancement flap transposition with Burow’s triangle is used less often than modified Limberg flap transposition, we could not determine a parameter that was statistically different such as operative time, postoperative complication, or the length of hospital stay. Hence, the lateral advancement flap is as viable an option as other more preferable techniques in the treatment of PSD, which particularly settled on the upper segment without a deep natal cleft.

Partial and Total Lower Lid Reconstruction: Our Experience with 41 Cases

Purpose: To report our experience on lid reconstruction in patients with epitheliomas. Methods: A total of 41 consecutive patients affected by basal cell (n = 32) or squamous cell carcinoma (n = 9) underwent partial (n = 35) or total (n = 6) surgical demolition of the lower lid. Surgical defects <25% (n = 10) received direct closure. If the defect involved 30–60% of the eyelid (n = 21), a Tenzel semicircular flap or lateral advancement flap with a free mucosal graft was used. If the entire lid or a major part of the outer lamella had to be reconstructed (n = 10), a cheek advancement flap was used, with a free mucosal graft if the posterior lamella was involved. The success rates and the cosmetic and functional results were evaluated. Results: All 21 flaps used for partial reconstruction remained viable, whereas 1 of the 10 cheek flaps developed partial distal necrosis. Of the 27 mucosal grafts, 2 had to be removed for total necrosis, and 2 developed partial necrosis. In all cases, normal lid function and acceptable cosmetic results were obtained. Complications occurring in 4 cases (1 ectropion and 3 epiphora) were successfully managed with appropriate surgical procedures. Conclusions: Local flaps are the gold standard for lower lid reconstruction as they are highly reliable and guarantee optimal results. The technical details described in this study can help in achieving such results.

Lateral Advancement Flap with Burow's triangle: An Ideal treatment for Pilonidal Sinus Disease

Lateral Advancement Flap with Burow's triangle: An Ideal treatment for Pilonidal Sinus Disease

Primary and Revision Cleft Lip Repairs Using Octyl-2-Cyanoacrylate

The purpose of our retrospective review is to examine our method and outcomes for the application of octyl-2-cyanoacrylate for the repair of primary and revision cleft lips in both pediatric and adult patients. Records and photographs were reviewed and analyzed for patient age, type of cleft, revision or primary repair, complications, length of follow-up, and aesthetic outcomes. Eighteen patients, both children and adults, who underwent cleft lip repairs using tissue adhesive performed by a single surgeon between 1999 and 2003 were included. Twelve patients underwent primary repair and 6 patients underwent revision repair. Repairs were performed using the Millard rotation advancement technique and the Mohler variant. The lateral advancement flap was kept long and redundant in its transverse dimension to create a pressure fit everting the skin edges with minimal sutures to set up the closure for application of the tissue adhesive. Seventeen of eighteen patients had excellent cosmetic outcomes. One patient had minor necrosis of the tip of the advancement flap. No allergic reactions, wound infections, or dehiscences occurred. The use of octyl-2-cyanoacrylate for the skin closure of primary and revision cleft lip repairs in both children and adults results in excellent cosmetic outcomes. Employing our pressure-fit technique for skin eversion prior to application of the tissue adhesive may be advantageous. The lack of suture removal in the pediatric population and decreased operative time are additional benefits.

Adipo-fascio-cutaneous Flaps in the Treatment of Pilonidal Sinus: Experience with 50 Cases

To retrospectively analyse the results of pilonidal sinus managed using wide excision with primary eccentric closure with various adipo-fascio-cutaneous flaps. Data from 50 consecutive patients who had elective surgery for chronic pilonidal sinus with wide excision of all the sinuses and primary eccentric closure with various adipo-fascio-cutaneous flaps (40 lateral advancements, 4 Z-plasties, four rotations, 1 rhomboid and 1 V-Y advancement) were retrospectively analysed. Special emphasis was placed on partial obliteration of the natal cleft, duration of wound healing, postoperative morbidity and hospital stay, loss of work days, cosmetic outcome and recurrence. In all patients, partial obliteration of the natal cleft was achieved by eccentric primary wound closure, with good cosmesis. Superficial necrosis of the flaps occurred in five patients (3 Z-plasties, 2 rotation flaps). None had collection, haematoma, infection or recurrence. Complete eccentric excision and partial obliteration of the natal cleft using various adipo-fascio-cutaneous flaps ensured reliable wound healing with fewer dressings and morbidity, shortened hospital stay and early resumption of work, good cosmesis and prevention of early and late recurrence. The lateral advancement flap is a viable option in the treatment of chronic pilonidal sinus.

Reconstruction of the Lower Eyelid by Third Eyelid Lateral Advancement and Local Transposition Cutaneous Flap After “En Bloc” Resection of Squamous Cell Carcinoma in 5 Cats

To describe a novel technique for blepharoplasty to cover a tissue defect involving >/=50% of the lower eyelid. Prospective clinical study. Five cats with lower eyelid squamous cell carcinoma (SCC). En bloc resection of SCC by removing >/=50% of the lower lid with either the medial or lateral canthus was performed without other adjunctive treatment for SCC. The lid defect was reconstructed with a transposition skin flap derived from the frontal (medial defect) or temporal (lateral defect) region. The third eyelid was advanced laterally without dissection from its insertion; its outer conjunctival layer was removed, and the skin flap was sutured with single interrupted sutures dorsally over the nictitating membrane, ventrally to the cutaneous edge of the surgical wound and medially or laterally (depending on the canthus removed) to the skin of the remaining lower lid. Satisfactory cosmetic and functional results were achieved and the Schirmer tear tests were normal. In 2 cats, the skin flap needed monthly hair trimming to avoid corneal lesions. After en bloc resection of SCC involving >/=50% of the lower eyelid, reconstruction can be achieved by relocation of the third eyelid and use of a cutaneous transposition flap sutured to the scarified external surface of the third eyelid. Eyelid apposition and lacrimal function were preserved. Blepharoplasty using a cutaneous transposition flap sutured to the scarified surface of a relocated third eyelid should be considered for reconstruction of lower eyelid defects with >/=50% tissue loss of the lid margin.

Lateral advancement flaps in obstructive sleep apnea

Objectives: Palatal and pharyngeal soft tissue laxity and redundancy contribute to upper airway obstruction and obstructive sleep apnea. Hypertrophic tonsils exacerbate the condition. Uvulopalatopharyngoplasty with-or-without tonsillectomy is the procedure of choice to correct the disorder. In some instances, however, excision of the excess lateral soft tissues creates a faucial arch defect that cannot be closed primarily. We present our technique using laterally-advanced full-thickness pharyngeal muscular-mucosal flaps to achieve tension-free closure of the tonsillar fossae. Methods: Open lateral wall defects in the oropharynx heal by secondary intention. Drawbacks with this approach include excess scar tissue deposition, contracture of the fauces, and decreased mobility of the pharyngeal arch, which contribute to a poor surgical result. Coincidentally, too tight a closure causes the same result. To avoid these complications, we undermine the lateral free edge of the posterolateral pharyngeal wall to include a thick cuff of muscle and overlying mucosa. The thickest flaps expose the prevertebral fascia. The flaps can be elevated unilaterally or bilaterally. The blood supply is random, primarily based on terminal branches of the ascending pharyngeal arteries, arising inferiorly. The venous plexus is sufficiently dense to provide adequate vascular drainage. Results: The vascular integrity and elasticity of the pharyngeal musculature permits medially based lateral soft tissue advancement sufficient to allow reapproximation to the palatoglossus. Defects approaching 50% of the flap’s length have been closed. Conclusion: In complex cases, primary, tension-free closure of the faucial arch using soft tissue advancement flaps from the posterior pharynx reduces the likelihood of infection and scar contracture, facilitates healing, and improves surgical results.

Lip height and lip width after extended Mohler unilateral cleft lip repair.

The purpose of this study was to evaluate the symmetry in lip height and lip width after extended Mohler unilateral cleft lip repair, with long-term follow-up monitoring. In the Mohler repair procedure, Millard's C-flap is used to fill the entire defect created by the downward rotation of the medial lip element. Because a lateral advancement flap is not transposed into this defect, Mohler repair is often expected to produce a short lip. In a retrospective study of 120 patients, anthropometric measurements were made on black-and-white photographs. Of those patients, 49 met the study criterion of having a set of photographs taken 13 months or less postoperatively and another set taken at least 2 years postoperatively. The distance from the Cupid's bow peak to a line tangent to the base of the columella (lip height) and the distance from the Cupid's bow peak to the ipsilateral commissure (lip width) were measured with a Vernier caliper. The medial intercanthal distance was also measured, for standardization of all measurements. All values were normalized to the mean intercanthal distance at age 6, as reported by Farkas. Matched-pair test analyses were used to assess the statistical significance of differences in cleft-side versus non-cleft-side measurements for each group, as well as changes with time. No statistically significant difference in cleft side versus non-cleft-side lip height for the two groups or with time was observed (< or =13 months, p = 0.28; >2 years, p = 0.08; change with time, p = 0.69). Statistically significant differences in lip width between the cleft side and the non-cleft side were observed for both time groups. The average difference in lip width at 1 to 13 months was 8.6 percent (p < 0.001). The average difference in lip width at 2 years or more postoperatively was 5.8 percent (p < 0.001). In comparisons of early versus late measurements, it was noted that lip width significantly increased with time (mean, 0.91 mm; p = 0.035). The findings suggest that extended Mohler repair does not produce a short lip. Interestingly, lip width was observed to be significantly smaller on the cleft side in the immediate postoperative period. However, this deficiency was observed to decrease significantly during long-term follow-up monitoring.

Lip Height and Lip Width after Extended Mohler Unilateral Cleft Lip Repair

The purpose of this study was to evaluate the symmetry in lip height and lip width after extended Mohler unilateral cleft lip repair, with long-term follow-up monitoring. In the Mohler repair procedure, Millard's C-flap is used to fill the entire defect created by the downward rotation of the medial lip element. Because a lateral advancement flap is not transposed into this defect, Mohler repair is often expected to produce a short lip. In a retrospective study of 120 patients, anthropometric measurements were made on black-and-white photographs. Of those patients, 49 met the study criterion of having a set of photographs taken 13 months or less postoperatively and another set taken at least 2 years postoperatively. The distance from the Cupid's bow peak to a line tangent to the base of the columella (lip height) and the distance from the Cupid's bow peak to the ipsilateral commissure (lip width) were measured with a Vernier caliper. The medial intercanthal distance was also measured, for standardization of all measurements. All values were normalized to the mean intercanthal distance at age 6, as reported by Farkas. Matchedpair t test analyses were used to assess the statistical significance of differences in cleft-side versus non-cleftside measurements for each group, as well as changes with time. No statistically significant difference in cleft side versus non-cleft-side lip height for the two groups or with time was observed (≤13 months, p = 0.28; >2 years, p = 0.08; change with time, p = 0.69). Statistically significant differences in lip width between the cleft side and the non-cleft side were observed for both time groups. The average difference in lip width at 1 to 13 months was 8.6 percent (p < 0.001). The average difference in lip width at 2 years or more postoperatively was 5.8 percent (p < 0.001). In comparisons of early versus late measurements, it was noted that lip width significantly increased with time (mean, 0.91 mm; p = 0.035). The findings suggest that extended Mohler repair does not produce a short lip. Interestingly, lip width was observed to be significantly smaller on the cleft side in the immediate postoperative period. However, this deficiency was observed to decrease significantly during long-term follow-up monitoring. (Plast. Reconstr. Surg. 111: 17, 2003.)

Advancement flaps to treat superficial wound infections after cardiac operations

The management of superficial sternal wound infections is not well-codified. In case of large necrosis or tissue defect we use a two-stage approach, consisting of a first surgical debridement, followed a few days later by wound closure by means of two lateral advancement flaps. We have used this technique with good cosmetic results and shorter hospital stays.

The neurovascular flap in finger injuries

Surgical Principles The finger tip with its protective nail on the dorsum and durable, yet highly sensitive, pulp on the volar aspect is a very important part of the digit. It is thus imperative, following an injury, to preserve as much as possible of this area. Numerous procedures, attempting to achieve this, have been described. These include simple split skin grafts, distant flaps and island pedicle flaps. The lateral advancement flap described by Kutler in 1947 [6] (Figure 1) and the volar flap described by Atasoy et al. in 1970 [1] (Figure 2) were important steps toward achieving skin cover by advancing local tissues. However, the mobility of their flaps was, of necessity, limited. The neurovascular flap, described here, utilizes the principle of distal advancement but entails the total mobilization of a triangular skin island on its own neurovascular pedicle. In this way distal mobility is greatly enhanced which allows for full thickness skin cover over the tip of the digit and yet preserves full sensation and durable skin.

Modified lateral cervical advancement flaps for the correction of webbed neck deformity

Modified lateral cervical advancement flaps for the correction of webbed neck deformity

Lateral Cervical Advancement Flaps for the Correction of Webbed-Neck Deformity

Lateral Cervical Advancement Flaps for the Correction of Webbed-Neck Deformity

Advancement flaps for treatment of anal stricture.

Anal stricture may be treated by lateral advancement flaps (Y closed as V). The technique is fast, easy, and gives good results. There was no morbidity in the four patients on which it was used. It is recommended for anal mucosal stricture with or without muscle involvement. In addition, the Y-V principle can be utilized to prevent stricture in primary operative procedures on the anus.