Local Rotation Flap Research Articles

Functional outcomes of traumatic lower extremity reconstruction

BackgroundLower extremity trauma accounts for over 300,000 injuries annually. While soft tissue transfer is a well-accepted practice for open fracture coverage, functional outcomes remain unclear. HypothesisThis study investigates functional outcomes following soft tissue reconstruction for open tibial fractures. Materials and methodsA retrospective review of a prospectively maintained database of open tibia fractures requiring soft tissue reconstruction was performed at an urban level 1 trauma center between October 2013 and March 2015. Outcomeswere evaluated using Pearson’s chi square test with significant p value<0.05. ResultsIn 30 patients, fractures were graded Gustilo-Anderson type I (3.3%), 30% type II, 3.3% type IIIa, 53.3% type IIIb, and 10% type IIIc. Fixation was 56.7% plate and screw, 20% intramedullary nail, and 16.7% external fixator. Definitive closure was achieved in 43.3% through local rotational flap (38.5% gastrocnemius, 61.5% soleus), and in 56.7% by free tissue transfer (29.4% latissimus, 23.5% rectus, 17.6% ALT, 17.6% gracilis). In 10 patients, 70% returned to full ambulation, 30% required an assistance device, and 50% achieved union in 6 months. Local flap use was predictive of ambulation at discharge. DiscussionFollowing lower extremity fracture, 70% of patients returned to pre-injury function. Use of a local tissue flap was associated with early ambulation.

Total Elbow Arthroplasty Following Septic Arthritis with Staphylococcus aureus: A Case Report and Review of the Literature

Septic arthritis of the elbow seems to be a contraindication for total elbow arthroplasty (TEA). We here describe a 65-year-old male, American Society of Anesthesiologists (ASA) class 3-patient, with a severely destructed right elbow due to septic arthritis with Staphylococcus aureus. His treatment consisted of multiple irrigation and debridement procedures including resection of the distal humerus, soft tissue coverage by local rotational flap and the use of a gentamicin-vancomycin loaded PMMA spacer, i.v. and oral antibiotics. After eradication of infection, a constraint cemented TEA could then successfully be performed eight months after the initial surgery and twenty-five weeks after the last debridement procedure. Twenty-one months after the TEA, the patient remained infect free and shows excellent functional results: Disabilities of the Arm, Shoulder and Hand (DASH) score: 38.3, Broberg and Morrey score: 91/100, Mayo elbow score: 95/100. To the best of our knowledge this is the first case in the literature that demonstrates TEA after septic elbow arthritis with S. aureus. Although TEA is known as a typical surgical procedure with a low volume in numbers and higher complication rates, such as elevated infection rates compared to other types of arthroplasty, septic arthritis with S. aureus can successfully be performed after eradication of the infection and targeted antibiotic therapy.

Chronic Open Infective Lateral Malleolus Bursitis Management Using Local Rotational Flap.

Background Using a sinus tarsi rotational flap is an uncommon approach to treating chronic open infective lateral malleolus bursitis. Methods We treated eight patients, including six males, using this approach. First, we debrided all the infected tissues and used a negative pressure wound closure system where needed. After acute infection had been controlled, the local rotational flap was used for cases where the wound could not be closed by a simple suture or bone exposure. The rotational flap was detached with a curved skin incision at the sinus tarsi next to the open wound and sutured to the defect, paying careful attention to the superficial peroneal nerve. The donor site was managed with a split-thickness skin graft. Results The patients' mean age was 74.1 years. Six patients had a wound after suppurative infection, but two patients had ulcer-type bursitis. Six patients demonstrated full flap healing, but two patients had venous congestion necrosis. Conclusion A sinus tarsi rotational flap is a useful method to ensure healing and coverage of chronic open lateral malleolus bursitis, especially for small to medium wounds with cavity and bone exposure.

Indigenous Flaps in ENT: Our Experience

The nose is undoubtedly an important facial feature. The rhinologic surgeon with interest in external nasal soft tissue surgery, oncologic or otherwise, may often require reconstruction of a soft tissue defect, from the medial canthus to the nasal ala laterally, to the nasal tip medially. The coverage needs tissues which resemble the adjoining skin texture and have a thickness which would fill the defect appropriately without appearing as a separate patch and upset the patient psychologically. Therefore we utilized local rotation and advancement flaps for the reconstruction of facial defects. Experience with these flaps is being shared. DOI: 10.21276/AABS.2017.1341

Complications in Tibial Pilon Fractures: Avoiding Errors in Judgment

Pilon fracture surgery is fraught with many potential complications. Careful preoperative evaluation is required. Techniques for preoperative soft tissue management include compression dressings, stable ankle spanning external fixation, and compression foot pumps. Errors in judgment regarding the timing of surgery and over aggressive surgical exposure can lead to soft tissue complications. Postoperative wound management techniques include negative-pressure wound therapy to reduce incisional edema. Wound complications can be handled with a number of newer local pedicled rotational flaps, as well as biomaterials. These include acellular biomembranes to facilitate formation of a well-developed subcuticular tissue layer to serve as a substrate for local skin grafting. Mechanical instability occurs when the surgeon fails to neutralize deforming forces. This is accomplished by correct plate application, as well as treating areas of bone loss, that can all lead to late deformation, mechanical failure, and nonunion. This review covers crucial decision-making points regarding soft tissue and fixation strategies in an attempt to help avoid the frequency and severity of these complications. Levels of Evidence: Diagnostic Level I, II, III, IV, and V. See Instructions for Authors for a complete description of levels of evidence.

The Use of Regional Flaps for the Repair of Synovio-Cutaneous Fistulas of the Shoulder after Attempted Rotator Cuff Repair: A Report of Two Cases

Context: The treatment of rotator cuff tears has become one of the most common orthopaedic sports procedures. The development of a synovio-cutaneous fistula is a rare, but serious, complication that has been described after rotator cuff repair. The purpose of this report is to present the local rotational flap as a treatment option for synovio-cutaneous fistulas of the shoulder and to emphasize the importance of recognizing when primary closure may not be sufficient for adequate repair. Case Reports: A 67-year-old male who previously underwent a right rotator cuff and a biceps tendon repair presented with a persistently draining shoulder fistula. The decision was made to proceed with extensive debridement and closure using vascularized tissue. A 63-year-old male presented for a postoperative wound complication following attempted open debridement of a left torn rotator cuff. The wound was initially managed conservatively, but a persistently draining fistula necessitated the use of vascularized tissue for closure of the wound. The recovery of both patients was uneventful with no recurrent fistula formation. Both patients had improved shoulder range of motion following surgery and resolution of their pain. Conclusions: The excessive tension placed on the rotator cuff tendons and deltoid during repair and the resultant inflammation may contribute to tissue necrosis and facial dehiscence over the glen humeral joint, allowing for fistula formation. Surgeons should be aware that when adequate soft tissue coverage cannot be accomplished over the glen humeral joint via primary closure, there are local flaps available to provide complete coverage over the joint.

Alar flap combined with free auricular composite flap for the reconstruction of nasal alar defect.

The nasal ala plays an important role in the aesthetic appearance of the nose. Repairing the nasal alar defect, especially full-thickness alar defect, is one of the difficulties of plastic surgeons. In this article, a new surgical method is introduced about repairing full-thickness alar defect with free auricular composite flaps and local nasal alar rotation and advancement tissue flaps. We retrospectively reviewed 6 patients with a diagnosis of full-thickness alar defect between 2010 and 2013. All of them accepted this new surgical method. The patients were followed up for 6 to 12 months. The method used local nasal alar rotation and advancement tissue flap to form new nasal rim and made the defect of nasal rim shift to alar groove region. After that, we harvested free auricular composite flap to repair the new defect. All patients attained relatively symmetrical nostrils with a natural, smooth, integrated alar rim and inconspicuous scars. All the reconstructed nasal alae were aesthetically satisfactory. Slight atrophy of grafts was observed in all patients. The shape of the donor ear changed a little. Two patients experienced hyperpigmentation change and one patient presented slight hypertrophic scar in the suture site. No other complications were observed. This simple method not only reconstructed almost normal nasal alar rims and alar grooves but also improved the survival rate of the composite grafts without any free edges. This method also changed the traditional free auricular tissue flap location from the nasal alar rim to the upper alar groove region, which would help achieve more aesthetic appearance. This new method is a creative and useful technique for the repair of full-thickness alar defect.

One-stage nasal soft tissue reconstruction with local flaps.

Because of better public education and earlier diagnosis of skin tumors, the number of soft tissue defects of the nose with limited size and depth after tumor resection is increasing. A variety of surgical methods such as skin grafts, regional flaps such as forehead flap, and local flaps have been described. The method of choice is dependent on the defect size, localization, skin structure and the wishes and expectations, and general condition of the patient. Nasal reconstruction for soft tissue defects in the supratip area, dorsum, and sidewalls using local rotation and/or advancement flaps is our primary option. But achieving supreme results with these non-subunit-based techniques is still a challenge. Showing schematic figures and case studies, this article is aimed at assisting surgeons in the planning and decision making of which flap is appropriate for the reconstruction of soft tissue defects of the nose.

The role of local rotational flaps in minimizing sphenoidal and maxillary sinuses ostium stenosis

IntroductionThere are several reasons for endoscopic surgery failure; some of the major causes are adhesion formation and osteal stenosis. The commonest anatomic finding in revision endoscopic surgery is an obstructed or stenosed ostium. Adhesion and stenosis after surgery are usually due to scar tissue or granulation formation during the tissue recovery process. The patency and the size of the sinus ostium and limiting cicatricial fibrosis are two significant factors in the evaluation of a successful endoscopic sinus surgery. To limit the spontaneous closure rate; several methods were used to prevent re-stenosis of the sinuses ostium such as the application of mitomycin C which inhibits fibroblast formation after surgery, or placement of a stent or balloon catheter dilatation at the middle meatus. ObjectivesThe aim of this study is to evaluate the effect of local rotational flap insertion in maxillary and sphenoid sinus ostia in minimizing postoperative ostium stenosis. Study designA prospective study is done on 160 patients diagnosed as having chronic maxillary and/or sphenoid sinusitis patients who are divided into two equal groups, a study and a control group. All patients in the study group will undergo rotational flap coverage of the ostia and the control group arm will undergo middle meatal antrostomy and sphenoid ostium enlargement without flaps. ResultsSignificant reduction in re-stenosis rate after 9months of follow up. ConclusionMiddle meatal antrostomy and sphenoidotomy by this technique have a higher patency rate than the standard techniques after 9months of surgery.

Reconstruction of the Trachea

This article reviews established methods of autologous tracheal reconstruction, the various synthetic prostheses that have been used in clinical practice, and briefly describes the latest developments in stem cell tracheal bioengineering and allogeneic tracheal transplantation. Reconstruction of the trachea is challenging due to its part cervical part thoracic location, proximity to major vessels, variable blood supply, and its constant colonization with bacteria. In cases of limited resection, primary anastomosis, autologous patch grafts, local advancement rotation flaps, and locoregional cutaneous and muscle flaps will often suffice. In more extensive resections, complex composite microsurgical reconstruction with a radial forearm free flap with cartilage grafts for skeletal support has proven to be viable and reliable. Synthetic tracheal prostheses, solid as well as porous, have been trialed with disappointing results. Infection, dislodgement, migration, and obstruction are not uncommon. Reconstruction with the cadaveric tracheal allografts and aortic allografts continue to be fraught with complications, specifically graft infections. Tracheal bioengineering and tracheal allotransplantation have emerged relatively recently. Despite early promising results, long-term outcome data on these new techniques are still lacking.

Operation nach Hughes und damit kombinierte Verfahren

The Hughes procedure is a standard and widely used technique for lower eyelid reconstruction. This paper presents the results of 55 patients who underwent reconstruction of the anterior and posterior lamella with the Hughes procedure at the University eye clinic in Salzburg between 2002 and 2012. This study included 55 patients who underwent lower eyelid reconstruction performed with the Hughes procedure including a full skin graft. In 95 % of patients (52/55) this method was performed after tumor resection. The defect size of the lower lid was at least 10 mm horizontally and ranged between 10 and 15 mm. Of the patients three were treated with a combined Hughes and Tenzel procedure whereas in five cases the Hughes procedure was combined with an autologous tarsoconjunctival flap of the contralateral upper lid and a local full skin rotational flap. In 42 out of 55 patients both the eyelid function as well as the restoration of good cosmesis could be achieved. In 6 out of the remaining 13 patients suffering from minor complications, the function and cosmesis were restored after secondary minor surgery or additional conservative treatment. For six patients, further reconstructive surgery was necessary and one experienced a major complication in the form of a recurrence of basal cell carcinoma necessitating exenteration. The Hughes procedure is a well-suited technique for eyelid reconstruction of shallow defects extending beyond 10 mm horizontally and involving up to 100 % of the eyelid. The latter require a combined procedure such as the Hughes procedure and an autologous tarsoconjunctival flap and skin graft.

Retalhos de rotação para cobertura após artroplastia total de joelho

OBJECTIVE: To evaluate the results obtained using local myocutaneous rotation flaps in cases of wound dehiscence after total knee arthroplasty. METHODS: Patients undergoing these surgical procedures were selected in the 2000-2012 period. The nine selected cases during this period were subjected to flap coverage due to skin dehiscence associated with infection. In eight cases we used rotation flaps of the medial gastrocnemius, and in one case we used advancing skin. RESULTS: Eighty nine percent of the cases were successful in the coverage of the prosthesis and the viability of the flaps. In four cases it was possible to maintain or review the prosthesis. Four other cases progressed to amputation due to failure on treatment of infections, and one case remained without the prosthesis. The functional evaluation showed an unsatisfactory outcome in 89% of cases. CONCLUSION: Coverage flaps are a good option for the treatment of cases of dehiscence with exposure of the prosthesis and the functional failure was associated with the inability to control the infection and the damage it caused. Level of Evidence IV, Case Series.

Repair of a large thoracolumbar myelomeningocele with associated lumbar kyphosis

This report describes a novel method of repair for a large thoracolumbar myelomeningocele with an associated lumbar kyphosis in the neonate. A Caucasian male child was born at term with an antenatal diagnosis of hydrocephalus and spina bifida. Lumbar spine X-ray showed a significant kyphosis at L2-L3 level. Kyphectomy was performed and a cervical plate was used to reduce the gibbus deformity and maintain a rigid construct. Local rotation flaps were elevated and advanced to cover the defect. Wound was well healed at 3-month follow-up and the patient remained shunt-free at 1 year. To our knowledge, this is the first description of myelomeningocele repair with kyphectomy and posterior fixation in a neonate.

Regional Grafts for Closure of Postsurgical Defect in Anterior Maxilla: Versatility of Chin Graft and Local Rotational Flap

ABSTRACTThe management of postsurgical defect is a challenge for the maxillofacial surgeon. With the success of various autogenous grafts and surgical flaps the reconstruction surgery creates definitive results. This article is a case report of reconstruction of osseous defect and closure of soft tissue fenestration in the right anterior maxilla. An autogenous corticocancellous graft from the mandibular symphysis is used for reconstruction of the osseous defect of around 15 × 15 mm. The mucosal fenestration of around 10 × 10 mm is closed by rotational flap based in the labial sulcus. The defect and the donor site healed uneventfully. Both osseous and mucosal defect healed with esthetic results. Thus, the regional flaps prove the versatility by convenience of graft taking, no donor site morbidity and biological resemblance of tissues.How to cite this articleManekar VS. Regional Grafts for Closure of Postsurgical Defect in Anterior Maxilla: Versatility of Chin Graft and Local Rotational Flap. Int J Head and Neck Surg 2013;4(1):47-50.

Rotational Flap Closure of First and Fifth Metatarsal Head Plantar Ulcers: Adjunctive Procedure When Performing First or Fifth Ray Amputation

Partial ray amputation is a common treatment of diabetes-related neuropathic ulcers located beneath the metatarsal heads. The standard incision for partial first or fifth ray amputation involves a tennis racket incision, with the proximal arm made mid-line along the respective medial or lateral side of the metatarsal head and neck, creating equal dorsal and plantar flaps. This incision works well when the ulcer is located within the excised soft tissue distal to the incision or when the plantar ulcer is superficial and will heal secondarily once the underlying bone has been removed. This standard first or fifth ray amputation incision does not, however, allow excision and closure of plantar ulcers located beneath the first or fifth metatarsal head. Two cases are presented to demonstrate our surgical protocol for partial first or fifth ray amputation using a local rotational flap to cover plantar metatarsal head ulcers. These cases highlight our patient selection criteria, staging protocol when cellulitis or abscess is present, rotational flap design, surgical technique pearls, and the typical postoperative healing progress.

Reconstruction of Large Anterior Scalp Defects Using Advancement Flaps

Reconstruction of the scalp may be challenging for reconstructive surgeons because of the special anatomic structure of the scalp and underlying skeleton. Anterior scalp defects especially deserve special care for pleasant hairline re-creation and redirection of hair follicles. Local transposition or rotation flaps are the most common reconstruction methods for moderate or large anterior scalp defects. However, currently available techniques usually require multiple stages for completion of the reconstruction without alopecia.In this study, we report our experience with unilateral or bilateral advancement flaps for moderate or large anterior scalp defect reconstructions. Eight patients who had anterior scalp defect of varying etiology were presented. The defect size ranged between 3 × 5 and 8 × 12 cm. The average size of the defect was 53. 3 cm. The defects were located on the frontoparietal area of the scalp in 3 patients and frontal area in 5 patients. Unilateral advancement flap was used in four cases. All the flaps survived except in one patient who had partial flap loss. Based on our experience, we suggest that large scalp defects located especially on the frontal or frontoparietal area can be reconstructed with unilateral or bilateral scalp advancement flaps in one stage without the need for multiple surgeries.

Rotation Flaps after Draf Procedures: A Cadaver Study

Objective: To describe the anatomy and application of local mucosal flaps to reduce cicatricial scarring of the frontal recess after Draf IIB and Draf III procedures. Method: Description and illustration of the surgical technique of 2 local mucosal flaps after Draf IIB and III procedures in a cadaveric model. Results: Two distinct local rotation flaps can be successfully used after Draf IIB and Draf III procedures. 1) Prior to superior middle turbinectomy, a medially based mucosal flap is elevated from the medial aspect of the middle turbinate to the nasal septum. This flap is then placed on the posteromedial raw bone of the frontal recess after the Draf IIB. 2) Bilateral posteriorly based flaps are elevated off of the anterosuperior septum prior to the septectomy in a Draf III procedure. After the drillout is performed, the mucosal flaps are rotated to cover the frontal sinus posterior table. Conclusion: Use of local mucosal flaps to provide primary healing after Draf IIB and Draf III procedures is technically feasible and may decrease the risk of restenosis after frontal sinus surgery.

Anterior Tibial Muscle Hernia Treated with Local Periosteal Rotational Flap - A Case Report -

Muscle can be protruded through a defect of the fascia into the subcutaneous fat and present clinically as a soft-tissue mass. Although most cases of muscle hernia are asymptomatic and don ’t require operative treatment, a few patients, often athletes, present with severe pain or cramps require surgery. We report a case of tibialis anterior muscle hernia treated with a local periosteal rotational flap.

Reduction Calcaneoplasty and Local Muscle Rotation Flap as a Salvage Option for Calcaneal Osteomyelitis with Soft Tissue Defect

Plantar heel wounds with infection remain a surgical challenge. Reduction calcaneoplasty combined with local muscle flap is an alternative technique to achieve limb salvage when standard wound therapy fails to resolve complex wounds of the plantar heel complicated by osteomyelitis of the calcaneus.

Angular Artery Cutaneous Flap for Reconstruction of Difficult Oronasal Fistulas

Oronasal fistulas after oromaxillary surgery may sometimes be encountered and remain a challenging problem. They can cause significant disabilities such as phonetic problems and food or liquid regurgitation while swallowing. A few methods are reported to solve this problem, including using a dental appliance, local tissue rotation, or even free-tissue transfer. An angular artery cutaneous flap was designed to repair the defect. The flap that included the skin and superficial fascia fed by the flow of angular artery was rotated through the buccal mucosa into the oral cavity to cover the palate defect. Two oronasal fistula cases were reported in this series. Case 1: A 71-year-old man had hard palate cancer and had received wide excision in our hospital 2 years previously. He had received adjuvant radiotherapy (28 times) and was transferred to the plastic surgery department for dealing with oronasal fistula. The palate defect was 2 × 2 cm. Case 2: A 72-year-old woman was a patient with left palate mucoepidermoid carcinoma. She had received an operation and adjuvant radiotherapy 10 years previously. For her oronasal fistula and hypernasality, she had received reconstructive operations 3 times with local rotation flap for left-side palate defect at a previous hospital. However, the local flap failed and the fistula persisted. She then approached our plastic surgery department for help. The palate defect was about 1 × 1 cm. We successfully reconstructed the oronasal fistula by using the angular artery cutaneous flap. The flap successfully sealed the oral cavity during the follow-up period. Angular artery cutaneous flap is a good alternative for reconstruction of the oronasal fistula. Especially in elderly patients, donor-site comorbidities are fewer due to the redundant aging skin and the missing tooth.