Local Rotation Flap Research Articles

First web-space reconstruction by Caroli's technique in congenital hand deformities with severe thumb ray adduction

A personal technique is described for reconstruction of the first web-space in congenital hand deformities with severe adduction of the thumb. The technique is based on the use of two local rotation flaps, one designed on the thenar area and the other on the radial half of the back of the hand. Seven patients were treated with such a technique and followed up for an average of 32 months. Excellent results were obtained in five cases.

A Two-layer Closure of Sino-orbital Fistula

A two-layer closure of sino-orbital fistulae using tension-free local flaps is described. For small fistulae, the opening is first closed with a mucosal turnover flap; this is combined on the orbital surface with a local rotational advancement flap of the orbital skin. For larger fistulae where a mucosal turnover flap cannot be fashioned, a two-stage, delayed, composite mucocutaneous rotational flap is used. The advantages of these techniques are: (1) a mucous membrane to provide nasal or sinus lining, insulating the raw ventral surface of the skin flap; (2) each flap has an independent blood supply; (3) local flaps are used, avoiding the use of a pedicle flap from forehead; (4) excellent cosmesis since tissues outside the orbital rim are not disturbed; and (5) does not require refitting of exenteration prosthesis since the integrity of the orbital rim is maintained. The authors have used these techniques in six patients with chronic sino-orbital fistulae of the exenterated socket. In one patient, a wound dehiscence occurred and a small fistula measuring 3 to 4 mm in diameter persisted. The fistulae of the remaining five patients were successfully closed.

Effect of muscle flap coverage on bone blood flow following devascularization of a segment of tibia: an experimental investigation in the dog.

Severe tibial fractures may be associated with soft tissue loss, devascularization of cortical bone, and significant morbidity. Local rotational muscle flap coverage is used to obtain coverage of acute open tibial fractures and to treat chronic osteomyelitis of the tibia. The purpose of this study was to determine (a) the longitudinal and cross-sectional regional blood flow characteristics of the canine tibia and (b) whether a muscle flap was superior to vascularized skin coverage in restoring blood flow to devascularized canine tibial cortex. A 2.5-cm segment of tibia between two standardized osteotomies was devascularized. The segment was replaced anatomically and stabilized with a plate. The animals were divided into two experimental groups: (a) skin coverage (n = 8), and (b) muscle flap coverage (n = 8). Thirty-one days postoperatively Ce141 microspheres were injected to measure bone blood flow. The tibial diaphysis was divided into proximal, middle (devascularized), and distal segments. The unoperated leg was used as a control. In the control tibiae, the middle segment was less vascular than either the proximal or distal segment and no difference between anterior and posterior cortical blood flow was observed. Blood flow to the devascularized segment of tibia was significantly greater when it was covered with a muscle flap (p less than 0.025). The most significant increase in bone blood flow in the muscle flap coverage group versus the skin coverage group occurred in the anterior cortex of the tibia (p less than 0.005). This may be clinically important since the soft tissues over the anterior tibia are commonly deficient following open fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

The VY tensor fasciae latae musculocutaneous flap.

When first introduced in 1978, the tensor fasciae latae flap was used both as a free-tissue transfer and as a local rotational flap. Its use as a free flap has diminished as other more appropriate flaps for free-tissue transfer have been described. The tensor fasciae latae flap has remained, however, an instrumental flap in the coverage of anterior and posterior soft-tissue defects around the hip region. The purpose of this paper is to present a new design of the tensor fasciae latae flap in the coverage of trochanteric pressure sores. By essentially creating a VY advancement flap into the trochanteric defect with the tensor fasciae latae, one can cover the trochanteric defect with the best-vascularized portion of the flap and avoid the dog-ear deformity.

Salvage of chronically exposed Gore-Tex vascular access grafts in the hemodialysis patient.

Exposure and infection of a Gore-Tex vascular access graft often results in removal of the graft. Salvage of the graft is possible, however, with the use of well-vascularized muscle flaps. In 1982, Hodgkinson was the first to use a sublimis muscle flap to cover an exposed vascular access graft. We used the flexor carpi ulnaris and flexor digitorum superficialis to cover exposed Gore-Tex grafts in nine patients. The sublimis was used to cover distal graft exposures, and the longer flexor carpi ulnaris muscle was used to cover more proximal sites. Multiple exposures required both flaps or combinations of muscle flaps and local rotation flaps. Eight of nine chronically exposed grafts were salvaged using these techniques; a graft was removed from one patient because of diffuse unrecognized graft bed infection. Disability is minimized by using only part of the sublimis, and loss of the flexor carpi ulnaris is compensated by local muscles with similar actions. Vascular puncture can be continued during healing.

A New Concept in Flap Transfers—Transposition and Rotation of Fasciocutaneous and Myocutaneous Flaps

SummaryA new technique of safely transferring tissues has been tried in three cases. This technique combines the principle of local transposition and rotation flaps in the transfer of fasciocutaneous and myocutaneous flaps, in such a way that the advantages of both the principles are complimented and disadvantages eliminated. The results in the cases treated are being presented.

Reconstruction of the stump after below-the knee amputation. Soft-tissue expansion and local muscle rotation flaps

Reconstruction of the stump after below-the knee amputation. Soft-tissue expansion and local muscle rotation flaps

Management of full-thickness burns of the scalp and skull.

Full-thickness burn injury of the scalp, with or without necrosis of underlying bone, is a complex therapeutic problem. Inability to diagnose depth of injury, controversy regarding wound closure, and a high incidence of acute morbidity are all associated with it. We reviewed the records of 17 patients who had suffered such injury. Wound closure was accomplished by split-thickness autograft alone in three patients, by bone dermabrasion and split-thickness autograft in six, by bone excision and split-thickness autograft in five, and by immediate local rotation flap in three. Systemic and/or local septic complications developed in 50% of all patients who underwent bony debridement. When feasible, early excision followed by immediate flap coverage is the procedure of choice. It avoids the multiple operative procedures required by the more conservative approach to wound closure, thereby shortening the period of primary hospitalization and virtually eliminating the risk of sepsis.

Free nail bed graft for treatment of nail bed injuries of the hand

Free full-thickness grafts of nail bed of the lesser toes or an amputated fingertip were successfully performed on 11 fingers of 10 patients since 1979. In nine patients in whom the nail beds had been severely crushed or lost, but the nail matrix was intact, the end results of this technique were excellent. In one patient in whom both the nail bed and matrix had been lost, free grafting of the toenail bed and matrix was performed, with a good result. The procedure can be used when restoring the length of the tip in fingertip amputation if used in combination with local skin flaps such as V-Y advancement or local rotation flaps.

The extended palmar advancement flap

A technique is presented that permits resurfacing up to 3 cm of palmar skin loss from the thumb, while preserving thumb length, minimizing thumb joint flexion contracture, and providing normal sensibility. The classic Moberg palmar advancement flap is extended proximally onto the thenar eminence. The radial and ulnar defects created by the distal advancement of the flap are closed by two additional local rotation flaps. Scarring is acceptable and follows natural lines. The technique is applicable for both primary repair and secondary reconstruction.

Wound coverage in the Achilles region

Skin loss over the distal Achilles region regardless of cause presents a problem in reconstruction. A variety of techniques have been employed. These procedures are critically reviewed and the technique which has proven helpful at our institution is discussed. The latter procedure employs a local random pattern rotation flap which has the advantages of simplicity, brief hospitalization, predictability of success, and coverage with sensate skin that is not bulky.

Revision of the first web space: technics and results.

Between 1975 and 1980, 91 patients in our series with involvement of 103 webs had revision of a contracted first web space. The five main causes of impairment were burns, trauma, congenital defects, cerebral palsy, and cerebrovascular accident. Technics used were simple Z-plasty; four-flap Z-plasty; modified double-opposing Z-plasty; and rotational flaps from the dorsum of the thumb, index finger, or hand. No pedicled, tubed, or distant flaps were needed. Simple Z-plasty was sufficient for increases to 1 cm; for greater increases a modified double-opposing Z-plasty or local rotational flap was necessary. The modified double-opposing Z gave excellent depth. Release of all contracting elements and addition of sufficient supple skin to the web are required for success.

Congenital giant nevi: clinical and pathological considerations.

A clinical and pathological review of 67 cases of congenital giant nevi and of 5 cases of malignant transformation in congenital giant nevi brings out the following. 1. The lesions should be regarded as premalignant. 2. An aggressive approach is advocated to remove the lesion before school age. 3. Staged excisions, combined with skin grafting and/or local rotation flaps, are advocated. 4. Any nodularity or ulceration developing within a congenital giant nevus should be regarded as an ominous sign. 5. A long-term follow-up is necessary in those patients having subtotal excisions.

Traumatic arteriovenous fistula of the external nose.

Arteriovenous fistulas of the face are rare, and no previous cases of nasal origin were found in the literature. Progressive enlargement is the natural course of arteriovenous fistulas and may cause considerable cosmetic deformity if unattended. Early recognition and total surgical extirpation is the treatment of choice. The use of local rotational flaps is an excellent method for cosmetic excision of nasal lesions.

Repair of large myelomeningoceles.

Prolonged, tedious nursing care and the everpresent danger of meningeal rupture attend the expectant management of infants with myelomeningocele. Conversely, early operation minimizes the special care of these infants, decreases hospital stay, and may ease subsequent bracing and gait training. In the past, we have preferred early surgical treatment of myelomeningocele, but have been discouraged by difficulties encountered in obtaining skin and soft tissue closure in very large lesions. These are the infants whose defects are so large that neither primary midline closure nor the utilization of local rotational pedicle flaps is feasible. To facilitate repair of large myelomeningoceles we have, for the past two years, used large bilateral bipedicled advancement flaps and have achieved success in all seven patients treated by this method. Technique The method of repair is illustrated in the Figure ( B and D ). Bipedicled verticle flaps of skin and soft tissue are outlined bilaterally adjacent to

THE BOUTONNIèRE DEFORMITY

1. A series of 106 central slip injuries has been reviewed. 2. Although the boutonnière deformity in many cases may be no more than a cosmetic defect, this survey has shown that in some instances it can constitute a slowly progressive lesion, with considerable disability and gross deformity of a digit. 3. Conservative treatment seems to be superior to operation, at least in those patients seen within six weeks of injury. Treatment by splintage alone yielded in this series a 75 per cent success rate, whereas operation showed only 50 per cent success. 4. When a sizeable fragment of bone has been avulsed from the middle phalanx, suture of the fragment in position is indicated and gives remarkably satisfactory results. 5. Injuries with soft-tissue loss over the proximal interphalangeal joint may yield successful results after suture or plastic repair of the tendon, and wound closure by split-skin grafts or local rotation flaps. 6. Poor results tend to occur in cases complicated by phalangeal fracture or by multiple hand injuries, and it may be advisable to defer the repair of the central slip until recovery from the other injuries has been completed. 7. With gross disruption of the proximal interphalangeal joint primary arthrodesis is probably indicated.