Locoregional Flaps Research Articles

Necrotizing fasciitis of the posterior neck. A rare clinical form of head and neck cellulitis: a case report from Togo

We report the case of a 75-year-old diabetic patient who presented with posterior cervical necrotizing fasciitis complicating cellulitis. Medical management in intensive care and surgical drainage were undertaken; sequential excision of the necrotic tissue left a large loss of substance of the nuchal region for which we opted for directed healing in the first instance. The definitive coverage of this loss of substance by locoregional rotation flap or by thin skin grafting was discussed. However, it was refused by the patient.

How I do it: using a hammock mesh in the reconstruction of inguinal ligament during a wide en-bloc resection of a groin mesenchymal tumor.

In case of soft tissue sarcomas (STS), an en-bloc resection with safe margins is recommended. To ensure safe removal without tumor rupture, STS of the groin area, retroperitoneal or pelvic mesenchymal tumors may require incision or resection of the inguinal ligament. Solid reconstruction is mandatory to prevent early and late postoperative femoral hernias. We present here a new technique of inguinal ligament reconstruction. Between September 2020 and September 2022, patients undergoing incision and/or resection of inguinal ligaments during a wide en-bloc resection of STS of the groin area in the Department of General Surgery in Strasbourg were included. All patients had an inguinal ligament reconstruction with biosynthetic slowly resorbable mesh shaped as a hammock, pre- or intraperitoneally, associated or not with loco-regional pedicled muscular flaps. A total of 7 hammock mesh reconstructions were performed. One or several flaps were necessary in 57% of cases (4 patients): either for inguinal ligament reconstruction only (n = 1), for recovering of femoral vessels (n = 1), and for both ligament reconstruction and defect covering (n = 2). The major morbidity rate was 14.3% (n = 1), related to a thigh surgical site infection due to sartorius flap infarction. After a median follow-up of 17.8months (range 7-31), there was neither early nor late occurrence of post-operative femoral hernia. This is a new surgical tool for inguinal ligament reconstruction with the implementation of a biosynthetic slowly resorbable mesh shaped as a hammock, which should be compared to other techniques.

Reconstruction of Foot and Ankle Defects: A Prospective Analysis of Functional and Aesthetic Outcomes.

Reconstruction of foot and ankle defects requires selecting an appropriate durable and aesthetically appealing option. From the different options, the procedure's choice depends on the defect's size, location, and donor area's availability. Patients' main goal is to have an acceptable biomechanical outcome. In this prospective study, we have included patients who had undergone reconstruction of the ankle and foot defects between January 2019 and June 2021. Patient demographics, location and size of the defect, different procedures, complications, sensory recovery, ankle hindfoot score, and satisfaction score were recorded. 50 patients with foot and ankle defects were enrolled in this study. All flaps survived except one free anterolateral thigh flap. Five locoregional flaps developed minor complications, and all skin grafts healed well. The Ankle Hindfoot Score outcome has no significant relation with the anatomical location of the defects and the reconstructive procedure. All patients reconstructed using random local flap and with free flap were satisfied with the aesthetic outcome. Because of limited soft tissue, local flap availability is restricted to small defects. Satisfaction rates are high in local and free flaps and are best suited for reconstructing the weight-bearing part of the foot. Bulky flaps should be avoided over the dorsum and ankle region.

Variations in Payer-Negotiated Prices for Head and Neck Reconstructive Surgery.

Little is known about pricing for reconstructive procedures of the head and neck. As of January 2021, the Centers for Medicare and Medicaid Services requires hospitals to disclose payer-negotiated prices for services, offering new insight into prices for privately insured patients. Cross-sectional analysis. Turquoise database. Payer-negotiated facility fees for 41 reconstructive surgeries were grouped by procedure type: primary closure, skin grafts, tissue rearrangement, locoregional flaps, or free flaps. Prices were normalized to account for local labor costs, then calculated as percent markup in excess of Medicare reimbursement. The mean percent markup between procedure groups was compared by the Kruskal-Wallis test. Subset analyses were performed to compare mean percent markup using a Student's ttest. We also assessed price variation by calculating the ratio of 90th/10thpercentile mean prices both across and within hospitals. In total, 1324 hospitals (85% urban, 81% nonprofit, 49% teaching) were included. Median payer-negotiated fees showed an increasing trend with more complex procedures, ranging from $379.54 (interquartile range [IQR], $230.87-$656.96) for Current Procedural Terminology (CPT) code 12001 ("simple repair of superficial wounds ≤2.5 cm")to $5422.60 ($3983.55-$8169.41) for CPT code 20969 ("free osteocutaneous flap with microvascular anastomosis"). Median percent markup was highest for primary closure procedures (576.17% [IQR, 326.28%-1089.34%]) and lowest for free flaps (99.56% [37.86%-194.02%]). Higher mean percent markups were observed for rural, for-profit, non-Northeast, nonteaching, and smaller hospitals. Wide variation in private payer-negotiated facility fees exists for head/neck reconstruction surgeries. Further research is necessary to better understand how pricing variation may correlate with out-of-pocket costs and quality of care.

Distally Based Anterolateral Thigh Flap Algorithm for Unexpected Situations during Soft-Tissue Defect Reconstruction around the Knee.

The distally based (d) anterolateral thigh (ALT) flap is an effective option for soft-tissue reconstruction around the knee; however, unexpected situations may occur intraoperatively, impeding flap harvest. The authors proposed an algorithm for surgical conversion for unexpected situations encountered intraoperatively. Between 2010 and 2021, 61 dALT flap harvests were attempted for soft-tissue defect reconstruction around the knee; 25 patients underwent surgical conversion for anomalies, including lack of a suitable perforator, hypoplasia of the descending branch, and compromised reverse flow from the descending branch. After excluding improper cases, 35 flaps were harvested as planned (group A) and 21 surgical conversion cases (group B) were finally enrolled for analysis. An algorithm was developed based on the cases in group B. Outcomes, including complication and flap loss rates, were compared between groups to verify the algorithm's rationality. In group B, the dALT flap was converted to a distally based anteromedial thigh flap ( n = 8), bipedicled dALT flap ( n = 4), distally based rectus femoris muscle flap ( n = 3), free ALT flap ( n = 2), or other locoregional flap that required additional incision ( n = 4). No differences in outcomes were observed between the two groups. The proposed contingency planning algorithm for dALT flap surgery proved rational, as surgical conversion could be made by means of the same incision in most cases, and outcomes generated by the algorithm were acceptable. Therapeutic, IV.

Locoregional Flaps for the Reconstruction of Midface Skin Defects: A Collection of Key Surgical Techniques.

The reconstruction of midface skin defects represents a challenge for the head and neck surgeon due to the midface's significant role in defining important facial traits. Due to the high complexity of the midface region, there is no possibility to use one definitive flap for all purposes. For moderate defects, the most common reconstructive techniques are represented by regional flaps. These flaps can be defined as donor tissue with a pedunculated axial blood supply not necessarily adjacent to the defect. The aim of this study is to highlight the more common surgical techniques adopted for midface reconstruction, providing a focus on each technique with its description and indications. A literature review was conducted using PubMed, an international database. The target of the research was to collect at least 10 different surgical techniques. Twelve different techniques were selected and cataloged. The flaps included were the bilobed flap, rhomboid flap, facial-artery-based flaps (nasolabial flap, island composite nasal flap, retroangular flap), cervicofacial flap, paramedian forehead flap, frontal hairline island flap, keystone flap, Karapandzic flap, Abbè flap, and Mustardè flap. The study of the facial subunits, the location and size of the defect, the choice of the appropriate flap, and respect for the vascular pedicles are the key elements for optimal outcomes.

Cosmetic outcome of nasal tip reconstruction with the frontonasal flap and other locoregional flaps - Cosmetic Outcome of Nasal Tip Reconstruction

This study investigates the results of nasal tip reconstruction with the frontonasal flap compared with other locoregional flaps. All nasal tip reconstructions with locoregional flaps performed during a 10-year period were included. Defect size, flap type, risk factors, comorbidities, complications, revisions, and secondary operations were retrospectively assessed. Clinical follow-up examinations were performed after 12 months. Digital photographs were taken in standard projections preoperatively and at the time of the last follow-up examination, and the aesthetic results were assessed by three independent examiners, with nasal contour, symmetry, scarring, and match of skin colour between flap and nasal skin rated on a 4-point scale. Finally, patient satisfaction was obtained. A total of 112 nasal tip reconstructions were performed in 68 women and 44 men with a mean age of 71,4±10,2 years. Taking into account defect size, individual factors and patient preference, reconstruction was performed with 58 frontonasal flaps, 23 Rintala flaps, 20 paramedian forehead flaps and 11 bilobed flaps. Mean age and comorbidities of patients were comparable between flap types, except for a higher incidence of arterial hypertension and a lower incidence of diabetes mellitus in patients treated with frontonasal flaps. Defect size was the same in reconstructions with frontonasal flaps and Rintala flaps, smaller in bilobed flaps, and more extensive in paramedian forehead flaps. There were no differences in complication rates between the different flap techniques. Taking into account the planned second interventions (flap pedicle separations) in the paramedian forehead flaps, the frequency of unplanned corrections was comparable for all flap techniques. Aesthetic results and patient satisfaction were rated as very good or good in more than 90% with all techniques. Compared with the paramedian forehead flap, the frontonasal flap avoids a planned secondary procedure and an extensive donor defect. It allows for the coverage of defects at least the size of the Rintala flap and larger defects than the bilobed flap.

Management of Through-and-Through Oromandibular Defects after Segmental Mandibulectomy with Fibula Osteocutaneous Flap.

Oromandibular defects involving the external skin are a reconstructive challenge. This study aimed to evaluate the use of the fibula osteocutaneous free flap (FOCFF) for through-and-through oromandibular defects by comparing the surgical outcomes and complications of different techniques to close the external skin defect. A retrospective analysis was conducted of patients who underwent reconstruction of through-and-through oromandibular defects after oncologic segmental mandibulectomy between January 2011 and December 2014. Five groups were analyzed according to the method of external skin coverage: primary closure, locoregional flaps, deepithelialized double-skin paddle FOCFF (deEpi-FOCFF), division of the skin paddle for double-skin paddle FOCFF (div-FOCFF), and a simultaneous second free flap. Intraoperative and postoperative outcomes along with complications were analyzed between groups. A total of 323 patients were included. The mean total defect area requiring a simultaneous second free flap was larger in comparison to other groups (p < 0.001). Reconstructions performed with div-FOCFF had a higher number of perforators per flap when compared with deEpi-FOCFF (p < 0.001). External defects closed with another free flap exhibited higher intraoperative time for the reconstructive segment in comparison to other groups (p < 0.05). The overall rate of complications was comparable between groups (24%, p = 0.129). The FFOCF is a reliable alternative to harvesting multiple simultaneous free flaps for through-and-through oromandibular defects. The authors recommend appropriate curation of the surgical plan based on individual patient characteristics and reconstructive requirements.

Awareness and attitude of maxillofacial surgeons in India towards prosthetic rehabilitation after ablative jaw surgery

Purpose: The study investigated the awareness and attitude of maxillofacial surgeons towards prosthetic rehabilitation after ablative jaw surgery. Materials and Methods: A questionnaire-based survey using google forms was designed to assess the awareness and attitude of maxillofacial surgeons. The questionnaire comprising of 23 closed- ended and multiple-choice questions. A total of 150 forms were sent to maxillofacial surgeons through e-mail. Results: Upon analyzing 103 responses it was observed that in the case of maxillectomy defects, the size of the lesion was designated as the most common factor (87%) for deciding between surgical reconstruction or prosthetic rehabilitation. 89% of respondents agreed that presurgical consultation with a maxillofacial prosthodontist could improve the rehabilitation success rate. The most common modality used for the reconstruction of mandibulectomy defects is vascularized bone grafts (32 %), reconstruction plate (30 %), and locoregional flaps for reconstruction by 20% of surgeons. Speech (64.1%) and nasal regurgitation (62%) were the two most important functions that the patient demanded to be corrected after maxillectomy whereas after mandibulectomy masticatory difficulties faced by the patient were the primary reason for seeking the prosthesis as suggested by 84% of respondents. Conclusion: The findings of this study show lack of awareness among surgeons regarding prosthetic rehabilitation of the post jaw resection patients. Ablative tumors of jaws necessitate amultidisciplinary team approach due to their effects on the functional and esthetic aspects of the patients involved. The response also emphasizes the need for a maxillofacial prosthodontist in the complete rehabilitation of the patients. (Int J Maxillofac Prosthetics 2023;6:8-15)

Use of negative pressure wound therapy on locoregional flaps: a case–control study

The use of negative pressure wound therapy (NPWT) is ubiquitous in the management of complex wounds. Extending beyond the traditional utility of NPWT, it has been used after reconstructive flap surgery in a few case series. The authors sought to investigate the outcomes of NPWT use on flap reconstruction in a case-control study. Patients who underwent flap reconstruction between November 2017 and January 2020 were reviewed for inclusion in the study, and divided into an NPWT group and a control group. For patients in the NPWT group, NPWT was used directly over the locoregional flap immediately post-surgery for 4-7 days, before switching to conventional dressings. The control group used conventional dressing materials immediately post-surgery. Outcome measures such as flap necrosis, surgical site infections (SSIs), wound dehiscence as well as time to full functional recovery and hospitalisation duration were evaluated. Of the 138 patients who underwent flap reconstruction, 37 who had free flap reconstructions were excluded, and 101 patients were included and divided into two groups: 51 patients in the NPWT group and 50 patients in the control group. Both groups had similar patient demographics, and patient and wound risk factors for impaired wound healing. Results showed that there was no statistically significant difference between flap necrosis, SSIs, wound dehiscence, hospitalisation duration as well as functional recovery rates. Cost analysis showed that the use of NPWT over flaps for the first seven postoperative days may potentially be more cost effective in our setting. In this study, the appropriate use of NPWT over flaps was safe and efficacious in the immediate postoperative setting, and was not inferior to the conventional dressings used for reconstructive flap surgery. The main benefits of NPWT over flaps include better exudate management, oedema reduction and potential cost savings. Further studies would be required to ascertain any further benefit.

VERSATILITY OF PERFORATOR-BASED PROPELLER FLAP IN RECONSTRUCTION OF VOLAR ASPECT OF DISTAL FOREARM, DISTAL LEG &amp; ANKLE DEFECTS - A RETROSPECTIVE ANALYSIS

Background: The use of regional flaps based on perforator arteries is generating more interest in limb reconstruction surgery. The surgical approach allows for the restoration of soft tissue lesions using neighboring homologous tissues without the need for microvascular anastomosis. The aim of the study was to evaluate the clinical results of local perforator flaps in the treatment of complex lower limb and upper limb defects. Materials and Methods:Fourteen patients (six upper limb and eight lower limb defects) underwent reconstruction using perforator-based flaps which were studied retrospectively during a three-year period. Donor sites were examined thoroughly and flaps selection was done using a handheld manual Doppler mapping preoperatively, to locate the perforator vessels and their flow. Thereby, perforator-based propeller flaps were raised and used for defect coverage based on their maximum arc of rotation. Results:Postoperatively, all the flaps included in the study survived. Partial flap necrosis and venous congestion in the flap were reported in two patients following intervention. Donor site morbidity was minimal without any loss of function. Most of the patients were satisfied with the aesthetic outcome. Conclusion:Perforator flaps using hand held Doppler are the most yielding, simple and safe flaps for the Reconstructive Surgeons. The need for the complicated microsurgical procedures can be avoided with the use of such locoregional propeller flaps which providedbetter aesthetic results with minimal donor site morbidity.

CT and MR Imaging Appearance of the Pedicled Submandibular Gland Flap: A Potential Imaging Pitfall in the Posttreatment Head and Neck.

Pedicled locoregional submandibular gland reconstruction flaps are increasingly used in oncologic head and neck surgery and have unique imaging characteristics that can mimic locally recurrent tumor. In this clinical report, 23 posttreatment imaging studies were evaluated in 19 patients who had undergone submandibular gland flap reconstructions after resection of a primary head and neck tumor. Submandibular gland flaps were most commonly mobilized into the parapharyngeal space or parotid bed, with others located inferior to the mandibular body and within marginal mandibulectomy defects. The original shape of the gland was typically not preserved. Identifying the submandibular gland hilum, vascular pedicle, glandular texture, and absence of submandibular gland in the orthotopic location was most useful in recognizing a flap. The interpreting radiologist must be familiar with the unique submandibular gland flap imaging characteristics to accurately differentiate normal postoperative appearance and recurrent tumor.

Reconstruction surgery in head and neck cancer patients amidst the COVID-19 pandemic: Current practice and lessons for the future.

The coronavirus disease 2019 (COVID-19) pandemic has imposed a radical change in daily life and work routine. In this context, health systems have suffered important and serious repercussions in all fields. Among the changes brought about by the state of global health emergency, adjustments to guidelines, priorities, structures, professional teams, and epidemiological data stand out. In light of this, the oncological field has witnessed several changes in the approach to cancer, whether due to delay in diagnosis, screening deficit, personnel shortage or the psychological impact that the pandemic has had on cancer patients. This article focuses on the management of oral carcinoma and the surgical approaches that oral and maxillofacial specialists have had at their disposal during the health emergency. In this period, the oral and maxillofacial surgeons have faced many obstacles. The proximity of maxillofacial structures to the airways, the need of elective and punctual procedures in cancerous lesions, the aggressiveness of head and neck tumors, and the need for important healthcare costs to support such delicate surgeries are examples of some of the challenges imposed for this field. One of the possible surgical 'solutions' to the difficulties in managing surgical cases of oral carcinoma during the pandemic is locoregional flaps, which in the pre-COVID-19 era were less used than free flaps. However, during the health emergency, its use has been widely reassessed. This setback may represent a precedent for opening up new reflections. In the course of a long-term pandemic, a reassessment of the validity of different medical and surgical therapeutic approaches should be considered. Finally, given that the pandemic has high-lighted vulnerabilities and shortcomings in a number of ways, including the issues of essential resource shortages, underinvestment in public health services, lack of coordination and versatility among politicians, policymakers and health leaders, resulting in overloaded health systems, rapid case development, and high mortality, a more careful analysis of the changes needed in different health systems to satisfactorily face future emergencies is essential to be carried out. This should be directed especially towards improving the management of health systems, their coordination as well as reviewing related practices, even in the surgical field.

Surgical Lip Cancer Reconstruction in the COVID-19 Era: Are Free Flaps or Loco-Regional Flaps Better?

Lip carcinoma is one of the most frequent conditions affecting the general population. It is among the ten most common neoplasms, but despite advances in research and therapy, its prognosis has not improved in a significant way in the past few years, making it a challenge in the medical research field and in surgical treatment. This study was conducted with the aim of evaluating the available reconstructive surgical options for the treatment of lip carcinomas in order to define which could be the most appropriate technique to achieve satisfying aesthetic and functional outcomes considering hospital resources in the COVID-19 era. Seventeen patients were included in this retrospective study, which took place between January 2019 and April 2021. There were two groups: seven patients who underwent a radial forearm free flap and ten who underwent locoregional flaps. The statistical analysis was performed to evaluate four different endpoints. Surgical length, ICU stay, and hospitalization time were minor for locoregional flaps. There was no statistically significant difference between the two groups when considering post-operative complications. Locoregional flaps have a more aesthetically pleasing result, but from a functional point of view, the results can be superimposable. Both techniques are associated with adequate speech, mouth opening, sealing, and symmetry. Given the impact of the COVID-19 pandemic on the healthcare system, locoregional flaps have been proven to be a good surgical option in the reconstruction of lip defects both in terms of aesthetics and functional outcome.

Handy locoregional flaps for nasal reconstruction

BackgroundSkin lesions on the nose are common. Multiple surgical techniques have been used for nasal reconstruction. These options may be autogenous or alloplastic and can be performed in single or multiple stages. The choice of coverage depends on the nature of the lesion, location on the nose, and available donor sites. This study aimed to evaluate the surgical outcomes of using locoregional flaps for nasal reconstruction. MethodsA total of 27 patients underwent surgery. There were 9 men and 18 women, aged 7 months to 93 years. Four patients presented with involuting hemangioma, five patients with ischemic necrosis of the columella, and five patients with congenital nevus; the remaining 13 patients were previously diagnosed with basal cell carcinoma. Six techniques have been described for nasal reconstruction at our institution from 2016 to 2020. Most patients had basal cell carcinoma (n=13). Locoregional flaps and primary sutures were used for nasal reconstruction. ResultsThe complications were minimal. One patient had a superficial infection and one experienced postoperative bleeding. No recurrence was observed, and none of the patients asked for a second opinion. ConclusionRadical excision of tumors combined with analysis of nasal defects and nearby donor sites is essential for nasal reconstruction. The use of locoregional flaps leads to consistent and good aesthetic outcomes.

Flaps for lower limb diabetic wound reconstruction: A systematic review and meta-analysis

The treatment of chronic diabetic wounds includes wound dressing, debridement, flap surgery, and amputation. For suitable patients with nonhealing wounds, locoregional flaps or free flaps may be used. This paper aims to review the outcomes of flap surgery and identify the risk factors for flap loss. MEDLINE, Embase, and Cochrane Library were searched. Articles reporting flap loss outcomes for flap surgery in lower limb chronic diabetic wounds were included. Case reports and case series with fewer than five patients were excluded. A subset of articles was used for revascularization subgroup analysis and another subset for meta-analysis of risk factors for flap loss. In the free flap group, the total flap failure rate was 7.14% and partial flap failure rate was 7.54%. The rate of major complications requiring operative takeback was 19.0%. Early mortality was 2.76%. In the locoregional flap group, the total flap failure rate was 3.24% and partial flap failure rate was 5.36%. The rate of major complications requiring operative takeback was 13.3%. There was no early mortality. The rate of free flap loss was 18.2% with revascularization, significantly higher than 6.66% without revascularization. Our findings concur with previously published studies on flap loss and complications in diabetic lower limb wounds. There is an increased risk of flap loss in patients who require free flap and revascularization compared to patients who only require free flap. This could be because of the fragile and fibrotic vessels found in diabetics with comorbid atherosclerosis.

Chicken Feet: A Model for Practising Locoregional Flaps of the Hand.

Background: The aim of this study was to determine the feasibility of the chicken foot model for surgical trainees interested in practising the designing, harvesting and inset of locoregional flaps of the hand. Methods: A descriptive study was performed to demonstrate the technical aspects of harvesting four locoregional flaps in a chicken foot model: fingertip volar V-Y advancement flap, four-flap and five-flap Z-plasty, cross-finger flap and first dorsal metacarpal artery (FDMA) flap. The study was performed in a surgical training laboratory on non-live chicken feet. No participants were involved in this study, apart from authors performing the descriptive techniques. Results: All flaps were successfully performed. Anatomical landmarks, soft tissue texture and flap harvest, as well as inset closely resembled clinical experience with patients. Maximal flap sizes were 12 × 9 mm for volar V-Y advancement, 5 mm limbs for Z-plasties, 22 × 15 mm for cross-finger flaps and 22 × 12 mm for FDMA flaps. The maximal webspace deepening with four-flap/five-flap Z-plasty was 20 mm and the FDMA pedicle length and diameter was 25 and 1 mm, respectively. Conclusions: Chicken feet can be effectively used as simulation models for hand surgical training with respect to gaining familiarity with the use of locoregional flaps of the hand. Further research requires testing for reliability and validity of the model on junior trainees.

Case Series: Pedicled Anterolateral Thigh Flaps for Groin Reconstruction

Objective: Groin reconstruction poses a challenge to the plastic surgeon given the comorbidities and prior surgeries typically present in patients with groin wounds, as well as the coverage demands that exposed vascular graft prosthetics and/or native vessels require. Muscle flaps such as the sartorius, rectus abdominis, and rectus femoris have classically been used to reconstruct groin defects, however these require muscle sacrifice and potential donor site morbidity. The anterolateral thigh flap (ALT) has emerged as a versatile flap for locoregional and free flap reconstruction, in this case groin reconstruction, with minimal donor site morbidity. Methods: Patients of the Spectrum Health Plastic Surgery Residency Academic Service from 2017 to 2021 with groin wounds reconstructed with pedicled ALT flaps were retrospectively reviewed in this case series. Five patients were included. The etiology of their wounds, comorbidities, dimensions of flap, time from initial debridement to flap, complications, and outcomes were assessed. Results: The mean age of the patients was 68 years old (range 56 – 76 years). Two of the patients developed groin wounds after repair of ruptured femoral pseudoaneurysms, two presented after infected vascular prosthetic debridement, and one after wound dehiscence following liposarcoma excision with adjuvant radiation. Flap sizes ranged from 10cm x 5cm to 27 centimeters x 9 centimeters. A cuff of vastus lateralis muscle was included in all flaps to provide flap bulk and incorporate musculocutaneous perforators. All donor sites were closed primarily. One patient redeveloped a pseudoaneurysm rupture after groin reconstruction although the overlying ALT survived. One flap developed venous congestion requiring leech therapy and subsequent debridement. One patient developed post-operative cellulitis which resolved. All patients went on to heal their groin wounds. There were no donor site complications. Average follow-up time was 104 days. Conclusion: All five patients had successful groin wound reconstruction with pedicled ALT flaps. This case series demonstrates the utility of the pedicled anterolateral thigh flap in groin reconstruction as a reliable locoregional flap option with minimal donor site morbidity and accommodating flap size. The pedicled ALT should be a first line option for groin reconstruction even in patients with comorbidities or altered vascular anatomy. Corresponding Author: Matthew E. Braza, 100 Michigan Street NE, MC 188, Grand Rapids, MI 49503, [email protected], 414-218-0645

Reconstruction of the oral cavity defects using local and locoregional pedicled flaps

Reconstruction of the oral cavity defects using local and locoregional pedicled flaps

Aesthetic Principles in Nasal Reconstruction after Squamous Cell Carcinoma Resection

"A successful nose reconstruction is represented by a normal look and nasal breathing preservation. The choice of method is based on the site, size, depth of the defect, donor availability, and surgeon experience. There are multiple methods of restoring nasal cover, from primary repair to healing by secondary intention, from primary suture, skin graft to locoregional flaps, but all of them should be integrated into a personalized approach, keeping the nasal functions, a good aesthetic outcome and without any tumor infiltration. This paper consisting of a retrospective study of 9 patients diagnosticated with squamous cell carcinoma revealed the importance of skin properties and skin changes during aging. Despite all aesthetic principles, skin is the most important resource in facial reconstruction. "