Mucocutaneous Flap Research Articles

Comparative Evaluation of Reconstructive Methods in Oral Submucous Fibrosis.

Oral submucous fibrosis is a chronic, progressive, scarring, precancerous condition of oral mucosa which on progression causes severe trismus. To compare and evaluate the efficiency of buccal fat pad, platysmal mucocutaneous flap, nasolabial flap, collagen membrane graft, split thickness skin graft and temporoparietal fascia in reconstruction of surgical defect created by excision of fibrous bands in oral submucous fibrosis. After 6months of follow-up, the interincisal mouth opening was 40.0mm in case of buccal pad fat, 24.5mm in temporoparietal fascia flap group, 33.8 in collagen membrane graft group, 34.5mm in platysma flap group, 34.7mm in nasolabial flap group, 29.3mm in split thickness skin graft. ANOVA statistical analysis for postoperative interincisal distance at various time intervals and between pre-, intra- and postoperative interincisal distances were carried out which showed the results were significant at p value < 0.05 in all groups. No postoperative complications were noted in buccal fat pad group, split thickness skin graft group and collagen membrane group. However, platysmal group had flap necrosis and temporoparietal flap group patients had to undergo a second debulking procedure after one month. From our study, we concluded buccal fat pad yields superior results with respect to postoperative mouth opening and related complications.

Surgical excision of polymorphous adenocarcinoma in the left maxilla with mucocutaneous flap reconstruction

ABSTRACT Low-grade polymorphous adenocarcinoma is a malignant neoplasm of salivary glands with uncommon occurrence in the head and neck region, almost exclusively affecting minor salivary glands. While this condition has typical clinical pathological signs, it commonly presents low biological damage potential. The lesions occur more frequently among elderly females between the sixth and eighth decades of life, with a higher prevalence for the hard palate, soft palate and, most regularly, the upper lip and jugal mucosa. The clinical and histological differential diagnosis of this condition is between pleomorphic adenoma and adenoid cystic carcinoma. The most indicated surgical treatment is extensive surgical excision, eventually including resection of the underlying bone. Although infrequent, there may be metastasis for regional lymph nodes. Radical dissection of the neck is not indicated unless there is clinical evidence of cervical metastasis. The present study reports the case of surgical excision of polymorphous adenocarcinoma in the left maxillary tuberosity region. A 63-year-old white male patient sought the Maxillofacial Surgery and Traumatology Service at the Federal University of Pernambuco Clinics Hospital, complaining of a tumor-like lesion in his left maxilla, which gradually increased in volume. The patient further reported a history of surgery ten years before for removal of a tooth in the same region, upper left arch. Given the extent and complexity of the lesion, the surgical treatment in this case consisted of hemimaxillectomy.

Description of Clinical and Surgical Aspects of Four Cases of Lip Commissure to Eyelid Transposition for Repair of Eyelid Coloboma in Cats

Background: Eyelid coloboma or eyelid agenesis is the most common congenital disease in cats. It can affect both the upper and the lower lids and is commonly bilateral. This congenital defect has been reported in several breeds, such as Persian and Domestic Short-Haired Cat. Generally, this defect results in inversion of the colobomatous eyelid, which can cause trichiasis and inflammatory keratitis and corneal ulceration. The only effective treatment is blepharoplasty. This paper describes the clinical and surgical aspects of four patients treated by lip commissure to eyelid transposition for the repair of eyelid coloboma using the technique described in 2010. Results of this procedure have never been reported in Brazil. Cases: Seven eyes of four cats presenting eyelid coloboma affecting up to two thirds of the eyelid were evaluated in this study. Two of the four cats were males and two were females; their average age was 3 years. All patients were admitted at the same institution, and the main issues were purulent discharge and impaired vision. Diagnosis was based on physical and ophthalmic examination. Non-ulcerative keratitis was present in all cases. Corneal ulcer was diagnosed in three patients by the fluorescein dye test. In two cats, a corneo-conjunctival dermoid was found at the temporal-dorsal region of one eye, and measured approximately 0.3 mm; and the other two exhibited microphthalmia in one eye. No abnormalities were seen in the anterior chamber, lens, and vitreous. One of the cats exhibited retinal detachment, and one exhibited testicular agenesis, both of the abnormalities diagnosed by ultrasound. Complete blood count and biochemical tests were performed in all patients before general anesthesia for the corrective procedure. Before surgery, eyes with ulcerative and non-ulcerative keratitis were treated with topical antibiotics and lacrimommimetics. In the 7 eyes, lip commissure to eyelid transposition technique was used for correction of the colobomatous defect. The procedure consisted of a mucocutaneous flap that simulates a natural eyelid. Corneo-conjunctival dermoids were also removed at the same time by superfcial keratectomy. In the postoperative period, all patients received oral non-steroidal antiinflammatory drug and an antibiotic, as well as cleansing of the surgical wound. All patients exhibited improvement of corneal abnormalities following one week of the procedure. However, three cats had suture dehiscence on the lip commissure, which healed by secondary intention after a week. Two weeks after surgery, superfcial necrosis was observed at the tip of the edge of the transplanted flap, in all cats. In order to promote healing, the necrotic edges were debrided at the time of sutures removal, 10 to 15 days after surgeries; at this time, both lip commissure and eyelid wound had already healed. Facial distortion was presente owing to skin overlapping on the site of the flap. All patients had their ability to blink restored, and there was absence of trichiasis on the flap. However, three cats had thichiasis caused by retraction of the pre-existing eyelid at the medial canthus. Discussion: Good functional and esthetic results were achieved, similarly to those previously described, which allows us to consider that this technique is appropriate for eyelid reconstruction in eyelid coloboma or agenesis cases. Nevertheless, this procedure can have some complications, such as suture dehiscence, facial deformity, superfcial necrosis of the edges of the flap, and trichiasis of the pre-existing eyelid of the medial canthus. To overcome these issues, authors suggest removal of the skin under the flap to decrease facial distortion, and removal of the whole pre-existing eyelid, in order to avoid trichiasis caused by retraction of this tissue. Keywords: blepharoplasty, congenital defect, eyelid, feline.

A 12‐year experience of the Trendelenburg perineal approach for abdominoperineal resection

The abdominoperineal resection (APR) is the current accepted surgical technique for low rectal cancers. Negative circumferential surgical margins are an important prognostic indicator and are best obtained by producing a cylindrical specimen. The 'ideal' approach to produce such specimen is debated between a standard lithotomy position and turning the patient in the prone position in the later stages of the procedure. We aimed to assess results of perineal morbidity and oncological outcomes following the lithotomy approach at a single institution. Data were collected retrospectively at a single institution. All patients undergoing the APR for low rectal cancers were included in the current study. Patients underwent this procedure in the standard lithotomy position and a mucocutaneous flap was not routinely used for closure of the perineal wound. The primary outcome measures in this study were local and systemic tumour recurrence and overall patient survival. Fifty-three patients undergoing APR were included in the current study. Majority of patients (87%) received neoadjuvant therapy. Perineal morbidity was observed in 11% of patients loco-regional recurrence occurred in 4% at 5 years. One-, 3- and 5-year survival was 87, 75 and 66%, respectively. Patients with T3/4 disease and positive circumferential surgical margins had significantly poorer survival outcomes. APR can be performed in the lithotomy position with acceptable perineal morbidity and oncological safety. Negative circumferential margins can be achieved reliably by producing a cylindrical specimen with this position.

Reversal of Young's procedure in hereditary haemorrhagic telangiectasia

Hereditary haemorrhagic telangiectasia is an autosomal dominant condition characterised by multiple venous malformations of the skin and mucous membranes which can bleed on contact. A Young's procedure is used to control severe epistaxis in patients with this condition. However, there has been no previous report of a reversal of Young's procedure in such a patient. A patient with hereditary haemorrhagic telangiectasia had his Young's procedure reversed under general anaesthetic by dividing the mucocutaneous flaps. Nasal vestibule patency was maintained using a custom-made silicone nasal mould. Intra-operative photographs show the patient's nasal mucosa shortly following reversal of his Young's procedure, and also illustrate the creation of the custom-made nasal mould. Stopping airflow through the nasal cavity via a Young's procedure prevents the telangiectasia from bleeding but does not make them disappear completely. Young's procedure does not seem to have any long-lasting effect on the nasal mucosa of patients with hereditary haemorrhagic telangiectasia.

Fístulas orocutâneas após cirurgia de câncer da cavidade oral: fatores de risco

To quantify the oral cutaneous fistulae after surgery and to identify possible risk factors. A retrospective study, interesting patients that were submitted to surgery, with a two years minimum post-operative follow up. The considered variables were: sex, concomitant diseases, tabacco and alcohol use, the anesthesic and pulmonary risks, clinical stage, cervical linphadenectomy, pre or postoperative radiotherapy, accidents during the surgery, wound infection and or hematoma, pulmonary infection, surgery and reconstruction extension. In 159 patients, oral cutaneous fistulae occurred in 48 patients (30,3%): Patients stage T1 in 26,6 %,T2 in 1,8 %,T3 in 16%, and T4 in 40,3% (p=0,0138). The cases N+ developed fistulae in 22.9%, (N2c with 42,8%, (p=0,0136), those with preoperative radiotherapy in 63,6% (p=0,0346) Those with wound infection in 47,3% (p=0,0146), and those with wound deiscense in 53,7 % (p=0,0030). The fistulae rate was of 60% in the regional mucocutaneous flaps reconstruction cases, 39,2% in the myocutaneous ones and 12,5% of microsurgery ones (p=0,0286). The general rate of oral cutaneous fistulae was 30,3%. The significant factors were: T stage, cervical linphadenectomy, pre or postoperative radiotherapy, wound infection and deiscense, and the use of flaps.

Der Einsatz des myokutanen Platysmalappens im Kopf-Hals-Bereich - Eine retrospektive Studie*

Following extended tumor resections in the head-neck area options immediate defect reconstruction is needed to reduce healing time and improve rehabilitation. Reconstruction of significant areas of mucosal defects is best accomplished by introduction of a pliable regional transplant. The platysma myocutaneous flap has been used for defect reconstruction in head and neck area since more than 20 years. Its popularity is limited. Since 2001 in our department the platysma mucocutaneous flap is used for such reconstructions. We present a retrospective study evaluating our experience with the platysma myocutaneous flap. From 2001-2003 25 patients have been subjected to surgical reconstruction applying the platysma mucocutaneous flap. The primary tumor was located in 16 patients (64 %) in the oropharynx, in 5 patients (20 %) in the hypopharynx and in 4 patients (16 %) in the oral cavity. Evaluation was based on medical records including the operative reports. All patients get a follow up in our outpatient clinic. The platysma flap is easy to harvest and has a low general risk level. Complications are minor and may be avoided by exact preoperative planning. Necrosis of the skin-muscle-flap was observed only after resection of the A. carotis externa (two cases). In these 2 cases an operative revision was necessary (stenting of the pharynx or secondary reconstruction by pectoralis major-flap). The resection of the A. facialis (three cases) did not lead to a serious complication. Considering the exact indication the platysma flap is suitable for reconstruction of surface defects in the pharynx and oral cavity. A special attention is given to the ipsilateral vascular supply and the length of the muscular pedicel. It proved to be a cost effective method due to the less time and personal expenditure.

Phimosis. Preputial plasty using transversal widening on the dorsal side with EMLA local anesthetic cream

Background/Purpose In the United States, the treatment of choice for the correction of phimosis is circumcision, whereas in European countries, the condition is usually treated by preputial plasty using Duhamel's method or modified versions. We report our experience in correcting phimosis by preputial plasty using transversal widening on the dorsal side with EMLA local anesthetic cream. Methods Twenty-six patients with phimosis were operated on by preputial plasty, under local anesthesia with EMLA cream. A transversal incision is made on the dorsal side of the ring of prepuce, like 3 contiguous Ts, the middle one inverted with the long arm on the preputial mucosa side. The 2 small mucocutaneous flaps of the prepuce are separated and then sutured with interrupted stitches, thus transforming the incisions from T to V. Results No postoperative complications were observed. At 1-year follow-up, the cosmetic and functional results were satisfactory. Conclusions The technique of preputial plasty that the authors present enlarges the stenotic ring of prepuce by a transversal widening on the dorsal side. The ring of prepuce obtained is wide and symmetrical on its dorsal and ventral sides and therefore cosmetically and functionally satisfactory. It is a good alternative to the more radical circumcision technique.

The change in the appearance of the vermilion border region caused by the difference of the design in symmetric bilateral incomplete cleft lip repair

In the widely performed methods for repair of bilateral cleft lips, such as Mulliken and Trott methods, the formation of the median tubercle is done with the mucocutaneous flaps from the lateral lips. By this manoeuver, a visible horizontal scar just above the white skin roll of the philtral region tends to result, especially among Asian patients. To avoid the formation of this visible scar, we changed our design in such a way that mucosal flaps, instead of mucocutaneous flaps, are elevated from the lateral lips, and the prolabial white skin roll is preserved to become the final philtral white skin roll. By this change in design, the horizontal scar is shifted to the inferior edge of the vermilion border. In the past 8 years, we have performed this refined method along with the conventional one. In the present study, the five cases of symmetric bilateral incomplete cleft lip from each of the two groups are evaluated: one group with the mucocutaneous flaps and the other with the mucosal flaps. From the review of the cases, it was noted that when the philtral region is formed with the mucocutaneous flaps, the horizontal scar tends to be visible. On the other hand, when it is formed with the mucosal flaps, the scar is less conspicuous, although the white skin roll sometimes becomes less-defined. The refined method involving mucosal flaps from the lateral lips produces a better-accepted appearance concerning the prolabial horizontal scar in the symmetric bilateral incomplete cleft lip repair.

Measurement of the thickness values of mucocutaneous flap for the reconstruction for oral and oropharyngeal defects

Measurement of the thickness values of mucocutaneous flap for the reconstruction for oral and oropharyngeal defects

Removal of inborn pigmented nevi of both eyelids and covering the defects with a free mucocutaneous flap

Removal of inborn pigmented nevi of both eyelids and covering the defects with a free mucocutaneous flap

Sliding mucocutaneous flap for the treatment of anal ulcer.

Diseases of the Colon & Rectum: July 1968 - Volume 11 - Issue 4 - p 285-288 doi: 10.1007/BF02617157