Skin-muscle Flap Research Articles

Clinical Practice Patterns and Evidence-Based Medicine in Blepharoplasty: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery.

The American Board of Plastic Surgery (ABPS) Continuous Certification tracer data on blepharoplasty offers valuable information on national trends in clinical practice. The present study was performed to analyze evolving trends in blepharoplasty and compare practice patterns to Evidence-Based Medicine (EBM) publications within the same timeframe. Tracer data for blepharoplasty procedures performed by ABPS-certified surgeons between 2005 and 2020 was analyzed. Data between two timeframes, 2005-2014 (early cohort, EC) and 2015-2020 (recent cohort, RC), were compared to identify evolving trends in blepharoplasty over time. Results were then compared to EBM-based publications. Of 3,050 blepharoplasties (1,510 EC; 1,540 RC), 82% were performed in female patients and the average age was 56 years. Blepharoplasty was most frequently performed in an ambulatory setting (56%) compared to in hospital (25%); significantly more cases are being performed in the office (p< 0.001) in the RC compared to the EC. Mean surgical duration has decreased by 13 minutes (p< 0.001), and fewer surgeries are being performed with concomitant procedures (p< 0.001). Fewer surgeons use antibiotics (p< 0.001), and fewer surgeons use DVT prophylaxis in the form of sequential compression devices after anesthesia (p< 0.001). More skin resections were performed for upper blepharoplasties (p=0.016), while fewer cases of lower lid blepharoplasty involved either skin-muscle flaps (p=0.038) or transcutaneous fat removal (p=0.004). Most surgeons did not perform canthal tightening during their blepharoplasty (82%). A review of over 15-years of ABPS blepharoplasty tracer data allows surgeons to compare their practice with national trends and EBM. The tracer data illustrates a shift in technique towards shorter and simpler procedures in the office setting.

P-55719761-1394 - Transcutaneous skin-muscle flap suspension for lower-eyelid tertiary blepharoplasty

P-55719761-1394 - Transcutaneous skin-muscle flap suspension for lower-eyelid tertiary blepharoplasty

Use of De-Epithalialized Flap for Elevating the Alar Base in Patients With Cleft Lip.

Alar base asymmetry is a common problem in cleft lip patients. Caused by a lack of bone support and soft tissue deficiency, it is one of the problems that must be corrected during cleft lip repair. While it is encountered during primary lip repair, it can also be seen as a secondary cleft lip nasal deformity after repair. This study aimed to provide alar base symmetry with a de-epithelialized muscle-skin flap during the primary cleft lip repair of incomplete cleft lip patients and secondary cleft lip deformity repair. In incomplete cleft lip patients, the tissue under the incomplete part is de-epithelialized and elevated as a superiorly based flap. The flap is rotated and sutured under the alar base for the elevation. In secondary patients, scar tissue to be removed is de-epithelialized and elevated as a superiorly based flap. It is turned over and sutured under the alar base for augmentation. The effect of the surgery is monitored during the follow-up period. There were no complications related to the flap, and no volume loss was observed. Using a de-epithelialized musculocutaneous flap, the augmentation of the alar base and nasal sill can be achieved without additional incisions in patients undergoing primary incomplete cleft lip repair and in patients undergoing secondary cleft lip deformity repair. We think it is an effective and safe method, improving the esthetic outcomes of cleft lip patients.

Modified Hughes Tarsoconjunctival Flap Procedure for Lower Eyelid Defect

Introduction : Hughes procedure of tarsoconjunctival flap is a method of choice in reconstructing full thickness inferior eyelid defect that involves &gt;50% of eyelid margin to restore anatomical integrity, function, and cosmetic of the eyelid. The modified Hughes procedure includes sparing of the marginal upper lid tarsus and removal of the levator muscle aponeurosis from the tarsoconjunctival flap.This article reports 2 patients who underwent modified Hughes procedure after basal cell carsinoma excision.&#x0D; Case Illustration : Two patients underwent inferior eyelid reconstruction using modified Hughes procedure. After wide excision of the tumor, tarsoconjunctival flap was made to reconstruct posterior lamella of the eyelid. Subsequently, anterior lamella of the eyelid were reconstructed using full thickness skin graft and advancement flap, respectively. Both patient then underwent second surgery, tarsus flap release, 6-8 week after the first surgery.&#x0D; Discussion : A tarsoconjunctival flap from the upper eyelid replaces the posterior lamella, whereas a skin graft, a skin flap, or a skin-muscle flap restores the anterior lamella. After surgery, tarsal flap apposition, skin flap/graft, and stitches were intact. After tarsus flap release, wound healing was good. Tumor biopsy showed basal cell carcinoma.&#x0D; Conclusion : Modified Hughes procedure is a treatment of choice in reconstructing full thickness inferior eyelid defect involving &gt;50% of eyelid margin. Full thickness skin graft and advancement flap to reconstruct anterior lamella of the eyelid is choosen after considering skin color and texture similarity and laxity of eyelid and cheek.

Lower Blepharoplasty With Fat Transposition and Three-Vector Suspension Technique

The aging appearance of the lower eyelids is multifactorial, involving changes in the skin, orbital fat, orbicularis muscle, soft tissue of the midface, tear trough, and tear valley. Traditional techniques of lower blepharoplasty are based on transcutaneous or transconjunctival approaches with skin removal, followed by adjunctive procedures, such as canthal suspension, fat resection, or repositioning. However, these approaches can hardly achieve excellent transitions simply because they do not effectively address every age-related issue affecting the lower eyelid. Conversely, the approach presented herein, focuses on blending the lid-cheek junction by means of skin resection, fat transposition, and three periosteal suspension vectors, including canthal, skin-muscle flap, and sub-orbicularis oculi fat (SOOF) suspensions. It provides adequate volume restoration in the tear trough and tear valley, along with enhanced support and stability to the eyelid with canthopexy, double muscle flap, and SOOF suspension. The aim of this article is to provide a detailed step by step description of this technique along with the results of 269 patients who underwent this procedure from 2019 to 2023. This technique offers a safe and effective solution for lower eyelid aging, yielding long-lasting aesthetic results with excellent transitions.

Clinical experience of combined organ-preserving treatment of laryngopharyngeal cancer with spread to the cervical esophagus

Introduction. Laryngopharyngeal cancer accounts for about half of the total number of malignant neoplasms of ENT organs. Despite the availability of examination, in most patients tumors of this localization are detected at late stages, and the long-term results of treatment of locally advanced cancer of the larynx remain unsatisfactory.Clinical case. This article presents two clinical cases of combined organ-preserving treatment of laryngopharyngeal cancer with spread to the cervical esophagus. At the first stage, patients underwent organ-preserving surgical treatment with a reconstructive plastic component according to the methodology developed at the A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Center of Radiology. Then a postoperative course of chemoradiotherapy was carried out.Conclusion. The use of combined organ-preserving techniques using displaced skin-muscle flaps in the treatment of locally advanced laryngopharyngeal cancer involving the cervical esophagus allows in some cases to avoid crippling surgery, preserve the larynx and achieve satisfactory functional results, which significantly improves the quality of life of patients.

Outcomes of Surgical Treatment of Malar Mounds and Festoons.

Malar mounds (congenital) and festoons (acquired) are persistent puffiness in the prezygomatic space between the orbicularis retaining ligament (ORL) and zygomatico-cutaneous ligament (ZCL). Non-surgical treatments often yield unsatisfactory results. This paper aims to demonstrate a surgical approach for the treatment of malar bags by outlining the author's surgical technique of treating malar mounds and festoons and reviewing outcomes in 89 cases. Correction of malar mounds and festoons was achieved with subciliary skin-muscle flap, release of the ORL and ZCL, midface lift, canthopexy, and muscle suspension. We performed a retrospective study of 89 patients, all of whom had surgical correction of malar mounds or festoons in the past 10 years and a follow-up period of at least 6 months. This study was conducted over the course of the past year and involved reviewing patient charts in the office. Specifically, patient data spanning 2012 to 2022 were analyzed. The predictor variable in this study is the specific class of malar bags the patient has, as determined by the underlying pathophysiology. Outcome variables include the presence or absence of prolonged lid or malar edema, necessary re-excision of excess orbicularis oculi of the subciliary area, lid malposition, permanent visual changes, the need for additional non-operative treatment, and recurrence requiring reoperation. The majority of patients presented with acquired festoons (81/89) with prior attempts of correction (49/89). The mean follow-up is 11.2 months. Persistent malar edema (> 6 weeks) was documented in 14 patients and mainly resolved with Medrol Dosepak (methylprednisolone) and hydrochlorothiazide. A two-proportion Z-test was conducted, comparing the proportion of patients with poor protoplasm who experienced postoperative malar edema to the proportion of those with excellent protoplasm who experienced postoperative malar edema. A p-value of 3.414e-7 was obtained, indicating a statistically significant difference of proportions between the two groups. Five patients received additional injections of deoxycholic acid and two needed fillers for smoother contour of the lower eyelids. Two patients with severe malar mounds required multiple reoperations including direct excision in one patient. One incidence of transient lid retraction was reported in a patient with previous facelift and facial nerve injury. Malar mounds and festoons present a unique challenge to plastic surgeons. They are persistent in nature and require close-interval, long-term follow-up as additional injections and reoperations are warranted. Our approach to malar mound and festoon correction is safe and effective and provides long-lasting results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dermatoplasty for decompensated forms of varicose veins and post-thrombotic syndrome

Objective(s). In order to improve the results of the treatment of the decompensated form of varicose veins and post-thrombotic syndrome, taking into account the angiosomal theory and using VAC and Magott therapy of the recipient woundof the trophic ulcer, evaluate different methods of dermatoplasty depending on the depth and area of the lesion.&#x0D; Methods. In the surgical clinic of the regional hospital named after A. Novak, 174 patients with chronic venous insufficiency (CVI) in the stage of lecompensation were under our observation. According to the etiology of the disease, there were 76 patients with varicose desease (VD) (group I), 98 patients with PTS (group II), while 27 patients with PTS had trophic ulcers on both lower extremities. With a trophic ulcer (TU) diameter of up to 10 cm in the I group of patients, 42.1% had the depth of the lesion of the IIst, and in the patients of the IIa group, the depth of the lesion was the IIIrd. was observed in 51.4% of cases. In the 1st group (76) patients, TU was cleaned with the help of VAC therapy in 32 patients, Magott therapy was used in 18 patients. TcpO2 was measured in the angiosomes of the anterior tibial artery (APA), posterior tibial artery (PTA), and peroneal artery (PA), as the corresponding arteries participate in the perfusion of the corresponding skin-muscle flaps&#x0D; Results. Rejection (lysis) of the graft was observed in 5 (6.6%) patients of the 1st group, and only in patients with dermatoplasty using the vintage method. Graft lysis was observed in 4 (5.6%) patients of the IIa group, in two with the vintage method and in two with split graft transplantation. In the IIb group (both limbs affected), partial lysis of the transplanted perforated split graft was observed in three limbs (6%). No complications were observed when the tissue complex was transplanted freely.&#x0D; Conclusions. Free flaps are units of tissue that can be transplanted from the donor site to the recipient wound while maintaining its blood supply. Pieces can be classified by the type of blood supply, their tissue composition, the method of transplantation, or the orientation of the vessels. The concept of angiosomes and venosomes explains the blood supply to the recipient wound necessary for the viability of the flap. Various monitoring methods are used to monitor patients after surgery, including assessment of physiological parameters and auxiliary methods (dopplerography, transcutaneous and epidermal oximetry). Factors affecting the viability of transplants after surgery include: thorough surgical intervention, adequate immobilization after surgery, prevention of infection, and adequate vascularization of the recipient wound.

Reconstruction of eyelid defects using the diplene adhesive membrane

BackgroundThe abundance of closely packed vital structures in the periocular and palpebral regions makes resection and subsequent reconstructive interventions extremely difficult. MethodsIn this novel article, we described a method for closing lower eyelid defects after tumor excision using a skin-muscle flap from the upper eyelid along with the use of an adhesive diplene biodegradable membrane. The membrane was used for seamless fixation of the flap and to prevent the development of lower eyelid deformity. ResultsThe case presented herein demonstrated that using diplene adhesive biodegradable membranes has excellent functional and aesthetic results. ConclusionOur findings suggest that an adhesive biodegradable diplene membrane can be used for the reconstruction of the lower eyelid to prevent the occurrence of retraction, for the surgical treatment of ectropion including recurrent cases, and for seamless fixation of flaps to wound surfaces in patients with a tendency to form keloids and hypertrophic scars.

Malposition of the Resorbable Sheet in Medial Orbital Wall Fractures: Frequency and Techniques for Prevention.

The aim of this report is to discuss malposition of the resorbable sheet in medial orbital wall fractures and how to prevent this problem. After making an incision through the skin and orbicularis oculi muscle, a skin-muscle flap was elevated just superficial to the orbital septum, extending to the arcus marginalis. Dissection was extended just below the anterior lacrimal crest to increase the exposure. Fracture site in medial orbital wall was visualized. A resorbable sheet (poly- l -lactide, d -lactide sheet, 0.5-mm thickness) was trimmed and molded in an L shape, with the vertical portion used to cover the medial wall defect and the horizontal portion for stability in the orbital floor. An extended part, measuring roughly 1cm, was bent across on the infraorbital rim, and this part was fixed with absorbable screws to prevent the sheet from crumpling. After the molded plate was put in position, the periosteum and skin were closed. From 2011 to 2021, the authors operated on 152 orbital floor or medial wall fractures. Among 152 patients who underwent surgery to reconstruct orbital floor or medial wall fracture, of whom 27 patients had both floor and medial wall fractures, the authors experienced 2 cases of medial orbital wall fractures where the resorbable sheet was malpositioned, requiring reoperation. To prevent malposition of the sheet in medial wall reconstruction, the inferomedial angle of the vertical portion and the horizontal portion of the sheet should be about 135°. Before fixing the sheet on the bony part, a complete tension-free forced-duction test is mandatory.

The skin-muscle flap of the pectoralis major muscle in reconstructive surgery of oral cavity

Annotation. The article presents a description of surgical intervention to replace a postoperative defect with a skin-muscle flap of the pectoralis major muscle in a patient with a tumor of the oral cavity. The pectoralis major skin-muscle flap in oral reconstruction is important as a transfer of a vascularized massive block of tissue from a non-irradiated area. The vascular pedicle of the skin-muscle flap of the pectoralis major muscle is of sufficient diameter and length to reconstruct the floor of the oral cavity. The arterialized flap, which includes the pectoralis major muscle, is indicated for the one-moment closure of large postoperative defects of the oral cavity.

Three-Dimensional Analysis of Tear Trough Volume After Lower Blepharoplasty with Midface Lift.

Background: This study aims to evaluate three-dimensional stereophotogrammetry measured volume changes in the tear trough area after lower blepharoplasty with midface lift with or without orbital fat manipulation. Objective: Among patients undergoing midface lift surgery, volume change by three-dimensional photography in the tear trough region was compared between those having no orbital fat manipulation, fat transposition, or fat resection. Methods: This is a prospective study of 260 eyelids of 130 patients who underwent cosmetic midface surgery. All patients had an external skin muscle flap midface lift. During the procedure, medial inferior orbital fat was resected, repositioned to a preperiosteal dissection pocket, or not manipulated. Forty-six patients (35.4%) had no fat manipulation, 42 patients (32.3%) had fat preservation with repositioning to the preperiosteal pockets on the medial inferior orbital rim, and 42 patients (32.3%) had fat resection without repositioning. Results: All patients had volume gain in tear trough volume. The amount was not statistically significantly different between fat treatment groups. Mean follow-up time was 12 months (range 6-20 months). Conclusions: Midface lifting improved tear trough volume irrespective of how fat was manipulated.

A Case of Multiple Radiation-related Complications during Long-term Follow-up after Sacral Ulcer Surgery

We report the clinical course of a patient who developed a sacral radiation ulcer 19 years after treatment for cervical cancer. The patient's postoperative course after a free latissimus dorsi muscle flap transfer was favorable, but various late radiation complications, including rectal perforation, a rectal fistula, sacral necrosis, a rectointestinal fistula, and sacroiliac joint osteomyelitis, occurred within 11 years. Plastic surgeons who treat such ulcers need to know that patients may develop other serious radiation-related complications. Being aware of these complications will allow appropriate measures to be taken and aid decisions regarding future surgical strategies. More careful assessment of sacral necrosis and bone resection may have ameliorated some of the complications. When encountering similar patients, we believe that careful magnetic resonance imagery (MRI) and intraoperative evaluation are warranted, as sacral necrosis may be detectable in some patients.

Risk Factors for Surgical Site Infection after Operative Management of Pilon Fractures

Category: Trauma; Ankle Introduction/Purpose: Pilon fractures are complex injuries that most commonly result from high-energy trauma. The extensive soft tissue damage and high rates of associated infection seen in these injuries remains a challenging concern for surgeons. The purpose of this study is to identify risk factors associated with surgical site infection (SSI) following operative management of pilon fractures. Methods: A retrospective review of all operatively managed pilon fractures at a single level 1 trauma center from 2014 to 2019 was performed. Minimum six-month follow-up and skeletal maturity was required for inclusion. Patients with amputation prior to definitive fixation were excluded. SSI consisted of superficial (defined as infection resolving with oral antibiotics) and/or deep infections (defined as return to the operating room for debridement with positive cultures). Patients were grouped based on presence or absence of SSI. Demographics, injury and operative characteristics, and surgical outcomes were compared between the two groups. Results: A total of 279 patients met inclusion criteria for the study, with 40 patients developing SSI (14.3%). Average follow-up was 3.2 years. Patients that developed SSI had a significantly higher proportion of open fractures (47.5% vs 23.4%, p=0.003); however, there were no significant differences in Gustilo-Anderson classification or open wound location compared to controls. The SSI group required significantly higher rates of skin grafts (25.0% vs 4.2%, p&lt;0.001) and muscle flap coverage (20.0% vs 1.7%, p&lt;0.001). Average operative time was significantly longer in the SSI group (283.1 vs. 222.3 minutes, p=0.002). Patients with SSI displayed significantly higher rates of nonunion at six-month follow-up compared to those without SSI (55.0% vs 10.9%, p&lt;0.001). There were no significant differences in mechanism of injury, AO/OTA fracture classification, associated ipsilateral lower extremity injuries, bone grafting, surgical approach, or presence of medial column fixation between the two groups. Conclusion: The present study showed that SSI after pilon fractures can lead to significant morbidity, with 55% of patients having nonunion at six months. Risk factors for SSI in these patients included open fracture, need for soft tissue coverage, and longer operative times. Future multicenter studies are needed to further investigate risk factors for SSI after operative management of pilon fractures.

Comparison of the Effects of Inhalation and Spinal Anesthesia on Microcirculation in Transverse Rectus Abdominis and Gluteus Maximus Muscle-Skin Flap Applications in Experimental Rat Models

Background: Alongside developments in the surgical approaches to flap dissections, significant advances have been seen also in anesthetic techniques, as one of the main factors in the performance of such interventions. Literature contains several clinical studies aiming to determine the optimum anesthetic technique for use in flap and microsurgical procedures, however there is still a lack of consensus on the ideal anesthetic technique. The present study compares experimentally the effects of inhalation and spinal anesthesia on different muscle-skin flaps during flap surgery. Methods: The study assigned 35 rats to five groups: Group 1) a control group with no ischemia induced; Group 2) undergoing an elevated transverse rectus abdominis muscle-skin flap under inhalation anesthesia; Group 3) undergoing an elevated transvers rectus abdominis muscle-skin flap under spinal anesthesia; Group 4) undergoing an elevated gluteus maximus muscle-skin flap under inhalation anesthesia; and Group 5) undergoing an elevated gluteus maximus muscle-skin flap under spinal anesthesia. After the experiment, the malondialdehyde, total antioxidant capacity and total oxidative stress values were measured. Specimens were taken for histopathological examination to assess hyalinization, inflammation, congestion, edema, hemorrhage, nuclear centralization, and fibrotic areas. Results: Inflammation, congestion and edema were significantly higher in Groups 2 and 4 than in the other groups. Conclusion: In the light of the study findings, it can be concluded that regional anesthesia is the preferable anesthetic method in flap procedures, since inhalation anesthesia has an oxidative effect on both transvers rectus abdominis and gluteus maximus muscle-flap models, while such effects are lower with spinal anesthesia.

An idea for bringing the recipient pedicle of cross leg free flap closer: Fasciocutaneous flap above pedicle.

Cross leg free flaps are one of the salvage methods used for free tissue transfer in large tissue defects in the absence of recipient vessels. The fasciocutaneous flap above the posterior tibial artery can be harvested to protect the pedicle and to advance a distance to wound, which is equal to the length of fasciocutaneous flap. Patients who were operated with cross leg free flap with the supporting fasciocutaneous flap on unwounded side were included in the study between years 2010 and 2020. Age, sex, location and size of the defects, arterial patencies, flap choices, fascio-cutaneous flap size, duration of operation, cross flap separation timing, complications, and time to return to work were evaluated. There were six patients with the etiology of high-energy electrical burns and trauma. There was only one arterial refilling for three patients and no refilling for others. Latissimus dorsi skin muscle flap was used in all but one patient. The mean defect size was 6.6×14.8 cm. The mean size of fasciocutaneous flaps was 4.08×5 cm. The mean operation time was 360 min. There was no complication except one dehiscence and one marginal necrosis and infection which were healed with wound care. Average time to return to work was 9 months. In similar cases, as wounded lower extremities with one or no artery refill, harvesting a fasciocutaneous flap with recipient vessels will be useful before considering the option of using a bridge free flap in medium to moderate sized defects.

Efficacy of Reverse – Flow Lateral Arm Flap for Coverage of defects Around the Elbow in Pediatric Patients

Background: Coverage of defects around the elbow can be treated by a variety of procedures as skin grafts, regional flaps, muscle flaps and free flaps. The reverse flow lateral arm flap (LAF) is a valuable option in coverage of these defects. The vascular basis of this flap, viz, the multiple communications around the elbow between the collateral and recurrent arteries, is consistent and reliable.Aim of the study: To explore the utility of the distally based lateral arm flap (LAF) in management of defects around the cubital fossa region.Patients and methods: This work was executed at The Menoufia University Hospitals, from October 2017 to December 2018, following our cases postoperatively for average one year. It entailed eight patients, six boys and two girls. The age of our cases was from 4 to 11 years. Six patients had post-burn contracture release defects, and 2 patients had traumatic avulsion of antecubital skin. All the defects were covered by the reverse- flow lateral arm flap (LAF) with skin grafting of the donor site.Results:All the flaps survived completely, except one case showed distal superficial necrosis and healed spontaneously. We applied skin graft to the flap donor site in the eight patients. Flap size ranged from 15x7 cm. to 12x5cm. Aesthetically, the flap and donor sites were satisfactory, and functionally, the range of motion of elbow was very adequate. One patient developed transient radial nerve palsy and completely recovered by conservative treatment and physiotherapy.Conclusion: The reverse flow lateral arm flap (LAF) is a valuable single-stage option in coverage of defects around the elbow. It provides reliable and stable coverage of these defects without sacrificing major vessel or functional muscle unit. The flap had satisfactory aesthetic and functional outcome.

Reconstruction of Large Area of Deep Wound in the Foot and Ankle with Chimeric Anterolateral Thigh Perforator Flap.

ObjectiveTo evaluate the clinical application and surgical efficacy of the chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap for the reconstruction of the large area of deep wound in foot and ankle.MethodsClinical data of 32 cases who underwent chimeric anterolateral thigh perforator flap to repair the large area of deep wound of the foot and ankle from January 2015 to December 2018 were retrospectively analyzed. The sizes of the defects ranged from 18 cm × 10 cm to 35 cm × 20 cm, with exposed tendon and bone and/or partial defects and necrosis, contaminations, accompanied by different degrees of infection. Following the radical debridement and VSD, chimeric anterolateral thigh perforator flap was employed to repair the deep wounds according to the position, site and deep‐tissue injury of the soft‐tissue defects. The skin flap and muscle flap were fanned out on the wound, and single‐ or two‐staged split‐thickness skin grafting was performed on the muscle flap. The operation time and blood loss were recorded. The survival and healing conditions of the operational site with chimeric anterolateral thigh perforator flap were evaluated post‐operationally. Complications at both recipient site and donor site were carefully recorded.ResultsThe mean time of the operation was 325.5 min and average blood loss was 424.8 mL. Among the 32 cases, two cases developed vascular crisis, which were alleviated with intensive investigation and treatment; Four cases suffered from partial necrosis of the flap or skin graft on the muscle flap or on the residual local wound, which were improved after treatment of further dressing change and skin grafting. Another four cases experienced post‐traumatic osteomyelitis accompanied by bone defect were treated with simple bone grafting or Mesquelet bone grafting at 6–8 months after wound healing. Postoperatively, the wounds were properly healed, and the infection was effectively controlled without sinus tract forming. Overall, all 32 cases received satisfactory efficacy, without influencing subsequent functional reconstruction, and observed infection during the 12–36 months post‐operational follow‐up.ConclusionThe chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap provides an effective and relative safe procedure for the repair of a large area of deep wound in the foot and ankle, particularly with irregular defect or deep dead space.

Ocular surface and tear film changes after eyelid surgery

: Eyelid surgery is widely and extensively used in facial plastic and reconstructive surgeries. There are many categories of eyelid surgeries, the most common of which include blepharoplasty, ptosis surgery, and eyelid reconstruction. In many cases, these procedures are combined, and there are many different techniques for each type of operation. Upper eyelid blepharoplasty usually includes the excision of skin, preseptal orbicularis oculi muscle, and orbital fat. Common methods of lower eyelid blepharoplasty are the skin-muscle flap, the skin flap, and the transconjunctival. Ptosis surgery is mainly divided into three types: transcutaneous, transconjunctival, and sling surgery. Surgeons often used the Hughes or Cutler-Beard Bridge Flaps in eyelid reconstruction. Different types and methods of surgery have their own advantages and disadvantages, and postoperative complications may occur. Therefore, postoperative complications of eyelid surgeries, such as dry eye symptoms, should be taken into serious consideration. Relevant literature involving these complaints can be found in PubMed by searching the terms “dry eye”, “eyelid”, “surgery”, and other related keywords. Moreover, various ocular surface and tear film alterations may be detected using the Ocular Surface Disease Index (OSDI), tear film breakup time, Schirmer test, fluorescein staining, and lissamine green staining after various eyelid surgeries. As dry eye disease is prevalent in the general population, it is more urgent to figure out what we can learn from these complaints. Further exploration in this field may help surgeons to choose a better surgical method and give an accurate evaluation of the postoperative effect.

Surgical treatment of pressure ulcer: various flaps and other surgical methods

Pressure ulcers remain a common health problem, particularly among physically limited or bedridden older adults, and they can cause significant morbidity and mortality. Conservative management is ineffective for stage III or IV pressure ulcers, and surgery to create flap coverage becomes inevitable. Basic surgical principles for the treatment of pressure ulcers include complete excision of the ulcer, surrounding scar, underlying bursa, and soft tissue calcification; radical removal of underlying bone and any heterotropic ossification; padding of bone stumps and filling dead space; resurfacing with large regional pedicled flaps; and grafting the donor site of the flap, if necessary. For effective edge resection, all the flaps should be designed to be as large as possible, placing the suture line away from the area of direct pressure, and the flap design should also not violate adjacent flap territories to preserve all options for coverage if a breakdown or recurrence dictates further reconstruction. There are surgical methods for stage III or IV wide range pressure ulcers: reconstruction surgery using a skin flap, muscle flap, fascia-skin flap, or free flap. The skin graft is not generally recommended as a surgical procedure for stage III or IV pressure ulcers because it cannot provide enough strength to cover the wound. This review presents various surgical treatments of pressure ulcers including muscle, musculocutaneous, perforator-based, and free flap.