Flap Outcomes Research Articles

Buccinator myomucosal neurovascular Island flap: anatomic cadaveric study and clinical experience.

Utilization of peninsular buccal flaps for primary cleft palate repair is well-documented in the literature. However, there is no report on the application of an island flap for primary cleft palate repair. This study aims to reveal the clinical application of an axial neurovascular propeller buccinator myomucosal flap. An anatomical study was performed by injection into the buccal pedicle of twenty-two fresh hemifacial cadavers. Additionally, we analyzed palatal healing and flap outcomes in twenty-five primary cleft palate reconstructions utilizing thirty-six pedicled propeller flaps. Cadaver study: the mean buccal artery diameter was 1±0.3 mm, the neurovascular pedicle entered the flap 11.4±2.9 mm anterior to the pterygomandibular raphe (1/6 th the length of the flap), and the buccal artery advanced inside the flap as much as 66.8%±6.0% of the total flap length. Clinical experience: all reconstructions were performed using a modified Furlow palatoplasty. Mean age of patients was 15.3 months and mean maximum cleft width was 11.7 mm. Eleven cases utilized bilateral flaps. The flap always reached the contralateral pillar, and the buccal nerve was always preserved. 11.11% flaps (4/36) underwent scar revision, and 5.56% flaps (2/36) were lost. Follow-up period was 11.3 months. This study suggests the utilization of axial neurovascular pedicled propeller buccinator myomucosal flaps is a safe and reliable option in primary cleft palate reconstruction. Our anatomical dissections and clinical outcomes reveal the consistent and robust nature of buccal neurovascular pedicle, and our modified surgical technique allows for preservation of the buccal nerve.

Effect of Enhanced Recovery after Surgery in Morbidly Obese Patients Undergoing Free Flap Breast Reconstruction.

Enhanced recovery after surgery (ERAS) pathways have been widely implemented across many surgical practices, including autologous breast reconstruction. However, the benefits of ERAS in the morbidly obese population have yet to be defined. A retrospective chart review of patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our institution from 2017 to 2022 was performed. Length of stay (LOS), intensive care unit (ICU) utilization, opioid usage, cost, and flap outcomes were analyzed in patients with body mass index greater than 35 before and after ERAS implementation. Thirty-five morbidly obese patients receiving DIEP flap breast reconstruction were identified before ERAS and 18 after ERAS. There were no differences in unilateral versus bilateral or immediate versus delayed reconstruction. LOS decreased with ERAS (3.43 vs. 2.06 days, p < 0.0000001). ICU utilization decreased with ERAS (0.94 vs. 0.0 days, p < 0.0001). Daily and total opioid usage decreased with ERAS (41.8 vs. 17.9 morphine milligram equivalent [MME], p < 0.0001; 190.5 vs. 54.7 MME, p < 0.0001). Financial metrics improved with ERAS, including decreased total cost ($33,454 vs. $25,079, p = 0.0002) and increased cost margin ($4,458 vs. -$8,306, p = 0.004). There were no differences in donor or recipient site outcomes including flap loss, deep venous thrombosis/pulmonary embolism, hernia/bulge, delayed wound healing, revisions, and blood loss. ERAS pathways maintain benefits in the morbidly obese population undergoing abdominally based autologous breast reconstruction, including decreased LOS, ICU utilization, opioid use, and cost while maintaining successful reconstruction outcomes.

Enhancing Anatomical Understanding of the Dermal Microvascular Plexus for Improved Flap Outcomes in Axillary Hyperhidrosis.

Enhancing Anatomical Understanding of the Dermal Microvascular Plexus for Improved Flap Outcomes in Axillary Hyperhidrosis.

A Commentary on an Article Entitled: "Enhancing Anatomical Understanding of the Dermal Microvascular Plexus for Improved Flap Outcomes in Axillary Hyperhidrosis".

A Commentary on an Article Entitled: "Enhancing Anatomical Understanding of the Dermal Microvascular Plexus for Improved Flap Outcomes in Axillary Hyperhidrosis".

Characterizing the Functional and Cosmetic Outcomes of Pedicled Neck Flaps in Patients Who Underwent Partial Tongue Resection: A Systematic Review

Introduction: Pedicled flaps from infrahyoid, pectoralis major, and trapezius were commonly used for partial tongue reconstruction. Not until a free radial forearm flap was introduced. The flap is recommended for patients with tongue defects ? 50% because of its thinness, pliability, and long pedicle. This systematic review explores the functional and cosmetic outcomes of pedicled flaps from the neck region for patients who underwent partial tongue resection or hemiglossectomy. Method: A systematic literature searching was performed on PubMed, Medline, Scopus, Embase, and Cochrane. Keywords included were pedicled flap, neck flap, partial tongue resection, hemiglossectomy, and partial neck surgery. Inclusion and exclusion criteria were applied to the search results. Relevant studies were assessed for their methodological quality using appropriate instruments. Results: Four hundred and twenty-four articles were obtained from the initial literature search. The authors finally gathered 11 full-text articles comparing the pedicled neck flaps with free flaps for partial tongue resection reconstructions. Pedicled neck flaps, such as submental, infrahyoid, sternocleidomastoid, and supraclavicular artery island flap, are clinically relevant for hemiglossectomy reconstruction with comparable functional and aesthetic outcomes. Conclusion: Regional flaps would be a preferred technique in more difficult patients such as those with advanced age, poor nutrition, or multiple medical issues as they are not always acceptable surgical candidates for potentially prolonged microsurgery.

The Role of Anticoagulation Regimen on Flap Outcome in Microvascular Head and Neck Reconstruction.

Thrombus formation following flap reconstruction reduces perfusion and can lead to flap compromise. Effective anticoagulation protocols are essential to prevent this complication. The study's purpose was to measure and compare flap compromise associated with 3 different anticoagulation protocols. This retrospective cohort study included patients with head and neck cancer who underwent flap reconstruction. Exclusion criteria included patients who did not consent to participate, did not receive the anticoagulation regimen, or had a history of adverse reactions to heparin or aspirin (ASA). The primary exposure was the anticoagulation protocol, which was divided into 3 groups: intravenous unfractionated heparin (IV-UFH), subcutaneous UFH (SC-UFH), and SC-UFH plus ASA. The outcome variable was postoperative flap outcome coded as compromised or not. Covariates included patient demographics, cancer type, neoadjuvant therapy, flap type, surgical procedure, intensive care unit stay, medical history, and postoperative complications. χ2, Mann-Whitney U, and Kruskal-Wallis tests were used for baseline data analysis. Multivariate logistic regression was conducted to examine the adjusted association between anticoagulation protocol and flap outcome. P values < .05 were considered statistically significant. The study sample consisted of 300 patients who met inclusion criteria with a mean age of 48.3 (±17.69) years, 202 (67.3%) of whom were male. There were 28 (9.3%) cases of flap compromise. The unadjusted analysis showed that patients receiving IV-UFH had a significantly higher risk of flap compromise compared to those receiving SC-UFH (relative risk: 3.43 [1.62 to 7.28]). Adding ASA to SC-UFH did not result in a statistically significant reduction in the risk of flap compromise (relative risk: 0.95 [0.35 to 2.61]). After adjusting for confounding factors, the anticoagulant type was not associated with flap compromise (P=.05). However, in the subgroup analysis, compared to SC-UFH, subjects receiving IV-UFH still had higher odds of flap compromise (odds ratio=2.69, 95% CI [1.003 to 7.205], P=.049) CONCLUSION AND RELEVANCE: Postoperative thrombosis in head and neck microsurgery remains a significant risk factor for poor outcomes. SC-UFH administration may be a practical approach to managing these risks compared to intravenous administration; however, the choice of anticoagulation protocol is not associated with the flap compromise.

Immediate Head and Neck Reconstruction Trough Pectoral Major Muscle Flap After a Huge Squamous Oncological Resection

The pectoralis major myocutaneous flap (PMMF) has long been considered one of the main flaps for reconstructing defects of substance of the face and neck. PMMF is nowadays increasingly neglected in the face of the rapid growth of free flaps, especially in developed countries. However, it remains of significant use in developing countries. Objective: Report an immediate head and neck reconstruction trough pectoral major muscle flap as a solution after a huge head and neck squamous oncological resection. Clinical Case: 56 years old male with a block oncologic resection that includes cigomatic arch and body + negative intraoperative frozen cut + modified radical neck lymph dissection and, on a second time immediate reconstruction by the Plastic and Reconstructive Surgery service through a left Myocutaneos pectoralis major flap + ipsilateral rotation scalp flap + muscle temporalis left flap and a VY advancement flap. Discusion And Conclusion:Myocutaneous flaps revolutionized the reconstruction of defects in head and neck oncological reconstruction. The pedicled pectoralis major flap is still harvested and mainly indicated for reconstruction in the polymorbid patient. Even with the develop and outcomes of the free flaps and the microsurgery has the gold standard in head and neck reconstruction, the pectoral major myocutaneous flap still maintain as one of the “battlehorse” in reconstructive surgery.

Evaluation and management of pressure ulcers in plastic surgery department at tertiary care center in India

Background: A pressure ulcer also known as decubitus ulcers, bedsores, or pressure sores is a localized injury to the skin and/ or underlying tissue usually over a bony prominence, as a result of unrelieved pressure or pressure in combination with shear. When extrinsic pressure exceeds the capillary pressure of 32 mmHg than vessel occluded and blood flow stops. When pressure not relieved for 5 minute every 2 hour, then necrosis and ulceration will result. Methods: Retrospective study of 74 patients with pressure injury admitted in SMS hospital Jaipur during 3 year duration from September 2019 to August 2022 requiring plastic surgery intervention. Patient specific factor, wound characteristics and flap outcomes analysed in study. Results: Patients with early-stage pressure injury (stage I and II) and advance stage (stage III and IV) with deteriorating or terminal co-morbidities, managed with conservative treatment in form of dressing with pressure management. Patients with advance stage pressure injury (stage III and IV) managed with active operative intervention in form of debridement and flap cover surgery. Conclusions: Prevention of pressure ulcer development is mainstay in management of both development and recurrence of pressure ulcer.

Implementation and clinical impact of an interdisciplinary tool to promote skin integrity after flap surgery in Veterans with spinal cord injury

Context/Objective Pressure injury (PrI) recurrence is common among persons with spinal cord injury and disorders (SCI/D) who undergo reconstructive flap surgery for pelvic stage 4 PrI (S4PrI). This paper describes the development and implementation of the Minneapolis Spinal Cord Optimization, Rehabilitation and Empowerment (SCORE), a preoperative interdisciplinary tool for risk assessment and mitigation, and reports its effect on the one-year flap failure rate (significant breakdown). Design Retrospective review. Setting Minneapolis Veterans Affairs Health Care System (MVAHCS) SCI/D Center, a tertiary care center. Participants 141 Veterans with SCI/D and pelvic S4PrI underwent 204 interdisciplinary assessments for flap surgery. Interventions The Minneapolis SCORE was developed by the MVAHCS SCI/D Center and first implemented in 2012. The eight domains of the tool and continuous improvements in tool implementation for risk assessment and mitigation are described. Outcome Measures Per-year incidence rate of flap failures within one year of surgery from 2009 to 2019. Results 48.3% (28/58) of S4PrI assessments during 2009–2011 (pre-SCORE) led to flap surgery the same year, increasing to 59.6% (87/146) of assessments after SCORE implementation during 2012–2019. The one-year flap failure rate abruptly decreased from 40.5% (15/37) of the 2009–2012 surgeries to 7.7% (6/78) of the 2013–2019 surgeries (P < .0001). Characteristics of patients by time period, operative status, and flap outcome are presented. Conclusion After an initial learning curve in tool implementation and subsequent tool refinement, the use of the Minneapolis SCORE before flap surgeries was associated with improved flap integrity at one year. Successful use of the tool requires collaborative problem-solving between the patient and interdisciplinary team.

Comparison of outcome of Simple Excision vs Limberg Flap of pilonidal sinus in terms of post operative pain, operative time, wound infection and hospital stay.

Objective: To compare post operative pain, wound infection, intraoperative time and length of hospital stay in both groups of simple excision and Limberg flap. Study Design: Comparative Prospective study. Setting: CMA Teaching and Research Hospital/Azra Naheed Medical and Dental College, Lahore, Pakistan. Period: 1st September 2021 to 1st September 2023. Methods: After approval from the Institutional review board of Azra Naheed Medical &amp; Dental College/CMA Hospital, the sample was 120 patients was raised using non-convenience probability sampling divided into 2 groups. Group A patients underwent simple excision while Group B patients underwent Limberg flap Inclusion criteria include all the patients with age more than 13 years and diagnosed as case of pilonidal sinus. All the data was entered and processed by using SPSS 26. Comparison of two groups was done by apply independent sample t-test. A p-value of ≤ 0.05 was considered significant. Results: The average age of the patients was 45.88 ± 9.78 years with minimum and maximum ages were 15 &amp; 59 year respectively. Mean post operative pain was 2.6 ± 1.9 in group A while 3.9 ± 2.7 in group B (p value = &lt;0.05). Similarly wound infection, duration of surgery and length of hospital stay were also less in group A patients as compared to group B patients. Conclusion: Simple excision of pilonidal sinus is better from Limberg flap in terms of post operative pain, wound infection, duration of surgery and length of hospital stay.

Comparative Retrospective Analysis of Cross-Finger Flap Outcomes: A Study on Split-Thickness Skin Graft vs. Full-Thickness Skin Graft in Donor Fingers.

Hand injuries, particularly those involving the fingers, are complex and often necessitate meticulous surgical interventions. Cross-finger flaps (CFFs) are a reliable technique for covering finger defects, with the choice of skin graft at the donor site playing a crucial role in the procedure's success. Split-thickness skin grafts (STSGs) and full-thickness skin grafts (FTSGs) are commonly used, each offering distinct advantages and drawbacks. This study compares the functional and aesthetic outcomes of donor fingers covered with STSG versus FTSG in CFF procedures. This retrospective observational study was conducted from January 2020 to 2024. A total of 82 patients who underwent CFF surgery were included, with 41 patients each in Group A (STSG) and Group B (FTSG). The functional and aesthetic outcomes were assessed. Statistical analysis was performed using SPSS version 26.0 (IBM Corp., Armonk, NY), with significance set at p < 0.05. The study revealed that Group B had superior outcomes across all measured parameters. The mean visual analog scale (VAS) score for aesthetic outcomes was significantly higher in Group B (8.5 ± 1.2) compared to Group A (7.0 ± 1.5, p < 0.01). Functional recovery in proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints, measured by range of motion, was also better in Group B compared to Group A (p = 0.002). Sensory recovery was more favorable in Group B, with 85% achieving S3+ or better, compared to 60% in Group A (p < 0.05). Additionally, the graft donor site scar was significantly less noticeable in Group B, with a Vancouver Scar Scale score of 3.5 ± 1.1, compared to 5.0 ± 1.4 in Group A (p < 0.01). FTSG offers superior functional and aesthetic outcomes compared to STSG in this study. The findings suggest that FTSG should be preferred for covering donor fingers. These results provide strong evidence for the use of FTSG in optimizing surgical outcomes and improving patient satisfaction.

Clinical Outcomes of Scapular versus Fibular free flaps in Head and Neck Reconstructions: A Retrospective Study of 120 patients".

The scapular free flap has increasingly gained popularity as an alternative to the fibular free flap in osseous head and neck reconstruction. The present study aimed to evaluate their use in maxillomandibular reconstructions and examine surgical and patient outcomes. Osseous head and neck defects reconstructed with an angular artery-based scapular flap or fibular flap from 2016 to 2022 at two Swedish University Hospitals were evaluated for their intraoperative execution (osseous and soft tissue combinations) and postoperative outcomes. Facial quality of life (QoL) was assessed using the FACEQ Head and Neck Cancer Module. Donor-site morbidity was assessed using the DASH and SEFAS questionnaires for scapular- and fibular-reconstructed patients, respectively. A total of 120 patients were recruited: 86 mandibular reconstructions (26 scapulas, 60 fibulas) and 34 maxillary reconstructions (32 scapulas, 2 fibulas). The concave scapula facilitated fewer osteotomies for curved reconstructions, particularly for lateral mandibular defects (p=0.039). Intraoral lining was primarily achieved with muscle accompanying the scapula and skin accompanying the fibula. Using the latissimus dorsi muscle instead of only teres major decreased fistulas, plate/bone exposure and non-unions (p=0.039) in scapular reconstructions. Both flaps demonstrated comparable facial QoL, but the scapula presented superior donor site outcomes (p=0.001). Donor limb outcomes were unaffected by harvesting the latissimus dorsi with the scapula (p=0.64), and by re-suturing the detached muscles to the remaining scapula. (p=0.35). The scapular free flap can be advantageous in osseous head and neck reconstructions, enabling non-osteotomized and chimeric reconstructions without compromising surgical outcomes or quality of life.

Postmastectomy Breast Reconstruction in Irradiated Patients: A 12-year follow-up of Deep Inferior Epigastric Perforator and Latissimus Dorsi Flap Outcomes

The aim of the current study was to conduct a 12-year follow-up on the authors´ previously evaluated group of irradiated patients who underwent postmastectomy breast reconstruction with deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD)-flaps with implant.The follow-up involved 67% of the patients from the original cohort (17 DIEP and 13 LD). Patient-reported outcome measures (PROMS) were measured using the BREAST-Q, SF-36, a satisfaction form, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires. Aesthetics were evaluated by a board of independent plastic surgeons.The average follow-up time was 12.6 years (DIEP) and 11.8 years (LD). Contralateral symmetry procedures were performed on 15 DIEP and 9 LD patients. Both groups underwent an average of 2.5 reconstructive procedures. The BREAST-Q and satisfaction questionnaires showed no group difference. SF-36 showed no group difference but had significantly higher values in both groups compared to the general population with regard to the physical role limitations (p=0.034 and p=0.004, respectively). The DASH scores showed minimal shoulder function impact in the LD group.Aesthetic evaluations revealed a discrepancy between the opinions of the patients and surgeons, with patients valuing the size (p=0.015) and overall aesthetic (p=0.012) of the reconstructed breast higher in the DIEP group. The weighted kappa analysis showed poor agreement between patients and surgeons. Over time, the patients´ preferences shifted from LD to DIEP flaps, possibly due to the more natural aging process associated with autologous reconstruction. This underscores the importance of long term follow-up studies.

Comparing the Outcomes of Osteocutaneous Radial Forearm and Fibula Free Flaps in the Reconstruction of Mandibular Osteoradionecrosis.

This study compares the outcomes of osteocutaneous radial forearm free flap (OC-RFFF) and fibula free flap (FFF) reconstruction of mandibular osteoradionecrosis (ORN). Retrospective review of patients undergoing OC-RFFF/FFF reconstruction for mandible ORN between 2005 and 2020 at a tertiary center. Patient characteristics, postoperative complications, and functional outcomes were evaluated using chi-squared and logistic regression analysis. Fifty-six patients were included (OC-RFFF: 38; FFF: 18). Significantly more OC-RFFF patients had lateral mandible defects (94% vs. 61%, p = 0.0014). There were significantly more patients with exposed intraoral bone in the OC-RFFF group (23% vs. 0% p = 0.02), but no significant differences in hardware complications or flap failure. Donor site partial skin graft loss was more common in the FFF group (22% vs. 2.6%, p = 0.016), but no other significant differences in donor site morbidity were seen. Bivariable analysis showed no impact of flap type, tobacco/alcohol use, diabetes, or hypothyroidism on postoperative complications. Sixty percent of OC-RFFF, and 67% of FFF, patients resumed an oral diet after surgery. Oral diet was not impacted by flap type (OR = 0.769, 95% CI = 0.201-2.706, p = 0.688). The OC-RFFF is an acceptable option in the reconstruction of ORN involving the lateral mandible, though there is increased risk of bone exposure. These findings can help guide surgeon selection of microvascular free flap donor sites and appropriate patient counseling.

Comparative Study between Grafts and Flaps in Staged Repair of Primary Proximal Hypospadias

Abstract Background Choosing between flaps or grafts to substitute the urethral plate in 2-stage hypospadias repair has been a matter of debate with no consensus in the literature. Flaps have reliable blood supply that maybe theoretically less liable for strictures or contractures. Grafts are more versatile, which can be used in primary and recurrent cases when healthy local skin is deficient. In this report, our aim was to compare outcomes of grafts and flaps when used to substitute the urethral plate in two-stage repair of primary proximal hypospadias with ventral curvature. Methods This retrospective study included primary cases of hypospadias with significant curvature who underwent two-stage repair using either grafts or flaps to substitute the urethral plate in the first stage. Cases included in the study were divided into two groups according to the technique of substituting the urethral plate at the first stage of repair. During first part of the study period (2015 through 2018), we mostly used grafts to substitute the urethral plate (group A); later, we shifted to skin flaps (Group B) during the period 2019 through 2021. Results The study included 37 boys with primary proximal hypospadias who underwent two-stage hypospadias repair. The meatus position was penoscrotal in 18, scrotal in 16, and perineal in three. Inner preputial graft was used to substitute the urethral plate in 18 cases (group A), while dorsal skin flaps were used in 19 (group B). Out of the 37 cases, 27 were available at follow-up after second stage (group A = 14; group B = 13). Follow up period ranged between 6 and 42 months (mean 19.7; median 18.5). Overall, 14 cases required reoperations for different indications: partial disruptions of distal part of the repair in six, closure of urethro-cutaneous fistula in six, and urethral strictures in two. The rate of complications was higher in group A (10 cases: 71%) compared to group B (4 cases: 31%) (Fisher exact test, p-value = 0.057). Conclusion Grafts were associated with higher complication rate than flaps when used to substitute the urethral plate in two-stage repair of proximal hypospadias with chordee. Type of Study and Level of Evidence. This is non-randomized comparative study (level III evidence).

A Comparison of Postoperative Outcomes Based on Muscle versus Fasciocutaneous Flaps in Scalp Reconstruction: A Systematic Review and Meta-analysis.

Scalp reconstruction in plastic and reconstructive surgery often necessitates the transfer of soft-tissue flaps to restore form and function. The critical decision lies in choosing between muscle-containing (MC) and fasciocutaneous (FC) flaps for scalp reconstruction, and while both variants have their merits, flap composition remains a subject of ongoing debate. This scientific discussion aims to explore this contentious issue through a comprehensive meta-analysis, shedding light on the rationale behind the choice of these flaps and the potential impact on clinical outcomes. A comprehensive systematic review was conducted following PRISMA-P guidelines, encompassing six prominent databases up to the year 2023. Data were collected from studies assessing outcomes of MC and FC flaps for scalp reconstruction. Quality evaluation was performed using ASPS criteria and the ROBINS-I tool. Statistical analysis included descriptive statistics, meta-analysis, sensitivity analysis, and assessment of bias using STATA software. The meta-analysis included 28 nonrandomized studies, totaling 594 flaps (MC: 380, FC: 214). MC flaps were significantly larger than FC flaps. There were no significant differences in flap loss, flap necrosis, or wound dehiscence between the two flap types. However, the incidence of venous congestion was significantly higher in FC flaps. Sensitivity analysis confirmed the robustness of results, and publication bias assessment showed no significant evidence of bias. While both MC and FC flaps offer viable options for scalp reconstruction, the choice should be tailored to individual patient characteristics and defect size. FC flaps may provide advantages such as shorter operative times and reduced morbidity, whereas MC flaps could be preferred for addressing larger defects. Future research should focus on prospective studies and strategies to mitigate venous congestion in FC flaps, enhancing their safety and efficacy in scalp reconstruction.

Flap-Based Reconstruction in Patients with Autoimmune Disease: An Institutional Experience with the Deep Inferior Epigastric Perforator Flap and Review of the Literature.

Autoimmune diseases are associated with characteristic chronic inflammation, aberrations in tissue perfusion, and hypercoagulability, and thus have considerable implications for local and free-flap reconstruction. We seek to summarize the current evidence on outcomes of flap-based reconstruction in patients with pre-existing autoimmune disease and present our experience with autologous breast reconstruction in this population. PubMed, Embase, Scopus, Cochrane, and Web of Science were searched for relevant articles, and pertinent data were presented qualitatively. Institutional data were queried for patients who underwent autologous breast reconstruction with deep inferior epigastric perforator (DIEP) flaps between 2015 and 2024. A retrospective review was conducted to identify DIEP patients with a history of autoimmune disease. Data on patient demographics, medication history, flap outcomes, and perioperative complications were collected. The majority of existing studies found no increased independent risk of flap complications. However, other complications, predominantly wound dehiscence, were independently associated with autoimmune disease. Regarding immunosuppressant therapy, the literature demonstrated that perioperative glucocorticoid use was consistently associated with all complications, including seroma, infection, wound disruption, and partial flap loss.Our 13-patient institutional experience identified no cases of total flap loss or microvascular thrombotic complications. There was one case of partial flap necrosis further complicated by abdominal site cellulitis, and one case of recipient-site dehiscence managed with local wound care. No patients required re-operation for flap or donor-site complications. The literature suggests that flap reconstruction can be performed safely in patients with autoimmune conditions, which was also supported by our institutional experience. While there is likely minimal risk of microsurgical complications in the context of free tissue transfer, donor-site morbidity and wound dehiscence remain major concerns for patients with a history of autoimmune disease. Limiting the use of immunosuppressive agents, especially corticosteroids, may potentially improve outcomes of flap reconstruction.

Prognostic Prediction of Multiterritory Flap: A Preliminary Clinical Study on the Classification of Priority Developing Artery and Arterial Anastomosis Utilizing Indocyanine Green Angiography.

Congestion and necrosis are frequent complications in multiterritory flaps. Indocyanine green angiography (ICGA) is a commonly utilized tool for evaluating blood flow and perforator location within the flap; however, there is currently no existing research investigating its potential to predict flap prognosis before surgery. The forehead skin of 50 surgical patients was assessed using preoperative ICGA, enabling observation and classification of the priority developing artery and arterial anastomosis among adjacent arterial perfusion territories during the arterial phase. Subsequently, 5 clinical cases of forehead flap transfer were studied to validate the classification method. First, the priority developing artery can be classified into 4 types and 5 subtypes, encompassing type Ⅰa: Bilateral ST-As equalization type (9/50), type Ⅰb: unilateral ST-A dominance type (11/50), type II: SOT-As dominance type (14/50), type III: unilateral ST-A plus SOT-A dominance type (6/50), and type IV: bilateral ST-As plus SOT-As equilibrium type (10/50). Second, arterial anastomosis can be divided into 5 types: type I: complete choke anastomosis type (13/50), type II: complete true anastomosis type (7/50), type III: central choke anastomosis type (10/50), type IV: bilateral choke anastomosis type (8/50), and type V: unilateral choke anastomosis type (12/50). Finally, the clinical flap outcomes showed that the ICGA classification could serve as a good prognostic indicator. The hemodynamic classification of priority developing artery and arterial anastomosis employed by ICGA has the potential to predict flap prognosis and offer valuable insights for preoperative design and perioperative treatment strategies. More sample size is needed to optimize and validate this classification.

Long-term Outcome of Conjunctival Transposition Flaps for Contracted Sockets.

To assess the efficacy, and reintervention rate, of a conjunctival transposition technique in the treatment of contracted fornices in anophthalmic sockets. Retrospective case-note review of patients with contracted anophthalmic sockets who received a novel conjunctival mucosal transposition flap for augmentation of socket lining. Contracted anophthalmic sockets were categorized as grade 1 (minimal contraction), grade 2 (inferior and/or superior fornix), grade 3 (advanced scarring of the entire upper and lower fornices), and grade 4 (severe palpebral phimosis, recurrent cases, and irradiated sockets). Of 32 patients (56% male), 53% had mild-to-moderate contracted anophthalmic sockets (grades 1 or 2). The transposition flap was combined with secondary ball implantation (3 cases), ball exchange (1 case), primary orbital floor (1 case), or revisional floor (3 cases) implantation. By an average follow up of 9.2 years, 16% (5 cases with grade 3 or 4) required additional relining, with another patient declining further surgery; this yielding an overall anatomic success of 81% (100% in grades 1 and 2; 60% in grades 3 and 4). At the last follow up, 91% of patients had adequate socket lining and 94% reported a comfortable socket with stable prostheses. Having results similar to free grafting but without remote donor-site morbidity, this novel transposition flap satisfactorily addresses mild-to-moderate fornix contracture, and most patients achieve stable and comfortable prosthetic wear. Some patients with severe contracted anophthalmic sockets required further autologous grafting: this generally arose because the transposition flap included tissue from above the socket's horizontal raphé (with later contracture of the upper fornix).

The Influence of Vasopressors on Free Flap Outcomes in Head and Neck Cancer Patients.

To compare free flap outcomes between those who received and did not receive vasopressors (VPs) at the time of free flap reconstruction. This retrospective cohort study includes patients from January 2013 to January 2023. This multicenter cohort study utilized data from the TriNetX Research Network which includes 80 health care organizations. Head and neck cancer patients older than 18 years who underwent free flap reconstruction were separated into those who received or did not receive VPs on the day of surgery. The primary outcomes were flap failure defined by need for secondary free flap procedures, blood vessel repair, and other flap revision procedures. After propensity score matching, 7446 patients were analyzed. The VP group included 3723 patients (mean age [SD], 62.9 [11.4] years; 2511 males [67.4%]). The non-VP group included 3723 patients (mean age [SD], 63.0 [11.2] years; 2479 males [66.6%]). Free flap outcomes were not statistically different between groups (secondary free flap: 166 [4.5%] VP vs 155 [4.2%] non-VP, P = .04; vessel repair: 314 [8.4%] vs 319 [8.6%], P = .06; other flap revision procedures: 416 [11.2%] vs 449 [12.1%], P = .02). Bony flaps were found to have decreased rates of vessel repair in the VP group (47 [6.1%] vs 69 [9.0%], P = .003]. For secondary outcomes, pneumonia (173 [4.6%] vs 231 [6.2%], P = .0002), urinary tract infection (34 [1.0%] vs 59 [1.6%], P = .0007), and deep vein thrombosis (93 [2.5%] vs 122 [3.3%], P = .004) were significantly different. VP use is not significantly associated with free flap complications. These results imply that VP use on the same day as surgery may be safe if clinically necessary.