Island Pedicle Flap Research Articles

Nasal Reconstruction Using a Myocutaneous Island Pedicle Flap Based on the Nasalis Muscle With Bilevel Undermining: Review of 57 Cases.

Nasal reconstruction after Mohs resection of skin cancer commonly uses local flaps, many of which present limitations concerning their movement and skin color/texture match. In this article, the use of a myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining for the management of defects at challenging locations on the nose is described as a versatile and cosmetically appropriate flap option. In addition, a novel mathematical sizing methodology for this flap is presented. Between March 2013 and May 2016, 57 patients having undergone Mohs resection of skin cancer underwent nasal reconstruction using a myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining at our clinic. During the postoperative follow-up, patients were monitored for complications and received proper wound care. The mean age was 68.4 (range, 34-94) years. The mean follow-up was 10.1 (range, 3.0-34.9) months. The mean defect size was 1.99 (range, 0.70-5.25) cm2. No complete losses of flap occurred. Incidence of minor complications (pin cushion effect, minor delayed healing, etc) was minimal (4/57; 7.0%). Two of the cases in this series involved the utilization of cartilage grafts in combination with the myocutaneus island pedicle flap. The myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining can be used as a versatile flap for the closure of defects of various sizes and locations on the nose because of its rich blood supply, ease and convenience of use, and highly acceptable cosmetic outcome.

Effects of three kinds of proximal pedicled flaps of hand for relaying repair of degloving injuries of fingertips and the soft tissue defects in the donor sites

Objective: To investigate the effects of the dorsal branch of digital artery pedicled flap combined with V-Y advancement flap for repair of degloving injury of fingertip and reverse dorsal metacarpal recurrent artery pedicled island flap for relaying repair of the soft tissue defects in the donor sites of the proximal dorsum. Methods: A total of 21 patients with degloving injuries of fingertips at the 2nd to 5th fingers were hospitalized in the Department of Hand Surgery of the Second Hospital of Tangshan from June 2016 to January 2019, including 14 males and 7 females aged 24-60 years. The retrospective clinical follow-up study was conducted. The areas of wounds after debridement ranged from 2.0 cm×1.5 cm to 3.5 cm×2.2 cm. The dorsal branch of digital artery pedicled flaps with dorsal branch of the proper digital nerve and dorsal digital nerve were designed in the proximal dorsum of the affected fingers to repair dorsal wounds in the distal dorsum of the affected fingers, and the sizes of the flaps ranged from 1.6 cm×1.5 cm to 2.6 cm×2.4 cm. The V-Y advancement flaps in the palmar side of the affected fingers were designed to repair palmar wounds in the distal segment of the affected fingers, and the sizes of the flaps ranged from 0.8 cm×0.6 cm to 2.0 cm×1.5 cm. The reverse dorsal metacarpal recurrent artery pedicled island flaps were used to repair the soft tissue defects in the donor sites of proximal dorsum, the sizes of the flaps ranged from 1.8 cm×1.7 cm to 2.8 cm×2.6 cm, and the donor sites of the flaps in back of hand were sutured directly. The survivals after the operation and the blood supply and appearance during follow-up of the three flaps were observed. At the final follow-up, the static two-point discrimination distance of the three flaps was measured, the satisfaction degree of patients for the appearance of hand was evaluated based on Michigan Hand Function Questionnaire, and the total active range of motion of the injured finger joints was assessed by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results: All the flaps survived after operation. Tension blisters appeared on the surface of one dorsal branch of digital artery pedicled flap, and the wound healed after removing the stitch at the pedicle and changing dressings. During follow-up of 6-20 months, with an average of 12 months, the three kinds of flaps had good appearance, soft texture, and similar color with surrounding tissue, and with only linear scars in donor sites of the dorsal hand. At the final follow-up, the static two-point discrimination distances of V-Y advancement flaps, dorsal branch of digital artery pedicled flaps, and reverse dorsal metacarpal recurrent artery pedicled island flaps were 4-7 mm, 5-10 mm, and 8-15 mm, respectively. Sixteen patients were strongly satisfied with the appearance of hand, and the remaining five patients were satisfied with the appearance of hand. The total active range of motion of the injured finger joints was evaluated as excellent in 17 cases, good in 4 cases. Conclusions: The operation is simple and reliable for dorsal branch of digital artery pedicled flap combined with V-Y advancement flap to repair the degloving injury of fingertip, and reverse dorsal metacarpal recurrent artery pedicled island flaps to repair the soft tissue defects in the donor sites of the proximal dorsum, and the appearance and function of the affected fingers recover well, with minimal injury.

Laterally Based Island Pedicle Flap Reconstruction of Distal Nasal Defects.

Laterally Based Island Pedicle Flap Reconstruction of Distal Nasal Defects.

Commentary on Tunneled Island Pedicle Flap for a Conchal Bowl Defect.

Commentary on Tunneled Island Pedicle Flap for a Conchal Bowl Defect.

Comparison of functional outcomes and health-related quality of life one year after treatment in patients with oral and oropharyngeal cancer treated with three different reconstruction methods.

We evaluated the functional outcomes and health-related quality of life (HRQoL) of 117 patients (who had had primary operations for oral and oropharyngeal squamous cell carcinoma) using the University of Washington Quality of Life Questionnaire version 4 (UW- QOL V4), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire version 3 (EORTC QLQ-C30 v3) and Head and Neck version 1 (EORTC H&N35 v1). The patients were divided into groups according to the reconstruction techniques used: primary closure, submental island pedicled flap (SIPF), and radial forearm free flap (RFFF). Patients who had reconstruction with RFFF had better HRQoL as measured by swallowing, mastication, speaking, and overall score, than the primary closure group (p<0.05). There was no significant difference (p>0.05) between the RFFF and SIPF groups in overall QOL one year postoperatively. The HRQoL of the SIPF group was also better than that of the primary closure group in terms of mastication, speaking, and loss of appetite. Swallowing, mastication, and speaking are major factors that affect the HRQoL of patients one year after operation for oral and oropharyngeal cancer. Flap reconstruction can improve patients' QoL postoperatively. They can regain their ability to speak and swallow through training, and the importance of this issue must be addressed postoperatively.

Comparison of Clinical Results and Quality-of-Life in Tongue Cancer Patients Undergoing Submental Island Flap and Radial Forearm Free Flap Reconstruction

Our goal was to compare the clinical results and quality-of-life (QoL) in tongue cancer patients undergoing submental island pedicled (SIP) flap and radial forearm free (RFF) flap reconstruction. Patients undergoing SIP or RFF flap reconstruction for primary tongue squamous cell carcinoma were prospectively enrolled and were asked to complete the University of Washington Quality-of-Life (UW-QOL) questionnaire, version 4, at 12months after the operation. The study's main interest was QoL as well as locoregional recurrence control. A total of 190 patients were enrolled for analysis, and the SIP and RFF groups showed significant differences in patient age, American Society of Anesthesiologists classification, and hospital cost. In the survival analysis, locoregional recurrence occurred in 35 patients in the SIP group and 48 patients in the RFF group; the difference was not significant (P=.440). In the QoL analysis, compared with patients in the SIP group, those in the RFF group had higher scores in the domains of activity and recreation. No significant differences were found with respect to the other domains. The SIP flap and RFF flap have comparable survival control in tongue squamous cell carcinoma patients. The RFF flap might lead to better QoL, but the SIP flap imposes fewer limitations on patients' health status and is associated with lower hospital cost.

Shifting Paradigms in Head and Neck Reconstructive Surgery During the COVID-19 Crisis.

Shifting Paradigms in Head and Neck Reconstructive Surgery During the COVID-19 Crisis.

Gaining Large Coverage With Small Island Pedicle Flaps in Tight Cosmetic Subunits: Taking Advantage of Rotation and Pincer Principles on the Nasal Ala.

Island pedicle flaps (IPFs) are widely used in reconstructive surgery due to their versatility, tissue efficiency, and excellent clinical outcomes. While IPF rotations and 'pincer flap' modifications have previously been sparsely described, they are not often discussed in the literature. We demonstrate the use of both rotating IPFs and pincer techniques for defects traditionally considered too large for classic IPF design on the nasal ala. Forty-four patients underwent alar repair using the rotation or combined rotation with pincer modification to the standard IPF technique from August 2014 to May 2017. Our technique is described and case examples are presented with photographs. Forty-four patients with an average alar defect size of 1.2 cm underwent repair using rotation only or rotation with pincer modification of the classic IPF approach. Reconstruction of large defects in small facial cosmetic subunits such as the nasal ala can be performed using principles of both rotating IPFs and the 'pincer flap' technique. The degree of rotation is directly related to the length of coverage. Modifications to the flap are straightforward to perform. Using these techniques, larger defects that previously would have been reconstructed using flaps that cross cosmetic boundaries can now be reconstructed within the same cosmetic unit, thus, improving aesthetic outcomes.

Myomucosal island pedicle flap repair for lower lip defects

A 69-year-old man had undergone surgery for a squamous cell carcinoma (Fig 1), resulting in a partial-thickness myomucosal defect involving 40% of the lower lip. Defects over 30% of the transverse width are commonly repaired with local flaps, which should aim to preserve the shape, symmetry, and oral sphincter function. 1 Isik D. Garca M.F. Durucu C. Goktas U. Atik B. Reconstruction of lower lip with myomucosal advancement flap. Head Neck. 2012; 34: 1562-1569 Crossref PubMed Scopus (4) Google Scholar

Shark island pedicle flap for large reconstruction of the upper lip

Shark island pedicle flap for large reconstruction of the upper lip

Submental Artery Island Flap for Soft Tissue Coverage of a Mandibular Reconstruction Plate in a High-Risk Patient With Medication-Related Osteonecrosis of the Jaw

We present a case of a 69-year-old woman with multiple complicating comorbidities who developed medication-related osteonecrosis of the jaw secondary to extraction of multiple teeth with a history of intravenous bisphosphonate therapy for metastatic breast cancer requiring staged management with segmental mandibulectomy with placement of external pin fixator with subsequent exchange of this device for a titanium reconstruction plate and a submental island pedicled flap for soft tissue coverage of the bridging reconstruction plate. Once the surgical sites were well-healed that patient would immediately return to a satisfactory functional outcome with ability to tolerate a soft diet. Furthermore, the patient did not have complications (ie, cardiac, pulmonary, venous thromboembolism, sepsis, surgical site infection, reoperation) during her hospitalization and has done well with her long-term recovery.

Difficult-To-Treat Periprosthetic Hip Infection: Outcomes of Debridment

Purpose of the study — to compare management efficiency for difficult-to-treat periprosthetic hip joint infection (PJI) during resection arthroplasty with grafting by vastus lateralis pedicle island flap in comparison with insertion of an antimicrobial-loaded cement spacer. Material and Methods. 132 patients were included into the retrospective study who underwent treatment from 2012 until 2018 including removal of orthopaedic implant, radical surgical debridement of infection focus, resection arthroplasty with grafting by vastus lateralis pedicle island muscle flap (PMF group — 57 patients) or insertion of antibacterial-loaded cement spacer (AMS group — 75 patients). The authors examined medical histories, nature of infection process, infection agent type, laboratory data in respect of systemic inflammation, size of bone defects, follow up status and remission of PJI in the late period. Results. 89.4% of patients (n = 51) who underwent grafting by vastus lateralis pedicle island flap had a history of 3 and more prior surgical procedures in the same area. At the same time the share of such patients in the spacer group was only 38.6% (n = 29) (p0.0001) while the share of patients with two and more recurrences was 78.9% (n = 45) and 25.3% (n = 19), respectively (p0.0001). No significant variances were observed between the groups in respect of type composition of PJI microbial infection agents. The infection in a vast majority of patients in both groups was caused by microbial association: 77.2% and 72.0% in PMF and AMS groups, respectively. In the early postoperative period secondary revision of surgical site was performed in 35% and 28% of cases in PMF group (n = 20) and AMS group (n = 21), respectively, including due to recurrent infection in 15.8% and 28% of cases, respectively. Stable remission of difficult-to-treat PJI in PMF group was 96.5% and 45.3% in AMS group. Conclusion. Despite some cases that required secondary revisions in early postoperative period the resection arthroplasty in combination with pedicle muscle flap can be considered a surgery of choice for management of recurrent difficultto-treat PJI with feasible re-implantation of prosthesis against the stable remission of infection.

Repair of Anterior Ear Defects Using Transcartilage Island Pedicle Flaps.

Surgical reconstruction of the anterior surface of the ear (concha, antihelix, scapha, and triangular fossa) is complicated by the paucity of mobile local skin. This is a retrospective study of the transcartilage island pedicle flap for reconstruction of surgical defects of the anterior ear. Two hundred thirty-two Mohs micrographic surgery defects were included in the study. The technique involves circumferential incision of the flap in the postauricular sulcus, transfer of the flap to the anterior ear through a surgically created cartilage slit, suturing of the flap on the anterior surface of the ear, and repair of the secondary postauricular defect. Preoperative, intraoperative, and postoperative details of each case were tabulated and analyzed. The mean defect size was 1.9 × 1.5 cm. Complications included flap edema (n = 6, 2.6%), postoperative bleeding (n = 4, 1.7%), partial thickness flap necrosis (n = 2, 0.9%), pinning back of the ear (n = 2, 0.9%), and central flap dimpling (n = 2, 0.9%). There was 1 acute staphylococcal abscess and 1 sterile abscess that developed 13 months postoperatively. All complications resolved with medical or surgical management. Transcartilage island pedicle flaps may be considered for single-stage surgical reconstruction of defects involving the anterior ear.

Crescentic Modification to Island Pedicle Rotation Flaps for Defects of the Distal Nose.

Island pedicle flaps based on a lateral sling of the nasalis have difficulty reaching distal nasal defects due to tethering of the muscle to its insertion point. The authors hypothesized that reach could be improved by modifying a crescentic flap to rotate around a pivot point equidistant to the flap and the defect. To describe the design, execution, and results with a modified crescentic island pedicle rotation flap for repair of distal nasal defects after Mohs micrographic surgery. The authors performed a retrospective analysis of patients who had distal nasal defects repaired with a modified crescentic island pedicle rotation flap over an 8-year period. All charts and photographs were examined. Sex and age of the patient, type of cutaneous carcinoma, location and size of the defect, and complications were recorded. Forty-eight patients were included. The flap was used to successfully reconstruct defects on the distal nose ranging in size from 0.25 cm to 3.8 cm. Complications involved one wound infection and one episode of postoperative bleeding. The authors' modifications to the island pedicle flap may be reliably used to reconstruct small- to medium-sized defects of the distal nose in a single stage with minimal risk of complications.

Checkmark rotation flap for nasal tip reconstruction in Asian patients

Background: Nasal tip reconstruction (NTR) of the Mohs defect is challenging, especially in Asians who have a relatively low nasal bridge and thin cartilages.Objective: To evaluate the usefulness of a new flap design, the checkmark rotation flap (CRF), for NTR in AsiansMethods and materials: We retrospectively reviewed 31 cases of NTR. Among these, 15 cases underwent CRF, which uses skin from the columellar or infra-tip area with a checkmark v-shaped incision (CRF group). The remaining 16 cases underwent reconstruction with other flaps such as the bilobed or island pedicle flap (Others group).Results: The average defect area was larger in the CRF than in the Others group (1.85 ± 1.01 cm2 vs. 1.10 ± 0.72 cm2, p = .0499), but the visual analog scale score was significantly higher in the CRF group (7.97 ± 1.36 vs. 6.25 ± 1.62, p = .0059). For complications, a depressed scar was observed in four cases (26.7%) in the CRF group; nine cases (56.3%) in the Others group presented with a depressed scar, hypertrophic scar, or scarring similar to a trap door deformity.Conclusion: CRF may be a favorable option for the reconstruction of intermediate-sized nasal tip defects, providing good cosmetic outcomes.

Extensor digiti minimi muscular flap: From a clinical case to an anatomical study

We present a case report of a failed posterior interosseous flap with distal pedicle rescued by an extensor digiti minimi (EDM) island pedicle flap supplied by the posterior interosseous artery (PIOA) in reverse flow to cover a soft tissue defect in the hand of a 25-year-old man. We subsequently performed an anatomical study on 5 cadaver limbs to determine the EDM muscle's vascularization: it was segmental, multiple and came from the PIOA. The rotation arc reached the dorsal side of the metacarpophalangeal (MCP) joints, as well as the distal part of the thumb. The indications selected are the same as those of the distal pedicle flap: defect on dorsal side of the hand and MCP joints, coverage of carpal tunnel, failure of posterior interosseous flap. This study describes a new flap and adds to our understanding of the EDM muscle's vascularization.

Reconstruction of Alar-Perialar Defects with a Combined Subcutaneous and Cutaneous Pedicled Rotation-Advancement Nasolabial Flap

Aim of the Study: During the reconstruction of alar defects involving the upper lip, reconstructive surgeons face the need for various thicknesses of tissues crucial to preserving the facial sulcus which is important for a cosmetically acceptable result. Our aim was to reconstruct the deep perialar and thinner lateral nasal alar defect in a single step procedure with a suitable flap which is reliable, has appropriate blood supply and provides an esthetically good result. Materials and Methods: Extended alar defect was reconstructed with a combined flap in 10 cases. During the procedure, a subcutaneous pedicle was created and the proximal part of the flap was rotated into the defect as a rotational flap. The procedure and the follow-up have been photo-documented in all cases. Furthermore, the perfusion of the flaps was monitored by means of laser Doppler flowmetry. Postoperative complications were evaluated with a semi-quantitative score and the patients completed a patient satisfaction questionnaire, too. Results: An optimal esthetic result was obtained in all cases after the operation. The lateral nasal alar part of the defect was reconstructed with the thinner proximal part of the flap while the deeper perialar region involving the upper lip was covered with the thicker distal part. The flaps have shown sufficient blood flow after the operation. There was no significant pin cushioning or “trap-door” effect in any case. Mild erythema and edema was found in few cases. The patients were satisfied with the cosmetic result of the intervention. Conclusions: The flap is suitable for the reconstruction of alar defects involving the perialar region. It has the advantage of covering the deeper perialar and the thinner alar defects, whilst eliminating the pin cushioning effect of the conventional subcutaneous island pedicle flaps.

Treatment of fingertip avulsion injuries using two periposition pedicled flaps

We described a treatment of fingertip avulsion injury by two periposition pedicled flaps, the reversed pedicle island flap of dorsal branch of proper digital artery and the cross-finger flap. From February 2009 to January 2017, 22 patients (22 fingers) with fingertip avulsion injury were treated with two periposition pedicled flaps, 14 male and 8 female, aged from 17 to 47 years (mean 32±9 years). All of the patients were followed up more than 6 months after operations (mean 9.6±2.6 months). All flaps survived completely. Compared with the traditional abdominal flaps, two periposition pedicled flaps had less pedicle division time. At last follow-up, the 2PD of the palmar part of the flaps, the TAM of the injured finger and the MHQ summary score of the two periposition pedicled flaps were much better than the traditional abdominal flaps. The reconstruction using two periposition pedicled flaps is a versatile treatment with better functions, less morbidity and better aesthetics. Level of evidence: Therapeutic, level III.

Reconstruction of Preauricular Wounds Using a Flipped Island Pedicle Flap.

Island pedicle flaps (IPFs) are a frequently used reconstructive option in dermatologic surgery. With variations in its execution, the flap can be used for an assortment of facial defects. To describe the execution of a flipped IPF for the reconstruction of medium to large preauricular wounds after Mohs micrographic surgery. An analysis of the flipped IPF reconstruction of 12 preauricular defects is presented. Patient demographics, surgical defects, aesthetic outcomes, and complications are described. Twelve patients with 12 preauricular tumors (9 basal cell carcinomas, 2 squamous cell carcinomas, and 1 malignant melanoma) were treated using Mohs micrographic surgery. A flipped IPF reconstruction was successfully used with good cosmetic outcomes and no complications in all 12 patients. In this series, the authors demonstrate the effective use of flipped IPFs for the reconstruction of medium to large preauricular defects with good aesthetic outcomes and no complications.

Postauricular revolving door island flap: surgical option to concha squamous cell carcinoma

The postauricular revolving door island flap is one versatile option that may be used to reconstruct the auricular concha of the ear after remove a squamous cell carcinoma. The technique has been described as an immediate one-stage elegant reconstructive procedure for closure of anterior auricular defects, simple and safe to perform with early excellent cosmetic results. A 71-year-old female Portuguese patient with Squamous Cell Carcinoma in left auricular concha and the external auditory canal is reported. Cutaneous squamous cell carcinoma is the second most common cancer of the skin in the United States. In the ear, this type of cancer because of its location is high risk and has a high possibility of metastasis. The tumor was completely excised including the cartilage. The surgical defect was reconstructed with Postauricular Revolving Door Island Flap based on the post auricular vessels. A full thickness design is made considering the defect, the flap is maintained to a subcutaneous central pedicle and is passed through the anterior window to resurface the anterior ear. This case demonstrates the use of the postauricular (revolving door) island pedicle flap for cover large anterior ear defects with loss of cartilaginous support and illustrates how the flap improve ear contour after resection successfully.