Island Pedicle Flap Research Articles

Internal mammary artery perforator (IMAP) flap for tracheostoma reconstruction

Tracheostoma reconstruction requires a thin flap to avoid occlusion. Although the deltopectoral flap has been used as a rotational flap for decades, clinical use of a true internal mammary artery perforator island flap has not been reported. In two cases, tracheostoma and anterior neck reconstruction were performed by use of an internal mammary artery perforator flap as a pedicled island flap. One flap was based on the perforator vessels in the second intercostal space and, the other, on the third. Donor sites were closed primarily in both patients. The internal mammary artery perforator flaps were well perfused in both cases. Both flaps healed uneventfully, with reliable reconstruction of the tracheal stoma and coverage of the anterior neck, although overall prognoses were poor. The internal mammary artery perforator flap is a relatively thin and reliable flap for tracheostoma and lower neck reconstruction.

Lenticular Island Pedicle Flap

Various modifications of island pedicle flaps have been devised to address difficult reconstructive situations. Nevertheless, currently described designs can have limited applicability in many cases, especially for large defects and defects near free margins. Our purpose is to describe and illustrate a curvilinear lens-shaped island pedicle flap modification flap called the "lenticular" island pedicle flap (LIPF). Illustrative examples with the descriptive technique and a flap comparison chart are provided for the LIPF. Conceptually, the LIPF is a hybrid design between a rotation flap and a traditional triangular island pedicle flap (TIPF). The flap fills a void between the designs and applications of the TIPF and the dog-ear rotation flap. As such, the flap reproducibly exhibits simultaneous rotational and translational movement to achieve wound coverage in situations in which neither a rotation flap nor a TIPF would be ideal. The lenticular shape is not incidental but, in fact, maximizes wound coverage by the flap. The lenticular design is often accommodated by a teardrop-shaped wound modification, which facilitates inset of the flap. The benefits of the LIPF include (a) closure of wounds in skin too tight to accommodate a TIPF or a rotation flap, (b) redirection of the closure's tension vector, and (c) an esthetically superior scar line. The LIPF modification provides several benefits relative to commonly used flaps that rely primarily on either translational or rotational movement to achieve wound closure.

Nasalis Island Pedicle Flap in Nasal Ala Reconstruction

Defects of the nasal ala can be difficult to repair in a one-stage procedure. We describe a laterally based nasalis myocutaneous island pedicle flap to repair small but deep defects of the superior nasal ala. To describe a single-stage flap for repair of small defects on the nasal ala that confines the repair to one cosmetic unit. We discuss the anatomy of the flap and illustrate the method of placing the flap. We present several case examples and discuss potential applications of the flap. We also discuss the flap's limitations by citing an example of necrosis. The nasalis myocutaneous island pedicle flap for repair of nasal alar defects is a new application of a one-stage procedure that yields excellent functional and cosmetic results. Knowledge of the limitations and the anatomy of the flap is crucial for a good outcome.

The Extended Approach to the Vascular Pedicle of the Anterolateral Thigh Perforator Flap: Anatomical and Clinical Study

The anterolateral thigh perforator flap is a well-described and versatile flap that has specific advantages. However, the variable anatomy makes flap elevation challenging. Furthermore, the dissection of the proximal part of the pedicle that runs underneath the rectus femoris muscle demands continuous pull by an assistant and is inconvenient and tiring for the surgeon. A technique that facilitates dissection of the proximal pedicle part is suggested. It is useful in both pedicled and free flap transfer, when maximum pedicle length is crucial. Five anterolateral thigh perforator flaps were dissected using the extended technique. Four were transferred as free flaps and one as an island pedicled flap. In addition, anatomical cadaver studies were performed bilaterally in five fresh cadavers to further clarify the relevant anatomy. All flaps survived well. One patient suffered from donor-site infection caused by inadequate drainage. Conservative treatment with daily dressing changes resulted in satisfactory healing. Two patients suffered from hypesthesia of part of the lateral thigh area. No patient experienced any difficulty in daily activities and none suffered from knee extension lag. An extended approach for dissection of the anterolateral thigh perforator flap is described that is useful in both pedicled and free flap transfers. Cautious tunnel creation is a prerequisite for avoidance of complications.

The Rotating Island Pedicle Flap: An Aesthetic and Functional Improvement on the Subcutaneous Island Pedicle Flap

The Rotating Island Pedicle Flap: An Aesthetic and Functional Improvement on the Subcutaneous Island Pedicle Flap

An innovation in the subcutaneous island pedicle flap for cutaneous reconstruction

The aim of this study was to describe an innovation of the transposition pedicle island flap for reconstruction of the medium-sized skin defects in the face, neck and hand. Twenty-seven cases of skin tumours and scars were surgically excised and reconstructed with this island flap. ALL flap survived with primary healing postoperatively. With a follow-up from 1 to 22 months, functionally and cosmetically satisfactory outcomes were achieved. This modification of transposition island flap provides a competitive repair alternative for the treatment of medium-sized skin defects.

The Island Pedicle Flap

Surgical defects following the extirpation of cutaneous neoplasia may present challenges to the dermatologic surgeon. There are many repair options for an individual defect, including second-intention healing, primary closure, skin graft, and skin flap closure. The island pedicle flap is a random pattern advancement flap well suited to reconstruct a variety of small- to intermediate-sized soft tissue wounds. To review the utility of the island pedicle flap in reconstructive dermatologic surgery and to detail the operative technique to achieve reproducible functional and esthetic results. The method of flap reconstruction is presented. A variety of defects repaired with this technique are reviewed. The subcutaneous island pedicle flap yielded excellent functional and cosmetic repair of the presented defects with minimal operative morbidity. Secondary to a well-preserved central vascular pedicle, complications are infrequent. The random pattern island pedicle flap is a versatile and robust flap used to repair a variety of soft tissue wounds in a single-stage procedure with reproducible operative outcomes.

Advancement Flaps

The advancement flap involves the linear advancement of tissue in one direction. Despite its straightforwardness and simple concept, it can be used to close a variety of defects, ranging from small defects on the scalp or extremities to large, complicated defects involving cosmetic units on the face. To provide a basic and useful review for the indications, advantages, disadvantages, and techniques for the use of advancement flaps in the reconstruction of defects in dermatologic surgery. We performed a literature search for articles discussing advancement flaps and compiled a brief review of our findings. The movement of the advancement flap must be balanced by the blood supply of the flap. The excision of Burow's triangles along various aspects of the advancement flap can increase movement and improve cosmesis of the flap. The types of advancement flaps discussed include the single advancement flap, double advancement flap, A-T flap (O-T flap), Burow's triangle flap (Burow's wedge flap), crescenteric advancement flap, island pedicle flap (V-Y flap), helical rim advancement flap, and facelift flap. Advancement flaps are versatile and useful basic flaps for repairing defects.

Bi-lamellar lower eyelid reconstruction with superficial temporal artery island flap and hard palate muco-periosteal free graft

ABSTRACTThree cases of single stage, bi-lamellar reconstruction of full-thickness, horizontal, lateral three-quarter lower eyelid defects using pedicled island flaps of adjacent vascular territories and hard palate muco-periosteal graft are being presented. All cases were done for Basal Cell Carcinoma of the region. While the island flaps allowed for a simple, single stage reconstruction of the external lamella, the hard palate muco-periosteal graft, by virtue of its inherent resilience and a rich glandular component, took well and provided for a good functional and aesthetic result.The follow-up ranged from 6 to 40 months and the final result has been oncologically, functionally and aesthetically satisfactory.

Homodigital reverse flow island flap for reconstruction of neuropathic great toe ulcers in diabetic patients

Diabetic ulcers located in the plantar surface of the great toe resist conservative treatment modalities including skin grafts and usually require flap coverage for a stable reconstruction. Free tissue transfer is not feasible in these patients, because these defects are closely associated with peripheral vascular disease and local flap alternatives are extremely limited in this region. Reported here is the use of homodigital reverse flow island flap for reconstruction of neuropathic great toe ulcers in diabetic patients with encouraging results.

Nasalis Island Pedicle Flap in Nasal Ala Reconstruction

Defects of the nasal ala can be difficult to repair in a one-stage procedure. We describe a laterally based nasalis myocutaneous island pedicle flap to repair small but deep defects of the superior nasal ala. Objective To describe a single-stage flap for repair of small defects on the nasal ala that confines the repair to one cosmetic unit. Methods We discuss the anatomy of the flap and illustrate the method of placing the flap. Results We present several case examples and discuss potential applications of the flap. We also discuss the flap's limitations by citing an example of necrosis. Conclusions The nasalis myocutaneous island pedicle flap for repair of nasal alar defects is a new application of a one-stage procedure that yields excellent functional and cosmetic results. Knowledge of the limitations and the anatomy of the flap is crucial for a good outcome.

Anatomical basis for a vascular pedicled island flap from the dorsal area op the wrist

We explored the cutaneous vascularity of the dorsal wrist area to examine the possibility of using reverse island flaps from this area for reconstruction of the hands and fingers. Four dominant arterial branches including the dorsal branches of the ulnar and radial arteries and terminal branches of the anterior and posterior interosseous arteries, which supplied the dorsal skin over the extensor retinaculum, were explored. The location, number, and diameter of skin perforators from these arteries were examined. The dorsal branches of the radial and ulnar arteries that passed along the dorsal cutaneous nerves gave off 2-4 skin perforators (diameter 0.1-0.2 mm) at the level of the carpal bone and always connected distally to perforating arteries from the palmar arterial system at the metacarpal head. Skin perforators from the anterior and posterior interosseous arteries were found passing through the extensor retinaculum in the second and third and fifth and sixth intercompartmental areas. The terminal branches of the anterior and posterior interosseous arteries always continued to the dorsal carpal arch, and lay over the distal carpal row. It may be anatomically possible to raise two different island flaps from the dorsum of the wrist.

The outcome of one-stage hypospadias repairs

Objective Hypospadias is an increasingly common condition, and many procedures have been described for operative correction. We reviewed our experience of different techniques of one-stage hypospadias repair. Materials and methods We retrospectively reviewed 107 hypospadic boys who were younger than 15 years between January 1986 and June 2003. We included all patients who underwent one-stage hypospadias repair. All patients were evaluated for age, type of hypospadias, associated anomalies, surgical technique, and morbidity rate. The functional and cosmetic results were evaluated at 1 month, 6 months and 1 year postoperatively. Univariate analysis was done to identify those variables that might serve as interdependent predictors of postoperative complications. Results The median age was 7 years (6 months to 13 years). Severe chordee was observed in 15 patients. The majority of cases were anterior hypospadias (53%), while the majority of complications were observed in the middle group (62%). Cosmetic and functional results were satisfactory in the majority of the patients. Complications included 16 fistulae (15%) and 11 meatal stenoses (10%). Some prognostic factors such as age, insertion of a suprapubic cystostomy tube, suture structure, and time of catheter removal did not significantly affect the risk of complication, whereas some other factors such as associated anomalies, severe chordee, middle and posterior hypospadias, and use of a pedicle island flap were significant in their relation to the complication rate. Conclusion Such possible risk factors as severe chordee, middle and posterior localized hypospadias, and use of a pedicle island flap may increase the postoperative complication rate. There is no gold-standard technique for hypospadias repair; the procedure of choice should depend on the individual anatomy of the penis. The long-term outcome after puberty has to be awaited.

Effects of surgical or chemical delaying procedures on the survival of proximal pedicled venous island flaps: Am experimental study in rats

To increase the survival of proximally pedicled venous island flaps, which are known to be safe only when small, we used surgical and chemical delaying procedures both individually and in combination for 7, 14, and 21 days. Survival was 1% in those flaps designated as controls, in which there was neither surgical nor chemical delay. However, it was 3%, 31%, and 68% at 7, 14, and 21 days, respectively, when surgical delay was used and 16%, 56%, and 86%, at 7, 14, and 21 days, respectively, when chemical delay was used. Survival was 32%, 84%, and 87%, at 7, 14, and 21 days when both chemical and surgical delays were used. We conclude that chemical delay is more effective than surgical delay in increasing survival of proximally pedicled venous island flaps, but the use of combined chemical and surgical delay may reduce the time required for delay.

Bi-lamellar lower eyelid reconstruction with superficial temporal artery island flap and hard palate muco-periosteal free graft

Three cases of single stage, bi-lamellar reconstruction of full-thickness, horizontal, lateral three­ quarter lower eyelid defects using pedicled island flaps of adjacent vascular territories and hard palate muco-periosteal graft are being presented. All cases were done for Basal Cell Carcinoma of the region. While the island flaps allowed for a simple, single stage reconstruction of the external lamella, the hard palate muco-periosteal graft, by virtue of its inherent resilience and a rich glandular component, took well and provided for a good functional and aesthetic result. The follow-up ranged from 6 to 40 months and the final result has been oncologically, functionally and aesthetically satisfactory.

Back to Basics: The Subcutaneous Island Pedicle Flap

Optimal aesthetic reconstruction of cutaneous defects following excisional surgery is largely dependent on the availability of regional donor tissue that shares a likeness of the original tissue in color, texture, sebaceous quality, and thickness. The island pedicle flap is a useful tool in facial reconstruction because it minimizes regional anatomic distortion and optimizes tissue match. The objective was to review four locations where the island pedicle flap is a well-suited closure tool. We review flap planning and specific modifications of the island pedicle flap at four sites of closure, reinforcing its role as an important tool in facial reconstruction. Through careful planning and implementation, the island pedicle flap may be used on the nasal tip, the nasal ala, the upper cheek, and the upper lip for closures with much success. The island pedicle flap remains an important tool in the armamentarium for surgeons in the repair of facial defects.

Refinement of the Island Pedicle Flap: Parallel Placed Release Incisions to Increase Translation Movement

The island pedicle flap is a widely used flap for reconstructions in the face and on the extremities. The movement of the flap is limited because of the traditionally inferiorly based pedicle that allowed only rotation or advancement. The purpose was to enhance translation movement by modifying the pedicle. The modification of the flap is demonstrated with graphics and documented with photographs. Parallel release incisions did not interfere with the viability of the island pedicle flap. Parallel incisions enhance largely the translation vector of the island pedicle flap and the myocutaneous island flap without interfering with the viability of the flap.

Refinement of the Island Pedicle Flap

Refinement of the Island Pedicle Flap

The rotating island pedicle flap: an aesthetic and functional improvement on the subcutaneous island pedicle flap.

The subcutaneous island pedicle flap is a useful closure in many areas on the face, particularly the cheek and upper lip. One disadvantage can be that the advancing edge of the flap leaves a scar at right angles to the local lines of relaxed skin tension. Tension on free edges such as the lid can also be a problem, but may be mitigated by incorporating an element of rotation into the closure. A variation on the subcutaneous island pedicle flap is described to help avoid the problems of the subcutaneous island pedicle flap while retaining its strengths. Our experience with more than 120 rotating island pedicle flaps over 10 years is described to demonstrate the versatility of this subcutaneous island pedicle flap for facial and reconstructive surgery. The technique is described and seven representative cases are presented with photographs. The flap is simple to perform, has minimal complications, and has good cosmetic results. Temporary alteration of sensation in the flap skin is a possible complication and can be largely avoided with a bipedicled dissection technique. Our experience shows the rotating island pedicle flap to be versatile, reliable, and aesthetic island pedicle flap for skin cancer surgery both on and off the face and a practical modification of the subcutaneous island pedicle flap.

Innovations in the Island Pedicle Flap for Cutaneous Facial Reconstruction

Innovations in the Island Pedicle Flap for Cutaneous Facial Reconstruction