Primary Closure Of Donor Site Research Articles

Scalp Flap Rotation with Primary Donor Site Closure

A 57-year-old man with a 7-cm defect of the left temple underwent reconstruction with a large scalp rotation flap that shifted the donor defect to the back of the neck so that it could be closed primarily. This approach, also used successfully in 7 other patients with similar defects, avoided the need for an unsightly skin graft in the donor site while providing tissue with a color and texture that blended well with the surrounding forehead and facial skin. Primary closure of the donor site reduces scalp flap morbidity and improves the overall aesthetic outcome.

Expansion of Fascial Flaps

In order to meet the requirements of large defects created by sacral and trochanteric pressure ulcers, tensor fasciae latae and lumbosacral fasciocutaneous flaps were expanded with a silicone expander in six patients (10 flaps). In 8 of the flaps the location of pressure ulcers was trochanteric, and in 2 it was sacral. In each case the period of expansion was 4 weeks. Histopathologic examination after expansion showed an increase in the vascularity and overall thickness of fascia in both types of flaps. After 4 weeks of expansion, the perifascial areolar tissue was replaced with thick granulation tissue in the tensor fasciae latae flaps. This markedly vascular layer of granulation tissue interposed between the fasciae and the subcutaneous tissue augmented the internal matrix of the flap, thereby lowering the potential for shearing during flap elevation. Conceivably, owing to the absence of an areolar tissue layer in the lumbosacral fasciocutaneous flaps, no layer of granulation tissue was observed. The average thickness of the fibrous capsule formed around the expanders was 573.2 microns, which was composed of three structurally different zones. Prior tissue expansion obviously assisted primary closure of the flap donor site. In addition, it seems that the tissue-expansion process rendered the distal portion of fascial flaps more robust because of increased vascularity. It is therefore proposed that preparatory tissue expansion of fascial flaps has several advantages. The obvious benefits include the ability to close larger defects while closing the donor site primarily. As a result of this study, the additional benefits may include a reduction in the mechanical shear potential of these flaps and an improvement in their vascularity.

下腿外側皮弁による咽頭後壁再建例

A peroneal flap, developed by Yoshimura et al, has been used mainly for the repair of lower leg injuries. We applied this flap to the reconstruction of the posterior pharyngeal wall of a 49-year-old female with pharyngeal cancer, resected through a transmandibular approach.A free vascularized peroneal flap has pedicles consisting of peroneal artery and vein and their cutaneous branches. Under a microscope, the facial artery and external cervical vein were anastomosed to the peroneal artery and vein respectively. The peroneal flap has the following advantages : 1) It is thin enough to fit the posterior pharyngeal wall. 2) Primary closure of donor site is possible. 3) The donor site is less conspicuous than that of forearm flap.

Primary closure of the split-thickness donor site : Hagerty RC, Warm H. Plast Reconstr Surg 85:2, 1990

Primary closure of the split-thickness donor site : Hagerty RC, Warm H. Plast Reconstr Surg 85:2, 1990

Primary Closure of the Split-Thickness Donor Site

A simple method of improving the donor site of split-thickness skin grafting is presented. Advantages include fewer wound-care problems, decreased pain, and a more aesthetic donor site. The disadvantage of increased operating time and expense are well compensated for by this method.

Subcutaneous V-Y advancement flap for closure of nasal tip defect.

Our experience with V-Y subcutaneous flaps for nasal tip closure after tumor resection in 10 patients is reported. This method has distinct advantages over previously used methods such as skin graft, rotation, or transposition flap. It allows primary closure of recipient and donor site without the formation of dog-ear or trapdoor deformity. It is easy to design, reliable, and offers good cosmetic results. This method is performed under local anesthesia as an office procedure. It is recommended to plastic surgeons for the closure of nasal tip defects.

The Stair-step Flap for Nasal Reconstruction

The stair-step nasal flap, which was originally designed to allow re-creation of the alar rim, has proved to be equally versatile for reconstruction of many other soft tissue defects of the nose. When a skin graft is unwarranted, this is a simple method for local flap transposition that minimizes any aesthetic deformity while allowing primary donor site closure. It is best suited for small or moderate sized defects of the lower and middle thirds of the nose.

The Bilobed Flap in Nasal Repair

Surface defects resulting from excision of nasal lesions are commonly repaired by direct primary closure, skin grafts, or pedicle flaps. An effective but seldom used bilobed adjacent flap described by Esser and Zimany deserves increased attention in nasal reconstruction. This flap design possesses the following virtues: (1) Primary nondelayed transposition, (2) excellent color match, (3) primary closure of donor site, (4) one-stage repair, and (5) minimal tissue distortion. Zimany described the bilobed flap as one consisting of two lobes separated by more or less of an angle and based upon a common pedicle. The glabellar and nasolabial area serve as an abundant resource for tissue donation in nasal defect repair, without significant residual donor site deformity. The secondary donor site of the bilobed flap is effectively camouflaged in a natural skin fold or wrinkle, creating no significant facial deformity and providing a cosmetically superior repair.

The Supraclavicular Flap for Reconstruction of Postburn Mentosternal Contractures

BackgroundThe thin and pliable skin of the neck is a region with multidirectional activity, and postburn scar contractures tend to form there easily. The supraclavicular flap is used to correct neck scar contractures. Its main vascular supply is the supraclavicular artery, and it can be harvested as either a skin pedicle flap or an island flap (vascular pedicle flap).ObjectiveIn this article, a total of 41 flaps are studied retrospectively and their efficacy in reconstruction of post-burn neck scar contractures is discussed. Also donor-site morbidity, patient satisfaction, and complications were evaluated.Patients and MethodsBetween November of 2004 and January of 2009, 41 supraclavicular flaps were used for reconstructions in 32 patients at the authors’ hospital. Twenty-four of these flaps were skin pedicle flaps, and 17 were island flaps. The range of flap size was 18 ± 6 cm in length, and 9 ± 3 cm in width. Pre-expansion was performed in 14 flaps. Primary closure of donor site was performed in 35 flaps.ResultsThirty-seven of the 41 flaps survived completely, but there were three cases of distal necrosis (10-30%), and one case of complete flap necrosis. Twenty-nine of the 32 patients were satisfied with both the functional and aesthetic results.ConclusionsScarring of the neck produces problems with function, and appearance. In our view, the supraclavicular flap, a thin flap of good texture, is an excellent and highly reliable flap for covering defects of the anterior neck. This flap is easy to harvest, with good functional and aesthetic results.