Random-pattern Flap Research Articles

Comparison of sensory recovery between random pattern flap and axial pattern flap in finger defect reconstruction

Background: This study aimed to investigate the association between the use of different flaps, including random- and axial-pattern flaps, and sensory recovery following finger soft tissue reconstruction using local pedicle flaps. Methods: A longitudinal study was conducted on 115 patients with 130 finger soft tissue defects treated with local pedicle flaps between December 2016 and December 2020. Assessments were made at early postsurgery (119 flaps), three months postsurgery (110 soft tissue defects), and six months postsurgery (94 soft tissue defects). Sensory recovery outcomes were compared between soft tissue defects reconstructed using random- and axial-pattern flaps. Results: In the early postsurgery period, there was a significantly higher prevalence of a static sense of two-point discrimination (s2PD) ≤6 mm among fingers with random-pattern flaps (96.2%) than among fingers with axial-pattern flaps (64.5%). The probability of s2PD ≤ 6 mm at the donor and recipient sites with the direct flap was 75.5% and 25.5%, respectively, which was significantly higher than that with the reversed flap. After six months, there was a significant difference in sensory recovery compared to that at three months postsurgery, but not between different flap types. Conclusions: Sensory recovery after reconstruction was observed with all flap types, and better sensory recovery can be achieved in a shorter time postsurgery using random-pattern flaps.

The effect of KUS121, a novel VCP modulator, against ischemic injury in random pattern flaps.

Surgery using skin flaps is essential for soft tissue reconstruction. However, postoperative ischemic injury of the skin flap is a major complication and a top concern after the surgery. Currently, evidence-based drugs to fully prevent ischemic injury are not available. The purpose of this study was to evaluate the effect of KUS121, a VCP modulator, on flap ischemia using a rodent model. 26 Sprague-Dawley rats were randomly divided into two groups. The experimental group was intraperitoneally administered with 100 mg/kg KUS121 dissolved in 5% glucose solution 1 hour before surgery and once per day after surgery. The control group received the same amount of glucose solution on the same schedule. On day 7, 33.6 ± 3.7% of skin flaps in the control group had developed black necrosis compared with 26.4 ± 3.6% in the KUS121 group (p < 0.01). Immunohistochemistry showed that the KUS121 treatment reduced the number of apoptotic cells in the distal third of the flap (p < 0.01); moreover, in the KUS121-treated rats, the number of cells expressing CHOP, an endoplasmic reticulum (ER) stress marker, in the middle third of the flap was significantly lower than in the controls (p < 0.01). We examined the mRNA expression of Ddit3 (CHOP) and Casp3 (caspase-3) on day one after the surgery; mRNA expression of both genes appeared to decrease in the KUS121 group, as compared with the control group, although differences between groups were not significant. Thus, in a random pattern flap, KUS121 reduces ER stress and the number of apoptotic cells, thereby reducing ischemic damage of the flap.

Optimizing Lower Extremity Local Flap Reconstruction in Peripheral Vascular Disease.

Local flaps remain a valuable reconstructive tool as a means for limb salvage for patients with advanced arterial disease. Our single-center, retrospective cohort study aims to compare the outcomes of different patterns of blood flow affected by vascular disease to pedicles in local flap reconstruction of the foot and ankle. A retrospective review of 92 patients and 103 flaps was performed. On angiograms, pattern of blood flow to the flap pedicle was determined to be direct inline flow (DF) or indirect flow (IF). Patterns of IF were either by arterial-arterial connections (AC) or unnamed randomized collaterals (RC). Primary outcomes were immediate flap success and limb salvage. Comparative analyses were performed using the χ2 and Fisher tests for categorical variables. Among all flaps, 73.8% (n = 76/103) had DF and 26.2% (n = 27/103) had IF. Both groups experienced similar rates of immediate flap success (DF = 97.3% vs IF = 92.6%, P = 0.281) and limb salvage (DF = 75.% vs IF = 66.7%, P = 0.403). However, the rate of contralateral amputation was significantly higher in the IF group (26.9% vs 5.3%, P = 0.006). When comparing the 3 distinct patterns of blood flow (DF vs AC vs RC), pedicled flaps were more commonly supplied by DF and AC, while random pattern flaps were more commonly supplied by RC (P = 0.042). Alternative routes of revascularization can maintain local flap viability and achieve similar rates of limb salvage but risks contralateral amputation. We found that pedicled and local muscle flaps require inline blood flow or blood supply by ACs. Meanwhile, random pattern flap can be supported by random collaterals.

Experimental study of contrast-enhanced ultrasound in the evaluation of random-pattern flap blood supply in the early postoperative stage in rats.

This study aims to investigate whether contrast-enhanced ultrasound (CEUS) could be used to reveal the status of blood supply of the superficial flap of rat model in the early postoperative stage. One viable and one ischemic random-pattern flap were prepared on the left and right back of the same rat respectively with a number of 40. CEUS examinations were applied within 12 h and 7 days postoperatively, and the quantitative measurements of microvascular blood volume (BV) of the base and the end of both flaps were expressed using acoustic intensity as a ratio to that of the healthy skin. Within 12 h post operation, there was a smaller BV value of the ischemic ends than that of both the ischemic bases and viable ends (p < 0.001), while no difference was indicated between ischemic bases and viable bases or between viable bases and viable ends. The same result was provided 7 days post operation. Microcirculation of superficial tissues such as random-pattern flaps in this rat model can be assessed quantitatively by CEUS. It could sensitively and accurately reveal the objective status of tissue perfusion in the early postoperative stage.

Optimizing the Use of Pedicled versus Random Pattern Local Flaps in the Foot and Ankle.

The aim of this study was to compare the use of pedicled local (PFs) versus random pattern flaps (RpFs) in foot and ankle reconstruction in patients with chronic, nonhealing wounds. A single-center, retrospective review of 204 patients with 118 PFs and 86 RpFs was performed. The primary outcome included rates of limb salvage. PFs were used more often in the hindfoot (44.1% versus 30.2%, P = 0.045), lateral and medial surface (39.8% versus 18.6%, P = 0.001), and wounds containing exposed bone and hardware (78.8% versus 62.8%, P = 0.018). RpFs were used more for forefoot (19.8% versus 10.2%, P = 0.053) and plantar defects (58.1% versus 30.3%, P = 0.000). RpFs had a higher rate of immediate success (100% versus 95.8%, P = 0.053), with no significant differences in rate of long-term limb salvage (77.1% versus 69.8%, P = 0.237). PFs had higher rates of ischemia requiring intervention (11.0% versus 3.5%, P = 0.048). RpFs had a higher rate of minor amputations (15.12% versus 6.8%, P = 0.053) but similar rates of major amputation (15.1% versus 16.1%, P = 0.848). There were no significant differences in rates of mortality or ambulatory status. Both RpFs and PFs remain reliable options to reconstruct defects of the foot and ankle. Optimizing the use of each flap type should consider wound characteristics. RpFs are preferred for dorsal and plantar defects, whereas PFs are protective for minor infections and preferred for deeper wounds despite a higher rate of partial necrosis.

Application of Stem Cells Shows Antiinflammatory Effect in an Irradiated Random Pattern Flap Model.

In reconstructive surgery, local flaps might develop tissue necrosis or partial flap loss especially after previous irradiation, which may be necessary in many tumor entities. The application of stem cells seems promising to improve flap perfusion and might be a possible solution to optimize flap survival. Twenty rats received harvesting of bilateral random pattern fasciocutaneous flaps. The right flaps received 20 Gy ionizing radiation 4 weeks prior to the surgery, while the left flaps served as the non-irradiated control. After flap harvest, four different stem cell mixtures (5 × 106 ASC, ASC-HUVEC, MSC, MSC-HUVEC) were applied under both right and left flaps using 1 mL fibrin glue as the delivery vehicle. Flap size and its necrotic area were examined clinically. Two weeks after the surgery, HE staining and immunohistochemical staining for CD68 and ERG, as well as PCR analysis (Interleukin 6, HIF-1α and VEGF), were performed. Application of ASCs, ASCs-HUVECs and MSCs resulted in a lower number of CD68-stained cells compared to the no cell group. The expression of Hif1α was higher in the ASC group compared to those in the MSC and previously treated no cell groups. Treatment with MSCs and MSCs-HUVECs prevented shrinking of the flaps in this series. Application of ASCs, MSCs and ASCs-HUVECs was shown to have an antiinflammatory effect. Treatment with MSCs and MSCs-HUVECs can prevent early shrinking of the flaps.

Puerarin enhances TFEB-mediated autophagy and attenuates ROS-induced pyroptosis after ischemic injury of random-pattern skin flaps

Background and aimNecrosis of random-pattern flaps restricts their application in clinical practice. Puerarin has come into focus due to its promising therapeutic effects in ischemic diseases. Here, we employed Puerarin and investigated its role and potential mechanisms in flap survival. Experimental procedureThe effect of Puerarin on the viability of human umbilical vein endothelial cells (HUVECs) was assessed by CCK-8, EdU staining, migration, and scratch assays. Survival area measurement and laser Doppler blood flow (LDBF) were utilized to assess the viability of ischemic injury flaps. Levels of molecules related to oxidative stress, pyroptosis, autophagy, transcription factor EB (TFEB), and the AMPK-TRPML1-Calcineurin signaling pathway were detected using western blotting, immunofluorescence, dihydroethidium (DHE) staining, RT-qPCR and Elisa. Key resultsThe findings demonstrated that Puerarin enhanced the survivability of ischemic flaps. Autophagy, oxidative stress, and pyroptosis were implicated in the ability of Puerarin in improving flap survival. Increased autophagic flux and augmented tolerance to oxidative stress contribute to Puerarin's suppression of pyroptosis. Additionally, Puerarin modulated the activity of TFEB through the AMPK-TRPML1-Calcineurin signaling pathway, thereby enhancing autophagic flux. Conclusions and implicationsPuerarin promoted flap survival from ischemic injury through upregulation of TFEB-mediated autophagy and inhibition of oxidative stress. Our findings offered valuable support for the clinical application of Puerarin in the treatment of ischemic diseases, including random-pattern flaps.

The Effect of Necrostatin -1 and Enoxaparin Molecules on Random Pattern Flap Viability

Distal flap necrosis is seen more often in random pattern flaps and is an important complication that shortens the flap length. There has been much research many drugs and molecules in an effort to prevent this complication. The aim of this study was to investigate the efficacy of necrostatin-1 and enoxaparin molecules in preventing distal flap necrosis and increasing flap viability in a random pattern flap model created in rats. A total of 32 Wistar albino female rats, each weighing 300-350 gr were separated into 4 groups. All the animals underwent an operation to create a 3×9 cm caudal-based Mcfarlane flap. The treatments defined for each group were applied. Full layer tisssue samples 1×1 cm2 were taken from all the flaps and stored until histopathological and immunohistochemical examination, the parameters of inflammation, capillary proliferation, necrosis, fibroblast proliferation and fibrosis were compared histopathologically. In the necrostatin-1 group, the inflammation, necrosis and fibrosis scores were observed to be lower and the capillary proliferation and fibroblast proliferation scores were higher. In the enoxaparin group, the fibroblast proliferation and capillary proliferation scores were higher. The receptor interacting protein kinase-1 immunohistochemical staining results showed statistically significantly less staining in the necrostatin-1 group compared to the other groups. The results of this study suggest that necrostatin molecule has important therapeutic potential in increasing flap viability in the random pattern flap model, considering the percentage of flap necrosis, and the immunohistochemical and histopathological data. The flap necrosis percentage and histochemical parameters of the enoxaparin molecule demonstrate that the effects on flap viability are limited.

Effect of adipose tissue-derived stromal vascular fraction on the viability of random-pattern skin flaps: an experimental study

Aims: Random pattern skin flaps are still widely used in plastic surgery. However, necrosis in distal flap sections resulting from ischemia is a serious problem, increasing the cost of treatment and hospitalization. The aim of this study was to test the effects of adipose tissue derived stromal vascular fraction (SVF) on random pattern skin flaps in rats. Methods: In this experimental study conducted on Wistar rats, three groups were formed using the simple random sampling technique. Group 1 consisted of rats with a raised flap and a subcutaneous SVF injection. Group 2 comprised rats that underwent a flap operation with no additional treatment. Group 3 included rats with a raised flap and a subcutaneous saline injection. Tissue necrosis and level of survival area was detected with planimetric method and histopathologic examination was performed for detect of level of vascular density. On the 7th day post-operation, the viability assessment was calculated based on the ratio of the living flap area to the total flap area. Results: The mean viability rate in Group 1 was higher compared to other groups, while there was no significant difference between Group 2 and Group 3 (Group 1 = 79.2 ± 4.9 % vs. Group 2 = 41.0 ± 5.9 % vs. Group 3= 39.2 ± 2.7 %, p &lt; 0.001). The mean vascular densities of the flaps were higher in Group 1 compared to the other groups, while it were similar between Group 2 and Group 3 (Group 1 = 29.8 ± 1.2 vs. Group 2 = 8.4 ± 4.6 vs. Group 3= 9.3 ± 1.8, p &lt; 0.001). Conclusion: The use of fat tissue-derived SVF injections has been found to be advantageous in improving the survival of random pattern flaps, frequently utilized in plastic and reconstructive surgery.

Random pattern sub-clavicular flap in digital degloving injuries: an alternative in the reconstructive ladder

Degloving soft tissue detachment injuries occur when the skin and subcutaneous tissue detach from the underlying structures, affecting the skin coverage. The hand is usually the most frequent affected site. In digital lesions, the best results are obtained by revascularization; nevertheless, this procedure is challenging for the surgeon. Random pattern flaps represent an effective alternative for the treatment of these devastating lesions. We present two clinical cases with digital degloving injury from the proximal phalanx. Both cases required reconstructive surgery in 2 stages, using a successful random pattern sub-clavicular flap. This article aims to share the results of using this method as another reconstructive option with good results. After an average follow-up of 8 months in both cases, adequate skin coverage and functionality of the finger treated with the described flap was observed. Patient A presents a finger with proper healing and functionality. Patient B at 10 months, presents a thumb with adequate length for clamping and opposition. Sub-clavicular flap is an excellent reconstructive alternative for digital degloving injuries where revascularization is unattainable, providing good skin coverage and functionality and being a reproducible outpatient procedure.

Surgical delay increases the survival of expanded random-pattern flap in pediatric patients

Despite the aid of tissue expansion, the ideal design of random pattern flap is not always available in patients with extensive skin lesions. We investigated the effectiveness of surgical delay on expanded flaps in pediatric patients. Retrospective cohort study was performed on patients who underwent tissue expansion surgery for extensive skin lesions at Seoul National University Children’s Hospital. The surgical delay technique was employed for patients with unfavorable flap conditions related to location or transposition angles. The dimensions of skin lesions and flaps were measured based on medical photographs. Fifty patients underwent a total of 66 tissue expansion procedures (49 conventional procedures among 41 patients, 17 surgical delay procedures among 15 patients) from January 2016 to September 2019. Although flaps in the surgical delay group were more narrow-based (p < 0.001), the partial flap loss rate and excised area-to-inflation amount ratio was comparable between the two groups (p = 0.093 and p = 0.194, respectively). Viable flaps, excluding postoperative necrosis, in the surgical delay group were significantly more narrow-based in terms of the length-to-base width ratio and the area-to-base width ratio compared to conventional group (p < 0.01, p < 0.01). Surgical delay can result in outcomes comparable to well-designed random flaps, even in disadvantageous conditions. Patients with large skin lesions but limited areas for expansion may benefit from surgical delay.

The Influence of Different Irradiation Regimens on Inflammation and Vascularization in a Random-Pattern Flap Model.

Irradiation plays an important role in the oncological treatment of various tumor entities. The aim of the study was to investigate the influence of different irradiation regimens on random-pattern flaps at the molecular and histopathological levels. Twenty-five rats underwent harvesting of bilateral random-pattern fasciocutaneous flaps. The right flaps received irradiation, while the left flaps served as non-irradiated intraindividual controls. Five rats served as a non-irradiated control group. Four different irradiation regimens with give rats each were tested: 20 Gy postoperatively, 3 × 12 Gy postoperatively, 20 Gy preoperatively, and 3 × 12 Gy preoperatively. Two weeks after surgery, HE staining and immunohistochemical staining for CD68 and ERG, as well as PCR analysis to detect Interleukin 6, HIF-1α, and VEGF, were performed. A postoperative cumulative higher dose of irradiation appeared to result in an increase in necrosis, especially in the superficial layers of the flap compared to preoperative or single-stage irradiation. In addition, we observed increased expression of VEGF and HIF-1α in all irradiation groups. Even though no statistically significant differences were found between the different groups, there was a tendency for fractional postoperative irradiation with a higher total dose to have a more harmful effect compared to preoperative or single-dose irradiation.

Caloric Restriction: A Novel Conditioning Strategy to Improve the Survival of Ischemically Challenged Musculocutaneous Random Pattern Flaps.

Caloric restriction (CR) is a cost-effective and easy-to-perform approach to counteracting surgical stress. The present study therefore evaluates the tissue-protective effects of a 30% CR in musculocutaneous flaps undergoing ischemia. For this purpose, a well-established murine dorsal skinfold chamber model, in combination with random pattern musculocutaneous flaps, was used. C57BL/6N mice were divided at random into a CR group (n = 8) and a control group with unrestricted access to standard chow (n = 8). The CR animals were subjected to a 30% reduction in caloric intake for 10 days before flap elevation. Intravital fluorescence microscopy was carried out on days 1, 3, 5, 7 and 10 after flap elevation to assess the nutritive blood perfusion, angiogenesis and flap necrosis. Subsequently, the flap tissue was harvested for additional histological and immunohistochemical analyses. The CR-treated animals exhibited a significantly higher functional capillary density and more newly formed microvessels within the flap tissue when compared to the controls; this was associated with a significantly higher flap survival rate. Immunohistochemical analyses showed a decreased invasion of myeloperoxidase-positive neutrophilic granulocytes into the flap tissue of the CR-treated mice. Moreover, the detection of cleaved caspase-3 revealed fewer cells undergoing apoptosis in the transition zone between the vital and necrotic tissue in the flaps of the CR-treated mice. These results demonstrate that a CR of 30% effectively prevents flap necrosis by maintaining microperfusion on a capillary level and inhibiting inflammation under ischemic stress. Hence, CR represents a promising novel conditioning strategy for improving the survival of musculocutaneous flaps with random pattern perfusion.

Meningomyelocele Reconstruction: Comparison of Repair Methods via Systematic Review.

The purpose of this article was to appraise the various methods of reconstruction for meningomyelocele (MMC) defects. A systematic review of the literature was performed to evaluate all reconstructions for MMC. The method of reconstruction was categorized by: primary closure with and without fascial flaps, random pattern flaps, VY advancement flaps (VY), perforator flaps, and myocutaneous flaps. Perforator flaps were subsequently subcategorized based on the type of flap. Upon systematic review, 567 articles were screened with 104 articles assessed for eligibility. Twenty-nine articles were further reviewed and included for qualitative synthesis. Two hundred seventy patients underwent MMC repair. The lowest rates of major wound complications (MWC) were associated with myocutaneous and random pattern flaps. A majority of MWC was in the lumbrosacral/sacral region (87.5% of MWC). In this region, random patterns and perforator flaps demonstrated the lowest rate of MWC (4.5, 8.1%). Plastic surgery consultation should be strongly considered for MMC with defects in the lumbosacral/sacral region. Perforator flaps are excellent options for the reconstruction of these defects.

Nose tip defect reconstruction with a modified extended Rintala flap: A case report.

Nose tip defect reconstruction with a modified extended Rintala flap: A case report.

A CASE REPORT: THE STAGED RETRO AURICULAR FLAPS FOR AURICLE RECONSTRUCTION AFTER TRAUMATIC AMPUTATIONS

Highlights: Instances of severe ear injuries are uncommon. The paragraph explores the efficacy of the staged retro-auricular flap (SRF) as a proficient approach to ear reconstruction. SRF demonstrates the ability to successfully reinstate the ear's dimensions, contour, and functionality, yielding highly satisfactory functional and aesthetic outcomes. Abstract: Introduction: A complete amputation or other severe auricular injury is rare. The amputated ear also presents a significant problem for the plastic surgeon. Case Illustration: A 29-year-old man had his left ear amputated due to trauma presented. He cut off his ear to get rid of the whisper because he has a history of psychiatric illnesses and complaints about hearing them. The remaining portion of the cartilage that was still linked to the ear attachment area was sutured to the preserved cartilage. The defect is covered using a stage pedicle flap. A skin transplant was used to close the donor flap's retro-auricular defect, which was its secondary defect. Discussion: A random-pattern flap with an abundant vascular supply is the staged retro-auricular flap (SRF). This flap's main disadvantage is the two-stage process required to complete it. Excellent cosmetic outcomes can be achieved by matching skin color and texture well in the postauricular sulcus, mastoid area, and posterior ear. Conclusion: SRF is an efficient ear reconstruction technique that offers relatively little operational morbidity and can restore the ear's size and shape with good to exceptional functional and cosmetic results when used on appropriately chosen helical ear abnormalities.

774 Providing Essential Burn Reconstructive Surgery in Resource-Limited Environments Using a Cleft Organization

Abstract Introduction Cleft non-governmental organizations (NGOs) collaborate with multidisciplinary teams of healthcare professionals to provide safe and effective cleft surgery in resource limited environments. Unfortunately, other significantly disabling conditions like burns, which require similarly multidisciplinary reconstructive interventions, often lack the same degree of local and international support. Therefore, cleft NGOs are well positioned to support essential reconstructive burn care through sustainable service delivery models like those developed for cleft care. Methods An NGO with experience delivering global cleft care established a collaborative effort in COUNTRY between local and international burn experts from to provide burn care. Preoperative screening was performed by a local burn surgeon to identify patients. Virtual conferences were held bi-weekly to discuss candidates and operative planning. Following 3 months or preparation, a 5-day surgical program with a mixed team of COUNTRY and international volunteers was held. Patient demographics, interventions, and outcomes were monitored to determine efficacy of this Cleft NGO at delivering essential burn reconstruction. Results Of the 52 burn patients who were screened, 32 were surgical candidates, and 20 received a total of 26 surgeries during the 5-day program. Average age was 17 ± 16 years with 65% (13) females and 25% (5) refugees. Most had scald (65%) or flame (30%) burns from household accidents with average age at burn of 8 ± 12 years. Random pattern flaps were used in all cases. Only 1 patient required supplementary skin grafting. Seven patients had multiple operative sites that were addressed with a 2-team approach. No perioperative complications occurred. All patients were followed-up by the in-country team between 7 and 42 days. Five patients presented with minor complications - 5 flaps with partial necrosis and 2 partial dehiscence. None required surgical intervention. Conclusions Cleft NGOs have the resources and experience that allows them to implement impactful surgical programs for other conditions that are critically lacking access to essential reconstructive care. Applicability of Research to Practice Cleft NGOs can provide safe and effective burn surgery through collaborative local and international efforts aimed at sustainability and capacity building.

The effect of taurine on flap perfusion and viability in random pattern flaps in rats

BackgroundIn present study, the effect of taurine on flap perfusion and viability was examined using the modified random pattern dorsal flap model (DFM). Materials and MethodsEighteen rats were included and divided equally (n=9) to taurine treatment and control groups in this study. Taurine treatments were given orally at a dose of 100 mg/kg/day. Taurine group received taurine, starting 3 days before the operation till the postoperative 3rd day. Angiographic images were recorded when the flaps were sutured back and on postoperative 5th and 7th days. Necrosis calculations were made with all the images obtained by the digital camera and the indocyanine green angiography. Fluorescence intensity, fluorescence filling rate and flow rate of DFM were calculated by the SPY device and the SPY-Q software. All flaps were analyzed histopathologically, also. ResultsPerioperative taurine treatment significantly reduced necrosis rates and increased the fluorescence density, the fluorescence filling rate and the flap filling rates in the DFM (p<0.05). Reduced amounts of necrosis, ulcer and polymorphonuclear leukocyte supported the beneficial effect of taurine histopathologically (p<0.05). ConclusionsTaurine may be used as an effective medical agent for prophylactic treatment options in flap surgery.

Limberg flap revisited: for closure of facial soft tissue defects

The Limberg or rhomboid flap can be used to close defects almost anywhere on the body. It is versatile in that a random pattern flap can be raised from any one or all corners of the rhomboid. The defect is filled with tissue of the same thickness and colour, and with good vascularity. The purpose of this paper is to demonstrate the versatility that a single flap can be used to close defects almost anywhere on the body. This study was conducted in the department of plastic and reconstructive surgery, Saveetha Medical College and Hospital, during the period between January 2018 and December 2019. Twenty patients (fifteen males and five females) took part in this study. Their ages ranged from 20-60 years with a mean age of 42 years. From each patient history was taken and physical examination was performed. All the procedures were done under local anesthesia. Postoperatively suture removal was done on the 5th post-operative day. There were twenty patients who took part in the study. Seventeen patients had naevi and three had basal cell carcinoma. The size of the lesions ranged from 2.0×1.8 cm to 4.8×4.5 cm. All the flaps settled well with no complications. The procedure resulted in a very fine and less noticeable scar with smooth contour of the skin which was acceptable in all patients. Limberg flap is a safe and reliable option that could be used in the reconstruction of small and medium‐sized cutaneous defects of the face especially in elderly patients with no morbidity.

Local Random Pattern and Axial Flaps for Reconstruction of Nasal Surgical Defects: Retrospective Analysis with an Attempt to Inspire ENT Surgeons.

Aim: Reconstruction of the surgical defects of the external nose has been challenging and largely considered to be the domain of plastic reconstructive surgeons. The present study aims to share our experience in reconstructing such defects. Materials and methods: A retrospective analysis of 11 patients who underwent external nasal reconstruction secondary to surgical defect at our otolaryngology department in a tertiary care hospital from 2017 to 2019 was done. All the patients underwent surgical excision of a part of the external nasal dorsum followed by reconstruction by our team of otolaryngology surgeons using local random pattern/ axial flaps. The patients were followed up postoperatively for a period ranging from 3months (for benign pathologies) to 2years (malignant pathologies). Results: The flaps were taken up in all the patients. Minor complications like postoperative infection were seen in 2 cases, resulting in wound dehiscence in one that required resuturing that was uneventful. The appearance was bulky in all the patients, although the patients were satisfied with the overall cosmetic appearance. The average hospital stay was 2 to 4days. Conclusion: Reconstruction of external nasal surgical defects is a challenging task. Thorough knowledge of relevant anatomy, proper planning, and availability of abundant vascularized donor tissue in the near vicinity of the defect makes this challenge acceptable with good outcomes even in the hands of otolaryngologists.