Reconstruction Of Defects Research Articles

“Floating Island Flap”—A New Technique for the Reconstruction of Full-Thickness Lower Eyelid Defects with Spontaneous Healing (Folded V-Y Island Flap with Orbicularis Oculi Muscle)

Background: Due to the high incidence of malignant tumors of the lower eyelids and the widespread use of surgery for their treatment, the reconstruction of tissues in this area is a frequent task for surgeons. Methods for restoring full-thickness lower eyelid defects are often invasive, pose a significant risk of complications, and do not provide optimal results. Methods: The authors developed a simple technique for the reconstruction of full-wall defects of the lower eyelids. It is a V-Y-type musculocutaneous island flap from the lower eyelid, with the orbicularis oculi muscle folded in the upper part and partially left for spontaneous healing, called by the authors a “floating island flap”. Between 2012 and 2023, 39 patients were operated on using this method. Results: Surgical procedures performed under local anesthesia were well tolerated by the patients. The healing process was quick and well accepted. Complications were rare. The most common were: eye irritation and temporary swelling of the flap. In 37 patients, proper protection of the eyeball and good esthetic results were achieved; only in two cases was the cosmetic result assessed as poor. Corneal defects occurred in two cases and healed after conservative treatment. In no cases was reoperation necessary. Conclusions: The developed method is simple and effective. It can be widely used in the reconstruction of full-thickness defects of the lower eyelids.

Mechanical vascular anastomoses

Mechanical anastomoses of blood vessels represent amajor advance in modern surgery. Highly specialized instruments ensure the precise connection of blood vessels, enabling the immediate restoration of blood flow. Ring coupler systems for venous anastomoses, in particular, have proven themselves in clinical practice due to their convenience and reliability and are now an indispensable part of surgical routines. Precise and functionally proper anastomosis of blood vessels; shortening of the anastomosis time; minimization of perfusion disorders in the affected tissue; reduction of intraoperative and postoperative complications. Replantation of extremities after amputations and injuries; defect reconstruction using free flaps; microsurgical vascular bypass procedures. Severe vascular pathologies such as vascular aneurysms, arteriosclerosis or severe inflammation in the area of the anastomosis; large differences between the vessel lumina; too small or too large vessels. Clamping of both vessel ends; selection of the appropriate ring coupler size based on the vessel diameter; mobilization of at least 1 cm at each vessel end; functional testing of the coupler device; threading the vessels, securely joining the rings and removing the holding device; removing clamps, inspection of the anastomosis. Regular blood circulation checks; avoiding pressure on the anastomosis; adequate anticoagulation. Precise anastomoses; reduction in operating time.

Surgical Innovation in Serial Reconstruction of Micrognathia Using Free Fibular Flap: Insights From a Study and Literature Review.

Free fibular flap (FFF) is the main modality in the reconstruction of maxillofacial defects. Micrognathia is a condition where the mandible is smaller than it should be. Micrognathia is typically treated with mandibular distraction osteogenesis, bilateral sagittal split osteotomy, and conventional costochondral graft. In cases in which these procedures cannot be performed, FFF becomes a suitable alternative. Publications regarding the use of FFF in cases of micrognathia are currently still limited. In this case, we present the use of FFF in the reconstruction of a severely micrognathic mandible in an adult patient. A 28-year-old woman with micrognathia was referred to Dr. Ciptomangunkusumo Hospital for reconstruction. The patient had previously undergone temporomandibular joint (TMJ) reconstruction surgery with interpositional TMJ arthroplasty 10 years prior due to an ankylosing TMJ that prevented the opening of the jaw. The treatment for ankylosing TMJ was necessitated due to the patient's inability to open their mouth, resulting in significant challenges with alimentation, speech, and facial morphology. Here the authors reported mandibular lengthening reconstruction in the anteroposterior axis with FFF. A surgical osteotomy was performed on the posterior segment of the bilateral mandibular ramus, then the segmented fibula was inserted into the resulting defect. Flap refinement was also performed following FFF. Postsurgical evaluation revealed notable enhancements in the patient's esthetic appearance, occlusal function, and amelioration of obstructive sleep apnea symptoms. FFF for mandibular reconstruction is feasible and effective in improving esthetic and functional outcomes in patients with micrognathia.

Reconstruction of a Complex Medial Canthal Defect.

Reconstruction of a Complex Medial Canthal Defect.

Contemporary role of the plastic and reconstructive surgeon in the outcome of female peripelvic defects after oncologic extirpation.

Reconstruction of female oncologic peripelvic defects is challenging due to complex anatomy, neoadjuvant chemoradiation, operative resection margins, and wound healing risks. Functional restoration requires thoughtful management focused on defect reconstruction and patient-reported outcomes. A retrospective chart review of peripelvic reconstruction in female patients at MD Anderson Cancer Center from 2016 to 2023. Data collected included the patient'scomorbidities, tumor characteristics, and reconstructive details. Complications were classified as nonoperative or operative within 30 days. Patient outcomes included hernia rates, sexual activity, and revision needs. In the study period, 164 patients underwent peripelvic defect reconstruction. Most had colorectal (57%), anal (17%), or gynecologic malignancies (10%). 83% had prior radiation. 33.3% had Class II or III obesity. The most common resection was open colorectal resection with partial vaginectomy (66%). Pedicled flaps (93%) were frequently used, mainly vertical rectus abdominis muscle (65%) and gracilis (11%). For multi-visceral resections, abdominal-based flaps were used in 95% of open casesand thigh-based flaps in 88.9% of robotic cases. 51% had formal abdominal wall repair. Complications occurred in 47%, with 9.1% needing surgery. Postoperative hernias were reported in 4.9%, with 3% requiring repair. Approximately 11% reported being sexually active at the last follow-up. Of those instructed on vaginal dilator therapy (42%), 24.6% were sexually active. Peri-pelvic soft tissue reconstruction in the oncologic population is safe. Operative complications and hernia rates are low. In robotic surgery, thigh-based flaps are increasingly used to reconstruct the peripelvic region. Return to sexual activity is higher in patients when given dilator therapy instruction.

Effects of Neoadjuvant Radiation and Recipient Vessel Characteristics on Microvascular Complication Rates in Reconstruction of Lower Extremity Soft-Tissue Sarcoma Defects.

The treatment approach for soft-tissue sarcomas (STS) of the lower extremity has shifted toward the use of neoadjuvant radiation combined with limb-sparing surgery (LSS). The resulting defects often require reconstruction with free tissue transfer for adequate outcomes. Data has demonstrated a potential increased risk of microvascular complications for free flaps performed using irradiated recipient vessels. Similarly, certain anatomic areas of the lower extremity have a high proportion of unnamed perforators that are available as recipient vessels, increasing the technical difficulty. We aimed to determine if the characteristics of recipient vessels that were used for reconstruction of STS defects influenced rates of microvascular complications in our patients. A retrospective chart review of all patients who underwent reconstruction of lower extremity STS defects with free tissue transfer from 2009-2020 was conducted. Data regarding recipient vessel type (axial vessel vs. unnamed perforator), radiation status of the recipient vessels (irradiated vs. non-irradiated), and microvascular complications was compared across groups. A total of 204 free flaps were included. The overall microvascular complication rate was 13.7% (28 cases). Most microvascular complications were detected postoperatively (82.1%) rather than intraoperatively, with the majority involving venous congestion/thrombosis (20 cases, 71.4%). While there was a trend toward increased microvascular complications with the use of irradiated recipient vessels (27 cases, 96.4%), this did not reach statistical significance (OR = 1.98, p = 0.52). The use of perforating branches as recipient vessels did not confer increased risk of microvascular complications (OR = 0.87, p = 0.75). Reconstruction of irradiated lower extremity STS defects represents a particularly challenging issue. This analysis demonstrates that free tissue transfer can be safely performed using irradiated vessels without significant increased risk of microvascular complications. Furthermore, unnamed perforating branches can also be successfully used for reconstruction in anatomically challenging areas of the lower extremity.

Treatment of a patient with Ollier’s disease

The objective was to demonstrate a clinical case of an adult patient with Olier’s disease (enchondromatosis), severe hand deformity, and its treatment in orthopedic department. Patient K., 71 years old, was treated with severe deformation of the left hand due to Ollier’s disease in Ya. L. Tsiv’yan Novosibirsk Research Institute of Traumatology and Orthopedics in 2017. The patient underwent a one-stage multi-stage surgical intervention with removal of the endochondromas of the 1st, 2nd, 4th and 5th fingers, bone and tendon grafting of the defects.In 5 years after surgery, patient notes a high degree of satisfaction with the treatment. At the control visit, the preservation of the intraoperatively achieved result was established without signs of recurrence of the process or signs of malignancy. The achieved result led to the improvement of motor skills, restored a number of social self-service functions.Due to the high risks of recurrence and malignancy of the process, patients with Olier’s disease require close monitoring by clinicians. Surgical treatment of benign forms of the disease involves the implementation of an organ-preserving intervention with the reconstruction of bone and tendon ligament defects. The main goals of the intervention in this case were a removing of the pathological substrate and the improvement of hand function.

Generalizable procedure for Brown's Class Ⅱ and Ⅲ defects reconstruction with deep circumflex iliac artery flap using computer-assisted technique

ObjectiveThis study summarizes and analyzes the characteristics of deep circumflex iliac artery (DCIA) flap reconstruction for maxillary defects and proposes a generalized protocol under the guidance of computer-assisted technology to enhance surgical efficiency and success rate. Materials and methodsWe retrospectively reviewed 10 cases of maxillary defects reconstructed using DCIA flaps under the application of computer-assisted technology, collecting clinical data for statistical analysis. ResultsThese cases included 2 cystic lesions, 2 mucinous tumor, 2 ameloblastoma, 1 mucoepidermoid carcinoma, 1 odontogenic fibroma, 1 bone defect following squamous cell carcinoma (SCC) surgery, and 1 ossifying fibroma. According to the Brown's classification system, there were 7 Type IIb defects, 1 Type IId defect, 1 Type IIIb defect, and 1 Type IIId defect. The lengths of the iliac bone harvested ranged from 42 mm to 100 mm, and the widths from 20 mm to 51 mm. In 7 patients, chimeric iliac myofascial flaps were used; in 2 patients, deep circumflex iliac artery perforator (DCIAP) flaps were utilized; and in 1 patient, a vascularized iliac crest was employed. The recipient vessels were the facial artery and vein in all cases. Intraoral anastomoses were performed in 4 cases, and submandibular anastomoses in 6 cases. The donor site was chosen from the ipsilateral ilium in 8 patients and from the contralateral ilium in 2 patients. The mean operative time was 8.74 hours. Postoperatively, 9 patients recovered well without any complications, while 1 patient experienced necrosis of the bone flap on the first day after surgery and underwent secondary reconstruction using a vascularized fibula flap. The average postoperative hospital stay was 8.6 days. ConclusionThe combination of DCIA flaps with computer-assisted technology provides a reliable method for the reconstruction of maxillary defects and functional restoration. Establishing generalized procedures could facilitate its broader application.

Linked Flaps of the Thoracodorsal Vascular Tree for Correcting Extensive Post-Burn Deformities and Achieving Optimal Reconstruction Outcomes.

Autologous skin grafting has been the popular method for reconstructing post-burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post-burn scar contracture in the lower and upper extremities and trunk. Patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. Patients received thoracodorsal vascular tree-linked flaps for the correction of post-burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self-report questionnaire for upper extremity reconstruction. Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact (n = 8), followed by flames (n = 5), scalds (n = 4), electrical contact (n = 2), and friction (n = 1). The most frequently utilized combinations were the thoracodorsal artery perforator (TDAp) and anterolateral thigh (ALT) flap (11 cases). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator (DIEP) flap. The average DASH score for upper extremity burn patients was 10.58. Three-dimensional tissue coverage achieved through the linkage of two or even three independent free flaps is increasingly utilized in post-burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction.

The Vascular Anatomical Basis for a Well-Designed Reconstruction of the Ala Nasi by a Microsurgical Preauricular Flap Technique

Background: A microsurgical auricular flap represents a single-step technique for the reconstruction of full-thickness defects of the ala nasi. To achieve the best surgical outcomes, it is essential to have an exhaustive knowledge of the vascular network to improve the management of the surgical flap. This study aimed to provide an anatomical and surgical guide for a well-designed reconstruction of the ala nasi using a free preauricular flap. Methods: In this study, three fresh-frozen and two formalin-fixed human head specimens injected with red silicone rubber to enhance the arterial facial system were used. The reconstruction of the full-thickness defect of the ala nasi was performed using a microsurgical auricular flap technique, with the dimensions of the ala nasi and the preauricular flap duly noted. In addition, anatomical dissections were conducted, during which the positions and diameters of the main donor and recipient vessels were measured. Results: A presurgical evaluation was performed to define the flap design. A comparison of the shape and mean dimensions of the ala nasi defect (height 9.66 ± 1.40 mm; thickness 3.52 ± 0.53 mm) and the preauricular flap (height 8.50 ± 2.68 mm; thickness 3.92 ± 1.29 mm) indicated that this flap was an optimal option for the reconstruction of the ala nasi. The surgical procedure involved the full-thickness removal of the ala nasi, and the harvesting and insertion of the preauricular flap. The anatomical measurements demonstrated that the facial artery and veins were the optimal recipient vessels, with a diameter of >1 mm (2.08 ± 0.56 and 2.85 ± 0.74 mm), suitable for anastomosis with the superficial temporal artery and vein (1.86 ± 0.58 and 1.66 ± 0.15 mm). In addition, the postsurgical evaluations indicated a slight mean difference in the thickness (1.14 ± 0.65 mm) and height (1.68 ± 1.18 mm) between the ala nasi and helix and a satisfactory VAS score (7.9 ± 0.57). Conclusions: Our surgical and anatomical data provide compelling evidence in favour of free preauricular flap reconstructions of the ala nasi. This procedure allows for the correct choice of recipient vessels and the creation of a well-designed surgical flap.

Innovative Use of Bilateral Pedicle Advancement Flap for Post-auricular Defect Reconstruction

Innovative Use of Bilateral Pedicle Advancement Flap for Post-auricular Defect Reconstruction

Reconstruction of Central-Type Nail Bed Defect Using a Subcutaneous Flap and Subsequent Nailbed Graft

Full-thickness nail bed defects with exposure of the distal phalanx are difficult to reconstruct with limited options for bone coverage. A subcutaneous flap can effectively cover bone exposure, followed by a nail bed graft. We report a case of successful nail bed reconstruction using this approach, incorporating a split-thickness nail bed graft. A 59-year-old woman sustained injuries to the nail bed of the right middle finger from a blender blade. The defect, measuring 1.2 × 0.6 cm, was located in the center of the nail bed with associated bone exposure. Both lateral nail folds remained intact and our aim was to reconstruct the defect without disrupting these structures. A subcutaneous flap incorporating the digital artery was elevated. The flap was then transposed beneath the lateral nail fold and uninjured nail bed to provide coverage for the defect. This technique allowed for the reconstruction of the damaged area while preserving the vascular supply and ensuring adequate soft-tissue coverage. Three weeks post-surgery, the flap survived, and the eponychial folds were all preserved, allowing for a subsequent split-thickness nail bed graft. At 12 months post-surgery, the outcome was evaluated as “very good” according to Zook’s criteria.

Prosthetically Driven Approach to Post-Ablative Maxilla Rehabilitation with an Implant-Supported Overdenture: A Case Report

This clinical report details the prosthetic rehabilitation of a patient following maxillary ablation to remove a peripheral giant cell granuloma. After a hemimaxillectomy, the defect was reconstructed with a fasciocutaneous radial free flap. Implant placement was digitally planned using the dual scanning technique, and implants were inserted with the aid of an acrylic surgical guide. After implant osseointegration, a removable implant-supported overdenture with an electroplated secondary structure retained on a titanium bar was fabricated. At the 3-year follow-up, peri-implant tissues remained healthy, showing only mild gingival hyperplasia around the bar, while no prosthesis retention loss or significant technical complications were observed. In conclusion, the reconstruction of the moderate maxillary defect using a soft-tissue flap provided satisfactory functional and esthetic outcomes, significantly enhancing patient satisfaction. However, the limited bone availability necessitated precise implant planning to ensure adequate biomechanical support for the overdenture.

Pre-Surgical Planning Using Virtual And 3D Printing Model as Guidance for SECONDARY Mandible Reconstruction with Bone Graft: A Case Report

Reconstruction of mandibular defects due to trauma or tumor resection is a significant challenge for surgeons, given the unique and variable shape of the mandible in terms of curvature, length, and height. Numerous techniques have been developed to achieve both aesthetic and functional outcomes. This case report presents a 28-year-old patient with mandibular irregularity following ameloblastoma dissection, which was reconstructed with non-vascularized bone grafts (NBGs) from the left iliac crest approximately 10 years ago. Prior to our procedure, virtual planning and 3D modeling were employed to accurately assess the bone defect. After debridement, a 5 cm defect was identified, and NBGs were harvested from the right iliac crest for reconstruction. NBGs are commonly used for small mandibular defects (<6 cm), non-continuity defects, and benign pathologies, and they can be performed in centers without microsurgical expertise. The use of virtual planning and 3D printing enables the surgical team to thoroughly study the case, anticipate potential issues, and improve precision, resulting in better outcomes and reduced operative time. NBGs, guided by virtual planning and 3D modeling, prove to be an effective technique in reducing surgical time and minimizing the risk of failure during the postoperative recovery period.

Challenging frontiers in neuroplastic cranial reconstruction: addressing neurosurgical wound healing complications through interdisciplinary collaboration – an observational study

Background and objectivesAlthough rare, complications like skin dehiscence and necrosis after neurosurgery pose significant challenges by increasing the risk of infections spreading to the epidural, subdural, or intracerebral spaces. This retrospective, single-center study aims to assess the prior clinical courses, neuroplastic repair, and outcomes of patients with skin defects following cranial neurosurgical procedures, and to outline our interdisciplinary reconstructive protocol.MethodsA retrospective analysis was performed on cranial surgeries conducted at the Department of Neurosurgery, spanning from 2017 to 2023. Patients with skin defects requiring the combined expertise of neurosurgery and plastic surgery for effective treatment were included. The sizes of the skin defects were measured using intraoperative photographs analyzed with the freeware ImageJ software, version 2018. All patients provided informed consent for the surgeries. If informed consent was not possible due to neurological deterioration, consent was sought from adult representatives or next of kin except for acute circumstances. All patients admitted to our hospital agree to the pseudonymized use of their medical data and tissue specimens for research purposes in their treatment contract.ResultsA cohort of 24 patients experiencing wound healing complications after neurosurgical procedures underwent a total of 29 interdisciplinary surgeries for the reconstruction of skin, dural, and bone defects. After the neuroplastic surgery, 8 out of 24 patients (33.3%) developed surgical complications, with 6 of these requiring revision surgeries due to persistent cranial infection. In all cases, permanent wound closure was successfully achieved following adherence to the proposed treatment algorithm.ConclusionsOur study underscores the necessity of an integrated neurosurgical and plastic surgical approach to effectively manage wound healing complications in a single stage surgery. Key interventions include differentiation between necrosis and gaping lesions, alongside precise management of neurosurgical issues like cerebrospinal fluid fistulas and hydrocephalus. Plastic surgical expertise in assessing the possibilities and limitations of both local and free flap surgeries is essential.

Superficial circumflex iliac perforator flaps for maxilla defects with intraoral anastomosis or pedicle elongation techniques

BackgroundTo evaluate the feasibility and safety of the superficial circumflex iliac perforator flap (SCIP) for maxillary reconstruction with intraoral anastomosis, pedicle elongation, and super-microsurgery techniques to overcome its anatomical shortcomings due to the attractive merits of the flap.MethodsPatients who underwent reconstruction of maxillary defects with SCIPs from July 2020 to December 2022 were included. Intraoral anastomosis, pedicle elongation, and super-microsurgery were performed during surgery with or without a neck incision. The sizes, pedicle lengths, inner calibres of vessels, complications and flap survival statuses were recorded.ResultsA total of 12 patients were included, with 3 males and 9 females, and the median age was 45 years, ranging from 14 to 74 years. There were 5 class IIa and 7 class IIb defects, 6 cases underwent maxillary defect reconstruction via SCIPs with intraoral anastomosis, and the other 6 cases with distally design and/or de-epidermis pedicle elongation. Super-microsurgery interventions were needed in 5 patients. The size ranged from 3 cm×4 cm to 6 cm×8 cm. The pedicle length ranged from 4 cm to 12 cm, with a median of 6 cm. The inner caliber of the arteries ranged from 0.7 mm to 2 mm, with a median of 1 mm, and the veins ranged from 1.5 mm to 4 mm, with a median of 2.5 mm. All the flaps survived, and no donor site complications occurred.ConclusionSuperficial circumflex iliac perforator flaps can be regarded as feasible and safe choices for maxillary defects with the support of intraoral anastomosis, pedicle elongation and super-microsurgery.

Full Thickness Earlobe Defect Reconstruction.

Full Thickness Earlobe Defect Reconstruction.

Lateral Calcaneal Artery Perforator/Propeller Flap in the Reconstruction of Posterior Heel Soft Tissue Defects

Abstract Introduction Posterior heel soft tissue defects with/without tendoachilles injury are difficult to reconstruct because of bony prominence, limited expendable local soft tissues, and significant donor site morbidity. In this study, we evaluate the lateral calcaneal artery (LCA) perforator/propeller flap for posterior heel soft tissue defect reconstruction. Materials and Methods A preliminary cadaveric study was done on 22 specimens to study the course of the LCA and its perforators. The knowledge gleaned from the cadaveric study was applied in our clinical study. The clinical study was conducted from January 2018 to May 2023 in 13 patients (10 males and 3 females) with posterior heel defects. The primary movement of the perforator flaps were either V-Y advancement (n = 10) or propeller (n = 3). Results All the flaps settled well except for superficial epidermolysis in one patient (7.69%) which healed conservatively. The average follow-up period was 14.53 months. Postoperatively, all patients had normal gait and normal range of movements. The LCA with the maximum number of perforators in the retrofibular/retromalleolar segment and the islanded flaps based on these perforators provided the excellent coverage for tendoachilles insertion defects and posterior heel defects facilitating excellent shoeability in all cases. Conclusion The study concludes that the LCA perforator/propeller flap may be a reliable cover for the posterior heel defects with good color, texture, thickness, and contour match rendering a shoeable stable foot.

Computer diffraction tomography: a comparative analysis of the use of controlled and wavelet filters for image processing

The paper provides digital processing of 2D X-ray projection images of a Coulomb-type point defect in a Si(111) crystal recorded by a detector against the background of statistical Gaussian noise. A managed filter and a wavelet filter with a 4th-order Daubechies function are used. The efficiency of filtering 2D images is determined by calculating the relative quadratic deviations of the intensities of filtered and reference (noiseless) 2D images averaged over all points. A comparison of the calculated values of the relative deviations of the intensities shows that the considered methods work quite well and both, in principle, can be effectively used in practice for noise processing of X-ray diffraction images used for 3D reconstruction of nanoscale defects of crystal structures.

Reconstruction of a Wide Mental Defect.

Reconstruction of a Wide Mental Defect.