Reconstruction Of Medium-sized Defects Research Articles

Reconstruction of Medium-Sized Defects of Oral Commissure by Combining Double Full-Thickness Cheek Rhomboidal Flaps and a Small Lip Switch Flap

Reconstruction of oral commissure defects aims at securing oral competence and providing an acceptable appearance. The methods described by using either a cross lip flap or a flap from the adjacent cheek skin and mucosa may not be able to achieve such goals if each method is used on its own. We have combined double full-thickness cheek rhomboidal flaps with a small lip switch flap from the remaining lip segment to reconstruct medium-sized full-thickness defects of the oral commissure, following tumor excision in 7 patients. The functional and aesthetic outcomes were assessed by the evaluation of 3 parameters under each category. Each parameter received a score of good, moderate, or poor. Six patients had a good overall functional score. Microstomia was noted only in 1 patient. The overall aesthetic score for all the 7 patients was moderate. In conclusion, reconstruction of medium-sized commissural defects by the present technique achieves adequate oral competence and a satisfactory cosmetic result.

Forefoot reconstruction by reversed island flaps in diabetic patients.

Soft-tissue coverage of the foot is often difficult, especially when the distal third of the foot (dorsal or plantar aspects) is involved. The clinical situation can be further complicated when diabetic patients are affected by painful and unstable wounds of this kind because of the familiar phenomenon of vasculopathy. The purpose of this study was to evaluate the possibility of using distally based foot flaps to cover forefoot defects in diabetic patients. Preoperative selection of patients was the key to this study; those who had other major disease, chronic infection, bone involvement, and/or insufficient foot vascularization were excluded from the study. The authors report a series of 12 diabetic patients in whom the reconstruction of medium-sized defects (ranging from 1.5 x 2.0 cm to 3.0 x 7.0 cm) of the forefoot was performed using distally based dorsalis pedis flaps or medial plantar flaps. The transferred flaps survived and adapted well to the defects, except for one flap in a patient who had a slight venous insufficiency at outset. Wearing their own footwear, patients could walk after 20 to 30 days. After the follow-up period (3 months to 3 years), no skin breakdown in the treated areas was observed. Temporary donor-site pain was reported by medial plantar flap patients, and partial skin graft loss at the donor site occurred in some of the dorsalis pedis patients. The authors suggest that in selected cases, medium-sized soft-tissue defects involving the dorsal aspects or the weight-bearing areas of the diabetic foot can be successfully covered with distally based island flaps.

Forefoot Reconstruction by Reversed Island Flaps in Diabetic Patients

Soft-tissue coverage of the foot is often difficult, especially when the distal third of the foot (dorsal or plantar aspects) is involved. The clinical situation can be further complicated when diabetic patients are affected by painful and unstable wounds of this kind because of the familiar phenomenon of vasculopathy. The purpose of this study was to evaluate the possibility of using distally based foot flaps to cover forefoot defects in diabetic patients. Preoperative selection of patients was the key to this study; those who had other major disease, chronic infection, bone involvement, and/or insufficient foot vascularization were excluded from the study. The authors report a series of 12 diabetic patients in whom the reconstruction of medium-sized defects (ranging from 1.5 × 2.0 cm to 3.0 × 7.0 cm) of the forefoot was performed using distally based dorsalis pedis flaps or medial plantar flaps. The transferred flaps survived and adapted well to the defects, except for one flap in a patient who had a slight venous insufficiency at outset. Wearing their own footwear, patients could walk after 20 to 30 days. After the follow-up period (3 months to 3 years), no skin breakdown in the treated areas was observed. Temporary donor-site pain was reported by medial plantar flap patients, and partial skin graft loss at the donor site occurred in some of the dorsalis pedis patients. The authors suggest that in selected cases, medium-sized soft-tissue defects involving the dorsal aspects or the weight-bearing areas of the diabetic foot can be successfully covered with distally based island flaps. (Plast. Reconstr. Surg. 106: 823, 2000.)