Reliable Flap Research Articles

Cubital fossa defect- our reconstructive experience with pedicle flaps

IntroductionCubital fossa wounds can be complicated by the non-availability of reliable, well-vascularized donor tissue. Closure with pliable and readily available donor tissue for cubital defect and early mobilization of the elbow joint is essential for better results. The authors did this study to see how best the results of cubital fossa defect cover can be achieved by pedicle flaps in a single stage without compromising the donor areas. Material and methodPatients having deep elbow wounds in which vital structures were lying exposed in the cubital region were included in this study. The patients were assessed for the availability of tissue for cover, reliability of flaps, flap pliability, the functional outcome of the elbow and donor site morbidity. ResultsA total of 17 cases of cubital region defects are presented wherein closure of the wound by means of primary closure was not possible. Out of these, eight were covered with Pedicled Thoracodorsal Artery Perforator (TDAP) flaps, five with Pedicled split Latissimus Dorsi Muscle (SLDM) flaps and four with reversed lateral arm flaps (RLA). Post-operatively all the flaps were healthy, patients attained a good range of elbow joint movements with no clinically evident morbidity of the donor site. ConclusionCubital fossa defect coverage needs dedicated planning to obtain a sturdy tissue for cover. In the presence of local tissue damage or scarring, we have looked elsewhere to bring pliable and well-vascularized tissue which is reliable. The flaps we used have allowed single-stage reconstruction and early mobilization of the elbow joint with good functional recovery.

Different surgical procedures for reconstruction of soft-tissue defects around the ankle

IntroductionManagement of soft tissue defects around the ankle is a difficult and challenging situation for all reconstructive surgeons. A microsurgical free flaps coverage can solve this problematic situation especially with large defects that is not available in all trauma centers. Moreover, long operating time and suitable operative demands are considered obstacles. Materials and methodEighty five patients having soft tissue defects around ankle were included in this study. They underwent various reconstructions in our specialized hand and reconstructive microsurgery unit from 2015 to 2019. Fifty two were males and thirty three patients were females. Road traffic accident was the main cause of injury in 66 patients followed by implant exposure in 15 patients and chronic osteomyelitis in 4 patients. Distally based superficial sural artery flap was used to reconstruct the defects in 21 cases, free flap was used in 32 cases, Rotational local flap was used in 8 cases, contralateral distally based superficial sural artery flap was used in 2 cases, full or partial skin flaps were used in 10 cases and Propeller flap was used in 12cases. ResultsAll flaps survived except for one modified sural flap with 98% success rate and average follow up of 48 months. All patients were satisfied with the functional capacity of operated limbs. Average time of bone healing postoperative was 3 months with gradual return to original work with acceptable degrees for cosmotic appearance of the limbs. ConclusionMany treatment options are available to cover defects around the ankle. Propeller and rotational flaps are fast and easy but cover small defects, distally-based modified sural artery flap is an excellent reliable flap. Microsurgical free flaps provide good contour, color, texture and cover large defects but require microsurgery facilities to execute.

Distally Based Sural Flap in Children: Experience in Our Department

The reverse sural artery flap (RSAF) was first described approximately four decades ago in 1983 by Donski and Fogdestam [1] and has since been used frequently for reconstruction of soft tissue defects in the distal part of the leg. Coverage of soft-tissue defects of the ankle and foot is often challenging. The distally based sural fascio-cutaneous flap is useful for reconstructing the lower leg, ankle, heel, and foot but has rarely been evaluated in paediatric patients. The objectives of this study were to assess the reliability of this flap in children, to get a global experience with the sural flap in our department of plastic and reconstructive pediatric surgery, and to describe the complications. Material and methods: A distally based sural fascio-cutaneous flap was used to cover soft-tissue defects of the ankle and foot in 5 paediatric patients between 2018 and 2021. The median age of patient at surgery was 6 years old. The most frequent mechanism of soft tissue defect was trauma caused by vehicular accident (open fractures) crush injuries, lacerated wound. Results: One of the 5 flaps was a cross leg sural flap, 4 recovered well without necrosis, only one developed partial necrosis requiring excision and skin grafting. The other complications where an early postoperative complications: partial or total necrosis of the flap late complications including impaired touch sensation over the flap and donorsite. Discussion: The distally based sural fascio-cutaneous flap is a method of choice for covering soft-tissue defects of the ankle and foot in paediatric patients. This reliable flap spares the major blood vessels and has a good blood supply. When there is exposure of a vital structure, distal sural flap is the best indication for coverage in a traumatic soft-tissue defect. The use of a distally based sural fascio cutaneous flap is not free from delayed complications most of them at the donor site.

Facial Artery Musculomucosal Flap Operative Techniques.

Regional flaps are an important component of the reconstructive ladder and represent a versatile option in reconstructing various oral cavity defects. An axial buccal flap based on the facial artery, the facial artery musculomucosal flap, was first described by Pribaz et al. and has been shown to have good functional outcomes with minimal morbidity. Indeed, other surgeons have praised its favorable arc of rotation, reliability, and role as an alternative to free tissue transfer, with shorter duration of general anesthesia and allowance for earlier postoperative mobilization. The facial artery musculomucosal flap has significant versatility, as it can be superiorly or inferiorly based and can be performed in either single- or two-stage fashion. It is of particular advantage for reconstruction of the oral cavity (retromolar trigone, hard palate, alveolar ridge, lip, tongue, and floor of mouth), oropharynx (tongue base, lateral pharynx, and soft palate), and sinonasal structures. Despite its advantages, its widespread use has been limited by a lack of familiarity and difficulty in safely raising a reliable flap consistently. The senior author (S.C.D.) has successfully utilized a high volume of facial artery musculomucosal flaps with a low complication rate in a broad array of oral cavity and oropharyngeal defects. In this article, the authors share technical details on how to harvest and inset this flap by incorporating key landmarks in a reliable fashion.

Reliability of Perforator-based UPM Flap for Coverage of Little Finger and Dorsal Hand Defect

Background:There are different approaches for reconstruction of little finger and dorsal hand defects. The ulnar parametacarpal flap, first introduced by Backhach et al in 1995, is considered a good option for reconstructing such defects. In this study, we elevated this flap on one perforator and applied it as a propeller flap. We then discussed the reliability of this flap and which perforator (the proximal or the distal one) is more reliable.Methods:This study was carried out on 20 patients with different little finger and dorsal hand defects between June 2017 and March 2019. All defects were covered by perforator-based ulnar parametacarpal flaps. Ten flaps were based on the proximal perforator, whereas the other 10 were based on the distal perforator.Results:With a period of follow-up ranging from 6 months to 1 year, all flaps that were raised on the proximal perforator survived completely, whereas two of 10 flaps raised on the distal perforator showed venous congestion and also one flap showed partial necrosis of the distal one-third due to ischemia.Conclusions:The perforator based ulnar parametacarpal flap is a reliable option for reconstruction of little finger and dorsal hand defects. It is more reliable when it is raised on the proximal perforator rather than on the distal one.

The reliability of submental flap for soft tissue reconstruction in patients with carcinoma of the oral cavity

Background: The submental island flap (SIF) has gained popularity as a reliable option for reconstruction of the defects of the oral cavity following cancer resection. Advantages include reliable axial vascular pedicle, low donor site morbidity, good functional and cosmetic outcome, shorter operative time and lower cost compared to free flap reconstruction.

Novel use of Pedicled Medial Sural Artery Perforator flap for Post Burn Knee Contractures

<br><b>Background:</b> Postburn flexion contractures of the knee may arise even with adequate treatment of the burn injury. Pedicled medial sural artery perforator (MSAP) flap has been described for the reconstruction of defects of the knee and proximal third of the leg. Its use in the management of postburn contracture release is sparse. We are presenting the use of a medial sural artery pedicled flap for the reconstruction following postburn knee contracture release. <b>Materials and Methods:</b> This study included six patients with postburn unstable scars and a mild degree of knee contractures who underwent release of the contracture and coverage using MSAP pedicled flap. The results in terms of flap size, recurrence, complications, functional outcome, and cosmesis were assessed. <b>Results:</b> The flap size ranged from 7 cm × 6 cm to 13 cm × 7 cm with a mean pedicle length of 9.41 cm. All six flaps survived without any complications with a satisfactory outcome. The patients were followed up for 6–18 months. There was no recurrence of contracture without any restriction of knee joint mobility. <b>Conclusion:</b> MSAP flap is a reliable flap and should be considered for the management of postburn knee contracture of grade 2 and grade 3 contractures, as it provides optimum and ideal coverage with fewer chances of recurrence.<br>

Distally Based Peroneus Brevis Muscle Flap for Soft Tissue Reconstruction in Lower Third of Leg: A Case Series

Covering soft tissue defects in the distal part of leg and ankle is difficult. Most of the flaps used in reconstructing these defects are bulky and aesthetically unpleasing. The peroneus brevis muscle flap is ideal for covering these defects and providing an aesthetically better outcome. Peroneus brevis is a muscle located in the lateral compartment of the leg. It can be used for covering defects over the ankle and distal part of the leg without causing loss of function. This study was done to assess the surgical technique and clinical outcomes in the use of this muscle flap. This case series presents the authors’ experience of six cases of distally based peroneus brevis muscle flap. Three of the six patients were found to have superficial flap necrosis. Two of these three was treated with debridement and Split Skin Grafting (SSG) while one was managed conservatively with daily dressings. This flap is simple, easy to rise and useful in covering small defects of 3-4 cm width in the distal part of the leg and ankle. The donor site to be closed primarily leaving behind only a thin linear scar. Overtime the flap thins down and gives good cosmetic results. Donor site morbidity is minimal as the peroneus longus muscle is preserved and thus the function of the foot (plantar flexion and foot eversion) is intact. The distally based peroneus brevis flap is a reliable flap for covering defects over the distal one third of the leg, the upper half of the medial and lateral malleoli and the posterior aspect of the heel.

Interest of the McGregor flap in covering loss of substance in the forearm: About a case and review of the literature

The McGregor flap is a remotely pedicled “axial” inguinal flap. This is a very reliable flap for coverage of major upper limb substance loss, even if its major drawback is that it requires two operations. It remains a flap of choice in the therapeutic arsenal of hand and forearm surgery, in emergency or scheduled surgery. Tissue loss has always been a challenge for reconstructive surgeons. We report a case of loss of substance of the posterior surface of the forearm following a road traffic accident, treated with a McGregor flap with good results.

An Upper Airway Obstruction by Dieffenbachia: A Case Report

The inguinal flap is a remotely pedunculated "axial" flap. This is a very reliable flap for coverage of major upper limb soft tissue loss. It remains a flap of choice in the therapeutic arsenal of upper limb surgery, in emergency and deferred surgery [1-3]. McGregor in 1972 made the first description of this flap which depends on a constant vascular system [4]. The indication for this flap depends on the location of the area of soft tissue loss. It finds its place in the back of the hand and the forearm [5-7]. We report in this context the case of a 70-year-old female patient, who was referred to us from a provincial hospital for the management of cutaneous post-traumatic defect in the posteroexternal region of the right forearm. For the cover, we opted, given its simplicity and reliability, for an inguinal flap with a completely favorable post-operative evolution

Couverture d’une prothèse de hanche infectée par un lambeau perforant épigastique inférieur profond pédiculé

The deep inferior epigastric perforator (DIEP) flap is a reliable flap mostly used in skin resurfacing after signifiant resection for sarcoma or correction contour deformities. This case is about a pedicled DIEP flap covering the trochanteric region after a total hip arthroplasty infection. A 62years old woman with a BMI at 42kg/m2 presents an infected total hip arthroplasty with a cutaneous defect. The hip prosthesis is changed and covered with a pedicled DIEP flap. This original case reports the used of pedicled DIEP flap in hip coverage. This local fasciocutaneous flap covered the hip osteoarticular infection. The limb is salved and the patient can walked again. The success of this surgery is the collaboration between infectious disease specialist, orthopedic surgeon and plastic surgeon.

The use of the dorsal metacarpal artery for reconstruction of distal dorsal finger defects: an anatomic study and clinical experience

Purpose: Dorsal metacarpal artery (DMA) flaps have been used successfully for distal dorsal finger defects. Some studies have reported inconsistent DMA anatomy, and there have been no studies on the anatomic variation of DMAs in Asian cadavers. Therefore, we evaluated the anatomy of DMA using Korean fresh cadavers and reported the clinical outcomes of the DMA flaps.Methods: In the cadaver study, four human forearms from adult fresh cadavers were dissected. The dorsal metacarpal arteries and their communicating branches were identified. From July 2016 to June 2019, five patients with dorsal finger defects underwent a first DMA (FDMA) flap or a reversed DMA (RDMA) flap.Results: In our cadaver study, the ulnar branch of the FDMA and the second and third DMAs were absent in two of four (50%) of the cadavers. In our case series, five flaps survived, and one had partial necrosis, which healed by the second intention. The mean operation time was approximately 100 minutes, and the mean outpatient follow-up period was 6 months.Conclusion: DMA flaps are a reliable flap for the reconstruction of relatively large soft tissue defects of the dorsal finger. However, in our anatomical study, inconsistency of the anatomy of DMAs was identified. Therefore, preoperative Doppler examination is required to evaluate the anatomy of the DMA before considering the use of DMA flaps.

Pedicled Anterolateral Thigh Flap As A Workhourse Flap for Reconstruction of Inguino-Scrotal Defects

Background: Reconstructions around inguinoscrotal region has been a challenging task owing to complex anatomy. There are variety of flap options available for reconstruction of Inguinoscrotal region. Our study was done to evaluate the use of pedicled anterolateral thigh flap for reconstruction of defects around inguinoscrotal regions. Methodology: In this study a total of 18 patients with various types of defects around inguinoscrotal region were evaluated. The etiology of defects included trauma (𝑛=6), infection (𝑛=8), malignancy (𝑛=2) and burn (𝑛=2). Patients were evaluated in terms of viability of the flap, number of perforators included, pedicled length and flap dimensions and donor site morbidity. Results: All flaps were survived well except 1 flap develop venous congestion in immediate post operative period due to tension over vascular pedicle which was managed by increasing pedicle length. 2 patients had developed partial loss of the skin graft at the donor site which got healed secondarily in due course. All patients were followed up for an average period of 6 months, ranging from 1 to 12 months. Donor site morbidity was minimal. Conclusion: Pedicled ALT flap is a versatile, reliable flap, with wide arc of rotation which makes it as an ideal flap for the coverage of defects around inguinoscrotal region.

English

BACKGROUND The maxillofacial region has several congenital and acquired defects. Because of its abundant blood supply and proximity to different intraoral abnormalities, the buccal fat pad flap (BFP) is a simple and reliable flap that can be used to repair a variety of these abnormalities. BFP has remarkable qualities as a scaffold and autogenous dressing in the healing of intraoral defects after excision of oral cavity intraoral lesions. Filling and allowing slippage of fascial spaces between muscles of facial expression, advancement of intermuscular motion, isolating mastication muscles from one another, counteracting negative pressure during suction in the newborn, protection and cushioning of neurovascular bundles from injuries are among the functions of BFP. It also has a dense venous network that facilitates exoendocranial blood flow via the pterygoid plexus. For many years, the BFP was considered a surgical annoyance due to its incidental encounter during various surgeries in the pterygomaxillary space or following injuries to the craniofacial region. However, various clinical applications of BFP have been introduced in recent years. We looked at BFP and its anatomical foundation, surgical procedures, and clinical applications in this review article. The surgical method is easy and effective in a wide range of clinical situations, including oroantral fistula closure, congenital defect rectification, Osteoradionecrosis treatment, and reconstruction of tumor or cyst defect. Thus BFP is a dependable flap that may be used in a variety of therapeutic conditions. KEY WORDS Buccal Fat Pad Flap; Oral Mucosa; Reconstruction; Defect.

The external pudendal artery free flap in women: Anatomical study of a novel flap for buccopharyngeal reconstruction

BackgroundBecause of the widespread and high reliability of free flaps in head and neck reconstruction, the challenge today is to reduce donor site morbidity. The external pudendal artery (EPA) free flap has been described in men and provides a minimal functional and cosmetic impact. This study aimed to assess the feasibility of the EPA free flap in women for buccopharyngeal reconstruction. MethodsA dissection of the inguinal region was performed bilaterally on fresh female cadavers. The anatomy of the EPA and its angiosome were described, along with the design of the EPA free flap. A computed tomography angiographic study of the flap perfusion was performed. ResultsFourteen cadavers were dissected. The EPA was constant. Its diameter ranged from 1.12 to 2.96 mm (median 2.0 mm). The mean area of its angiosome was 167.3 ± 38.5 cm2. An axial fasciocutaneous flap was designed with a horizontal skin paddle measuring on average 9.2 × 6 cm and a pedicle length of 8.4 ± 1.9 cm. The mean flap thickness was 11.7 ± 6.8 mm and depended on individual factors. A primary closure was achieved in all cases with a scar hidden in the underwear. ConclusionsThis anatomical study demonstrates that the EPA seems constant despite variations in its origin pattern. Its diameter and angiosome allow the design of an EPA free flap in women. A clinical study should confirm that this flap is suitable for the repair of buccopharyngeal defects and could be added to the armamentarium of the head and neck reconstructive surgeon.

English

BACKGROUND Sacrococcygeal pilonidal sinus disease is defined as a hair-filled cavity in the subcutaneous fat of the natal cleft (postsacral intergluteal region). This study was done to investigate the prevalence, clinical presentation, body mass index (BMI) as a risk factor; and complications of Limberg flap and Z-plasty, for the reconstruction of defects after excision of sacrococcygeal pilonidal sinus in terms of the incidence of seroma, wound infection, wound dehiscence, flap necrosis, recurrence, duration of hospital stay and time taken for complete wound healing after the procedure. METHODS This was a prospective study done on 50 patients from January 2018 to October 2020 at a tertiary care hospital in 15 to 50 years of age group presenting with pilonidal sinus disease. Statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Significance was assessed at 5 %. RESULTS The mean age of presentation was 25 years with chief complains of swelling, discharge and pain, the mean BMI was 24.39 kg/m2 . Anaerobic infection is more common in the sinus (40 %), and among aerobic organisms, Staphylococcus was the most common organism (19 %). In Limberg flap closure, only one 1 developed wound infection and this same patient had partial wound dehiscence, while in Zplasty group, 3 developed seroma, 2 wound infections and 2 partial flap ischemia. CONCLUSIONS The goals of management of pilonidal sinus diseases include conservative management along with definitive surgical treatment of the disease. Pilonidal abscess is managed by incision and drainage and is followed by definitive treatment, later on. Flap procedures are effective ways to treat the disease, of which Limberg flap is the most reliable flap with minimum complications, lesser hospital stay and faster wound healing. KEYWORDS Pilonidal Sinus, Limberg Flap, Z-Plasty

Inferiorly Based Nasolabial Flap: A Reliable Option for Oral and Maxillofacial Reconstruction.

Abstract Introduction: Reconstruction of defects in the maxillofacial region can be challenging. Anatomy, location and size of the defect are major determinants of type of flap that could be used whether local, regional or distant. Nasolabial flap is one of the local flaps that can be used for reconstructing small to moderate size soft tissue defects, especially when microsurgical free flaps are less feasible due to lack of infrastructure, expertise or financial constraints. Aims and Objectives: To study the effectiveness of the nasolabial flaps in reconstruction of orofacial defects of various origins. Materials and Methods: A prospective study was conducted on 37 patients (49 nasolabial flaps) 25 unilateral flaps & 12 bilateral flaps. Of these, 30 patients had reconstruction following oncological resection. All flaps were inferiorly based, and 36 flaps required a second stage for separation after 3 weeks. Patients were evaluated for postoperative complications, flap uptake, donor site morbidity, postoperative extraoral scarring and patient’s satisfaction. Results: Good results in form of function and cosmesis were obtained in most of patients. Postoperative complications were relatively minor as tip of flap necrosis, and oro-cutaneous fistula. The average time taken for flap harvesting was 43 minutes for bilateral nasolabial flaps and 27 minutes for unilateral ones. Conclusion: The nasolabial flap is a simple and reliable flap that can be used in reconstruction of small to moderate sized defects in orofacial region with good cosmetics and functional outcomes.

Tibial nailing in a lateral decubitus position facilitates simultaneous harvest of scapular flaps for single stage definitive orthoplastic management

Abstract Open tibial fractures can be challenging to manage because of the paucity of soft tissue available locally to cover any wound post debridement. They commonly require both skeletal stabilisation and complex soft tissue reconstruction. This combined approach to manage open tibia fractures is the foundation upon which orthoplastic care is based. The optimal method of managing these patients is to perform a debridement on day one and then a combined “fix and flap” procedure no more than 7 days later. We present three patients who underwent suprapatella tibial nailing in a lateral position purely to facilitate ease of access to the back so scapular and para-scapular flap could be harvested. These flaps are usually pliable, conformable and hair free with a reliable, long and large calibre pedicle which allows a relatively rapid flap harvest. To use scapular flaps the plastic surgery surgeons would have to wait for the orthopaedic surgeons to complete supine tibial nailing prior to commencing flap harvest. For a “fix and flap” procedure, this could mean performing microsurgical anastomosis late in the evening when surgeons may be tired. Therefore, other flaps with less reliable pedicles were used. Stabilising open tibial fractures that require intramedullary tibial nailing and a free flap in a lateral position promotes orthoplastic teamwork. It facilitates the harvesting of a relatively straightforward flap in a time efficient manner as both surgical teams can operate simultaneously. This increases surgical efficiency, promotes orthoplastic teamwork and utilises a more reliable flap giving the best chance of recovery for these complex injuries.

Vein preservation strategies to improve the survival rate of the infrahyoid musculocutaneous flap.

The infrahyoid musculocutaneous flap (IHMCF) is a good alternative in the reconstruction of moderate‐sized oral cavity surgical defects. Insufficient venous drainage can significantly affect the survival rate of this flap.ObjectivesIdentify the survival rates of the IHMCF and evaluate the functional capacity of reconstructed patients.DesignWe report a case series.SettingThis study took place at the Department of Head and Neck Surgery of Oncology Hospital Ho Chi Minh City, the largest oncology center in South Vietnam.ParticipantsOne hundred and twelve patients with surgical defects after oral cavity resection for cancer underwent IHMCF reconstruction from November 2013 to November 2018. During the harvest of the flap, our modification of the surgical technique specifically attempted to preserve more secondary veins for IHMCF.Main Outcome MeasuresPostoperative viability of the flap was checked by clinical observation. The last examination was performed at 3‐months after reconstructive operation or after the completion of adjuvant radiotherapy. The functional capacity of our patients was evaluated by three physicians (Head and Neck Surgeon, Radiation Oncologist, and Physiatrist) with understandability of speech scale and the functional oral intake score items assessed.ResultsTwo cases of partial skin necrosis (1.8%) were experienced. The majority of patients demonstrated favorable functional rehabilitation at long‐term follow up.ConclusionsThe IHMCF is a reliable flap suitable for moderate‐sized defects of the oral cavity. Altering the surgical approach to specifically preserve more venous outflow can improve the survival rate of the flap.Level of Evidence4.

Locoregional Flap Reconstruction Following Oromaxillofacial Oncologic Surgery in Dogs and Cats: A Review and Decisional Algorithm.

Primary treatment of most oromaxillofacial tumors in dogs and cats is resective surgery. Management of malignant tumors may be very challenging as wide/radical free-margin surgical removal must be achieved while preserving vital functions. Removal of orofacial tumors may result in large defects exposing the oral cavity or creating a communication with the nasal, pharyngeal, or orbital cavities. Such defects require orofacial reconstruction in order to restore respiratory and manducatory functions. The veterinary surgeon must be familiar with reconstructive techniques in order to prevent the inability of closing the defect, which could lead to an insufficient resection. Small oral defects exposing the nasal cavity are best closed with local random mucosal flaps. Closure of large oral defects may be better achieved with a facial or major palatine-based axial-pattern flap. Small to moderate facial defects can be closed with local advancement or transposition skin flaps. Reconstruction of large facial defects often requires the use of locoregional axial pattern flaps such as the caudal auricular, the superficial temporal, or the facial (angularis oris) myocutaneous axial pattern flaps. Recent publications have shown that the facial (angularis oris) flap is a very versatile and reliable flap in orofacial reconstructive surgery. A surgical decision algorithm based on the size, nature, and location of the defect is proposed.