Reverse Flap Research Articles

Repair of skin defects of the fingers with dorsal reverse island neurocutaneous flaps from the hand and finger

Objective To evaluate the treatment outcome of using dorsal reverse island neurocutaneous flaps from dorsum of the hand or finger for repair of finger skin defects. Methods Eighteen reverse island flaps (in 18 cases) pedicled on the nutritional vessels of dorsal metacarpal cutaneous nerve and 17 reverse island flaps (in 15 cases) pedicled on the nutritional vessels of dorsal branch of the proper digital nerve were used to repair skin defects of the fingers. The survival rate, texture, colour, and sensation of the flaps were observed.Results Swelling of the flap occurred in 2 cases, while venous crisis was seen in 2 cases. All 35 flaps of the 33 eases survived. Postoperative follow up period ranged from 3 to 18 months, with an average of 12 months. The appearance, texture and elasticity of the flaps were good. Partial recovery of light touch was observed.Conclusion Harvest of dorsal reverse island neurocutaneous flap does not sacrifice major vessels and nerves.The operation is simple. It is an ideal method for repairing soft tissue defects of the finger. Key words: Finger injuries; Surgical procedures, operative; Island flaps

Treatment for soft tissue defect combined with infection in the knee and upper leg used reverse anterolateral thigh flap or musculocutaneous flap.

Objective To investigate the clinical effect of reverse anterolateral thigh flap with lateral superior genicular artery or musculocutaneous flap for treating soft tissue defect combined with infection in the knee and upper leg. Methods From March 2007 to March 2008, 11 patients with soft tissue defect combined with infection in the knee and upper leg were treated in our hospital. There were 8 males, 3 fe-males, with the mean age of 33.4 years (range, 23-65 years), left thigh for 7 patients and right thigh for 4 patients. The course of disease was ranged for 6 hours to 8 months. One patient was caused by a open injury leading to skin and soft tissue defect in the anteroinferior knee combined with the fracture of tibial plateau, and was treated with debridement, internal fixation and transferring flap; ten patients were caused by the chronics infection with skin and soft tissue defect, and were treated with transferring anterolateral thigh flap later after treating with anti-infection, debridement and drainage. The injury area ranged from 6.3 cm×3.0 cm to 12 cm×7 cm. Results All patients were followed up for 3 to 6 months, with the average 4.7 months. All the flaps kept alive after operation. Three cases were debrided again in the followed 1-2 weeks because of the unhealing borderline of the flaps. Nine cases were sutured without need for skin graft, 2 cases had partial skin graft. No infection and necrosis were found in all flaps and the flaps were all alive after 3 months fol-low-up. The knee joints of all patients had a good motion. Conclusion The soft tissue defect combined with infection in the knee and upper leg can be treated with reverse anterolateral thigh flap, after controlling in-fection successfully. The flaps were thin and easy to alive, the musculocutaneous flaps can obturate the space and anti-infection. This method can reduce the operative trauma especially without need for the skin graft and get a good effect. Key words: Surgical flaps; Soft tissue injuries; Infection

The reverse posterior interosseous flap and its composite flap: Experience with 201 flaps

The reverse posterior interosseous flap and its composite flap: Experience with 201 flaps

Defects of fore foot repaired by reverse medial dorsal neurocutaneous flap of foot in emergency

Objective To investigate the possibility of repairing the defects of fore foot by reverse medial dorsal neurocutaneous flap on foot in emergency.Methods Flap was designed along medial dorsal cutaneous nerve of foot,the axis of the medial branch was the line between lateral part of malleolar middle point and medial part of first metatarsophalangeal joint,and the axis of the lateral branch was the line between middle point of two malleolars and the tip of the great toe webspace,the pedicle located on the distant part of the foot.Based on the size of wound,the flap was cut off from the deep fascia layer,and medial dorsal cutaneous nerve of foot was anastomosed with nerve of digitales plantares proprii.All patients were operated in emergency.Results Eleven patients with defect of fore foot were perfectively recovered and all the wounds healed primarily.The appearances and functions of the foots were satisfactory,with two point sensation of 2-3 cm after 6-11 months postoperatively and without any skin fester.Conclusion Medial dorsal cutaneous nerve of foot has advantages as follows:simply procedures,avoidance of sacrificing major arteries,less harm to donor area,good recovery of sensation.So it is a good method to repair tissue defects of fore foot. Key words: Medial dorsal cutaneous nerve of foot; Surgical flaps; Transplantation; Microsurgery

Are Reverse Flow Fasciocutaneous Flaps an Appropriate Option for the Reconstruction of Severe Postburn Lower Extremity Contractures?

Full thickness burns involving the lower extremity can result in severe contractures, which impair extremity functions if they are not managed with proper treatment and rehabilitation. After release of postburn contracture of the knee, ankle, and metatarsophalangeal joints, defects often require coverage by flaps. Twelve distally based reverse flow flaps were performed for lower-extremity reconstruction after release of postburn flexion contractures. All of the patients were male and their age ranged from 20 to 23 years, with a mean age of 21. After the release of the contractures, 3 flaps were used based on the location of the contractures. The reverse flow anterolateral thigh flap was used for knee reconstruction (n = 4, 33%). The reverse flow sural flap was used for ankle reconstruction (n = 4, 33%), and the reverse flow medial plantar flap was used for metatarsophalangeal reconstruction (n = 4, 33%). The sizes of the flap varied from 2 to 17 cm wide and 3 to 18 cm in length. All defects were covered successfully. Reverse fasciocutaneous tissue transfer to reconstruct the soft tissue defects provide early motion. Sufficient contracture release is achieved without displacement of anatomic landmarks. The reverse-flow flap is a reasonable and reliable choice for each joint level in the lower extremity.

Reconstruction of the first web space in severely burned hand by the reverse posterior interosseous flap

First web space widening is crucial in the reconstruction of severe thermal burn contracture of the hand. A thin, pliable flap with a long vascular pedicle is required. We describe our experience with the reversed posterior interosseous artery flap in nine patients over a 5-year period for this surgical indication. All flaps survived and we were able to achieve good functional and cosmetic outcomes with minimal donor morbidity. We believe that the reversed posterior interosseous flap is the excellent option for the first web space reconstruction.

Left Upper Limb Shortening following Reverse Flap Subclavian Artery Angioplasty

Left Upper Limb Shortening following Reverse Flap Subclavian Artery Angioplasty

Reverse dorsolateral proximal phalangeal island flap: a new versatile technique for coverage of finger defects

All flaps described for the reconstruction of finger defects have limited indications and many disadvantages. In this study, I successfully developed a reverse digital artery flap raised from the overall side and dorsal aspects of the proximal phalanx, excluding the digital nerve, for closure of fingertip and middle phalangeal defects, and called this the 'reverse dorsolateral proximal phalangeal island flap'. The donor site defect was covered by another flap called the 'dorsal metacarpal V-Y island flap'. The method was used for 12 complicated phalangeal defects in 11 patients. Flap sizes ranged from 2 x 1.5 cm to 3 x 2.5cm. The flap was applied with versatile designs including distal interphalangeal (DIP) (9) or proximal interphalangeal (PIP) anastomoses-based flaps (3); homodigital (10) or heterodigital flaps (2) from the injuries or adjacent finger, respectively; multiple flaps from the two distinct fingers in the same hand (1); and a sensate flap (1). The average follow-up time was 11.5 months. All reverse flaps and V-Y donor site flaps survived completely. Finger lengths and motions were satisfactory with favourable aesthetic results in all cases. The mean value of static two-point discrimination was 9.3mm. I strongly advocate this new flap, as a single versatile flap, for repair of different-sized or complex phalangeal defects. By means of this 'dual-flap manoeuvre', any defect distal to the PIP joint in various dimensions can safely be covered without using a skin graft in the donor area. I also suggest the dorsal metacarpal V-Y island flap alone for dorsal phalangeal defects proximal to this point.

Aesthetic Abdominal and Breast Reconstruction with Reverse Lateral Thoracodorsal Flap

Aesthetic Abdominal and Breast Reconstruction with Reverse Lateral Thoracodorsal Flap

The simple modification of the reverse Karapandzic flap for reconstructing the subtotal upper lip including the columellar defect: a case report

Reconstruction of the subtotal upper lip with a columellar defect is still a problem for reconstructive surgeons. Various techniques have been reported for this purpose. Each technique has its own drawbacks, and few can be performed in one stage. Although Karapandzic describes the standard procedure that functionally reconstructs large defects in the upper and lower lip, the Karapandzic flap is not sufficient for the columellar defects. It is a simple and safe technique; results are satisfactory, functional, and aesthetically well tolerated, sacrifice less tissue, and are effective for repairing defects. We report a 74-year-old male who presented with a large, fungating, pus-discharging ulcerative mass on his upper lip including the columella. Biopsy results confirmed squamous cell carcinoma. The tumor was excised and defects were reconstructed using a simple modification of the Karapandzic flap. This modification of the Karapandzic flap provides adequate tissue for the subtotal upper lip defect including the columellar defect.

A Free Reverse Preauricular Flap for Reconstruction of a Nasal Defect

A Free Reverse Preauricular Flap for Reconstruction of a Nasal Defect

The reverse sural artery neurocutaneous flap under combined sciatic and femoral nerve block for lower limb defects: a series of ten cases

The case of reverse sural artery neurocutaneous flap done for lower leg defects under combined sciatic and femoral nerve block is presented. Doing the flap using this method of anesthesia makes the positioning changes necessary during surgery easy. All flaps survived. Nine out of the ten blocks acted satisfactorily. The technique of giving the combined block is described in brief. The mean time of onset of action was 16.62 min, and the mean duration of action was 6.26 h using 1% Lidocaine with 1 in 200,000 adrenaline.

Posterior interosseous reverse flap

Losses of skin substance of the dorsal face of the hand occasionally justify resorting to cover flaps when the noble elements (bones, tendons) are whether damaged or exposed. Few flaps allow filling in these losses of substance. Among those, which do, posterior interosseous reverse flap is indicated in some cases. We will present the technique and the main indications for the posterior interosseous flap. It is an island flap receiving reverse-flow vascularisation by the posterior interosseous artery. This flap is harvested from the second proximal quarter of a line extending from the lateral epicondyle of humerus to the ulnar head. The antebrachial fascia is incised longitudinally on the ulnar extensor of wrist and digiti minimi. The cutaneous flap is raised from radial to ulnar while sectioning the different intermuscular septa. Only the septum dividing the digiti minimi and ulnar extensor of wrist is preserved because it contains the pedicle. Once the main pedicle is identified, the skin paddle can be raised from proximal to distal. Then the septum holding the pedicle is detached from the ulna through to the distal radio-ulnar articulation, level with the bone surface. This flap is appropriate for losses of skin substance of the dorsal face of the hand extending to the first phalanxes and the first commissure. It can also be used to cover the anterior face of the wrist and is perfectly suited for retraction of the first commissure. Contrarily to the Chinese and ulnar flaps, it does not cause any damage to any significant arterial axis. Its main drawback is the scar on the donor site, which is often unsightly, while in the child; direct closure is possible in most cases.

The “Central” Approach for Single-Stage Debulking of the Reverse Sural Artery Fasciomusculocutaneous Flap

The "central" approach for single-stage debulking of the reverse sural artery fasciomusculocutaneous flap is described. A "central" incision is made along the longitudinal axis of the flap, and the skin is completely elevated up to the edges of the flap. The technique was used in 20 consecutive cases and primary wound healing was noted in all patients. The technique has several advantages such as providing wide exposure and single-stage debulking of large flaps without the risk of vascular compromise. The only disadvantage is the extra scar in the middle of the flap.

Reverse latissimus dorsi musculocutaneous flap for reconstruction of lumbar radiation ulcer

The surgical treatment of large, deep defects on the midline of the lower back or lumbar area comprises difficult reconstructive challenges. Various flaps have been designed to reconstruct the defect area. We herein report a 70-year-old Japanese woman with a large, deep ulcer in the midline of the lower back, caused by postoperative radiation therapy for eccrine porocarcinoma. The ulcer was successfully treated with surgical debridement followed by reverse latissimus dorsi musculocutaneous flap. This flap is reliable and useful for reconstruction of a large, deep midline defect of the lower back, having large and bulky tissue with a sufficient blood supply.

A-0253 14.1 Homodigital innervated reverse flaps for extensive pulp loss

A-0253 14.1 Homodigital innervated reverse flaps for extensive pulp loss

Reverse Second Dorsal Metacarpal Artery Flap for Reconstruction of Fourth-Degree Burn Wounds of the Hand

We sought to show how severe soft-tissue injuries of the proximal index finger caused by fourth-degree electrical burns to the hand may be surgically reconstructed. Soft-tissue coverage was provided with a reverse second dorsal metacarpal artery flap in two patients. Both digits were successfully salvaged by use of this reconstructive method. Both donor sites were closed primarily and healed without difficulty. The reverse second dorsal metacarpal artery flap provides well-vascularized tissue without excess bulk and allows near-normal hand function.

Management of an Unusual Extreme Extension Contracture of an Index Finger: A Custom-Designed Exercise Program in Achieving a Good Range of Movement and Prevention of Recontraction with the Reverse Fasciocutaneous Forearm Flap and Full-Thickness Skin Graft

Management of an Unusual Extreme Extension Contracture of an Index Finger: A Custom-Designed Exercise Program in Achieving a Good Range of Movement and Prevention of Recontraction with the Reverse Fasciocutaneous Forearm Flap and Full-Thickness Skin Graft

Outcome Evaluation of Skin-Grafted Free Muscle Flap versus Reverse Sural Fasciocutaneous Flap in Soft Tissue Reconstruction of Weight-Bearing Heel

There were eighteen patients received soft tissue reconstruction of weight-bearing heel at our institution in past 10 years. Eleven patients received skin-grafted free muscle flaps and seven received reverse sural fasciocutaneous flaps. The etiology of the wounds were osteomyelitis (55.6%), necrotizing fasciitis (11.1%), trauma (11.1%) and tumor resection (11.1%). The patients who received free muscle flap surgery were younger (average 45.2 y/o), had much larger wound size (12.4x 6.6cm^2) longer operative time, and less hospital days. The complication rate was comparable between these two modalities. They all achieved a considerable successful rate and limb salvage rate. The muscle flap group presented as higher percentage in resuming walking and working. It also had better functional score but higher chance of chronic ulcer. In consideration of weight-bearing heel reconstruction, the skin-grafted muscle flap seems to be the first choice. In elder patient or patient who is not suitable for long operative time, reverse sural fasciocutaneous flap is probably an alternative with acceptable successful rate but less functional result is expected.

Reverse digital flaps pedicled with distal arterial branches to repair fingertip defects

目的 探讨指动脉终末分支皮瓣在临床指端修复中的可行性及相关手术指征.方法 2001年11月～2006年3月,以指固有动脉向指背侧的终末分支和向指掌侧的终末分支为蒂,设计中节指背侧的逆行皮瓣(16例16指)和中节指掌侧的逆行皮瓣(14例15指),对因切割伤、挤压伤、撕拉伤造成的指端软组织缺损进行覆盖修复.指背侧皮瓣面积为(1.0～1.7)cm×(2.0～2.8)cm,指掌侧皮瓣面积为(1.0～1.5)cm ×(2.0～2.5)cm.供皮瓣区皮片移植.结果 本组30例31指获2周～4个月随访.指背侧逆行皮瓣全部成活;指掌侧逆行皮瓣1例坏死,1例部分坏死,其余皮瓣成活.成活皮瓣二点辨别觉一般为7～10 mm,平均8 mm,疗效最好1例为3 mm.远指间关节伸屈活动无明显障碍.结论 指动脉终末分支皮瓣对有骨裸露或肌腱裸露的伤指创面覆盖良好,适合末节指横断创面、斜行创面的修复。