Rotation Advancement Flap Research Articles

Medially Based “Abdominal Rotation Advancement Flap”: A Promising Technique for Mastectomy Defect Reconstruction in “High-Risk Patients” Awaiting Adjuvant Radiotherapy

Abstract Background Extensive postmastectomy defects and soft-tissue defects often require some additional flap cover of reconstruction after excision. The reconstruction aim in this group should be a diligent and easy closure with a quality skin cover, early recovery, and brief stay in hospital so that the patients can receive early postoperative radiotherapy/chemotherapy. Medially based abdominal transposition flap is a type C fasciocutaneous flap based on medial perforating vessels. We present our experience in significant postmastectomy defects, especially in high-risk morbid patients. Materials and Methods This is a retrospective study conducted by the department of plastic surgery, from an analysis of the breast cancer database maintained by our hospital from 2019 to 2023. A total of 826 breast cancer patients underwent surgery, of which 547 were locally advanced breast cancer (LABC) patients and 138 (32.5%) LABC patients needed flap cover for mastectomy defect. Medially based abdominal transposition flap was used in 56 of 138 (40.5%) LABC patients for defect closure, and 42 of the 56 patients were stage IIIB patients. Upfront surgery was primarily done in 20 patients and 36 patients underwent surgery after neoadjuvant chemotherapy. This analysis aimed to assess the operative duration, postoperative morbidity, hospital stay, and time taken to start adjuvant treatment by analyzing the medical records of patients who underwent this procedure. Results Fifty-six patients with breast cancer underwent surgical intervention, whereby 8 patients presented with tip and edge necrosis, and 3 patients were infected. The mean duration of operation was 58.852 minutes, and the average length of hospital stay was 5.39 days. It took 24.57 days for the patients to stabilize sufficiently for adjuvant therapy. The average age of the patients in the study was 48.73 years. Conclusion Our clinical experience has demonstrated that the medial abdominal transposition fasciocutaneous (MATF) flap represents a straightforward, reliable, and cost-effective method for managing extensive postmastectomy soft-tissue defects in a subset of patients with LABC. This group typically consists of high-risk and comorbid patients. The procedure holds considerable promise for developing countries with limited infrastructure and expertise, owing to its ease of execution and short learning curve. By its simplicity and affordability, the MATF flap offers a viable and sustainable solution for treating LABC-associated soft-tissue defects.

Multicenter Pattern of Cleft Surgeries and Factors Associated with Late Primary Cleft Surgery in Nigeria.

This study aimed to analyze multicenter patterns in cleft deformity surgeries and identify factors associated with the timing of primary cleft repair in Nigeria. A cross-sectional study of children managed for clefts from January 2009 to December 2020 at three Smile Train partner tertiary institutions situated in the east (Enugu), west (Ibadan), and northern (Jos) parts of the country using a prospectively collected database. Outcomes were the types of surgery performed, yearly volume of surgeries, methods of repair, and time of surgery (early versus late). Of 1043 cleft surgeries, nearly half (45.7%) involved infants (<12 months). Primary repairs of the lip or palate were performed in 83.4% of cases, with 58.4% for lip repairs and 25.1% for palate repairs. The most common cleft lip repair method was a variant of Millard rotation advancement flap. Over the study years, there was a shift from von Langenbeck palatoplasty to methods such as Bardach's palatoplasty and intravelar veloplasty. Patients with bilateral cleft lip defects were significantly more likely (P < 0.001) to undergo early repairs compared with those with unilateral defects. Late primary cleft lip repairs were significantly (P < 0.001) more common in Enugu. This study highlights the variability in cleft surgery patterns in Nigeria. Late primary cleft surgeries were associated with less severe cleft lip or cleft palate and were more prevalent in Enugu, Southeastern Nigeria. The findings contribute valuable insights for optimizing surgical approaches and resource allocation in the management of cleft deformities in the region.

Long-Term Comparison of Esthetic Outcomes Between Hatchet and Transposition Flaps in Facial-Defect Reconstruction.

Transposition flaps are commonly used for facial-defect repair after wide excision of skin cancers. However, such repair often causes excessive tension at the donor site that can result in distortion of the adjacent area. The hatchet flap, a rotation-advancement flap, can prevent distortion by redistributing the donor site tension evenly to the recipient site. This study aims to compare the esthetic outcomes of the hatchet flap and transposition flap in facial-defect reconstruction. We retrospectively included 50 patients who underwent facial reconstruction with the hatchet flap or transposition flap after excision of skin cancer. They were followed up for more than 6months. At the last follow-up visit, the esthetic outcome was evaluated by subjective and objective assessments using the patients and observer scar assessment scale and Manchester scar scale. Thirty patients and 20 patients underwent reconstruction using the hatchet flap and the transposition flap, respectively. The total score from the patient and observer scar assessment scale was significantly lower in the hatchet flap group compared with the transposition flap group (p = 0.009). The Manchester scar scale showed a total score of 7.67 ± 2.2 for the hatchet flap and 9.95 ± 1.99 for the transposition flap: in the color (p < 0.001), distortion (p < 0.001), and texture (p < 0.02) categories, the hatchet flap yielded significantly better outcomes than the transposition flap. The hatchet flap had good esthetic outcome for facial reconstruction and could be a valuable option for reconstructing facial defects. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

Evaluating Pedicled Pectoralis Major Myocutaneous Flap Reconstructions for Oral Malignancy and the Influence of Laterally Based Rotational Advancement Flap on Donor Site Integrity and Nipple Position in Male Patients.

Oral cancer poses a significant health burden, particularly in the male population of India. This study focuses on evaluating the outcomes of 48 pedicled Pectoralis major myocutaneous (PMMC) flap reconstructions in male patients with oral malignancy. Given the challenges associated with microvascular flap reconstructions, especially in advanced cancer cases, older patients, and resource-constrained settings, the PMMC flap still serves as a valuable alternative. The study introduces a novel approach by incorporating a laterally based rotational advancement flap (LBRA) to address donor site integrity and decrease the nipple-areolar complex (NAC) displacement. Traditionally, PMMC flap designs tend to cause inward shifting of the NAC during chest donor site closure, impacting the aesthetic outcome. Surgical techniques involved wide local resection, neck dissection, and PMMC flap reconstruction. The Flap design included a horizontal orientation with adjustments based on defect location. Additionally, a laterally based rotational flap from the chest aided in donor site closure. Results demonstrate the versatility and reliability of PMMC flap reconstructions, with no total flap necrosis or major complications observed in the 48 cases. The LBRA technique effectively mitigated NAC displacement. The study contributes to the existing literature by providing insights into the advantages of PMMC flap reconstructions and introducing a technique to optimize donor site closure and decrease the medial shifting of the nipple. The adaptability, reliable vascular supply, and simplified learning curve make the PMMC flap a preferred choice in resource-constrained settings with high patient demand. In conclusion, this research underscores the continued relevance and effectiveness of the PMMC flap in head and neck reconstruction, offering satisfactory cosmetic and functional results. The introduction of the LBRA technique adds a nuanced dimension to improve outcomes, particularly in male patients with oral malignancy.

Treatment for benign skin lesion in zygomatic-infraorbital region by the expanded multi-lobe cervicofacial advancement rotation flap in pediatric patients

PurposeBenign skin lesions in zygomatic-infraorbital regions severely influence pediatric patients’ appearance as well as mental health. Treatments are difficult for the high requirements of patients’ guardians in both function and aesthetics. The present study aims to introduce a surgical method, Expanded Multi-Lobe Cervicofacial Flap, which combines the advantages of the classical cervicofacial advancement rotation flap and the tissue expansion technique.MethodsA total of 21 pediatric patients were enrolled. The treatment process included 2 stages: implantation of the skin tissue expander and flap transfer. The excessive skin created by tissue expansion extended the coverage area of the multi-lobe flap.ResultsIn this retrospective study, follow-up periods were all more than 12 months (20.8 ± 6.7). In the last follow-ups, the flaps were all in good condition, and No facial organ displacement was observed. The patients’ guardians were satisfied with the outcomes.ConclusionsUsing the expanded multi-lobe cervicofacial flap for the zygomatic-infraorbital benign skin lesion repair is effective, and this method is especially applicable to the pediatric population.

Surgical Management of Oro-Facial Clefts at a Tertiary Care Hospital in a Resource-Limited Setting: A Tanzanian Experience

Background: Orofacial clefts are the most common craniofacial anomalies in most parts of the world and its management remains a challenge to otorhinolaryngology, plastic/reconstructive, oral and maxillofacial surgeons practicing in resource limited countries. There is limited data on surgical management of these birth defects in Tanzania and Bugando Medical Centre (BMC) in particular. This study aimed to describe our own experience regarding the surgical management of orofacial clefts at BMC, a tertiary care hospital in Tanzania. Methods: This was a cross sectional study involving all children with orofacial clefts that were treated at BMC between February 2019 and June 2019. Results: A total of 98 patients with orofacial clefts were recruited. Males outnumbered males by a male to female ratio of 1.7:1. The majority of patients (64.3%) were within 12 months at presentation. The median ages at surgery in patients with cleft lip and those with cleft palate were 3 [IQR, 2 to 8] and 11(IQR, 7 to 18) months, respectively. Orofacial clefts in association with congenital anomalies were recorded in 5(5.1%) patients. More than half of patients (55.1%) had combined cleft lip and palate. Unilateral clefts, 77(78.5%) were more common and showed left side preponderance in 52(53.1%) patients. All patients underwent cleft surgery under general anesthesia. Millard rotation advancement flap repair and von-Langenbeck were the most common techniques of cleft lip and palate repair performed in 42(52.5%) and 30 (41.7%) patients, respectively. The overall complication rate was 14.3% and the most common postoperative complications were bleeding, palatal fistula, wound dehiscence and surgical site infections in 6(31.6%), 4(21.1%) and 3(15.8%) each respectively. No death was recorded in this study. Among the 98 patients operated, 79 were treated successfully giving an overall success rate of 80.6%. The success rate was significantly influenced by nutrition status (p= 0.010), co-existing con

Rhinoplasty with Concurrent Repair of Septal Perforation.

Concurrently performing septal perforation repair and rhinoplasty is challenging. Successful management of patients who require or desire these procedures performed simultaneously can be achieved with appropriate preoperative workup and optimization, thoughtful surgical planning, masterful execution, and diligent postoperative care. Consideration of perforation etiology and status of the perforation along with overall nasal health are the foundation upon which surgery may be planned. Preoperative evaluation to determine locations of obstruction, aesthetic goals, and feasibility of procedure is required. Rhinoplasty techniques and perforation closure techniques may share common maneuvers making concurrent surgery possible. Surgical techniques to achieve perforation closure often influence rhinoplasty considerations, and vice versa. Care must be taken to account and possibly even to capitalize on these influences. Perforation closure techniques that may be readily combined with rhinoplasty include interposition grafting and intranasal mucosal rotational advancement flaps, which may exert forces upon the nose with aesthetic or functional consequences. Rhinoplasty techniques targeting any third of the nose also can impact tension or available mucosa for perforation closure techniques. Combining these procedures can be very rewarding for the patient and provider but should be considered responsibly and thoughtfully.

Fingertip coverage with uni-pedicled volar rotational advancement flap with large Z-plasty: a report on 112 cases

BackgroundSimple and safe fingertip reconstruction methods involve the use of local neurovascular islands flaps that can preserve functional length and sensitivity, and reconstruction with skin of the same texture. However, techniques involving flaps have numerous drawbacks and do not satisfy all the requirements for fingertip reconstruction. A particular problem is the persistence of contracture deformity due to lack of full flap advancement. We present a new technique using uni-pedicled volar rotational advancement flap with large Z-plasty, and describe the results of long-term follow-up.MethodsFrom October 1993 to December 2009, 112 fingers of 98 patients were covered with uni-pedicled volar rotational advancement flap with large Z-plasty after sustaining various types of injuries or finger pulp avulsion. A longitudinal incision was made along the lateral border of the digit and a large neurovascular volar flap was elevated just above the pulleys and flexor tendon sheath. To release tension, a large Z-plasty was applied at the metacarpophalangeal joint or interphalangeal joint crease. The final patient outcomes were reviewed retrospectively.ResultsAll fingertip injuries were treated without flap necrosis. Partial wound dehiscence was observed in two patients and average static two-point discrimination was 5.2 mm. There were no postoperative contracture deformities, joint stiffness, paresthesia, or hypersensitivity. Most patients were left with acceptable scarring and were free of postoperative pain and cold intolerance during the long-term follow-up.ConclusionsOur novel technique provides durable, completely sensate, and well-vascularized coverage of the fingertip with minimal discomfort to patients.

Modified H-plasty in large basal cell carcinoma defect reconstruction on the forehead.

Basal cell carcinoma (BCC) is the most common malignancy worldwide. Surgical removal is considered the gold standard treatment. However, large defects following excisional surgery can pose a significant challenge for reconstruction, especially in cases where primary closure is not possible. In these cases, skin flaps may be used. Most traditional skin flaps are limited by design to take advantage of only one region of relative skin excess. This paper reports a case of a large forehead defect following BCC excision that was successfully reconstructed by a modified Hplasty involving a U-plasty and rotation-advancement flap. Maintenance of aesthetics without impaired function is the aim of closure defects with combined flaps.

Dermoglandular advancement-rotation flap for conservative treatment of breast cancer - description of technique, objective and subjective assessments.

to describe and evaluate the dermoglandular advancement-rotation flap with no contralateral surgery as a technique for the conservative treatment of breast cancer when skin or a large proportion of gland requires resection. 14 patients with breast tumors with a mean size of 4.2cm and need for skin resection. The resection area is included within an isosceles triangle, with its apex located on the areola, which is the pivot for rotation of a dermoglandular flap released through a lateral extension along that triangle base. Symmetry before and after radiotherapy was objectively assessed by authors using the BCCT.core software, as well as subjectively by three experts and patients themselves using the Harvard scale. Experts considered the breast symmetry results to be excellent/good for 85.7% of patients in the early post-operative period and 78.6% in the late post-operative period. Excellent/good ratings provided by BCCT.core software amounted to 78.6% of cases in the early post-operative period and 92.9% in the late post-operative period. Symmetry was rated as excellent/good by 100% of patients. Dermoglandular advancement-rotation flap technique with no contralateral surgery provides good symmetry when a large proportion of skin or gland requires resection on breast conservative cancer treatment.

Giant basal cell carcinoma of the scalp: rotation advancement flap as a successful dermatosurgical approach.

Giant keratinocyte tumors, in particular basal cell carcinomas of the scalp area, are a serious challenge for dermatosurgeons, oncologists, and maxillofacial and reconstructive surgeons. The scalp area is limited in terms of skin mobility, and its elasticity decreases with age. The size of the tumors in this area and the degree of infiltration of the underlying tissues are important for the therapeutic choice, from surgical removal, waiting for granulations to form, and placing a split skin mesh graft (at a later stage) to performing complex rotational/transpositional or advancement flaps. Achieving an optimal aesthetic result is often the consequence of interventions carried out or based on the decisions of multidisciplinary teams. Alternatives, such as radiotherapy and targeted therapy with vismodegib, could be administered both preoperatively and postoperatively or as first-line therapy, depending on the tumor board decisions. We present the case of a 69-year-old female patient with a histopathologically proven preoperative giant basal cell carcinoma of the scalp that did not infiltrate the tabula externa. A preoperative ultrasound was performed to preserve the feeding flap arteries. Surgical treatment under general anesthesia was planned and subsequently carried out. During surgery, the surgical resection lines were in close proximity to the arterial vessels, but they remained preserved and ensured a subsequently unproblematic healing process. After the application of the rotational advancement flap technique under general anesthesia, an optimal cosmetic effect was achieved.

Marjolin’s Ulcer of the Scalp: A Case Operated with Reconstruction by Advancement Flap Completed by a Skin Graft Performed at the Sominé Dolo Hospital in Mopti (Mali)

Introduction: Cutaneous squamous cell carcinoma encompasses about 16% of scalp tumors. They can arise de novo or more often mark the evolution of lesions considered as non-invasive precursors: actinic keratoses and Bowen's disease more rarely, they occur on a burn scar (Marjolin's ulcer). We report a case of invasive squamous cell carcinoma on a burn scar (Marjolin's Ulcer) operated with reconstruction by advancement flap completed by a skin graft performed at the Sominé Dolo hospital in Mopti (Mali). A 62-year-old Malian man consulted for a scalp ulceration that had been evolving for 10 years. The lesion began with small trailing erosion that appeared on a burn scar. There was no notion of initial trauma and the patient had no particular history. Physical examination found a large ulceration (6×4 cm) of parietal seat on the scalp with a fibrinous bottom and a sclerotic border. There was a large left latero -cervical mass measuring 13 x 6 cm. The computed tomography of the skull did not find any bone lesions and that of the latero -cervical mass was in favor of adenopathy. Histological examination of a biopsy fragment confirmed the diagnosis of invasive squamous cell carcinoma. Deep resection removing the tumor with the periosteum exposing the parietal bone was performed. Reconstruction by advancement-rotation flap supplemented by a skin graft was performed. The management of squamous cell carcinoma is based on surgery, which is the reference treatment, against which other treatments must be compared. On the scalp, Rotation-advancement flaps are the preferred one-stage surgical repair technique.

Evaluating the effects of botulinum toxins to minimize post cleft lip hypertrophic scar

Abstract:&#x0D; &#x0D; Background: Cleft lip deformity is one of the most common congenital anomalies. Repair of cleft lip may create too much tension especially when done in wide cleft lip, and this may result in unacceptable scar.&#x0D; &#x0D; Aim of study: To evaluate the efficacy of botulinum toxin in reducing or preventing post cheiloplasty hypertrophic scar.&#x0D; &#x0D; Patient and method: Between the period from October 2019 to August 2021, 10 patients with cleft lip were subjected to primary cheiloplasty using Millard rotation advancement flap technique followed by botulinum toxin injection into the site of repair. Follow up period was 6 months postoperatively.&#x0D; &#x0D; Results: All of our patients showed excellent result which was evaluated using visual analogue scale assessment which was done by tow independent surgeons. Our patients showed barely visible scar at 6 months postoperatively with no recorded hypertrophic scar. No side effect was recorded related to botulinum toxin injection.&#x0D; &#x0D; Conclusion: Botulinum toxin injection after primary cheiloplsty showed to be safe and effective in prevention of development of unacceptable hypertrophic scar.&#x0D; &#x0D; &#x0D; Keywards: botulinum, cleft lip, hypertrophic scar, cheiloplasty.

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: A retrospective cohort study.

Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital. Nothing is also known about the relationship between the clinical characteristics of the patients and the timing of primary repairs. To determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria. A retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test, Student's t-test and Mann Whitney U were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis. There were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5-65) months and 8 (IQR: 5.5-16) kg respectively. Over half (n = 184, 58.6%) of the cleft surgeries were for primary repairs of the lip and a third (n = 94, 29.9%) were surgeries for primary repairs of the palate. Millard's rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Langenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59-193.70, P-value = 0.005). There has been a change from Von Langenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher's method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip.

Modified Bilateral V-Y Rotation Advancement Flap for Coverage of Fingertip Amputations.

Background: The use of homodigital antegrade flow flaps is an appealing option for coverage of fingertip injuries with exposed bone as it provides good padding, sensation and colour match with no need for splinting or secondary procedure for flap separation. V-Y flaps presented by Atasoy and Kutler have limited ability of distal advancement. We used two separate V flaps each based on a separate neuro-vascular bundle to allow better advancement while keeping good vascularity and sensation. Methods: We used a modified bilateral V-Y rotation advancement flap for coverage of fourteen fingertip injuries with bone exposed in 11 adult patients. Time to complete healing and return to work was recorded. Range of motion of injured finger as well as fingertip sensation using two-point discrimination were assessed and compared to non-injured contralateral finger 6 months after surgery. Fingertip hypersensitivity, cold intolerance and hooked nail deformity were assessed as well. Results: All flaps survived, and all patients resumed their activities after a mean period of 5 weeks. The mean two-point discrimination was 3.9 mm and was comparable to non-injured side. All patients regained full range of motion and were satisfied by the result. Two cases suffered from hypersensitivity that resolved at 3 months post-operative. Hooked nail deformity and cold intolerance were not recorded in our study. Conclusions: This modified bilateral V-Y rotation advancement flap technique presents a simple and single step procedure that provides good padding of fingertip with cosmetically pleasant contour and normal sensation. Level of Evidence: Level IV (Therapeutic).

Treatment of Basal Cell Carcinoma Involving the Medial Canthus by Multiple Local Flaps: A Case Report

Introduction: Basal cell carcinoma (BCC) is a skin malignancy that commonly appears on the face. Although surgical resection remains the therapeutic gold standard, it always produces a skin defect. Fine aesthetic reconstruction is a persisting challenge for all dermatologists. We herein present a case of BCC affecting the patient’s medial canthus. Case presentation: A 61-year-old woman presented with BCC of her right medial canthus. After lesion excision, a 2.5- × 3.5-cm skin defect remained in her canthal area. We used three local flaps to cover the defect according to aesthetic subunits. The defect over the nasal dorsum was covered by a glabellar flap, the upper eyelid defect was covered by a rotation advancement flap, and the lower eyelid defect was covered by a subcutaneous island pedicle flap. The result remained both functionally and aesthetically satisfactory throughout 2 months of follow-up. Discussion: Skin malignancies can occur in areas that require special treatment. The medial canthus is a fundamental element of the “facial triangle.” Restoration of color, texture, and thickness of the soft tissue is essential in this area. Full-thickness skin grafts and single flaps seem unsuitable for large defects in this region. Instead, a combination of local flaps according to aesthetic subunits can give desirable results. Conclusion: Defects in the medial canthus are difficult to reconstruct. This case provides a novel technique for the treatment of BCC in the medial canthus. Multiple local flaps were used to cover the defect with low tension, giving both a good cosmetic appearance and effective structural reconstruction.

The clinical application of lateral chest flap transfer combined with relay skin flap transfer to repair soft tissue defects of the chest wall after tumor resection.

BackgroundAfter thoracic tumor resection, there is often a large area of soft tissue defect left, even with exposed ribs and sternum, which needs to be repaired by skin flap transplantation. This study aims to introduce lateral thoracic flaps combined with local flaps to repair the soft tissue defect of the chest wall after the repair of malignant tumors, and try to retain the latissimus dorsi myocutaneous flap as a spare repair myocutaneous flap to avoid subsequent tumor recurrence and lack of local flaps for supply body source.MethodsA total of 26 patients with chest wall soft tissue defect with or without exposed rib and sternum after tumor resection at presentation from January 2017 to October 2021 were included in this study. None of the patients required breast reconstruction. Patients ranged in age from 34 to 56 years old. The above patients were treated with lateral thoracic flaps combined with local rotational advancement flaps to repair chest wall soft tissue defects. The postoperative wound healing, scar hyperplasia and recurrence of the patients were followed up.ResultsAmong the patients in this study, 25 incisions healed by primary incision, 1 incision was delayed, and healed after 10 days of dressing change. Postoperatively, the incisions of the patients were all intact, and there were no complications such as skin necrosis and infection. All patients were followed up for 6–18 months, and the incision healed well without complications such as skin necrosis and infection. Of the patients, 2 males developed dermatofibrosarcoma carina recurrence 6 and 10 months after surgery, respectively. After extensive excision, an ipsilateral latissimus dorsi myocutaneous flap was used to repair the defect. The Vancouver scar scale was used to evaluate the hyperplasia of all incisions at 6 months postoperatively. The mean score was 5.92±1.6.ConclusionsThe lateral thoracic flap combined with the local flap to repair the chest wall soft tissue defect after tumor surgery is a strategic decision for surgical treatment, which is beneficial to the sequential surgical treatment of tumor patients.

V-Y Rotation Advancement Flap for Sacral Sore: Experiences at Rajshahi

Grade III and Grade IV sacral pressure sores are required surgical closure. The gluteal fascio-cutaneous rotation advancement flap with V-Y closure was performed in our hospital on 50 cases of sacral sore from 2017 to 2019. The largest defects closed with a unilateral flap were up to 14 cm, and a bilateral flap needed to close 15-22 cm in diameter. In 1.5 to 24 months of follow-up time, none of the patients developed wound dehiscence or flap necrosis requiring repeated surgery. The V-Y rotation advancement flap technique is simple, can be performed quickly, has minimal associated morbidity, and has a good outcome. Furthermore, we can use the same flap design in recurrent cases.&#x0D; TAJ 2022; 35: No-1: 33-38

Comparison of Outcomes of Millard's Rotational Advancement Flap and Fisher's Techniques for Surgical Correction of UCLD

Objective: The objective of our study is to compare the surgical outcomes of two surgical techniques namely Fisher’s technique and Millard’s Rotational Advancement Flap, particularly in terms of white roll symmetry, lip length, lip height, scar quality, notching, cupids bow and alar base symmetry. Study design: Prospective Randomized Clinical Trial study. Place and duration of study: Department of Pediatric surgery, Sheikh Zayed Hospital, Rahim Yar Khan for a period of six months from 1st March 2021 to 31st August 2021. Patients and method: A total of 56 patients were enrolled in the study, equally divided into two groups. Group 1 will include patients undergoing treatment via Millard's Rotational Advancement Flap technique, while group 2 will include those receiving Fisher's procedure. A single consultant performed the procedure. Variables like lip length, Alar base symmetry, scar quality, cupids bow symmetry, and notching were accessed postoperative via the Steffensen grading method, and Vernier caliper was used for anthropometric measurements. The SPSS v 23 was used to evaluate the data. All numerical data were provided in mean and standard deviation (SD) formats. Frequencies were computed for qualitative data. Nonparametric tests (paired and unpaired t-tests) and parametric tests (Fisher's exact test) were utilized to compare the variables. P-value of &lt; 0.05 was considered statistical significant. Results: Both groups had identical outcomes in terms of lip length, nasal symmetry, and alar dome. On the other hand, Fisher's approach was superior in terms of vermilion roll symmetry, white roll symmetry, scar appearance, and Cupid Bow. Anthropometric measures, such as lip height and breadth, were taken; however, the results were statistically insignificant. There was no discernible difference between the outcomes of complete and incomplete cleft lip. Conclusion: We propose using the Fisher's surgical method in unilateral cleft lip repair since it produces better outcomes than the Millard's procedure. Keywords: Anthropometric measurement; Fisher; Lip Notching; Millard; Scar; Unilateral cleft lip.

Near Total/Total Lower Lip Reconstruction—Chin Rotation Advancement Flap

Summary: Total lower lip reconstruction is a challenging reconstruction procedure. Its main role is to restore lip function, maintain the proper relationship between the upper and lower lips and optimize cosmesis. Various techniques ranging from local flaps to free tissue transfer have been developed. For patients who are not candidates for microsurgical techniques or for those who do not want complex procedures, the local flap technique is a good solution. Most of the reported techniques, based on cheek advancement and nasolabial flaps, lead to scars located in the midface and therefore to unaesthetic results. We hereby present a novel technique for total lower lip reconstruction using a rotation advancement flap based on the excess tissue of the lower face. To our knowledge, this method has not been described previously in the literature.