Secondary Flap Research Articles

Double Onlay Preputial Flap for Proximal Hypospadias Repair

Purpose We describe a new technique for primary repair of proximal hypospadias. The double onlay preputial flap combines the principles of onlay urethroplasty and the double face preputial flap, namely preservation of the urethral plate and use of a total preputial flap. Materials and Methods Common problems of classic onlay urethroplasty, including rotation and asymmetry of the penile shaft when the preputial flap is brought laterally around the shaft and the viability of the Byars flaps after dissecting the pedicle for the onlay flap, are avoided with this technique by passing the penis through a buttonhole incision in the pedicle of the total preputial flap. Onlay urethroplasty is performed using a secondary flap outlined from the total preputial flap. The remainder of the total preputial flap tissue is used to cover the ventral skin defect. Results Since June 1994, 18 patients 6 months to 9 years old (median age 10 months) underwent primary hypospadias repair with the double onlay preputial flap technique, representing 15 percent of all repairs performed. Complications included a urethrocutaneous fistula, persistent chordee, a recessed meatus and a urethral diverticulum in 1 patient each. In all cases complications were corrected surgically with minor procedures. No patient had urethral stricture. Functional and cosmetic results were satisfactory in all patients. Conclusions This technique yields good functional and cosmetic results for proximal hypospadias repair.

Prefabrication of a Secondary TRAM Flap

A secondary TRAM flap was prefabricated in a rat model using the rectus muscle. The right rectus muscle was elevated as an inferiorly pedicled muscle flap in one experimental group (n = 6) and as a superiorly pedicled muscle flap in a second group (n = 5) and then sandwiched between a silicone sheet and the abdominal skin. Two weeks later, the abdominal skin and attached rectus muscle were elevated over the silicone sheet as a secondary TRAM flap. The surviving skin paddle areas of these prefabricated TRAM flaps were compared with superiorly (n = 7) and inferiorly (n = 8) pedicled TRAM flaps in a control group. One-way analysis of variance did not show significant differences between groups (p = 0.07). TRAM flap prefabrication in the rat model yields a skin paddle survival area comparable to that of a conventional TRAM flap, and it is possible to perform this procedure without using the anterior rectus sheath.

Comparison of speech quality in 6-year-old cleft palate patients with and without simultaneous adenoidectomy and primary palatal repair

This study aims at comparing the quality of speech in 6-year-old cleft palate children with and without adenoidectomy performed simultaneously with primary palatal repair. The total material comprised 105 children. Adenoidectomy was done simultaneously with primary palatal repair at the age of 12 to 18 months to 32 children (Group A), and not done to 73 children (Group B), but of these children 14 had undergone adenoidectomy later. Groups A and B did not differ remarkably. Groups differed significantly from each other only with respect to the occurrence of audible nasal air emissions. and the mean nasalance scores for two of the test sentences. The groups did not differ significantly from each other concerning the number of secondary velopharyngeal flaps required to eliminate persisting signs of velopharyngeal insufficiency after primary palatal repair. It was concluded that adenoidectomy done simultaneously with primary palatal repair at the age of one year has some effect on the quality of speech, but n...

Necrosis of abdominoplasty and other secondary flaps after TRAM flap breast reconstruction.

The risks of abdominoplasty flap necrosis, umbilical necrosis, and mastectomy flap edge necrosis were compared in a series of 227 patients who had undergone transverse rectus abdominis myocutaneous (TRAM) flap breast reconstructions. Abdominoplasty flap necrosis was more common in patients who smoked or previously had smoked (27.5 percent) than in nonsmokers (5.9 percent). It also was more common in patients who had had conventional TRAM flaps (16.5 percent) than in those with free TRAM flaps (7.8 percent). Similarly, umbilical necrosis was more common in smokers (27.5 percent) than in nonsmokers (11.8 percent). Current smokers had higher risks than ex-smokers, who in turn had higher risks than patients who had never smoked. Obesity appeared to have only a minor influence on abdominal flap and umbilical necrosis. Mastectomy flap edge necrosis, which had little or no impact on the final outcome, was more common after free TRAM flaps than after conventional TRAM flaps.

Reconstructing the Breast Mound Employing a Secondary Island Omental Skin Flap

We have shown in an initial animal study that omentum will adequately vascularize a skin flap and allow transfer of this tissue composite for use in surgical reconstruction of the breast. Based on this experimental procedure, a technique employing a two-stage operation has been developed and used in 21 female patients in reconstruction of the breast after radical mastectomy. In the first stage, the omentum, attached to one gastroepiploic artery and vein, is exteriorized to the subcutaneous tissue of the lower abdominal wall. In the second stage, the distal omentum, now vascularizing the overlying skin and soft tissue, is moved as a secondary island flap to the anterior chest wall to complete the breast reconstruction. In all but 1 of our 21 patients who have been followed for 1 to 8 years, reconstruction of large defects, including the chest wall, breast mound, and infraclavicular axillary fold depression, was performed without use of a prosthesis. In one patient, there was complete necrosis of the flap due to vascular impairment; there were three instances of delayed healing and a significant but partial loss of the flap in one patient. All complications were encountered in the first 10 patients of the series during the time the technique was being refined.

Determining the neovascularization time of secondary island skin flaps ? Experimental investigations in rats

Using rats, secondary island skin flaps were prepared and the flap neovascularization time from the recipient bed determined. The results were compared with comparable standard island skin flaps on rats. The changes in neovascularization at the fourth and fifth days occur earlier in the secondary island skin flaps. This could not be confirmed statistically.

Determining the neovascularization time of secondary island skin flaps—Experimental investigations in rats

Determining the neovascularization time of secondary island skin flaps—Experimental investigations in rats

Prefabricated Neovascularized Free Muscle Flaps: Pedicle Variations

Current techniques of free muscle transplantation with microvascular anastomosis have the disadvantages of limitation of available donor sites, loss of donor muscle function, and the possibility of donor site defect or deformity. Using modifications of a "secondary tissue flap" created by neovascularization of a given tissue, neovascularized muscle flaps with pedicle vessels were created by wrapping external abdominal oblique muscles around the superficial inferior epigastric blood vessels. Different pedicle types were examined to explore possible differences in neovascularization. In 60 rats, four groups of neovascularized muscle flaps were created and transplanted as free flaps, with a high degree of success. After transplantation, neovascularization of the flaps was evaluated by histology and latex casts of vascular tree of the muscle flaps. Degree of neovascularization differed, depending on the type of vascular pedicle used to create the flap.

Use of scarred flaps and secondary flaps for reconstructive surgery of extensive burns

We report the usefulness of scar flaps and secondary flaps in the surgical repair of extensively burned patients. Burn scar contractures repaired with scarred axial pattern flaps, scarred musculocutaneous flaps and scarred fasciocutaneous flaps are described. However, it is our contention that their application should be strictly limited. An example of the use of scarred secondary axial pattern and musculocutaneous flaps for reconstruction of a burned ear is shown.

Two cases of reconstruction using the secondary axial pattern flap made by burying the superficial temporal vascular bundles. (Japanese) Jpn

Two cases of reconstruction using the secondary axial pattern flap made by burying the superficial temporal vascular bundles. (Japanese) Jpn

Retroauricular secondary island flap.

A new method consisting of conversion of the retroauricular skin into an axial flap is described. During the first stage the superficial temporal vessels are transposed under the skin of the retroauricular region. The second operative step consists of elevation of the retroauricular-mastoid skin on the dissected axial pedicle. The secondary island flaps proved to be efficient in the repair of small and medium-sized defects of the facial region.

Development and utilization of a composite island flap employing omentum: experimental investigation.

In 39 pigs, four varieties of secondary island flaps were created using omentum as a carrier. This study demonstrates that: 1. Skin grafts (split- or full-thickness), when grafted to omentum, can be transformed into an "island flap," and the free transfer of this flap with microvascular anastomosis is feasible. 2. A skin flap, a combined skin flap, or both and subjacent muscle could be vascularized with omentum to obtain an omental island skin flap or an omental island musculocutaneous flap and transferred as already described. 3. Three varieties of secondary island osteocutaneous flaps were created using the omentum. Of these flaps, eight successfully underwent microvascular transfer. Bone vascularity and incontinuity viability were demonstrated by employing a variety of standard diagnostic techniques, including 99mTc-pyrophosphate tetracycline labeling, microangiography, and histologic sectioning. In addition to the many recognized advantages of a free living bone graft in reconstructive surgery, other benefits of this new kind of island composite flap include its unlimited size, minimal donor deformity, and ease of transfer. We have demonstrated that omentum can be used to vascularize skin, a skin flap, and either tibial, costal, or iliac bone graft to obtain a secondary island flap. The clinical uses of these flaps promise a new and exciting horizon in reconstructive surgery.

ANESTHESIA AND ANTISEPTICS IN PLASTIC RESTORATION OF THE FACE AND MOUTH

Plastic restoration of war wounds has made a new requirement of operative surgery. Sliding and turning flaps, bone transplants, secondary flaps, and even skin grafts open tissues that are not infected. The mouth, and particularly war wounds of the mouth, always contain infective organisms. Newly opened tissues should, if possible, be protected from infection in these operations. The anesthetic devices in general use have in the main proved satisfactory. In addition to conductive and local anesthesia, the chief reliance for general anesthesia has been the ordinary mask and pumps and blowers of various types and combinations. By none of them, however, may one secure even an approximately aseptic field for operations about the mouth. None of them protect the field from mouth secretions, and none of them permit the use of efficient antiseptics, for the reason that the respiratory tract is only relatively protected. An efficient antiseptic, like tincture of