Single Flap Research Articles

A preliminary exploration of reduced port laparoscopic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (ROSF)

Objective: This study aimed to share preliminary experiences of single-incision plus two ports laparoscopic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (ROSF). Methods: Following the 6th edition of the Japanese Gastric Cancer Treatment Guidelines, proximal gastrectomy with lymphadenectomy was performed. Using a single-port approach, the esophagus was transected at least 2 cm above the tumor's upper margin with linear staplers. The stomach was then extracted through a periumbilical incision, and the proximal stomach was subsequently transected extracorporeally, while ensuring appropriate resection margins on both the greater and lesser curvatures. A single flap was created before returning the remnant stomach to the abdominal cavity and re-establishing pneumoperitoneum. The No.2 clip was used to grasp and elevate the esophageal stump. An incision was made at the right lower edge of the esophageal stump to guarantee that the esophageal lumen was open. The linear stapler was then inserted into the openings of the stomach and esophagus to perform a side overlap anastomosis with a length of 3 cm. Another barbed suture was used to close the common opening of the esophagus and the stomach, and the same barbed suture were used to suture the gastric wall to the lower edge of the muscle flap. The first barbed suture was then used to sequentially suture the proximal brim of the flap to the esophagus and the right brim of the flap to the right brim of the mucosal window. After completion of anastomosis, a drainage tube was inserted through the right upper port. This procedure was employed from November 2023 to March 2024 on five patients diagnosed with adenocarcinoma of the esophagogastric junction and upper stomach. The cohort consisted of three males and two females, with an age range of 62 to 75 years and a body mass index (BMI) of 13.7 to 24.2 kg/m². All cases were preoperatively staged as T1-2N0M0, confirmed by endoscopic biopsy and enhanced CT scans of the chest, abdomen, and pelvis. Results: All five patients successfully underwent the surgery. The median surgery time was 180-325 minutes, with the intraoperative blood loss of 30-50 ml. The number of lymph nodes harvested ranged from 18 to 27. The time to first flatus, and restore liquid diet and was 2.0-5.0 and 1.0-3.0 days, respectively. The postoperative length of stay was 9.0-11.0 days. The pain scores on the Numeric Rating Scale (NRS). On the first day, the pain scores were 3.0 in two cases, 2.0 in two cases, and 1.0 in one case. On the second day, the pain scores were 2.0 in two cases and 1.0 in three cases. On the third day, the pain scores were 1.0 in four cases and 2.0 in one case. No short-term postoperative complications were observed, and there were no perioperative deaths. Conclusion: Single-incision plus two ports laparoscopic proximal gastrectomy with ROSF is safe and feasible.

Viability of Free Bone Graft in Combination With Free Tissue Transfer and Post-Operative RT in Orbital Floor Reconstruction.

Orbital floor reconstruction post cancer ablation is challenging especially when associated with extensive soft tissue defects. Due consideration is to be given to the possible toxicities of adjuvant radiotherapy as well. Free bone-soft tissue flaps are ideally suited in such situations. However, a single flap may fall inadequate for large defects. Using two free flaps in combination increases operating time and donor site morbidities. Non-vascularized bone grafts combined with large soft tissue flaps harbor the risk of bone resorption and osteo-radio necrosis. Alloplastic implants can lead to exposure and infection. We conducted a study researching the outcome of non-vascularized cortico-cancellous iliac bone graft (NVCIBG) used in orbital floor reconstruction along with free anterolateral thigh (FALT) flap in subjects undergoing extensive surgical ablation and adjuvant radiotherapy. Ten consecutive subjects who underwent maxillo-mandibular resection with or without skin were included in the study. The parameters assessed were diplopia, ectropion, bone viability, and osteointegration. Subjects were assessed in the immediate post-operative period, 1 month after surgery, and after 1 year of radiotherapy. The size of iliac bone harvested ranged from 3 to 5.5 cm (mean 4.8 cm). Forty percent subjects complained of binocular diplopia in the initial post-operative period which subsided subsequently. Thirty percent subjects developed ectropion all of whom required external skin reconstruction. None developed osteoradionecrosis. NVCIBG along with FALT flap is an excellent reconstructive option for orbital floor defects. It can withstand the toxicities of adjuvant radiotherapy and avoids the need for double free flap reconstruction. 4 Laryngoscope, 2024.

Palatal groove associated with periodontal lesions: a systematic review illustrated by a decisional tree for management

BackgroundPalatal groove represents a relatively uncommon developmental root anomaly, usually found on the palatal aspect of maxillary incisors. While its origin is controversial, its presence predisposes to severe periodontal defects.AimThis study aimed to provide a systematic review of the literature focusing on the varied diagnostic techniques and treatment modalities for periodontal lesions arising from the presence of palatal groove. Based on the existing evidence and knowledge, the study also provides a comprehensive decisional tree, guiding clinicians in the challenging decision-making process face to a palatal groove.MethodsThe literature search was conducted on Medline and Cochrane databases by two independent reviewers, who also performed the screening and selection process, looking for English written articles reporting on diagnosis and management (all treatment approaches) of periodontal lesion(s) associated with a palatal groove. Based on this literature, a comprehensive decisional tree, including a standardized palatal groove evaluation and tailored treatment approaches, is proposed. Moreover, a clinical case is described to demonstrate the practical application of the developed decisional tree.ResultsOver a total of 451 articles initially identified, 34 were selected, describing 40 patients with 40 periodontal lesions associated with palatal grooves. The case report illustrates a deep, large, circumferential intra-bony defect on the palatal side of the tooth #22 associated with a shallow, moderately long palatal groove in an 18-year-old male patient. Following reevaluation, a single flap surgery was deemed necessary, combined with a regenerative procedure. At 2 years post-treatment, the tooth #22 is healthy, in a functional and esthetic position. The decision-making process, based on local and systemic patient’s conditions, should allow an early and precise diagnosis to prevent further complications and undertake an adequate treatment.ConclusionPalatal grooves are relatively rare; however, they are frequently associated with severe periodontal defects. The identification, diagnosis, prompt, and tailored management of the associated lesion is essential to mitigate potential periodontal and endodontic complications related to the presence of palatal groove.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [C CRD42022363194].

CGull: A Non-Flapping Bioinspired Composite Morphing Drone.

Despite the tremendous advances in aircraft design that led to successful powered flights of aircraft as heavy as the Antonov An-225 Mriya, which weighs 640 tons, or as fast as the NASA-X-43A, which reached a record of Mach 9.6, many characteristics of bird flight have yet to be utilized in aircraft designs. These characteristics enable various species of birds to fly efficiently in gusty environments and rapidly change their momentum in flight without having modern thrust vector control (TVC) systems. Vultures and seagulls, as examples of expert gliding birds, can fly for hours, covering more than 100 miles, without a single flap of their wings. Inspired by the Great Black-Backed Gull (GBBG), this paper presents "CGull", a non-flapping unmanned aerial vehicle (UAV) with wing and tail morphing capabilities. A coupled two degree-of-freedom (DOF) morphing mechanism is used in CGull's wings to sweep the middle wing forward and the outer feathered wing backward, replicating the GBBG's wing deformation. A modular two DOF mechanism enables CGull to pitch and tilt its tail. A computational model was first developed in MachUpX to study the effects of wing and tail morphing on the generated forces and moments. Following the biological construction of birds' feathers and bones, CGull's structure is mainly constructed from carbon-fiber composite shells. The successful flight test of the proof-of-concept physical model proved the effectiveness of the proposed morphing mechanisms in controlling the UAV's path.

Single Flap Approach Versus Conventional Flap in the Treatment of Intrabony Defects: A 6-Month Clinico Radiological Study

Abstract Introduction: The comparison of single-flap approach (SFA) and conventional flap (CF) techniques in the treatment of intrabony defects is a significant area of periodontal research. This clinical-radiological study evaluates the effectiveness of these methods over a 6-month period. SFA involves minimal surgical intervention, promoting faster healing and reduced patient discomfort. Conversely, CF is a traditional method with broader exposure to the surgical site for more extensive cleaning and repair. This study aims to provide insights into the relative advantages and clinical outcomes associated with each approach, contributing to evidence-based periodontal therapy practices. Materials and Methods: Thirty sites with chronic/aggressive periodontitis were selected for the present study. Phase I therapy was performed and evaluated after 4 weeks. Clinical parameters such as plaque and gingival index and probing pocket depth (PPD) were measured at baseline and 6 months postoperatively. The mean defect fills and percentage defect fill were calculated with the help of cone-beam computed tomography at baseline and 6 months postoperatively. The subjects were divided into two equal groups with the help of a coin toss. The Group I (test sites) underwent an SFA, whereas the Group II (control) site underwent conventional surgical procedures. Results: The PPD in both groups was reduced over a 6-month post-operative period. The mean defect size and percentage of defect fill between baseline and 6 months postoperatively in both groups were statistically significant. Conclusion: The single-flap approach and the CF are equally effective in treating periodontal intrabony defects.

Clinical application of free peroneal artery leaflet perforator flap in postoperative complex defect of oral cancer

Objective:To investigate the clinical effect of a segmented perforator flap of free peroneal artery to repair a complex defect after oral cancer. Methods:Forty-eight patients with oral cancer admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2022, including 8 of buccal cancer, 7 of floor cancer, 14 of tongue cancer, 5 of retromolar cancet, 9 of maxillary gingival cancer and 5 of mandibular gingival cancer. After lesion resection, 24 patients in the experimental group used the partial perforator flap to repair the defect, and 24 patients in the control group used the single flap to repair the defect. Compared with the general data of the two groups, the difference was not statistically significant（P>0.05）, which was comparable. The flap cutting range of the experimental group was 38.5-74.5 cm², and tension-reduced suture for the donor area. In the control group, the myocutaneous flap incision range was 61.0-76.5 cm², and skin graft suture for the donor area. Flap survival and patient survival were recorded and compared. The patients were followed up at 6 and 12 months after surgery, and their swallowing function and speech function, including the drinking water test, functional oral food intake scale and the Chinese language clarity test word table, were evaluated respectively, and their subjective satisfaction with the repair appearance was recorded. Patients in both groups were followed up for 12 to 60 months. Kaplan-Meier method was used to calculate the cumulative survival rate of patients, and survival curves were plotted. log-rank test was used to compare the survival curves between groups. Results:The survival rate of the two groups was 100%. The 5-year survival rate was 62.5% in the experimental group and 54.2% in the control group. There was no significant difference between the two groups （P>0.05）. According to the results of the functional recovery evaluation, the groups in swallowing and speech function and subjective satisfaction（P>0.05）, and at 12 months after surgery（P<0.05）. Conclusion:The segmented perforator flap of free peroneal artery is flexible and can repair different anatomical structures of postoperative composite defect of oral cancer, which can effectively improve postoperative functional recovery and patient satisfaction. Therefore, the peroneal artery segmented perforator flap is the ideal flap for reconstructing postoperative composite defect of oral cancer.

Optimizing perfusion and volume in autologous breast reconstruction: dual-plane, conjoined and stacked flaps

Microsurgical breast reconstruction has continued to evolve to improve outcomes and minimize complications. Dual-plane, conjoined and stacked flaps represent one aspect of this evolution in an effort to improve tissue perfusion and flap volume. Dual-plane flaps combine the superficial and deep circulation in abdominally-based free flaps to augment perfusion. Conjoined flaps use additional pedicles to supply multiple perforasomes combined in a single flap. Stacked flaps utilize separate flaps on individual pedicles to increase volume at a single recipient site. Multiple donor sites, pedicle configurations and recipient vessel choices have been described, primarily focusing on using the cranial and caudal internal mammary system as well as intra-flap anastomoses. Though more technically demanding, dual-plane, stacked and conjoined flaps allow for improvement in flap perfusion and volume, and are important tools for optimizing results in autologous breast reconstruction.

Endoscopic Double Flap Tympanoplasty.

This study is aimed to compare the outcomes of the two techniques (endoscopic single flap tympanoplasty- ESFT versus endoscopic double flap tympanoplasty - EDFT) of endoscopic tympanoplasty for repairing large tympanic membrane (TM)perforations with limited anterior remnant. In this randomised controlled trial, forty patients with large sized TM perforations were included and randomised in the ESFT and EDFT arms with twenty patients in each group. Both the groups underwent endoscopic tympanoplasty using temporalis fascia graft. The graft uptake rates and hearing results were compared. Graft success rate was 85% (17/20 cases) in the ESFT group and 90%(18/20 cases) in the EDFT group. The ABG (air-bone gap) improvement median with interquartile range(IQR) was 5 dB (3.12 dB-10 dB) in the ESFT group and 8.75 dB (5dB-11.87 dB) in the EDFT group. The difference was not statistically significant. In our study, there was no statistically significant difference in the graft success rate or hearing gain in ESFT or EDFT group. Moreover, there was longer operative time and need for an extra incision while raising the anterior flap. This lack of statistically significant results in our study may be since the study has a very small sample size. Whether the same conclusion is reproducible needs to be further explored by a larger sized randomised controlled trial.

Numerically Investigating the Energy-Harvesting Performance of an Oscillating Flat Plate with Leading and Trailing Flaps

This study investigates the power generation capability of an oscillating wing energy harvester equipped with two actively controlled flaps positioned at the leading and trailing flaps of the wing. Various parameters, including flap lengths and pitch angles for the leading flap and trailing flap, are explored through numerical simulations. The length of the main wing body ranges from 40% to 65% of the chord length, c, while the leading and trailing flaps vary accordingly, summing up to the total length of the flat plate c = 100%. The pitch angles of the two flaps are adjusted within predefined limits. The pitch angle for the leading flap varies between 25° and 55°, while the trailing flap’s angle ranges from 10° to 40° across 298 different simulation scenarios. The results indicate that employing both leading and trailing flaps enhances the power output compared to a wing with a single flap configuration. The trailing flap deflects the incoming fluid more vertically, while the leading flap increases pressure difference across the surface of the main wing body, synergistically improving overall performance. The power output occurs at a specific length percentage: a leading flap of 30%, a main wing body of 50%, and a trailing flap of 20%, with pitch angles of 50°, 85°, and 30°, respectively, increasing the output power increments by 4.39% compared to a wing with a leading flap, 4.92% compared to a wing with a trailing flap, and 28.24% compared to a single flat plate. The highest efficiency for the specified length percentages is 40.37%.

The Expanded Forehead Flap for Resurfacing of Multi-unit Congenital Nevi of the Face.

The forehead flap is a timeless and robust reconstructive option for complex facial defects. In accordance with aesthetic subunit principles, it has traditionally been used to resurface defects affecting a single cervicofacial region, most commonly the nose or periorbital unit. In this article, we present three cases of congenital nevi treated with expanded forehead flap reconstruction of the nasal, periorbital, and cheek units in early childhood. This series demonstrates an approach that, while violating facial units, limits total scar burden and optimizes aesthetic and functional results. With precise staging and execution, this reconstructive technique allows for a single flap to resurface multi-unit defects in the pediatric population with excellent long-term results.

MODIFIED PORT POSITION FOR BILATERAL INGUINAL TAPP CREATING UNILATERAL PERITONEAL FLAP

Abstract Introduction Usually, the TAPP approach for bilateral inguinal hernia requires bilateral port placement and two separate peritoneal flaps to facilitate dissection and mesh placement. Our technique with modified port placement allows bilateral repair through unilateral flap with equal ease and feasibility and thus not only reduces the efforts of two flap suturing but also mimics TEP approach for hernia contralateral to ports. Material and Method During a period from February 2015 to December 2022 we have managed 48 patients with this approach. Patients with bilateral, primary, reducible inguinal hernias were managed, all of them do not have any history of previous surgery. With experience even complete irreducible hernias were managed in the same manner. Ports were placed on the side of the symptomatic or bigger hernia in triangular fashion for better ergonomics. Results In all patient’s adequate dissection of myopectineal orifice was achieved on either side through single flap. In few patients there were accidental small peritoneal rents on contralateral side which required single suture to close them. Medium weight PP mesh of size 15 × 12 cm was used in all except few, in which either 3D meshes or self-adhesive Progrip mesh was placed. No post-operative complications were seen in the form of recurrence or seroma and chronic pain in all patients. Discussion and conclusion Our technique of single peritoneal flap requires small unilateral flap to be raised to deal with bilateral defects without compromising on the steps of the procedure. Modification in port placement for the approach allows better ergonomics and ease of contralateral dissection and mesh placement along with easy closure of small peritoneal flap.

Surgical Reconstruction of a Large Defect after Excision of Infiltrative Squamous Cell Carcinoma in the Scalp and Occipital Region: A Case Report

Squamous cell carcinoma (SCC) of the scalp is the second most prevalent skin cancer, following basal cell carcinoma. Notably, it has the capability to infiltrate the skull, dura mater, and even brain tissue. The cornerstone of treatment is the surgical removal of the lesion, with a particular focus on the depth of invasion, which is directly correlated with recurrence rates. Post-surgical strategies may involve immediate or delayed cranial bone reconstruction and repair of scalp defects using either artificial dermis or skin grafts. In the case presented, a substantial defect necessitated more than a single flap for primary repair. Hence, a single pedicle double-island flap was designed for reconstructing the occipital area. Due to increased tension on the flap following cranial bone repair, the bone repair was temporarily deferred. Postoperative care included adjuvant chemotherapy and radiotherapy to mitigate the risk of SCC recurrence.

Extended arc of rotation of Latissimus Dorsi Musculocutaneous Flap providing well-vascularized tissue for reconstruction of complete defects of the sternum: An anatomical study of flap pedicle modification.

Deep sternal wound infections (DSWI) following cardiothoracic surgery represent a life quality endangering sequelae and may lead to sternal osteomyelitis. Radical debridement followed by Negative Pressure Wound Therapy (NPWT) may achieve infection control, provide angiogenesis, and improve respiratory function. When stable wound conditions have been established a sustainable plastic surgical flap reconstruction should be undertaken. This study analyses a method to simplify defect coverage with a single Latissimus Dorsi Myocutaneous Flap (LDMF). Preparation of 20 LDMF in ten fresh frozen cadavers was conducted. Surgical steps to increase pedicle length were evaluated. The common surgical preparation of LDMF was compared with additional transection of the Circumflex Scapular Artery (CSA). Alteration of the surgical preparation of LDMF by sacrificing the CSA may provide highly valuable well-vascularized muscle tissue above the sensitive area of the Xiphisternum. All defects could be completely reconstructed with a single LDMF. The gain in length of flap tissue in the inferior third of the sternum was 3.86±0.9 cm (range 2.2 to 8 cm). By sacrificing the CSA in harvesting the LDMF a promising gain in length, perfusion and volume may be achieved to cover big sternal defects with a single flap.

Limitation of microdissected thinning in free anterolateral thigh flap for hand reconstruction

BackgroundHand defects, especially complex defects involving tendon or bone exposure, are challenging to reconstruct. With the limited size and options of local flaps, the free-thinned anterolateral thigh (ALT) flap remains an excellent choice. However, many authors have described thinning procedures differently, leading to inconsistent outcomes. We present our clinical experience of immediate thinning ALT flaps depending on the anatomical structure of the perforator.Materials and methodsBetween 2007 and 2021, we used a free ALT flap in 42 cases to cover hand defects after crushing and friction injuries, burning and burn scars, and animal bite wounds. There were 38 males and 4 females; the mean patient age was 31.2 years. Thinning procedure was performed in all flaps. The primary and microdissected thinning procedure was performed for 35 single flaps and 7 chimeric flaps, including 14 flaps for the fingers (29%), 4 flaps for the palm (8%), 12 flaps for the hand dorsum (24%), and 19 flaps for combined areas (39%).ResultsThe mean flap thickness was 18.6 (11–30) mm before defatting and 6.0 (3–12) mm after defatting, an approximately 65% reduction. The retained fascia island around the perforator was ≤ 1 cm in 73.5% of cases, 2–3 cm in 18.4%, and the remaining 8.1% had a fascia size ≥ 4 cm. The incidence of a well-survive flap was 93.9%. Three cases had partial to total necrosis. None of the patients required a secondary defatting procedure.ConclusionEvery case has a perforator pattern after running through the fascia, which allows surgeons to choose the appropriate thinning method. Perforators that run parallel to the superficial fascia are not good candidates for thinning. Instead, the thinning process should be performed with more perpendicular perforators.Level of evidence: Level IV, therapeutic study

A Minimally Invasive Osseous Resective Surgical Protocol for Pocket Elimination at Maxillary and Mandibular Posterior Sextants: MI-PES.

The purpose of the present study was to describe a novel protocol for a minimally invasive pocket elimination surgery (MI-PES) in the posterior maxilla and mandible, which consists of the combined use of (1) an access flap based on an internally beveled gingivectomy with minimal to no papilla mobilization at the buccal aspect, and (2) a resective procedure with an apically positioned flap on the lingual aspect. The interproximal bone defects were accessed with a single (lingual) flap, and the bone architecture was modified by the adoption of piezoelectric inserts for controlled bone recontouring associated with fiber retention. Mean probing depth (PD) was 5.5 ± 0.8 mm before surgery and 2.7 ± 0.6 mm at the 6-month reevaluation. All treated pockets showed a postsurgical PD < 4 mm. Gingival recession (REC) was 0.3 ± 0.5 mm at baseline and increased to 1.6 ± 0.8 mm at 6 months. When buccal and lingual pockets were analyzed separately, a trend toward a similar PD reduction, less REC increase, and greater clinical attachment level gain was recorded for buccal pockets. These preliminary observations seem to support the use of MI-PES as a valuable option for pocket elimination, at least when residual pockets are associated with a shallow interproximal osseous crater in the posterior maxilla or mandible.

A Case Report of Periodontal Regeneration in Failing Tooth by Single Flap Approach Using Sticky Bone and Platelet-rich Fibrin Membrane

Periodontal regeneration aims to regenerate the diseased or lost periodontium. Regenerative periodontal therapy utilises growth factors, autogenous soft and hard tissue grafts for the purpose of regeneration. Platelet-rich Fibrin (PRF) is an autologous biomaterial which works on the principle of centrifugation. The injectable PRF (i-PRF) that is formed when centrifuged at low Revolutions Per Minute (RPM) produces an excellent matrix when mixed with bone graft called “sticky bone”. Sticky bone possesses the property of mouldability along with its inherent potential of bone formation. The PRF matrix also enhances the wound healing through the release of various growth factors. PRF membranes which are obtained at higher centrifugation levels also act as a substitute to augment the soft-tissues. The present case is that of a 45-year-old male, who underwent a one-year follow-up for the management of endodontic periodontal lesion in the lower left first molar with sticky bone and PRF membrane by single flap approach. The patient was periodically reviewed clinically and radiographically and prosthetic restoration was given on accessing the radiographic bone fill after six months. After six months there was a significant difference in the radiographic bone fill, along with the reduction in the probing pocket depth from 7 mm to 4 mm and clinical attachment from 9 mm to 7 mm. The results indicate that sticky bone and PRF membrane serves as a predictable source for the management of intrabony defects.

Flap Necrosis After Large Myelomeningocele Repair Using Good Wound Care and Secondary Intention: Case report

Abstract Myelomeningocele (MMC) is the commonest type of neural tube defect; it represents a protrusion of neural tissue from a bony defect. Treatment of myelomeningocele depends on the size of the defect; with small ones, reconstruction with primary closure or local single flaps may be sufficient, while large (more than 5-8 cm) defects require more complicated reconstructive techniques. Flap necrosis is a major complication of large myelomeningocele repair. In our case, we discuss a new proposed method in post-surgical flap necrosis management based on good wound care, wound coverage, and healing by secondary intention

Single-flap approach versus without concentrate growth factor in the treatment of periodontal supra-osseous defects: A randomized controlled clinical trial

ObjectivesWe aimed to compare treatment outcomes of periodontal supra-bony defects using single flap (SFA) plus concentrate growth factor versus SFA alone. Methods32 supra-bony periodontal defects were randomly assigned to test and control groups. Outcome variables were clinical attachment level (primary outcome). Probing pocket depths, gingival recessions, bone gain, post-surgical pain using visual analogue scale and wound healing index were recorded as secondary outcomes. Clinical and radiographic assessments were recorded at baseline and 6 months after treatment, whereas pain score and wound healing index were recorded within 10 days after surgery. ResultsTest group showed a significant improvement in all tested parameters compared to control group (P-value ≤ 0.05). Better patient centered outcomes (wound healing and pain scores) were highly achieved in the test group compared to controls. ConclusionThe tested combined approach offers better periodontal and patient centered treatment outcomes in management of periodontal supra-bony defects.

Virtual surgical planning/3D printing assisted fibula osteoseptocutaneous flap combined with anterolateral thigh flaps for extensive composite oromandibular defects reconstruction: a retrospective study of case series.

Oromandibular tumors or osteoradionecrosis often lead to extensive composite defects encompassing intraoral, bone and extraoral tissues. A single flap cannot simultaneously offer sufficient bone and soft tissue. The combination of free flaps could be a prospective approach to overcome the challenge. The study aims to assess the efficacy of virtual surgical planning (VSP) and 3D printing assisted fibula osteoseptocutaneous flap (FOSCF) combined with anterolateral thigh flaps (ALT) in reconstructing extensive composite defects in the oromandibular region. A retrospective analysis was conducted on 8 patients who underwent reconstruction using FOSCFs combined with ALTs. Post-surgical excision of the lesions, we obtained mean values for the defects of intraoral soft tissue, bone, extraoral soft tissue, namely, being 42.7cm2, 96mm, and 68.9cm2. The mean surgical procedures took 712.5min. A total of 16 flaps were harvested and transplanted for the 8 patients, with all successfully surviving. Postoperatively, complications manifested as localized intraoral infections in 2 cases, intermuscular vein thrombosis in another 2 cases, and pulmonary infections in 2 patients. Two patients unfortunately experienced tumor recurrence, at 12 and 3months post-operation respectively. For the surviving 6 patients, the average follow-up period was 12.2months. Regarding patient satisfaction, one expressed dissatisfaction with the contour of the mandible, and two exhibited moderate trismus. Objective assessments identified 1 case of oral incontinence and 2 cases where external flap contractures were observed. All 8 patients experienced restoration of masticatory function and were able to consume a soft diet within a month post-surgery. VSP/3D printing assisted FOSCFs combined with ALTs can be performed safely to reconstruct the extensive composite tissue defects in our study, with desirable esthetic and functional results, and it is a reliable option in selecting patients with defects involving multiple tissue types. However, the benefits of this method needed more cases to validate.

Bilateral Perineal Reconstruction Using an Oblique V-shaped DIEP Flap

The reconstruction of soft tissue defects in the peritoneal region after malignant tumor resection is challenging. To reconstruct large defects, primary closure or local flaps are inadequate, and they do not provide cosmetically and functionally good results. The gracilis, gluteal, and rectus abdominis flaps are workhorse flaps for reconstructing large peritoneal defects. Surgical procedures should be carefully chosen on the basis of the size and location of the defect. In this report, we describe two cases of bilateral large defect reconstruction after malignant tumor resection using a V-shaped deep inferior epigastric artery perforator flap. Our procedure is useful as it shows that single flaps can be used to reconstruct large and bilateral peritoneal defects.