Split Flap Research Articles

COMBINATION OF THE MULTIMODAL ALGORITHM AND THE RECONSTRUCTIVE-RESTORATIVE LADDER IN THE TREATMENT OF THE WOUNDED WITH FLAMMABLE DEFECTS SOFT FABRIC

Resume. Most wounds formed as a result of a gunshot wound require staged, and in some cases, multistage reconstructive and restorative operations and rehabilitation.
 Materials and methods. During treatment at the Military Medical Center of the Republic of Poland for 6 months (from 24.02.22 to 10.09.22), reconstructive and surgical treatment of 54 wounded soldiers was carried out using the principles of reconstructive and plastic surgery. The treatment process was based on a multimodal approach - dynamic screening of gunshot wounds with soft tissue defects, which was used in the pre-, intra- and postoperative periods.
 Results and their discussion. A total of 54 wounded people were included in the study. Methods of closure that were used during the recovery process: spontaneous epithelization — 3 (5.6 %) of the injured, secondary sutures — 10 (18.5 %), PHO with the use of a split skin flap - 12 (22.2 %), sliding flaps – 12 (22.2 %), propeller flaps – 17 (31.5 %). When using full-layer flaps (sliding, propeller) in wounded patients, inflammatory complications were not observed in the postoperative period, but the phenomena of venous stasis, marginal necrosis of the distal part of the flap were noted. The average number of postoperative bed days before independent movement or self-care was 7.5 days. The aesthetic component in wounded patients with the use of flaps increased by 1.8 times compared to the RSK technique.The functional component was restored in 35 % during further observation.
 Conclusions. As the experience of the VHP in previous military conflicts has shown, primary closure of a gunshot wound is not possible, and in some cases even harmful. Therefore, in our opinion, the preparation of a gunshot defect of soft tissues, based on multimodal monitoring, can be considered as a bright addition to the reconstructive-plastic ladder. Performing reconstructive and plastic closure of gunshot wounds with propeller flaps is an actual method of restoring the damaged anatomical area, which allowed to obtain better aesthetic, as well as anatomical and functional results, in some cases - without additional wound surfaces (places for the collection of RAS).

Trailing-edge jets for UCAV's flight control over a wide speed range

With fluidic control effectors, the flying-wing aircraft have been expected to achieve flapless fight which can reduce the radar cross section (RCS). However, most researches are focused on their control capability at low speed (Ma<0.3). This paper numerically investigates using trailing-edge jets (TE jets) to control a flying-wing UCAV over a wide speed range (Ma=0.145∼0.7) to evaluate 3-axis flight control capability, bleeding air impacts on engine performance, and stealth improvement. The three-dimensional flow is simulated by a Reynolds–averaged Navier–Stokes (RANS) solver with k−ω SST turbulence model. The power consumption of bleeding air is converted into additional drag, and the control efficiency factor is proposed to compare the efficiency of fluidic and solid control effectors under a unified framework. The RCS is evaluated by the Large Element Physical Optics (LEPO) solver. The results show that, for pitch and roll control, TE jets relying on circulation control (CC) can produce the same moment as control surfaces deflected 30°, 20°, and 10° at Ma=0.145,0.4, and 0.7, respectively. Meanwhile, TE jets have less effect on the engine mass flow and thrust, and are more efficient at producing control moments than control surfaces. For yaw control, relying on the recoil effect, TE jets' control capability is equal to that of split flaps at low speed with relatively higher bleeding air impacts on engine performance, but will not be affected by the flow separation at the high angle of attack. For stealth characteristics, the RCS of jet-controlled UCAV in frontal, lateral, and some specific azimuth ranges reduces remarkably. This study indicates that TE jets are highly promising pitch and roll control effectors for a flying-wing UCAV to enhance survivability from low speed to high subsonic speed.

The Role of Split Anterolateral Thigh Free Flaps in Reconstructive Surgery: a Systematic Review and Case Report

Radical tumor ablation or severe trauma can result in challenging tissue defects. The split anterolateral thigh free flap has been promoted as an ideal option for complex defects. We aimed to evaluate whether this flap could be performed without major morbidity. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted to assess this hypothesis. An illustrative case about pharyngeal reconstruction is discussed, and the role of free split anterolateral thigh free flaps in modern reconstructive surgery is evaluated. The systematic search of literature yielded 221 studies with 7 articles about free anterolateral thigh flaps fully split in two separate flaps based on one pedicle. Favorable outcomes in a total of 31 patients were described. Tissue defects were mainly located at extremities, chest wall, lip, and cheek. A low complication incidence was reported in all studies, in terms of flap loss, donor site morbidity, and general wound healing problems. The flap was utilized for pharyngeal reconstruction and simultaneous neck resurfacing, which allowed a more convenient way of flap monitoring in the present case. Being technically a rather demanding flap variant, splitting the anterolateral thigh free flap has still become an accepted technique among microsurgeons. Currently, literature suggests that it can be performed without major complications for reconstructing extremities and the head and neck area. Rearrangement of the flap units in pharyngeal reconstruction increases the flap’s versatility as it allows neck resurfacing and external monitoring of buried inaccessible flaps.

Перший в Україні досвід закриття тотального дефекту діафрагми (при її аплазії) м’язовим аутотрансплантатом у новонародженої дитини

Congenital diaphragmatic hernias, in newborns, with large defect of the diaphragm, are an extreme risk group and characterized by high mortality. We present our own experience of successful surgical treatment of a newborn with aplasia of the left half of the diaphragm. The child was born in the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova National Academy of Medical Sciences of Ukraine» with a prenatal diagnosis. After preoperative stabilization, for the first time in Ukraine, the left half of the diaphragm was completely replaced with a split muscle flap from the anterior abdominal wall. The child survived after the operation, his physical development corresponds to age. During the 3-year follow-up, there are no signs of recurrence. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: congenital diaphragmatic hernia, diaphragmatic aplasia, surgical correction, flap of the muscles of the anterior abdominal wall, newborn baby.

A split flap technique shifting the location of perforator entry point to lengthen the pedicle of a multiple perforator based free flap

Background Pedicle length deficiency in microsurgical procedure is a challenging issue. The aim of this report is to present a case series of a flap-splitting technique for pedicle lengthening of large multiple perforator-based (MPB) free flaps. Methods In this retrospective case series, we reviewed the medical records of patients who underwent free flap repair with “split flap” pedicle-lengthening technique between August 2017 and December 2021. Main outcome measures included patient demographics, indications, defect size, flap type, additional vascular pedicle length, and flap survival. Results Data from 16 patients (age 38-78 years) were reviewed. Indications included breast reconstruction, repair of scalp malignancy or titanium mesh implant exposure, and repair of burn scar contracture. Flaps included ALT flap, LD flap and DIEP flap. The mean added pedicle length was 3.8 cm. Fifteen flaps survived completely and one flap was necrotic distally. No major complications occurred. Conclusions The ‘split flap’ technique could be an effective remedy for unexpected pedicle length deficiencies in large MPB free flaps.

Objective Comparison of Donor-Site Morbidity following Full and Thoracodorsal Nerve-Preserving Split Latissimus Dorsi Flaps.

The latissimus dorsi flap is a workhorse for reconstruction. However, flap harvest has been variably reported to result in donor-site morbidity. The aim of this study was to compare donor-site morbidity following harvest of a split latissimus dorsi flap, preserving the anterior branch of the thoracodorsal nerve, and a traditional nerve-sacrificing full latissimus dorsi flap. Patients who underwent split or full latissimus dorsi flaps between July of 2017 and August of 2020 at a single center were recalled for assessment. Donor-site morbidity in the shoulder was evaluated through the Disabilities of the Arm, Shoulder and Hand questionnaire; the Shoulder Pain and Disability Index; and the American Shoulder and Elbow Surgeons questionnaire. Medical Research Council strength grading was also performed. A total of 22 patients in the split latissimus dorsi cohort and 22 patients in the full latissimus dorsi cohort were recalled. Patient-reported outcomes as assessed through the Disabilities of the Arm, Shoulder and Hand questionnaire; Shoulder Pain and Disability Index; and American Shoulder and Elbow Surgeons questionnaire scores revealed statistically greater (p < 0.05) donor-site morbidity associated with the traditional compared to split latissimus dorsi flap. Seven patients in the full latissimus dorsi cohort had less than Medical Research Council grade 5 power at the shoulder, whereas all patients in the split latissimus dorsi cohort demonstrated full power at the shoulder. Traditional full latissimus dorsi flaps were found to result in greater donor-site morbidity compared to thoracodorsal nerve-preserving split latissimus dorsi flaps. Split latissimus dorsi flaps may be beneficial in preserving donor-site function and strength. Therapeutic, III.

The Assessment of the Usefulness of Platelet-Rich Fibrin in the Healing Process Bone Resorption

The main subject of this research was the use of PRF in dental surgery aimed at preventing changes in alveolar height and width after tooth extraction. Due to the large growth factor content, it seems to be particularly useful in bone loss management starting from the simplest loss occurring after tooth extraction through loss resulting from tooth resection ending with loss caused by large bone cysts. The study was performed on 50 patients. The extraction of two maxillary or mandibular homonymous teeth was carried out in each patient, where PRF was placed in one alveolus while the other alveolus was left empty. Then, the alveoli were surgically managed with a split flap technique. On the extraction day, after 10 days, and after 6 months, the alveolar process was measured, soft tissues healing was assessed, and imaging examinations were analyzed. It was proved that the healing of soft tissues in the PRF group was better. In the PRF group after 6 months from surgery, the newly formed bone had higher grayscale values in volumetric tomography (CBCT). Moreover, the reduced atrophy of the alveolar process at the site of the extracted tooth was proved in this study.

Split Buccal Fat Flap in Modified Furlow Palatoplasty: Surgical Technique and Early Result.

Encouraging results have been described for the use of pedicled buccal fat pad flap in primary cleft palate repair. This retrospective study describes the surgical technique and early results of a technical innovation utilizing the split buccal fat flaps in modified Furlow palatoplasty with small double-opposing Z-plasty. This technique introduces buccal fat tissue for coverage of lateral denuded palate surfaces to reduce the bone exposure and scar formation to potentially attenuate maxillary growth interference and for reinforcement of the palatal areas of high tension or with incomplete closure to decrease the risk of postoperative dehiscence and oronasal fistula formation. Consecutive nonsyndromic patients (n = 56) with cleft palate were treated with this method, all of whom demonstrated fast mucosalization of lateral palatal recipient regions within 3 weeks postoperatively and showed no fistula with 12 months' follow-up. Of 19 patients (33.9 percent) who underwent auditory-perceptual assessment, 15 (78.9 percent) had normal resonance. Surgeons could add this alternative surgical maneuver to their armamentarium during the primary palatoplasty, in which coverage of lateral surfaces and reinforcement with fat tissue in the anterior soft palate space are of paramount relevance. Therapeutic, IV.

Clinical and functional features of rectal sphincter in patients with rectovaginal fistulas before and after split vaginal-rectal flap application

Dysfunction of the rectal sphincter is noted in more than 70 % of patients with rectovaginal fistulas (RVF), which require an extremely careful evaluation of the rectal sphincter function both by clinical and instrumental methods. Objective: to study the state of rectal sphincter in patients with rectovaginal fistulas before and after surgical treatment. Materials and methods: in the period from 2012 to 2021 198 patients (age from 20 to 73 years, Me = 35 (30; 45)) were included in the comprehensive study of the rectal sphincter functional state before and after surgical treatment. 106 (53,5 %) cases were recurrent. Traumatic childbirth was the most common cause of RVF (43,9 %). Results: dysfunction of the rectal sphincter is revealed in 154 (77,8 %) patients with rectovaginal fistulas. The etiology of the disease and the recurrent course do not affect the severity of the rectal sphincter functional disorders. Using of a split rectal-vaginal flap do not lead to a worsening of the rectal sphincter function. Conclusion: A significant mismatch between the obtained objective (sphincterometry) and subjective (Wexner scale) data of the rectal sphincter function in patients with rectovaginal fistulas proves the need for sphincterometry in this category of patients. Elimination of rectovaginal fistulas by using a split vaginal-rectal flap is a safe and low-traumatic surgical method.

Decreasing complications of pectoralis major muscle flap reconstruction with two modalities of negative pressure wound therapy.

Deep sternal wound infection is a feared complication of open-heart surgery. Negative pressure wound therapy has gained an important role in the treatment of deep sternal wound infection. Incisional negative pressure wound therapy has been introduced as a method to prevent wound complications after sternotomy, and lately, after flap reconstructions in the treatment of deep sternal wound infection. We aimed to study if incisional negative pressure wound therapy with PICO™ had similar beneficial effect described earlier with competing commercial devices. This study included 82 patients treated with pectoralis major muscle flap for deep sternal wound infection during the years 2006-2020. PICO group consisted of 24 patients treated with preoperative negative pressure wound therapy and postoperative incisional negative pressure wound therapy (PICO™). Two control groups included 48 patients with conventional treatment and 10 patients with preoperative negative pressure wound therapy only. In the PICO group, the complication rate declined from 50.0% to 33.30%, major complication rate from 29.2% to 12.5%, and need for an additional flap from 14.6.% to 4.2% when compared to conventional treatment. The length of hospital stay decreased as well. Preoperative negative pressure wound therapy alone was associated with moderate decline in the complication rates. In addition, we described the use of split pectoralis major muscle flap reconstruction in 57 patients. To our knowledge, this is the largest published patient series describing this method in the treatment of deep sternal wound infection. Incisional negative pressure wound therapy with PICO™ seems beneficial after flap reconstruction. Split pectoralis major muscle flap is a versatile reconstruction option suitable to be used as a workhorse in the treatment of deep sternal wound infection.

V10-07 URETHROPLASTY WITH ILEAL FREE FLAP

You have accessJournal of UrologyLower Tract Reconstruction (V10)1 Sep 2021V10-07 URETHROPLASTY WITH ILEAL FREE FLAP Alice Drain, Nabeel Shakir, Jordan Frey, Min Suk Jun, Jamie Levine, and Lee Zhao Alice DrainAlice Drain More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Jordan FreyJordan Frey More articles by this author , Min Suk JunMin Suk Jun More articles by this author , Jamie LevineJamie Levine More articles by this author , and Lee ZhaoLee Zhao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002061.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Salvage urethroplasty of a recurrent urethral stricture presents a technical challenge. Our objective is to present the evaluation, surgical approach and outcomes of urethral reconstruction with ileal free flap. METHODS: We present a 35 year old male with obliterative stricture which was repaired with ileal free flap urethroplasty. The patient had previously undergone multiple endoscopic and open attempts including excision and primary anastomosis, buccal mucosa, gracilis flap and split thickness skin flap and perineal urethrostomy with recurrence. Reconstruction with ileal free flap was performed with success. The medical record and intraoperative photographs and video were reviewed to create this presentation. RESULTS: Urethroplasty with ileal free flap was successfully performed. At seven months post-operatively the patient reported normal erections and strong stream with low post void residual. CONCLUSIONS: Reconstruction of extensive urethral stricture after failed endoscopic and open attempts can be successfully accomplished with the use of an ileal free flap urethroplasty. Source of Funding: No funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e757-e757 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alice Drain More articles by this author Nabeel Shakir More articles by this author Jordan Frey More articles by this author Min Suk Jun More articles by this author Jamie Levine More articles by this author Lee Zhao More articles by this author Expand All Advertisement Loading ...

Periorbital and Perioral Defect Reconstruction Using the Split Pre-Expanded Medial Arm Flap Aided by Using Indocyanine Green Angiography.

The pre-expanded medial arm flap provides suitable skin for the resurfacing of a periorbital or perioral defect. However, the flap must be intraoperatively split to imitate the appearance of the oral or ophthalmic fissure, which can compromise flap perfusion. This study aimed to evaluate the safety and effectiveness of splitting pre-expanded medial arm flaps with the aid of indocyanine green angiography. All 8 patients underwent periorbital or perioral soft tissue reconstruction using a split pre-expanded medial arm flap. Flap splitting was aided by indocyanine green angiography. It was used during 2 stages of the procedure, tissue expander placement and flap transfer. The pedicle was divided 3 weeks later, and the flaps were used to resurface the defect. The distal portion of the flap was split into a fishmouth pattern in 5 patients and a window pattern in 3 patients. The donor sites were closed directly or by using a latissimus dorsi myocutaneous flap. There were no perioperative complications or flap necrosis. A pre-expanded split medial arm flap could be an option for the reconstruction of periorbital and perioral defects. With the assistance of indocyanine green angiography, vessel distribution and distal flap perfusion can be reliably evaluated, facilitating the safe splitting of the flap for the reconstruction of defects.

Split Lateral Forehead Flap for Reconstruction of Upper and Lower Eyelids

Background: Eyelids reconstruction after tumor resection has be one of the most challenging procedures in reconstructive plastic surgery. Small defects may be closed by primary suture or covered by small local flaps or skin graft. But in large eyelids defects, we need to find a bigger source of color and texture matching tissue that will ensure functional and aesthetical outcomes. Many techniques have been described, but in this case, the author suggest a split lateral forehead flap designed to cover upper and lower eyelids. Patient and Operation Techniques: A Male 51 years-old-patient, presented himself in our clinic with a basal cell carcinoma involving the right upper and lower eyelids. The tumor had a history of 7 years, without any pain or vision disorders involved. Tumor was widely excised, leaving a full thickness on upper and lower eyelids. The inner lining palpebral was replaced by composite auricular graft following by lateral cantophexy. A lateral forehead flap raised with a right temporal pedicle, and the distal part of flap was split in half, and inset into the upper and lower eyelids defect. The donor region was closed with an STSG from Femur Dextra. After 14 days the flap was divided, the functional result was excellent. Discussion: At first, surgeons were worried of raising forehead flaps beyond the midline, fearing that by splitting the distal flap would cause its compropmise. However, rich anastomostic plexus exists between the major forehead angiosomes lined by the smaller calibre “choke” vessels. Conclusions: Periorbital Basal cell carcinoma resection may leave great defect to the underlying tissue. The need to provide adequate support to this structure requires complex techniques with minimum two flaps. In our case, we performed a split lateral forehead flap with a good functional and cosmetic outcome.

Full versus partial thickness flap to determine differentiation and over keratinization of non‐keratinized mucosa. A 3‐year split mouth randomized pilot study

ObjectivesIt was shown, that Connective Tissue Grafts (CTG) retrieved from the tuberosity tends to determine hyperplastic responses and may induce a beneficial over‐keratinization of non‐keratinized mucosa. Clinically evaluate and compare CTG from tuberosity ability to increase soft tissue thickness and the keratinization potential after recipient area is either prepared using split or full thickness flap in edentulous mandible.Materials and methodsFourty implants were placed in 10 edentulous patients with atrophied mandible (Class IV of Misch) presenting less than 1.0 mm of keratinized tissue using a flapless approach and immediately restored with acrylic temporary bridge on multi‐unit abutments. The surgical sites were split‐mouth randomized and prepared as CTG recipients by a tunneling procedure. Twenty benefited of a partial thickness approach and 20 of a full thickness one. The CTG was placed buccally using partial thickness or full thickness flap according to the randomization schedule. The width of keratinized tissue (KT), the horizontal soft tissue thickness (STT), the marginal hard and soft tissue levels as well as the implant success parameters were collected and analyzed.ResultsAfter a 3 year follow‐up period the increase of KT was statistically significantly (p < 0.001) larger in the partial thickness group from 0.6(0.6) to 5.1(0.72) mm, while full thickness group showed very little improvement from 0.5(0.51) to 1(0.57) mm (p < 0.001). STT was significantly increased in both groups over time: from 2.4(0.88) to 5.4(0.68) mm in full thickness group and from 2.5(0.51) to 5.8(0.41) mm in partial thickness group without any significant difference between the groups.ConclusionThe increase of soft tissue thickness by using CTG from tuberosity was found in both groups, while keratinization of non‐keratinized mucosa appeared more in the partial thickness group.

Technical Considerations and Clinical Applications of the Free Anterior Branch Split Latissimus Dorsi Flap.

The free anterior branch split latissimus dorsi flap has a reliable anatomy and advantages over the traditional latissimus dorsi flap. By preserving the posterior branch of the thoracodorsal nerve, morbidity at the donor site is reduced, preserving shoulder strength. The purpose of this article is to review our experience with the split latissimus flap, describe our surgical technique, and finally review representative cases of reconstruction in different anatomical regions. From April 2017 to October 2020, 39 free split latissimus flaps were performed at a single center. Flaps were performed for coverage in the upper extremity (n = 2), lower extremity (n = 32), and head and neck (n = 5). Flap success rate was 97.4%. Mean dimensions of the flap were 17.0 × 8.3 cm, with a mean area of 145 cm2. The flap has a broad application and can be utilized in many different reconstructive scenarios including for coverage of defects in the extremities, trunk, and head and neck.

Split Pectoralis Muscle Patch: A Surgical Adjunct During Prepectoral Breast Reconstruction Salvage.

Prepectoral implant-based breast reconstruction after mastectomy is a safe and reliable surgical option to restore aesthetic contour. Perioperative radiation therapy lends a morbidity to the integrity of the thin-walled mastectomy construct. Wound complications may result in implant exposure, which is potentially devastating to the reconstructed breast. Salvage often leads to implant explantation with the subsequent need for autogenous tissue grafts. Such rotational and free flap procedures result in prolonged operative times and inpatient length of stay, as well as donor site morbidity. Here we present a technique that utilizes a pedicled split pectoralis muscle flap as an internally rotated breast envelope patch to buttress a mastectomy flap repair during salvage of the prepectoral breast envelope when full-thickness tissue defect is present.

Fournier\u2019s gangrene: a retrospective review of management outcomes and seasonal variations of clinical presentation

BackgroundTo review retrospectively the outcomes of management of Fournier’s gangrene (FG) and to assess for possible seasonal variations in clinical presentations of FG to a referral hospital in a tropical African country.MethodsThe medical records of patients who presented with FG from February 2012 to December 2019 were reviewed. Of interest were age of patient, vital signs at presentation, site of gangrene, duration of hospital admission, and management interventions deployed. Analysis was with SPSS® version 21.ResultsTwenty-three of 28 medical records could be analyzed. Median Fournier’s Gangrene Severity Index (FGSI) was 5 (IQR:3–10), the median Uludag-FGSI (UFGSI) was 7 (IQR:4–14). In 82.6%, the scrotum was the site of onset; in 8.7%, the lesion had spread beyond the pelvis. Diabetes mellitus (30.4%), HIV infection (13.0%) and nephropathy (17.4%) were identified co-morbidities. There were 2.4 ± 1.0 debridement sessions and 1.5 ± 1.3 transfused units of blood per patient. In 60.9%, the wound edges were undermined and apposed; in 17.4%, split skin grafting or fascio-cutaneous flap cover was deployed. In 17.4%, satisfactory wound closure needed more than 1 theater session. Mean duration of hospital admission was 51.4 ± 19.4 days. No mortality was recorded.Majority (91.2%) presented in hot, dry months of October through March with peak in December. No case presented in the wet months of May through September.ConclusionMeager resources notwithstanding, FG management outcomes are generally satisfactory. Furthermore, FG is observed to present mostly in the hot, dry months of the year in the 8 years under review.

Analysis of the impact of trailing-edge wing flaps on the aerodynamic characteristics and performance of the Diamond DA-20 aircraft

One of the factors affecting the aerodynamics and performance of aircraft profiles are flaps. The work presents the influence of selected types of flaps on Diamond DA-20 properties. The aircraft aerodynamics is described in detail. Furthermore, the three types of steady flight are presented and the ways of calculating the basic performance of the airplane are taken into consideration. The techniques used to carry out the research are discussed, the conclusions are drawn and the final results are presented. The aim of this article was to analyse the influence of trailing-edge wing flaps on the aerodynamic characteristics and performance of the Diamond DA-20 aircraft. The research focused on the aircraft in smooth configuration and with four types of trailing-edge wing flaps: pop-up, split flap, single-slotted flap and double-slotted flap in 15° and 45° positions.

The Use of Split Temporalis Muscle Flap in Maxillofacial Reconstruction

Study Design: Case Report. Objective: The Temporalis muscle (TM) Flap is a reliable, versatile flap with adequate bulk and flexibility. However, temporal hollowing is the most common postoperative complication after harvesting the flap. We describe a surgical modification for harvesting the split TM flap to prevent postoperative temporal hollowing and report 2 cases with up to 18 months of follow-up. Method: This study discusses the posterior ⅔ split temporalis muscle flap in preventing temporal hollowing. We report 2 well-documented cases with up to 18 months of postoperative follow-up. Also, the authors discuss the key points regarding the technique’s indication and limitation. Results: The posterior ⅔ split temporalis muscle flap is reliable in both benign and malignant disease processes. The results demonstrate the flap’s reliability with minimum donor site morbidity. Conclusion: The use of the posterior ⅔ of the TM flap is a viable technique to prevent the flap’s harvest’s temporal hollowing.

Modifications of Paramedian Forehead Flap

Introduction Paramedian forehead flap an interpolated flap based on supratrochlear vessels is considered as a workhorse for nasal and periorbital reconstruction however it re-quires modification’s to meet reconstruction requirement. Modifications includes islanded single stage forehead flap, expanded forehead flap, pre-fabricated with rib cartilage, folded forehead flap, split forehead flap and delayed flap, are associated with complications which can be minimized using different techniques. This article’s objective is to re-view indications for modification of Paramedian forehead flap, its complications and techniques of minimizing them. Methods: Twenty-three patients with facial defects reconstructed with modified Paramedian forehead flap were analysed by non-probability purposive sampling from September 2010 to August 2014, while traditional forehead flap reconstructions were excluded. Results: Nasal and periorbital region defects were present in twenty-one and two patients respectively.13 had full thickness nasal defects, 14 had BCC while SCC in 2 patients. Reconstruction was performed in multiple stages except in three patients. Expanded forehead flap was used in four, subcutaneously islanded pedicle forehead and flap prefabricated forehead flaps in three each, split forehead and delayed reconstruction in two patients each. No total loss of flap was observed except in one folded forehead flap where partial distal one cmnecrosed; one patient with expanded forehead flap required revision due to flap contraction. Conclusions: Modifications of Paramedian forehead flap appear reliable, versatile and excellent tool for nasal and periorbital reconstruction. Judicious modifications of flap de-sign as per indication can give satisfactory results with minimal complications by following the techniques mentioned in literature.