Subdermal Vascular Network Research Articles

More potential uses of specific perforator flaps in the calf – A cadaveric study on the subdermal vascular structure of the lower leg

BackgroundThe perforator flap has garnered significant interest since its inception due to its advantage of not needing a vascular network at the deep fascial level. Perforator flaps are commonly utilized in different flap transplant surgeries, and the thigh flap is presently the most widely used perforator flap. Is it possible for the calf to replace the thigh as a more suitable site for harvesting materials? Currently, there is a lack of relevant anatomical research. This study aims to address this question from an anatomical and imaging perspective. MethodsThis study used cadavers to observe the branches and courses of perforators on the calf and the distribution of skin branches using microdissection techniques, digital X-ray photography, and micro-computed tomography techniques. ResultsThe perforators had three main branches: the vertical cutaneous branch, the oblique cutaneous branch, and the superficial fascial branch. The superficial fascial branch traveled in the superficial fascia and connected with the nearby perforators. The vertical and oblique cutaneous branches entered the subdermal layer and connected with each other to create the subdermal vascular network. ConclusionsWe observed an intact calf cutaneous branch chain between the cutaneous nerve and the perforator of the infrapopliteal main artery at the superficial vein site. Utilizing this anatomical structure, the calfskin branch has the potential to serve as a substitute for thigh skin flap transplantation and may be applied to perforator flap transplantation in more locations.

Benefits of Reducing Incision Tension in Hard-To-Close Keloid Surgery.

Benefits of Reducing Incision Tension in Hard-To-Close Keloid Surgery.

The Transfer of Expanded Forehead Superthin Flap Without Frontalis and Less Hair Follicles Pedicled by Superficial Temporal Vessels.

The expanded forehead flap pedicled with superficial temporal vessel(s) is a common method to treat facial scar deformity. However, local bulkiness and hair retention have limited the use of this flap. Five cadavers were used for anatomy to confirm the forehead "safety zone." A retrospective study was performed on 15 patients with facial scar deformity who were undergoing the expanded forehead superthin flap (without the expanded capsule, frontalis muscle, and with less hair follicles) pedicled with superficial temporal vessel(s) to transfer and repair the deformity. Through cadaver anatomy, the range where the subdermal vascular network laid superficial to the hair follicle level was named the "safety zone," whose average distance between the bilateral penetrating points was 10.2 cm (8.7-11.6 cm). Fifteen patients with facial scar deformity were treated with the superthin flap technique. The trimming size of the safety zone flap was (6-10) × (12-20) cm. The median time of thinning the safety zone was 35 minutes (range, 25-40 minutes). All flaps healed well. The median residual ratio of the hair follicle was 39.8% (29.9%-50.5%). All patients were satisfied with the contour of the flap. We firstly proposed a concept of forehead safety zone and used the superthin flap without the frontalis muscle and less hair follicles to treat facial scar deformity, and obtained an improved therapeutic effect. We think this is an appealing technique that can manifest facial concave and convex in the fine part, improve compliance of the flap, and reduce the times of laser hair removal.

Supraciliary Incision as a New Double-Eyelid Approach for Asian Patients: Clinical Experience of 528 Cases.

The double-eyelid operation is the most requested cosmetic surgery in Asians. The incision is usually located at the pretarsal skin 6mm to 8mm above palpebral margin. The purpose of this paper is to report a novel approach of double-eyelid operation through a supraciliary incision (SCI). Three transverse curved lines were drawn on the upper lid skin. The location of line 1 (SCI) was 1.5mm above the eyelash, line 2 according to the amount of redundant skin excised and line 3 at 3mm to 4mm above line 2. After the incisions were made between line 1 and line 2, the subcutaneous dissection is carried out over 5mm the line 3. Then, the redundant skin and a strip orbicularis oculi muscle were removed to open the orbital septum and to explore underside levator aponeurosis. Along the line 3, the internal buried fixation sutures between dermal tissue and the fusion line of the orbital septum and levator aponeurosis were placed. Finally, the wounds were closed between line 2 and line 1. There were 528 patients who underwent the double-eyelid operation through the supraciliary approach. In long-term follow-up, 288 patients were evaluated at 6months to 78months postoperatively. Of those, 266 patients were satisfactory for the result (92.36%) with natural shape and invisible surgical scar. In another 22 patients (7.63%), a revised blepharoplasty was performed in 22 eyelids. The double-eyelid surgery using the SCI has several advantages including less visibility of the incision, the protected subdermal vascular network, the intact continuity of the upper eyelid skin, the combination of the SCI and internal dermal buried suture method. The approach can be considered an efficient technique for Asian patients. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Application of self-made vacuum sealing drainage device in postoperative fixation and drainage of abdominal pedicled flaps in 8 patients with deep burns of upper limbs

From January 2013 to December 2017, 8 patients with deep burns of upper limbs were admitted to our hospital, including 6 males and 2 females, aged 23-48 years. The wound area of full-thickness burns to burns with tendon and bone injury was 4.5 cm×2.0 cm-20.0 cm×10.5 cm. After debridement, thin abdominal flaps with subdermal vascular network in the size of 5.0 cm×2.5 cm-22.0 cm×12.0 cm were applied to cover the wounds, and the donor sites were sutured directly by relaxation. The disposable suction tubes with holes cut on side walls were used as drainage tubes. The part of drainage tubes with holes were wrapped with nano-silver antimicrobial dressings and then placed at the lowest position of pedicle and donor site of abdominal flap and the space between the injured limb and the abdominal wall. The loose nano-silver antibacterial dressing was used to fill the webs of fingers and the gap between the injured limb and the abdominal wall. The transparent film dressing was used to close the surgical area and then connected with a low negative voltage electric suction device to continuously suck at a negative pressure of -15 to -10 kPa. The self-made vacuum sealing drainage device was replaced at intervals of 4 to 5 days until pedicle breakage was performed 2 to 3 weeks after operation. The pedicled abdominal flaps of 8 patients had no torsion or avulsion, no pedicle blood supply disorder, and no infection or skin erosion in the operation area, and all the flaps survived after pedicle breakage.

Application of reverse dermal revascularization combined with vacuum sealing drainage in the large area of skin avulsion of the lower extremities

To summarize the clinical effect of emergency subcutaneous vascular network reverse skin replantation combined with vacuum sealing after drainage of large area skin avulsion injury. Clinical data of 30 patients with extensive skin avulsion of the lower limb treated between July 2010 and March 2018 were collected. There were 20 males and 10 females, ranging in age from 16 to 67 years old, with an average of(48±13) years old. Cause of injury: 19 cases of car accident injury, 11 cases of crush injury. The surgery time was 3 to 10 h, with an average of (5±1) h. All cases were completely debrided in stage I. The subdermal vascular network was reversed and skin grafted with multiple incision drainage combined with negative pressure closed drainage technique for 7 to 10 days. The wounds were removed by VSD observation:if the necrotic area is large, debridement is required. After the granulation growth of the wound is satisfactory, the skin grafting is performed again after electrification; the small area of necrotic skin strengthens the dressing and heals. 30 patients were followed up for 7 to 48 months, with an average of (20±11) months.No infection in 1 case appeared, 30 patients, living area more than 85% of the wound after treatment survival in the stage I; The skin necrosis ranged from about 12% in 5 patients in the stage II. The second stage was healed after redebriding free skin grafts. The other patients were healed after the dressing, capillary meshwork layer of skin color, good elasticity, feeling, wearable pressure, each joint activities is good, no obvious skin adhesion cause physical activity is limited. Reverse skin grafting combined with VSD for the treatment of large skin avulsion of lower limb can greatly reduce wound infection rate, promote the application of skin and wound, conducive to drainage, improve the survival rate of reverse skin grafting and improve the function of lower limb joints.

Anatomic basis and clinical application of perforator flap thinning of posterior tibial artery

Objective To explore the anatomic basis of the thinning of the free posterior tibial artery perforator flaps and the clinical effect of repairing wound on hand or foot due to trauma. Methods From November, 2016 to December, 2017, 10 cases of lower extremity cadaver specimens perfused with red ralex were dissected, which were perfused through the amputated femoral artery. Five of them were left and the rest were right. All cases were males. The number, diameter, branches and distribution of the perforator was observed. From September, 2012 to September, 2017, there were 13 cases of clinical application, which were 5 cases of hand wound and 8 cases of foot wound. The size of the wound was 3.0 cm × 2.0 cm to 6.0 cm × 4.0 cm, and the flap area was 3.5 cm × 2.2 cm to 6.5 cm × 4.5 cm. The repairing procedure was suitable for the wound associated with tendon, bone, joint capsule exposure. Results The number of posterior tibial artery perforating branches that more than 0.50 mm in diameter was 4 to 6, and the mean diameter was (0.87±0.26) mm. The perforating branch penetrated into the fat layer and was divided into 3 layers of vascular network: deep fat vascular network, superficial fat vascular network and subdermal vascular network. The perforating branch was located according to the positional relationship from deep to shallow, and vessel diameter become smaller step by step. The perforating branch trunk gave off branches to the deep vascular network, and the superficial vascular network had the same origin or shared with the deep blood vessels. The subdermal vascular network issued from the superficial vascular network or directly from the perforating branch trunk. There was no or few communicating branch between the deep vascular network and superficial ones, besides the vessel pedicle. So trimming deep fat layer will not affect the blood supply of superficial vascular network and neither will affect the flap blood supply. Most of the deep fat tissue was trimmed in 13 cases. The superficial and subdermal fat vascular network was preserved, and the same to the trunk and branches of the pedicle. All the flaps survived. Of which, 1 appeared arterial crisis on the 2nd day after operation, and relieved by the local injection of papaverine. There was 1 case of venous crisis on the 3rd day, and improved by stitches, local release of congestion. Followed-up time was ranged from 2 to 12 months. All flaps were soft with good blood supply and good appearance, and did not need a second thinning surgery. Flaps restored the protective feeling 6 months later. Conclusion The microdissection of perforator flap of posterior tibial artery provides a theoretical basis for the perforator flap thinning, and the thinning of perforator flap is a good method to repair the appearance and function of the wound after foot and hand injuries. Key words: Posterior tibial artery perforator flap; Applied anatomy; Wound; Repair; Microsurgical operation

Reconstruction of neck and face scar contractures using occipito-cervico-dorsal supercharged “super-thin flaps”: A retrospective analysis of 82 cases in Vietnam

BackgroundThe concept of the “super-thin flap” (also known as the subdermal vascular network flap) was introduced in Japan in 1994. Its distinctive characteristic is its extreme thinness: it is thinned to the point that the subdermal vascular network (subdermal plexus) can be seen through the minimal fat layer. Since 2006 in Vietnam, we have used circumflex scapular artery-supercharged occipito-cervico-dorsal (OCD) super-thin flaps to reconstruct cases of neck and face scar contracture. Materials and methodsThis case series comprised all 82 patients with neck and face scar contracture who underwent reconstruction with an OCD supercharged super-thin flap from 2006–2015 at the Vietnam National Institute of Burns. The flap was thinned and anastomosed at the distal area after elevation. All patients received one flap. ResultsOf the 82 flaps, 77 survived completely. The remaining five developed distal superficial necrosis (n=3) and interruption of the sutures due to infection; these required resuturing (n=2). In two of the three necrosis cases, the necrotic area affected 50% of the flap. Eighty of the eighty-two patients were satisfied with both the functional and aesthetic results. ConclusionsThe OCD super-thin flap has clear benefits, and although it is thin, its vasculature is reliable. Thus, it may be one of the best choices for reconstruction of neck and face scar contractures.

Free super-thin peroneal artery perforator flap containing neurovascular axis for coverage of hand or foot tissue defects

Objective To investigate the clinical results of free super-thin peroneal artery perforator flap containing neurovascular axis in reconstruction of hand or foot soft tissue defects. Methods A retrospective case series study was made on 23 cases of hand or foot soft tissue defects admitted from January 2006 to March 2013. There were 16 males and 7 females, with a mean age of 33 years (range, 17-51 years). Wounds were located in dorsal hand (n=12), dorsal pedis or amputated forefoot (n=8), greater thenar (n=2) and index finger (n=1) respectively. Defects ranged in size from 5.0 cm×3.5 cm to 11.5 cm×7.5 cm. Flap elevating was performed underneath the deep fascia and the perforator supplying the flap was dissected thoroughly, ligated and cut at the location arose from the peroneal artery. Most of the deep fascia except stripe shaped areas along the main blood supply chains was moved sharply and the fat underlying thinned primarily to the subdermal vascular network. After transferred to the recipient site, the flaps were revascularized by anastomosis of the perforating artery and its venae comitantes to appropriate recipient vessels. A total of 15 cases received innervated flap reconstruction. Flap vascularity and cosmetic results were recorded. Hand function was evaluated with the standard set up by the hand surgery branch of Chinese Medical Association. For foot reconstruction, shoe wearing status, gait, pressure-sore, flap sensibility, donor site appearance and complications were evaluated. Results All flaps were transplanted successfully with satisfactory cosmetic results, except that one flap used to cover dorsal ring finger defect left slightly bulky appearance. Mean duration of follow-up was 19 months (range, 11-26 months). For hand reconstruction, the functional results were excellent in 6 cases and good in 9 cases. Repairing of foot defects with the flaps caused no problem of shoe wearing and no sore occurred. Normal gait was acquired except two cases of partially amputated foot. If innervated, flap sensibility was restored at least to the degree of S3. Protective sensation and touch-pressure sensation were restored in eight non-innervated cases, and two of them were recovered to the degree of S3. There was only suture or small grafting scars on the donor leg and partially sensibility loss of lateral foot without functional defects in 13 cases. Conclusion Free super-thin peroneal artery perforator flap containing neurovascular axis is an easy and reliable technique that can attain satisfactory results for accurate coverage of hand or foot soft tissue defects. Key words: Surgical flaps; Hand injuries; Foot

Repair of skin and soft tissue defects of the extremity by transplantation of a U-shaped trimmed ilioinguinal flap

Objective To explore the efficacy of transplantation of a U-shaped ilioinguinal flap in the repair of skin and soft tissue defects of the extremity. An axial flap based on the superficial iliac circumflex artery and trimmed to a subdermal vascular network flap was used for the procedures. Methods Seven patients with skin and soft tissue defects treated between June, 2009 and May, 2014 were studied. The patients were 22-45 years of age (mean, 32 years) , and included 5 males and 2 females. Four patients had punch-press injuries, 1 patient had a hot-crush injury, and the remaining 2 patients were injured in the accidents. The wound sizes were 14.0 cm × 10.0 cm to 6.0 cm × 5.0 cm, with a varying extent of exposed tendons and bones. Repairs were performed using free ilioinguinal flaps, which were 15.0 cm × 11.0 cm to 7.0 cm × 5.0 cm in size. The axial flap was trimmed to a U-shaped subdermal vascular network flap and transplanted to the recipient site with anastomosis of blood vessels. Results All transplanted flaps survived. Four patients were followed for 1-6 months, with a mean duration of follow-up of 4 months. The trimmed flaps showed gradual reddening immediately after surgery, and the capillaries were recovered with a flat surface. Re-examination 3 months after surgery showed that the flaps were thin and flexible and met the aesthetic demand. No obvious pigmentation occurred, and the donor site was sutured directly, leaving only linear scars. Conclusion Repair of skin and soft tissue defects of the extremity using a U-shaped trimmed ilioinguinal flap has the advantages of a hidden donor site, small scar, and conformity to aesthetic requirements. The trimmed flaps are preferred over untrimmed flaps in terms of color and texture. The former flap is thinner, meets the aesthetic demand, and achieves a better efficacy. Key words: Ilioinguinal flap; Subdermal vascular network flap; Extremity; Microsurgical operation

Bipedicled “Superthin” Free Perforator Flaps for Facial Burn Scar Reconstruction

Background:“Superthin flap” is a distinctively thin flap that is thinned primarily to the point that the subdermal vascular network can be seen through a minimal fat layer. Reconstruction of severely disfigured neck and face can be performed using the occipito-cervico-dorsal superthin flap that is harvested from the dorsal region and supercharged by the circumflex scapular vessels. We used bipedicled superthin free perforator flaps to reconstruct scar contractures on half of the face, whole face, or the whole chin-neck area in 17 postburn patients.Methods:This case series report includes all 17 cases. Flaps in the dorsal area were designed. In all cases, one pedicle consisted of the circumflex scapular vessels. In 11, 5, and 1 flaps, the second pedicle consisted of contralateral posterior intercostal perforators (type 1), ipsilateral posterior intercostal perforators (type 2), and ipsilateral circumflex scapular vessels (type 3), respectively. Four patients underwent whole-face reconstruction after acid burn with type 1 or type 3 perforator. The recipient vessels were the superficial temporal vessels and contralateral or ipsilateral facial vessels. Intraoperatively, all adipose tissue in the flap, including between the 2 pedicles, was thinned by scissors before the pedicles were detached from the donor sites. Maximum flap size was 35 × 15 cm. Donor sites were covered by a split full-thickness skin graft. Flap survival and functional and cosmetic results were assessed retrospectively.Results:Fifteen of the 17 flaps survived completely. Two developed partial necrosis due to perforator thrombosis. Some patients developed hypertrophic scars around the flap, but these improved naturally over time. All patients were satisfied with both the cosmetic and functional outcomes of the reconstruction.Conclusion:Bipedicled superthin free perforator flaps may be an excellent choice for reconstruction of severe neck scar contracture. This report expands the scope of previously used “superthin flaps.”

Application of anti skin grafting and two pedicled abdominal flap to repair the whole hand degloving injury

Objective To explore the application of anti skin grafting and two pedicled abdominal flap to repair the whole hand degloving injury.Methods From June,2007 to December,2013,20 cases of hand degloving injury of skin and skin graft,waste application and combined application of VSD vacuum suction and two fingers abdominal pedicled skin flap repair,postoperative fingers activity,strength,degree of sensory recovery and function of four standards,respectively.After doing comprehensive evaluation.Evaluation standard:excellent for 13-16,good for 9-12 minutes,could be 5-8,difference of 4 points.Results Excellent functional recovery in 19 cases,accounting for 95％.In 1 patient the pain was not combined with exercise induced proximal interphalangeal joint part stiffness function can,accounted for 5％.Metacarpophalangeal joint activity of about 80 °-90 °,proximal interphalangeal joint activity of about 85 °-90 °.The 6 cases of sensory recovery grade S5,14 cases of abdominal two-way two subdermal vascular network flap for repair of sensory recovery S3.The patients were followed up for 2-6 years,results of 19 cases of activity were 4 points,1 case of active degree was 3,16 cases of power:4 points,3 points in 3 cases,1 case of 2 points.Feel:18 cases was 3,2 cases of 2 points.Function:18 cases was 4,2 cases of 3 points.Conclusion The operation method of small trauma,no multiple finger operation,avoids the contracture of the first web space and joint stiffness,for basic level hospital. Key words: Hand; Degloving injury ; Vacuum sealing pressure drainage technique ; Skin graft ; Microsurgical operation

Applied anatomy of cervico-acromial crossing skin flap

To investigate the applied anatomy of the blood supply of the cervicoacromial crossing flap and its feasibility in clinical application. 5 fresh adult and 10 forman fixed adult cadaver specimens were used. The arteries, veins, cutaneous arteries, subdermal vascular network, and vascular network of the superficial layer of deep fascia in the cervico-acromial area were observed and studied under the microscope. The frontier border of the cervico-acromial area is clavicle, the posterior border is the spine of scapula, the outer border is acromion and the inner border is cervical base. (1) The perforator branches concentrate at the front edge of trapezius muscle; (2) The vessel network around the front edge of trapezius muscle is abundant. Among the anastomosis, two or three anastomosis which across the area from the base of the neck to acromion can be observed in the axial of every cervico-acromial area. Abundant vessel network can be observed in the superficial layer of deep fascia. The blood supply of the cervico-acromial flap is abundant, which constains constant perforator point. The cervico-acromial crossing skin flap can be applied with the rich blood supply and abundant vessel network in the superficial layer of deep fascia.

Repair of degloving injury of the fingers using the H shape abdominal flaps with subdermal vascular plexus

Objective To introduce a surgical procedure for repair of skin aegloving injury of the fingers using H shape abdominal flaps with subdemal vascular plexus. Methods Eleven cases(30 fingers)of skin degloving iniury of the fingers distal to the proximal interphalangeal joint were treated with several H shape abdominal flaps with subdermal vascular plexus.Early functional exercises were carried out postoperatively. Results Sixty H shape abdominal flaps for the 30 finers of 11 cases all survived.Postoperative follow up ranged from 3 months to 5 years.The involved fingers had good movement.The apaearance of the fongers was satisfactory without flap bulkiness.Sensory recovery of the 60 flaps reached S0 in 6,S1 in 46 and S2 in 8.According to the criteria of Chinese Hand Surgery Society,the functions of these fingers were evaluated as good in 7 cases,fair in 2 cases and pool in 2 cases.The overall excellent and good rate was 81.8%.Threr was no morbidity at flap domorsite. Conclusion The H shape abdominal flaps with subdermal vascular plexus is an ideal option for repairing skin degloving injury of the fingers.It is simple,has minimal donor site morbidity and is a valuable option for functional recovery. Key words: Fingers; Wounds and injuries; Surgical flaps; Subdermal vascular network

Anatomical Study of Pectoral Intercostal Perforators and Clinical Study of the Pectoral Intercostal Perforator Flap for Hand Reconstruction

The authors have used pectoral intercostal perforator flaps to reconstruct burned or injured hands by staged transfer. This flap is designed with a narrow skin pedicle that includes intercostal perforators from the fifth to eighth intercostal spaces, with a wide flap area that lies on the upper abdomen. The distal area is thinned down to the subdermal vascular network level; thus, such flaps are called "superthin flaps" or subdermal vascular network flaps. In this article, the authors discuss the arterial networks associated with this flap and present clinical cases. The authors performed an anatomical study using 13 cadavers to obtain angiograms and dissect the anterior chest and abdominal region. Clinically, the authors retrospectively analyzed 21 cases over 13 years. Anatomically, the anterior intercostal regions could be divided into three segments with regard to vascular supply to the skin and subcutaneous layer. In particular, in the fifth to eighth intercostal spaces, perforators communicated with one another to form a "latticework" pattern. In addition, the vascular territories participating in the pectoral intercostal perforator flap, that is, the intercostal perforators, the superior epigastric artery system, and the deep inferior epigastric artery system, linked with each other through choke vessels. In the authors' clinical cases, functional and aesthetic results were satisfactory. The pectoral intercostal perforator flap was supported by the arterial networks among perforators in the intercostal spaces and in the upper abdomen. This flap is one useful method for reconstruction of the hand region, providing good quality in terms of thinness and texture.

Repair of Faciocervical Scars by Expanded Deltopectoral Flap

To explore the approach to repair faciocervical scars. Eighty-six patients with large faciocervical scars were repaired using the expanded deltopectoral flaps. After expansion, the flaps were transpositioned to repair faciocervical scars. Three weeks later the pedicles were separated and their skin tubes were flattened for the repair of the remaining faciocervical scars. Of the 86 cases, 80 achieved effective results with all the flaps surviving. Six cases showed achromatosis after healing because of the compromised blood supply. The application of expanded deltopectoral flaps is proved to be an effective way of repairing faciocervical scars. The flaps are as thin as those subdermal vascular network flaps', so when transferred to the facial region, the flaps will not swell and can well match with their peripheral tissues.

Arterial anatomy of the lateral orbital and cheek region and arterial supply to the “peri-zygomatic perforator arteries” flap

Arterial anatomy of the lateral orbital and cheek region and subsequently of the "peri-zygomatic perforator arteries" flap is described, based upon the dissection of the 24 human cadaver head halves. Each specimen was dissected in subdermal, first fascial and deep level. The subdermal vascular network of lateral orbital and cheek region, its orientation and contributing arteries were studied. Origin, perforation sites and diameters of transverse facial, zygomaticoorbital, zygomaticofacial and zygomaticotemporal arteries were also described and measured. Our findings support the view that the cheek island flap used for lower eyelid is a reverse flow axial pattern flap. It includes arterioles of the transverse facial artery, which are part of the subdermal vascular plexus and are uniformly longitudinally oriented. The flap receives its blood supply via perforators of the zygomaticoorbital, zygomaticofacial and zygomaticotemporal arteries, which are connected via their terminal branches with transverse facial artery.

Reconstruction of the face and neck scar contractures using staged transfer of expanded “Super-thin flaps”

Background The authors introduced the “Super-thin flap” concept, which is sometimes called the subdermal vascular network (SVN) flap, in 1994. Since 1994, we have reconstructed face and neck scar contractures using various types of “Super-thin flaps.” In this report, we introduce expanded “Super-thin flaps” for reconstruction of the face and neck for the first time in a patient. Methods Since 2000 we have used 21 expanded flaps to reconstruct 21 face or neck scar cases in nine males and 12 females. In the first operation, an expander was inserted on the fascia of the pectoralis major muscle, and then about 1000 cc of saline was injected during a 2-month period. In the second operation, the flap was thinned primarily and applied to the recipient site. Three weeks after the second operation, the pedicle of the flap was cut down and sutured. Results Flap size ranged from 4 cm × 14 cm to 10 cm × 22 cm. Expanded volume ranged from 800 cc to 1200 cc. All flaps survived completely and scar tissues were replaced with normal skin. Flaps did not shrink after the operations, and contractures did not recur. Conclusion Advantages of the expanded flaps are presented: (1) Large flaps can be harvested because of the expander; (2) Extremely thin flaps can be safely employed; (3) Texture and color match are good; (4) Donor site can be closed primarily; and (5) Microsurgery is not required. However, the disadvantage of the method is the requirement for two or three operations.

Dorsal intercostal perforator (DICP) augmented scapular “super-thin flaps” for the reconstruction of extensive scar contractures in the axilla and anterior chest: a case report

The concept of microvascular augmented subdermal vascular network (SVN, super-thin) flaps for the reconstruction of cervical scar contractures was first described by Hyakusoku in 1994 [1]. The paper presented a new concept and technique for reconstructive burn surgery. These very thin yet large flaps nourished only by subdermal vascular networks are especially useful for the reconstruction of contour-sensitive areas, such as the face and neck, and of flexural areas over joints. Since the original report, various flaps with superthinning and microvascular augmentation have been developed [2]. Recently, the dominant dorsal intercostal perforators (DICPs) have been put forward as a useful source for microvascular augmentation of narrow-skin-pedicled super-thin flaps in the back [3]. In this report, we present a new reconstructive technique for releasing severe scar contractures of the anterior chest involving the bilateral axillae using this type of flap.

Reconstruction of a defect after harvesting a radial forearm flap using a narrow pedicled paraumbilical perforator-based subdermal vascular network (super-thin) flap

The radial forearm flap is one of the most reliable flaps, but it has serious cosmetic donor site morbidity. We therefore reconstruct the defect after harvesting a radial forearm flap using a narrow pedicled paraumbilical perforator-based subdermal vascular network (super-thin) flap to overcome this problem.