Flap Thickness Research Articles

Iatrogenic Keratectasia after Refractive Surgery - Causes, Prophylaxis, Therapy.

Iatrogenic keratectasia is induced thinning and protrusion of the cornea after laser refractive surgery. Known risk factors include an excessively thin postoperative residual stromal bed, a thicker flap, or preoperatively undetected evidence of preexisting subclinical keratoconus. The rate of post-refractive ectasia in eyes without identifiable preoperative risk factors is 20 per 100 000 eyes for photorefractive keratectomy, 90 per 100 000 eyes for laser in situ keratomileusis, and 11 per 100 000 eyes for small incision lenticule extraction. Traditional screening tools for preoperative risk include the ectasia risk score system and percentage of tissue alteration. More recent methods include corneal elastography and epithelial mapping, in addition to Artificial Intelligence methods for data analysis. Therapy includes contact lenses, cross-linking, implantation of intracorneal ring segments, penetrating or lamellar keratoplasty, and, in early studies, implantation of corneal lenticules.

Malignant Phyllodes Tumor in the Male: A Case Report

Phyllodes tumors are breast tumors accounting for about 1% of all breast neoplasms in women and are rare in males. Reported here is a case of a 45-year-old male presenting with a rapidly enlarging right breast mass with invasion of the anterior chest wall. Core Needle Biopsy revealed Malignant Phyllodes Tumor. He underwent wide excision and chest wall resection. Reconstruction was performed using polyropelene mesh, a latissimus dorsi flap and split thickness skin grafting. Patient was discharged on the 33rd post-operative day due to delayed expansion of the right lung from splinting and subsequent near-complete loss of the split thickness skin graft over the latissimus muscle flap. On the recommendation of the plastic surgeon, the wound was allowed to heal by secondary intention. This report draws attention to the rarity of malignant phyllodes tumor in males, and the difficulty of recognizing a malignant pathology in males presenting with breast mass. It also highlights a cost-effective treatment option in the management of these tumors. Key words: Malignant Phyllodes tumor, Male Phyllodes tumor, breast

Supraclavicular Artery Island Flap for Head and Neck Oncologic Reconstruction: 15-year Experience, Past, Present, Future

Background: Head and neck reconstruction poses unique challenges due to the complex structure of the region. Primary goals include soft-tissue coverage, adequate color and texture match, and minimal donor-site morbidity. Local and musculocutaneous regional flaps have largely been replaced with fasciocutaneous free flaps (FFF) over recent years. The supraclavicular artery island flap (SCAIF), a locoregional, fasciocutaneous, axially-based flap, has been shown to produce similar outcomes to FFF. We present our 15-year experience using the SCAIF for head and neck reconstruction, discuss its evolution, and provide case examples for its range of indications. Methods: Retrospective chart review identified 128 patients who underwent reconstruction of the head and neck with the SCAIF between the years 2006-2021 at Tulane University Medical Center. Patient demographics, lengths of stay, operative times, surgical indications, and complications were recorded. Results: The cohort mean age was 66.9 years. Mean lengths of stay and follow-up times were 6.9 days and 9.1 months, respectively. The most common indications for SCAIF reconstruction were recurrent radiated neck disease (n=27, 21.1%), pharyngeal wall defects (n=23, 18.0%), and parotidectomy defects (n=21, 16.4%). Overall complication rate was 17.2%. Partial thickness flap loss (5.5%), contained pharyngeal leak (3.2%), and distal tip necrosis (2.4%) were the most common complications. No functional donor site morbidity was encountered. Conclusions: The SCAIF is a versatile, fasciocutaneous, axially-based flap able to produce similar outcomes to FFF in the reconstruction of the head and neck region while reducing costs, lengths of stay, operative times, and donor site morbidity.

Aortic dissection: computed tomography characterization of the true and false lumen in acute and chronic stages

Aortic dissection is a longitudinal rupture of the aorta associated with the destruction of the middle layer of the aortic wall, the separation of intima and adventitia and the formation of two lumens, which is an urgent condition requiring emergency surgical care. The presented illustrated literature review is devoted to the differentiation of true and false lumens in the acute and chronic stages of aortic dissection during computed tomography. The article summarizes and systematizes the experience of computed tomography diagnostics in aortic dissection based on data available in domestic and foreign publications, as well as the results of their own clinical observations. We have identified the main and secondary signs detected by computed tomography in cases of aortic dissection. The most important and unambiguously indicative of false lumen in classical acute and chronic aortic dissection are the larger size of the false lumen, the sign of a beak and the sign of a web. Other signs, such as calcification of the aorta, changes in the curvature and thickness of the intimal medial flap, the Mercedes-Benz symptom, the presence of thrombotic masses, the characteristics of the interposition of the lumens and the wind indicator symptom are less constant, however, a careful analysis of the totality of all secondary signs allows you to give important diagnostic information and characterize as fully as possible the manifestations significant for a cardiovascular surgeon dissections of the aorta. A cumulative analysis of computed tomographic signs in cases of aortic dissection will help a practicing radiologist not only distinguish the true lumen from the false aorta, but also determine the stage of the process based on their characteristics, which affects the tactics of complex treatment, especially with atypical dissection.

Https://scholarhub.ui.ac.id/jdi/vol30/iss1/1/

Fenestration term is derived from the Latin word ‘fenestra’ means ‘window’. Gingival fenestration is not found in routine while its actual occurrence is assumed to be higher. Additionally, if these mucogingival defects persist for a longer duration it may lead to adverse outcomes like compromised esthetics, hypersensitivity, plaque and calculus deposition, and susceptibility to dental caries. Present cases of gingival fenestration were successfully treated by using full-thickness flap elevation with connective tissue graft placement. Two cases were presented with the accumulation of plaque and calculus and having gingival fenestration to the respective sites. After phase 1 therapy, full thickness flap was raised and a connective tissue graft was placed beneath the fenestrated area. The successful results were obtained in both cases in terms of complete closure of gingival fenestration defects and well-adapted margins with adjacent tissues at one year of follow-up. Full thickness flap with connective tissue graft procedure resulted in complete closure of gingival fenestration in both cases with no recurrence at one-year follow-up and can be used as a successful and predictable treatment modality for the management of such cases.

APPLICATION OF A-PRF IN AN AREA WITH NON-INTEGRATED XENOGRAFT

Background: Xenografts are well-studied materials that are often used in regenerative dentistry. Nowadays the number of surgeries involving bovine‑derived xenografts in implant dentistry has increased significantly. However, the long-term success of these materials is still not well studied. A-PRF has been used as an autogenous product that can increase the predictability of the clinical procedure by introducing many platelets growth factors. Purpose: to describe a difficult for diagnostic and treatment clinical case and to propose a clinical protocol for resolving similar complications that can occur after guided bone regeneration. Materials and methods: 41 years old woman complains of pain, edema and inability to chew on the upper right quadrant after a history of placed dental implants and GBR procedure. A full thickness flap was reflected starting from tooth #11 to #16. A thorough decontamination of the affected area has been done with Piezoelectric instruments and A-PRF has been introduced to improve healing process. The flap was repositioned to its original position and sutured with single interrupted resorbable 6/0 sutures. Two weeks after the procedure of surgical removal of the xenograft the patient is relieved from all preoperative symptoms and complaints. Results: The normal architecture of the residual bone and alveolar mucosa is restored. A new CBCT is taken to evaluate the new clinical situation. Conclusion: The case demonstrates that the use of bone substitutes and especially xenografts should be done with caution because they are not resorbable and a potential infection around the graft particles may have long-term biological complications.

Medial Sural Artery Perforator Flap: A Middle Ground Between Anterolateral Thigh and Radial Forearm Flaps.

The medial sural artery perforator (MSAP) flap has gained popularity in head and neck reconstruction primarily as a less morbid alternative to the radial forearm free flap (RFFF). However, no direct comparison of thickness exists among the MSAP, RFFF, and anterolateral thigh (ALT) flaps, which together represent the commonly utilized nonosseus-free flaps in head and neck reconstruction. Thus, this study aimed to compare these flap sites and identify predictors of thickness that will aid in reconstructive surgical planning. Cross-sectional study. Tertiary referral hospital. The thickness of skin and subcutaneous tissue at the RFFF, MSAP, and ALT donor sites were measured in 54 adult patients using Doppler ultrasound. General linear models were generated to identify predictors of flap thickness. The mean thickness of the RFFF, MSAP, and ALT flaps was 3.8 ± 2.2 mm, 7.4 ± 3.8 mm, and 9.6 ± 4.7 mm. Body mass index (BMI) was the only statistically significant contributing factor (p < .0001, coefficient: 0.15) for the RFFF. MSAP was affected by age (p = .006, coefficient = 0.06), female gender (p < .0001, coefficient = 3.2), and BMI (p < .001, coefficient = 0.25), while the ALT was affected by female gender (p = .0005, coefficient = 3.3) and BMI (p < .0001, coefficient = 0.35). Thus, the ratio of increase for flap thickness with respect to BMI is 3:5:7 for the RFFF, MSAP, and ALT flaps, respectively. The MSAP is about twice the thickness of the RFFF and 2 mm thinner than the ALT; however, 22% of patients had thicker MSAP than ALT flaps. As the strongest predictors of flap thickness, female gender, and BMI may be taken into consideration during surgical planning for reconstruction.

The Dynamic Changes in Skin Thickness of Forehead during Tissue Expansion.

In addition to providing extra flap size, the tissue expansion process also brings changes in flap thickness. This study aims to identify the changes in the forehead flap thickness during the tissue expansion period. Patients undergoing forehead expander embedment from September 2021 to September 2022 were included. The thickness of the forehead skin and subcutaneous tissue were measured with ultrasound before and 1, 2, 3, and 4 months after expansion. Twelve patients were included. The average expansion period was 4.6 months, and the mean expansion volume was 657.1 mL. The thickness of skin and subcutaneous tissue in the central forehead changed from 1.09 ± 0.06 to 0.63 ± 0.05 mm and from 2.53 ± 0.25 to 0.71 ± 0.09 mm, respectively. In the left frontotemporal region, skin and subcutaneous tissue thickness changed from 1.03 ± 0.05 to 0.52 ± 0.05 mm and 2.02 ± 0.21 to 0.62 ± 0.08 mm. On the right side, skin and subcutaneous tissue thickness changed from 1.01 ± 0.05 to 0.50 ± 0.04 mm and 2.06 ± 0.21 to 0.50 ± 0.05 mm. This study measured the dynamic changes in the thickness of the forehead flap during expansion. The thickness of the forehead flap decreased the fastest in the first 2 months of expansion, and the changes in skin and subcutaneous thickness slowed down in the third and fourth months and tended to a minimum value. Additionally, the thickness of subcutaneous tissue decreased greater in magnitude than the dermal tissue.

Modified Progressive Tension Sutures for Closing the Wounds of Large Subcutaneous Tumor in Upper Back.

Large subcutaneous tumor removal in the upper back could leave "dead space" and increase postoperative complications. The progressive tension suture (PTS) has long been used in abdominoplasty to close dead space and reduce the complications rate. We aimed to explore the effectiveness of the modified PTS to reduce the complication of the large subcutaneous tumor removal in the upper back. Fity-nine patients with large subcutaneous upper back tumors (maximal length over 5 cm) were included in our prospective study and were randomly divided into the PTS group (n = 32) and the non-PTS group (n = 27). Based on the exposure of the deep fascia and the thickness of the flap, we modified the PTS technique and compared the outcomes (including necrosis, hematoma, and seroma) between the two groups. The tumor size, flap thickness, and the total surgical duration were comparable between the two groups. The incidence of flap necrosis (6.30% versus 25.90%, P = 0.0659) and seroma (0.00% versus 33.30%, P = 0.004) in the PTS group was lower than that in the non-PTS group. The length of hospital stay in the PTS group was shorter than that in the non-PTS group (6.4 ± 1.3 versus 9.4 ± 2.1 days, P < 0.0001). The modified PTS technique can effectively close the dead space after surgical removal of large upper back tumor and reduce the complications compared to the conventional approach.

Use of Customized Thickness Anterolateral Thigh Flap in Head and Neck Reconstruction

Objective: This study demonstrates different techniques of anterolateral thigh flap (ALT) with the appropriate surgical planes according to the thickness of the defect, which have not been previously found in the literature, with our reconstruction experiences. &#x0D; Materials and Methods: A retrospective study was performed including 26 flaps in 25 patients who underwent reconstruction of head and neck defects with different surgical planes of ALT flap including subfascial, superthin, suprafascial, chimeric and composite flaps from March 2017 through December 2020. Flap planes were chosen according to the thickness of the defect, determined during surgery by using caliper. We evaluated the characteristics, flap thicknesses, complications and need of revision surgery in postoperative period. &#x0D; Results: One of the superthin flaps was totally lost; there was not any other flap loss. Three patients died in postoperative period. Although appropriate plane of the flaps was chosen, 4 of all 26 flaps needed revision surgery. One of the patients who was performed lip reconstruction with superthin ALT flap had bulky appearance needed liposuction in postoperative 6 months and 3 patients who received subfascial ALT flaps were performed debulking surgeries. &#x0D; Conclusion: ALT flap is a versatile, reliable flap which can be harvested in different planes according to the thickness of the defect in head and neck region. The ALT flap with convenient thickness provides definitive reconstruction in a single stage without revision surgeries and the most optimal aesthetic results can be obtained.

Aesthetic Considerations in Extremity Salvage and Reconstruction.

After studying this article, the participant should be able to: 1. Have an in-depth understanding of the functional and aesthetic requirements of lower extremity reconstruction. 2. Describe the considerations for achieving an optimal aesthetic outcome in the primary reconstruction settings. 3. Describe modalities of secondary flap revision for achieving an optimal aesthetic outcome. Significant advancements have been made in the management of lower extremity reconstruction since Dr. Taylor's seminal case in 1973. Improvements in our understanding of vascular anatomy and evolution of microsurgical techniques have allowed for an ever-increasing array of free tissue transfer options for lower extremity reconstruction. The resulting expertise has engendered a paradigm shift toward the reconstructive elevator approach, with increased emphasis on cosmetic results. In the primary setting, aesthetic considerations play an important role in precoverage wound preparation, flap selection, and harvest technique, with the goal of achieving excellent like-with-like reconstruction at the time of initial surgery. Flap selection should be made to best match the three-dimensional architecture of the wound, and take into account the defect thickness, flap thickness, flap composition, and pedicle length. Primary flap thinning and harvest in the superficial fascial plane has been shown to be an effective modality to address excess adiposity and improve contour. Despite these efforts, secondary procedures are often required to optimize the limb's final appearance and functional outcomes, particularly in the foot and ankle region. These include debulking, liposuction, and staged excisions. As the field of limb salvage keeps evolving, aesthetics will continue to play an important role in extremity reconstruction planning and execution.

Evaluation of the predictive value of the body-mass-index choosing perforator flaps from different donor sites

BackgroundFree flap design must fulfill different criteria to ensure functional and aesthetic reconstruction of different types of defects in different body areas. A four-dimensional planning concept was used including flap length, width, thickness and tissue composition. This study evaluates if body-mass-index (BMI) has a predictive value for flap design.MethodsA prospective study including hospitalized patients in the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery was conducted. Not taking into account the reason for admission, the patients were examined based on age, weight, height, BMI and sex. The areas of a potential harvest of free fasciocutaneous and perforator flaps were measured using ultrasound examination to determine the thickness of the subcutaneous layers and prove blood perfusion.ResultsOver the period of four months, a total of 101 patients (36 females and 65 males) were included in this study and gave written consent. No statistical significance regarding the demographic data such as age, sex and BMI could be identified. An average to high correlation between free flap thickness and BMI was shown for the thoracodorsal artery perforator (TDAP), anterior lateral thigh (ALT) and deep inferior epigastric perforator (DIEP) flap in both, male and female patients.Free flaps of distal body parts such as the interosseous posterior flap, showed a lower correlation. No correlation using the Pearson coefficient could be found for age and volume.ConclusionOur study demonstrated that the BMI is a predictive indicator that can be used in the preoperative planning of reconstructions using free flaps. Depending on the defect location, the BMI can be considered to predict the thickness of the free flap and may influence the surgeon’s choice.On the other hand, a lower correlation between BMI and flap thickness encourages the use of standard flaps if more volume is desired, as the DIEP flap might be sufficient even in normal-weight women. Flaps of distal body parts, such as the forearm or lower leg, are not prone to such predictions and require other selection criteria.

Abstract ED6-3: How to reconcile novel reconstructive techniques with the need to radiate

Abstract The indication for postmastectomy radiotherapy (PMRT) is mainly based on tumor stage and the extent of lymph node involvement. The results of EBCTCG meta-analysis (EBCTCG Lancet, 2014) support the need of radiation therapy (RT) for patients with one to three axillary metastatic lymph nodes (LN), as well as for patients with &amp;gt; 3 affected LN. In nearly 40% of patients with mastectomy (ME) RT is required. According to the plastic surgery statistics report 2020 approximately 80% of patients seeking breast reconstruction in the USA receive an implant-based breast reconstruction (IBBR), while 18% undergo autologous reconstruction (ASoPS 2020). PMRT, regardless of reconstructive method, has been found to have a detrimental effect on outcomes with increased postoperative complications and decreased patient satisfaction. Nevertheless, even in this cohort the number of breast reconstruction (BR) is increasing over time. Surgical techniques for ME and BR are advancing constantly. With the increasing use of skin-sparing ME (SPM) techniques, particularly nipple-sparing ME (NSM), one stage IBBR (single-stage direct-to-implant, DTI) become more popular. With the availability of supportive materials such as synthetic/biological mesh or acellular dermal matrix (ADM) there has been a significant improvement in pre-pectoral implant reconstruction. The impact of PMRT on the outcomes of pre-pectoral IBRR has been recently summarized in a systemic review and meta-analysis by Awadeen (Aesth Plast Surg, 2022). Wound infection, capsular contraction and implant loss were significantly more frequent in the irradiated than in the non-irradiated breasts. Several studies describe the delayed/2-stage IBBR in the setting of PMRT as more promising and discuss different timings of exchange from expanders to implant. In one systematic review, PMRT to permanent implants reduced the rate of reconstructive failure compared to TE (J Surg Oncol,2015). After prosthetic-based BR and RT, conversion to autologous reconstruction can always be considered. Recommendations for immediate autologous reconstruction vary when PMRT is required. PMRT can result in wound complications, fat necrosis and volume loss, but overall cosmetic results are better than with IBBR and PMRT. When undergoing delayed reconstruction after PMRT, the optimal time from PMRT to reconstruction is unknown. In patients with a history of RT, NCCN-guidelines (V.4.2022) recommend autologous reconstruction as the preferred reconstruction option. Fat grafting, which can optimize tissue perfusion and wound healing, is playing an emerging role in breast surgery. Lipofilling can be used to improve the thickness of the mastectomy flap and to recontour breast defects after PMRT. There is an increasing awareness for better understanding of the different reconstruction types to define target volumes depending on the varying risk for residual tissue and potential recurrences. The ESTRO-ACROP guidelines discuss adapted dose distribution in accordance with the different locations of the implant (pre-or sub-pectoral) (Radiotherapy and Oncology, 2019). The risks and benefits of immediate versus delayed as well as implant-based versus autologous reconstruction must be considered for each individual patient and should be planned in a multidisciplinary setting, especially when PMRT is required. Citation Format: Christine Solbach. How to reconcile novel reconstructive techniques with the need to radiate [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr ED6-3.

Renaissance of prepectoral implant-based breast reconstruction: theoretical basis and research status

To overview the theoretical basis and research status of prepectoral implant-based breast reconstruction. The domestic and foreign researches on the application of prepectoral implant-based breast reconstruction in breast reconstruction were retrospectively analyzed. The theoretical basis, clinical advantages, and limitations of this technique were summarized and the future development trend in this field was discussed. The recent advances in breast cancer oncology, the development of materials and the concept of oncology reconstruction have provided a theoretical basis for prepectoral implant-based breast reconstruction. The selection of patients and the experience of surgeons are crucial for postoperative outcomes. Ideal thickness and blood flow of flaps are the most important considerations for the selection of prepectoral implant-based breast reconstruction. However, its long-term reconstruction outcomes and clinical benefits and risks in Asian populations still need to be confirmed by more studies. Prepectoral implant-based breast reconstruction has a broad application prospect in breast reconstruction following mastectomy. However, the evidence is limited at present. Randomized study with long-term follow-up is urgently in need to provide sufficient evidence to evaluate the safety and reliability of prepectoral implant-based breast reconstruction.

Ultrathin Anterolateral Thigh Free Flap: An Adipocutaneous Flap with the Most Superficial Elevation Plane.

Although many efforts have been made to create thinner anterolateral thigh (ALT) flaps, their thickness varies among patients, and the flap may be still too thick to match shallow defects. The authors successfully harvested an ALT flap through the most superficial elevation plane, the superficial fat layer, which was useful to match the shallow defects. All patients who underwent ALT free flap reconstruction for upper and lower distal extremity defects were divided retrospectively into groups by ALT flap elevation plane: thin, above the deep fascia; superthin, at the superficial fascia; and ultrathin, through the superficial fat. Preoperative computed tomographic angiography and duplex ultrasonography planning were used for all patients. Anatomical characteristics of donor subcutaneous tissue and surgical details, including flap thickness, flap size, and incidence of flap necrosis were compared among the groups and between sexes. The average deep and superficial fascial depths were 16.7 and 10.8 mm, 12.5 and 8.2 mm, and 9.1 and 5.6 mm ( P < 0.05), and the average flap thickness was 5.8 mm, 7.9 mm, and 7.8 mm ( P = 0.29) in the ultrathin, superthin, and thin ALT groups, respectively. No significant intergroup differences existed in flap size or complications. The deep and superficial fascia were located significantly deeper in female patients (9.4 and 6.0 mm in male patients and 14.9 and 9.6 mm in female patients, respectively). With precise preoperative planning, the most superficially elevated, ultrathin ALT flap can achieve optimal reconstructions of thin body areas. Female patients with thicker thighs and patients with a high body mass index would benefit from this flap. Therapeutic, IV.

Safety and Precision of Two Different Flap-morphologies Created During Low Energy Femtosecond Laser-assisted LASIK.

Currently, two major principles exist to create LASIK flaps: firstly, a strictly horizontal (2D) cut similar to the microkeratome-cut and secondly an angled cut with a "step-like" edge (3D). The strictly horizontal (2D) cut method can be performed using apparatus such as the low-energy FEMTO LDV Z8 laser and its predecessors which are specific to this type. Alternatively, the low-energy FEMTO LDV Z8 laser's 3D flap design creates an interlocking flap-interface surface which potentially contributes toward flap stability. In addition, the FEMTO LDV Z8 offers flap-position adjustments after docking (before flap-creation). The current study analyzed precision, safety, efficacy, as well as patient self-reported pain and comfort levels after applying two different types of LASIK flap morphologies which were created with a low-energy, high-frequency femtosecond (fs) laser device. A prospective, interventional, randomized, contralateral eye, single-center comparison study was conducted from November 2019 to March 2020 at the Hamburg vision clinic/ zentrumsehstärke, Hamburg, Germany. Eleven patients and 22 eyes received low-energy fs LASIK treatment for myopia or myopic astigmatism in both eyes. Before the treatment, the eyes were randomized (one eye was treated with the 2D, the other eye with the 3D method). The mean central flap thickness one month after surgery was 110.7 1.6 μm (2D) and 111.2 1.7 μm (3D); P = 0.365 (2D vs 3D). Flap thickness measured at 13 different points resulted in no statistically significant differences between any of the measurement points within/between both groups; demonstrating good planarity of the flap was achieved using both methods. Despite not being statistically significant, the surgeons recognized an increase in the presence of an opaque bubble layer in the 3D flap eyes during surgery and some patients reported higher, yet not statistically significant, pain scores in the 3D flap eyes during the first hours after the treatment. Overall, safety- and efficacy indices were 1.03 and 1.03, respectively. In this prospective, randomized, contralateral eye study, the low-energy fs laser yielded predictable lamellar flap thicknesses and geometry at one-month follow-up. Based on these results, efficacy and safety of the corresponding laser application, that is, 2D vs 3D, are equivalent.

Perforator mapping and clinical experience with the superthin profunda artery perforator flap for reconstruction in the upper and lower extremities

Thin skin flaps have gained popularity for extremity reconstruction. However, the use of the profunda artery perforator (PAP) flap has not been explored as much. With its concealed donor site on the medial thigh and bulk, the PAP has become popular for reconstruction in the breast, head, and neck. The thickness of the subfascial PAP flap is decreased through elevation on the thin or superthin plane, making it more suitable for extremity reconstruction. A consecutive series of 28 patients with 29 flaps who received a thin or superthin single perforator PAP flap for upper or lower extremity reconstruction was reviewed. Our technique for preoperative localization of the dominant perforator using computed tomography angiography (CTA) and color duplex ultrasonography (CDU) is described. Flap success rate was 93.1%. Mean flap artery diameter, vein diameter, area, and thickness were 1.7+0.4mm, 2.2+0.4mm, 157.3+52.1cm2, and 0.7+0.2cm, respectively. Skin thickness at the suprafascial bifurcation point of a dominant "T" perforator measured on preoperative CTA correlated with actual intraoperative flap thickness. Patient body mass index did not correlate with flap thickness. The thin and superthin PAP flap has multiple favorable characteristics, making it suitable for extremity reconstruction, and it has become the workhorse skin flap in our institution. Conventional low-frequency CDU together with CTA can be used effectively to map the dominant perforator preoperatively, allowing accurate flap design and rapid flap harvest. Therapeutic Level IV.

GINGIVAL WOUND HEALING RESPONSE FOLLOWING PLACEMENT OF A LIGHT CURE DRESSING WITH AND WITHOUT BLUE M®GEL AFTER GINGIVAL DEPIGMENTATION. A RANDOMIZED SPLIT MOUTH STUDY

Background: In todays world pigmentation of gingiva not just has an impact on esthetics but also creates psychological negativity.Esthetic awareness of dental patients has extended to include requests of gingival color modification.Different treatment modalities which have been reported include bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery. However, pain and healing are the two drawbacks associated with the post operative discomfort after the procedure which can be catered well with use of a newly developed oxygen releasing gel ie. Blue M® Gel and light cure periodontal dressing. Method: A total of 10 patients randomly divided into two groups were selected for this randomized split mouth study. Gingival depigmentation using a scalpel were performed followed by Placement of a light cure dressing (Barricaid®) in10 anterior sextants after gingival depigmentation in Group â… and Application of an oxygen releasing oral gel (BlueM®) before placement of a light cure dressing (Barricaid®) in Group â…¡. Wound Healing Index at day 7, VAS Score (Pain) at day 3 and GI &amp; PI at day 7 &amp;14 after the gingival depigmentation were evaluated for both the groups. Results:There was no significant difference in clinical parameters recorded at various time intervals between both the groups. Conclusion: The use of Blue M® Gel underneath light cure periodontal dressing did not enhance the healing following Gingival depigmentation.

Factors Influencing Residual Glandular Breast Tissue after Risk-Reducing Mastectomy in Genetically Predisposed Individuals Detected by MRI Mammography.

This study seeks to evaluate MR imaging morphological factors and other covariates that influence the presence of residual glandular tissue after risk-reducing mastectomy in patients with a familial predisposition. We analyzed women of a high-risk collective with pathogenic mutation (BRCA1 (n = 49), BRCA2 (n = 24), or further mutation (n = 9)). A total of 117 breasts were analyzed, 63 left and 54 right, from a cohort of 81 patients, who were on average 40 years old. The mean follow-up was 63 months (range 12-180 months, SD = 39.67). Retrospective analysis of MR imaging data from 2006-2022 of patients of a high-risk collective (all carriers of a pathogenic mutation) with contralateral (RRCM) or bilateral risk-reducing mastectomy (RRBM) was performed. In the image data the remaining skin flap thickness by distance measurements at eight equally distributed, clockwise points and the retromamillary area, as well as by volumetry of each breast, was elected. Residual glandular tissue was also volumetrized. In addition, patient-related covariates were recorded and their influence on postoperative residual glandular tissue and skin flap thickness was analyzed by uni- and multivariate regressions. A significant association with postoperative residual glandular tissue was shown in multivariate analysis for the independent variables breast density, skin flap mean, and surgical method (all p-values < 0.01). A negatively significant association could be seen for the variables preoperative breast volume (p-values < 0.01) and surgeon experience (most p-values < 0.05-<0.1). Postoperative residual glandular tissue is an important tool for quantifying the risk of developing breast cancer after risk-reducing mastectomy. Different effects on residual glandular tissue were shown for the independent variables breast density, skin flap, surgical method, preoperative breast volume, and surgeon experience, so these should be considered in future surgical procedures preoperatively as well as postoperatively. Breast MRI has proven to be a suitable method to analyze the skin flap as well as the RGT.

Evolution of Radiographic Changes of a Vascularized Pedicled Nasoseptal Flap after Endonasal Endoscopic Skull Base Surgery.

There is active research involving the radiographic appearance of the skull base following reconstruction. The purpose of this study was to describe the radiographic appearance of the vascularized pedicle nasoseptal flap after endoscopic skull base surgery across time. We performed chart and imaging review of all patients with intraoperative nasoseptal flap placement during endoscopic skull base surgery at a tertiary academic skull base surgery program between July 2018 and March 2021. All patients underwent immediate and delayed (>3 months) postoperative MR imaging. Primary outcome variables included flap and pedicle enhancement, flap thickness, and flap adherence to the skull base. Sixty-eight patients were included. Flap (P = .003) enhancement significantly increased with time. Mean nasoseptal flap thickness on immediate and delayed postoperative scans was 3.8 and 3.9 mm, respectively (P = .181). The nasoseptal flap adhered entirely to the skull base in 37 (54.4%) and 67 (98.5%) patients on immediate and delayed imaging, respectively (P < .001). Our findings demonstrate heterogeneity of the nasoseptal flap appearance after skull base reconstruction. While it is important for surgeons and radiologists to evaluate variations in flap appearance, the absence of enhancement and lack of adherence to the skull base on immediate postoperative imaging do not appear to predict reconstructive success and healing, with many flaps "self-adjusting" with time.