Tissue Flaps Research Articles

Algorithm for the reconstruction of the parotid region: a single institution experience

ObjectiveThis study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap reconstruction of soft tissue for postoperative defects.Materials and methodsA retrospective review was conducted on 11 cases of soft tissue flap reconstruction for postoperative defects following the resection of malignant tumors in the parotid region. Statistical analysis was performed based on clinical data.ResultsAmong the 11 cases of malignant tumors in the parotid region, there were 2 cases of secretory carcinoma (SC) of the salivary gland, 2 cases of squamous cell carcinoma (SCC), 2 cases of carcinosarcoma, 1 case of mucoepidermoid carcinoma (MEC), 1 case of epithelial-myoepithelial carcinoma (EMC), 1 case of salivary duct carcinoma (SDC), 1 case of basal cell carcinoma (BCC), and 1 case of osteosarcoma. Among these cases, 4 were initial diagnoses and 7 were recurrent tumors. The defect repairs involved: 8 cases with anterolateral thigh free flap (ALTF), 2 cases with pectoralis major muscle flaps, and 1 case with forearm flap. The size of the flaps ranged from approximately 1 cm × 3 cm to 7 cm × 15 cm. The recipient vessels included: 4 cases with the facial artery, 4 cases with the superior thyroid artery, and 1 case with the external carotid artery. The ratio of recipient vein anastomosis was: 57% for branches of the internal jugular vein, 29% for the facial vein, and 14% for the external jugular vein. Among the 8 cases that underwent neck lymph node dissection, one case showed lymph node metastasis on pathological examination. In the initial diagnosis cases, 2 cases received postoperative radiotherapy, and 1 case received 125I seed implantation therapeutic treatment after experiencing two recurrences. Postoperative follow-up revealed that 2 cases underwent reoperation due to local tumor recurrence, and there were 2 cases lost to follow-up. The survival outcomes after treatment included: one case of distant metastasis and one case of death from non-cancerous diseases.ConclusionImmediate soft tissue flap reconstruction is an important and valuable option to address postoperative defects in patients afflicted with malignant tumors in the parotid region.

Application of Fixation of Orbicularis Oculi Muscle and Orbital Septal Tissue Flap at the Upper Edge of Incision in Double Eyelid Plasty.

In order to make the postoperative effect of open double eyelid more close to the physiological and anatomical structure of double eyelid, we improved the traditional open double eyelid operation according to the anatomical characteristics of the upper eyelid. We fixed part of the orbicularis oculi muscle above the incisal margin with the orbital septum flap to make the double eyelid formed after surgery more natural and beautiful. A total of 76 patients who received open double blepharoplasty in department of plastic surgery from February 2019 to May 2022 were selected as this study objects, all of whom were female. Their ages ranged from 18 to 32 years, with a mean of (23.6 ± 5.2) years. The surgical method is open double blepharoplasty by fixing part of the orbicularis oculi muscle above the incisal margin with the flap of the orbital septum. In this study, all 76 patients underwent successful surgery, with an average operation time of (1.5 ± 0.2) h. The postoperative double eyelid curvature was smooth and the double eyelid width was basically symmetrical. In terms of the doctors' satisfaction evaluation of the postoperative effect, 64 cases were very satisfied and 12 cases were satisfied. In terms of patients' satisfaction evaluation of the postoperative effect, 60 patients were very satisfied, 15 patients were satisfied and 1 patient was dissatisfied. Through this study, we found that this surgical method invented by us has short operation time, good operation effect, few postoperative complications and high patient satisfaction, which is worthy of promotion and application in plastic surgery clinical practice. 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 www.springer.com/00266 .

Treatment for benign skin lesion in zygomatic-infraorbital region by the expanded multi-lobe cervicofacial advancement rotation flap in pediatric patients

PurposeBenign skin lesions in zygomatic-infraorbital regions severely influence pediatric patients’ appearance as well as mental health. Treatments are difficult for the high requirements of patients’ guardians in both function and aesthetics. The present study aims to introduce a surgical method, Expanded Multi-Lobe Cervicofacial Flap, which combines the advantages of the classical cervicofacial advancement rotation flap and the tissue expansion technique.MethodsA total of 21 pediatric patients were enrolled. The treatment process included 2 stages: implantation of the skin tissue expander and flap transfer. The excessive skin created by tissue expansion extended the coverage area of the multi-lobe flap.ResultsIn this retrospective study, follow-up periods were all more than 12 months (20.8 ± 6.7). In the last follow-ups, the flaps were all in good condition, and No facial organ displacement was observed. The patients’ guardians were satisfied with the outcomes.ConclusionsUsing the expanded multi-lobe cervicofacial flap for the zygomatic-infraorbital benign skin lesion repair is effective, and this method is especially applicable to the pediatric population.

Danger Zone for Paramedian Forehead Flap Elevation: Maximizing Flap Length and Viability

The supratrochlear artery (STA) demonstrates anatomical variability that impacts facial reconstruction with a paramedian forehead flap. STA branching patterns and the distance to the midline have been reported, but the STA pedicle has not been characterized. Our aim was to triangulate the STA pedicle relative to known anatomical landmarks and identify a danger zone to aid surgeons in creating viable tissue flaps. The upper facial region was dissected bilaterally on 38 cadaveric donors. Measurements from the supraorbital neurovascular bundle, orbital rim, and medial canthus to the STA pedicle were collected. Data were tallied and statistically analyzed. Measurement means, range, and standard deviations were calculated; no significant differences were found in the laterality of the measurements (p > 0.05). Statistically significant, sex-based differences were identified for all measurements collected among male and female donors. This study characterizes a surgical danger zone for the STA pedicle specific to a paramedian forehead flap and identifies important differences within this danger zone among male versus female donors that surgeons should consider to prevent pedicle violation and enhance surgical success while maximizing flap length and mobility.

Utility of J-Shaped Scar Tissue-Based Flap for Secondary Bilateral Cleft Lip Repair: A One-Stage Procedure with Successful Outcomes on Correction of Vermilion Border, Volume Deficiency of Lip, and Muscular Function.

This study aimed to evaluate the utility of J: -shaped scar-tissue-based flap as a new technique in secondary bilateral cleft lip reconstruction in patients with challenging secondary deformities. A total of 52 patients, comprising 38 males and 14 females with a mean age of 21.0 years (range: 16-42 years), who underwent secondary bilateral cleft lip repair operation via the J: -shaped scar tissue flap technique in our clinic between 2014 and 2019 were included. Postoperatively, patients were followed up for an average of 2 years (range, 6 months to 5 years) to assess the outcomes regarding vermilion border, philtrum symmetry, function of the orbicularis muscle, and lip volumetric symmetry, based on the Global Aesthetic Improvement Scale (GAIS), patient-reported outcomes, and independent plastic surgeons' examinations. After an average follow-up of 2 years, outcomes regarding vermilion border, philtrum symmetry, function of the orbicularis muscle, and lip volumetric symmetry were successful, and none of the patients experienced new notch formation, muscular functional loss, lip volume loss, or asymmetry. Owing to good muscular function preventing the stretching, the postoperative scars become more acceptable to the patients. The technique has proven to be safe and successful through the GAIS objective assessment, as also confirmed by the examinations of the three independent surgeons, while the majority of patients reported an exceptional improvement in the appearance alongside a more than 95% satisfaction rate with the operation. In conclusion, our findings revealed successful functional and aesthetic outcome of using J: -shaped scar tissue flaps in secondary repair of cleft lips. The technique was associated not only with the correction of significant secondary deformities yielding an improved and symmetrical lip volume, correction of vermilion notch, and prevention of notch re-formation but also with the restoration of orbicularis oris muscle function and thus integrity of the lip with minimal scarring.

In Situ Monitoring and Assessment of Ischemic Skin Flap by High-Frequency Ultrasound and Quantitative Parameters.

Skin flap surgery is a critical procedure for treating severe skin injury in which post-surgery lesions must well monitored and cared for noninvasively. In the present study, attempts using high-frequency ultrasound imaging, quantitative parameters, and statistical analysis were made to extensively assess variations in the skin flap. Experiments were arranged by incising the dorsal skin of rats to create a skin flap using the chamber model. Measurements, including photographs, 30 MHz ultrasound B-mode images, skin thickness, echogenicity, Nakagami statistics, and histological analysis of post-surgery skin flap, were performed. Photograph results showed that color variations in different parts of the skin flap may readily correspond to ischemic states of local tissues. Compared to post-surgery skin flap on day 7, both integrated backscatter (IB) and Nakagami parameter (m) of the distal part of tissues were increased, and those of the skin thickness were decreased. Overall, relative skin thickness, IB, and m of the distal part of post-surgery skin flap varied from 100 to 67%, -66 to -61 dB, and 0.48 to 0.36, respectively. These results demonstrate that this modality and quantitative parameters can be feasibly applied for long-term and in situ assessment of skin flap tissues.

Chronic Cinacalcet improves skin flap survival in rats: the suggested role of the nitric oxide pathway.

Cinacalcet is a calcimimetic medicine that has been used to treat secondary hyperparathyroidism and parathyroid cancer. Various studies have proposed the positive role of calcium and its receptor in skin wound healing. Furthermore, Cinacalcet interacts with other skin repair-related mechanisms, including inflammation and nitric oxide pathways. The present study evaluated the effect of Cinacalcet on the random-pattern skin flap survival. Eighty-four Wistar male rats were used. Multiple doses of Cinacalcet (30, 3, 1, 0.3, and 0.05 mg/kg) were used in 3 different routes of administration before the surgery. Histopathological evaluations, quantitative assessment of IL-6, TNF-α, and nitric oxide (NO), and the expression of calcium-sensing receptor (CaSR) and E-cadherin were evaluated in the skin tissue. To assess the role of NO, a NO synthase inhibitor, N-nitro-L-arginine methyl ester hydrochloride (L-NAME), was used, and histopathological effects were investigated. Cinacalcet pretreatment at the IP chronic 1 mg/kg dose significantly increased the skin flap survival rate and enhanced the NO tissue level compared to the control. However, the administration of L-NAME abolished its protective effects. IP Chronic 1 mg/kg of Cinacalcet could also decline the levels of IL-6 and TNF-α and also increase the expression of CaSR and E-cadherin in the flap tissue compared with the control group. Chronic Cinacalcet at 1 mg/kg could improve skin flap survival, probably mediated by the CaSR, NO, and inflammation-related pathways.

Free Flap Perfusion in Microvascular Head and Neck Reconstruction: Influence of the Number of Ischemia Intervals and Ischemia Duration-A Retrospective Study.

In microvascular head and neck reconstruction, ischemia of the free flap tissue is inevitable during microsurgical anastomosis and may affect microvascular free flap perfusion, which is a prerequisite for flap viability and a parameter commonly used for flap monitoring. The aim of this study was to investigate the influence of the number of ischemia intervals and ischemia duration on flap perfusion. Intraoperative and postoperative flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation at 2 and 8 mm tissue depths, as measured with the O2C tissue oxygen analysis system, were retrospectively analyzed for 330 patients who underwent microvascular head and neck reconstruction between 2011 and 2020. Perfusion values were compared between patients without (control patients) and with a second ischemia interval (early or late) and examined with regard to ischemia duration. Intraoperative and postoperative flap blood flow at 8 mm tissue depth were lower in patients with early second ischemia intervals than in control patients [102.0 arbitrary units (AU) vs 122.0 AU, P = .030; 107.0 AU vs 128.0 AU, P = .023]. Both differences persisted in multivariable analysis. Intraoperative and postoperative flap blood flow at 8 mm tissue depth correlated weakly negatively with ischemia duration in control patients (r = -.145, P = .020; r = -.124, P = .048). Both associations did not persist in multivariable analysis. The observed decrease in microvascular flap blood flow after early second ischemia intervals may reflect ischemia-related vascular flap tissue damage and should be considered as a confounding variable in flap perfusion monitoring.

Medical and legal evaluation of injuries due to dog bites: a Türkiye study.

Dog bites are the most common type of injury related to animal bites in our country and worldwide. Dog bite wounds pose significant public health concerns and have medicolegal implications. In this study, we aimed to assess the problems associated with dog bites and propose potential solutions. We conducted a retrospective analysis of 149 cases submitted by judicial authorities to our institution, the Istanbul Council of Forensic Medicine, between 2015 and 2021, to obtain medicolegal expert opinion reports. Information regarding the cases included in the study was obtained from our archives and the National Judicial Network Project (UYAP) system. Data were recorded using Microsoft Excel 2016, and statistical analysis was performed using SPSS 25.0 for Windows (SPSS Inc., Chicago, IL). The mean age of the cases was 33.7 years, with 57% being male. 56.4% of the incidents occurred in the city center, and 30.9% took place during the summer months. 65.8% (n=98) of the cases were attributed to stray dogs. Superficial injuries without muscle tissue involvement were observed in 54.4% (n=81) of all cases, while 22.8% (n=34) had deep tissue defects or flap injuries, 4.7% (n=7) involved vascularnerve injuries, 16.1% (n=24) included bone fractures, and 2% (n=3) featured visceral injuries. Surgical treatment was performed on 37.5% (n=56) of the cases. Impairments were reported in 22.1% of the cases, with permanent facial scars affecting 16.7% of them. Psychiatric evaluations were required for 48.9% (n=89) of the cases, and 57.5% of them received a diagnosis of post-traumatic stress disorder. People attacked by dogs may experience serious physical or psychological sequelae. Therefore, it is crucial to evaluate all victims using a multidisciplinary approach, addressing their physical, social, and psychological needs, and providing rehabilitation when necessary. Non-governmental organizations, such as those dedicated to the prevention of cruelty to animals, in collaboration with local veterinary services, should play a role in national initiatives to provide objective and humane solutions for both victims and animals.

Surface Morphology and Performance of New and Reused Microblade for Dental Surgery

Objectives: Several dental surgical procedures use disposable and reusable instruments. This study aimed to compare the clinical performance of new and reused microblades to perform dental surgery. Methods: The clinical performance of the microblade was evaluated by the cutting capacity during root coverage modified tunnel surgery. The surgery involved cutting the initial portion of the sulcus in the mandible of ex-vivo pigs. After each surgery, the microblades were cleaned, sterilized, and the surface was analysed by scanning electron microscopy and surface roughness measurement. The surface roughness parameters (Ra, Rq, PV, the number of peaks, the number of valleys, and the density of the peaks and valleys, respectively) were determined by a 3D optical profilerugosimeter. Results: Clinical results showed that in the first, second, and third uses, the forces applied to the microblade to perform the soft tissue flaps were similar. During the fourth surgery, there was a need to increase the force on to microblade to perform the dissection. In a visual inspection of the microblade, no differences were observed in the surface morphologies after any uses. Scanning electron microscopy (SEM) analysis showed that the number of grooves increased as the number of reuses increased. The surface roughness parameters increased after each use. Conclusions: Based on the clinical results, it is possible to conclude that it is feasible to sterilize and reuse microblades a maximum of three times. Visual inspection proved to be an inadequate procedure to identify surface damage and impairment of instrument performance. Clinical Significance: Visual inspection and scanning electron microscopy analysis are inadequate procedures to identify surface damage and impairment of surgical cutting instrument performance. It is advisable to efficiently use the same instrument a maximum of 3 times.

Combined use of biomaterials and revascularisation in autoplasty of ulnar nerve

Surgical treatment of peripheral nerve injuries is effective in only 50% of cases. This is primarily due to the significant extent of the diastasis between the fragments of the damaged nerve, in which autoplasty has to be performed. The drawbacks of this technique are the formation of scar tissue, possible necrotisation of the autograft, mismatch of the donor and recipient nerve diameters. In order to overcome these drawbacks and improve the efficiency of surgical intervention, the study presents a clinical case of successful multifascicular ulnar nerve autoplasty with the use of domestic biodegradable biomaterials SpheroGel and ElastoPob, revascularization of the autograft with a connective tissue flap on a vascular pedicle. A persistent regression of local pain syndrome was observed in the early postoperative period. The effectiveness of the performed surgical intervention was confirmed by ultrasound examination: there was no evidence of neuroma in the area of the operation, regeneration of nerve bundles was noted at the site of stitching. Positive dynamics was observed in the results of VAS, DN4, DASH questionnaires.

Advances in the Application of Common Tissue Flaps for the Repair of Oral and Maxillofacial Defects

Advances in the Application of Common Tissue Flaps for the Repair of Oral and Maxillofacial Defects

Palatal Pedicle Connective Tissue for Reconstruction of Through‐and‐Through Soft Tissue Defects in Esthetic Zone Around a Dental Implant: An 8‐Year Follow‐Up Case Report

Soft tissue management for immediate implant placement in the esthetic zone is crucial for successful treatment outcomes. Several surgical and restorative techniques have been proposed to treat unesthetic implant soft tissue defects or dehiscence. However, there is a scarcity of clinical evidence on addressing complications associated with through‐and‐through soft tissue defect (TTSD). In this case, a 61‐year‐old female patient, who underwent immediate implant placement at the right central incisor 3 months prior, presented with chronic peri‐implant mucosal infection and soft tissue recession of TTSD in 2015. The palatal pedicle connective tissue flap (PPCTF) was utilized to provide horizontal and vertical soft tissue augmentation and to cover the defect in combination with the labial contour collapse. At the 8‐year follow‐up, favorable white and pink esthetic outcomes were observed, and the pink esthetic score (PES) for soft tissue around the implant achieved 9 points, indicating satisfactory esthetic and functional results. The findings from this case study suggest that soft tissue augmentation techniques, such as PPCTF grafts, can provide a reliable and innovative method for both soft tissue augmentation and reconstruction of TTSD, resulting in long‐lasting functional and esthetic outcomes and stable ideal PES scores.

Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers.

Free tissue transfer has fundamentally changed head and neck surgery, enabling reliable reconstruction of large defects with better function and aesthetics. This study assesses two decades of trends in free flap reconstruction, and how disease incidence, survival, surgeon caseload, team approach, and technology have impacted practice. Retrospective analysis of 1027 head and neck free flaps from 2006 to 2022. Outcomes examined include chronological changes in flap selection, indication, length of stay, incorporation of virtual surgical planning (VSP), annual caseload, survival, and their associations with the single versus multi-team approach. There were 764 soft-tissue and 263 osseous reconstructions utilizing 21 different flaps. Anterolateral thigh and radial forearm accounted for 76.7% of soft tissue flaps, with recent increase in superficial circumflex iliac perforator flaps in young patients. Osseous flap proportion remained stable, but fibula flaps increased five-fold with more VSP, dental implants, oral cancer, and multi-team surgery. Outcomes such as complication rates, length of stay and disease specific/overall survival have improved over time despite increasing complexity (P = 0.001, P = 0.001, P < 0.001, and P < 0.001, respectively). However, there was no significant difference in operative time, complication rate, or disease specific/overall survival between single team or multi-team approaches (P = 0.45, P = 0.054, P = 0.57, and P = 0.60, respectively). Single and multi-team approaches may have similar fundamental outcomes, but as caseload, complexity, and life-expectancy increases, both patients and surgeons benefit from a collaborative multi-team approach that focuses on improving long-term functional outcomes.

Accurate tissue flap reconstruction method based on the quadratic surface developability for head and neck soft tissue defects

Soft tissue defects resulting from head and neck tumor resection seriously impact the physical appearance and psychological well-being of patients. The complex curvature of the human head and neck poses a formidable challenge for maxillofacial surgeons to achieve precise aesthetic and functional restoration after surgery. To this end, a normal head and neck volunteer was selected as the subject of investigation. Employing Gaussian curvature analysis, combined with mechanical constraints and principal curvature analysis methods of soft tissue clinical treatment, a precise developable/non-developable area partition map of the head and neck surface was obtained, and a non-developable surface was constructed. Subsequently, a digital design method was proposed for the repair of head and neck soft tissue defects, and an in vitro simulated surgery experiment was conducted. Clinical verification was performed on a patient with tonsil tumor, and the results demonstrated that digital technology-designed flaps improved the accuracy and aesthetic outcome of head and neck soft tissue defect repair surgery. This study validates the feasibility of digital precision repair technology for soft tissue defects after head and neck tumor resection, which effectively assists surgeons in achieving precise flap transplantation reconstruction and improves patients' postoperative satisfaction.

Postoperative volume maintenance rate of microvascular free flap in oral and maxillofacial region: Systematic review and meta-analysis

Background and objectivesThe resorption of flap's volume can be frequently observed in the transplantation of microvascular free flaps, which could significantly affect postoperative function. Therefore, it's essential to comprehend the postoperative flap volume and the mechanisms behind before making clinical decisions. MethodsLiterature search was conducted from database on PubMed, EMBASE, Cochrane Library, Chinese database and Google Scholar. A random effects model meta-analyses and descriptive systematic review were performed. ResultsThe search identified 420 articles, of which 9 studies included in meta-analysis and 14 studies included in descriptive systematic review. Postoperative flap volume maintenance rate is used to represent the volume change. The pooled mean postoperative flap volume maintenance rate was 62.82 % for soft tissue flap (95 %CI: 58.83 to 66.82, p = 0.076, I2=56.3 %) and 85.96 % for bone flap (95 %CI: 84.19 to 87.73, p = 0.274, I2=20.4 %). Weight loss, muscle atrophy, and decreased serum albumin levels are risk factors for postoperative volume reduction of soft tissue flaps. The bone resorption rate of bone flaps in women is higher than that in men. ConclusionWhen designing microvascular free flaps for oral and maxillofacial surgery, soft tissue flaps should consider an anticipated postoperative shrinkage of 37 %, while bone flaps should consider an anticipated postoperative shrinkage of 14 %.

Prosthetic Condyle with Concurrent Microvascular Reconstruction for Mandibular Disarticulation Defects: A Retrospective Series.

Reconstruction of mandibular disarticulation defects is a challenging area of head and neck surgery, with a variety of options available for replacement of the condylar head. The gold standard is autogenous reconstruction of the condyle-ramus unit. The use of a prosthetic condylar head is controversial, but in challenging cases, and those with a likely poor prognosis it may be considered and can achieve a good functional result. The objective of this study is to evaluate the outcomes of its use in a high volume head and neck reconstructive unit. A retrospective analysis of all patients treated at the Queen Elizabeth Hospital, Birmingham who underwent mandibular disarticulation resections and prosthetic condylar reconstruction from January 2008 to December 2019 were included. This retrospective review included 25 patients; 16 for malignant disease (16), osteoradionecrosis (4), osteomyelitis (2), medication related osteonecrosis (1), and secondary reconstruction(2). Free flap reconstruction was performed in 23 cases; 18 bony composite free flaps, 3 patients required double flap reconstruction, and 2 underwent soft tissue flaps only. Mean follow up was 43 months. Prosthesis related complications were encountered in 6 patients, all malignant cases. Four prosthetic condyles required removal due to recurrent infections and glenoid fossa perforation, This appeared to be related to significant surrounding dead space, and limited bony reconstruction. Rate of complications was lowest for non-malignant cases, and patients who had concurrent bony reconstruction extending up the ascending ramus. Functional outcomes were good with majority of patients having a balanced occlusion and oral intake. Prosthetic condyle outcomes are best when concurrent bony free flap reconstruction is performed with ascending ramus reconstruction. Avoid prosthetic condyles in cases where the articular disc is removed, and cases where a large amount of dead space is expected around the prosthesis. Careful attention to occlusal factors and vertical support of the reconstruction plate can lead to good functional outcomes. A review of the literature and potential future advances is also presented.

Utility of a novel Exoscope, ORBEYE, in re-resection for recurrent brain tumor

BackgroundRe-resections is one of the treatment options for recurrence brain tumors, including both benign and malignant brain tumors, such as meningioma and glioblastoma. Re-resection for recurrent brain tumor sometimes needs extension of original craniotomy. However, extending original craniotomy is troublesome and can easily damage the adhered brain tissue and reconstruct of bone flap sometimes cause cosmetic problems, thus ideal way to re-resect recurrent brain tumor is to use the same original craniotomy.However, when using an operative microscope, performing re-resections without extending craniotomy requires the surgeon to operate in an awkward position. A recently developed high-definition (4 K-HD) 3-D exoscope system, ORBEYE, can improve this problem. In this study, we analyzed the utility of 4 K-HD 3-D exoscope system, ORBEYE, for re-resecting recurrent brain tumor. MethodsWe report 32 cases managed by re-resecting recurrent brain tumor by ORBEYE. Perioperative clinical, surgical, and radiographic data were retrospectively examined. ResultsRe-resecting tumors for recurrent brain tumor by ORBEYE were successfully performed for all 32 resections, using ORBEYE, without any severe postoperative neurological deficit. In addition, we could avoid extending original craniotomy as much as possible by adjusting the ORBEYE camera angle. ConclusionRe-resecting tumors for recurrent brain tumors by ORBEYE are feasible and can avoid extending original craniotomy as much as possible.

Application of free serratus anterior muscle-fascial composite tissue flap and facial lipofilling in repairing progressive hemifacial atrophy

IntroductionProgressive hemifacial atrophy (PHA) is a nonnegligible disease, and its treatment currently lacks consensus. We aim to conduct an analysis of PHA patients to summarize the postoperative effect. Moreover, we introduced the free serratus anterior muscle-fascial composite tissue flap as a safe and novelty surgical procedure for moderate-severe PHA. MethodsThis clinical study included four patients who received a free serratus anterior muscle-fascial composite tissue flap and 19 patients who received Coleman fat transplantation. Preoperative (preoperative photograph and imageological examination) and postoperative (postoperative photograph, complications, therapeutic effect, and satisfaction) assessments were performed for all PHA patients. Body Image Concern Inventory (BICI), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) were performed preoperatively and postoperatively. ResultsAll the cases were cured with a good appearance with two kinds of operations. Free serratus anterior muscle-fascial composite tissue flap could correct face defects in one surgery and achieve good long time and short-time postoperative satisfaction in moderate-severe PHA. Fat transplantation could also enhance appearance in numerous operations for mild-moderate PHA. The volume of free-fat grafts decreased obviously after implantation in many cases. So, many patients (42.11%) accepted a series of operations to achieve satisfied postoperative effect. BICI, SAS, SDS score decreased a year later in all patients. ConclusionFree serratus anterior muscle-fascial composite tissue flap transplantation is an effective and safe treatment for moderate to severe PHA.

The keystone island perforator flap: An “ideal” local soft tissue flap for the lower extremity

BackgroundLower extremity reconstruction best requires co-operation between orthopedic and plastic surgeons to preserve the musculoskeletal integrity while establishing essential skin coverage. Traditional dogma suggests microvascular tissue transfers alone would be preferable, but today inherent risks can be avoided by instead using mainly local perforator flaps. MethodsOver a 5 year timeframe, 68 local flaps were used in 66 patients for non-specific lower extremity problems in all regions of the lower extremity in lieu of a free flap. These included both muscle and perforator flaps, the latter including peninsular, propeller, “true” island, and advancement variations. Particular emphasis on the choice of the keystone advancement flap alternative was here undertaken. ResultsAll chosen lower extremity local flaps were successful without resorting to a second flap or skin graft to treat complications. Muscle flaps were used only on 4 occasions, whereas the remaining flaps were perforator flaps. Of these, the keystone island perforator flap was by far the most common choice, [27 (42.2 %)], even exceeding the combined use of propeller and peninsular flaps [26 (40.6 %)]. Keystone flap complications were virtually nil. Keystone flaps were most often used within the flexible tissues of the thigh, but could be used throughout the lower extremity. ConclusionPerforator flaps may be the optimal local flap choice for the lower extremity. Since no discrete perforator need be dissected, the simplest variation is the keystone flap. Harvest and insetting is facile, reliable, aesthetically acceptable, and often sensate. The keystone island perforator flap indeed is an “ideal” lower extremity local soft tissue flap.