Traditional Flap Research Articles

Clinical application of free latissimus dorsi lobulated musculocutaneous flap for repair of tissue defect of the shank

Objective To explore the clinical outcomes of free latissimus dorsi lobulated musculocutaneous flap for repairing the soft tissue defects of the shank. Methods From January 2011 to December 12, free latissimus dorsi lobulated musculocutaneous flap was transferred to repair soft tissue defects of the shank in 22 cases. There were 16 males and 6 females retrospectivelyanalyzed, with an average age of 37.5±2.5 years. The wounds all had tendon,bone and/or internal fixation exposed. The size of the defect area was 18 cm×10 cm to 28 cm×15 cm. At first, the site of perforator vessels was determined by Doppler as the center, then the lobulated flaps were designedaccording to the wound shape and size. During the operation, the thoracic and dorsal nerves and part of latissimus dorsi muscle were preserved, and the myocutaneous flap was formed into lobulated myocutaneous flap. Finally, the pedicle was dissociated to the appropriate lengthwhen only the vascular pedicle was connected with the flap. After the combination of the two lobulated myocutaneous flaps, the skin flap was trimmed, and the subcutaneous fat was removed in a step-like way from the peripheral to the point of perforation of vascular cutaneous branches. Only the dermis was retained around the integral skin flap, and the blood supply of the skin flap was observed at the same time to prevent the injury of perforating vessels. The transplantation of musculocutaneous flap was performed to repair the leg wound. All donor sites were sutured directly. The flap survival was observed according to the comprehensive evaluation standard of hand surgery. Results All the 22 flaps survived, and the size of lobulated musculocutaneous flap was 20 cm×12 cm to 30 cm×16 cm. No vascular crisis happened, and all skin grafts survived in donor sites. 22 cases were follow-up for 6 to 24 months. The flaps were supple and elastic with nearly normal color. There was no bulkiness. Sensory function recovered well and two-point discrimination (2-PD) was about 3.5-5.0 cm. The function and appearance of the foot and ankle was good. According to the operative hand surgery function evaluation of flap, the results were excellent in 13 cases,good in 8 cases, fair in 1 case, with excellent and good rate of 95.45% (21/22). 1.0 cm×0.5 cm of the distal of flap was necrosis in 1 case and healed by dress changing. Conclusion The free latissimus dorsi lobulated musculocutaneous flap is an improvement of the traditional latissimus dorsi flap. The survival rate of musculocutaneous flap is high and the clinical effect of repairing soft tissue defect of lower leg is satisfactory. Key words: Leg; Soft tissue injuries; Surgical Flaps; Treatment outcome

Horizontal Bone Augmentation in the Anterior Esthetic Area of the Maxilla Using a Flap Design Adapted from Mucogingival Surgery in Association with PLA Membrane and β-TCP

Systematic reviews showed possible esthetic complications with the use of traditional flap designs after guided bone regeneration (GBR) procedures in the esthetic zone and the aim of this case series was to analyze hard and soft tissue changes over 18 months after these procedures. Healthy subjects requiring tooth extraction and single-implant placement in the anterior maxilla were enrolled in the study. Three months after tooth extraction and ridge preservation, a prosthetic-driven implant was placed. The horizontal bone deficiency was treated with a resorbable bone graft substitute (beta tricalcium phosphate [β-TCP]) and a bioresorbable polylactic acid (PLA) membrane. Primary closure was obtained by a novel coronally advanced flap adapted from mucogingival techniques. Final metal-free implant restorations were delivered 4 months after placement. Clinical measurements, pictures, and radiographs were acquired after delivery of the final restoration (T1) and at the 18-month follow-up (T2). Digital impressions were taken at the time of tooth extraction (T-1) and implant insertion (baseline; T0) and at T2. Marginal bone level changes were assessed by radiographic analysis, while soft tissue changes were evaluated with ExoCad software. Student t test for paired data was used to detect differences between the different time points. Twelve subjects (7 men and 5 women; mean age: 63.7 ± 14 years) completed the study and received 15 implants. All implants healed uneventfully and were clinically osseointegrated and stable, showing no sign of infection. No GBR complications were noted. Statistically significant ridge-width changes were observed after extraction (T-1 vs T0 = -1.72 ± 0.30 mm; P = .00001) and after horizontal GBR (T0 vs T2 = 1.41 ± 0.64 mm; P = .00001). Radiographic bone levels after implant placement remained stable T0 to T2 (0.09 ± 0.08 mm). Periodontal parameters never exceeded physiologic levels. It can be concluded that GBR using a bioresorbable PLA membrane and resorbable β-TCP bone graft in conjunction with a coronally advanced flap is a predictable procedure for horizontal bone augmentation with simultaneous implant placement in the esthetic area.

A Radiographic Evaluation of Peri-implant Bone Level in Immediate and Conventionally Loaded Implants Using Flap and Flapless Techniques

The purpose of this research is to compare peri-implant bone level in immediate and conventionally loaded implants using flap and flapless techniques. Forty patients were selected and were subjected into four groups. Group A: 10 patients with immediate loading (IL) by raising the flap. Group B: 10 patients with IL without raising the flap. Group C: 10 patients with conventional loading by raising the flap. Group D: 10 patients with conventional loading without raising the flap. It was observed that for most of the flapless techniques with IL cases, the bone loss settled at first thread or just below the implant collar after 6 months. It was seen that the crestal bone height was reduced in both flap and flapless techniques by immediate and conventional loading, respectively. On comparing the bone loss, the flapless approach by IL showed statistically significant lesser reduction as determined by radiovisiography. Postoperative pain was less in the flapless technique as compared to the traditional flap technique. IL minimizes invasiveness, complexity, and also improves acceptance by patients.

Repair of large area of soft tissue defect of calf by the retrograde anterolateral thigh flap with single high cutaneous perforator

Objective To explore the clinical effect of repairing the large area of soft tissue defect of the calf by the retrograde anterolateral thigh flap with single high cutaneous perforator. Methods From January, 2014 to July, 2017, 9 cases of large area of soft tissue defects were repaired by the retrograde anterolateral thigh flap with single high cutaneous perforator. There were 7 males and 2 females, aged 24-48 years. Soft tissue defects area of the calf was 10.0 cm×7.0 cm to 35.0 cm×15.0 cm, including skin grafting and skin stretch to repair the area. The perforating point of the high cutaneous artery branches was designed at the proximal end of the flap, which was used as the single nutrient vessel of the flap. The rotation point of the flap was moved upward to the proximal thigh, which not only increased the blood supply of the flap, but also made the flap repair range to the distal calf. The flap range was 15.0 cm×10.0 cm to 22.0 cm×12.0 cm. Results All flaps were cut smoothly, and no vascular crisis occurred. All flaps survived smoothly. All patients were followed-up for 6-12 months. The appearance of flaps was plump, slightly bloated, and their color was similar to the recipient area. The texture was soft, and no active disorder in the donor site. Conclusion The retrograde anterolateral thigh flap with single high cutaneous perforator can be designed at a high rotation point. By increasing the number and caliber of the anastomotic branch between the pedicle and lateral superior genicular artery, the blood supply and reflux of flap can be improved, and the survival rate is not affected. Compared with the traditional anterolateral thigh flap, it has great advantages. Key words: Anterolateral thigh flap; High cutaneous perforator; Lower leg; Soft tissue defect

Modified thin anterolateral thigh flaps for reconstruction of hand and foot defects

Objective To evaluate the clinical efficacy of modified thin anterolateral thigh flaps for reconstruction of hand and foot defects. Methods Between March, 2016 and September, 2017, 17 patients were reconstructed with modified thin anterolateral thigh flap. There were 6 cases for reconstruction of hand, and 3 of them were located in the back dorsal of hand defects. There were 11 cases for reconstruction of ankle and foot, and 5 of them were located in the dorsal of foot. The size of the flap was 5 cm×3 cm-33 cm×10 cm. The traditional perforator flap was elevated just above the deep fascial plane. The debulking procedures could follow before the pedicle was cut off. The modified method was that the flap was elevated from the superficial fascia and the plane between deep and superficial fat without intraoperative debulking procedures. Results Three flaps were eventually survived after secondary exploratory operation caused by the hematoma. Two flaps had partial loss, 1 of which needed secondary skin grafting, and the other flap healed with additional intention. Followed-up period was 3-18(average, 7) months . All flaps showed relatively good contour and the patients were satisfied with clinical outcomes. Conclusion It is a safe and reliable way that perforator flap can be elevated from the superficial fascia and the plane between deep and superficial fat. It can obtain a thin flap immediately and reduce donor-site morbidity without additional defatting and time-consuming. The flap is soft with good contour. This technique is an ideal option for covering defects composed of dorsal of the hand or foot and the head and neck regions. Key words: Anterolateral thigh flap; Perforator flap; Modified method of thin type flap; Microsurgical operation

Nipple Reconstruction Techniques: Which is the Best Choice?

Nipple-Areolar Complex (NAC) reconstruction represents the final, concluding journey of breast reconstruction by being able to give to reconstructed breasts the shape of a natural breast mound. Nevertheless an enormous amount of nipple reconstruction techniques are described in literature, given the fact that most reconstructive options fail to give satisfactory outcomes in relation to the long-term nipple projection. In this review, the authors will browse most common nipple reconstruction techniques, taking into account: Indication, outcome, and side effect. Composite nipple grafts, traditional flaps, flaps with autologous graft augmentation, flaps with allograft augmentation, and flaps with alloplastic augmentation are the main strategies employed nowadays. Composite nipple grafts give the best guarantee of color-texture match with the contralateral side and show satisfactory nipple projection even at long-term follow-up. Skate, star, C-V, and arrow flap are by far the most commonly employed and the most reliable local flaps, however loss of projection of up to 70 percent are reported in literature. Alloplastic grafts were associated with the lowest rates of projection loss followed by autologous and allogenic ones. Nevertheless allogenic grafts are also associated with the highest complication rate, while autologous and allogenic ones have similar rates. Infection, seroma, and fat necrosis are the more commonly reported complications of autologous grafting along with donor site morbidity, while allogenic and alloplastic augmentation grafts may also experience the risk of overcorrection and graft exposure. Given the numerous techniques described in literature it is clear that the ideal nipple reconstruction hasn’t been found yet. Whereas it should be chosen on case to case basis depending on type of mastectomy, radiotherapy, type of reconstruction, skin thickness, tissue condition, and patients’ expectations to ensure the best cosmetic outcome.

Functional considerations in oral cavity reconstruction.

The treatment of oral cavity cancer may impair speech and swallowing function. Optimizing posttreatment function may lead to significant improvement of quality of life. Although oncologic control remains the main goal of treatment for oral cavity cancer, posttreatment function for surviving patients has over the last decades been recognized as an important secondary outcome. Reconstruction of oral cavity defects range from primary closure to advanced microvascular reconstruction, including multiple tissue types. Free flap reconstruction has greatly enhanced the ability to tailor transferred tissue to specific defects. In this review, we describe recent findings in reconstruction of tongue defects, including data from perforator flaps. We also summarize recent evidence regarding reinnervated flaps. When vascularized tissue is needed, it remains unclear how the reconstructive choice impacts postoperative outcome, although in many situations it appears to be dominated by the donor site morbidity rather than the reconstructive technique. Despite numerous case series, the functional impact of motor and sensory reinnervation in vascularized tissue remains unknown. Although perforator flaps have emerged as a promising flap option, with favorable donor site morbidity, their ultimate impact on functional outcomes remains unclear, whereas the success rate appears to be lower than traditional flaps.

The experimental study of shunt-decompression arterialized vein flap

BackgroundArterialized vein flap is a kind of unphysiological flap. Unphysiological reconstruction of blood circulation leads to higher load than that supported by physiological flap and is the culprit of flap swelling, blood stasis, skin blistering, and necrosis after flap grafting. To resolve the multiple disadvantages of traditional flap grafting, by introducing the principles of fluid mechanics, shunt-decompression surgery is prepared to decline the circulation preload and improve the prognosis of arterialized vein flap grafting.MethodsBy introducing the principles of fluid mechanics, we established the model of shunt-decompression arterialized vein flap, which satisfied the common properties of general fluid that the interface pressure between object and fluid is reduced when the velocity of fluid is increased and vice versa—the effect of Bernoulli. Under this rule, we anastomose the arterialized vein to the branch of main artery of recipient region or make end-to-side anastomosis, which can maintain the blood flow of main artery, decrease the perfusion of flap, and preserve the decompressive effect of main artery to branches. From March, 2016 to September, 2016, we performed animal experiments on ten male bama mini pigs with average weight of 28 ± 2.35 kg. Superior epigastric artery of pig was used for feeding artery to arterialize the superficial epigastric veins. The total area of flap is 8 cm × 6 cm. End-to-side anastomosis and end-to-end anastomosis were established in experimental group and control group, respectively. Doppler speckle perfusion imaging apparatus was used to monitor the alterations of flap perfusion, blood flow of flap, tissue swelling and survival of flaps.ResultsThe average flap perfusion (PU) at 1 week after surgery is 83.62 ± 3.14 in experimental group and 98.14 ± 6.54 in control group, respectively (P < 0.05), indicating the significant reduction of flap blood perfusion in experimental group as compared with control group. As to the survival of flaps, 7 flaps completely survived, 3 showed partial necrosis, and no one was found as complete necrosis in experimental group, while only 3 flaps survived, and 4 flaps and 3 flaps showed partial necrosis and complete necrosis in control group, respectively (P < 0.05).ConclusionBased on the physiological features of arterialized vein flap and its problems in clinical application, we improved the anastomosis strategy of flap grafting and obtained excellent experimental outcomes, which provides an insight for the clinical application of arterialized vein flaps.

Knee reconstruction using a distally based anterolateral thigh flap: an anatomical cadaveric study.

To study the vascular territory of the descending branch of the lateral circumflex femoral artery and its anastomosis around the knee and to identify the cutaneous perforator supply to the distally-based or reverse flow anterolateral thigh (dbALT) flap. In particular, the distance of the first perforator branch arising from the knee and above region, as well as the number of branches and position of each perforator, beneficial for effective flap design, are also examined. Fresh cadaveric lower limbs were dissected and the distance of the first perforator branch arising from the knee and above regions, which are vascular supplies for flaps, as well as the number of branches and position of each perforator are described. A total of 54 thigh cadavers had at least two cutaneous perforator branches above the knee 10cm from the superior border of the lateral patella. The mean (± standard deviation) of the first perforator distance was 2.57±0.93cm above the superior-lateral border of the patella. All perforating branches were 4±2cm, 93% were 10±2cm from the superior lateral border of patella, and 100% were at 20±3cm (mid-thigh length) which were the traditional anterolateral thigh flap. The dbALT flap technique resulted in constant and reliable references about perforator sites. Thus, this type of flap is a viable option in patients who present with soft tissue defects around the knee and upper third of the leg.

Design and clinical application of postoperative marker system of perforator flap

Objective To investigate the design of the postoperatively marker system based on the perforator flap and its clinical application. Methods According to the basic anatomy and blood supply characteristics of perforator flap, the observation points were marked on the flap surface and recipient area postoperatively, and judge flap blood flow changes with hand-held Doppler(HHD) and clock-face measurement based on perforators. From November, 2015 to November, 2017, prospectively conducted a control study evaluating the incidence of vascular crisis, accuracy rate, reoperation rate and survival rate of flaps between simple traditional flap monitoring group (n=100) and traditional flap monitoring combine with postoperatively marker system monitoring group (n=100). Results Vascular crisis was mostly concentrated with in 48 h postoperative in traditional flap monitoring group and combined group. There was no significant difference in the incidence, positive rate and negative rate of vascular crisis in the two groups (P>0.05). The reoperation rate in the traditional flap monitoring group (87.5%) was higher than the combined group (27.8%)(P<0.01). The survival rate of flap of combined group (99%) was higher than the traditional falp monitoring group (90%) (P<0.05). Conclusion The postoperatively marker system of perforator flap can effectively guide the medical staff to observe the blood supply of the flap, detect and judge the vascular crisis in time, and It is simple and easy to do without increasing the patient’s trauma and medical expenses as well as no additional equipments. Key words: Perforator flap; Postoperatively marker; Hand-held Doppler ultrasound; Vascular crisis

Plate osteosynthesis for one-stage definite treatment of Gustilo type III open fractures of long bone

Objective To report our efficacy of one-stage definite treatment of Gustilo type Ⅲ open fractures of long bone by plate osteosynthesis. Methods A retrospective case series study was conducted of the 69 cases who had undergone plate osteosynthesis for one-stage definite treatment of Gustilo type Ⅲ open fractures of long bone from January 2006 to June 2016 at Microsurgery and War Trauma Center of Chengdu Military Command, 59 Hospital of Chinese PLA. They were 47 males and 22 females with an average age of 34.2 years (from 2 to 62 years). There were 27 shaft fractures of tibia or fibula (13 cases of type ⅢA, 12 cases of type ⅢB and 2 cases of type ⅢC), 4 fractures of distal tibia (2 cases of type ⅢA and 2 cases of typeⅢB), 14 shaft fractures of ulna or radius (9 cases of type ⅢA, 3 cases of type ⅢB and 2 cases of type ⅢC), 12 factures of humeral shaft (7 cases of type ⅢA, 3 cases of type ⅢB and 3 cases of type ⅢC), 3 fractures of distal humerus (all type ⅢC), 6 fractures of femoral shaft (5 cases of type ⅢA and one type ⅢC), and 3 fractures of distal femur (2 cases of type ⅢA and one type ⅢC). The intervals between injury and operation ranged from 4 to 17 hours, averaging 9.6 hours. After thorough debridement, osteosynthesis was performed with locking compression plate, limited contact dynamic compression plate or/and reconstruction locking plate, or 1/3 tubular plate. Direct closure with decreased tension or without tension was used for type ⅢA injury; deep open defects were repaired with perforator flaps, neurovascular axis flaps, traditional axis flaps and muscular flaps, or local flaps; limb reconstructions included neurovascular repair in 12 cases, tendon and ligament repair in 5 cases, and muscle reconstruction in 3 cases. Superficial defects were covered by skin grafts simultaneously or secondarily. Results The duration of hospitalization averaged 19 days (from 5 to 37 days). Partial necrosis occurred in one case of sural neurovascular axis flap. Superficial infection with multiple antibiotic-resistant bacteria occurred in 2 cases. Follow-up for the 69 patients ranged from 12 to 27 months (average, 19.2 months). No deep bone infection occurred. Implant breaking occurred in 4 cases and implant loosening in one. The implant failures were corrected by change into intramedullary nails or plate refixation (respectively in 2 cases) in addition to bone graft. Bone union was achieved after 5 to 15 months (average, 7.7 month) with satisfactory aesthetic and functional outcomes. Conclusion For patients with Gustilo type Ⅲ open fracture of long bone, especially those with metaphyseal, intraarticular or upper limb fracture and pediatric ones, plate osteosynthesis can be a satisfactory one-stage definite treatment besides intramedullar nailing and external fixation, providing that through debridement and satisfactory soft-tissue coverage can be achieved. Key words: Fractures, open; Bone plate; Surgical flaps; One-stage procedures

Clinical application of dorsal digital nerve fasciocutaneous flap with superficial vein anastomosis for repair of fingertip defects

Objective To investigate the clinical efficacy of dorsal digital nerves fasciocutaneous flap with superficial vein anastomosis in the treatment of fingertip defects. Methods From January 2016 to February 2017, 25 cases (25 fingers) of fingertip defects were treated with proximal dorsal digital nerve fasciocutaneous flap. After the flap was transferred to cover the wound, the stump of a superficial vein retained at the proximal end of the flap was anastomosed to the stump of fingertip subcutaneous vein for reconstruction of flap venous circulation. Results All the flaps survived uneventfully. The appearance of flaps was good without blisters and purple skin 2 weeks after operation. The postoperative follow-up time ranged from 6 to 8 months with an average of 6.5 months. The flap had good appearance, no obvious bulky shape and soft texture. Some flaps had pigmentation. The skin pain and temperature sensation were restored. The joints of the fingers were in good motion. All the skin grafts survived. Conclusion The dorsal digital nerve fasciocutaneous flap with superficial vein anastomosis for repair of fingertip defects overcomes the shortcomings of the traditional flap with poor backflow, and the survival of the flap is effectively guaranteed. Key words: Surgical flaps; Treatment outcome; Fingertip defects; Fascial pedicle; Superficial vein anastomosis

Clinical application of web-space artery perforator and dorsal branch of the proper digital artery network flap for repair of finger pulp defects

Objective To evaluate the clinical efficacy of web-space artery perforator and dorsal branch of the proper digital artery network flap in the treatment of finger pulp defects. Methods From January 2015 to May 2017, 30 cases (36 fingers) of finger pulp defects were treated by web-space artery perforator and dorsal branch of the proper digital artery network flap. The nerve stump and dorsal digital nerve were sutured to reconstruct the flap sensation. The area of finger pulp defects ranged from 1.1 cm×0.8 cm to 2.3 cm×4.0 cm. The donor site was sutured directly or covered with skin graft. Results After the operation, tension vesicles appeared at the distal end of the flap in 3 cases which achieved secondary healing after dressing changes and flaps edge bleeding. Partial skin flap necrosis and scab occurred in 1 case that achieved healing after the decrustation. The rest of the flaps achieved primary healing. All the patients were follow-up for 3 to 24 months with an average of 16.8 months. The texture of skin flap was soft with satisfactory appearance. The skin flap recovered pain and temperature sensation 2 months after operation. And 3 months after the operation, the tactile sensation was restored. The two-point discrimination was recovered at 6 months after operation, with an average of 7.5 mm and an average of 6.2 mm at 12 months postoperatively. The total active movement (TAM) achieved 105° to 230° with an average of 204.6°. The results were graded as excellent in 22 fingers, good in 11 fingers, fair in 2 fingers, and poor in 1 finger with an excellent and good rate of 91.7%. Conclusion Compared with the traditional digital artery island flap, the island flap of web-space artery perforator and dorsal branch of the proper digital artery is used to repair the defects of the finger pulp, lengthening the length of the pedicle and enlarging the indication of the operation. The operation is simple and safe. It is a better method to repair the defect of the finger pulp. Key words: Finger injuries; Surgical flaps; Web-space artery perforator; Dorsal branch of the proper digital artery

Aerodynamic performance analysis of a trailing-edge flap for wind turbines

In this paper, a trailing-edge flap is designed based on the wind turbine airfoil S809. The aerodynamic performance and flowfield of the proposed trailing-edge flap airfoil are predicted by computational fluid dynamics (CFD) at angles of attack from -5° to 12.5°. The lift coefficient, drag coefficient, pressure contour, and streamline distribution of the proposed trailing-edge flap airfoil are analyzed and then compared with those of the traditional flaps. The results illustrate that the lift coefficient and the lift-to-drag ratio of the trailing-edge flap are markedly larger than those of the traditional flaps and that the trailing-edge flap can effectively improve the stall characteristics of the trailing-edge airfoil.

Clinical observation of combined skin flap and abdominal flap for repair of distal finger degloving injury

Objective To compare the clinical effect and operation difficulty of the combined skin flap with reversed proper palmar digital arterial dorsal branch island flap and cross-finger flap and the abdominal flap in the treatment of distal finger degloving injury. Methods Inclusion criteria: ①Soft tissue defect far beyond the level of distal interphalangeal joints. ②The inured finger was from second to fifth. ③Single finger injury. ④ Iniury time within 8 h. Exclusive criteria: ①With tendon injury.② Multiple finger injuries. ③Followed-up time within 6 months. Between February, 2009 and September, 2016, 52 patients (52 fingers) with distal finger degloving injury were reviewed, there were 32 males and 20 females, aged from 18 to 60(36.02±11.00) years. The time from injury to operation was 2.5-8.0 (4.81±1.28) h. Affected fingers included index finger in 15 cases, middle finger in 22 cases, ring finger in 10 cases, and little finger in 5 cases. Twenty patients (20 fingers) were treated by combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap(group combined-flap). The cubital skin was grafted onto the donor sites. Thirty-two patients (32 fingers) were treated by abdominal flap (group abdominal-flap). Results The patients were followed-up 6-25 (9.25±3.97) months. The operation time: group combined-flap was 80-130(98.46±8.34) min and group abdominal-flap was 85-125(107.84±8.63)min. There was no significant difference in two groups(P>0.05). Pedicle division time: group combined-flap was 15-24 (16.75±1.74) d and group abdominal-flap was 24-45(28.31±5.12) d. There was a significant difference in two groups(P<0.05). And the pedicle division time in group combined-flap was much shorter than in group abdominal-flap. Flap function at last follow-up, the excellent and good rate of the flap in group combined-flap and group abdominal-flap was 90.00% and 59.38%, respectively. There was a significant difference in two groups (P<0.05), and the flap function in group combined-flap was much better than in group abdominal-flap. Affected finger function at last follow-up, the excellent and good rate of the affected fingers was 95.00% and 71.88%. There was a significant difference in two groups(P<0.05), and the affected finger function in group combined-flap was much better than in group abdominal-flap. Conclusion The combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap is a simple and high-survival-rate flap, whose texture, appearance and clinical outcome for repair of distal finger degloving injury are much better than traditional abdominal flap. Key words: Degloved injury; Finger; Dorsal branch, proper palmar digital artery; Island flap; Cross finger skin flap; Combined skin flap; Repair

Measurement of Time Involvement in Family Activities: Alternative Scaling Procedures for the Family Leisure Activity Profile

ABSTRACTThis research note describes an alternative scaling procedure for the Family Leisure Activity Profile (FLAP; Zabriskie & McCormick, 2001). The alternative scaling procedure preserves the ratio-level character of responses to FLAP questionnaire items, and it produces an estimate of prevalence of participation with interpretable units of time (hours). In contrast, the traditional FLAP scoring approach produces scores on an arbitrary scale, and these scores can be distorted indicators of involvement in core and balance activities. The increased precision and greater variation produced by the alternative scoring procedure may be a key to more consistent findings regarding family leisure in future studies.

Research progress of pedicled flaps for defect repair and reconstruction after head and neck tumor resection

To summarize the current status of pedicled flaps for defect repair and reconstruction after head and neck tumor resection, and to present its application prospects. Related literature was reviewed, and the role evolution of pedicled flaps in the reconstruction of head and neck defects were discussed. The advance, anatomical basis, indications, advantages, disadvantages, and modification of several frequently used pedicled flaps were summarized. The evolution of pedicled flaps application showed a resurgence trend in recent years. Some new pedicled flaps, e.g., submental artery island flap, supraclavicular artery island flap, submandibular gland flap, and facial artery musculomucosal flap, can acquire equivalent or even superior outcome to free flaps in certain cases. Technological modification of some traditional pedicled flaps, e.g., nasolabial flap, pectoralis major myocutaneous flap, latissimus dorsi musculocutaneous flap, temporalis myofascial flap, and temporoparietal fascial flap, can further broaden their indications. These traditional flaps still occupy an irreplaceable role, especially in patients with poor condition and institution with immature microsurgical techniques. The pedicled flaps still plays an important role in head and neck reconstruction after tumor resection. In certain cases, they demonstrate some advantages over free flaps, e.g., more convenient harvest, more rapid recovery, less expenditure, and better functional and aesthetic effect.

Minimally invasive erbium flap (MINIETM flap)—a retrospective surgical treatment for chronic periodontitis

This clinical retrospective split-mouth study was designed to evaluate the efficacy of two (FDA approved) erbium laser wavelengths in a minimally invasive flapped approach for the treatment of generalized chronic periodontitis. Twenty-eight (28) patients diagnosed with generalized chronic periodontitis with pocket depths ranging from 4 to 9 mm had 551 posterior teeth surgically treated in a minimally invasive manner and were followed over 6 months. Minimally invasive erbium (MINIE) flaps were performed in all four posterior sextants (distal of cuspid to distal of second molar) in a traditional split-mouth design. Mean baseline probings were 5.4 mm. Patients were randomly assigned to Laser 1 (Er:YAG, Erbium doped yttrium, aluminium, garnet, 2940 nm or Laser 2 (Er, Cr:YSGG, Erbium, chromium doped yttrium, scandium, gallium, garnet, 2780 nm) in the first appointment. The alternate laser wavelength was used in the second appointment. Pre-surgical examination for pocket depth (PD), recession (RC), and clinical attachment levels (CAL) was performed and then repeated 6 months post-surgery. Patients with history of traditional flap surgery (> 5 years ago) completed a visual acuity test (VAT) describing their surgical experience compared to the conventional approach. The results showed statistically significant improvements in PD (1.43 mm) and reduction in CAL (1.41 mm), whereas the change in RC (0.01 mm) was not statistically significant. Clinical improvements of PD and CAL in this study are consistent with the range reported in previous landmark papers implementing a modified Widman flap (MWF) or osseous surgery (OS). The difference compared to traditional procedures was that there was no statistically significant change in RC over 6 months. The patients’ experience was much improved compared to traditional flap surgery [1, 2].

Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators &amp;amp; Its Clinical Applications in Head &amp;amp; Neck Reconstruction

Resume of the study & Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction. Although there are several advantages, it requires sacrifice of a major artery of forearm. Several modifications are described in harvesting a forearm flap. In order to achieve a reliable, safe flap harvest & design one must have a very clear understanding of radial artery perforators, relative to its distribution, territory & flow. The purpose of this study is to determine the location, size & vascular territory of the radial artery cutaneous perforators & to demonstrate application of shape modification of radial forearm free flap based on its distal & proximal perforators in various head & neck defects. Materials & Methods: Anatomical Study: 12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the number, location, size & vascular territory of radial artery perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram to determine the vascular network. Clinical Study: 15 patients with various head neck defects following oncological resections were reconstructed with shape modified adipo-fascio cutaneous free forearm flap. All these patients were prospectively followed for donor site healing, motor & sensory nerve deficit, function & quality of life questioner for donor site assessment. Results: 12 fresh human cadavers & 24 cadaveric forearms were dissected, and a total of 222 perforators were dissected for an average of 18.5 perforators per forearm. 118 were smaller than 0.5 mm in diameter (53.15%) & were not clinically significant. 104 perforators were greater than 0.5 mm in diameter (46.84%) & were clinically significant. 127 perforators (57.20%) were radially distributed & 95 perforators (42.79%) had ulnar distribution. 90 perforators (40.54%) were identified on distal side (Radial styloid) & 132 perforators (59.45%) were identified on proximal side (Lateral epicondyle). Mean number of perforators, on radial side was 10.6 & 7.9 on ulnar side; comparison of both using student t paired test gives a P value of 0.006, which is significant. Comparison of mean number of perforators on the distal side was 7.5 & proximal side was 11.0; Student Paired t test gives a P value of 0.003, which was statistically significant. Comparison of mean diameter of perforators on Distal side (1.11) & Proximal side (0.86), side using Student Paired t test gives a P value of 0.01 which was statistically significant. A chi square test was done to compare mean diameter of perforators on distal side, which was more than 1 mm (80%) & less than 1 mm (20%) & on proximal side more than 1 mm (35.6%) & less than 1 mm (64.4%). Chi square value of 42.406 was obtained, degree of freedom value was 1 & P value of <0.001 was achieved which was found to be highly significant. Methylene blue injections demonstrated clusters both in proximal & distal forearm & also marked the cutaneous territory of flap. Three-dimensional computed tomographic angiography reveals a network of linking vessels found to communicate between adjacent perforators & running parallel to radial artery. A total of 15 patients were reconstructed with shape modified radial forearm flap following oncologic resections. Wound healing in all 15 patients was good, with scar assessment faring better than traditional radial forearm flap. There was no sensory or motor nerve deficit. Although pedicle length was comparatively shorter in shape-modified flap, there was no problem in anastomosing to neck vessels. Conclusion: Increase in knowledge of vascular territory of radial artery perforators with regards to numbers, size, location, & cutaneous territory can lead to expanded use of radial forearm flap based on either distal or proximal perforator alone. Shape modified technique for harvesting radial forearm flap allows primary closure of donor site. Donor site is better healed and shows a predicted pattern, which is functionally and aesthetically good.

Crestal Bone Changes around immediately loaded Single-piece Implants using Flap and Flapless Technique: A Radiographic Study

With the trend shifting toward the minimally invasive surgeries in implant surgery, the flapless technique of implant placement is gaining popularity among the implantologists. This study was done to assess the crestal bone loss level in flap and flapless surgery at follow-up periods of 0, 1, and 3 months. Patients presenting with missing teeth requiring dental implants for rehabilitation were included in the study. Implant placement was done in 10 patients with traditional flap technique, while in other 10 patients, flapless technique was performed after determining the availability of sufficient bone width with ridge mapping. Radiographical follow-up was done for 3 months at 0-, 1-, and 3-month intervals. It was observed that for most of the flapless cases, the bone loss settled at 1st thread or just below the implant collar after 3 months. It was seen that crestal bone height was reduced in both flap and flapless techniques. On comparing the bone loss, the flapless approach showed statistically significant lesser reduction as determined by radiovisiography. The study has been done to evaluate crestal bone level using flap and flapless technique. It was seen that reduction of crestal bone height was seen in both flapless and with flap techniques. However, on comparison, less bone resorption was observed in flapless technique.