Transposition Flap Technique Research Articles

Treatment of Multiple Soft Tissue Maxillofacial Wounds: A Case Report

Introduction: Trauma to the maxillofacial area is a frequent problem in medical emergencies, including injuries caused by external forces such as traffic accidents. These injuries can result in damage to the soft tissues, especially the face, which plays an important role in a person's expression, appearance, aesthetics, and identity. Prompt and appropriate treatment is essential to prevent serious complications, including infection and long-term damage. Case Report: A 21-year-old male patient suffered facial bleeding due to a traffic accident. This incident caused lacerations to the frontal region dextra, palpebra dextra, zygoma dextra, and mental, as well as multiple abrasions to the face. Radiographic examination showed no bone fracture, but the wounds required debridement and suturing of the lacerated soft tissues. Management: The patient was diagnosed with multiple lacerations to the maxillofacial area. Initial measures included Tetagam as anti-tetanus protection, followed by Ceftriaxone as prophylactic antibiotics, Omeprazole to reduce gastric irritation, and Ketorolac for analgesic and anti- inflammatory effects. Wound cleansing and debridement were performed to reduce the risk of infection and preserve healthy tissue. The wound was then sutured with the transpositional flap technique, which allows a change in wound direction to reduce the risk of infection and ensure aesthetic and functional wound closure. Conclusion: Multiple soft tissue wounds of the maxillofacial area due to physical trauma require prompt and appropriate management to prevent serious complications. Debridement, wound cleansing, and the use of transpositional flap technique in the treatment of laceration wounds in this case showed optimal wound healing results without complications. Keywords: Transpositional Flap, Maxillofacial, Soft tissue trauma, soft tissue wound, debridement

Simple incision and suture modeling on fixed structured grids

This paper presents a simple yet versatile approach to simulate skin incisions and suturing using nonlinear finite element analysis on a fixed structured grid with a spring-based suture model. Incisions and wounds are introduced by element removal and the sutures are discretely modeled by applying linear constraint relations pairwise to groups of nodes. Two numerical examples utilize the closing of an elliptical wound to study the influence of the number of sutures and their location, and two test cases use the Z-plasty transposition flap technique to investigate the versatility of the proposed method and for comparison with state-of-the-art results. The results indicate that the presented method is able to recreate literature results to an acceptable level of accuracy. Further, the method proves versatile due to the ability to freely introduce incisions and wounds onto the fixed grid modeling domain without remeshing. Lastly, the two main advantages of the discrete suture representation are the ability to capture local stress concentrations near the sutures and the full freedom in placing the sutures.

Management of supraglottic stenosis using interarytenoid Z-plasty: how I do it.

Supraglottoplasty is the primary surgical treatment of congenital laryngomalacia. Supraglottic stenosis is a rare complication of supraglottoplasty that is difficult to manage. This study presents a new endoscopic mucosa-sparing Z-plasty double transposition flap technique that was used to manage supraglottic stenosis following supraglottoplasty for severe congenital laryngomalacia in an eight-month-old infant. At 10 months post-operatively, the patient remained asymptomatic and flexible laryngoscopy showed adequate supraglottic patency. Endoscopic interarytenoid Z-plasty is a safe and effective technique in the management of paediatric supraglottic stenosis.

A Novel Local Transposition Flap for Lateral Breast Reconstruction After Breast Conserving Surgery

BackgroundBreast conserving surgery (BCS) followed by radiotherapy is used for the management of early-stage breast cancers. There are different techniques to reconstruct the breast after BCS, each has its own advantages and disadvantages. In this study, we aim to present a novel local transposition flap and report the follow-up results of patients who underwent breast reconstruction using this method in the short and long term. Material and MethodsWe enrolled 100 patients who underwent BCS in the form of upper or lower outer quadrant lumpectomy with or without axillary lymph node dissection. After lumpectomy, the patients underwent breast reconstruction using the local transposition flap technique. We followed the patients for 1 year, and the satisfaction results are assessed and reported postoperation, after radiochemotherapy, and after 1 year. ResultsThe patients’ mean age is 47.6 (±11.7) years, and the mean BMI is 32.4 (±2.5). The duration of hospitalization was 1 day in 96 patients and 2 days in 2 patients. There were 2 patients hospitalized for 3 days. Three patients developed seroma and there were no cases of any other complication. The surgeon and patients satisfaction surveys conducted postop, after the radiochemotherapy course, and 1 year after BCS shows that the excellent and good satisfaction rate is 85%, 85%, and 92% respectively. ConclusionWe believe that the local transposition flap can be an excellent substitution for the existing methods in the reconstruction of the lateral side breast defects.

Experience of tear-drop-shaped excision with modified limberg transposition flap among sacrococcygeal pilonidal sinus diseases

Background: Sacrococcygeal pilonidal sinus disease (PSD) is notorious for prolonged morbidity and recurrence. Mild pain, shorter hospitalization, mild risk of complications, early return to routine activities, better cosmesis, and minimal recurrence rate are the suggested criteria of ideal treatment of PSD. In Limberg flap technique, flattening of the intergluteal cleft is flattened, and the scar is placed away from the midline. This eliminates the causative factors of PSD. However, the drawbacks of this procedure are necrosis of flap at its vertex and maceration of skin at the incision site. This study aimed to perform tear-drop-shaped excision and reconstruction with modified Limberg transposition flap technique among patients for PSD at the sacrococcygeal region and discuss the clinical results. Materials and Methods: Eleven patients with primary sacrococcygeal PSD were included in the study between September 2017 and September 2018 at the JNMC, Wardha, Maharastra, India. It was planned for each case to undergo tear-drop-shaped resection and reconstruction with a modified Limberg transposition flap with a suction drain. Drains were removed after 48 h. Results: The mean age of the patient was 28.2 ± 8.4 years. All were male with a mean duration of symptoms of 3.8 ± 1.3 years. The mean operative time was 84 ± 23 min. Primary healing was obtained in all patients. Stitch was removed on the 14th postoperative day. The average hospital stay was 10 days as 2/3rd patients wanted discharge after stitch removal. The mean time to resume work was 22.6 ± 7.2 days. The mean follow-up period was 18 ± 6 months without any documented recurrence except hypoesthesia on the flap among two cases. Conclusions: More cases are required to conclude better methods among the two procedures of tear-drop-shaped modified Limberg flap and classical Limberg flap.

Comparison of conjunctival autograft and conjunctival transposition flap techniques in primary pterygium surgery

PurposeTo investigate and compare the efficacy of conjunctival autograft and conjunctival transpositional flap for the treatment of primary pterygium surgery. DesignRetrospective, interventional case series analysis. Materials and methodsMedical records of 48 patients who underwent pterygium surgery by conjunctival autograft or conjunctival transpositional graft for primary pterygium surgery were reviewed. The conjunctival defects after pterygium excision were repaired in 21 eyes with conjunctival autograft and in 27 eyes with conjunctival transpositional flaps. All operations were performed under subconjunctival anesthesia using 8.0 vicryl sutures. Two groups were compared in terms of pterygium size, surgery time, complications and pterygium recurrence. ResultsMean pterygium size was 2.8 mm in conjunctival transpositional flap group, and 3.4 mm in conjunctival autograft group (p < 0.01). Mean surgery time in conjunctival transpositional flap and conjunctival autograft groups was 15.9 and 21.7 min, respectively. The haematoma formation under the graft was observed postoperatively in one eye of conjunctival autograft group. The only one case of recurrence was observed in both conjunctival autograft and conjunctival transpositional flap groups (3.7% and 4.7%, respectively). Mean follow up time was 11.78 months in conjunctival transpositional flap group and 14.95 months in conjunctival autografting group (p < 0.01). ConclusionBoth conjunctival transpositional flap and conjunctival autograft techniques have same results in terms of pterygium recurrence and surgery complications in the treatment of primary pterygium. Surgery time in conjunctival transpositional flap technique is significantly shorter. Conjunctival transpositional flap technique may be a good alternative method for primary pterygıum surgery.

A novel technique for full thickness medial canthal reconstruction; playing with broken lines

PurposeTo introduce a new modification of transposition flap technique for reconstruction of the medial canthal region. MethodsThis prospective study included 58 patients with the full thickness involvement of both upper and lower lid in the medial canthal area. Reconstruction of posterior lamella was performed by utilizing periosteal flaps and tarsoconjunctival grafts, and anterior lamellar reconstruction was performed using transposition of multiple full-thickness skin flaps, a modified form of rhomboid flap technique. Post-surgical outcomes, advantages, and drawbacks of this technique are discussed. ResultsBetween 2010 and 2014, 58 patients with basal cell carcinoma (BCC), proven by histopathologic study, underwent medial canthal reconstruction. The mean age was 72.8 ± 8.3 years. In 30 patients, the lacrimal apparatus was excised, and periosteal flaps or tarsoconjunctival grafts were prepared to reconstruct the posterior lamella. Anterior lamellar reconstruction was performed in all patients, and the mean number of transposition flaps was 3.63 in addition to the blepharoplasty flap. Patients were followed for 24 months. None of the patients developed flap necrosis or other intraoperative and postoperative complications, with acceptable aesthetic and functional outcomes. ConclusionFull-thickness reconstruction of the medial canthal area by utilizing periosteal flaps and modified transposition flap technique all in one session can be considered an alternative method in medial canthal reconstruction, with acceptable functional and aesthetic outcomes.

Zetaplasty as an alternative for reconstructing double surgical defects

The authors present the surgical reconstruction after excision of two synchronous adjacent basal cell carcinomas in the left infraclavicular region, using the Zetaplasty transposition flap technique. Being versatile and simple to perform, Zetaplasty was proven a useful solution for the reconstruction of double defects within a single procedure

Hypertrophie cicatricielle précoce post-chirurgicale de la région nasale : intérêt des injections de corticoïde retard

"Pincushioning" is a complication of post-surgical scarring following use of transposition flaps particularly when surgery is performed on the nasal region. The transposition flap technique is very useful for the repair of certain defects of the tip of the nose, the medial canthus or of the ala nasi. The aim of this study is to define the clinical characteristics of this scarring dystrophy, which we propose to call "early hypertrophy scarring", to clarify the nature thereof and to assess the efficacy of intralesional injection of corticosteroids at the first signs of hypertrophy. A prospective, open, non-comparative, single-centre study examined the clinical and histological characteristics of early hypertrophy scarring and the effectiveness of therapy with one or two injections of corticosteroids performed on the 15th day post-operatively and optionally repeated at D45 depending on the outcome. From January 2011 to January 2013, 12 consecutive patients with early hypertrophy scarring were included (ten men and two women - mean age: 64 years). All had undergone surgery for basal cell carcinoma under local anaesthesia with one-stage repair by means of a rhombic flap or a bilobed flap located in the nasal area. Scars were injected strictly intra-lesionally with triamcinolone acetate (40 mg/1 mL) until whitening occurred. A single injection was performed in three cases of rhombic flap while a second injection was given at D45 in the remaining nine cases. Complete regression of the early hypertrophy scarring was obtained in ten of the 12 patients by D90. Incomplete regression was observed but with a marked improvement in the other two patients. Early hypertrophy scarring is distinguished by its clinical characteristics of hypertrophic or keloid scars. Biopsy performed in two cases showed the fibrous but non-fatty nature of early hypertrophy scarring. Biomechanical factors particular to the nasal region and the transposition flap technique could account for the early and excessive collagen production causing early hypertrophy scarring. Early injection of corticosteroids, which was consistently effective in our study, could represent a simple treatment for early hypertrophy scarring, thus avoiding surgical correction. These preliminary results in a small number of patients require confirmation by a comparative, multicentre, prospective controlled study.

Fibrin glue sealing in the treatment of a recto-urethral fistula in Crohn's disease: A case report

Recto-urethral fistulas in Crohn's disease are rare, and managing them is difficult. The various surgical techniques are not reliably effective and are associated with a significant risk of morbidity. The rectal mucosal transposition flap technique, which is used most frequently, requires the rectal mucosa to be in a healthy condition. We report here on a case where treatment was by injecting fibrin glue into a complex fistula with a single anorectal point of origin but combining a median recto-urethrocutaneous tract with two deep lateral rectoperineal tracts. The patient had presented with active rectal Crohn's disease. This treatment produced complete closure, verified by MRI, of all the fistula tracts, which was still maintained after three years, and with normal anal continence. When confronted with this type of fistula, and particularly when the condition of the rectal mucosa is poor, the specialist should be encouraged by this good result to consider the injection of fibrin glue, a technique without risk of morbidity, as a first course of action.

Effect of Inferior Conjunctival Transposition Flap Surgery for Primary Pterygium

Purpose: To evaluate the efficacy and safety of the inferior conjunctival transposition flap for primary pterygium surgery. Methods: This study reviewed 59 eyes in 59 patients with primary pterygium who were treated with pterygium excision and an inferior conjunctival transposition flap. The inferior conjunctival flap was obtained from lower bulbar conjunctiva and was secured with 8-0 vicryl. Patients were followed-up on the third day after surgery and then at 1, 2, 4 and 12 weeks postoperatively. Results: The mean patient age was 55.6 (ranging from 34 to 74) years. The mean follow-up period was 24.9 (ranging from 12 to 46) months. During the follow-up period, the pterygium recurred in one (1.7%) of the 59 eyes. There were no severe complications except for mild congestion and hemorrhage of the conjunctival flap. Conclusions: Inferior conjunctival transposition flap technique may be considered as a safe and effective method that reduces complications and recurrences after primary pterygium excision.

Sacrococcygeal Pilonidal Sinus Treated by a New Fascio-Cutaneous Flap

This study reported the technical details and preliminary clinical outcomes of a new fascio-cutaneous transposition flap for the surgical treatment of pilonidal sinus. Fifty-two patients with pilonidal sinus were surgically treated. During the surgical procedure, an inferiorly pedicled, fascio-cutaneous flap with specific geometric characteristics was prepared and transposed. Postoperative pain, complications, duration of hospital stay, and time off worked were assessed. Patients were followed for eighteen months after surgery. The mean hospital stay was 2 days. Drains and sutures were removed after 3 and 12 days, respectively. No flap ischemia, wound dehiscence or major complications were observed. Tension on suture lines and pain after surgery were negligible. Wound infections occurred in 4 patients (7.7 percent) and were managed by removing a few sutures. Seroma was detected in 6 patients (11.5 percent). The mean time patients missed work was 7 days. No recurrence was observed during the follow-up period of 18 months. With no disease recurrence, minimal complication rate, time off work, and acceptable aesthetic outcome, this fascio-cutaneous transposition flap technique is a safe and effective method for surgically treating pilonidal sinus.

Temporal changes in grip and pinch strength after open carpal tunnel release and the effect of ligament reconstruction

Symptoms of pain and weakness are nearly ubiquitous after carpal tunnel release. This study investigates the length of time before restoration of grip and pinch strength after open carpal tunnel release, in a population of patients without workers' compensation-related injuries. Two different forms of carpal ligament reconstruction were carried out in 2 groups of patients, and a third group underwent no ligament reconstruction. Grip and pinch strengths were measured for participants in each group both preoperatively and at set postoperative intervals. Mean changes in strength were calculated and analysis of variance used to determine statistical significance of the changes. Grip strength at 6 weeks after surgery in the group that underwent transposition flap repair exceeded preoperative grip strength values and all 3 groups surpassed preoperative grip strength measurements at 12 weeks. By 6 weeks after surgery, all pinch measurements for 3 groups equaled or exceeded preoperative pinch measurements. The transposition flap repair group recovered faster than did the other 2 groups and surpassed those groups in maximum grip and pinch strength at 12 weeks. These results suggest that transverse carpal ligament reconstruction, particularly the transposition flap technique, after open carpal tunnel release confers a mechanical advantage and that the transverse carpal ligament is an important pulley in flexor tendon excursion.

Hydroxyapatite augmentation of the anterior portion of the maxilla with a modified transpositional flap technique

Tunneling as a technique for augmentation of an atrophic maxilla has been described in the literature. The use of this technique has presented several prosthodontic problems, such as diffusion of material into adjacent tissues, incorrect positioning of the material on the ridge, and inadequate ridge height. Use of the transpositional flap technique described by Lew and modified by Williams has been used to overcome these problems. Twenty-five patients were treated with this method during a 30-month period. The patients had worn a maxillary complete denture for at least 5 years and had opposing natural mandibular anterior teeth with unsupported posterior occlusion. Use of the transpositional flap technique was shown to overcome the common prosthodontic problems seen with the tunneling procedure for anterior maxilla augmentation with hydroxyapatite.