U-shaped Flap Research Articles

Enucleating the large and median geniohyoid dermoid cysts of the floor of the mouth with intraoral inferior based U‐shaped flap technique: how we do it

Clinical OtolaryngologyVolume 34, Issue 5 p. 479-481 Enucleating the large and median geniohyoid dermoid cysts of the floor of the mouth with intraoral inferior based U-shaped flap technique: how we do it M. Eken, M. Eken Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorZ.A. Oktay, Z.A. Oktay Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE. Ayduran, E. Ayduran Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE.E. Eken, E.E. Eken ENT clinic, Sultanbeyli state hospital, Istanbul, TurkeySearch for more papers by this authorA. Sanli, A. Sanli Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this author M. Eken, M. Eken Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorZ.A. Oktay, Z.A. Oktay Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE. Ayduran, E. Ayduran Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this authorE.E. Eken, E.E. Eken ENT clinic, Sultanbeyli state hospital, Istanbul, TurkeySearch for more papers by this authorA. Sanli, A. Sanli Second ENT, Kartal training and research hospital, Istanbul, TurkeySearch for more papers by this author First published: 24 September 2009 https://doi.org/10.1111/j.1749-4486.2009.01956.xCitations: 3 Dr Mehmet Eken, Kartal Dr. Lutfi Kirdar, Training and Research Hospital 2nd ENT Clinic, Uskudar street, Konak Apartment number: 39/11, Kartal Istanbul, Turkey. Tel.: +90 505 234 45 96; fax: +90216 330 95 02; e-mail: memedken@yahoo.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume34, Issue5October 2009Pages 479-481 RelatedInformation

A Simple Myocutaneous Flap for Short-Stump Mediastinal Tracheostomy

A long, U-shaped myocutaneous flap was designed to construct mediastinal tracheostomy in patients with a short tracheal stump. The technique was used in 1 patient who had tracheal carcinoma and whose tracheal stump was 1.5 cm and in 2 patients whose posterior part of the tracheal stump was 3 cm and 5 cm, respectively, and who had advanced cervicothoracic esophageal carcinoma. The flap provides a cosmetic effect and its construction saves time in the surgery of long-segment tracheal carcinomas and locally advanced cervicothoracic esophageal carcinomas.

Repair of hypospadias with severe chordee using a long, wide, U-shaped flap that preserves ventral penile tissues intact for second-stage urethroplasty

Purpose The aim of the study was to report a new technique for repairing hypospadias with severe chordee (HSC). Methods Our new technique involves making a long, wide, U-shaped incision on the ventral penis from the coronal sulcus to very distal to the meatus and dissecting to create a flap (U-flap). During dissection, the urethra is divided just proximal to the meatus. After release of chordee, the U-flap is returned to the ventral penile shaft and sutured in place. A buttonhole made distally in the U-flap is anastomosed to the cut end of the urethra to create a neomeatus. Snodgrass urethroplasty is performed 6 to 18 months later. We have treated 11 patients with HSC (mean age, 22.3 months) using this technique. Results Postoperatively, all U-flaps were viable. The neomeatus appeared to be more proximal because the penis was straighter. Urethroplasty using the central part of the U-flap was uncomplicated by scar tissue and successful in all cases. After a mean follow-up of 15.7 months, all patients have satisfactory penises without stenosis or diverticulum, although 1 had fistula. Conclusion Our U-flap technique allows the ventral penis to be preserved intact without scarring for second-stage urethroplasty and as a result is well suited for treating HSC.

Simple and New Surgical Procedure for Laryngotracheal Separation in Pediatrics

In children with severe physical and mental disabilities who repeatedly develop aspiration pneumonia due to intractable aspiration, laryngotracheal separation/tracheoesophageal anastomosis or laryngotracheal separation has been performed in many institutions for the prevention of aspiration, and good results have been reported. However, families sometimes show a marked reluctance to give consent to these surgical techniques because of tracheal transection. A purpose of this study is to evaluate a new surgical procedure for laryngotracheal separation without tracheal transection. Case-series study. As a new, simple, less invasive surgical technique for the prevention of aspiration without tracheal transection, we performed tracheal closure (tracheal flap method) in six children. A U-shaped flap of the tracheal anterior wall from the 2nd to the 4th/5th tracheal ring was produced, bent toward the tracheal lumen, and sutured to the tracheal posterior/lateral walls by mattress stitches for tracheal closure. In addition, the closure was covered with a cutaneous U-shaped flap for reinforcement and a permanent tracheal stoma was constructed. In all six patients, aspiration pneumonia could be prevented without severe complications. Tracheal closure (tracheal flap method) has effects comparable to those of other surgical techniques for the prevention of aspiration, and may be useful for aspiration prevention in children with severe physical and mental disabilities.

Canadian Society for Aesthetic (Cosmetic) Plastic Surgery/Société canadienne de chirurgie plastique esthétique

Umbilicoplasty is a component of abdominoplasty to achieve a nice, natural looking umbilicus with minimal scarring. Various techniques have been attempted to achieve the natural looking umbilicus. One hundred cases of umbilicoplasty have been done and are presented with good and pleasing results. SURGICAL PROCEDURE: A 10 to 12 cm. position is maintained from the suprapubic area to the umbilicus. At that level, an inverted u-shaped incision is made for the desired umbilicus. The original umbilicus, in the meantime, is tacked to the abdominal fascia to shorten the pedicle. The abdominoplasty flap is secured to the suprapubic incision to stabilize the skin. After the u-shaped incision is made in the abdominal flap, defattening of the umbilicus and u-flap is done. The original umbilicus is sutured onto this flap, burying the suture, securing the umbilicus. This u-shaped flap becomes a tongue which is sutured to the inferior component of the original umbilicus to give a natural hood. This completes the repair and steri-strips and compressive dressings are applied. The rest of the body contouring procedure is then completed. One hundred cases have been done. Complications seen: 2 inferior separations, closed by secondary closures. Infections – nil. Keloid formation and hypertrophic scar formation less than 1% – treated by Kenalog injection. Revisional procedures – nil. Overall satisfaction over 99%. SUMMARY: This technique has shown predictably good and very natural looking umbilicus, complimenting the abdominoplasty procedure for aesthetic body contouring surgery.

Repair of Large Defects in the Forehead Using a Median Forehead Rotation Flap and Advancement Lateral U-Shaped Flap

The forehead is a large and highly expressive and dynamic cosmetic unit. Most forehead defects that cannot be closed primarily are reconstructed with laterally based advancement flaps. A combination of median forehead rotation flap and advancement lateral U-shaped flap for repair of medium- to-large-size defects in paramedian and lateral forehead is described. Technically, the design of median forehead rotation flap based on supratrochlear vessels used here is similar to the median forehead transposition flap used to reconstruct large defects of the nasal dorsum. The length and the movement of the flap are much smaller in this case. Approximately 2/3 of the closure of the defect is achieved by displacing the median forehead flap while the remaining 1/3 corresponds to the advancement of the lateral U-shaped flap. The flaps are simple to perform, have minimal complications, and have good cosmetic results. A representative case is presented with photographs. For selected medium- to large-size horizontal defects in the paramedian and the lateral forehead, the combination of a median forehead rotation flap and an advancement lateral U-shaped flap offers a simple, visually pleasing repair that preserves the forehead architecture.

Repair of Large Defects in the Forehead Using a Median Forehead Rotation Flap and Advancement Lateral U-Shaped Flap

Repair of Large Defects in the Forehead Using a Median Forehead Rotation Flap and Advancement Lateral U-Shaped Flap

原発性膀胱尿管逆流症に対する内視鏡下三角部形成術II

We report a technique and outcome of endoscopic trigonoplasty II (ET II), anti-reflux surgery via a transvesicostomy transurethral approach and discuss its usefulness. Fifteen female patients, aged 5 to 64, with 23 refluxing ureters (grade I : 5, II : 2, III : 14, IV : 2) underwent the ET II. The principle of this surgery is tightening the muscular backing and elongating the intramural ureter. The operation consists of three steps: 1) two 5 mm locking trocars are placed into the bladder, 2) irrigating with 3% D-sorbitol solution, the bladder wall is incised upward along each side of the ureter using a resectoscope, to make a 2 to 3 cm U-shaped bladder flap including the ureter, 3) under a pneumobladder, the incised wall is sutured to make a muscular bed with a needle-holder via the urethra and forceps via the abdominal trocar. The U-shaped flap is fixed with two distal anchor sutures and four additional mucosal sutures. Urethral catheter is indwelled and the operation is finished. In recent four cases, we closed the tracts endoscopically. The average operative time was 144 minutes per ureter. In one patient with unilateral reflux, we switched to open surgery because of bleeding. Of 22 refluxing ureters, the reflux disappeared in 18 ureters (82%) and improved grade III to I in 1 ureter (5%) after 3 months and disappeared in 19 ureters (86%) after 12 months postoperatively. Ureteral injury was occurred in 3 patients during the transurethral incision of the bladder. Though we repaired it by placing a double-J stent in the 2 patients, reflux recurred in 12 months postoperatively in one of them. In the other patient cystoscopy revealed a vesicoureteral fistula in the injured portion. She subsequently underwent successful open Politano-Leadbetter ureteroneocystostomy. The average duration of indwelling catheter was shortened from 4.3 to 3.0 days by closing the tracts endoscopically. The overall cessation rate of the ET II was inferior to those of open anti-reflux surgeries or laparoscopic extravesical ureteral reimplantation. We do not recommend ET II for vesicoureteral reflux.

Split-Thickness Skin Graft Attachment to Bone Lacking Periosteum

To develop an animal model to investigate the survival of split-thickness skin grafts (STSGs) on bone without periosteum, to compare STSG attachment to bone with and without periosteum, and to determine the effect of fibrin glue on STSG attachment to bone. Prospective laboratory study. University laboratory. Sprague-Dawley rats. Percentage of survival of the STSGs at 2 weeks determined independently by the authors and a third, blinded head and neck surgeon. In experiment 1, which included 40 rats, the sutured STSGs showed an average survival rate of 38% when attached to bone with periosteum, 6% when attached to bare bone, and 10% when attached to bare bone using fibrin glue. The poor survival rate was thought to be attributable to the animals scratching at their bolster dressings. In experiment 2, 18 animals underwent a posteriorly based U-shaped flap of skin and subcutaneous tissue. The grafts were placed and isolated from the overlying flap with a biosynthetic wound dressing. The sutured STSG survival rates were as follows: 87% when attached to bone with periosteum, 94% when attached to bare bone, and 74% when attached to bare bone using fibrin glue. The survival of STSGs attached to bare bone was comparable to that of STSGs attached to bone with periosteum when grafts were protected with the skin-subcutaneous flap. The STSGs that were fixed with 0.1 cc of fibrin glue demonstrated poorer survival rates than those attached with sutures and were associated with more seromas.

A new capsuloplasty technique in open reduction of developmental dislocation of the hip.

A meticulous capsuloplasty is needed to maintain concentric reduction in the surgical treatment of developmental dysplasia of the hip (DDH). The authors present a new capsuloplasty technique that was named as 'reverse U-shaped capsuloplasty'. It was performed in 72 dislocated hips of 62 children with a mean age of 2.7 years. The reverse U-shaped flap, created in the redundant superolateral capsule was turned downwards, advanced medially, anteriorly and inferiorly and brought over the anteroinferior capsular incision. After a mean follow-up period of 3 years there was neither redislocation nor restriction of the hip joint motion in any hips.

A new capsuloplasty technique in open reduction of developmental dislocation of the hip

A meticulous capsuloplasty is needed to maintain concentric reduction in the surgical treatment of developmental dysplasia of the hip (DDH). The authors present a new capsuloplasty technique that was named as ‘reverse U-shaped capsuloplasty’. It was performed in 72 dislocated hips of 62 children with a mean age of 2.7 years. The reverse U-shaped flap, created in the redundant superolateral capsule was turned downwards, advanced medially, anteriorly and inferiorly and brought over the anteroinferior capsular incision. After a mean follow-up period of 3 years there was neither redislocation nor restriction of the hip joint motion in any hips.

A simple and reliable continent bladder stoma constructed from bladder wall.

Patients presenting with recurrent bladder neck strictures or severe incontinence refractory to all forms of infravesical treatment usually require chronic catheterization or supravesical urinary diversion. As an alternative, we use a simple continent bladder stoma made from the bladder wall. After extraperitoneal bladder mobilization, a Lapides-like 4 x 8 cm U-shaped bladder flap is excised and sutured to a tube. Depending on the location of the stoma, the base of the flap can be chosen and/or the length of the flap can be adapted. After bladder neck closure the tube is reflected and, after incision and dissection of the detrusor in the middle of the base of the flap, embedded in Lich-Gregoir's technique. The distal end of the tube is then sutured to the stoma site. Five of our patients now have a minimum follow-up of 11 months (mean 17 months). All are continent with a bladder capacity between 250 and 560 ml. In two, stomal stenosis at the skin level required epifascial stomal revision.

A New Endoscopic Ureteral Reimplantation for Primary Vesicoureteral Reflux (Endoscopic Trigonoplasty II)

We describe a new technique of endoscopic antireflux surgery. The principle of the procedure is to make a reliable muscular backing and elongate the intramural ureter. We performed this new endoscopic surgery in 8 female patients in whom 4, 1, 8 and 1 refluxing ureters (total 14) were diagnosed with grades I to IV reflux, respectively. The operation consists of 3 steps. Two 5 mm. locking trocars are placed into the bladder. Irrigation is done with 3% D-sorbitol solution and the bladder wall is incised upward along each side of the ureter using a resectoscope to make a 2 to 3 cm. U-shaped bladder flap, including the ureter. Under pneumobladder the incised muscle is sutured to make a muscular bed with a needle holder via the urethra and forceps via the abdominal trocar. The U flap is fixed with 2 distal anchor sutures on the embedded muscular layer and 4 additional sutures are placed to approximate the mucosa of the U-shaped flap and bladder. Mean operative time was 245 minutes. Ureteral injury occurred in 2 patients. A Foley catheter remained indwelling for 3 to 5 days (mean 4.1). Reflux resolved in 12 of the 14 ureters (86%) 12 months postoperatively. Vesicoureteral reflux persisted in 1 case because of insufficient fixation and recurred in 1 because of ureterovesical fistula. The patients were satisfied with better cosmesis and minimal postoperative discomfort. We believe that procedure is feasible for female patients with primary vesicoureteral reflux.

Reconstruction of the superior labial sulcus in secondary bilateral cleft lip deformities: an inverted U-shaped flap.

A shallow buccal sulcus deformity following bilateral cleft lip repair is not rare. A variety of techniques are described for the secondary reconstruction of a deficient sulcus. Most of these are associated with a variable amount of contraction with subsequent obliteration of the sulcus. In this article, an inverted U-shaped flap is described for the secondary reconstruction of the deficient sublabial sulcus. In these patients, mobility of the upper lip was severely restricted, so orthodontic treatment was not possible. This technique was used in nine patients whose primary cleft lip repairs were performed in different institutions. The amount of re-adhesion or contraction was negligible, because a bare surface was not left behind and skin or mucosal grafts were not used. By advancing the lateral segments of the lip medially, projection of the upper lip was increased. The procedure resulted in adequate upper lip mobility for all patients, and sufficient sulcus was maintained during 1 to 6 years of follow-up. The patients experienced no difficulty with orthodontic appliances after this reconstruction.

Anocutaneous advancement flap repair of transsphincteric fistulas

The purpose of this study was to evaluate the healing rate of transsphincteric perianal fistulas after anocutaneous advancement flap repair and to examine the impact of this procedure on fecal continence. Between January 1997 and June 1999, 26 consecutive patients with a transsphincteric perianal fistula passing through the middle or upper third of the external anal sphincter underwent anocutaneous advancement flap repair. There were six female patients, and the median age was 39 (range, 27-54) years. Twenty patients (77 percent) had previously undergone one or more prior attempts at repair. With the patient in the prone-jackknife position, the internal opening of the fistula was exposed using a Lone Star Retractor System, and the crypt-bearing tissue around the internal opening as well as the overlying anoderm was excised. An (inverted) U-shaped flap, including perianal skin and fat, was created. The base of the flap was approximately twice the width of its apex. The flap was advanced and sutured to the mucosa and underlying internal anal sphincter proximal to the closed internal opening. The median follow-up time was 25 months. Fecal continence was evaluated in 23 patients by means of a questionnaire. Anocutaneous advancement flap repair was successful in 12 patients (46 percent). Success was inversely correlated with the number of prior attempts. In patients who had undergone no or only one previous attempt at repair (n = 9), the healing rate was 78 percent. In patients with two or more previous repairs (n = 17) the healing rate was only 29 percent. In seven patients (30 percent) continence deteriorated after anocutaneous advancement flap repair. Eleven patients (48 percent) had a completely normal continence preoperatively. Two of these patients (18 percent) encountered soiling and incontinence for gas after the procedure, whereas two subjects (18 percent) complained of accidental bowel movements. Twelve patients (52 percent) presented with continence disturbances at the time of admission to our hospital. In this group, deterioration was observed in two patients (17 percent). The results of anocutaneous advancement flap repair in patients with no or only one previous attempt at repair are moderate. In patients who have undergone two or more previous attempts at repair the outcome is poor. Based on the relatively low healing rate and deterioration of continence, this procedure seems less suitable for high transsphincteric fistulas than transanal mucosal advancement flap repair.

RESULTS OF UMBILICOPLASTY FOR BLADDER EXSTROPHY

The umbilicus is an important aesthetic landmark and its absence or deformity may be associated with poor self-image. In patients born with bladder exstrophy the umbilicus is attached to the upper margin of the bladder and reconstructive surgery often removes the navel. The umbilicus marks the waistline and serves to complete the harmony of the curved lines above and below the waist. We present our experience with children born with exstrophic anomalies during the last 2 decades. Our database included 61 children born with classic bladder and 8 born with cloacal exstrophy treated between 1980 and 1998. We performed primary reconstruction in 35 children, while 34 children and young adults were referred for secondary surgical repair, including bladder augmentation, continent diversion, genitoplasty and so forth. Neoumbilicoplasty was done in all of the former and in 30 of the 34 latter cases. Early in the series a V-shaped flap was raised and buried subcutaneously. The flap eventually became a tube around the cystotomy tube and the cicatrix formed the umbilical dimple. This method necessitated packing with iodoform gauze for 4 weeks with weekly dressing. The technique evolved into a tubularized U-shaped flap. A rubber tube was placed indwelling as a stent to maintain inward projection of the neoumbilicus. In 66 of the 69 cases the early results of umbilicoplasty were described by the surgeon as excellent or satisfactory. In 3 cases the neoumbilicus appeared flat, lost depth and was described as unsatisfactory. Long-term followup of more than 1 year was available in 48 patients, of whom 2 underwent umbilical repositioning for an off center or low umbilicus and 3 underwent repeat umbilicoplasty for a flat umbilicus that had lost depth. The best cosmetic results were achieved in patients with a relatively thick layer of subcutaneous fat, whereas cosmesis was suboptimal in thin children. Nevertheless, the patients and parents were generally pleased with the umbilical appearance even when the surgeon was not. Although the navel is a functionless depressed scar, it represents an important and pleasing landmark. Umbilical construction should be attempted early during functional closure or urinary diversion.

Dissection of the anterior abdominal wall and the deep inguinal region from a laparoscopis perspective

The usual dissection by medical students of the anterior abdominal wall and the inguinal region proceeds from superficial to deep; special emphasis is placed on the sheath of the rectus abdominis muscle and lateral muscular layers. We suggest an alternate approach to dissection of this region that has the following advantages: (1) sparing of delicate deep structures not often fully appreciated by students; (2) provision of an opportunity to visualize the region from a laparoscopic surgeon's vantage point; (3) considerably reduced time spent dissecting and identifying structures and relationships, especially peritoneal reflections important in laparoscopic procedures. Our dissection begins with bilateral subcostal incisions through the entire thickness of the anterior abdominal wall and peritoneum, which extend laterally and inferiorly to the level of the anterior superior iliac spines, thereby forming a large, inverted, U-shaped flap. This flap is reflected inferiorly, allowing abdominal viscera to be dissected, and ultimately removed en bloc. The flap is then drawn cranially and stretched somewhat to approximate its position when the abdomen is inflated with CO2 during laparoscopic procedures. Major landmarks, including the deep inguinal ring, are noted and the flap is again reflected inferiorly for dissection beginning with the peritoneum and transversalis fascia. This method of dissecting the anterior abdominal wall and inguinal region results in more facile and timely identification of both superficial and deep structures of the anterior abdominal wall and inguinal region, and provides a clinically relevant demonstration of anatomy from a laparoscopic perspective.

A technique for coronary artery reimplantation in composite aortic root replacement.

Currently, three techniques are used for reimplantation of coronary arteries following the insertion of a composite aortic valve graft: Bentall, aortic button, and Cabral interposition graft. We have utilized an alternative technique based on the creation of an inverted U-shaped flap, which is then reflected and sutured to an appropriately sized coronary button. The technique is simple, obviates the needs for coronary mobilization, and assures a tension-free anastomosis and accessible suture line.

Recto-vagino-vestibuloplasty using a vagino-colonic flap with double colonic implantation for rectocloacal fistula

This technique was devised to obtain a good cosmetic appearance of the perineum and a functional neovagina, without any need for a dilator, by using a vaginocolonic flap marsupialized to the perineum and by creating a vestibule with noncornifying squamous epithelium. The technique was used to treat a 2 year old girl who had a single small orifice in the upper part of a featureless perineum, with a high-confluence rectocloacal fistula between a short urethra and double vagina, which was separated by a septum. A long inverted U-shaped flap at the posterior wall of the vagina was reversed to become the anterior wall of the distal vagina. The urogenital sinus (UGS) was preserved to serve as the urethra. The colon distal to the colostomy was divided into two loops; a segment of the distal loop was opened and trimmed to form a flap, and served as the posterior wall of the distal vagina. The proximal segment was pulled down to become the rectum. To construct the vestibule, a vertical midline incision was made from the fused labia minora to the perineum, cutting back the UGS. The anterior wall of the vagina, which was pulled through just behind the UGS, was divided vertically and sutured around the opened UGS and the suitably prepared labia minora. The posterior wall, which consisted of the colonic flap, was sutured to the incised perineal skin, creating a posterior commissure. At present, 2 1 2 years after the repair, the patient is dry between completely continent urinations and has little vaginal discharge. A dilator has not been necessary, and the appearance of the perineum is almost normal.

Experience with U-shaped Gluteal Thigh Flap for Reconstruction of Radionecrosis in the Sacral Region

The gluteal thigh flap first reported by Hurwitz in 1980 can provide a large reliable flap for coverage of the sacrogluteal and perineal regions. This flap can be extended quite some way along its axial inferior gluteal vessels, but its width is limited to approximately 10 cm if direct approximation of the donor site defect is required. In this article, we report a U-shaped modification of the gluteal thigh flap for efficient use of the flap in covering a large defect in the sacrogluteal region.