Ultra-thin Flap Research Articles

Concentrated growth factor intradermal injection assisted super-thin flap expansion for repairing skin defects: A randomized, single blinded, split-site study.

The super-thin skin flap formed by skin and soft tissue expansion has large area and good ductility, so it can be used to repair skin defects. However, because the flap is thin, the blood flow in the dermis of the super-thin expanded flap is weakened, and flap rupture and necrosis after secondary flap transfer may occur. To compare the skin thickness difference between the expanded ultrathin flaps injected with concentrated growth factor (CGF) and the blank group or saline group. From June 2021 to December 2023, 10 patients (44 sites) with large-area scars or skin tumors were treated, and a single center half randomized controlled trial was conducted. The test site of expander implantation was divided into three groups: intradermal injection of CGF group, normal saline group and blank group. The same amount of expansion was performed every 1-2 weeks, and CGF or normal saline was injected into the dermis every 4 weeks, a total of three times. After 2-3 months of expansion, color Doppler ultrasound was used to measure the skin thickness of each group. Compared with the blank group, the skin thickness of CGF group was 1.75 ± 0.08 mm, and that of BLA blank group was 1.42 ± 0.07 mm, with statistically significant difference (p < 0.0001); In the other group, compared with the saline group, the skin thickness of the CGF group was 1.54 ± 0.08 mm, and the average skin thickness of the saline group was 1.40 ± 0.08 mm, with significant difference between the two groups (p = 0.0067). CGF intradermal injection can increase the skin thickness of super-thin skin flap in the process of soft tissue expansion, which is a safe and effective auxiliary method of skin expansion.

Comparative analysis of the groin and SCIP flap in reconstructive microsurgery of soft tissues of the maxillofacial area and oral cavity

Most of the articles on the groin flap were published in the period from 1975 to 2010, from 2015 to 2022, the SCIP flap surpassed the groin flap in the number of publications. According to the results of a literature search in PubMed and RINC, 30 articles were found and selected, including 288 flaps from the iliac region. The length of the vascular pedicle, the diameter of the vessels, the complications, the prevalence of the flap in the reconstruction of the head and neck, the thickness and the size of the flap were evaluated. Both of these flaps have the same nutrition, but different levels of dissection. In comparison with the groin flap, the SCIP flap has a longer vascular pedicle, which can be enlarged due to new techniques, which also allows it to be used as an ultra-thin flap, and it reduces the need for secondary procedures for defatting and reduces the risks of the complications in the donor area. The thickness of the SCIP flap is less than the groin one, which, according to the author, increases the aesthetic level of operations in the facial area in the case of the texture and color of the flap. Vascular anatomy of the SCIP flap is variable, therefore, the use of preoperative planning is necessary. Despite this, complications in the donor or recipient area during reconstruction with a SCIP flap are minimal. It has been proved that the SCIP flap is versatile and safe in all aspects of reconstruction. It can be concluded that the SCIP flap should be considered as a «workhorse» in reconstructive microsurgery of soft tissues of the throat and oral cavity.

Особенности морфологических изменений биоптатов конъюнктивы, полученных с использованием фемтосекундного лазера

Purpose. To give a morphological assessment of human conjunctival biopsies obtained manually and using a femtosecond laser. Material and methods. Morphological studies were carried out in 4 groups of patients with pterygium who underwent autoplasty with a bulbar conjunctival flap. In groups 1–3 conjunctival biopsies with a thickness of 70, 80 and 100 microns respectively, were obtained using a femtosecond laser, in group 4 – a flap of the minimum possible thickness was cut out manually. Conventional methods of preparing histopreparations with hematoxylin-eosin staining and the Van Gieson method were used. Results. A feature of the manual technique for preparing a conjunctival graft is the formation of a flap with insufficiently smooth edges, uneven and unpredictable thickness. In the structure of such biopsies, violations of the continuity of cell layers, areas of epithelial rupture were noted. During the formation of a flap with a thickness of 80 and 100 microns using a femtolaser, morphological changes were noted in the form of destruction of epithelial cells, the appearance of foci of coagulation in the epithelial layer and cavitation vesicles in the connective tissue stroma. The severity of pathological changes increased as the depth of the conjunctival incision increased, which may be due to the use of a higher power of the femtolaser for this purpose. The smallest pathohistological changes in the conjunctival biopsies of the eyeball were observed when receiving a femto flap 70 microns thick. Conclusion. The use of various methods (manual technique or femtolaser) for obtaining a conjunctival transplant does not exclude the use of each of them in practical medicine. The femtolaserassisted technique makes it possible to obtain ultra-thin flaps that can be fixed seamlessly, in particular with fibrin glue. Key words: conjunctival biopsy, morphological examination, femtosecond laser, pterygium

Ultrathin free flaps for foot reconstruction: impact on ambulation, functional recovery, and patient satisfaction

Background Plantar reconstruction is a complex procedure due to the paucity of tissue around the foot. Tissues used for reconstruction should provide similar properties, which can be accomplished by using ultra-thin flaps. Validated functional scales may provide essential information regarding patients’ evolution. Methods Information concerning a series of 12 cases of plantar reconstruction using ultra-thin free flaps was gathered retrospectively by the authors. Data from preoperative functional scores in Lower Extremity Functional Scale and American Orthopaedic Foot and Ankle Society scale were obtained from clinical records; these were compared to postoperative scores assigned prospectively during follow-up. Differences were determined using Student’s t-test for paired samples. Objective measurements concerning evolution (ulceration, footwear usage, sensation), as well as patient satisfaction, were also explored. Results The mean follow-up duration was 16.5 (range 12 to 24) months. The Lower Extremity Functional Scale scores mean modified from 39.1 to 60.2, p = 0.004; the American Orthopaedic Foot and Ankle Society scale mean modified from 42.2 to 53.4, p = 0.012. No patient showed plantar ulceration. Protective sensation was achieved in 75% of the patients, and 10 out of 12 could use regular footwear. All patients reported satisfaction with the surgical procedure. Conclusions Ultra-thin flaps for foot reconstruction are related to improvement in functional scales, high rates of patient satisfaction, and use of regular footwear as well as a limited range of complications.

Eighty-micron flap femtosecond-assisted LASIK for the correction of myopia and myopic astigmatism.

To evaluate the safety and efficacy of 80-μm flap femtosecond laser-assisted LASIK and the early clinical and refractive outcomes in the correction of myopia and myopic astigmatism. Private practice, outpatient. Prospective study. Patients who underwent femtosecond-assisted LASIK between February and April 2018 were included. Inclusion criteria were myopia from -1.00 to -8.00 diopters (D) and astigmatism up to -3.00 D and no previous surgeries. All patients were tested preoperatively and on day 1 and month 3 for uncorrected distance visual acuity (UDVA), manifest refraction, corrected distance visual acuity (CDVA), intraocular pressure (IOP), slitlamp and dilated fundus examination, Schirmer I test with anesthesia, and ocular surface disease index questionnaire. The FEMTO LDV Z8 was used for flap construction and the Wavelight Allegretto 400 excimer for refractive treatment. Flap thickness was measured at week 1 with anterior segment optical coherence tomography (AS-OCT). Eighty-two eyes were included. Logarithm of the minimum angle of resolution UDVA was 1.28 ± 0.53 preoperatively, 0.02 ± 0.05 at day 1, and 0.14 ± 0.127 at month 3. There was no loss of CDVA lines. The mean flap thickness measured at 1 week with AS-OCT was 73 ± 6.7 µm. The use of ultrathin flaps, just below Bowman's layer, with the Ziemer LDV Z8 femtosecond laser was possible, safe, reliable, and reproducible. Eighty-micron flaps allowed for excellent vision on 1 day post-LASIK and might be a good alternative to maintain an appropriate percentage of tissue altered, especially when attempting greater corrections or larger treatment zones.

Technology for obtaining an ultrathin posterior lamellar corneal graft at the Eye Tissue Bank

Objective: to develop technologies for preoperative preparation of the posterior lamellar corneal graft based on our own formulation of the preservation medium for optimal dehydration of the donor cornea and a technique for cutting out an ultrathin flap using an optimized method at the Eye Tissue Bank. Materials methods. In a series of experimental studies, we obtained data on the hydration level of cadaveric donor corneas that were preserved in various solutions at different observation periods. Using 16 corneas, analytical weighing and pachymetry were performed via optical coherence tomography in the experimental (n = 8) and control (n = 8) groups. Morphological and functional characteristics of the corneal endothelium were then assessed. At the next stage of work, ultrathin grafts were formed from 16 corneas after hypothermic preservation in the experimental (n = 8) and control (n = 8) solutions by single-pass microkeratome, followed by microscopy of the samples using a scanning electron microscope. Results. After the first days of preservation in the proposed solution, there was dehydration of 9% cornea in the experimental group in comparison with the samples of the control group. After 4 days of preservation, there was no reliable difference found between the groups (p &gt; 0.05) in the study of the endothelial cell viability of ultra-thin corneal grafts by immunofluorescent microscopy using the «Live and dead» marker. Scanning electron microscopy revealed that corneal stromal collagen fibers, preserved in the proposed medium, retained their integrity. Conclusion. The proposed technology can be recommended for use at eye banks for formation of an ultra-thin corneal graft at the preoperative stage.

Beyond the anterolateral thigh: the descending branch intermuscular septal (DBIS) flap

The anterolateral thigh flap (ALT) is widely utilized for coverage of a variety of defects across the body, though use of this flap is limited due to the its size and bulky nature. We describe a flap from the descending branch of the lateral circumflex system including the intermuscular septum (DBIS) without use of the perforator for use of an ultra-thin flap for defect closure. A retrospective review of all patients who underwent wound closure with use of the DBIS flap from March 2016 to August 2018 was performed. Data on patient demographics and date on operative time, defect type, defect size, flap size, vessel size, complications and need for revisions were collected. Seven patients were identified who underwent reconstruction with DBIS flap, six patients for ankle defects and one for a scalp defect. Average age of patients was 66 years and average BMI was 28.9. The most common indication for flap coverage was tendon or joint exposure following total ankle arthroplasty. Average flap area was 36cm2, average operative time with a single team of surgeons was 258 min, and average length of hospital stay was 3.7 days. The DBIS flap is an excellent option for reliable coverage of defects requiring thin, pliable tissue. Advantages of this flap include ease of dissection, relatively short operative time, primary closure of donor site and minimal contour deformity. Disadvantages include need for a skin graft for flap coverage and limited pedicle length. In the reported series, no complications were reported.

Clinical study on combining femtosecond thin- flap and LASIK with the Triple-A profile for high myopia correction

BackgroundFemtosecond laser–assisted LASIK (FS-LASIK) can make ultra-thin corneal flap accurately. MEL 90 excimer laser provides Triple-A ablation mode, which significantly reduces the amount of corneal tissue cutting. This study aimed to investigate the visual and refractive outcomes in patients with high myopia after thin-flap FS-LASIK using the 500 Hz pulse rate of the Triple-A profile.MethodsThis prospective study included 90 eyes from 90 patients received thin-flap FS-LASIK using the 500 Hz pulse rate of the Triple-A profile. According to the pre-operative spherical equivalence (SE), the treated eyes were divided into two groups: the first group (ranged from − 9.0D to − 6.0D) and the second group (ranged from − 11.15D to − 9.0 D). The parameters evaluated pre-operatively and 6 month post-operatively included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), SE, efficacy and safety index, posterior central elevation, and corneal higher-order aberrations (HOAs).ResultsThe efficacy indexes were 1.149 ± 0.150 for the first group and 1.173 ± 0.136 for the second group (P > 0.05), whereas safety indexes were 1.135 ± 0.154 and 1.158 ± 0.137 (P > 0.05) respectively. Moreover, 93.8 and 90.6% of patients had an UDVA of 20/20, 51.2 and 49.8% had a UDVA of 20/16 for the first and second groups, respectively; yet, there were no significant differences between both groups at the 20/20 and the 20/16 levels (P > 0.05). 84 and 100% of the firse group patients had a SE within ±0.5 D and ± 1.0 D, and 82 and 100% of the second group patients. There was no significant myopia regression in both groups after 6 months follow-up. At 1, 3 and 6-month after surgery, there were no significant differences in the posterior central elevation between the two groups (P > 0.05). The induction of total HOAs, spherical aberration, and horizontal coma in the first group were significantly less than that in the second group at the 6- month follow-up (P < 0.05), while the differences of the RMS value of vertical coma between both groups were not significant (P > 0.05). The ablation was significantly associated with the post-operative increase in total HOAs, spherical aberration and horizontal coma (P < 0.05),but not with vertical coma (P > 0.05).ConclusionOur results indicate that using the Triple-A ablation profile of the MEL 90 excimer laser associated with thin-flap is a safe, efficient, and predictable method to correct SE up to − 11.15D. However, for patients with high myopia, under the premise of ensuring a certain optical zone diameter, the ablation depth should be minimized to reduce the increase of the post-operative HOAs so as to improve the visual quality.

Moria One-Use Plus sub-Bowman’s keratomileusis head: a useful tool in the refractive surgeon’s armamentarium

Patients and methods A total of 500 eyes of 250 patients underwent laser in situ keratomileusis (LASIK) surgery using the One-Use Plus sub-Bowman’s keratomileusis head for the creation of an ultrathin LASIK flap. During the follow-up at 1, 6, 12, and 24 months, both uncorrected visual acuity (UCVA) and best-corrected visual acuity were recorded. A keratoconus screening corneal topography was carried out during the last follow-up visit. Results A total of 500 eyes of 250 myopic patients were included in this study. There were 115 male patients and 135 female patients. The mean age was 27.5 years (range: 18–44 years). The mean preoperative refractive error was −5.0 diopter sphere (DS) (range: −3 to −9 DS). The mean cylindrical error was −2.5 diopter cylinder (DC) (range: −0.75 to −4.5 DC). The mean UCVA was 0.07 (range: 0.01–0.3), and it improved to 1.0 (range: 0.8–1.25) on day 1 postoperatively. At the end of the follow-up, the mean UCVA was 1.0 and the mean best-corrected visual acuity was 1.0. The mean stromal residual bed thickness was 362 μm (range: 304–466 μm), and the mean central flap thickness was 102 μm (range: 82–120 μm). Complications were perilimbal bleeding in 15 eyes and fine irregular stromal edge cuts at the sides of the hinge in 10 eyes. There were no epithelial defects, no epithelial heaping or sliding, no irregular stromal bed surface cuts, no free caps or button holes, or incomplete flaps. Diffuse lamellar keratitis occurred in one eye of one patient, and no slipped flaps, macrostriae or microstriae, or epithelial downgrowth was seen during the follow-up period. At the end of the follow-up period none of our patients had topographic evidence of keratoconus. Conclusion The One-Use Plus sub-Bowman’s keratomileusis head is a safe and effective method for creating an ultrathin LASIK flap and allows the surgeon to treat higher errors of refraction while maintaining a higher safety margin by leaving more residual stromal tissue.

The Antero-Lateral Thigh Flap in Coverage of Extensive Post Traumatic Upper Limb Defects

Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and February 2016. Antero-lateral thigh flaps were performed to cover post traumatic upper limb soft tissue defects. Brachial interposition grafts were used in all cases. Harvesting was performed using saphenous vein graft. A 10% larger than defect, flap was used to cover defect. Results: The age range was 15 to 46 years. All 15 cases were male. The indication for soft tissue reconstruction was trauma all patients. Each procedure was performed by a “two team” approach with an experienced surgeon raising the flap and a team preparing the recipient vessels. Flap size ranged from 15 to 25 cm in length and from 8 to 10 cm in width. Ischaemic time ranged from 91 to 157 min. We experienced a 100% flap success rate, with good cosmesis and return to function in all cases. Only two anastomoses required explorations or revision. Minor complications were seen in two patients including a superficial wound infection and a small wound dehiscence. The donor site was closed directly all cases, light dressing with slab support was utilized in all patients Early postoperative management warming the patient, half-hourly flap observations, and ensuring adequate hydration and urinary output. All patients received antithrombotic therapy. Conclusion: The anterolateral thigh flap is one of the most versatile and useful perforator flaps for multidimensional reconstructions for head and neck, limb, trunk, and perineal region. It can be ultrathin flap for resurfacing and filling dead spaces with superior functional and aesthetic outcomes.

Microsurgical free flaps: Controversies in maxillofacial reconstruction

Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps.

Application of hydrophilic contact lens for preventing the fine wrinkle of LASIK ultrathin flap

Objective To study the effect of hydrophilic contact lens to prevent wrinkle of ultrathin corneal flap in LASIK.Methods 32 cases(64 eyes)were divided into two groups after LASIK.One group was weaved hydrophilic contact lens immediately,and the other group was not.The incidence rate of wrinkle of ultrathin corneal flap were compared.Results The incidence rate of wrinkle of uhrathin corneal flap in wearing hydrophilic contact lens group was lower than that not weared.Conclusion Wearing hydrpphilic contact lens immediately after LASIK as the physical barrier between eyelid and corneal flap could effectively reluce and avoid the wrinkle of ultrathin corneal flap,on account of inappropriate nictitation power to comeal flap directly. Key words: Hydrophilic contact lens; LASIK; Ultrathin flap; Fine wrinkle

Simultaneous treatment of the broken corneal flap during ultra-thin flap LASIK

Objective To observe the effect of primary operation of corneal flap breakage in ultra-thin flap LASIK. Methods 7 eyes of 7 patients who confronted corneal flap breakage during ultra-thin flap LASIK in our department during Feb. 2006-Oct. 2009 received primary treatment during the operation： erase the broken flap epithelium of the uncutted part within the laser treatment area ,while expose the corneal stroma bed of the eutted part and deliver the laser treatment. Results All the 7 patients accepted the operation smoothly ,There were no epithelium implant ,flap displacement or other complications. The vision kept stable 1-3 months after the opera- tion , no correct vision decrease. Haze happened in 3 eyes 3 months after the operation, all of them are 0.5 grade. Conclusion primary operation of corneal flap breakage in ultra-thin flap LASIK is safe and effective. Key words: Eximer laser in-situ keratomileusis; ultra-thin coneal flap; Complication; Myopia corretion

Clinical observation of the treatment in myopia with sub-Bowman' s membrane keratomileusis

Objective To evaluate the clinical efficacy, safety and predictability of treatment of myopia with sub-bowman's keratomileusis (SBK). Methods SBK was performed on 100 eyes of 50 cases with,to produced under ultra-thin corneal flap at sub-Bowman' s by means of VISX STAR S4 excimer laser equipment. Postoperatively 1 d, 1 week, 1 month, 3 months for review. Results (1) Postoperative recovery was quick,reaction is light,and astigmatism is small. (2) Treatment area of excimer laser in situ keratomileusis (LASIK) was widened by the ultra-thin corneal flap, so that more patients with high myopia and corneal ply inadequacy will undergo surgery. (3) In a certain, the safety of LASIK can be extented and the postoperative corneal expansion can be reduced. Conclusion SBK is the best choice for patients with LASIK, which is a method with safety, validity and accuracy. Key words: Bowman's membrane ; corneal flap,ultra-thin; LASIK

Dry eye complaints and patient satisfaction after LASIK surgery with ultra thin flap

Dry eye complaints and patient satisfaction after LASIK surgery with ultra thin flap

Clinical application of free anterolateral thigh flap in the reconstruction of intraoral defects

The purpose of this study was to assess the clinical features and therapeutic efficacy of the intraoral defects reconstruction with 3 types of anterolateral thigh flaps. The clinicopathologic data of 39 cases with oral tumors were obtained from the School of Stomatology, Nanjing University Medical Center, from December 2008 to June 2010. These patients underwent the simultaneous tumor resection and intraoral defects reconstruction with free anterolateral thigh flaps. There were 22 male and 17 female patients; the ratio of male to female was 1.3:1; the mean age was 56.1 years. Twenty-two of the anterolateral thigh flaps were musculocutaneous flaps (56.4%), 8 were fasciocutaneous flaps (20.5%), and 9 were ultrathin flaps (23.1%). Five patients required operative exploration in the perioperative period. Three flaps were thrombotic events, 1 flap was hematoma, and 1 flap was twisting of perforator. After the salvages, 1 flap was partial failure, 1 flap was total failure, and the other 3 flaps were complete survival. The free anterolateral thigh flap was the ideal soft tissue flap in the intraoral defects reconstruction. This flap presents good functional results at the receiving site with the additional advantages of minimal donor-site morbidity and a high level of patient satisfaction.

Comparison of LASEK and LASIK with Thin and Ultrathin Flaps After Excimer Laser Ablation with the SCHWIND Aspheric Ablation Profile

to compare visual, refractive, and wavefront aberration outcomes of laser epithelial keratomileusis (LASEK), thin-flap LASIK (flap thickness 110 to 130 microm), and ultrathin-flap LASIK (flap thickness <110 microm) after excimer laser ablation with an aspheric ablation profile. a retrospective analysis of 97 eyes of 56 patients with myopia <6.00 diopters (D) sphere (30 eyes, alcohol-assisted LASEK; 30 eyes, LASIK 110; and 37 eyes, LASIK 130) was conducted. Surgery was performed using the SCHWIND ESIRIS Aberration-Free aspheric ablation profile and the Carriazo-Pendular microkeratome. groups were comparable preoperatively except for lower astigmatism and ocular trefoil (3,+3) in the LASIK 130 group and lower corneal thickness in the LASEK group. At 6 months postoperative, the groups were comparable for uncorrected and corrected distance visual acuity, efficacy index, safety, and refractive predictability. All groups demonstrated improved contrast sensitivity. All groups demonstrated a significant change in spherical aberration compared to preoperative levels. The induced spherical aberration was 0.057 microm/D in the LASEK group, 0.039 microm/D in the LASIK 110 group, and 0.044 microm/D in the LASIK 130 group. Other higher order aberrations did not show significant change except for a reduction in corneal trefoil (P=.034) in the LASEK group and increased ocular trefoil (P=.002) in the LASIK 110 group. The extent of change in higher order aberrations was not significantly different among groups. the aspheric ablation profile is safe, effective, and predictable and produces similar visual and refractive results with three different surgical approaches of LASEK, thin-flap LASIK, and ultrathin-flap LASIK. The ablation profile demonstrated a low induction rate of higher order aberrations regardless of surgical approach.

The Versatility of the Anterolateral Thigh Flap

In the last two decades, the anterolateral thigh flap has emerged as one of the most popular reconstructive options for multiple body sites. Based on a perforator flap harvest concept, the flap encompasses the advantages of versatility, pliability, and potential for composite tissue replacement. Although numerous anatomical variations exist, these are well-described, and flap safety remains uncompromised if certain anatomical boundaries are respected. Careful preoperative planning and identification of perforators remain the cornerstone of successful flap harvest. Once perforators are identified, variations in skin paddle design allow for multiple skin paddle configurations, central or eccentric orientations, and custom-made flaps tailored to fit almost any defect. A suprafascial dissection allows for "ultra-thin" flaps ideal for folding, tubing, or packing purposes. The versatility of the lateral circumflex femoral artery branches can be exploited to include muscle, iliac bone, tendon, fascia, or nerve in extended designs. The anterolateral thigh flap is currently the frontline choice for head and neck reconstruction, including intraoral, mandibular-maxillary, tongue, and facial defects, and is gaining popularity in abdominal and pelvis reconstruction. It can also be used as a pedicled flap in phallus or perineum reconstruction. More recently, the flap has proved to be extremely useful in skin resurfacing and even functional reconstruction in traumatic wounds. This review summarizes the anatomy, planning, flap harvest, donor morbidity, and clinical applications of the anterolateral thigh flap. An algorithm is proposed that facilitates a clear, problem-based approach for the use of this versatile reconstructive option.

Predictive factors of femtosecond laser flap thickness measured by online optical coherence pachymetry subtraction in sub-Bowman keratomileusis

To evaluate possible factors responsible for the difference between predicted and measured parameters during 100 microm flap creation with a femtosecond laser (IntraLase FS30) using online optical coherence pachymetry (OCP). AugenVersorgungsZentrum, Weilheim, and the Technical University of Munich, Munich, Germany. In this nonrandomized prospective interventional case study, 287 eyes of 146 consecutive patients were monitored by online OCP before and after flap creation with the femtosecond laser. The laser-specific settings were held constant during the study to attempt a 100 microm flap in all eyes. A multiple linear regression model with backward variable selection procedure was applied to evaluate possible multivariable explanatory powers of several covariates. In addition, very thin and very thick flaps (ie, lower and upper quartiles of flap thickness distribution) were analyzed separately in a logistic regression model. Central flap thickness measured with online OCP subtraction varied according to a Gaussian distribution from 57 to 138 microm, with a mean of 100.4 microm +/- 13.6 (SD). Regression analysis between predicted and measured flap thickness showed no predictive power of 11 variables including the keratometry value of the cornea, preoperative corneal thickness, and patient age. The plano applanation interface of the IntraLase FS30 femtosecond laser produced ultrathin flaps for sub-Bowman keratomileusis that were independent of some preoperative and surgical factors known to affect outcomes with mechanical microkeratomes.

Treatment of massive skin avulsion of limbs with ultrathin flaps and full-thickness skin grafts

Objective To discuss the treatment of massive skin avulsion of limbs with ultrathin flaps and fuU-thickness skin grafts. Methods Twenty-one patients with massive skin avulsion of limbs were included in this study.In this group,the area of skin avulsion occupied 2%to 6%of the total body surface. Averaging 3.3%.According to the characteristics and conditions of their wound surfaces.the avulsed skin Wma divided into absolute ischemic zone,partial ischemic zone and abnormal zone.The 3 zones were shaped into a graft complex composed of full-thickness skin zone,junctional zone and ultmthin flap zone respectively.The graft complex was transplanted onto the wound surface.Results In all the patients.90%to 100%of the avulsed skin survived.with an average of 94.1%.There wag no infection.In the 12 cases that had bee followed up for 2 months t0 3 years,the grafted skin showed normal shape,color,texture,sensstion,and function. Conclusions Since the graft complex effectively combines the advantages of both full-thickness flaps and ultmthin flaps and maintains the maximum morphology of the avulsed skin as well.it can improve the survival of avulsed skin.Moreover,the operation is easy and safe. Key words: Avulsion of skin; Flap; Complex; Graft