Unilateral Flap Research Articles

Women’s Experiences With Flap Failure After Autologous Breast Reconstruction

Clinical experience suggests that flap failure after autologous breast reconstruction can be a devastating experience for women. Previous research has examined women's experiences with autologous breast reconstruction with and without complications, and patients' experiences with suboptimal outcomes from other medical procedures. The authors aimed to examine the psychosocial experience of flap failure from the patient's perspective. Seven women who had experienced unilateral flap failure after deep inferior epigastric perforator flap surgery in the past 12 years completed semistructured interviews about their breast cancer treatments, their experiences with flap failure, the impact of flap failure on their lives, and the coping strategies they used. Interpretive phenomenological analysis, a type of qualitative analysis that provides an in-depth account of participant's experiences and their meanings, was used to analyze the interview data. From these data, patient-derived recommendations were developed for surgeons caring for women who have experienced flap failure. Three main themes (6 subthemes) emerged: coming to terms with flap failure (coping with emotions, body dissatisfaction); making meaning of flap failure experience (questioning, relationship with surgeon); and care providers acknowledging the emotional experience of flap failure (experience of being treated "mechanically," suggestions for improvement). In conclusion, flap failure in breast reconstruction is an emotionally difficult experience for women. Although there are similarities to other populations of patients experiencing suboptimal outcomes from medical procedures, there are also unique aspects of the flap failure experience. A better understanding of women's experiences with flap failure will assist in providing more appropriate supports.

Bilateral versus unilateral autologous free flap reconstruction in unilateral breast cancers: Impact of comparisons between PREDICT and BODICEA scores

Bilateral versus unilateral autologous free flap reconstruction in unilateral breast cancers: Impact of comparisons between PREDICT and BODICEA scores

Techniques and Perforator Selection in Single, Dominant DIEP Flap Breast Reconstruction: Algorithmic Approach to Maximize Efficiency and Safety.

Perforator selection is critical to deep inferior epigastric perforator (DIEP) flap harvest. Commitment to a single perforator has the potential benefit of a simpler dissection, but may increase fat necrosis or perfusion-related complications compared with multiple perforator harvest. A 3-year retrospective study was carried out of all patients who underwent DIEP flap breast reconstruction performed by the senior author (M.S.-C). Data were collected on patient demographics and surgical outcomes. One hundred eighty-three flaps were performed (105 patients) over 3 years. One hundred fifty-six bilateral (78 patients) and 24 unilateral flaps were included in the final study. Mean age was 47.8 ± 8.4 years and mean body mass index was 29.1 ± 5.3 kg/m. Seventy-five percent of flaps were based on single dominant perforators. Single perforators were used in 33.3 percent of flaps weighing over 1000 g, 80 and 74 percent of flaps weighing 500 to 1000 g and less than 500 g, respectively (p = 0.01). There were no differences in overall complications between single- versus multiple-perforator DIEP flaps. Neither body mass index nor flap weight posed additional risk to overall complications. Conversion to a muscle-sparing flap was 9.4 percent. The authors present an algorithm for perforator selection, stepwise approach to flap harvest, and considerations for intraoperative decision-making in DIEP flap reconstruction. Single-dominant perforator flaps can be safely performed, but inclusion of the largest perforator is critical to flap perfusion. Additional perforators must be weighed against the associated tradeoff with donor-site morbidity. The threshold for conversion to a muscle-sparing flap is reduced with increased clinical experience. Therapeutic, III.

Modified Gluteal Fold V-Y Advancement Flap for Reconstruction After Radical Vulvectomy.

To describe the surgical technique of the V-Y cutaneous supra-fascial (modified) gluteal advancement flaps for reconstruction after radical vulvectomy and to assess the outcome of patients according to their clinical characteristics. Between January 2006 and July 2012, 36 V-Y flaps were performed in 21 patients to cover the defect after radical surgery of primary vulvar cancers. Surgery duration, blood loss, hospital stay, and wound healing were assessed according to patient age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, and the initial defect size. Median patient age, BMI, and ASA score were 80 (range, 31-91), 28 (range, 18-36), 3 (range, 1-3), respectively. Median surgery duration and blood loss were 180 minutes (range, 60-275) and 400 mL (range, 100-1000), respectively. Median operating time was higher in patients ASA3 than ASA less than 3, 200 versus 120 minutes (P = 0.038). Median initial defect size was higher in patients with BMI greater than 28 than 28 or less, 92 versus 55 cm (P = 0.004). Local scar defect was observed in 16 patients (76%), mild, less than 10 cm in 10 patients. Median wound healing duration was higher in patients with bilateral than unilateral flap, 16 versus 9.5 days (P = 0.034). The V-Y cutaneous suprafascial gluteal advancement flap for vulvar reconstruction after vulvectomy is an easy, safe, and reliable procedure. However, even mild local scar defect after bilateral flap may impact on wound healing and hospital stay, in elderly and ASA3 patients.

Aesthetic reconstruction strategy for postburn facial scar and its clinical effect

To explore the aesthetic reconstruction strategy for postburn facial scar and its clinical effect. Three hundred and forty-two patients with postburn facial scars were hospitalized from January 2000 to December 2015. Local expanded flap or deltopectoral expanded flap was used for reconstruction according to the location and size of the facial scar. The forehead expanded flap could be chosen for the scar in dorsum nasi or inferior eyelid. The local expanded flap was chosen when the scar width was smaller than 5 cm in cheek, chin, and marginal mandible region. The expanded deltopectoral flap was chosen when the scar width was larger than 5 cm in cheek, chin, and marginal mandible region or the scar contracture was too serious to cause displacement of lips, nose, or eyelid, and the wound width was larger than 5 cm after release. The facial scars of 82 patients, with size ranged from 6.0 cm×2.5 cm to 15.0 cm×10.0 cm, were reconstructed with expanded local flaps. The facial scars of 260 patients, with size ranged from 8.0 cm×7.0 cm to 38.0 cm×13.0 cm, were reconstructed with expanded deltopectoral flaps. After expansion of 2 to 6 months, the facial scars were excised and completely released first of all. The transfer way of local flap and size of deltopectoral flap with pedicle were designed according to the size and shape of the wound. Three weeks after transfer of deltopectoral flap, flap delay procedure was conducted. One week later, the pedicle was severed from the flap to reconstruct the remaining scar. Anti-scar medicine, laser therapy, and elasticized fabric were used postoperatively on the scars in both donor and recipient sites. During the postoperative follow-up for 3 to 12 months, the flaps of 40 out of 82 cases reconstructed with expanded local flaps were in good color and texture. Before 2008, mild scar hyperplasia was observed in the incision of 19 patients; with application of laser after 2008, the number of patients with scar hyperplasia was decreased. During the postoperative follow-up for 3 to 12 months, the flaps of 90 out of 260 cases reconstructed with expanded deltopectoral flaps were in good color and texture. The expander was exposed from the incision in 15 patients, while it did not affect the later treatment. Nine unilateral flaps showed poor blood circulation at the distal end, and they were healed after dressing change. In the early phase, necrosis was observed in one flap after transfer, and it was healed after transplantation of free skin graft. Scar hyperplasia was observed in the chest donor site of one patient, and it was improved after laser therapy. Postburn facial scar could be reconstructed with local or deltopectoral flaps, following the principle of similarity. The expansion could increase the size of the flaps, reduce the thickness of the flaps, and lower the donor site damage.

Le lambeau perforant de fascia lata en reconstruction mammaire : une option intéressante en cas de contre-indication au DIEP

The musculocutaneous tensor fascia latae flap was one of the first free flaps described. It is possible to harvest a flap with the same skin paddle, vascularized by a septo-cutaneous perforator running through the tensor fascia lata muscle septum and coming from the ascending branch of the lateral circumflex femoral artery. The DIEP is currently the workhorse of autologous breast reconstruction, but there are some contraindications. The septo-cutaneous tensor fascia latae perforator flap may be an alternative for women with lateral upper thigh lipodystrophy. Between 2010 and 2014, three flaps have been performed in two patients for delayed breast reconstruction (one case of unilateral reconstruction, and one bilateral). Perforators were identified by preoperative angiography. The intervention was performed in a two-team approach, in only one operative position. Perforators were located in the horizontal axis of the upper rim of the pubis bone. One perforator artery was dissected for each flap. The mean caliber of the pedicle was 2.8mm, and the mean length was 6.4cm. The operative time was 240minutes for unilateral flap, 375minutes for bilateral flap. There was no case of total or partial necrosis, or complications on the donor site. Cosmetic results were considered satisfying by patients and surgeons with the reconstructed breast as well as the donor site. Septo-cutaneous fascia lata perforator flap is an attractive flap for breast reconstruction in patients with DIEP contraindication and lateral upper thigh lipodystrophy. It has many advantages: easy to harvest, length and calibre of the pedicle, double team approach, only one operating position, quality of reconstruction. It is necessary to carry out a larger series of cases to study the complication rate in the donor site.

Nasolabial pedicled compared with island flaps for intraoral reconstruction of oncological defects: complications, recovery of sensitivity, and assessment of quality of life

Our aim was to compare pedicled and island nasolabial flaps used for reconstruction of oral defects in terms of postoperative complications, recovery of sensitivity, and quality of life. We organised a retrospective cohort study of 49 patients who had had intraoral reconstruction with nasolabial pedicled (n-=13) and island (n=36) flaps. Twenty- two patients filled in a validated quality-of-life (QoL) questionnaire and we did sensitivity tests (sharp discrimination with the aid of a Semmes-Weinstein™ aesthesiometer). Descriptive and bivariate statistics were computed and probabilities of 0.05 were accepted as significant. There were 11 flap-related complications (22%), and the flap was totally necrotic in three patients (6%), all of whom had island flaps. There was a significant association between flap-related complications and the use of reconstruction plate p=0.001, 95% CI 2.36 to 11.37) and advanced stage (T3 and T4 p=0.01, 95% CI 1.45 to 5.26). Skin sensitivity recovered in both island and pedicled flaps. Patients treated with island flaps had significantly more problems with prosthetic rehabilitation than those treated with pedicled flaps.The relatively low morbidity and adequate functional and aesthetic results make the pedicled nasolabial flap a viable technique. De-epithelialisation of the pedicle in island flaps permits coverage of defects with unilateral flaps in a one-stage reconstruction. However, the pedicle may be excessively stretched, leading to ischaemic complications.

Inferiorly based nasolabial flap for reconstruction of the moderate to large defects of lips following cancer resection

Reconstruction of the lip defects following wide excision of the squamous cell cancer is challenging for the surgeon. Our aim was to define the role of the inferiorly based nasolabial flap for lip reconstruction in such cases with moderate to large size defects. Lip defects were reconstructed with a unilateral or bilateral subcutaneous nasolabial flaps depending on the size of the defect following wide resection of their lip cancers. All the defects were reconstructed in a single stage. We achieved good lip seal and at least good function in eating and speaking. There was no entropion of the lip, and all the reconstructed lips preserved their height. Simplicity of dissection, robust blood supply, best color match, short procedure time, and minimal donor site morbidity reinforce this flap as a useful adjunct in lip reconstruction. Level of Evidence: IV, therapeutic study.

Unilateral breast reconstruction using bilateral inferior gluteal artery perforator flaps.

Background:For reconstructing moderate-to-high projection breasts in nulliparous patients with insufficient abdominal tissue or prior abdominal surgeries, a unilateral inferior gluteal artery perforator (IGAP) flap is an alternative procedure. In patients with slim hips, however, unilateral gluteal tissue is insufficient and inferior gluteal crease displacement may develop postoperatively. Donor-site asymmetry is also a major disadvantage. In these circumstances, bilateral IGAP flaps provide sufficient tissue without significant gluteal deformity.Methods:We retrospectively reviewed 20 patients who underwent unilateral breast reconstruction using bilateral IGAP flaps by a single surgeon between November 2007 and December 2012. A quantitative outcome assessment was performed and compared with that of 22 unilateral IGAP flap patients operated on by the same surgeon.Results:Twenty patients underwent reconstruction with 40 IGAP flaps. Of the 40 flaps, 39 survived and 1 developed total necrosis due to repeated venous thrombosis. In 15 of 20 patients, the size of reconstructed breast was comparable to that of the contralateral breast. Final inset flap weight was 462.3 g for bilateral flaps and 244.3 g for unilateral flaps. Total operating time was 671.1 minutes (bilateral flaps) and 486.8 minutes (unilateral flaps).Conclusions:Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side. In patients with moderate-to-high projection breast whose abdominal tissue cannot be used for reconstruction, IGAP flaps may be a suitable alternative.

Transverse Musculocutaneous Gracilis Flap for Treatment of Capsular Contracture in Tertiary Breast Reconstruction

Capsular contracture is a common complication associated with implant-based breast reconstruction and augmentation leading to pain, displacement, and rupture. After capsulectomy and implant exchange, the problem often reappears. We performed 52 deepithelialized free transverse musculocutaneous gracilis (TMG) flaps in 33 patients for tertiary breast reconstruction or augmentation of small- and medium-sized breasts. The indications for implant removal were unnatural feel and emotion of their breasts with foreign body feel, asymmetry, pain, and sensation of cold. Anyway, most of the patients did not have a severe capsular contracture deformity. The TMG flap is formed into a cone shape by bringing the tips of the ellipse together. Depending on the contralateral breast, the muscle can also be shaped in an S-form to get more projection if needed. The operating time for unilateral TMG flap breast reconstruction or augmentation was on average 3 hours and for bilateral procedure 5 hours. One patient had a secondary revision of the donor site due to disruption of the normal gluteal fold. Eighty percent of the unilateral TMG flap reconstructions had a lipofilling procedure afterward to correct small irregularities or asymmetry. The advantages of the TMG flap such as short harvesting time, inconspicuous donor site, and the possibility of having a natural breast shape make it our first choice to treat capsular contracture after breast reconstruction and augmentation.

Position of alveolodental fragments before and after primary gingivoperiosteoplasty in unilateral cleft lip and palate

The orofacial clefts are the most frequently facial congenital malformations in the world (1 birth per 700). There are a lot of protocols which are different in the management of timetables and surgical techniques.The aim of this work is to study the tridimensional evolution between two alveolodental fragments during orthodontic surgery cares of patients with unilateral FLAP in the center MAFACE (maxillo-facial and plastic surgery unit at Necker's hospital and rare diseases unit at Rothschild’s hospital).The first step of orthodontic care is to make a transversal expansion of maxillary in order to obtain an optimal width before gingiviperiostoplasty (GPP) with bone grafting.We have studied the tridimensional radiographic documents at different times: T0 (initial time before orthodontic treatment and GPP), T1 (after the orthodontic expansion and before GPP) and T2 (six months after GPP).

Predictive and Protective Factors for Partial Necrosis in DIEP Flap Breast Reconstruction

Although success rate of deep inferior epigastric perforator (DIEP) flap breast reconstruction has greatly improved, complications still occasionally occur. Perfusion-related complications (PRCs) (ie, fat necrosis and partial flap necrosis) are the most frequent concern, affecting aesthetic final result of the reconstructed breast. The aim of our study was to retrospectively investigate 287 consecutive DIEP flap breast reconstructions to investigate predictive and protective factors for PRCs.From May 2004 to February 2012, 287 DIEP flap breast reconstructions were performed on 270 patients; 247 unilateral flaps, including Holm vascular zones I to III, were retrospectively selected and analyzed. Tobacco use, mean blood pressure over the first postoperative 48 hours, superficial epigastric vein drainage, medial/lateral row perforator, nulliparity, crystalloid versus combined crystalloid/colloid intravenous fluid infusion therapy, and learning curve were evaluated by univariate and multivariate logistic regression analyses.Perfusion-related complications occurred 32 (12.9%) times, 79 (31.9%) patients were smokers, 48 (19.4%) showed postoperative mean blood pressure less than 75 mm Hg, 29 (11.7%) were nulliparous, and 173 (70%) had superficial epigastric vein drainage. Selected perforators were 110 (44.5%) from lateral row, 137 (55.5%) from medial row; 91 (36.8%) received crystalloid fluid infusion, whereas 156 (63.2%) combined crystalloid/colloid fluid infusion. From univariate analysis emerged significance of nulliparity, perforator row and intravenous fluid infusion for PRC. Nevertheless, multivariate model confirmed only nulliparity as a significant risk factor (P = 0.029), although variable correlations to other predictors were found: both medial row perforator and combined crystalloid/colloid fluid infusion potentially decrease the PRC risk of 11.6% and 27.6%, respectively. Learning curve did not show significant decrease of PRC risk over time.Our study first proved nulliparity as a statistically significant predictor for PRCs in DIEP flap breast reconstruction, possibly due to different superficial abdominal perfusion between pluriparous and nulliparous women, with potential weaker pattern of perforators and smaller angiosomes in the latter. The choice of medial row perforators and combined crystalloid/colloid fluid infusion might reduce PRC risk.

FAMM Flap in Reconstructing Postsurgical Nasopharyngeal Airway Stenosis.

Introduction. Postsurgical nasopharyngeal airway stenosis can be a challenge to manage. The stenosis could be as a result of any surgical procedure in the nasopharyngeal region that heals extensive scarring and fibrosis. Objective. To evaluate patients with nasopharyngeal stenosis managed with FAMM flap. Study Design. Prospective study of patients with nasopharyngeal stenosis at the Kenyatta National Hospital between 2010 and 2013 managed with FAMM flap. Materials and Methods. Patients with severe nasopharyngeal airway stenosis were reviewed and managed with FAMM flaps at the Kenyatta National Hospital. Postoperatively they were assessed for symptomatic improvement in respiratory distress, patency of the nasopharyngeal airway, and donor site morbidity. Results. A total of 8 patients were managed by the authors in a duration of 4 years with nasopharyngeal stenosis. Five patients were managed with unilateral FAMM flaps in a two-staged surgical procedure. Four patients had complete relieve of the airway obstruction with a patent airway created. One patient had a patent airway created though with only mild improvement in airway obstruction. Conclusion. FAMM flap provides an alternative in the management of postsurgical severe nasopharyngeal stenosis. It is a reliable flap that is easy to raise and could provide adequate epithelium for the stenosed pharynx.

Buccinator myomucosal flap in cleft palate repair: Revisited

Objective: To present various ways of transfer and result of buccinator myomucosal flap (BMMF) in primary and secondary repair of palatal cleft and palate fistula. Design: This study has been designed on the basis of a clinical experience and literature search. Route of single or two BMMF(s) transfer was either lateral or posterior to the greater palatine neurovascular bundle. The flap has been used to repair defect in nasal layer, oral layer, or in combined nasal as well as oral layer of the palate. Materials and Methods: More than 160 palatoplasties have undergone palate repair with the use of BMMFs between 1999 and 2011. The analysis includes 98 palate repair. Unilateral flap was used most commonly in primary repair of nasal side of wide unilateral cleft palate (CP); whereas, two flaps were used mostly in primary repair of wide bilateral CP and in secondary palate repair for large fistula. Results: The fistula rate; in primary palatoplasty patients was 4.8% and in secondary palatoplasty patients, it was 8.3%. Good speech has been achieved in primary palatoplasty patients. After secondary palatoplasty also patients had good speech following therapy. Conclusion: The presented technique has been effective in anatomical and functional repair of wide palatal defects primary as well as secondary. The literature has been reviewed along with.

Vascularized interpositional periosteal connective tissue flap in implant dentistry

Background: Due to the morphologic alteration, that occur following tooth extraction, augmentation procedures are often necessary. In the upper jaw, submucosa of palate can be used for soft-tissue reconstruction in implant dentistry. Materials and Methods: Thirty eight VIP-CT flaps in 37 patients were used for small maxillary reconstruction. In 97.3% of events, unilateral VIP-CT flap for each patient was used. Complications occur in this study include of flap necrosis in one case (2.7%), palatal sloughing in twenty four cases (63%) and donor site deformity in one patient (2.7%) respectively. Results: Patients, that VIP-CT flap was used for preparation of the mouth before implant insertion or during and after dental fixture insertion to preventing esthetic or functional problems, were selected. Indications, extension of palatal incision, donor site morbidity in the form of mucosal sloughing as well as deformity were reported. Sloughing of mucosa was evaluated at 1st week and palate was checked for deformity at 2 month after operation. The flap survival or necrosis was recorded. Conclusion: VIP-CT flap is a reliable source of soft-tissue for replacement of mucosa in the maxilla for implant dentistry.

Modified Gluteal Fold V-Y Advancement Flap for Vulvovaginal Reconstruction

The gluteal fold V-Y advancement flap is a good option for the reconstruction of a vulvovaginal defect because it is thin, sensate, reliable, and has matched local skin quality. However, in situations where wider and deeper vulvovaginal reconstruction is needed, advancement of the flap alone may not be sufficient to create tension-free closure. To overcome these limitations, we designed a modified gluteal V-Y advancement flap, which has 1 or 2 additional transposition flaps at the base of the conventional advancement flap.This study includes a total number of 16 patients who had received vulvovaginal reconstruction with our new technique between March 2008 and April 2011. The causes of the defects were vulvar cancer in 13 patients and extramammary Paget disease in 3 patients. We examined the location and size of the defect, the flap design, and postoperative clinical courses. The mean follow-up period was 10.6 months, and the defect sizes ranged from 8 × 6 to 15 × 12 cm. Overall, 11 of 16 patients were reconstructed with bilateral modified gluteal fold V-Y advancement flaps, and 5 patients were treated with a unilateral flap. All flaps survived without major complications, and the aesthetic and functional results were satisfactory. The modified gluteal fold V-Y advancement flap is useful and reliable for the reconstruction of wide and deep vulvovaginal defects. It can cover the defect without tension, and the complications associated with it are rare.

Reconstruction of upper lip defect

To summarize the clinical experience for the reconstruction of upper lip defects in different degrees. Different treatment methods were selected to reconstruct the upper lip defects according to the subunit, size or location of defects on the upper lip. The therapeutic results were analyzed and compared. From Jan. 1998 to Apr. 2012, 243 cases with upper lip defects were treated, including 85 cases of traumatic defects, 110 cases of defects secondary to lip cleft and 48 cases of defects after tumor resection. 48 cases were treated with direct closure, 69 cases with cross-lip flaps, 5 Cases with orbicularis oris muscle flaps, 53 cases with unilateral labial flaps, 42 cases with bilateral labial flaps, 22 cases with lower lip flaps, and 1 case with forehead flap, 1 case with forearm flap and 2 with nasolabial fold flaps. The patients were followed up for 3-18 months with satisfactory results. Satisfactory results could be achieved for upper lip defects with appropriate treatment methods according to the defects degree and characters.

Lateral vermilion border transposition flap to correct vermilion deformities with unilateral or bilateral cleft lip

Previously, bilateral lateral vermilion border transposition flaps were reported to correct whistling lip deformity in patients with cleft lip. This study examined the long-term outcome in these patients and modified the procedure. Here, the use of this procedure is reported in 69 cleft lip patients. The follow-up period after the operation ranged from 4–14 years. In addition to the standard method, a unilateral flap was applied for asymmetrical vermilion and small bilateral flaps were applied to loosen the transverse tightness of the vermilion. The asymmetry of the tightness was improved in all patients. The reconstructed tubercle diminished in volume gradually over a few years postoperatively. Secondary deformities after its use were subtly everted tubercle during smiling (18.8%) and irregularities on the labial-free margin (21.7%). They were corrected by minor follow-up revision. Although it is necessary to wait several years until the postoperative shape has stabilised, this is a simple and widely available method to reconstruct a naturally-shaped vermilion in cleft lip patients.

Morphological and Histological Changes of the Septal Cartilage after Unilateral versus Bilateral Mucoperichondrial Flap Elevation

Bilateral mucoperichondrial flap elevation is often needed to properly correct the septal deformity although it has been discouraged because of possible complications. This study investigated the effect of unilateral versus bilateral mucoperichondrial flap elevation on the morphological and histological changes of the septal cartilage in a rabbit model. Eighteen mature New Zealand white rabbits were categorized into three groups (six animals for each) according to the procedures they received: unilateral mucoperichondrial flap elevation versus bilateral mucoperichondrial flap elevation versus no flap elevation. In each group, one-half of the animals were killed 3 months after the procedure and the other half were killed 6 months after the procedure. Thickness of cartilage was measured and histological changes of chondrocyte and extracellular matrix were evaluated using hematoxylin and eosin, Masson's trichrome, Alcian blue, and Verhoeff's elastic stains. There was no difference in changes of thickness of the cartilage among the three groups. Histological examination revealed that the chondrocyte numbers and dystrophic features as well as the ratio of chondroblast were not different among three groups. Masson's trichrome stain in the bilateral group showed lesser dense collagen fibers than the other groups. Alcian blue stain for proteoglycan documented that the peripheral zone showed lower expression in the bilateral group than the other groups. However, Verhoeff's elastic stain did not differ among the three groups. Bilateral mucoperichondrial flap elevation of a rabbit model decreased deposition of collagen fibers and proteoglycan while maintaining the similar chondrocyte cellularity compared with the other groups.

Reconstruction of a Perineoscrotal Defect Using Bilateral Medial Thigh Fasciocutaneous Flaps

Reconstruction of a Perineoscrotal Defect Using Bilateral Medial Thigh Fasciocutaneous Flaps