Use Of Pedicled Flap Research Articles

Modified alar swing procedure in saddle nose correction.

Reconstruction of the saddle nose may involve the use of different augmentation materials, from autogenous bone and cartilage to alloplastic materials. The most important problems when considering the choice of reconstructive technique, besides underlying pathology and expected result, include: long-term stability, donor morbidity, tendency of the implant to infection, extrusion, and resorption. The use of the lateral crura of the lower lateral cartilages as dorsal onlay was reserved for the corrections of minor supratip depressions (flying wing and alar swing procedure). The authors suggest the use of pedicled flaps of cephalic portions of lateral crura as dorsal septal strut, which may increase the profile line more than dorsal onlay. Reconstruction is performed using open rhinoplasty approach. Pedicled flaps of the cephalic portions of lateral crura are transfixed in the sagittal plane and, following separation of upper lateral cartilages and medial crura, placed on the dorsum of nasal septum. Upper laterals are sutured to newly formed cartilaginous dorsum, or a new bridge is created using conchal cartilage. Columellar strut may be formed of the septal cartilage. Authors have performed such corrections in 15 patients with good long-term functional and aesthetic results.

Use of Pedicle Flap from the Labia minora for the Repair of Female Urethral Strictures

Introduction: We present the method of pedicle labial urethroplasty for urethral reconstruction in female patients treated for urethral strictures. Patients and Methods: We performed urethral reconstruction using a pedicle labial flap in 2 female patients (23 and 70 years old) for urethral stricture (posttraumatic and postinflammatory origin). We used as a patch a pedicle skin flap obtained from the labia minora. The pedicle flap is slid beneath the vulvovaginal wall, until the urethra is reached. Results: In both cases a normal micturition was obtained, and cystourethrography after 24 months showed a good urethral silhouette, without residual urine. Conclusion: The pedicle labial urethroplasty seems to be a reliable technique for the repair of urethral strictures.

Utility of the omentum in the reconstruction of complex extraperitoneal wounds and defects: donor-site complications in 135 patients from 1975 to 2000.

To examine donor-site complications after omental harvest for the reconstruction of extraperitoneal wounds and defects. The omentum, with its immunologic and angiogenic properties, is a versatile organ with well-documented utility in the reconstruction of complex wounds and defects. However, the need for laparotomy and the potential for intraabdominal complications have been cited as relative contraindications to the use of the omentum as a reconstructive flap. Further, few series have assessed long-term results, and no reports have focused on donor-site complications. Patients who underwent reconstruction of extraperitoneal defects with the omentum at a single university healthcare system were identified by searching discharge databases and office records. Charts were reviewed to determine patient demographics, surgical indications and technique, postoperative complications, and outpatient follow-up. Patients with donor-site complications were compared with patients who had no complications using the Student t test and chi-square analysis. Statistical significance was defined at P <.05. From 1975 to 2000, the authors successfully harvested 135 omental flaps (64 pedicled, 71 free transfer) for reconstruction of the following defects: scalp (n = 16), intracranial (n = 1), orbitofacial (n = 33), neck (n = 8), upper extremity (n = 7), lower extremity (n = 4), intrathoracic (n = 3), sternal (n = 34), breast (n = 3), chest wall (n = 18), abdominal wall (n = 1), and perineal (n = 7). Donor-site complications in 25 patients (18.5%) included abdominal wall infection (n = 9), fascial dehiscence (n = 8), symptomatic hernia (n = 8), unplanned reexploration (n = 6), postoperative ileus (n = 3), gastrointestinal hemorrhage (n = 2), delayed splenic rupture (n = 1), gastric outlet obstruction (n = 1), and late partial small bowel obstruction (n = 1). Factors associated with increased donor-site complications included the use of pedicled flaps (compared with free tissue transfer), mediastinitis, advanced age, and pulmonary failure. Of note, 53 patients had undergone previous abdominal surgery; of these, 26 patients required extensive adhesiolysis and 4 patients sustained enterotomies. Eleven patients (8.1%) had partial flap loss and three patients (2.2%) had total flap loss. Mean length of stay was 28 days. Average follow-up was 2.4 years. The death rate was 5.9%. The omentum can be safely harvested and reliably used to reconstruct a diverse range of extraperitoneal wounds and defects. Donor-site complications can be significant but are usually limited to abdominal wall infection and hernia. Risk factors associated with complications include the use of pedicled flaps, mediastinitis, and pulmonary failure. This low rate of donor-site complications strongly supports the use of the omentum in the reconstruction of complex wounds and defects.

Myringoplasty: update on onlay pedicle skin flap and temporalis fascia sandwich graft.

The technique of onlay sandwich grafting of tympanic membrane perforations fashioned by the use of pedicle flap raised from the posterior deep meatal skin and autologous temporalis fascia is described. The results of a series of 124 ears operated between 1987 and 1999 are the basis of this report. Of these 106 patients had myringoplasty for the first time. The operation was successful in 102 (96.23 per cent) patients. Eighteen patients had revision myringoplasty, with a successful result in 14 (77.78 per cent). None of the patients developed complications usually associated with onlay grafting. A preliminary report of this work was presented at the XVI World Congress of Otolaryngology Head and Neck Surgery at Sydney in 1997.

Reconstruction of the Abdomen and Perineum in Cancer Surgery

Trunk and perineal defects after tumor resection present a challenge to the reconstructive surgeon. When primary closure is not possible, the use of well-vascularized autogenous tissue is required to achieve adequate soft-tissue coverage. Pedicled muscle or myocutaneous flaps provide excellent sources of vascularized tissue for postradiation defects. When local tissues preclude the use of pedicled flaps, free-tissue transfers can be performed. A thorough understanding of radiation wounds and the reconstructive options is essential for treatment of these challenging defects.

Review of the literature on construction of a neourethra in female-to-male transsexuals.

Voiding in a male fashion has priority for most female-to-male transsexuals. For that reason, lengthening of the urethra has been attempted by various surgeons. Because constructing a neourethra has frequently led to fistulas and strictures, some authorities abandoned their attempts. In this report, a review of the literature on the construction of a pars pendulans and a pars fixa urethrae in phalloplasty is given. The techniques used in our institute are mentioned. The use of local tissue for lengthening of the fixed part of the urethra can be successful in case a vaginal flap is incorporated. In phalloplasty, the free flap technique is a useful alternative to the use of pedicled flaps. The techniques necessitating opening the abdomen and viscera are too elaborate and too risky to be used as routine procedures. The use of external devices for urination as suggested by some investigators is not only unsatisfactory to the patient, it also carries the risk of urinary duct infection and trauma.

Wound closure at the trunk by micro vascular free flap transfer

Defects of the thoracic or abdominal wall can be congenital or caused by trauma or tumour resection. There may be other problems, such as infection and irradiation effects. In most cases those defects can be closed by local cutaneous and fasciocutaneous or by muscle and myocutaneous flaps. In some rare instances, the use of pedicled flaps may be limited. The size of the defect, the impossibility of closing the donor site, an impaired blood supply, or poor quality of local tissues represent such limitations. In these cases microvascular flap transfer has enlarged our choice of alternative methods. Advantages of this method are the one-stage procedure and the wound coverage by well-vascularized tissue. This is especially beneficial in areas of infected or irradiated tissue. On the other hand microvascular flap transfer requires high technical skill and extensive perioperative and postoperative care.

Management of Infected Thoracic Aortic Prosthetic Grafts

Between 1975 and 1981, late infection of the prosthesis developed in 4 out of 207 patients (1.9%) who had prosthetic grafts placed in the chest or mediastinum. Organisms were Staphylococcus epidermidis (2 patients), Enterococcus, and Aspergillus. Infection occurred 4 to 57 months after initially clean operations for thoracoabdominal aneurysm, aortic angioplasty with valve replacement, ruptured postcoarctation aneurysm, and type A dissecting aortic aneurysm. All 4 patients were managed successfully and remain free from infection 11 to 42 months later. Based on this experience, several guidelines useful in the management of these infections have evolved: (1) prompt reoperation with complete debridement of infected and necrotic tissue, (2) removal of infected prosthetic material if suture lines are involved, (3) local antiseptic irrigation and appropriate, specific systemic antibiotics, (4) rerouting of blood flow through clean operative fields, and (5) use of pedicle flaps.

Utilization of the Extensor Retinaculum in the Radiocarpal Joint of Rheumatoid Wrists

Synovectomy and debridement were combined with use of pedicled flaps of the extensor retinaculum as interposition material in the radiocarpal joint to cover the eroded articular surfaces of the radius and ulna in rheumatoid wrists. The technique was devised for the purpose of preventing postoperative osseous ankylosis of the radiocarpal joint. Results were satisfactory in 13 of 17 wrists operated on during the period from 1974 to 1979 and followed up for 38 to 84 months (average, 61 months).

Partial reconstruction of the lower eyelid

Reconstruction of the lower eyelid after a full-thickness loss can be accomplished with flaps and free grafts. Results of the use of pedicle flaps from the upper eyelid to rebuild the lower eyelid are described.

Open fractures of the shaft of the tibia: analysis of wound and fracture treatment

Cooperation between orthopaedic and plastic surgeons is an important factor in the treatment of open fractures. In this article a report is made on a retrospective study of a 5-year series of open fractures of the shaft of the tibia treated at the University Hospital in Uppsala between 1972 and 1976. The study proves that the change to external fixation of these fractures and 'open' treatment of the wounds has meant that to a large extent the previous use of pedicle flaps to cover skin defects has been replaced by split skin grafts. The results in the reported series were good, with adequate function in most cases. The final results may, however, be less good than they appeared at this early review time.

THE WHEELER METHOD FOR CORRECTION OF CICATRICIAL ECTROPION.

There is no question in the writer's mind, and most ophthalmic plastic surgeons will agree, that Wheeler's 1 method of correcting cicatricial ectropion by the use of free skin grafts and lid adhesions is unsurpassed by any other method. Almost without exception there is no place for the use of pedicle flaps, Gillies' 2 epithelial outlay, or Brown's 3 modification of the latter, for this condition. Correction of cicatricial ectropion by Wheeler's method will give great satisfaction to surgeon and patient if his technique is closely followed. It is not a difficult operation and can be performed by the average ophthalmic surgeon with good result. The initial skin incision is made about 5 mm from the eyelid margin and parallel to it. This extends the length of the involved area. Badly scarred skin should be excised (Case 2). The skin should not be undermined toward the lid border, but usually

A Cured Case of Radiation Ulcer

A case of 71 years old male suffering from radiation ulcer in the anterior cervical region after laryngectomy was reported. In this case, a skin grafting by use of pedicle flap from lateral neck after complete resection of pathological tissue around the ulcer was performed to effect.

Use of pedicle flaps of skin for closure of perianal and sacral defects.

Chronic ulcerations and portions of actinodermatitis near and around the anus sometimes require pedicle flaps of skin for repair. The types of flaps which offer the most satisfactory results for this purpose have been described.

Treatment of pilonidal cyst and sinus.

AGREAT diversity of procedures continue to be recommended for the cure of pilonidal cyst and sinus. Although differing in technical details, it is reassuring to note that there has been a trend away from the more complicated types of operations which involve transposition of muscle bundles and the use of pedicle flaps. As we view our attempts to successfully excise a relatively small cyst and allowing for the unusual contours of the pilonidal region, it is little short of amazing that the results have been so unsatisfactory, even when a sinus is present and a lowgrade infection complicates the picture. In other parts of the body presenting a similar problem, nothing other than a permanent good result would be expected. However, one can readily visualize healing problems in any area where a large segment of tissue has been excised and closure is associated with tension on wound edges. Earlier ideas

Practical procedures for the correction of scar contractures of the hand

1.1. All incisions, suture lines and skin graft edges on hand and finger surfaces must be calculated so that they will fall either transversely or obliquely across the longitudinal axis.2.2. Free full-thickness skin grafts give the best surface-bearing qualities and maximum degree of elasticity on flexor surfaces. Thick split-thickness grafts provide adequate covering for extensor surface defects and are preferred in this area because of the simpler technic associated with their use.3.3. The use of pedicle flaps is reserved for those instances in which it is necessary to carry subcutaneous fat with the skin grafts. This condition arises primarily in covering exposed tendons, bone or joints, or when it is planned to re-elevate the graft at a future date for the purpose of carrying out subsequent tendon, bone or joint surgery.4.4. When adequate skin and subcutaneous tissue is found in the border flaps after removal of a contracting scar, the use of the Z-plasty will frequently give rise to the most ideal final result.

“Hits, Strikes and Outs” in the Use of Pedicle Flaps for Nasal Restoration or Correction

“Hits, Strikes and Outs” in the Use of Pedicle Flaps for Nasal Restoration or Correction

Two Cases Illustrating Use of Pedicle Flaps

Two Cases Illustrating Use of Pedicle Flaps