Use Of Regional Flaps Research Articles

VERSATILITY OF PERFORATOR-BASED PROPELLER FLAP IN RECONSTRUCTION OF VOLAR ASPECT OF DISTAL FOREARM, DISTAL LEG & ANKLE DEFECTS - A RETROSPECTIVE ANALYSIS

Background: The use of regional flaps based on perforator arteries is generating more interest in limb reconstruction surgery. The surgical approach allows for the restoration of soft tissue lesions using neighboring homologous tissues without the need for microvascular anastomosis. The aim of the study was to evaluate the clinical results of local perforator flaps in the treatment of complex lower limb and upper limb defects. Materials and Methods:Fourteen patients (six upper limb and eight lower limb defects) underwent reconstruction using perforator-based flaps which were studied retrospectively during a three-year period. Donor sites were examined thoroughly and flaps selection was done using a handheld manual Doppler mapping preoperatively, to locate the perforator vessels and their flow. Thereby, perforator-based propeller flaps were raised and used for defect coverage based on their maximum arc of rotation. Results:Postoperatively, all the flaps included in the study survived. Partial flap necrosis and venous congestion in the flap were reported in two patients following intervention. Donor site morbidity was minimal without any loss of function. Most of the patients were satisfied with the aesthetic outcome. Conclusion:Perforator flaps using hand held Doppler are the most yielding, simple and safe flaps for the Reconstructive Surgeons. The need for the complicated microsurgical procedures can be avoided with the use of such locoregional propeller flaps which providedbetter aesthetic results with minimal donor site morbidity.

HEAD AND NECK RECONSTRUCTION WITH MAJOR REGIONAL FLAPS; WHAT THE COVID-19 PANDEMIC TAUGHT US

Objectives The aim of this study was to record the patients with advanced head and neck cancer who received a major regional flap for reconstruction in the COVID-19 pandemic period. Materials and Methods The surgical registry of a single centre was retrospectively searched for identification of patients who met the inclusion criteria of receiving a major regional flap for head and neck reconstruction, after resection of a locally advanced tumour, during the COVID-19 pandemic. The period recorded on this study as March 2020 to February 2021. All data available were recorded (tumour type, staging, operation, reconstruction) as well as post-operative follow up until up to date. Results 10 patients met the inclusion criteria. Mean age was 71.9 years old. 6 patients were newly diagnosed patients, whereas 4 were patients with recurrence. As far as staging is concerned, all had stage IV cancers, whereas 6 patients had T4 tumours, 2 T3 and 2 Tx. The latter 2 concern a patient with an occult neck mass of unknown origin and a patient with parotid adenocarcinoma. 4 patients were reconstructed with pectoralis major flap, 4 patients with cervicothoracic flaps, 1 with cervicofacial flap and 1 with deltopectoral flap. All immediate post-operative periods were uneventful but one, who presented a localized hematoma which required drainage. 5 patients appeared with a recurrence in the follow-up period of the first year and did not survive. The rest are surviving disease free with a mean follow-up period of 1.5 years. Conclusion Major regional flaps remain a valid alternative for head and neck reconstruction in patients with advanced head and neck cancer. The COVID-19 pandemic reduced the available human and technical resources for other types of flap reconstructions, forcing the use of regional flaps as the treatment of choice for advanced patients.

The Use of Regional Flaps for the Repair of Synovio-Cutaneous Fistulas of the Shoulder after Attempted Rotator Cuff Repair: A Report of Two Cases

Context: The treatment of rotator cuff tears has become one of the most common orthopaedic sports procedures. The development of a synovio-cutaneous fistula is a rare, but serious, complication that has been described after rotator cuff repair. The purpose of this report is to present the local rotational flap as a treatment option for synovio-cutaneous fistulas of the shoulder and to emphasize the importance of recognizing when primary closure may not be sufficient for adequate repair. Case Reports: A 67-year-old male who previously underwent a right rotator cuff and a biceps tendon repair presented with a persistently draining shoulder fistula. The decision was made to proceed with extensive debridement and closure using vascularized tissue. A 63-year-old male presented for a postoperative wound complication following attempted open debridement of a left torn rotator cuff. The wound was initially managed conservatively, but a persistently draining fistula necessitated the use of vascularized tissue for closure of the wound. The recovery of both patients was uneventful with no recurrent fistula formation. Both patients had improved shoulder range of motion following surgery and resolution of their pain. Conclusions: The excessive tension placed on the rotator cuff tendons and deltoid during repair and the resultant inflammation may contribute to tissue necrosis and facial dehiscence over the glen humeral joint, allowing for fistula formation. Surgeons should be aware that when adequate soft tissue coverage cannot be accomplished over the glen humeral joint via primary closure, there are local flaps available to provide complete coverage over the joint.

Surgical treatment of low rectal cancers with APER and IGAP flap.

This article describes current treatments for individuals with a low rectal cancer. It examines the rationale for surgical treatment involving abdominoperineal excision of the anus and rectum (APER) and outlines how surgery for rectal cancer has evolved over recent years. Surgical advances mean the use of regional flaps is advocated to overcome the common problem of impaired perineal wound healing and the principles of this surgery are summarised. Postoperative nursing considerations relating to the inferior gluteal artery perforator (IGAP) flap will be discussed, as well as the importance of scrupulous wound care and patient education. The implications of this form of surgery on a patient's recovery and discharge planning are also explored.

Regional flaps: a move to simpler reconstructive options in the head and neck.

The use of regional flaps in head and neck reconstruction is experiencing a resurgence. This review surveys the growing body of clinical evidence supporting these techniques. The supraclavicular flap and submental island flap are two regional flaps that provide thin pliable tissue for head and neck reconstruction. The submental island flap has been demonstrated to be oncologically safe in the setting of oral cavity malignancy in patients without clinical level I disease. For moderate mucosal defects, the facial artery myomucosal flap and palatal island flap provide regional options for reconstruction with minimal donor-site morbidity. The pectoralis major and latissimus dorsi flap remain excellent options in patients medically unsuitable for a free flap, salvage reconstructions, vessel depleted necks and when the defect is able to accommodate the bulk of the flap. Regional flaps continue to evolve and remain an integral part of a reconstructive surgeon's armamentarium. A working knowledge of these techniques is integral to maximizing outcomes for head and neck reconstructions, while minimizing morbidities and cost.

The Surgical Treatment of Irradiated Wounds: A Report on 36 Patients

Radiation therapy, although a useful modality for cancer therapy, injures the surrounding uninvolved tissues. Although surgery is often necessary for non-healing ulcers, surgery of irradiated wounds is recognized as challenging. In this study, we evaluate the outcomes and complications of patients who underwent surgical treatment of irradiated wounds. We reviewed 36 patients who underwent reconstructive surgery for irradiated wounds at our institution. A regional flap was applied in 17 patients, a local flap in 13 patients, a skin graft in 2 patients, and direct closure was performed in 4 patients. The complication rate was 65%, 69%, 50%, and 25%, respectively, and was not significantly different based on the type of reconstructive procedure used. Of the 30 patients who underwent flap reconstruction, 21 (70%) had flaps that included muscle and the remaining 9 patients (30%) had flaps that did not include muscle. The complication rate was 67% for both groups. Thus, the use of a muscle flap did not lead to superior outcomes. A radiation dose >60 Gy was correlated with a higher wound complication rate (p < 0.001). This study demonstrated that the use of regional flaps did not diminish the complication rate; moreover, contrary to previous reports, the use of muscle/musculocutaneous flaps did not reduce complications. Radiotherapy dose was the only factor associated with wound complications. Although reconstructive surgery of wounds irradiated with high-dose radiation was quite difficult, most of the irradiated wounds in our study were ultimately closed.

Contemporary skull base reconstruction.

Tumors of the skull base that would have been considered inoperable thirty or forty years ago are now routinely resected with reliable results due to the advancement of modern reconstructive techniques. High mortality rates were common prior to the use of vascularized tissue for skull base repair. However, the advent of local flap reconstruction for skull base defects in the 1960s revolutionized skull base surgery. The use of regional flaps in the 1970s and 1980s allowed skull base surgeons to perform more extensive surgeries, but complication rates were still quite high. Experience with free tissue reconstruction increased through the 1980s and 1990s and has become a reliable method to separate the intracranial from extracranial environments. Free tissue transfer has allowed surgeons to address the large volume defects created by extensive skull base resections and has provided dependable, vascularized tissue that is relatively resistant to adjuvant radiation. Local flaps have also become a powerful reconstructive tool in conjunction with free tissue transfer, and in some select cases, may be sufficient alone for reconstruction. The prevention of serious complications after skull surgery has improved with the use of vascularized tissue. Depending on the anatomic site, the extent of the defect, and the quality of local tissues, either free tissue transfer and/or local flap reconstruction is preferred. Regional flap reconstruction should be reserved for cases where alternative reconstructive techniques are not available.

A regional approach to reconstruction of the upper lip

This articles reviews the results obtained when cheek or lower lip flaps, or a combination of these flaps, are used for the reconstruction of defects of the upper lip. Twenty-four cases of either partial or total full-thickness defects of the upper lip were reconstructed. Four cases with lateral full-thickness partial defects were reconstructed by advancing a cheek flap using the Bernard-Burow method. In five cases, defects located at the junction of the upper lip and the cheek were reconstructed with an Estlander flap. Four patients with a tight upper lip were corrected with an Abbé flap. In two cases, a modified mucomuscular Abbé flap was used for reconstruction of a vermilion defect of the upper lip. Nine patients with subtotal or total full-thickness defects of the upper lip were reconstructed with a combination of bilateral or unilateral cheek flaps using either the Bernard-Burow or Dieffenback method and T-shaped or oblong Abbé flap. All regional flaps healed uneventfully, and the function of reconstructed upper lips had recovered within 2 years postoperatively. Use of regional flaps to reconstruct partial or total full-thickness defects of the upper lip can usually achieve satisfactory functional and esthetic results.

Irradiated mandibular autografts.

The cosmetic and functional disability associated with mandibular resection has been a major problem to the patient with direct invasion of the mandible by oral cancer. Marginal resections with combined postoperative radiation therapy have frequently been substituted for the more preferred segmental resections and resultant deformities. Presented are 15 cases of oral cavity cancer involving resection of the mandible, immediate radiation to 10,000 rad, and primary reconstruction as irradiated mandibular autografts. The longest following is 4 years and 3 months, with a success rate of 66%. Morbidity is minimal as compared to autogenous bone grafting. Tumor size, previous radiation, or use of regional flaps have not been a factor in the success of this method in reconstruction of the mandible primarily.

The use of regional flaps in head and neck surgery.

The use of regional flaps in head and neck surgery.