V-shaped Flap Research Articles

Improvement of 1-Stage Comprehensive Operation Technique for Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome.

This retrospective case series presents the clinical results of a modified 1-stage comprehensive surgical method for blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). A total of 25 patients with BPES underwent a modified reverse Z-plastic surgery method to bisect the epicanthus into 2 unequal V-shaped flaps and suture them alternately. The medial canthus ligament was partially incised, shortened, and sutured; the outer canthus was opened with a V-Y flap. The gray line of the outer canthus was cut to extend the eyelid margin length. Ptosis was corrected using the orbicularis oculi-frontalis composite flap technique. We studied the inner intercanthal distance (IICD), interpupillary distance (IPD), horizontal palpebral fissure length (HPFL), marginal reflex distance 1 (MRD-1), IICD/IPD ratio, IICD/HPFL ratio, Vancouver Scar Scale, and overall postoperative satisfaction. The 25 patients included 12 girls and 13 boys (mean age, 8.3 ± 6.8 years), 19 of whom had a family history of BPES. The mean IPD value was 50.15 ± 7.43 mm. IICD decreased from 39.38 ± 2.39 mm preoperatively to 31.64 ± 2.37 mm postoperatively, IICD/IPD from 0.8 ± 0.1 preoperatively to 0.6 ± 0.1 postoperatively ( P < 0.05), and IICD/HPFL from 1.98 ± 0.33 preoperatively to 1.22 ± 0.10 postoperatively ( P < 0.01). HPFL increased from 20.08 ± 3.53 mm preoperatively to 26.04 ± 1.36 mm postoperatively ( P < 0.01), and MRD-1 from -1.12 ± 0.71 mm preoperatively to 3.24 ± 0.47 mm postoperatively ( P < 0.01). The postoperative Vancouver Scar Scale score was 3.68 ± 1.07. Patient satisfaction was rated as 8.8 ± 1.08, with a relatively high overall satisfaction rate. The corrective effect on BPES was noticeable, improving the IICD/HPFL and IICD/IPD ratios. Postoperative scars were not evident, and patient satisfaction was high. Therapeutic, IV.

Standard and modified glabellar flap for medial canthus reconstruction following mass removal in three dogs and two cats

To describe the surgical technique and clinical outcomes of the glabellar flap and its modification for the reconstruction of the medial canthus following resection of tumors in three dogs and two cats. Three dogs (7-, 7-, and 12.5-year-old mixed breeds) and two cats (10- and 14-year-old Domestic shorthair) presented with a 7-13 mm tumor affecting the eyelid and/or conjunctiva in the medial canthal region. Following en bloc mass excision, an inverted V-shaped skin incision was made in the glabellar region (i.e., the area between the eyebrows in humans). The apex of the inverted V-shaped flap was rotated in three cases, whereas a horizontal sliding movement was performed in the other two cases to better cover the surgical wound. The surgical flap was then trimmed to fit the surgical wound and sutured in place in two layers (subcutaneous and cutaneous). Tumors were diagnosed as mast cell tumors (n= 3), amelanotic conjunctival melanoma (n= 1),andapocrine ductal adenoma (n= 1). No recurrence was noted in a follow-up time of 146 ± 84 days. Satisfactory cosmetic outcome with normal eyelids closure was achieved in all cases. Mild trichiasis was present in all patients and mild epiphora was noted in 2/5 patients, but there were no associated clinical signs such as discomfort or keratitis. The glabellar flap was easy to perform and provided a good outcome in terms of cosmetic, eyelid function, and corneal health. Postoperative complications from trichiasis appear to be minimized by the presence of the third eyelid in this region.

V-shaped Folded Nasolabial Flap in the Repair of the Anterior Buccal Mucosal Defect.

To investigate the efficacy of V-shaped folded nasolabial flap in the repair of small-sized and medium-sized defects of the anterior buccal mucosa. From March 2019 to December 2021, 9 cases of male patients with anterior buccal mucosal lesions were enrolled in this study. After the lesions were completely excised, the mucosa and part of the buccal mucosal defect were left. A transverse V-shaped folded nasolabial flap was created with the pedicle located at the corner of the mouth and the long axis along the nasolabial fold. The lower part was lifted from the end to the pedicle. Next, from the level of the superficial musculo-aponeurotic system, the upper and lower parts were lifted from the end to the pedicle, and the V-shaped flap was folded and turned over through the buccal tunnel to repair the mucosal defect. The extraoral donor site was directly pulled and sutured. The nasolabial flap survived in 9 patients, and the wounds inside and outside the mouth healed at stage I. The postoperative follow-up time was 4 to 32 months, and the patients had no recurrence, with symmetrical buccal shape, and no traction and deformation in the affected buccal organs. In addition, the linear scar had no obvious hyperplasia and was hidden in the affected nasolabial folds, without symptoms of buccal nerve injury, and the shape of the corner of the mouth was normal. The width and opening degree of oral fissure were not significantly reduced compared with those before operation. Meanwhile, the intraoral flap was thin and flat, and healed well with the surrounding mucosa, without obvious flap contracture, buccal bite, or incomplete closure. Overall, V-shaped folded nasolabial flap has the advantages of flexible design, simple preparation, reliable blood supply, and protection of the donor site, which may be one of the effective methods for repairing small-sized and medium-sized defects in the anterior buccal mucosa.

A New Technique for Correction of Fibrous Pollybeak Deformity Using a Rotational V-Shaped Flap in Secondary Rhinoplasty

Pollybeak deformity is a postoperative nasal deformity. This occurs when the lower third of the dorsum is more projected than the tip. Several etiologies due to primary and secondary rhinoplasty have been described in the literature. Some of these are preventable, while others are postoperative. We designed a convenient technique to correct fibrous pollybeak deformities presented in revision surgeries. The procedure is performed under tumescent local anesthesia. An open technique was used to expose the supratip deformity. A flap is designed and elevated anatomically from the supratip area and then divided into 2 halves, resulting in a forked flap joined at the vertex resembling a “V.” Then both flaps are overlapped to project the tip to the desired position. The V-shaped flap is fixed in its position by simple sutures to the underlying cartilage. A significant improvement in correcting fibrous supratip deformity was noted in postoperative evaluation. All our patients were satisfied with the result and healed uneventfully with no significant complications. This alternative technique is simple and practical for correction of fibrous pollybeak deformity over traditional techniques. The V-shaped flap can be addressed with 1 maneuver, both the pollybeak deformity and the nasal tip projection.

Complex Patellofemoral Reconstruction for Recurrent Instability

Background: Patellofemoral instability is due to a combination of bony and soft tissue factors. While recurrent patellar dislocations are rare, evaluation and treatment of these conditions require addressing patellar height and lateralization of the tibial tubercle (TT), restraint to lateral patellar subluxation, and trochlear dysplasia. Other factors to consider are coronal limb-length alignment outside of the physiologic 5 to 8° of valgus, which may significantly alter the Q angle and contribute to lateral instability. Other ligaments around the patella contribute to soft-tissue restraint, including the medial and lateral patellotibial ligaments, patellomeniscal ligaments, and the medial quadriceps tendon femoral ligament. Patellar tilt is assessed with and without quadriceps contraction to further evaluate the patella’s relationship to the trochlear groove. The Caton-Deschamps Index, as well as patellar trochlear index (PTI), are used to measure patellar height for patella alta or baja. Technique Description: The technique is to surgically manage a patient in neutral mechanical alignment on standing limb radiographs, with moderate-to-severe DeJour type B trochlear dysplasia and a trochlear sulcus angle of around 145°, patella alta with a Caton-Deschamps Index of 1.6 and PTI of 0.22, a TT to trochlear groove (TT-TG) distance of 8 mm, and a deficient medial patellofemoral ligament (MPFL). The MPFL reconstruction is done first, with harvesting of the ipsilateral quadriceps tendon and maintenance of its distal attachment on the superior patellar pole. The quadriceps tendon graft is folded medially upon its distal attachment and fixed in this position with suture anchors. Tibial tubercle osteotomy is accomplished by spacing drill holes 2 mm apart, medially and laterally, on the TT and connecting the drill holes with an osteotome and reciprocating saw. A distalized location to secure the TT is selected and superficial bone is excised. A medial parapatellar arthrotomy is performed, and bur attachments are used to drill into the subchondral bone beneath the femoral articular surface to create a V-shaped flap of trochlear cartilage. An arthroscope is inserted under the trochlear flap during this process to visualize the appropriate depth. The trochlear flap is then secured with screws passed over guide pins to secure the flap to the desired location. Cannulated screws and washers are then used to secure the TT to its distalized and/or medialized position, with fluoroscopic verification of screw depth and location. The arthrotomy is then closed with the knee at 45°. The quadriceps graft is passed through a subretinacular channel and secured with suture anchors, adjacent to the adductor tubercle, to complete the MPFL reconstruction. Before closure, appropriate tracking and translation of the patella is verified. Results: Sulcus-deepening trochleoplasty, with or without MPFL reconstruction, has been reported to obtain satisfactory outcomes at 2 years, with close to 85% return to sport and 100% return to work, with improvements in International Knee Documentation Committee (IKDC) scores from 50.8 to 79.1 in some studies. MPFL reconstruction with tibial tubercle osteotomy (TTO) has yielded a 94.5% patient satisfaction rate in the literature. Discussion/Conclusion: In patients with recurrent patellar instability and DeJour types B-D trochlear dysplasia, MPFL reconstruction with TTO and sulcus-deepening trochleoplasty provides excellent subjective outcomes and restores patellar tracking with elimination of recurrent subluxation.

Correction of alar rim protrusion after direct closure of small alar defects

The tip and alar subunits are the challenging regions in dermatologic surgery. We read with interest the surgical pearl by Castiñeiras-González et al1 describing a V-shaped flap for reconstruction of supra-alar groove defects and found it very useful.

V-Y advancement flap to correct a perineal defect after an episiotomy dehiscence.

Episiotomy scar may be the site of complications and result in wound dehiscence in the long term. The aim of this video article was to describe the surgical steps required to repair a right perineal defect after episiotomy using a V-Y advancement flap. Our patient had an episiotomy dehiscence that had already benefited from an end-to-end repair, but the perineal defect recurred. A V-Y advancement flap was performed. The first step of this surgery was to remove the episiotomy scar. A V-shaped flap was then created to fill the perineal defect. Upon advancement, the V flap was transformed in a Y shape and secured using tension-free absorbable sutures. There was no flap necrosis, and the esthetic result was satisfactory.

Long V-Y advancement technique for large nipple reconstruction in Asian women.

Previously reported nipple-areolar complex reconstruction (NAR) methods involve multiple incisions and wide skin redraping, which increase retraction forces and heighten the risk of nipple-areolar complex (NAC) flattening. We introduce a NAR method using the long V-Y advancement technique that can overcome these disadvantages. A V-shaped flap is designed with the width of the flap base 4–5 mm larger than the diameter of the normal nipple. The flap length is designed to be at least 2.5 times its width. Dissection is performed to the top of the artificial dermal matrix or muscle layer. The nipple is constructed with the same projection as the contralateral side by folding the elevated flap. The tip of the elevated flap is apposed in the middle of the donor defect to minimize the deformity during donor site closure. A 3-point skin suture is applied to the upper third of the folded flap to mold its shape. Using this long V-Y advancement technique, we successfully decreased skin tension in NAC flaps and improved the maintenance of reconstructed nipple projection. The long V-Y advancement technique provides an easy, simple NAR method, effectively maintaining longer nipple projections and reducing breast deformities, especially in Asian women with relatively large nipples.

Distal humerus dual plating with triceps tongue technique: A case series

Background: Fixation of intra-articular distal humerus fractures has remained a challenge to orthopaedic surgeons due to complicated anatomy of elbow, comminution at fracture site and osteopenia of articular surfaces. We aimed to evaluate the functional outcomes and complications after dual plating for distal humerus fractures with triceps tongue technique. Material and methods: We conducted a retrospective study which consisted of 20 cases of distal humerus fracture with intraarticular extension and treated with open reduction and internal fixation with dual column plating using triceps tongue technique. Triceps Tongue approach allows exposure of distal humerus articular surface by forming an inverted V-shaped flap of distal triceps at the musculotendinous junction. Results: Union was achieved in all cases. Mean time of fracture union was 12.55±1.82 weeks. There was no case of non-union although elbow stiffness occurred in one patient. The mean MEPS score was 84.45±8.18 with a range of 70-96. Conclusion: Triceps Tongue approach is a simple and less technically demanding approach for the surgeon that can be used in management of the majority of the distal humeral fractures, giving adequate exposure of the surgical field, aiding in proper reduction of fracture fragments and thus obviating the need for an olecranon osteotomy.

Comparative Evaluation of Suture Versus Sutureless Surgery in Mandibular Third Molar Impactions.

The purpose of this study is to compare the suture versus sutureless surgery in impacted mandibular third molar and to evaluate the morbidity and complications associated with each technique. A total of 50 patients with asymptomatic impacted mandibular third molars were randomly divided into two groups of 25 patients each. Radiographs were taken to assess the angulation and degree of eruption in the third molar. A small modified Szmyd, V-shaped flap was raised in all cases, and teeth were extracted. In Group I-Suture group (suture was used to close the flap), and in Group II-Sutureless group (no suture used to close the flap). The post-operative pain, swelling, trismus, haemorrhage, periodontal pocket, and alveolar osteitis were evaluated at 24h, 48h, 5th days, 7th days, and 2weeks after surgery. The statistical analysis was done using the Chi-square "t" test and Independent Samples "t" test. Pain, swelling, and trismus were found to be significantly reduced especially in the immediate post-operative period in the sutureless group as compared to the suture group (p < 0.001). There were no incidences of intra-operative and post-operative haemorrhage in any case. Follow-up of all the patients showed that there was no difference in periodontal sequelae and alveolar osteitis. Sutureless surgery with small flap was found to be less invasive, time-saving, and also a cost-effective method. This technique significantly reduced the early crucial phase of patient discomfort and demonstrates good results.

Aesthetic reconstruction of localized periurethral cancer defects: a case report

Although several techniques of vulvar reconstruction have been reported, the aesthetic repair of localized periurethral defects has not been investigated yet. A 60-year-old woman presented with a neoplasm located on the right side 1–2 mm from the urethral meatus. A radical wide local excision was performed with the resection of the distal part of the urethra. The urethral meatus was reconstructed by the mobilization of the anterior and lateral vaginal mucosa. The vulvar defect was repaired by the advancement of the two bilateral V-shaped local flaps harvested at the level of labia majora. The present case emphasizes the importance of tailoring reconstructive options for vulvar reconstruction to provide aesthetically appealing results, to prevent or restore organ function and to reduce disease and treatment-related morbidity. Level of evidence: Level V, therapeutic study.

V-shaped flap reconstruction for a supra-alar groove defect

V-shaped flap reconstruction for a supra-alar groove defect

Application of modified keystone flap in repairing of skin and soft tissue defect around joint

To explore the effectiveness of keystone flap in repairing skin and soft tissue defects around joint. Between March 2013 and December 2017, 10 patients of skin and soft tissue defects around the joint were repaired with keystone flaps. There were 6 males and 4 females. The age ranged from 17 to 72 years, with an average age of 57.5 years. The skin and soft tissue defects located around the joints, including 2 cases of hip joints, 4 cases of knee joints, 3 cases of elbow joints, and 1 case of wrist joint. The cause of skin and soft tissue defects included scar contracture in 3 cases, basal cell carcinoma in 3 cases, squamous-cell carcinoma in 3 cases, and dermatofibrosarcoma protuberant in 1 case. The area of defects ranged from 4 cm×3 cm to 11 cm×11 cm. The keystone flap was designed beside the wound, and the V-shaped flap was designed at the longer side of the fan-shaped flap. The area of flap ranged from 7 cm×3 cm to 35 cm×10 cm. The flap was constantly compressed by vacuum assisted closure after operation for 3-6 days. Primary wound healing was achieved and the flaps survived. All patients were followed up 6-24 months (mean, 15 months). The texture and color of flap was similar to the adjacent area. The appearance and function of joint were satisfactory. The keystone flap is a feasible and efficient way to repair the wound around joint. Furthermore, the skin color and texture is similar to the surrounding tissue after healing.

Reconstruction of a Traumatic Cleft Earlobe Using a Combination of the Inverted V-Shaped Excision Technique and Vertical Mattress Suture Method.

Traumatic cleft earlobes are a common problem encountered by plastic and reconstructive surgeons. Various techniques have been reported for the repair of traumatic cleft earlobes. Usually, the techniques of split earlobe repair are divided into two categories, namely straight- and broken-line repairs. Straight-line repair is simple and easy, but scar contracture frequently results in notching of the inferior border of the lobule. It can be avoided by the broken-line repair such as Z-plasty, L-plasty, or a V-shaped flap. Between April 2016 and February 2017, six patients who presented with traumatic cleft earlobe underwent surgical correction using a combination of the inverted V-shaped excision technique and vertical mattress suture method. All the patients were female and had a unilateral complete cleft earlobe. No postoperative notching of the inferior border the lobule occurred during 6–16 months of follow-up. Without the use of a broken-line repair, both the patients and the operators attained aesthetically satisfactory results. Therefore, the combination of the inverted V-shaped excision technique and vertical mattress suture method is considered useful in the treatment of traumatic cleft earlobes.

The V-shaped mini flap method for microform cleft lip repair

Background We have devised a new operative technique for microform cleft lip repair via the use of a V-shaped flap method. From 2006 to 2015, nine patients with unilateral cleft lip diagnosed as mini-microform cleft lip or microform cleft lip by the classification of Yuzuriha and Mulliken, were recorded.

The V-Plasty: A Novel Microsurgical Technique for Anastomosis of Vessels with Marked Size Discrepancy.

The art of reconstructive microsurgery is still progressing after Carrel's original description of "vascular repair" in 1902. Reports of the successful repair of vessels smaller than 1 mm in diameter are currently commonplace. However, the technique of microvascular anastomosis to connect vessels with large diameter discrepancy, greater than 1 mm, has not yet been perfected. This article reports a novel option to anastomose two vessels of different sizes by adapting the diameters of the two stumps and creating a gentle slope that dramatically reduces turbulences in the blood stream. The "V-plasty" consists in designing a v-shaped flap on the wall of the large vessel and a longitudinal incision on the small one. The V-flap is then introduced into the V-defect of the small vessel, creating a smooth transition of the diameters between the two vessels. Mathematical calculation of the dimensions of the V-flap was conducted with different ratios' discrepancies of the two vessels ranging from 1.5 to 4. Clinically, 14 microvascular V-plasty were performed in 8 patients. The theoretical simulation and our clinical experience of 14 cases allowed us to propose the different dimensions (length and width) of the V-plasty according to the ratio of vessels discrepancies. The V-plasty microanastomosis is an alternative method to attach vessels with size discrepancy. It simply equalizes the donor and recipient vessels' diameters. Its main advantage is to maintain a linear axis between the two vessels whatever the discrepancy ratio is.

Management of type C distal humeral fracture using Von Gorder approach

Introduction: Exposure of articular fragments is a key factor to achieve accurate anatomical reduction in distal humeral fractures. Olecranon osteotomy is considered as gold standard for these fractures. Von Gorder's approach allows exposure of articular surface by forming an inverted V-shaped flap of distal tricep in the distal humeral fracture. We evaluated the functional outcome in the management of distal humeral fractures treated by open reduction and internal fixation by Von Gorder's approach. Method and Material: Total 22 patients with AO Type C distal humeral fracture were taken, C1 include 11, C2 includes 5 and rest 6 were C3 type. All patients were managed by open reduction and internal fixation through Von Gorder approach. Out of 22 bicolumnar fracture,19 were by recon plate and dynamic compression plate while 3 fractures were fixed by pre-contoured locking plates. Cases were followed up clinically as well as radiologically. Functional outcomes of patient were accessed in terms of Mayo Elbow Performance score (MEPS). Results: All patients had shown radiological union at an average 12.4 weeks, 17 (77%) patients had shown good to excellent score, 4 patients (18%) had fair outcome while 1 (4%) had poor outcome Mean MEPS score at final recent follow-up was 87. No patient had loss of rotatory motion although 86% patients had loss of terminal range of flexion/extension as compared to the normal side but their functional range of movement was good. The range of flexion was 123.0° (range 90°-135°), range of extension was 7° (range 0°-13°). Conclusion: Tricep Reflecting approach can be used in management of most of the distal humeral fractures as it provides adequate visualization and reduction however fractures having communition of trochlea and fractures involving anterior capitellum should not be attempt with this approach.

Simultaneous correction of deviated columella and wide nostril floor using the Y–V advancement in unilateral cleft lip nasal deformities

Here, we describe an operative method for the simultaneous correction of deviated columella and wide nostril floor in unilateral cleft lip nasal deformities. The V-shaped flap of the affected nostril floor was inserted into the side wall of the columella using the Y-V advancement. By suturing the anterocaudal septum, which is often deviated to the unaffected side, with the subcutaneous tissue of the affected alar base, it was possible to simultaneously reposition the columellar base in the midline as well as narrow the wide nostril floor. This method was technically simple, with low invasiveness for the septal cartilage. Furthermore, as noted in one of the two cases described, it would enable the reconstruction of the natural shape of the nostril sill.

A New Umbilical Reconstruction Technique Used for 306 Consecutive Abdominoplasties

The search for a natural-appearing umbilicus that does not compromise the aesthetic outcome of abdominoplasty began in the 1950s and coincides with the period that saw increasing exposure of the female body. Since then, umbilical transposition has been favored by most surgeons. This report describes a new technique for umbilical reconstruction using a small X-shaped incision that creates four V-shaped flaps, which are sutured to the aponeurosis with absorbable sutures. This technique was used for 306 consecutive abdominoplasty patients, and a survey was performed to determine their level of satisfaction with the surgical outcome. A natural-appearing new umbilicus was created with no visible scars, a low complication rate (9 %), and a high level of patient satisfaction. The described technique had a low complication rate and allowed the creation of a new umbilicus with a natural appearance in a rapid, safe, and simple manner. This journal requires that authors assign a level of evidence to each article.

Cryptotia correction – the post-auricular transposition flap

Cryptotia is a congenital ear deformity in which the upper pole appears buried beneath mastoid skin. Here we describe our method of cryptotia correction which we have used to good effect with minimal complications. 20 patients and 24 ears were operated on. All surgery was performed by the senior authors WS and DG. Patient age range was 4-19 years and mean follow up was 2.1 years. We use a superiorly based V-shaped flap raised from the post-auricular skin. Following ear release, the flap is rotated into the defect and donor site closed directly. Our technique ensures all scars are hidden behind the ear, there are no skin grafts required. All patients had a satisfactory release of cryptotia, there were no cases of partial or total flap failure, none of wound dehiscence and no patients required revisional surgery. The post-auricular flap is a simple technique, retaining the depth of the auriculotemporal sulcus, providing a good skin colour match without the need for skin grafting and without distorting the hair line. Our results are comparable or superior to those seen with other techniques previously described.