Vascularized Flap Research Articles

Vascularized bone flaps for trauma induced bone defects of the upper extremity in young adults: Presentation of two cases

Nonunions after complex upper extremity injury in young adults may result in diminished function, pain and decreased quality of life. The use of vascularized bone flaps is challenging. However, it offers the most bone healing stimulating properties in revision surgery. First, we describe the case of a young man with complex open wrist injury. He developed an osteoarthritis of the wrist, with abundant bone loss of the distal radius, ulna and carpal bones. He underwent wrist arthrodesis with the use of a vascularized iliac crest bone flap. Secondly, the case of a young woman is presented following a 4-part luxation fracture of the proximal humerus. She developed a nonunion with concomitant avascular necrosis. A reconstruction with plate fixation and a vascularized fibula flap was performed. In our cases, the use of vascularized autologous bone flaps resulted in union and a good clinical outcome. In literature, scarce evidence is present on the indications, procedure specifics, complications, clinical outcome, and patient related outcome measurements of the use of vascularized bone flaps for posttraumatic bone defects of the upper limb. This is likely due to the heterogeneity and scarcity of the patient population. The use of vascularized bone flaps is a viable treatment option for patients with complex nonunions of the upper extremity. • Impaired fracture healing of the upper extremity results in diminished functional outcome. • The use of vascularized bone flaps is an important option in revision surgery. • Vascularized fibula flaps and iliac crest flaps have good bone healing properties. • Osteoconductivity, osteoinductivity, osteogenicity and structural support determine the effectiveness of the graft.

Study of functional outcome of free flap reconstruction in oral cavity malignancies

<p class="abstract"><strong>Background: </strong>Oral cavity squamous cell carcinoma are likely to be associated with occult nodal metastasis at presentation so diagnosis is usually late when the disease has already reached an advanced stage, for this reason, neoplasm dimensions of clear margins needs be at least 1 cm around the tumour, which leads to large resections requiring reconstructive surgery with important functional outcomes. The aim can be achieved with the use of micro vascular free flaps that have replaced regional flaps to ensure better functional and aesthetic results.</p><p class="abstract"><strong>Methods:</strong> A total of 100 patients with oral cavity malignancies were assessed for the functional outcome of cosmoses, speech and swallowing and were compared for each flap using the Fischer’s test. Follow up was done at 3 and 6 months after completion of curative treatment.</p><p class="abstract"><strong>Results:</strong> The failure rate of free fibular flap was 48% which is higher than ALT (18%) and FRAFF (22%). Functional outcome of cosmetic (p=0.38), speech (p=0.58) and swallowing (p=0.10) with pedicle was not as good as free flap for cases of buccal mucosa after failure with free flap.</p><p class="abstract"><strong>Conclusions: </strong>In carcinoma of buccal mucosa and tongue free flaps offered better functional outcome in terms of cosmesis, speech and swallowing compared to pedicled flaps. </p><p> </p>

Histology and Vascular Architecture Study of Keloid Tissue to Outline the Possible Terminology of Keloid Skin Flaps.

Using the keloid "epidermis" to cover a wound is widely used during treatment for keloids. Many flap terminologies have been used in literature. However, the definition of the flap is not well established. Here, we refined the definition of the flap and associated terminology and explored the survival mechanism of the 'flap' through histological analysis and blood supply studying. Histology and vascular study of keloid was carried out with keloid and its surrounding normal skin tissue which were collected from keloid patients following keloid resection operations. The histological structures and thicknesses of epidermal and subepidermal of the keloids were analyzed and measured using hematoxylin & eosin (H&E) staining. Vascular density and blood perfusion in the subepidermal layer of keloids (KDS) were analyzed using CD31 immunohistochemical staining and a laser speckle contrast imaging system (LSCI), respectively. The vascular network in KDS was visualized by CD31 immunofluorescence staining and three-dimensional reconstruction. 29 pieces of keloid and its surrounding normal skin tissue sample from ten patients were collected. Keloid samples were about 2 cm wide and 5 cm long. The normal skin samples were about 2 to 3 mm in width. The thickness of epidermal layer of keloids was (136.4 ± 35.3) μm, and the thickness of epidermal layer of surrounding normal skin was (78.8 ± 13.9) μm. There was statistical thickness difference between the two layers, t(20) = 7.469, P < 0.001. The total thickness of keloid epidermal and subepidermal layers was 391.4 ± 2.3 μm. The vascular density (13.9 ± 3.4/field) and blood flow perfusion (132.7 ± 31.3) PU in KDS were greater than that of surrounding normal skin (7.8 ± 2.3/field, 73.9 ± 17.9 PU), P < 0.001. Horizontally distributed vessels with several vertical branches were observed in 3D vascular network reconstruction. The epidermal layer of keloid is thicker than that of surrounding normal skin. There is a vascular network structure under it. The vessels mainly locate at a depth of about 150 to 400 μm from the surface of keloid epidermis, randomly distribute and run parallel to the epidermis. Based on these characteristics which may ensure an adequate blood supply, we propose the concept of a "keloid subepidermal vascular network flap." This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical Observation of Subepidermal Vascular Network Flaps in Keloid Patients.

There are many different keloid treatment modalities. One surgical technique is to keep the "shell" of the keloid to cover the defect. We named this "shell" keloid subepidermal vascular network flap (KSVNF), and we outlined the characteristics of this flap by observing 35 flaps in keloid patients. A total of 35 KSVNFs were designed in 15 patients during 2020-2021. All patients underwent the operation and adjuvant radiotherapy as well as hyperbaric oxygen therapy. All flap lengths and widths were recorded, and the blood perfusion of the flaps was measured on the first day postoperation and the day of stitch removal. Flap survival and the quality of flaps were evaluated on the day of stitch removal. All harvested data were analyzed using the R (version 4.0.1) package. The mean blood perfusion on the first day postoperation (pod1) and the day of stitch removal was 120.4013 and 168.6900, respectively (p = 0.02249); 2 flaps had partial necrosis (5.714%). Receiver operating characteristic (ROC) curve analysis showed that when the length/width ratio was less than 1.05, the quality of the flap was good (AUC = 0.724), which suggests that the effective safe length/width ratio was 1.05. KSVNF is an applicable method for covering the remaining wound after keloid mass removal with sufficient blood perfusion and adequate skin quality. We recommend that the length/width ratio of the flap design not exceed 1. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Comparative Study of Analog Preoperative Planning Versus Virtual Preoperative Planning for Mandibular Reconstruction With Fibula Free Flap.

Mandibular reconstruction is a challenging procedure, especially in cancer patients with defects that are greater than 6 cm. Free vascularized fibular flap is the gold standard treatment in these cases since it allows three-dimensional restoration of the lost segments after ablative surgery in addition to providing the possibility of a subsequent implant-supported rehabilitation improving the functional and aesthetic outcomes of the surgery.To obtain accurate results, preoperative planning must be done with detail. Approaches for the preoperative planning include both the conventional analog planning and the virtual planning that are valid alternatives in meeting the trans-surgical requirements.This study makes a comparative analysis of 2 clinical cases with a diagnosis of squamous cell carcinoma that were reconstructed using a vascularized fibular free flap. The first case was planned using the conventional analog method whereas the second case was planned using the virtual planning approach.The impact of virtual planning and conventional analog planning on preoperative planning time, ischemia period, and total surgical time is analyzed according to the experience obtained in the cases presented. In addition, the authors described the technique used for each planning method along with a literature review in which the results are contrasted and discussed.

Features of the use of vascularized flaps for plastics of skull base defects after removal of meningoencephalocele in children

Basal meningoencephalocele is a rare pathology that occurs due to the prolapse of meninges and brain tissues through a bone defect in the skull base. Treatment of patients with this pathology consists in the removal of the meningoencephalocele, followed by plasty of the skull base defect. One of the ways to close defects of the skull base is to use vascularized flaps. Vascularized flaps are the method of choice of plastic material in adults, however, in pediatric practice, there is insufficient data on the effectiveness and safety of their use. Purpose: to assess the effectiveness and safety of the use of vascularized flaps in the removal of meningoencephalocele, as well as to clarify the indications for their use in pediatric practice Material and methods. A retrospective analysis of a series of patients with basal meningoencephalocele aged 0 to 18 years, operated from 2008 to 2020. Comparison of two groups, divided according to the types of methods used for plastics of skull base defects, has been carried out. Results. There was a statistically significant difference in the groups for the localization of defects (p = 0.048), complaints in the postoperative period for pain in the wound on the left hip (p &lt; 0.001). There was no statistically significant difference in the groups in terms of the size of the defect (p = 1), the frequency of using lumbar drainage (p = 0.141), the duration of surgery (p = 0.2), and blood loss (p = 0.248). Conclusions. Vascularized flaps are effective for plasty of the skull base defect in children in the removal of meningoencephalocele. The safety of using flaps intraoperatively and in the early postoperative period has been proved. The question of the long-term results and the influence of the formation of a vascularized flap on the structures of the facial skeleton remains unstudied. When planning the elimination of meningoencephalocele in children and the choice of plastic material, it is necessary to take into account the localization of the fistula.

Abstract WP261: Encephalomyosynangiosis Improves Angiogenesis And Recovery In Mice After Transient Ischemic Stroke

Background and Purpose: The ability of the brain to self-heal after stroke is limited by inadequate blood supply and acute inflammation. Hence, we hypothesized that improved blood supply via promoting neoangiogenesis will reduce acute inflammation and improve recovery after stroke. Encephalomyosynangiosis (EMS) is a neurosurgical procedure that achieves angiogenesis with low morbidity in patients with moyamoya disease, reducing risk of stroke. EMS has never been studied in ischemic stroke. Here, we developed a novel model of EMS after ischemic stroke induced by middle cerebral artery occlusion model (MCAo) in mice. We demonstrated that this novel EMS procedure can induce angiogenesis and improve recovery after stroke. Methods: After 60 minutes of MCAo, mice were randomized to MCAo or MCAo+EMS groups. After 3-4 hours, EMS was performed. In brief, EMS involves a craniotomy and placement of a vascular temporalis muscle flap on the pial surface of the ischemic brain. Mice were sacrificed at day 7 or 21 after MCAo. Viability of temporalis muscle was measured using a nicotinamide adenine dinucleotide reduced tetrazolium reductase assay. ARY015 Proteome Profiler Mouse Angiogenesis Array (R&amp;D Systems) was used to quantify angiogenic and neuromodulating protein expression. Immunohistochemistry was used to visualize immune infiltration by measuring F4/80 positive macrophages. Results: EMS after ischemic stroke did not increase mortality despite dual invasive surgery. Grafted temporalis muscle remained viable up to 21 days after EMS. We found a significant increase in FGF-acidic (0.677±0.007 vs. 0.585±0.014, p=0.045) and decrease in osteopontin (0.692±0.007 vs. 0.758±0.014, p=0.048) protein levels in the MCAo+EMS group 21 days after stroke, suggesting improved angiogenesis and recovery respectively. Mice in the MCAo+EMS group also showed reduced F4/80+ve macrophage accumulation in the peri-lesional territory of ischemic tissue, suggesting attenuated inflammation after stroke. Conclusions: These proof-of-concept data support that our novel EMS procedure is well-tolerated and may improve angiogenesis and recovery after stroke. EMS after MCAo is a promising new method of improving angiogenesis and recovery after stroke.

Double pedicled nasoseptal flap for skull base repair after endoscopic expanded endonasal approach.

Expanded endonasal approach offers a spectacular corridor for skull base tumour resection but requires reliable multilayer reconstruction techniques with a vascularized nasoseptal flap. On the basis on our substantial experience of 136 patients operated on between January 2008 and January 2020, the double pedicled nasoseptal flap technique was developed for skull base repair. The technique is finely detailed. The nasal floor mucosa was preserved. CSF leakage occurred in 4% of patients. Double pedicled nasoseptal flap is a reproducible and efficient technique for skull base reconstruction after expanded endonasal approach and is associated with limited rhinological complications.

Single-stage microsurgical reconstruction of large complex tissue defects of the lower extremities with two vascularized flaps

The purpose of this study was to explore the effectiveness of combined one-stage reconstruction of extensive complex defects of lower limb tissues and to analyze postoperative complications.Material and methods. The research involved 25 patients with bone and soft tissue defects of lower extremities. The first group included 16 patients, where the replacement of bone and soft-tissue defects of the lower leg was carried out with one complex bone-skin graft. The second group consisted of 9 patients who, along with major defects of the tibia, had concomitant extensive damage of soft tissues. To replace bone and soft-tissue limb defects, the autotransplantation technique of 2 free flaps, bone and soft-tissue (combined) was used.Results and discussion. In our study, we analyzed early and late postoperative complications, as well as the average time of fusion of the graft with the recipient bed and restoration time of the lower limb supportability. In the second group of patients, we did not observe any critical complications in the early postoperative period that would affect the results of patient`s treatment. The increase in the incidence of vascular complications is not statistically significant. In the late postoperative period (30 days or more), stress fractures of the fibular graft, traumatic fracture of the fibular graft, delayed consolidation of the graft ends with the recipient bone lasting more than 6 months were observed in both groups of patients. The incidence of these complications was comparable in both groups, there were no statistically significant differences. The average time of fusion of the graft with the recipient bed and the time of restoration of the lower limb supportability did not have statistically significant differences.Conclusion. One-stage reconstruction of extensive deep limb tissue defects by using an appropriate combination of two vascularized complex grafts (bone and soft tissue) provides a complete reconstruction of complex limb tissue defects without increasing the time of bone consolidation and the frequency of occurrence of critical complications in the postoperative period (total necrosis of vascularized flaps and deep wound infection process).

Lateral Circumflex Femoral Vascular Chimeric Fascia Flap Reduces Pain and Promotes Wound Healing in Repairing Skin and Tendon Defects of Hand, Foot, and Ankle.

The purpose of this study was to investigate the clinical efficacy of lateral circumflex femoral artery embedded with fascia lata flap in the repair of skin and tendon defects in hand, foot, and ankle. From January 2020 to June 2021, 32 patients with skin and tendon defects of the hand, foot, and ankle admitted to our hospital were selected as the study subjects. According to the random number table method, they were divided into the observation group (16 cases, treated with rotational lateral femoral vascular inlay broad fascial flap repair) and the control group (16 cases, treated with conventional skin flap repair) and followed up for 6 months. The postoperative tendon midactivity measurement scale (TAM), ankle-hindfoot scoring system (AOFAS), and lower limb functional evaluation scale (LEFS) scores were all higher in the observer group than in the control group The number of people with infection, implant necrosis, and subcutaneous hematoma in the observation group (total incidence 6.25%) was less (lower) than that in the control group (50.00%), and the total number of people with significant and fair clinical efficacy in the observation group (total effective rate 100.00%) was more (higher) than that in the control group (68.75%). The application of early plastic surgery to the clinical treatment of patients with deep burns on the hand can reduce the patient's pain and promote the healing of the wound. It is of great significance to reduce the risk of complications such as necrosis of the skin graft and improve the efficacy of the surgery.

First Clinical Application in Microsurgery of Vascular Anastomoses and Flap Transplantation Via a Portable NIR-II Imaging System with ICG

First Clinical Application in Microsurgery of Vascular Anastomoses and Flap Transplantation Via a Portable NIR-II Imaging System with ICG

Transcutaneous medial fixation sutures for free flap inset after robot-assisted nipple-sparing mastectomy.

The application of minimal invasive mastectomy has allowed surgeons to perform nipplesparing mastectomy via a shorter, inconspicuous incision under clear vision and with more precise hemostasis. However, it poses new challenges in microsurgical breast reconstruction, such as vascular anastomosis and flap insetting, which are considerably more difficult to perform through the shorter incision on the lateral breast border. We propose an innovative technique of transcutaneous medial fixation sutures to help in flap insetting and creating and maintaining the medial breast border. The sutures are placed after mastectomy and before flap transfer. Three 4-0 nylon suture loops are placed transcutaneously and into the pocket at the markings of the preferred lower medial border of the reconstructed breast. After microvascular anastomosis and temporary shaping of the flap on top of the mastectomy skin, the three corresponding points for the sutures are identified. The three nylon loops are then sutured to the dermis of the corresponding medial point of the flap. The flap is placed into the pocket by a simultaneous gentle pull on the three sutures and a combined lateral push. The stitches are then tied and buried after completion of flap inset.

Современные принципы эндоскопической трансназальной пластики дефектов основания черепа Обзор литературы

Cerebrospinal fluid (CSF) leak is an urgent problem of modern neurosurgery. In elective surgery, this condition is most commonly encountered in the removal of skull base tumors. The reconstruction stage is the final stage in the course of such operations and directly affects the postoperative period of the patient. Due to advances in technology, a number of techniques that allow for hermetic closure of the intracranial space have now been developed. The most significant was the introduction of vascularized flaps, which reduced the incidence of liquorrhea many times over. This paper presents the current trends in this section of neurosurgery.

Current trends in microsurgical education – review of types of training and skill assessment instruments

Microsurgery became an essential part of various specialties. Hand replantation, vascular free flap reconstruction, and cerebral bypasses are impossible to conduct without mastering microsurgical skills. Currently, the gold standard of microsurgical training is the course with living models during which participants perform basic microsurgical procedures under the supervision of an experienced tutor. However, due to high cost of training and ethical issues new training models, which reduce the usage of living animals, appeared. Widespread availability of personal digital technology has caused creation of new types of in-house training using training videos and non-living models. The key factor of microsurgical training is assessment of obtained skills. For this reason, several evaluation scores have been developed: from comprehensive questionaries filled by experienced tutor to simple scales suitable for selfassessment. In this article authors review current types of microsurgical training and scores for assessment of the microsurgical competence.

Risk factors impacting intra- and postoperative cerebrospinal fluid rhinorrhea on the endoscopic treatment of pituitary adenomas: A retrospective study of 250 patients.

We aimed to identify the risk factors associated with intra- and postoperative cerebrospinal fluid (CSF) leakage in pituitary adenomas treated with endoscopic transsphenoidal surgery.This study is a retrospective analysis of 250 pituitary adenoma cases from January 2017 to December 2019 at our hospital. All patients underwent endoscopic endonasal transsphenoidal surgeries. Univariate and multivariate analyses were performed to investigate the risk factors associated with intra- and postoperative CSF rhinorrhea.Eighty (32.0%) and nine (3.6%) patients had intra- and postoperative CSF leakage, respectively. Tumor size was an independent risk factor for intraoperative CSF leakage (odds ratio [OR], 1.229; 95% confidence interval [CI], 1.133–1.334; P < .001); intraoperative CSF leakage was an independent risk factor for postoperative CSF leakage (OR, 7.707; 95% CI, 1.336–44.455; P = .022). Chronic respiratory disease (OR, 57.500; 95% CI, 8.031–411.682; P < .001) was also an independent risk factor for postoperative CSF leakage. Vascularized septal mucosal flap was a protective factor (OR, 0.107; 95% CI, 0.013–0.894; P = .039).Intraoperative CSF leakage is more likely to occur in large pituitary adenomas. In the presence of intraoperative CSF leakage, postoperative CSF rhinorrhea is very likely to occur. Patients with chronic respiratory disease are also more likely to develop postoperative CSF leakage. The sellar base reconstructed using vascularized nasal septal flaps can significantly decrease the risk. The Knosp grade, degree of tumor resection, and postoperative use of a lumbar subarachnoid drain did not have any effects on postoperative CSF rhinorrhea.

Reconstruction of a large anterior skull base defect with a multilayer graft augmented by a vascularized flap: A technical note

Reconstruction of a large anterior skull base defect with a multilayer graft augmented by a vascularized flap: A technical note

Microvascular free flap for head and neck reconstruction: our experiences with 218 free flaps for head and neck reconstructions

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Defect following radical resection for advance head and neck cancers are complex and without doubt microvascular free flap offer the best reconstructive option. The purpose of this study is to investigate the flap survival rate and review each vascular compromised flaps.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a reviewed of 218 microvascular free flaps done for reconstruction of 204 head and neck patients. There were 112 (51.3%) radial forearm flaps (RFF), 82 (37.6%) fibula flaps (FF) and 24 (11%) anterior lateral thigh (ALT) flaps. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 16 complete flap loss and 3 partial flap loss, giving an overall flap survival rate 91.8% (19/218) and flap survival in turn of complete loss 92.7% (16/218). In RFF, there were 7 complete and 1 partial flap loss, giving an overall flap survival rate 92.9% (8/112) and flap survival in turn of complete loss 93.8% (7/112). In FF, there were 6 complete flap loss, giving a flap survival rate 92.7% (6/82). In ALT flap, there were 3 complete and 2 partial flaps loss, giving an overall flap survival rate 79.2% (5/24) and flap survival in turn of flap complete loss 87.5% (3/24). In our series vascular flaps complications rate was 12.3% (27/218), with a salvageable rate of 29.6% (8/27). The most salvageable flap was RFF 46.6% (7/15).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study re-enforce the learning curve in microvascular free flap and RFF is a good flap for a beginner. &lt;/p&gt;

Microvasular Free Flap Reconstruction in Head and Neck Surgery: Complication and Outcome of 80 Flaps.

Head and neck carcinoma can prompt destroying cosmetic and functional deformities with resultant mental, physical and nourishing burden. Regardless of ongoing advances in medication and surgical procedure, the general endurance for patients with head and neck malignant growth has stayed still for as long as 35 years. This endurance rate has prompted the foundation of the standards of tumor extraction with most extreme tissue saving and more up to date endoscopic laser-helped methods for auto-digestive region malignant growths targeting diminishing operational morbidity without influencing the general endurance. This retrospective and prospective study contained 80 patients who went through miniature vascular free flap remaking following a significant head and neck oncosurgery procedure from 01/01/2017-to-31/12/2019. Three kinds of free flaps were fundamentally utilized. The current study was directed to assess the clinical result in patients going through miniature vascular free flap reproduction and to decide the viability after head and neck onco-surgical procedure method. Despite the fact that miniature vascular free flaps are today viewed as cutting edge in head and neck remaking after composite resection with predominant effective and stylish rebuilding, it is as yet not basic in India at numerous focuses. This retrospective and prospective study were conducted for a time of 3 years to know the clinical result, decide the adequacy and assess the occurrence and reasons for pre- and post-surgical intricacies in patients going through miniature vascular free flap recreation after head and neck onco-surgical procedure method. It was inferred that the free flaps were dependable in accomplishing effective reproduction of the head and neck following an effective onco-surgical procedure methodology. Despite the fact that there is a critical loss of delicate tissue and bone however after an effective acknowledgment of free flap, close to ordinary anatomical and physiological capacities can be accomplished in larger part of the patients. The frequency of complexities was straightforwardly related to the co-morbidity level and specialist's working experience.

Autotransplantation of Flaps in the Treatment of Peri-Implant Infection After Osteosynthesis (Analysis of Clinical Observations)

Unfortunately, suppuration of a postoperative wound remains the most frequent complication of surgical intervention. If suppuration is located superficially, within the subcutaneous fat, it can be successfully managed with minimal functional losses. The clinical course is significantly complicated if the focus of infection is located under the skin, in the thickness of the muscles, in the fracture zone. In the case of suppuration in the area of osteosynthesis, the complication may become critical.Such a complication is a serious condition that requires multi-stage complex and sometimes multidisciplinary treatment.The conditions for a successful outcome in this pathology are the minimum period from the moment of suppuration, active surgical tactics, stability of the implant, and good vascularization of the surrounding soft tissues.Active surgical tactics involves the opening and sanitation of purulent foci, leaks, recesses. Staged necrectomies are inevitable companions of surgical treatment and can cause the formation of defects in the skin, subcutaneous tissue, and muscles.The resulting soft tissue defect leads to exposure of the bone and plate. Removal of the metal fixator becomes inevitable.Only the closure of the defect with a complex of tissues based on free vascularized composite grafts can radically solve the problem.The article presents two clinical observations of deep wound infection after bone osteosynthesis, where autotransplantation of a vascularized flap was used. The use of this technique made it possible to achieve suppression of infection, wound healing by primary intention, to create conditions for consolidation of the fracture, restoration of function and preservation of the limb as a whole.

Aesthetic Design of Expanded Bilateral Superficial Temporal Vascular Fascial Pedicled Flap for Repairing Maxillocervical Scars.

Large-scale maxillocervical scars impair face and neck function and damage appearance. The forehead expanded bilateral superficial temporal pedicled flap is a good treatment strategy for this area; however, the traditional cutaneous pedicled flap damages the temporal hair area. This impairs aesthetics and causes alopecia; furthermore, requires an additional pedicle-cut operation. A retrospective study was performed on 7 patients with large-scale maxillocervical scars from January 2014 to August 2018. Forehead expanders were implanted in the first-stage operation for all patients. After the injection and rest period, patients were treated using the forehead expanded bilateral superficial temporal vascular fascial pedicled flap. Superficial temporal vascular fascia pedicles were carefully harvested. The use of an intralesional or hidden retrotragus incision was determined by the presence of a preauricular scar. Patient satisfaction with postoperative neck activity and the incision scar was evaluated. Intralesional and retrovagus incisions were used in 4 and 3 cases, respectively. One flap developed hematoma, which recovered completely after conservative treatment; all other cases had no complications. All flaps healed well. The neck mobility of the patients was significantly improved with no visible scar in the temporal region. Six cases reported being "very satisfied" and one was "relatively satisfied" with their improvement in neck mobility. All cases reported being "very satisfied" with frontotemporal morphology. The forehead expanded bilateral superficial temporal vascular fascial pedicled flap is a good choice for patients with large-scale maxillocervical scars. This technique can maintain the aesthetics of temporal hair and reduce patients extra surgical injury.