Vertical Flap Research Articles

Sperm banking: use and outcomes in patients treated for testicular cancer

To identify the frequency that sperm banking was used by men being treated for testicular cancer at our institution, and to characterize the differences between men choosing to bank sperm or not, and outcomes in terms of after-treatment pregnancies. A questionnaire addressing sperm banking and fertility was administered to men treated for testicular cancer at our institution between 1994 and 2004; the results were evaluated statistically. Overall, 31 of 129 (24%) respondents had banked sperm. Of these, two had used their banked sperm to father a child, and 12 had had children naturally. Men who banked sperm were a mean of 10.3 years younger (P < 0.001) and less likely to have children at the time of diagnosis (P < 0.025) than men choosing not to bank sperm. The cost of banking sperm was reported to include a mean fee of US dollars 358 (median 300, range 0-1000), and a mean annual maintenance fee of US dollars 243.86 (median 300, range 0-1200). Only a minority of men in this study chose to bank sperm (24%). Among those who did, the use of banked sperm was low (<10%), and many men could have children without using banked sperm. Given the relatively high costs of sperm banking and the low rate of sample use, patients should be counselled on the costs and benefits of sperm banking before treatment for testicular cancer.

Extended vertical lower trapezius island myocutaneous flap for reconstruction of cranio-maxillofacial defects

This study explored an effective method for repairing cranio-maxillofacial soft-tissue defects following radical craniofacial surgery in four patients with malignant tumours involving the skull base and frontal region. The large cranio-maxillofacial soft-tissue defects were reconstructed using an extended vertical lower trapezius island myocutaneous flap based on the transverse cervical artery. The flap was 8–12 cm long and 5–7 cm wide. No major flap failure occurred, and there was no shoulder dysfunction. The patients were followed for 3–12 months. One patient suffered a local recurrence, and another died of lung metastasis 12 months postoperatively. The extended vertical lower trapezius island myocutaneous flap is a simple, reliable and large flap. It is preferred for reconstructing cranio-maxillofacial soft-tissue defects when a pedicled flap is used following craniofacial surgery for cancer.

Clinical review of three types of platysma myocutaneous flap

This study evaluated the survival rates of three types of platysma myocutaneous flap: transverse flap, vertical flap that preserved the facial artery and vein and vertical flap that sacrificed the facial artery and vein. Modified radical or supraomohyoid neck dissection was also performed in all patients. Out of 54 patients, transverse and vertical flaps were used for 12 and 42 cases, respectively. In 42 cases of vertical flaps, 26 cases preserved the facial artery and vein, 16 cases sacrificed them. Ten cases of the transverse flaps survived and two cases had partial necrosis. In the 26 cases of vertical flaps that preserved the facial artery and vein, 23 cases survived and three cases had partial necrosis. With the 16 cases of vertical flaps that sacrificed the facial artery and vein, 10 cases survived, four cases had partial necrosis and two cases had total necrosis. The flap survival rates were 83.3, 88.5 and 62.5%, respectively, in the transverse, vertical flap preserving the facial vessels and vertical flap that sacrificed them. The survival rates of transverse and vertical platysma myocutaneous flaps preserving the facial artery and vein were higher than vertical flap that sacrificed the facial artery and vein.

Bilateral Modified V-Y Advancement Flaps for Closing Meningomyelocele Defects

Various reports describe surgical techniques for closing a meningomyelocele defect. We have used a combination flap consisting of a vertical bipedicled flap and V-Y advancement flap and used this technique in the successful repair of 11 meningomyelocele defects. The vertical bipedicled flap enhances the blood supply to the V-Y advancement flap with no sacrifice of muscle tissue. This flap can easily be moved to the midline, and the donor area can be primarily sutured with no complications. Our method has several advantages compared with previously reported methods: 1) no skin grafts are needed; 2) no muscle tissue is killed; 3) it is simple and easy, leading to less blood loss and minimal operative time; and 4) it is safe and produces reliable results while eliminating wound dehiscence and skin necrosis.

Chirurgische Therapieoptionen bei Weichteildefekten der Leiste

Treatment of groin defects remains challenging due to their location and origin. Such defects commonly result from resection of tumours but can also occur after surgical or medical therapy. From 2003 to 2005, 11 patients were treated with groin defects following radiation therapy and resection of lymph node metastasis, primary carcinoma, and sarcoma. Seven patients received wound closure with rectus femoris muscle flaps, and three had vertical rectus abdominis muscle flaps. One patient was amputated at the hip, and the defect was covered with dorsally pedicled muscle and skin flaps. All flaps healed primarily. There were no secondary infections or lymphorrhea. The flaps described here are well vascularised standard flaps which are easily harvested with no major donor site morbidity. They provide sufficient coverage for the groin, reduce long-term conservative treatment, hospitalisation, and problems such as scar contracture.

Application of vertical lip flaps in repair of whistling deformity on lip

目的 探索运用一种较为简单、有效的手术方法,修复唇吹哨状畸形.方法根据红唇组织缺损的不同程度,设计1或2个垂直易位唇黏膜瓣.首先,在红唇缺损部位做一横行切开,形成受区创面,然后在其邻近部位设计与之垂直的1个或2个易位唇黏膜瓣.瓣的长度0.6～1.4 cm,宽度0.4～0.7 cm,其最大长宽比例约3:1,将唇黏膜瓣向上旋转覆盖红唇受区修复缺损.有时,还可以通过附加切口,修复唇缘及白唇畸形.结果共治疗25例,经1～15个月随访,全部病例效果令人满意,无任何并发症,唇部切口瘢痕不明显.结论如果供区有较丰富的黏膜组织,应用垂直易位唇黏膜瓣修复唇组织吹哨状畸形是一种简单有效实用的手术方法,效果令人满意。

Versatility of vertical rectus abdominis musculocutaneous flaps

The purpose of the study was to demonstrate a variety of indications for the vertical rectus abdominis musculocutaneous (VRAM) flap with respect to donor-site morbidity and alternative procedures. Fifteen VRAM flaps were performed in 15 patients during a 4-year period. The average age of patients was 58 years (range, 34-76 years). Inferiorly based VRAM flaps were used for defect coverage after tumor resection and for penile reconstruction in 7 cases. Superiorly based VRAM flaps were performed in 7 cases for reconstruction of osteocutaneous defects following sternal osteomyelitis and tumor resection. Arterial and venous "supercharging" was necessary in one case. One free VRAM flap was performed in a patient suffering from an osteocutaneous defect after resection of a malignant melanoma metastasis with infiltration of the brain and skull. The reconstructive goals were achieved in all cases using VRAM flap procedures. No total flap loss occurred. Minor complications as well as abdominal wall bulging and hernias were observed in four cases. The pedicled VRAM flap provides a reliable tool for coverage of large soft-tissue defects of the chest wall, groin, hip, and perineum even in a high-risk population, in which a safe and fast forward flap procedure is the primary reconstructive goal. Arterial and/or venous supercharging may be necessary, particularly in superiorly based VRAM flaps. An inferiorly based VRAM flap is a reliable tool for phalloplasty under special circumstances. The indication for free VRAM flaps is given in rare clinical situations. Stabilization of the donor site using artificial mesh is highly recommended.

Looking Back to Look Forward

Looking Back to Look Forward

Question Mark Ear Deformity and a Modified Surgical Correction Method: A Case Report

Question mark ear (Cosman ear) deformity, a rare congenital malformation, is characterized by a cleft between the helix and the ear lobe and marked prominence of the auricles. Although the features of question mark ear deformity are well described in the literature, there is no definitive surgical technique for repair of this deformity, Several surgical methods have been introduced for the correction of the deformity. These techniques mainly provide for repair of the cleft between the helix and ear lobe. However, marked prominence of the upper auricle usually is also present with the cleft. We modified the surgical technique to correct the cleft and the upper prominence at the same time. With this procedure, the cleft is exposed by raising a vertical cutaneous flap based on the cleft on the posterior side of the ear, After anterior scoring to form the antihelix and cleft repair using an ipsilateral conchal cartilage graft, the cutaneous flap is used to cover the cartilage graft and the flap donor site is closed primarily to facilitate restoration of the antihelix. The authors report on a patient with Cosman ear and introduce their modified technique that can be used for repair of the cleft between the helix and ear lobe and the prominence of the upper helix in the same procedure.

Simultaneous Bilateral Breast Reconstruction with Autologous Tissue Transfer after the Removal of Injectable Artificial Materials: A 12-Year Experience

Over the years, breast augmentation with injectable artificial materials has presented significant clinical and social problems, particularly in Japan, because of later complications. The authors have used autologous tissue to treat patients who want not only to have these materials removed but also to maintain breast contour. The purpose of this study was to review the clinical outcome of the authors' reconstruction procedures retrospectively. A total of 38 breasts in 19 consecutive cases treated between 1991 and 2002 were reviewed. The patients were all women, ranging in age from 41 to 70 years old (mean age, 53.4 years). The average period from injection to reconstruction was 26.5 years. After removal of the injected materials, both breasts were simultaneously reaugmented with deepithelialized rectus abdominis flaps. The incidence of associated complications was investigated. The 38 flaps consisted of 31 free transverse rectus abdominis musculocutaneous flaps, five pedicled transverse rectus abdominis musculocutaneous flaps, and two pedicled vertical rectus abdominis musculocutaneous flaps. Three flaps with total necrosis (7.9 percent) because of venous thrombosis were found in two cases. Partial flap necrosis was observed in six flaps (15.8 percent). Hematoma requiring a surgical procedure occurred in one case (5.3 percent). Negligible abdominal bulging requiring no additional procedure was found in seven cases (36.8 percent). The complication rate seemed to be relatively high compared with that for breast reconstruction after mastectomy. Nevertheless, autologous tissue transfer may be one of the ideal procedures for breast reaugmentation after the removal of injectable materials, because affected patients prefer not to undergo reaugmentation with other artificial materials.

Vertical trapezius musculocutaneous flap: A retrospective study

From 1986 to 2001, 17 patients (aged 26-77 years) were treated using the vertical trapezius musculocutaneous flap. A two-stage procedure was used in 7 and a single-stage island flap in 10. The donor site was closed directly in all patients. Mean length of hospital stay was 16 days (range 12-25). There was no operative mortality. Complications were one partial flap necrosis and two seromas of the donor site, complicated by infection. With a minimum follow-up of more than two years, our study confirms the usefulness of the vertical trapezius musculocutaneous flap in head and neck reconstructive surgery. It is a reliable, thin flap of uniform thickness, which carries hairless skin. The length and thickness of its pedicle allows excellent mobility. The main disadvantage of the flap is the complete sacrifice of the muscle necessary for total mobilisation of the flap, and the intraoperative repositioning of the patient.

Thin flap laser in situ keratomileusis: Flap dimensions with the Moria LSK-One manual microkeratome using the 100-μm head

To determine the predictability and consistency of corneal flap thickness, flap diameter, and hinge length with the modern 100 microm head of the Moria LSK-One manual microkeratome. Private clinic, office-based practice. Forty-two consecutive eyes with no previous surgery having thin flap laser in situ keratomileusis with the Moria LSK-One manual microkeratome had a new 100 microm (predicted flap thickness) head used for flap creation. Flap thickness was measured intraoperatively by subtraction ultrasound pachymetry (difference between central corneal thickness before flap cutting and residual stromal bed thickness after flap lifting). Vertical flap diameter and nasal hinge length were measured with calipers. Mean flap thickness was 107 microm +/- 14 (SD) (range 82 to 137 microm). Standard deviation for mean vertical flap diameter was +/-0.24 mm. The cord length of the nasal hinge was variable with a mean of 4.26 +/- 0.63 mm (range 3.12 to 5.75 mm) in length. Postoperatively, there were no slipped flaps, flap striae, diffuse lamellar keratitis, or epithelial defects; there was 1 epithelial slide. At 1 day, the visual acuity was 20/20 or better in 76% of eyes. The 100 microm head of the Moria LSK-One manual microkeratome cut a very predictable flap thickness and diameter but with variable length hinges. This flap thickness predictability was superior to that in other series with thicker intended flaps cut with mechanical microkeratomes and is comparable to that reported with the IntraLase FS femtosecond laser. Visual recovery was rapid, epithelial risks minimal, efficiency superior, and cost nominal relative to femtosecond laser technology.

Anatomy of the Platysma Muscle and the Evaluation of It for the Reconstruction of Facial Defects

Reconstruction of the defects with various flaps is the main issue in plastic and reconstructive surgery. Tissues used for the repair of the defects of the face should be convenient for this most important aesthetic unit. Color, elasticity, and volume of the transferred tissues have the utmost importance for successful results. Platysma muscle flap appears to be a good alternative method for the reconstruction of the facial defects. Anatomic dissections on five fresh cadavers for the evaluation of the vascular structures and 11 clinical cases of reconstruction of the defects of the face and the neck with platysma muscle and musculocutaneous flaps are performed in this study to evaluate the efficacy and reliability of platysma flaps. Cadaveric dissections were performed on the face and the neck regions on both sides. Eleven patients with various defects on the face and the upper neck regions were surgically treated: three transverse cervical artery-based transverse musculocutaneous platysma flaps, seven facial artery-based vertical musculocutaneous platysma flaps, and one superior thyroidal artery-based platysma muscle flap were used for the repairs. The patients ranged in age from 42 to 74 years. The defects measured 2x3 cm to 6x9 cm and the flaps 3x3 cm to 7x10 cm. The follow-up periods were 2 to 21 months. Postoperative venous congestion between the 5th and 9th days was observed in seven patients. One patient had infection of the donor site, and another had infection of the recipient site; both recovered with systemic and topical antibiotherapy. Partial flap loss occurred in one patient. Our study concluded that platysma flaps showed sufficient tissue match with successful results for the reconstructive procedures of facial defects.

COMPLETE REPAIR OF BLADDER EXSTROPHY: MANAGEMENT OF RESULTANT HYPOSPADIAS

In our hands complete primary repair (CPR) of bladder exstrophy results in hypospadias in two-thirds of boys. To our knowledge hypospadias repair following CPR of bladder exstrophy has not been reported previously. We report our experience with hypospadias repair following CPR of bladder exstrophy. A total of 22 boys with bladder exstrophy underwent CPR using Mitchell's technique between November 1998 and January 2002. The procedure resulted in hypospadias in 15 boys (68%). The site of the meatus was distal penile in 5 patients, mid penile in 3 and proximal penile in 7. Hypospadias repair was performed in all 15 boys. The 5 patients with distal penile hypospadias underwent repair consisting of Thiersch-Duplay urethroplasty with dorsal incision in 3 and tubularized vertical island flap with glanular tunnel in 2. All patients with mid (3) or proximal (7) penile hypospadias underwent Mustarde repair with glanular tunnel. Followup ranged from 6 to 18 months (median 13). The Thiersch-Duplay procedure with dorsal incision resulted in fistula/stenosis in 2 of 3 boys. None of the remaining 12 boys with tubularized penile flap urethroplasty (tubularized vertical island flap or Mustarde) with glanular tunneling had development of fistula or stenosis. Complete degloving of the penis and penile skin redistribution were not necessary with the Mustarde technique. Thiersch-Duplay urethroplasty with dorsal incision does not seem to be a good option for hypospadias repair following CPR of bladder exstrophy. The use of penile skin as a tubularized flap with glanular tunneling seems to yield excellent functional/cosmetic results.

Two designs of platysma myocutaneous flap for reconstruction of oral and facial defects following cancer surgery

This study evaluates the effects of two different designs of platysma myocutaneous flap, vertical and transverse, used in the reconstruction of defects following the excision of oral and facial tumors. Modified radical neck dissection or selected neck dissection was also performed. Out of the 48 patients, vertical and transverse platysma myocutaneous flaps were used for 41 and 7, respectively. The postoperative outcome for the vertical flaps was 37 cases surviving, two cases of complete necrosis, and two cases of partial necrosis. With the transverse flaps, six survived and there was one case of complete necrosis. The success rate was 90.2% and 85.7% for the vertical and the transverse flap, respectively. The form and function of recipient sites were well recovered. In conclusion, the platysma myocutaneous flap has clinical value in selected patients needing reconstruction of small and medium-sized intraoral or facial defects. It is recommended that the vertical design be used for reconstruction of buccal mucosa defects, and the transverse design for mouth-floor and facial defects.

Formation of Functional Neovagina With Vertical Rectus Abdominis Musculocutaneous (VRAM) Flap After Total Pelvic Exenteration

Pelvic exenteration may be the only curative option for women with recurrent pelvic malignancies. After total pelvic exenteration, the resultant perineal defect heals slowly if left to do so by secondary intention. Reconstruction with the vertical rectus abdominis musculocutaneous (VRAM) flap brings a generous bulk of healthy tissue into the defect, speeding recovery by facilitating primary healing. Six women underwent reconstruction of a neovagina using a vertical rectus abdominis musculocutaneous flap. All 6 had total pelvic exenteration for advanced gynecologic malignancy. Primary diagnosis was cervical carcinoma (n = 3), vulvar carcinoma (n = 1), nonsmall cell vaginal cancer (n = 1), and vaginal melanoma (n = 1). Four patients had received adjuvant radiotherapy preoperatively. All flaps remained 100% viable postoperatively. There were no cases of fistula, infection, or bowel obstruction. Two patients died of cardiovascular arrest postoperatively. The 4 other patients report satisfaction with reconstruction. Three had vaginal intercourse with orgasm. The inferiorly based vertical rectus abdominis musculocutaneous flap is a dependable source of tissue for pelvic reconstruction and is the flap of choice in the Division of Plastic Surgery. In addition to facilitating healing, the VRAM flap (neovagina) improves a woman's psychosocial well-being.

Dermal suspension flaps for McKissock's vertical bipedicle flap vs. classical McKissock's technique: comparison of aesthetic results and patient satisfaction

McKissock's vertical bipedicle flaps technique is a common technique used in reduction mammaplasty. This technique includes a well-vascularised dermal-parenchymal pedicle for safe nipple-areola transposition, but it has been criticised as resulting in a flat breast with inadequate projection after long-term follow-up. Various techniques in which dermal suspension flaps are used have demonstrated decreased secondary ptosis. We used a dermal suspension flap technique for the vertical bipedicled flap of the McKissock's breast reduction and compared it with classical McKissock's technique by review of the patient charts, photographic analysis and patient-satisfaction questionnaire. Evaluations and measurements with postoperative photographs for the dermal brassiere group compared with the classical McKissock breasts were found to be statistically different. There were no differences in complication rates and patient satisfaction between the groups. McKissock's technique with dermal suspension flap is an easy and uncomplicated modification that provides additional advantages for prevention of the secondary ptosis of the reduced breasts in the long term.

Reconstruction of concomitant total loss of the upper and lower lips with a free vertical rectus abdominis flap

Total loss of both lips is fortunately rare as reconstruction of such defects poses an enormous challenge. We present a case of concomitant loss of both lips as a result of fulminant pneumococcal septicemia, which was reconstructed with a free vertical rectus abdominis myocutaneous flap due to lack of traditional donor sites.

Extended vertical trapezius myocutaneous flap in head and neck reconstruction as a salvage procedure.

In surgical treatment of head and neck cancer, when local tumor recurrence or failure of the previous reconstruction method occurs, reoperation for reconstruction of complicated soft-tissue defects can become a challenge for the plastic surgeon. This article describes the authors' experience with the extended vertical trapezius myocutaneous flap for head and neck complicated soft-tissue defects in nine patients ranging in age from 17 to 72 years. The causes of the defects were squamous cell carcinoma of the external ear (n = 2), lip (n = 2), larynx (n = 1), and oral cavity floor (n = 1); congenital hemifacial atrophy-temporomandibular joint ankylosis (n = 1); synovial sarcoma at the mandibular ramus (n = 1); and malignant fibrous histiocytoma at the posterior cranial fossa (n = 1). Eight of the nine patients had previously been operated on using other flap procedures, including free flaps and/or distant pedicled flaps (pectoralis major and deltopectoral flaps). One patient had been operated on using a graft procedure. After failure of the previous flap procedures in four patients and tumor recurrence in five patients, the extended vertical trapezius myocutaneous pedicled flap was used as a salvage procedure. The mean flap size was 7 x 34 cm. The flap was based solely on the transverse cervical artery. Superior muscle fibers of the trapezius were preserved and the caudal end of the flap was extended from 10 to 13 cm beyond the caudal end of the trapezius muscle. Three weeks postoperatively, the pedicle was separated. No flap failure occurred. The donor sites were closed primarily. There were no disabilities with regard to shoulder motion. Tumor recurrence was observed in two patients. In conclusion, for complicated soft-tissue defects of the head and neck, the extended vertical trapezius flap can be preferred as a salvage procedure because it is a simple, reliable, large flap that is located far enough from the damaged area.

The Oblique Rectus Abdominis Musculocutaneous Flap: Revisited Clinical Applications

The authors present their experience with a previously described but infrequently used variation of the rectus abdominis myocutaneous flap. Skin paddles angled obliquely from the line of the rectus abdominis and toward the rib cage were successfully carried on periumbilical perforators from the inferior epigastric system. Skin paddle dimensions ranged from 6.5 to 12 cm in width and from 10 to 27 cm in length in 14 consecutive patients. In six of the 14 patients, the flap was used intraabdominally to obliterate radiated pelvic defects and to close radiated vaginal defects. Five flaps were placed externally to repair radiated wounds of the perineum, thigh, and trunk, and the remaining three cases were performed as free tissue transfers. One cadaver injection study was performed to redemonstrate the preferential flow of fluid in a superior-oblique direction from periumbilical perforators. Termed the oblique rectus abdominis musculocutaneous ("ORAM") flap, this flap variation has significant advantages in terms of ease of dissection and versatility over its flap cousins the vertical rectus abdominis musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap.