Wide Flap Research Articles

Clinical application of parasacral artery perforator flap in the treatment of Pilonidal Sinus Diseases

Objective: To investigate clinical efficacy of parasacral perforator flap (PPF) on postoperative wound healing in pilonidal sinus diseases (PSDs). Methods: The surgery steps were as follows: (1) To preoperatively detect parasacral perforator arteries with the handhold Doppler probe and mark them; (2) To remove the infected and necrotic tissues of PSDs completely; (3) To design the PPF according to the wound size and the parasacral perforator arteries' localization; (4) To harvest the flap from the gluteus maximus muscle surface and transfer it to the wound without tension. Several data were documented, including surgical duration, flap length, flap width, drainage tube placement duration, hospital stay, duration from operation to stitch removal, postsurgical complications and recurrence. Results: There were six patients with PSDs whose postoperative wound healing was repaired by PPF, admitted in our department from March 2021 to March 2023. Of them, five were male and one was female. Their median age was 24 (range: 18-33) years old. Their median surgical duration was 165 (range: 134-207) minutes, median length of PPF was 8 (range: 7-11) cm, median width of PPF was 3 (range: 3-4) cm, mean duration of drainage tube placement was 8 (range: 4-17) days, mean hospital stay was 13 (range: 6-23) days, mean duration from operation to stitch removal was 14 (range: 14-17) days, median follow-up time was 6-16 months. Incisions of all six cases achieved first-intention healing without early- or late-stage complications. No recurrence occurred during follow-up. All patients involved were satisfied with their clinical efficacy. Conclusion: The utility of PPF in postoperative wound healing of PPDs was effective, safe and reliable.

Clinical study on anterolateral femoral interregional flap with turbocharge technique in the repair of large limb wounds.

To compare the clinical outcomes of anterolateral femoral interregional flap with turbocharge technique and traditional anterolateral femoral flap in repair of large limb wounds. Clinical data of 38 patients with large limb surface wound (11 cm×39 cm-16 cm×65 cm) admitted to the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from May 2018 to May 2022 were retrospectively analyzed. Eighteen patients were treated by anterolateral thigh perforator flap combined with superficial circumflex iliac artery flap (ALTP-SCIAP) with turbocharge technique (interregional flap group); while 20 patients were treated with unilateral or bilateral anterolateral femoral flaps, combined with skin grafting if necessary (traditional anterolateral femoral flap group). The survival of skin flap, repair of donor area, complications and patient satisfaction were compared between the two groups. In interregional flap group, 18 flaps were harvested and transplanted, the flap width, length and the viable area were (9.9±2.0) cm, (44.2±3.5) cm and (343.2±79.9) cm2, respectively. In traditional anterolateral femoral flap group, 29 flaps were harvested and transplanted, the flap width, length and the viable area were (11.0±2.8) cm, (21.7±3.2) cm and (186.4±49.2) cm2, respectively. There were significant differences in the flap length and the viable area between the two groups (t=22.365 and 8.345, both P<0.05). In the interregional flap group, the donor site of flap was closed by direct suture in 11 flaps, by skin retractor assisted suture in 6 flaps, and by skin grafting in one flap. In traditional anterolateral femoral flap group, the donor site of flap was closed by direct suture in 12 flaps, by skin retractor assisted suture in 11 flaps, and by skin grafting in 6 flaps. The skin graft rates of the two groups were 5.6% (1/18) and 20.7% (6/29), respectively (χ2=2.007, P>0.05). The interregional flap group had lower postoperative complications rate (5.6% vs. 35.0%, χ2=4.942, P<0.05) and higher patient satisfaction rate (94.4% vs. 70.0%, χ2=4.448, P<0.05) than traditional anterolateral femoral flap group. Compared with the traditional anterolateral femoral flap, the anterolateral femoral interregional flap with turbocharge technique has a larger flap area, most of the donor areas of the flap can be sutured directly without skin grafting and with less complications and a higher patient satisfaction rate.

A modified supraclavicular artery island flap for reconstruction of oral and maxillofacial defects

ObjectiveTo overcome the limitation of the supraclavicular artery island flap (SCAIF), we describe a modified SCAIF which incorporates a portion of the upper trapezius and the superficial branch of the transverse cervical artery (TCA) for the reconstruction of oral and maxillofacial defects. Study designThe modified SCAIF was used on 20 patients at our hospital between April 2013 to August 2022. All patients underwent resection of the primary lesion site and immediate reconstruction with the modified SCAIF. Demographic data and flap details were recorded. Complications were assessed for at least a 6-month follow-up period. ResultsThis study included 20 patients. The mean flap harvest time was 50 minutes. The mean flap length was 6.0 cm, and the mean flap width was 5.0 cm. All flaps of 20 cases survived with good appearance, and no shoulder morbidity was found during a follow-up period of at least 6 months. ConclusionThe modified SCAIF is a versatile and reliable local flap option for moderate to large reconstruction in this special region after resection of the primary lesions. We found this simple flap design has overcome the limitations of the traditional one with a reliable blood supply and adequate tissue for larger defects.

ICG-angiography in evaluation the quality of the full-thickness rectal flap's formation at the surgery treatment of complex rectal fistulas

AIM: evaluation the feasibility of usage ICG-angiography for the full-thickness rectal flap's formation at the surgery treatment of complex rectal fistulas.PATIENTS AND METHODS: a prospective cohort study based on the study of intraoperative ICG-angiography and its video recordings in the surgery treatment of complex pararectal fistulas with bringing down a full-thickness rectal flap was performed. The study included 9 patients: 6(66.7%) - men and 3(33.3%) - women.RESULTS: based on intraoperative ICG-angiography 3 types rectum's angioarchitectonics were identified: with 3, 4 and 5 distal branches of the rectal arteries, respectively. Subsequent detailed chronometry were showed that the time of onset of the arterial phase did not differ significantly, regardless of the formed flap's width. However, the following changes in the venous outflow were identified: at full-thickness flap's width of 1/3 of the rectal circumference, a slight lengthening of the venous outflow was observed, expressed in an increase of the average time for onset of the maximum fluorescence phase to 61.5 sec., compared with the intact rectum (58.2 sec.); at full-thickness flap's width of 1/4 of the rectal circumference - significant (p&lt;0.05) extension of the average time for onset of the phase of maximum fluorescence to 77.6 sec., that is, in 1.26 times compared to patients with flap's width of 1/3 of the rectal circumference.CONCLUSION: at the treatment of complex rectal fistulas with bringing down a full-thickness rectal flap, ICG-angiography makes it possible to visualize the vessels of the rectum at intraoperative condition, which contributes to the selection of the boundaries of the rectal area for the formation of a full-thickness flap, and also allows to assess of its blood supply.

Surgical Delay of Thoracodorsal Artery Perforator Flaps for Total Autologous Breast Reconstruction.

When abdomen-based free flap reconstruction is contraindicated, the muscle-sparing thoracodorsal artery perforator (TDAP) flap may be considered for total autologous breast reconstruction. The TDAP flap is often limited by volume and is prone to distal flap necrosis. We aim to demonstrate our experience combining the delay phenomenon with TDAP flaps for total autologous breast reconstruction. Patients presenting for autologous breast reconstruction between April 2021 and August 2023 were recruited for surgically delayed TDAP flap reconstruction when abdominally based free flap reconstruction was contraindicated because of previous abdominal surgery or poor perforator anatomy. We dissected the TDAP flap except for a distal skin bridge and then reconstructed the breast 1 to 7 days later. Data included flap dimensions (in centimeters × centimeters), delay time (in days), predelay and postdelay perforator caliber (in millimeters) and flow (in centimeters per second), operative time (in minutes), hospital length of stay (in days), complications/revisions, and follow-up time (in days). Fourteen patients and 16 flaps were included in this study. Mean age and body mass index of patients were 55.9 ± 9.6 years and 30.1 ± 4.3 kg/m2, respectively. Average flap skin island length and width were 32.1 ± 3.3 cm (n = 8 flaps) and 8.8 ± 0.7 cm (n = 5 flaps), respectively. Beveled flap width reached 16.0 ± 2.2 cm (n = 3 flaps). Average time between surgical delay and reconstruction was 2.9 days, ranging from 1 to 7 days (n = 18 flaps). Mean predelay and postdelay TDAP vessel caliber and flow measured by Doppler ultrasound increased from 1.4 ± 0.3 to 1.8 ± 0.3 mm (P = 0.03) and 13.3 ± 5.2 to 43.4 ± 18.8 cm/s (P = 0.03), respectively (n = 4 flaps). Complications included 1 donor site seroma and 1 mastectomy skin flap necrosis. Follow-up ranged from 4 to 476 days (n = 17 operations). We demonstrate surgically delayed TDAP flaps as a viable option for total autologous breast reconstruction. Our series of flaps demonstrated increased perforator caliber and flow and enlarged volume capabilities and had no incidences of flap necrosis.

Modified Internal Pudendal Artery Perforator Flap Interposition for Rectovaginal Fistula.

Rectovaginal fistula (RVF) is a challenging condition associated with recurrences and significant functional impairment. The internal pudendal artery perforator (IPAP) flap has become a viable option for reconstructing the vagina and perineal regions. This study aims to introduce a modified technique of IPAP flap interposition and evaluate its postoperative outcomes in the treatment of low RVF. Sixteen patients with RVF who underwent modified IPAP flap interposition between 2016 and 2021 were retrospectively enrolled. Recurrence rate, the satisfaction of vulvar appearance (Visual Analog Scale), and quality of sexual life (Female Sexual Function Index score) were followed up and analyzed. All patients presented with low fistula with a mean diameter of 8.3 mm. The mean width and length of the IPAP flaps were 3.8 and 6.2 cm, respectively. The mean follow-up period was 14.1 months. All patients achieved successful healing without recurrence. High satisfaction was reported for the cosmetic effect of the vulva with a mean Visual Analog Scale score of 8.4. The proportion of female sexual disorder exhibited a statistically significant reduction, decreasing from 100% preoperatively to 38% after surgery ( P < 0.05). The modified IPAP flap interposition is a reliable and safe option for repairing low RVF, with high success rates and minimal donor site morbidity. Moreover, this procedure provides a suitable volume flap and preserves the vaginal physiological environment, which benefits postoperative sexual function.

Donor-Site Morbidity Analysis of Thenar and Hypothenar Flap.

Background For the small glabrous skin defect, Thenar and Hypothenar skin are useful donors and they have been used as a free flap. Because of similar skin characteristics, both flaps have same indications. We will conduct comparative study for the donor morbidity of the Free thenar flap and Hypothenar free flap. Methods From January 2011 to December 2021, demographic data, characteristics of each flap, and complications using retrospective chart review were obtained. Donor outcomes of the patient, who had been followed up for more than 6 months, were measured using photographic analysis and physical examination. General pain was assessed by Numeric Rating Scale (NRS) score, neuropathic pain was assessed by Douleur Neuropathique 4 Questions (DN4) score, scar appearance was assessed by modified Vancouver Scar Scale (mVSS), and patient satisfaction was assessed on a 3-point scale. Statistical analysis was performed on the outcomes. Results Out of the 39 survey respondents, 17 patients received Free thenar flaps, and 22 patients received Hypothenar free flaps. Thenar group had higher NRS, DN4, and mVSS ( p < 0.05). The average scores for the Thenar and Hypothenar groups were 1.35 and 0.27 for NRS, 2.41 and 0.55 for DN4, and 3.12 and 1.59 for mVSS, respectively. Despite the Hypothenar group showing greater satisfaction on the 3-point scale (1.82) compared with the Thenar group (1.47), the difference was not significant ( p = 0.085). Linear regression analysis indicated that flap width did not have a notable impact on the outcome measures, and multiple linear regression analysis revealed no significant interaction between flap width and each of the outcome measures. Conclusion Despite the limited number of participants, higher donor morbidity in general pain, neuropathic pain, and scar formation was noted in the Thenar free flap compared with the Hypothenar free flap. However, no difference in overall patient satisfaction was found between the two groups.

Study on Aerodynamic Interaction of Rotor and Fuselage in Hover and Its Application to Flap Width Determination of Winged Helicopters

Study on Aerodynamic Interaction of Rotor and Fuselage in Hover and Its Application to Flap Width Determination of Winged Helicopters

Возможности применения подподбородочного лоскута для реконструкции нижней губы

Head and neck reconstruction surgery is a challenging area of surgery that requires the surgeon to be familiar with various reconstructive options. Achieving both functionality and aesthetic harmony of facial proportions constitutes one of the most important aspects of the head and neck defect elimination. For that various methods are used involving application of local, regional and free flaps on vascular pedicles. The reconstructive method is selected based on the defect size, location, composition, as well as on the age, comorbidity, surgeon’s and patient’s preferences. Submental flap is a regional flap that has proven to be a reliable fasciocutaneous flap, the tissues of which are identical to that of the lower face in width, texture, and color. Long vascular pedicle ensures wide flap rotation arc, thereby allowing one to use the flap for elimination of defects of the upper and lower lips, mental region, tongue, floor of the mouth, and preauricular area. Damage to the donor site is minimal, it is cosmetically invisible due to the scar hidden in the mental region. The paper presents the results of surgical treatment of the 38-year-old female patient with the soft tissue defect of the lower third of the face and the lip resulting from trauma. The wound did not heal for more than six months, no improvement was observed. It was decided to eliminate the defect using a rotation submental flap. The patient was followed up for a year after surgery. We managed to achieve complete aesthetic and functional rehabilitation of the patient.

Surgical Wound Repair with Innovative Hemostatic Glue: Clinical Case Report

Background: The labial frenulum may be associated with traction on the marginal gingiva of the incisors with resulting gingival recession, a condition known as “pull syndrome”. In this case, performing a frenulectomy at least 6 months before root covering surgery is necessary. Recently, tissue adhesives have been studied as a good alternative to conventional sutures. Methods: A 34-year-old female affected by pull syndrome of the central lower incisors underwent frenulectomy, and an n-hexyl-cyanoacrylate tissue adhesive was used to ensure wound closure. Results: The patient was instructed in hygiene maneuvers and rinsed with 0.12% chlorhexidine-based mouthwash for 15 days. The glue was partially removed at 7 days, and for the remaining, natural disposal time was expected. The wound healing process was complete after 15 days with minimal postoperative discomfort. Conclusion: This n-hexyl-cyanoacrylate surgical glue could be proposed as a viable alternative to conventional sutures during surgical procedures involving wide flaps with the impossibility of first-intention healing. Moreover, it could be indicated to reduce operative time and patients’ discomfort, even if these hypotheses should be confirmed by future clinical studies.

Fracture patterns formed by tearing adhesive thin films from curved surfaces

It has been reported that tearing adhesive thin films from smooth developable surfaces can produce various fracture patterns, which can be either convergent or divergent. We experimentally show that the parallel one can be realized from a properly undulating surface. Then, we demonstrate that the formation of all the discovered patterns is governed by a unified rule, where the local geometry near the crack tip matters. Our theory can provide a master curve, universally capturing distinct crack behaviors in experiments. And diverse observed fracture patterns become predictable. Based on the unified perspective, we reveal that the stability of a parallel pattern is decided by the local concavity of the surface near the crack tips. In addition, this rule also applies to the tearing from nondevelopable surfaces, such as tearing the fruit skin from the pulp with a wide initial flap width. Finally, we suggest that such predictable tearing can be harnessed for controlled fragmentation of thin films and used for characterizing the mechanical properties of a film-substrate system where the substrate can own nonzero curvature.

D119. Propeller Buccal Myomucosal Flap: Anatomical Study and Preliminary Experience in 25 Primary Cleft Palate Reconstructions

PURPOSE: Buccal artery myomucosal (BAMM) flap has been well-described for cleft palate reconstruction. However, anatomic analysis and application of a completely islanded propeller flap have not been reported in the literature. METHODS: Anatomical study was performed using Indocyanine green, red and blue latex injected directly into the buccal pedicle of 22 fresh hemifacial cadavers. Then, clinical analysis of the senior authors’ (BBG, AR) experience with 25 consecutive primary cleft palate reconstructions utilizing a propeller islanded BAMM flap was conducted to assess palatal healing and flap outcomes. RESULTS: Mean buccal artery diameter was 0.95±0.29mm. Neurovascular pedicle entered the flap 11.38±2.87mm anterior to the pterygomandibular raphe. Buccal artery advanced inside the flap as much as 66.8%±6.0% of the total flap length. All reconstructions were performed using Furlow palatoplasty. 36 flaps were utilized in 25 patients (mean age 478d). The mean maximum cleft width was 11.7 mm. Mean BAMM flap width was 1.2 cm and 11 cases utilized bilateral flaps. The flap always reached the contralateral pillar and the buccal nerve was always preserved. Mean follow-up was 400 days. There were 2/36 flap loss. In both flap losses, pedicles were aggressively dissected. 4/36 flaps underwent revision for flap debulking. CONCLUSION: This study shows that the buccal pedicle is the main blood supply to the flap and this modification allows preservation of the sensory innervation. The contralateral pillar could always be reached improving the traditional advancement and inset. Traditional extensive propeller flap dissection should be avoided in these neonates to avoid vascular compromise.

Extensive Defect Reconstruction With Pre-expanded Anterolateral Thigh Flap: Tissue Expansion of the "Outskirts".

Previously reported pre-expansion techniques of the anterolateral thigh flap are mainly perforator-based. The expansion will interfere with the flap harvest if the requisite perforator is found unsuitable as a pedicle. Expansion of the peripheral territories of the flap donor site can minimize the interference from the expansion. Forty-eight peripheral pre-expansions of the anterolateral thigh flap were retrospectively reviewed in 38 patients from 2012 to 2021. The reconstructive outcomes, including flap success, increase in flap size, donor-site closure, and complications, were assessed. In addition, subgroup analysis was performed based on the expanded territories. Rate of successful flap elevation of 100% and flap survival rate of 97.9% were achieved. One patient had total flap necrosis, which was salvaged with skin grafting. Peripheral expansion attained a mean 55.5% ± 19.6% increase in flap width. Primary donor-site closure was accomplished in 95.8% of flaps and fascial restoration in 97.9% of the donor sites. Three patients developed major expansion-related complications, which required surgical intervention. One patient had wound dehiscence in the donor site, which healed by secondary intention. Compared with other subgroups, the lateral-and-medial-side expansion provided a larger flap for reconstruction (P = 0.001). If time is not of the essence, peripheral pre-expansion permits direct donor-site closure with size augment of the anterolateral thigh flap. In addition, it preserves the reliability and versatility of the anterolateral thigh flap.

Clinical Application of Pectoralis Nerve Block II for Flap Dissection-Related Pain Control after Robot-Assisted Transaxillary Thyroidectomy: A Preliminary Retrospective Cohort Study.

Simple SummaryThe main findings of the study are that pectoralis nerve block II (PECS II) may be a valuable analgesic option that alleviates flap dissection pain and stress during a robot-assisted transaxillary thyroidectomy (RATT) and reduces opioid consumption in the early recovery phase. Patients who received PECS II experienced a more comfortable recovery and required fewer painkillers. PECS II may serve as a valuable new pain relief modality in addition to the multimodal analgesic strategy for patients undergoing RATT. Although we have yet to investigate the optimal block duration, regions of sensory loss, optimal technique, and possible complications, our preliminary study suggests that PECS II reduces flap dissection pain and thus promotes recovery. Appropriate analgesia during RATT remains challenging, but is a key issue for postoperative recovery. A further prospective investigation is required to validate our results and establish the optimal pain control regimen for patients undergoing RATT.Few studies have examined the clinical utility of ultrasonography-guided pectoralis nerve block II (PECS II) during wide flap dissection of a robot-assisted transaxillary thyroidectomy (RATT). We assessed the ability of PECS II to reduce postoperative pain. We retrospectively reviewed 62 patients who underwent elective RATT from December 2021 to April 2022 at Seoul St. Mary’s Hospital (Seoul, Korea). The patients were divided into a block group (n = 28, 50.9%) and no-block group (n = 27, 49.1%). Pain was measured using a visual analog scale (VAS) at 4, 10, 20, 25, 35, and 45 h after surgery, and the requirements for rescue painkillers in the post-anesthesia care unit and ward were recorded. The VAS scores did not differ significantly between the two groups at 4 h postoperatively. The block group had significantly lower VAS scores at 10 and 25 h (p = 0.017 and p = 0.034, respectively). The block group required fewer painkillers in the post-anesthesia care unit than the no-block group, although the difference was not statistically significant in the ward. PECS II may serve as a new pain relief modality and valuable addition to the current multimodal analgesic strategy for patients undergoing RATT.

Analysis of Dental Implant Rehabilitation in the Reconstructed Jaw by Deep Circumflex Iliac Artery Flap, a Retrospective Study

The purpose of this study is to analyze the clinical results of the implant rehabilitation for a jaw reconstructed by the deep circumflex iliac artery (DCIA) flap. A total of 13 patients were included in this study from 2010 to 2020. Medical records were collected retrospectively and analyzed. The mandible was involved in 10 cases and the maxilla was in 3 cases. The average width of the DCIA flap was 8.6 mm, and the height was 20.65 mm. A total of 41 dental implants with a diameter of 3.9–5.0 mm and a length of 10.0–11.5 mm were placed at an average of 12.3 months after the reconstruction. The average follow-up period after delivering a permanent prosthesis was 15 months (range, 2 to 51 months) and the overall mean follow-up period was 48 months. In all, 3 implants of the total 41 implants were removed. The DCIA flap is the most suitable for reproducing the original contour of the original jawbone compared with the fibular flap. In addition, the height and width of the reconstructed bone is appropriate for implant placement, which is advantageous for the rehabilitation of oral function and aesthetics using the implant.

Development of a mathematical formula and online tool to calculate the potential maximum flap width to allow for primary anterolateral thigh donor-site closure in Caucasians.

Primary anterolateral thigh (ALT) flap donor-site closure is crucial to achieve patient satisfaction, avoid burdensome secondary surgeries, and avert poor outcomes. Only vague maximum flap width recommendations have been suggested, which fall short of acknowledging individual patient habitus and thigh morphology. Therefore, we aimed at identifying a user-friendly preoperative calculation of maximum flap width for primary closure. A total of 429 ALT free flaps performed between 2009 and 2020 were analyzed. A total of 350 donor-sites were closed primarily (82%) and 79 (18%) were split-thickness skin-grafted (STSG). Patient demographics including sex, age, and BMI, operative details, and flap characteristics were compared to assess their impact on the outcome variable. Receiver operating characteristic (ROC) curves were plotted for all significant predictors discriminating between closure and STSG. Areas under the curve (AUCs) were calculated for each parameter combination and optimal cutoffs were determined using Youden's Index. Sex, age, BMI, and flap width alone were poor discriminators. Dividing flap width by BMI and logarithmized BMI yielded AUCs of 0.91 and 0.94, respectively. Including patient sex yielded the best fitting regression model (χ2 = 251.939, p< .0001) increasing the AUC to 0.96 (95% CI: 0.93-0.98, p< .0001). The optimal cutoff value discriminated between primary closure and STSG with 90% sensitivity and 89% specificity. An online calculator of patient-individual maximum ALT width was then programmed. Sex and BMI are reliable predictors of successful primary ALT donor-site closure in Caucasians. We devised a novel formula for calculating patient-individual maximum ALT widths preoperatively, predicting failure of primary closure with 90% sensitivity in our cohort, available at: https://kitteltaschenbuch.com/altwidth/calculate.htm.

Dual-Perforator Flap With Wide Pedicle Versus Sural Neurocutaneous Flap With Peroneal Artery Perforator in the Treatment of Soft Tissue Defects of Foot and Ankle

How to deal with large soft tissue defects around the foot and ankle is still controversial. The aim of this study was: (1) to display a new pedicled flap, also named the dual-perforator flap with wide pedicle (DPFWP), and (2) to compare it with the sural neurovascular flap with peroneal artery perforator (SNFPAP) in foot and ankle reconstruction. According to different surgical methods, 82 patients were divided into 2 groups: the DPFWP group (42 cases) and the SNFPAP group (40 cases). All cases underwent a flap surgery after radical debridement. The 2 groups were homogeneous in terms of age, sex, body mass index (BMI), etiology, location, and follow-up duration. Operation indexes were compared, including flap length, flap width, operation time and blood loss. Complications, cosmetic appearance, and functional outcome were analyzed, and statistical analysis was performed. The DPFWP group had larger flap length (24.5 ± 4.6 cm vs 16.3 ± 3.8 cm), and flap width (10.5 ± 2.7 cm vs 7.8 ± 1.7 cm) than the SNFPAP group. In postoperative follow-up, DPFWP group showed a lower complication rate and better cosmetic, functional outcomes than SNFPAP group. In conclusion, this study showed that a DPFWP flap brought better results than a SNFPAP flap in terms of complications, cosmetic appearance, and functional outcomes for patients undergoing reconstruction of foot and ankle defects.

The Use of Closed Incision Negative Pressure Therapy on the Medial Thigh Donor Site in Transverse Musculocutaneous Gracilis Flap Breast Reconstruction.

The objective of this study was to examine the impact of closed incision negative pressure therapy (CINPT) on donor site complications and patient perceptions in transverse musculocutaneous gracilis (TMG) flap breast reconstruction. Our institution conducted a retrospective cohort study, including all patients with TMG flap breast reconstruction from 1 January 2010 to 31 December 2021. Patients were grouped according to conventional wound management or CINPT. Outcomes were surgical site complications, fluid drainage, time to drain removal, and in-hospital stay length. A patient survey was created. A total of 56 patients with 83 TMG flaps were included (control group: 35 patients with 53 TMG flaps; CINPT group: 21 patients with 30 TMG flaps). Patient characteristics were similar in both groups. The flap width was significantly larger in the CINPT group (8.0 cm vs. 7.0 cm, p = 0.013). Surgical site complications were reduced in the CINPT group without statistical difference (30.0% vs. 50.9%, p = 0.064). Fluid drainage and time to drain removal were similar in both groups. The average in-hospital stay was significantly shortened in the CINPT group (10.0 days vs. 13.0 days, p = 0.030). The survey excluded pain, skin irritations, and discomfort during sleep and movement in the CINPT group and showed that the patients felt well protected. This study fails to provide compelling evidence for CINPT to enhance incision healing on the donor site in TMG flap breast reconstruction. There was a trend toward reduced surgical site complications on the donor thigh and the in-hospital stay was shortened. Prophylactic CINPT increases patient comfort and provides a feeling of additional wound protection.

Palatoplasty Using Alveolar Ridge Incisions: A Novel Approach for Addressing Cleft Palate Deformities.

Background:Traditionally, plastic surgeons have performed palatoplasties using mucoperiosteal flaps with lateral incisions that are medial to the alveolar ridge. However, narrow flaps can cause limitations in some cases. To construct larger and wider flaps and minimize exposed bone after closure, we propose a novel technique that entails creating the lateral incisions at the top of the alveolar ridge, instead of the base of the alveolar ridge, to capture more tissue when repairing the hard palate.Methods:A retrospective chart review was conducted for patients undergoing cleft palate repair with the aforementioned technique. Information collected included basic demographic and diagnostic factors related to cleft palate deformity and history of previous facial surgeries. Operative report details and postoperative complications were analyzed.Results:Nineteen patients with hard palate clefts were included in the analysis, with the majority being women (68%). There was a balanced representation of patients with Veau classifications of II (47%) and III (42%). The majority of patients had an isolated cleft palate (74%) and incomplete deformity (63%), with no other craniofacial deformities. One (5%) had postoperative self-limited oronasal fistula managed conservatively.Conclusions:We present a novel approach for repairing cleft palate deformities by extending the lateral incision to the top of the alveolar ridge to create larger mucosal flaps. Further longitudinal studies are needed to evaluate how this unique approach compares to traditional methods—with respect to impact on maxillary growth processes, requirement for subsequent surgeries beyond two years of follow-up, and ultimately normalized speech over time.

600 Reconstruction of Finger Contracture with an Expanded Dorsal Metacarpal Artery Perforator Flap

IntroductionThe first dorsal metacarpal artery perforator (DMCAP) flap is frequently used to cover exposed bone, tendon and neurovascular structures in the hand after trauma and burns. The size and width of DMCAP flap is limited and rotation arc generally lets to cover defects up to middle phalanx. Expansion of the DMCAP flap has not been reported in the literature and this technique might be solution to increase flap viability and size in order to cover defects up to distal phalanx. In this study, we will describe utilization of tissue expander to first DMCAP and present a case of electric burns in with flexor contracture.MethodsA nine-year-old male patient applied to our clinic with the complaint of inability to extend the second finger of the left hand after an electrical burn. Physical examination revealed flexor contracture in the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints. Reconstruction was planned for the patient with a two-session expanded first DMCAP flap.In the first session, a 16 cc 5x3 cm tissue expander placed through a 3 cm vertical incision at the fifth metacarpal level. From the second postoperative week, the tissue expander was inflated with 1 ml of isotonic three days a week. Six weeks later, the DMCAP area was enlarged by giving 45 cc saline.ResultsIn the second session, contractures at the level of the left hand 2nd finger DIP and PIP were excised.. Left hand 2nd finger was fixated in extension with K-wire. 9x3 cm DMCAP flap was elevated by dissection over the paratenon and the pedicle was preserved. The flap was adapted to the defect area on the volar face with 180-degree rotation angle. The flap donor site was closed primarily.There were no complications in the post-operative period. K-wire was removed at 6 weeks postoperatively. The patient was referred to the physical therapy.ConclusionsIn cases where the tissue defect cannot be closed with loco regional flaps, extra tissue can be provided by free flaps or using tissue expanders. Primary closure of the donor area, appropriate flap thickness for the finger, and aesthetically pleasing results are among the advantages of the expanded DMCA flap.. However, in tissue expander applications in the upper extremity, the patient should be followed closely, and pain and finger circulation should be constantly questioned.