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Flap reconstruction

Tian Meng, Hai-Lin Zhang, Xiao Long, Xiao-Jun Wang
RATIONALE: A significant clinical issue for treating patients with large upper lip defects is how to reconstruct the lip functionally and aesthetically. Traditional methods usually lead to asymmetry of the nasal base, philtrum and the lips. PATIENT CONCERNS: A 22-year-old lady presented with a large congenital nevus on her upper lip which involved the cutaneous, vermilion, and the philtrum. Secondary deformity caused by previous partial excisions was also identified...
March 2018: Medicine (Baltimore)
Chi S Yoon, Chang G Kim, Hoon Kim, Kyu N Kim
This study aimed to present a simple, fast, and safe technique, called freestyle perforator-based peninsular flap (FPBPF), for pressure sore reconstruction.Among the 21 patients who underwent pressure sore reconstruction between May 2013 and October 2016, 12 patients (Group A) and 9 patients (Group B) were subjected to perforator-based island flap (PBIF) and FPBPF, respectively. We retrospectively reviewed and statistically analyzed the data of both groups.All flaps completely survived in both groups. No significant differences were found in patient demographics, complications, hospital stay, and follow-up period...
March 2018: Medicine (Baltimore)
Blair M Barton, Charles A Riley, Jason D Pou, Christian P Hasney, Brian A Moore
Background: The submental island flap (SIF) is a pedicled flap based upon the submental artery and vein. Its utility in reconstruction following ablative head and neck procedures has been applied to various subsites including skin, lip, buccal mucosa, retromolar trigone, parotidectomy defects, and tongue. We review our experience using the SIF for reconstruction following tumor ablation. Methods: This prospective case series with medical record review includes consecutive patients undergoing SIF reconstruction following ablative surgery for malignancy at a single tertiary care facility between November 2014 and November 2016...
2018: Ochsner Journal
Mathew Geltzeiler, Ana Carolina Igami Nakassa, Meghan Turner, Pradeep Setty, George Zenonos, Andrea Hebert, Eric Wang, Juan Fernandez-Miranda, Carl Snyderman, Paul Gardner
BACKGROUND: Vascularized intranasal flaps are the primary reconstructive option for endoscopic skull base defects. Flap vascularity may be compromised by injury to the pedicle or prior endonasal surgery. There is currently no validated technique for intraoperative evaluation of intranasal flap viability. OBJECTIVE: To evaluate the efficacy of indocyanine green (ICG) near-infrared angiography in predicting the viability of pedicled intranasal flaps during endoscopic skull base surgery through a pilot study...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
Marco Ellis, Lisa Hwang, Ni-Ka Ford, Konstantin Slavin
BACKGROUND: Full-thickness scalp defects pose a reconstructive problem, especially in the setting of infection, chemotherapy/radiation, and underlying cranial defects. Current options include dermal matrices, skin grafts, and local flaps. Local flaps often fail, requiring subsequent microvascular free flap reconstruction. OBJECTIVE: To describe the visor flap, a novel bipedicled advancement flap design, and its role in reconstruction of scalp defects. METHODS: A retrospective review of 21 adult patients who developed scalp defects reconstructed using the visor flap from 2013 to 2017...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
Stephen L Viviano, Farrah C Liu, Paul J Therattil, Edward S Lee, Jonathan D Keith
BACKGROUND: Thinning of anterolateral thigh (ALT) flaps has been described to achieve optimal contouring. Previous studies caution against thinning large flaps owing to the risk of vascular compromise leading to partial or total flap necrosis. This study aims to demonstrate a reliably safe method for thinning extra-large (>240 cm) flaps. METHODS: A retrospective review of 53 consecutive ALT flaps performed at a single institution was completed. Of these flaps, 18 (34%) were thinned primarily by sharp excision of sub-Scarpa's fat along the periphery of the flap using loupe magnification...
March 16, 2018: Annals of Plastic Surgery
Hak Chang, SeungHwan Hwang, SooA Lim, SuRak Eo, Kyung Won Minn, Ki Yong Hong
BACKGROUND: Muscle flap is a valuable option in soft tissue reconstruction. Denervated skeletal muscle is known to undergo degeneration. However, information regarding histological and genetic changes in muscle free flap without reinnervation over long-term follow-up remains unclear. METHODS: We collected flap muscles obtained during secondary exploration surgery after more than 15 years of previous muscle free flap without reinnervation. Compared with normal muscle and fat, histomorphometric and gene expression analysis of flap muscle were performed...
March 16, 2018: Annals of Plastic Surgery
Hai-Chun Ni, Jie-Cong Wang, Jia-Ming Sun, Neng-Qiang Guo
BACKGROUND: Reconstruction of nasal tip defects presents a significant challenge for plastic surgeons. The form, function, and aesthetic appeal of all nasal subunits must be addressed. The expanded paramedian forehead flap is a good choice for nasal reconstruction, providing similar texture, structure, and skin color, and high reliability. This article discusses the authors' modification of the expanded paramedian forehead flap in reconstructing defects on or around the nasal tip. METHODS: Twenty-two patients with nasal defects located on or around the nasal tip were treated in our institution...
March 16, 2018: Annals of Plastic Surgery
Marjan Waterloos, Tom Claeys, Maxime Sempels, Erik Van Laecke, Piet Hoebeke, Anne-Françoise Spinoit
The adrenogenital syndrome is an autosomal recessive disorder in which an enzyme defect in the steroid pathway leads to excessive prenatal exposure of androgens. In the female fetus, masculinization of the external genitalia is observed. Surgery aims for functional and aesthetical reconstruction. Many techniques have been described. A video of our modified pull-through reconstruction technique is hereby presented. A retrospective descriptive database was created with patients who underwent genitoplasty for a CAH-associated genital condition...
March 8, 2018: Journal of Pediatric Urology
Alexandre Bozec, Pierre Demez, Jocelyn Gal, Emmanuel Chamorey, Marie-Yolande Louis, David Blanchard, Dominique De Raucourt, Jean-Claude Merol, Esteban Brenet, Olivier Dassonville, Gilles Poissonnet, José Santini, Frédéric Peyrade, Karen Benezery, Maria Lesnik, Etienne Berta, Pierre Ransy, Emmanuel Babin
OBJECTIVE: To assess long-term quality of life (QoL) and psycho-social outcomes, and to determine their predictive factors after oropharyngeal cancer (OPC) surgery and radial forearm free-flap (RFFF) reconstruction. METHODS: Patients who had undergone OPC surgery and RFFF reconstruction who were still alive and disease-free at least 1 year after surgery were enrolled in this prospective multicentric study. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) Core (QLQ-C30) and Head and Neck Cancer (QLQ-H&N35) QoL questionnaires, the Voice Handicap Index (VHI-10) questionnaire and the Hospital Anxiety and Depression Scale (HADS)...
March 2018: Surgical Oncology
Danny Mangual, Luis A Bisbal-Matos, Ricardo Jiménez-Lee, Román Vélez, Miguel Noy
The case of a 27-year-old Hispanic female who presented with an occipito-parietal tumor after suffering trauma to the area. A physical examination revealed no tenderness to palpation and with evidence of healing ulcerations. The biopsy was consistent with a synovial sarcoma. A wide excision of the mass (15cm x 14cm x 6cm) followed by a pericranial flap was performed. A follow-up CT showed recurrence involving the parietal sagittal sinus. After a second biopsy the mass was determined to be a small-cell sarcoma, consistent with Ewing's sarcoma...
March 2018: Puerto Rico Health Sciences Journal
Rebecca Shirley, Janka Fazekas, Martin McNally, Alex Ramsden
Aim : This study aimed to define the costs of surgical management of chronic osteomyelitis where free tissue transfer was required in addition to debridement of bone, particularly the increased costs incurred by a return to theatre. We hypothesised that there would be a significantly greater cost when patients required re-exploration for vascular compromise. Method : We retrospectively analysed the costs of a consecutive series of sixty patient episodes treated at the Bone Infection Unit in Oxford from 2012 to 2015...
2018: Journal of Bone and Joint Infection
Jun Li, Yi Shen, Liang Wang, Jin-Bing Wang, Jian Sun, Thorsen W Haugen
PURPOSE: The aims of this study are to review our surgical experience in maxillary and midface reconstruction using free vascularized tissue and to compare the postoperative outcomes based on superficial temporal versus cervical recipient vessels. MATERIALS AND METHODS: We performed a retrospective review of patients who underwent maxillary and midface reconstruction with free vascularized tissue from March 2001 to July 2014. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels and those in whom cervical vessels were used as the recipient vessels...
February 20, 2018: Journal of Oral and Maxillofacial Surgery
Chengshuai Yang, Shunyao Shen, Jingyang Wu, Shilei Zhang
Mandibular reconstruction after partial or subtotal resection is considered a challenging procedure that is crucial for facial contour and function. Many reports regarding the reconstruction of mandibular defects have been published over the years. The fibula free flap has become a popular option for mandibular reconstruction since its introduction by Hidalgo in 1989. However, the locations of the reconstructed mandibular angle and the condyle of the fibular bone segments play a crucial role in facial symmetry and function...
February 20, 2018: Journal of Oral and Maxillofacial Surgery
Khoi Anh Nguyen, Truong Xuan Bui, Hue Van Nguyen, Richard O Wein
OBJECTIVE: The purposes of the study was to evaluate for the functional improvement of outcomes of patients undergoing surgical management for tongue cancer at varying periods after surgery. DESIGN: Case series with intervention. PARTICIPANTS: Thirty consecutive patients, from 2011 to 2015, with carcinoma of the tongue undergoing surgical resection and reconstruction with a radial forearm free flap. MAIN MEASURES: The Speech Intelligibility Test (SIT) is used for objective evaluation of speech function...
March 7, 2018: American Journal of Otolaryngology
Sheng Yan, Hangyan Shi, Da Chen, Jincai Guo, Yi Sun, Sufan Wu
The reconstruction of large full-thickness scalp defects remains a surgical challenge, especially when the skull is exposed completely without periosteum. Surgical technique options for wound coverage have included tissue expansion, skin grafting, local or regional flaps, and microvascular free tissue transfer. In recent years, some authors have reported to use biological material as an alternative for repairing complex wounds. The authors report the successful reconstruction of a large defect with bare skull in bilateral temporal regions of a 3-year-old child...
March 14, 2018: Journal of Craniofacial Surgery
Hemant K Mehta
The purpose is to present a new refined surgical technique for mild-to-severe acquired myogenic ptosis correction under local anaesthesia (LA) as day cases with resection of myotarsal (MT) flap and demonstrate the safety and efficacy of the technique. MT flap consists of 2 mm tarsal strip with attached levator complex - levator muscle, its aponeurosis, and Müller muscle. This is a retrospective personal series of 400+ patients, who underwent surgical correction with MT flap resection of 8-24 mm under LA mostly as day cases...
March 15, 2018: Orbit
R Cuthbert, C Deutsch, A Roy, P Stimpson, H Patel
Introduction The free jejunal flap represents the gold standard for circumferential defects in upper digestive tract reconstruction. It is a technically demanding procedure with significant failure rates. Unrecognised failure leads to flap necrosis and potentially fatal sequelae, including sepsis and carotid artery bleed. Despite these catastrophic consequences, however, there remains no consensus on an optimum method for postoperative flap monitoring. Our unit has pioneered the use of external colour duplex ultrasound to monitor flap vascularity...
March 15, 2018: Annals of the Royal College of Surgeons of England
Daniele Alberti, Laura Righetti, Adrian Bianchi, Gian Luigi de'Angelis, Giovanni Boroni
BACKGROUND: Bowel dilatation is a common adaptive mechanism after intestinal resection. The symptomatic dilated dysmotile duodenum is difficult to manage, since conventional bowel tailoring and lengthening techniques are potentially hazardous because of the anatomy of the duodenal blood supply, the proximity to the pancreas, and the risk of injury to the common bile duct. METHODS: A 2-month-old child with short bowel and a symptomatic massively dilated duodenum was treated with a Transverse Flap Duodenoplasty (TFD)...
March 14, 2018: Pediatric Surgery International
Dorothee Boehm, Konstantin Bergmeister, Emre Gazyakan, Thomas Kremer, Ulrich Kneser, Volker J Schmidt
AIMS: Reconstruction of breasts and chest wall deformities in female patients after severe burn injury is a challenge for reconstructive surgeons. In these patients, neither implant-based procedures nor standard free flaps are sometimes applicable because of limited skin quality and unavailability of donor sites at the abdomen, back, buttock, or medial thigh. METHODS: We present a case of a young female patient with a history of 80 % total body surface area burn after electric high-voltage injury...
March 13, 2018: Annals of Plastic Surgery
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