Reverse sural artery flap for distal lower extremity defects

Traumatic and various dermatological conditions resulting in skin and subcutaneous tissue loss on the lower limb cause a therapeutic challenge for the dermatological surgeon, because this anatomical location lacks adequate skin laxity and has limited local soft tissue, especially around the heel. In this report, we present our experience with the reverse sural artery flap on seven patients. The soft tissue defect was traumatic in two patients. We also treated three diabetic patients. There were no immediate or late surgical complications in four cases; flap and donor site healing was uneventful. The remaining three cases were diabetic, and all presented with the following complications: rejection of split skin graft at donor site, infection at the flap border and superficial flap necrosis. The flap necrosis was concluded to be at least in part due to the patient's noncompliance with postoperative measures. We conclude that the reverse sural artery flap is a satisfactory alternative in the reconstruction of lower limb defects, but we also feel that the importance of proper evaluation prior to surgery in terms of vascular impairment and patient compliance should be emphasized to ensure a successful surgical outcome.     

Bridge flap repair of the lower limb: A hybrid alternative to the keystone

Surgery of the lower limb to remove skin cancer often requires the use of skin grafting due to tightness of the surrounding tissues and poor dermal integrity. We present a retrospective case review of our experience with the bridge flap as an alternative for lower leg reconstruction. The techniques of executing this hybrid flap are detailed.     

Cassiopeia flap: modification of Limberg flap for saving normal skin

Local flaps have the advantages of texture matching and increased flap survival rate. The proper local flap planning for each lesion causes the dermatologist to be reluctant to employ them. We propose a modified local flap, the "Cassiopeia flap", with three simple marking points made on the ends of the diameter and on the equidistant point along the diameter; two points from equilateral triangles form a "W (Cassiopeia)". We applied this modification to ten lesions on the face, scalp, trunk and thigh with excellent results.     

Reconstruction of a traumatic plantar foot defect with a novel free flap: The medial triceps brachii free flap

Introduction: Lower extremity defects may account for 14.6% of the approximately 117 million visits to emergency departments in the U. S. in 2007. In this article, we present a reconstruction of a traumatic plantar foot defect with a medial triceps brachii (MTB) free flap. Clinical case: A 53-year-old man sustained an accidental gunshot wound to the right foot. The patient was admitted after the failure of a sural flap procedure performed in another hospital. He presented with a soft-tissue defect with calcaneal exposition and osteomyelitis. The defect was reconstructed with a MTB free flap anastomosed to his dorsalis pedis vessels. Results: Flap raising time was 52 min. There were no intraoperative complications. The total flap surface was 38.5 cm². The pedicle length was 3 cm. The diameters of the artery and vein of the flap pedicle were 1.1 mm and 1.4 mm, respectively. Ischemia time was 28 min. His donor site healed uneventfully without any morbidity, and the scar was well concealed. The flaps survived and there was no partial flap necrosis. A split-thickness skin graft was performed 12 days postoperatively. Two months later, he had a completely healed wound with no contour abnormality. The total follow-up was 24 months. The patient was able to walk normally. Conclusion: MTB free flap appears to be an excellent option for plantar foot defects in patients with preserved vascularization of the foot. Due to the anatomical shape of the flap, the position of its pedicle, and the moldability of the muscle, we predict that the use of the MTB free flap will grow and develop rapidly for reconstruction of ankle and foot defects.     

乳癌改良根治术后皮瓣坏死的预防

目的探讨乳腺癌改良根治术后皮瓣坏死的预防途径。方法95例1997年6月前治疗的乳腺癌患者接受乳癌根治术（对照组）,60例1997年7月后接受治疗者接受乳癌改良根治术（研究组）：保留皮下脂肪,尤其是在厉切口3cm以上的地方,创口置双管引流、持续负压吸引,降低皮瓣缝合处的张力。观察皮瓣坏死、皮下积液等指标的情况。结果研究组皮瓣坏死的发生率为3．3％（2／60）,显著低于对照组（26．3％,25／95,P〈0．05）。研究组的皮下积液发生率为5．0％（3／60）,显著低于对照组（30．5％,29／95,P〈0．05）。结论严密缝合切口、防止腋下淋巴管瘘、创口置双管引流、持续负压吸引、合适的胸带包扎力、合理的皮瓣厚度以及皮瓣缝合不能有或零张力,是预防乳腺癌根治术后皮瓣坏死的关键。     

Utility of the quadrilobe flap for repairing defects of the nasal tip

The quadrilobe flap allows the mobilisation of the skin of the upper nose and nasofacial sulcus to the distal nose while avoiding unfavourable tension vectors that would distort the free margin of the ala. We report our experience over the past 3 years in the first case series of quadrilobe flaps for repair of surgical defects on the nose.     

Comparing the application of various engineered xenografts for skin defects: A systematic review

Introduction

Xenografts are a now a cornerstone in the management of wound dressings. Promising results were achieved since 1960 in the application of skin substitute for skin defects.

Objective

The objective of this study was to evaluate the efficacy of various xenografts.

Methods

A literature research was conducted using the following query: ‘Porcine skin dermatology substitute’, ‘bovine skin dermatology substitute’, ‘xenograft skin substitute dermatology’, ‘xenografts skin defect’, ‘porcine skin defect’, ‘bovine skin defect’.

Results

The review yielded 35 articles pertaining to the topic. Main indications for porcine and bovine xenograft application were burn wounds and post-traumatic wounds, respectively. Mean discharge date or length of stay was at the 6th day after porcine application, and the time of graft healing was reported for 33.7% (n = 510) of patients. Promising results were seen with Matriderm and split-thickness skin graft. Most wounds achieved an excellent cosmetic result with full range of motion and a smooth contour appearance. A great variety of tissue substitutes exist, and the choice of graft application should depend on a patient's factors, product availability, wound type, size, and physician's factors.

Conclusion

In summary, xenografts are more economic and affordable but have higher risk of infections compared to allografts.     

菱形皮瓣在面部肿瘤切除中的应用

目的探讨菱形皮瓣在面部肿瘤切除后的修复效果。方法 2008年10月—2013年8月应用菱形皮瓣治疗8例面部肿瘤患者。结果 8例患者皮瓣术后均Ⅰ期愈合,术后外观满意,均无不良并发症出现。结论菱形皮瓣可应用于面部肿瘤切除后皮肤缺损的修复,是一种实用、有效的临床技术。     

改良菱形皮瓣修复肩部颗粒细胞瘤切除后缺损一例

患者,女,62岁,因右肩部皮肤肿物1年余就诊。行手术切除肿物,病理诊断为:颗粒细胞瘤。设计改良菱形皮瓣修复切除后缺损创面。患者术后恢复良好。     

The Reappraisal of the Slide-Swing Skin Flap: A Versatile Technique for Surgical Defects

BackgroundThe slide-swing skin flap is a combination of transposition and adjacent skin sliding and can be used to close large, round defects with a flap that is smaller than the primary defect to produce aesthetically good results.ObjectiveTo evaluate the efficacy and safety of the slide-swing skin flap for various surgical defects caused by skin tumor excisions.MethodsThis retrospective case series, which includes 33 Asian patients between the ages of 25 and 86 years, describes the slide-swing skin flap after primary excision for malignant or premalignant skin conditions. The outcomes were assessed 12 weeks after surgery using the patient and observer scar assessment scale (POSAS).ResultsPatients were 25 male and 8 female, and the causes of surgery were various malignant skin tumors including malignant melanoma, dermatofibrosarcoma protuberans, and malignant nodular hidradenoma. Tumors were on the lower limb in eleven patients, back in nine patients, chest in five patients, face in three patients, buttock in three patients and two patients had tumors in other locations. The mean defect size was 3.5×3.1±1.9×2.2 cm (range, 1.4×0.9~9.0×12.0 cm). The mean patient POSAS total score was 9.7±3.0 and mean patient overall opinion score was 1.8±0.7. The mean observer POSAS total score was 11.0±2.7 and mean observer overall opinion score was 1.9±0.5. All flaps survived and postoperative recoveries were uneventful.ConclusionThe slide-swing skin flap is highly versatile and can be used to cover various surgical defects, irrespective of size and location, with excellent functional and cosmetic results.     

【开放获取】局部皮瓣联合修复鼻及鼻周Mohs显微外科手术后较大缺损11例效果分析

【摘要】 目的 探讨局部皮瓣联合应用修复鼻及鼻周非黑素瘤皮肤癌Mohs显微外科手术后较大缺损的效果及优势。方法 2018年3月至2020年11月,于河北医科大学第二医院皮肤科收集行Mohs显微外科切除术后应用局部皮瓣联合修复的11例鼻及鼻周非黑素瘤皮肤癌患者。 根据术后缺损部位及大小,遵循鼻亚单位美学原则设计皮瓣进行修复,对于直接缝合或单个局部皮瓣无法覆盖的较大缺损,联合应用风筝皮瓣、改良菱形皮瓣、鼻唇沟皮瓣、双叶皮瓣等局部皮瓣中2 ~ 3种皮瓣修复创面。结果 11例患者中,基底细胞癌10例,鳞状细胞癌1例,缺损面积2.0 cm × 2.3 cm～2.7 cm × 3.6 cm。经Mohs显微外科手术联合局部皮瓣修复后皮瓣均存活良好,未出现血运障碍,修复皮瓣质地、颜色、轮廓等与周围正常皮肤相近,缺损未见明显瘢痕。术后随访4 ~ 32个月,肿瘤无复发,患者对外观满意。结论 联合应用2 ~ 3种皮瓣修复鼻及鼻周非黑素瘤皮肤癌Mohs手术后的较大缺损,可保持鼻及鼻周正常形态结构和美学效果,达到满意的美容修复效果。     

斧头状皮瓣修复头面部皮肤肿瘤切除后创面

[摘要] 目的： 探讨采用斧头状皮瓣修复头面部皮肤肿瘤切除后形成的继发性创面的应用体会。方法： 42例头面部皮肤软组织缺损中, 面积最小0.8cm×0.7cm, 最大5cm×6cm,在缺损边缘的一侧形成斧头状皮瓣, 面积为创面的1～1. 5倍, 蒂部宽度约为旋转侧宽度的1/3～1/4, 形成深度在面部为SMAS的浅面, 头部为帽状腱膜与颅骨骨膜之间。皮瓣形成后向受区旋转推进修复创面。结果：全部皮瓣存活良好, 创面得以Ⅰ期修复,美容效果满意。结论: 斧头状皮瓣制作简单, 血运可靠, 是修复头面部皮肤软组织缺损的一种理想方法。     

Comparison of the efficacy of multiple antioxidant and hyperbaric oxygen treatments in the prevention of ischemia and necrosis of local random McFarlane skin flap

ObjectiveThe aim of this study was to compare the efficacy of multiple antioxidant (Proxeed Plus (PP) with Carnitine, Selenium, Zinc, Coenzyme Q10, Vitamin C, Folic Acid, Vitamin B12) on local random skin flap healing with the hyperbaric oxygen (HBO) therapy.MethodsFourty rats were equally divided into five groups (Control, PP, HBO, HBO + PP, PP + HBO + PP). Local random McFarlane skin flap was applied to all rats.Following the applications, evaluations were made biochemical (TAS, TOS, OSI, IL-1β, IL-6, TNF-α, TGF-β, VEGF) and histopathological parameters.ResultsNecrosis percentage was found to be lower in the PP + HBO + PP group than all other groups whereas the necrosis percentages of PP and HBO groups were similar. Oxidative stress rates were significantly higher in the control group compared to the other groups whereas it was lower in the PP + HBO + PP group than all other groups. The inflammation parameters were the highest in the control group and the lowest in the PP + HBO + PP group. Growth factors were higher in the PP + HBO + PP group than all other groups. Epithelialization and wound healing were better in the HBO and PP groups than in the control group. The greatest healing, epithelialization and vascularization was seen in the PP + HBO + PP group. The histopathological findings in the PP + HBO + PP group were better in each inner region than in the other groups.ConclusionBiochemical and histopathological parameters have shown that PP reduces ischemia and necrosis and increases oxygenation in flap healing by providing significant improvement thanks to the multiple molecular structures in its content.     

The epidemiology of skin conditions in the aged: A systematic review

BackgroundThe human population is aging. A systematic summary of the epidemiology of skin diseases in the aged is lacking.MethodsA systematic review was conducted including electronic database searches in MEDLINE, Embase, SCOPUS and Web of Science. The eligibility criteria were primary incidence and prevalence studies or secondary data analysis, English or German language, subjects being 65+ years and reported skin problems or diseases. Data extraction was conducted using a standardized data collection form and the methodological quality of included studies was assessed.ResultsAfter screening of 1491 records, 74 records were included reporting data for more than 20 skin conditions. The majority of prevalence and incidence figures was identified for hospital and long-term care settings. The most prevalent skin diseases were fungal infections (14.3%–64%), dermatitis (1%–58.7%), xerosis (5.4%–85.5%) and benign skin tumors (1.7%–74.5%). Additionally, pressure ulcer prevalence ranged from 0.3% to 46% and incidence from 0.8% to 34%.ConclusionSkin conditions and diseases in aged populations are frequent. Health care practitioners should pay attention to those, although skin conditions might not be the primary reason for seeking care. Epidemiological data are lacking especially for home care and community settings although this can be regarded as the most important from a public health and prevention point of view. The methodological quality and reporting of epidemiological studies in the aged populations must be improved.Systematic review registration numberCRD42014014553 (PROSPERO).     

Direct profilometry of the skin: its reproducibility and variability

Objective The degree of reproducibility and precision of the mechanical direct profilometry and the intra- and interindividual fluctuations of 7 surface parameters were investigated. Material and methods Negative replicas were sampled from defined areas of the skin of 31 volunteers an evaluated with the profile-tracking device TKC 300 Hommeltester in order to derive data about the inter- and intraindividual fluctuations. To determine the precision of this method 6 roughness parameters and J of waviness of each replica were repetitively evaluated. The practicability was tested introducing minimal changes in the experimental set-up. Further, the effect of urea-containing creme on the skins topography was investigated in a double-blind clinical setting on a collective of 11 patients. Results The precision of this method is shown by nearly unchanged topographic parameters. Moreover, our data show smaller intra- than interindividual fluctuations of roughness (Ra) and waviness (Wt), being an important demand for clinical investigations. Conclusion In this paper we demonstrate that the parameters of both roughness as well as the recently introduced waviness can be conveniently evaluated with a high degree of precision with the direct profilometry.     

The Chinese version of the skin tear knowledge assessment instrument (OASES): Cultural adaptation and validation

BackgroundSkin tear knowledge is an important predictor of the decreased incidence and management of skin tears, and the knowledge level among Chinese nurses is unknown so far. A validated instrument for measuring skin tear knowledge is urgent.ObjectiveTo culturally adapt the skin tear knowledge assessment instrument (OASES) into Chinese and verify its validity and reliability in the Chinese context.MethodsThe cultural adaptation process for OASES into Chinese was established on Beaton's translation model. Content validity was determined by the 8-expert group in wound care. A nationwide psychometric validation study was performed on a convenience sample of 3333 nurses from 113 tertiary hospitals, of whom 98 nurses finished the test-retest procedure for reliability analysis. Item validity (item difficulty and discriminating index) and construct validity (known-groups technique) were tested.ResultsThe content validity index was 0.88–1.00. The item validity was as follows: Item difficulty ranged from 0.16 to 0.86, with an average value of 0.52; the discriminating index varied between 0.05 and 0.61. The known-group technique demonstrated excellent construct validity with a significant difference between predefined groups with theoretically expected higher knowledge scores and theoretically expected lower knowledge scores (P < 0.001). For the test-retest reliability, the Intraclass correction coefficient (ICC) during a 14-day interval for the overall tool was 0.79 (95% CI = 0.71–0.86), and Cohen's kappa value for each item varied from 0.17 to 0.62.ConclusionsThe Chinese version of OASES was validated to be suitable for skin tear knowledge assessment with acceptable psychometric properties, through which the knowledge and training priorities of skin tear among Chinese nurses can be quantified.     

Combined high-grade basal cell carcinoma and malignant melanoma of the skin ("malignant basomelanocytic tumor"): report of two cases and review of the literature

We describe two cases of a malignant cutaneous neoplasm with combined phenotypical features of high-grade basal cell carcinoma and malignant melanoma. Some tumor cells showed a keratinocytic phenotype (cytokeratins, p63) and others a melanocytic phenotype (HMB-45, MART-1, Melan-A, S100-protein). We favor the hypothesis of a tumor with bidirectional keratinocytic and melanocytic differentiation, an exceptionally rare event.     

唇颊组织推进皮瓣修复上唇恶性肿瘤术后中重度缺损11例

唇是面部重要的美学区域之一,唇部肿瘤切除后的缺损对美观和健康影响极大。2008年11月至2013年11月,我们收治上唇皮肤恶性肿瘤11例,手术切除后均采用唇颊组织推进皮瓣修复,取得较满意效果,报道如下。 一、临床资料 本组共11例患者。男4例,女7例;年龄63 ~ 87岁,平均75.5岁。皮损经组织病理证实,均为基底细胞癌（BCC）……