Reconstruction of the upper vermilion employing combined flaps

Summary Reconstruction in the vermilion area presents a variety of difficulties, mostly because of donor site limitations. We have obtained good results, including color and texture, using a cross-lip vermilion flap for repair of large defects of the upper vermilion and an advancement vermilion myocutaneous flap for closure of its donor site. Although the operation requires two stages, this method seems very useful for reconstruction of the upper vermilion area.     

Reconstruction of a degloved thumb

We present two cases of degloving injuries of the thumb with amputation of the distal phalanx. The first one was treated with an osteocutaneous flap from the first toe, giving effective function to the thumb, and the second by a fasciocutaneous interosseous flap around the segment of the exposed thumb, with a satisfactory result.     

Fabricating Flaps in the Forearm Prior to Tracheal Reconstruction

Background  The process of reconstruction of tracheal defects is complex and still not optimum. Options range from using staged reconstructions, combining flaps with autologous or alloplastic implants, as well as use of tissue-engineered constructs combined with vascularized tissues which are lined with cell cultures. Staged reconstructions using prelaminated epithelium, and prefabricated flaps, help in reconstruction of this complex structure. Prefabricating the flap at a different site allows for integration of the tissues prior to its transfer. Method  This article reports two patients planned for tracheal reconstruction for the purpose of advanced papillary carcinoma of the thyroid invading the trachea. Staged reconstruction using a prefabricated radial artery forearm flap (RAFF) and split rib cartilage was performed. In the second patient, a young girl, a similar construct of the RAFF, prelaminated with buccal mucosa, was performed. However, in the latter case, an intraoperative decision by the head and neck team to limit excision of the trachea sparing the mucosa was taken; the reconstruct in the forearm was redundant and needed to be discarded, replacing the defect with a free superficial circumflex iliac artery perforator (SCIP) flap. Result  At 3 years follow-up, both the patients are free of disease, with the construct serving its purpose in the older female.     

Reconstruction of the orbital region with the “blepharoplasty flap”

A modified technique of unipedicled orbicularis oculi myocutaneous flap raised along an upper or lower blepharoplasty incision line for reconstruction of the orbital region is described. This procedure provides excellent aesthetic improvement in older patients with a standard blepharoplasty being performed on the other eyelid.     

耳后游离皮瓣移植修复鼻部分缺损

目的 应用能携带耳廓软骨，色泽与鼻部相近的小型游离皮瓣修复鼻部分缺损。方法 采用以耳后动、静脉为血管蒂的耳后游离皮瓣行吻合血管的移植，对5例鼻部缺损进行了修复。结果 3例术后皮瓣血运完全正常，2例术后1－4d内有不同程度的静脉回流障碍。5例皮瓣最终全部成活，术后效果较为满意。结论 本手术供区隐藏，皮瓣不臃肿，色泽与鼻部相近，1次手术即可达到较满意的修复效果，是修复鼻尖、鼻翼大部缺损可供选择的一种方法。     

分叶型穿支皮瓣在四肢皮肤软组织缺损修复中的临床应用

目的 探讨多个同源穿支血管为蒂的分叶型穿支皮瓣游离移植修复四肢不规则软组织缺损的临床疗效. 方法 2009年9月至2012年12月,我科采用吻合一组血管的分叶型穿支皮瓣游离移植修复四肢不规则创面15例.其中,股前外侧分叶穿支皮瓣10例、骨间后动脉分叶穿支皮瓣3例、腓肠内侧动脉分叶穿支皮瓣2例;双叶型皮瓣12例,三叶型皮瓣3例;皮瓣单叶切取面积2.5 cm×2.0 cm～15 cm×8.0 cm.所有皮瓣供区创面均一期缝合关闭. 结果 13例皮瓣顺利成活,2例各有一叶皮瓣部分坏死,经二期植皮可覆盖残留创面.术后随访3～15个月,皮瓣面积无明显回缩,色泽与受区相似,供区瘢痕挛缩不明显. 结论 由同一源血管供养的分叶型穿支皮瓣血供可靠,能一次性覆盖肢体相邻的多个创面;同时,通过皮瓣各叶间的不同组合,它又能把长条状皮瓣变为各种形状,特别适合于四肢不规则创面的修复重建.     

吻合血管的髂骨复合组织瓣移植修复下颌骨缺损的经验

目的 对下颌骨或伴有颌周软组织缺损畸形的显微外科重建技术及供区并发症预防进行研究与探讨。方法用髂骨复合组织瓣８０块，其中携带皮岛１５例，与前壁组织瓣串联重建面下１／３大型缺损５例，同时切取双侧髂骨复合组织瓣３例。结果 ８０块髂骨复合组织瓣中１例失败，７９块及相串联的５块前臂皮瓣全部成活，供区感觉，运动功能障碍早期普遍存在，术后６个月￣１年内大部分逐渐恢复，腹疝，股神经麻痹等并发症较少见。结论 单纯     

Reconstruction of distal nasal deficiency using the bilobed flap

Summary Many techniques have been described to repair defects of the distal nose. The author has found the bilobed flap to be a useful technique in the repair of partial thickness and full thickness defects. Good cosmetic results can be achieved. Several examples are described.     

舌侧缘瓣修复红唇部缺损

目的采用舌侧缘瓣移植，修复红唇部缺损畸形。方法对11例红唇部完全或部分缺损患者，根据缺损范围大小制备取蒂在舌尖部的双侧或单侧舌侧缘瓣，转移至红唇部缺损区，2周后断蒂，恢复红唇外形，其中有4例为唇部复合缺损患者，先行红唇部以外复合组织的修复，再行红唇部的修复。有4例红唇缺损范围均超过唇全长1／2，采用了双侧舌瓣修复法，其余7例，红唇缺损范围均小于1／2，则采用单侧舌瓣修复法。结果所有病例，舌瓣全部成活；红唇部外形、色泽及功能恢复较好，无舌运动受限，无感觉及味觉减退等症状。结论采用舌侧缘瓣修复法，尤其是双侧舌瓣修复法，能即时修复红唇部大范围缺损，无需分两次转瓣修复。舌瓣能提供较好颜色和丰满度，在最大程度上保留了舌黏膜乳头，无损于术后舌部的味觉功能；舌部供区隐蔽，术后不留明显畸形，对舌功能影响不大。     

面颌部洞穿缺损的双皮瓣及肌皮瓣修复

目的为解决由各种原因引起的面颌部洞穿性缺损的修复问题。方法采用两个带蒂的组织瓣搭配使用修复面颌部洞穿缺损４５例,共用组织瓣９０个。其中胸三角皮瓣５８个（占６４％）,依次是颈阔肌肌皮瓣,胸大肌肌皮瓣,额部皮瓣,胸锁乳突肌肌皮瓣,背阔肌肌皮瓣等。结果４５例洞穿性缺损所用９０个组织瓣中全部成活及绝大部分成活者８７个,成活率达９７％,全部或大部分坏死的３个（占３％）。结论面颌部洞穿性缺损即刻修复是可行的。修复洞穿缺损有多种皮瓣、肌皮瓣可供选择;提出胸三角皮瓣、颈阔肌肌皮瓣、胸大肌肌皮瓣等是修复面颌部洞穿性缺损的优质组织瓣。临床应用中取得了功能与外形同时修复的效果。