Reconstruction of trunk defects with bilobed myocutaneous flap.

This study describes the use of the bilobed myocutaneous (MC) flap for reconstruction of trunk defect. The authors employ this flap because it offers a greater flexibility in the use of available tissue than many other local conventional flaps, is easy to design, safe to elevate, and causes minimal donor-site morbidity. The bilobed MC flaps are based on their main muscular pedicle. The standard bilobed flaps are generally based on a random pattern blood supply, which were restricted to rigid length-to-width ratios to ensure viability. They are usually indicated in the repair of small defects of the nose, and scalp. When we want to apply to reconstruct on the larger trunk defect, especially for the potential to cause life-threatening complications, the bilobed M-C flap might be considered for reconstruction to decrease the potential risk of the complications.     

Reconstruction of full-thickness cheek defects using platysma myocutaneous flaps

Summary Myocutaneous flaps play an important role in reconstruction of full-thickness defects of the head and neck area. In this study, a different application of the platysma myocutaneous flap for the reconstruction of full-thickness cheek defects is presented. The technique described has provided an acceptable cosmetic and functional result. It was used in four patients operated on under local anesthesia. Reconstruction of full-thickness cheek defects is easily achieved, especially for palliation in poor risk patients.     

Reconstruction of circumferential pharyngoesophageal defects with laryngotracheal flap and pectoralis major myocutaneous flap

BACKGROUND: Hypopharyngeal cancer often presents at an advanced stage. Radical surgery has played an important role in the treatment of these cases; however, it always results in a large, or even a circumferential, defect of the pharyngoesophageal segment (PES) that causes some difficulties during reconstruction. MATERIALS AND METHODS: Twelve patients with advanced hypopharyngeal cancer and cervical esophageal invasion received surgery resulting in a circumferential defect of PES, which was reconstructed with the contralateral unaffected laryngotracheal flap and a patch-on pectoralis major myocutaneous flap (PMMCF). RESULTS: The operation time of this method was shorter compared with free flap reconstruction. Only two minor complications and no pharyngocutaneous fistulas were found postoperatively. Nine patients can resume a regular diet. During the follow-up period (median, 38 months), there were no local recurrences and only one contralateral neck recurrence. CONCLUSIONS: The preliminary result shows this technique is a simple and effective method with low morbidity and satisfactory oncologic and functional results.     

部分去表皮岛状带蒂肌皮瓣修复胸段气管壁缺损

目的 探讨应用去表皮岛状带蒂肌皮瓣修复胸段气管侧壁缺损的临床效果.方法 回顾性分析自2007年6月至2011年4月收治的胸段气管壁缺损患者5例,肿瘤切除后形成气管缺损的宽度为气管周径的1/3～2/5,缺损长度4.0～8.5cm,均采用部分去表皮的岛状带蒂肌皮瓣进行修复.结果 本组患者共5例,手术均顺利完成.术后随访3～12个月,恢复良好,胸腔残腔消失,气道通畅,未见气管狭窄.结论 部分去表皮岛状带蒂肌皮瓣可满意修复胸段气管侧壁缺损,扩大了肌皮瓣的应用范围,为胸段气管壁缺损的修复提供了一个安全有效的新方法.     

Reconstruction of complex defects with composite calvarial flaps

Over the past four years, composite calvarial flaps have been used to reconstruct complex defects in 14 patients. In three of the patients they were free flaps for hand reconstruction. Clinical application (technical details) and complications are also discussed.     

Reconstruction of circumferential oro- and hypopharyngeal defects with U-shaped pectoralis major myocutaneous flap.

OBJECTIVE: The purpose of the study was to evaluate the effectiveness of a U-shaped pectoralis major myocutaneous flap (PMMF) to reconstruct a large circumferential defect involving the oro- and hypopharynx. STUDY DESIGN AND SETTING: Retrospective case series. RESULTS: Twelve patients with advanced oro- and hypopharyngeal cancer (stage IV) underwent surgery resulting in a circumferential defect of pharyngoesophageal segment (PES). Those defects were reconstructed using a U-shaped PMMF. Four pharyngocutaneous fistulas were observed postoperatively and healed spontaneously within 3 to 7 weeks. Eight patients were able to resume a regular diet. A voice prosthesis was functional in 5 patients. CONCLUSION: This preliminary study shows that this technique is a simple and effective method with acceptable morbidity rate and satisfactory functional results. We demonstrate that this procedure allows the reconstruction of large defects involving the oro- and hypopharynx in irradiated patients. This technique could be an interesting alternative for surgical teams suffering from the absence of a microsurgical team. EBM rating: C-4.     

Reconstruction of major orbital-maxillary defects with free latissimus dorsi myocutaneous flap

Reconstruction following excision of tumors of the orbital-maxillary region represents a challenge to the head and neck surgeons. Microvascular techniques have significantly improved the possibilities of an adequate three-dimensional repair. Among the different available options, the latissimus dorsi myocutaneous flap (LDMF) has been considered, as it seems to fulfill the requirements for a functional obliterations of the orbital-maxillary cavity and to restore the facial contour. Two cases of large orbital-maxillary defects repaired with a LDMF are reported; in one of them the intraoral palatal competence and lining were achieved through a temporalis muscle flap. Technical remarks are presented and discussed as well as the indications and possibilities for more sophisticated reconstructions, aimed at a better cosmetic outcome.     

Reconstruction of sternal defects with pectoralis major muscle flap

The earliest treatment of the median sternotomy defects was serial debridements and secondary healing. The muscle flaps that can be used in reconstruction of the presternal defects are pectoralis major muscle flap, rectus abdominis muscle flap, vertical rectus abdominis muscle flap, latissimus dorsi muscle flap with or without skin island, bipedicled pectoralis-rectus muscle flap, and external oblique muscle flap. Pectoralis major muscle flap can be used either as bilateral or unilateral rotation advancement flap, island flap, turnover flap, split turnover flap, and segmental muscle flap. Forty-eight patients with median sternotomy defects, who were treated with pectoralis major muscle flap, were included in this study. The complications were mortality, flap loss, flap dehiscence, persistent infection, and hematoma. The patients were evaluated in terms of functional loss after the operation by shoulder movement measurements. Various techniques of flap transfer can be used for the closure of a presternal defect; almost all presternal defects can be covered with the pectoralis major muscle in a single stage operation. In our opinion, the pectoralis major muscle flap should be the first choice of treatment for sternal defects.     

Reconstruction of complex maxillectomy defects with the scapular-free flap

The defect resulting from partial or complete maxillectomy can often be reconstructed with a skin graft and a prosthesis. In situations where this simple maneuver is unsatisfactory, a more complex reconstructive modality, providing the restoration of composite tissue, is required. The scapular microvascular-free flap was used in this series of 11 patients, as a cutaneous flap in 3 and as an osteocutaneous flap in 8, to meet the specific reconstructive needs of each patient. Excellent to satisfactory restoration of facial contour and palatal function was achieved in 10 patients. There was 1 flap failure. There were no donor site complications. Selected case histories are presented to demonstrate a spectrum of reconstructive problems. There are clear limitations to its applicability, such as the odd scapular bone contour, the thickness of the cutaneous paddle, the position change required for flap harvesting, and the risk of flap failure. The scapular flap has proven to be useful in restoring bony and soft tissue contour of the face, rigid support for the velum, oronasal separation, support for the orbit, and obliteration of the maxillary sinus. We found the scapular-free flap to be a useful tool for reconstructing complex and variable maxillectomy defects.     

Reconstruction for cervical irradiation ulcers with myocutaneous flaps

Radiation-induced skin changes are commonly seen in patients who have been treated for head and neck malignancies. Some of these skin changes can progress into chronic postradiation ulcers, which despite aggressive medical wound management will not resolve spontaneously. Skin grafts and local cutaneous flaps located within the radiation field are unreliable and rarely provide adequate stable coverage. In this article, the authors report a combined experience of 52 patients whose postradiation cervical ulcers were successfully and reliably treated with myocutaneous flaps.     

Reconstruction of complex thoraco-abdominal defects with extended anterolateral thigh flap

Background:

The reconstruction of complex thoraco-abdominal defects following tumour ablative procedures has evolved over the years from the use of pedicle flaps to free flaps. The free extended anterolateral thigh flap is a good choice to cover large defects in one stage.

Materials and Methods:

From 2004 to 2009, five patients with complex defects of the thoracic and abdominal wall following tumour ablation were reconstructed in one stage and were studied. The commonest tumour was chondrosarcoma. The skeletal component was reconstructed with methylmethacrylate bone cement and polypropylene mesh and the soft tissue with free extended anterolateral thigh flap. The flaps were anastomosed with internal mammary vessels. The donor sites of the flaps were covered with split-skin graft.

Result:

All the flaps survived well. One flap required re-exploration for venous congestion and was successfully salvaged. Two flaps had post operative wound infection and were managed conservatively. All flap donor sites developed hyper-pigmentation, contour deformity and cobble stone appearance.

Conclusion:

Single-stage reconstruction of the complex defects of the thoraco-abdominal region is feasible with extended anterolateral thigh flap and can be adopted as the first procedure of choice.     

Reconstruction of large head and neck deformities: Experience with free gracilis muscle and myocutaneous flaps

Microvascular free flaps continue to revolutionize coverage options in head and neck reconstruction. The authors describe their experience with the gracilis free flap and the myocutaneous gracilis free flap with reconstruction of head and neck defects. Eleven patients underwent 12 free tissue transfer to the head and neck region. The reconstruction was performed with the transverse myocutaneous gracilis (TMG) flap (n = 7) and the gracilis muscle flap with skin graft (n = 5). The average patient age was 63.4 years (range, 17–82 years). The indications for this procedure were tumor and haemangioma resections. The average patient follow‐up was 20.7 months (range, 1 month–5.7 years). Total flap survival was 100%. There were no partial flap losses. Primary wound healing occurred in all cases. Recipient site morbidities included one hematoma. In our experience for reconstruction of moderate volume and surface area defects, muscle flaps with skin graft provide a better color match and skin texture relative to myocutaneous or fasciocutaneous flaps. The gracilis muscle free flap is not widely used for head and neck reconstruction but has the potential to give good results. As a filling substance for large cavities, the transverse myocutaneus gracilis flap has many advantages including reliable vascular anatomy, relatively great plasticity and a concealed donor area. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.     

Reconstruction of major abdominal wall defects using the tensor fasciae latae myocutaneous flap

Five cases of abdominal wall reconstruction using the tensor fasciae latae myocutaneous flap are described. This flap provides a deep layer of tissue of sufficient strength to prevent herniation and external cover in a single stage repair. We regard it as the method of choice in the reconstruction of major defects of the abdominal wall.     

Reconstruction of the laryngotracheal complex in children using the sternocleidomastoid myocutaneous flap

Laryngotracheal stenosis in children should be treated effectively with minimal delay, and the tracheostomy should be closed within a reasonable period after surgery so that the child may develop normal speech and language. Successful reconstruction of the laryngotracheal complex was achieved by applying the superiorly based compound myocutaneous sternocleidomastoid muscle flap for wedge enhancement and resurfacing of the endolaryngeal and endotracheal lumen. A short stenting period, incorporating a custom-carved soft silicone laryngeal stent in direct continuity with an oversized silicone T-tube, helped in stabilizing the airway and ensuring good take of the flap. Postoperative recovery was relatively short, with good ventilation and vocal results. This single-stage technique may be readily performed, and it interferes minimally with the child's development.     

Reconstruction of complex groin defects with inferior epigastric artery-based rectus abdominis muscle flaps: report of two cases

Because the extremities are dependent on a single vascular supply, namely the brachial and femoral arteries, injuries around the girdles are challenging, and may contribute to high morbidity rates such as extremity loss, or even mortality due to bleeding, sepsis or vascular compromise. The reconstruction or aided closure of these regions may present additional technical difficulties in the presence of a vascular injury that complicates the use of a microvascular-free transfer, which sometimes may be needed to cover the exposed vessels, bones, tendons, and cartilages whenever the neighboring skin and subcutaneous tissue are inadequate or demised. In these circumstances, pedicled regional flaps of muscular or musculocutaneous consistency (especially if a bulk or rich vascular tissue is needed) would be an alternative. In this report, we present two cases that underwent femoral artery repair via saphenous vein grafting in the vascular surgery clinic followed by our inferiorly based pedicled rectus abdominis muscle flap coverage procedure.     

Reconstruction of complex and unusual defects of the thoracic wall

Summary From 1981 to. 1989, a total of 13 procedures were performed on 12 patients requiring complex reconstructions of the thoracic wall. The most common cause of these defects was cancer. Muscle flaps remain the treatment of choice for thoracic wall reconstruction and have been used in 10 cases. Microsurgical tissue transfer opens even larger therapeutic perspectives. A team approach is recommended.     

Reconstruction of extensive partial or total sacrectomy defects with a transabdominal vertical rectus abdominis myocutaneous flap

Following partial or total sacrectomy, extensive soft tissue defects are frequently created. These ablations typically involve an anterior and a posterior approach, creating a large communication between the abdominal cavity and the central gluteal region. Local flap options are usually not sufficient for definitive closure of these large defects. We have found that the most useful option for reconstruction in these cases is a vertical rectus abdominis myocutaneous (VRAM) flap, passed transabdominally through the peritoneal cavity into the sacral defect during the initial anterior-approach portion of the procedure and then inset following completion of the posterior-approach final resection. Advantages of the VRAM flap are that it can supply ample skin, as well as soft tissue bulk, is easy to perform, and does not require microvascular techniques. Utilizing a prospectively maintained database, all patients over the last 14 years who underwent reconstruction utilizing a transabdominal VRAM flap following extensive partial or total sacrectomy with intraabdominal communication were identified. A retrospective chart review was then performed. Our study population consisted of 12 patients with a mean age of 58.5 years. Following sacrectomy, all patients underwent reconstruction with a VRAM flap. Flap sizes averaged 9.1 x 27 cm. Early flap complications included 3 small areas of flap necrosis at the distal, superior portion of the flap, 2 of which required minimal operative intervention of debridement and reclosure. No late flap complications have occurred, and all 12 patients completely healed, with a mean follow-up time of 29.1 months. Following sacrectomy, extensive soft tissue defects are created in the sacral area and communicate with the abdominal cavity. In these situations, we have found the inferiorly-based pedicled VRAM, passed transabdominally, to be the most reliable and useful choice of flap reconstruction. It has a low incidence of complications, low morbidity, and is easy to perform with a high success rate.     

上睑滑行睑板结膜瓣联合颧颊部皮下蒂肌皮瓣修复下睑缺损

目的 探讨下眼睑全层缺损的手术治疗方法及疗效.方法 对6例下眼睑恶性肿瘤患者采用Mohs控制性切除术,利用上睑滑行睑板结膜瓣修复下睑后层缺损,颧颊部皮下蒂肌皮瓣修复下睑前层缺损.术后6周分离睑板结膜瓣,结果本组患者术后均随访3～6个月,无上睑退缩,下睑外翻及兔眼形成,外形、视觉功能良好,肿瘤无复发.结论 上睑滑行睑板结膜瓣联合颧颊部皮下蒂肌皮瓣修复下睑缺损是治疗下睑全层缺损的有效方法.