Coronary artery revascularization after chest wall reconstruction with rectus abdominis myocutaneous flap

The standard incision for a cardiac operation is a median sternotomy. In special situations, alternative approaches are needed. We report a 53-year-old woman who required coronary artery bypass grafting 10 days after chest wall reconstruction with a transverse rectus abdominis myocutaneous flap. We describe our technique, which allowed us to preserve the flap and resulted in good functional and aesthetic outcome.     

Postauricular myocutaneous flap in otologic surgery

Management of a large mastoid defect resulting from skull base operations or extensive surgical procedures because of chronic ear disease continues to challenge the otologic surgeon. Various local muscle or periosteal rotation flaps have been used to help reduce the size of the postoperative mastoid cavity. With these techniques there are problems with flap retraction and epithelization that may result in delayed healing or chronic drainage. Closure of the ear canal and tissue obliteration of the mastoid results in a maximal conductive hearing loss. A postauricular myocutaneous flap based on the occipital artery and sternocleidomastoid muscle has been used effectively to reconstruct mastoid defects after both surgical procedures for chronic ear disease and skull base operations. The skin muscle flap reduces the mastoid cavity and promotes rapid healing of the surgical defect. Although postauricular myocutaneous flaps have been found to be reliable, their viability may be compromised by arterial embolization used in larger glomus tumors. Indications for and creation of a postauricular myocutaneous flap, with results in 18 cases, are presented. (Otolaryngol Head Neck Surg 1998;118:743-6.)     

A cross-over pectoralis myocutaneous flap

Summary A right pectoralis major myocutaneous flap was raised and crossed over the midline to cover an exposed clavicle. This again illustrates the versatility of the pectoralis myocutaneous flap.     

Refinements of nasalis myocutaneous flap

During the last 3 years, we have applied the nasalis myocutaneous island flap for reconstruction of nasal defects following excision of skin basal cell carcinoma and melanoma in 19 patients. By refinements with Z plasty, early dermabrasion, and placement of a bolster, we could minimize the trapdoor deformity, obvious scars, and blunting of the alar groove. No patients required revisional surgery, and flap survival was 100%. On the basis of our experience, the nasalis myocutaneous island flap is the solution for reconstruction of moderate-sized distal nasal defects in terms of reliability, aesthetics, and simplicity.     

The split sternocleidomastoid myocutaneous flap

The transposition of both portions of the sternocleidomastoid muscle for the reconstruction of the face leaves a "flat neck deformity" which has discouraged many surgeons from using it in the treatment of benign cases. By splitting the muscle in its two portions and transposing only one, this deformity can be avoided. We present five cases to illustrate the versatility of the split sternocleidomastoid myocutaneous flap.     

Distally based gastrocnemius myocutaneous flap augmented with an arterial anastomosis--a combination of myocutaneous flap and microsurgery

Microsurgical techniques can augment the arterial blood supply of a distally based myocutaneous flap, by reanastomosis of the sural artery to a main artery of the leg, allowing the flap a greater length and arc of rotation to cover defects of the distal half of the leg. No venous anastomosis is required. This procedure was used in 17 patients with open tibial fractures. They all healed primarily without any early or late complications. The use of this augmented flap provides a simple and reliable method for reconstruction of difficult wounds of the distal lower leg. It is easier and safer than a free flap.     

Chin reconstruction with pectoralis myocutaneous flap

Chin reconstruction after radical surgery for carcinoma of the oral cavity is a complex and controversial problem. We have developed a simple, single-stage, primary procedure for chin reconstruction. It is easily mastered and is based on a simple modification of the pectoralis major myocutaneous flap. Our experience includes seven cases, including two with total chin reconstructions. The number and type of complication is low and consistent with the magnitude of the surgical procedure. This operation provides acceptable aesthetic and functional results to patients undergoing partial or total resection of the chin.     

The rectus abdominis myocutaneous free flap

The successful transfer of a free rectus abdominis myocutaneous flap based on the inferior epigastric vessels is reported. The preliminary experimental investigations leading to the design of this flap are described.     

Oblique latissimus dorsi myocutaneous flap in breast reconstruction

Breast reconstruction with latissimus dorsi myocutaneous flap is a reliable technique. Its width is limited to between 10 and 12 cm if direct closure of the donor site defect is required. We report a study with assessment of the dorsal skin laxity in 25 women, simulating vertical, horizontal and reverse oblique flap. The average width was 12.5 cm (11.6 to 14 cm) for reverse oblique flap, 9.4 cm (8 to 11 cm) for vertical and 9.2 cm (8 to 10.6 cm) for horizontal flap. Our study suggests that the reverse-oblique flap provides a wider flap and reduces the donor site morbidity.     

Infrahyoid myocutaneous flap in head and neck reconstruction

Infrahyoid myocutaneous flap is one of the alternatives to be considered for the reconstruction of moderate defects following resection of the oral cavity, oropharynx, or hypopharynx cancers. The flap is based on the uni-or bilateral superior thyroid pedicle; its major limitations are due to small flap volume and arc of rotation. The authors reviewed a series of 15 consecutive patients with carcinomas of the oral cavity or pharynx who underwent radical surgical resections followed by immediate reconstruction using an infrahyoid myocutaneous flap. Four of five cases with prior irradiation presented complications. The incidence of flap necrosis in this series (47%) was higher than that reported by others (10%). We consider the presence of massive neck metastasis and prior irradiation contraindications to the use of this flap.     

Latissimus dorsi myocutaneous flap in cervicofacial cancer surgery

Summary The authors present their experience with the latissimus dorsi myocutaneous flap in cervicofacial oncologic reconstructions. They conclude that it is a very reliable flap allowing a one stage reconstruction of extensive defects. Nevertheless they prefer to use it as a pedicle flap rather than a free flap because of the independence of the recipient site vascularisation and a shorter operative time.     

A dynamic myocutaneous flap for hand reconstruction

Relocation of functional units by neurovascular pedicle transfer is firmly established in reconstructive hand surgery. Transfer of muscle and overlying skin, the myocutaneous flap, to provide skin cover is equally established. The dynamic myocutaneous flap is an extension of these concepts. Injection studies confirmed that the abductor digiti quinti muscle and its overlying hypothenar skin could be transferred on its neurovascular bundle. This dynamic myocutaneous flap was used to reconstruct both skin cover and functional opposition following resection of an arteriovenous malformation involving the thumb. Other clinical applications would include reconstruction of thenar skin and muscle lost secondary to electrical burns, avulsion, or tumor resection.     

Platysma myocutaneous flap for intraoral reconstruction.

Fourteen patients were treated for intraoral epidermoid carcinoma with a single stage reconstructive technic employing a myocutaneous flap based upon the platysma muscle. This flap carries on its distal tip a portion of isolated cervical skin to be used for intraoral replacement of the resected tissue. The flap has proved to be highly reliable and has significant benefits over many other technics commonly employed for head and neck reconstruction.     

Reconstruction of chest wall using myocutaneous flap

Reconstruction of chest wall using myocutaneous flap has been performed in 2 cases. A 72-year-old female referred to our hospital for locally recurrent left breast cancer without any distant metastases. The other patient was a 77-year-old female, having locally recurrent liposarcoma of the left lateral chest wall. Chest wall was resected with wide margin of normal tissue, and myocutaneous flaps of latissimus dorsi were used for reconstruction of skin defect (13 x 8 cm and 14 x 10 cm) in both cases. Although additional split-thickness skin graft was required for one of them, myocutaneous flaps were useful for the reconstruction of widely defected chest wall. By using this technique, wider margin can be obtained, which could decrease the risk for local recurrence of malignant tumor.