Comparison of the outcomes of adipofascial and two–staged fasciocutaneous reverse sural flap in patients with lower leg trauma

BackgroundDistal one – third trauma of the lower limb is a complex condition to treat. The reverse sural flap is a time tested procedure for reconstruction of such defects especially in patients where free flaps are ruled out due to comorbidities. The purpose of this study is to compare the two modifications of the classical technique of reverse sural flap (adipofascial and fasciocutaneous) which is lacking in the literature.Material & methodsIn this study, the authors conducted a retrospective analysis of 67 patients with lower one-third leg defects reconstructed with either adipofascial reverse sural flap (Group A, n = 37) or two-staged fasciocutaneous reverse sural flap (Group B, n = 30) in a tertiary care hospital in North India between 2015 and 2019. An evaluation of the different flap characteristics of the two variants of the reverse sural flap was done and compared. Mean follow up period was 12 months.ResultsThe adipofascial group showed shorter operative time, was a single-stage and with better reach and aesthetic outcome. The complications did not differ except that for the adipofascial group was associated with unstable skin graft over the flap initially which did not require any treatment.DiscussionLower one-third defect of the lower limb has been a challenge for reconstructive surgeons all over the world. The goal of reconstruction is a functional lower limb. Although free tissue transfer is the preferred modality of treatment of such cases but it may not be possible in all cases due to various reasons. Reverse sural flap is a very lucrative local option for such reconstructions as it is easy to perform, reliable, low profile and bulk, require minimal facilities with less operative time. Adipofascial flaps represent an extremely useful modification of the reverse sural flap which is quick to perform with minimal donor site morbidity.ConclusionAdipofascial reverse sural artery flap is a good option for patients with lower limb trauma with the added advantage of being single-stage and with better donor site cosmesis as compared to the fasciocutaneous reverse sural artery flap.     

耳后联合筋膜皮瓣全耳廓再造的临床研究

目的：探讨颞顶筋膜瓣、耳后筋膜瓣两瓣（简称：耳后联合筋膜瓣）包裹Medpor支架行先天性小耳畸形全耳再造术的方法和效果。方法：手术分为两期：I期采用颞浅动静脉顶支为血管蒂的岛状筋膜瓣,植入残耳乳突区耳后剥离的皮下腔穴,然后植入皮肤扩张器与耳后筋膜皮瓣进行同期同步扩张;II期取出扩张器,将扩张耳后联合筋膜皮瓣包裹Medpor支架行全耳廓再造术。结果：38例患者中,经6个月～3年的随访,再造耳形态结构稳定,颜色与周围皮肤相近,微细结构清晰,颅耳角良好与健耳对称。结论：该方法既可解决覆盖支架的难题,又将手术并发症减少到最低限度,避免支架外露。是目前较为理想的全耳廓再造术的一种新方法。     

Transformation of the glabellar flap into an island flap

Summary Glabellar flaps have traditionally been used to cover nasal skin and soft tissue defects. The narrowing of its vascular pedicle to the cutaneous arterial branch of the angular artery categorizing it as an axial flap pattern. Three cases are presented, the first of which typifies the standard glabellar flap with an intact skin and subcutaneous pedicle. The other two cases utilize a glabellar island flap based on a subcutaneous pedicle containing cutaneous arterial branch of the angular artery. This technique extends the mobility of this flap to allow one-stage reconstruction of adjacent defects.     

Monitor selection according to the defect location in the medial femoral condyle flap,

BackgroundMedial femoral condyle(MFC) flap is frequently used in hand reconstruction, but like other buried flaps, MFC is not easy to monitor and follow.In this study, we present our adipofascial and periosteal tissue technical modifications and results for MFC free flap monitoring and compare different monitoring methods.MethodsTwenty one patients with wrist bone or metacarpal defect reconstructed with MFC flap were included in the study. Adipofascial tissue in wrist defect and periosteal tissue in metacarpal defect were selected as MFC flap's monitor. Patient characteristics, type of injury, flap size, early or late-period complications, flap elevation time,satisfaction scale, visual analogue scale (VAS) and postoperative X-ray view were noted.ResultsThere were 3 female and 18 male patients in the study. The mean age of the patients was 50.8 (38–68). The elevation times of flaps with adipofascial and periosteal monitors were 48 and 53.3 min, respectively. The satisfaction scale averages for the adipofascial and periosteal monitor groups were 3.5 and 3.54, respectively. The VAS scores of the adipofascial and periosteal monitor groups were 2.9 and 3.9, respectively. The flap sizes with periosteal and adipofascial monitors were 10.48 cm³ and 1.36 cm³, respectively. There was no statistically significant difference between flap elevation, VAS, and satisfaction scale (>0.05). There was a statistically significant difference in flap sizes. (<0.05)ConclusionMFC free flap is frequently used in wrist and metacarpal reconstruction. Monitor selection according to the defect area positively affects the prognosis of the flap in the postoperative period.     

筋膜皮下组织瓣加植皮术修复足部创面

目的：探讨小腿逆行筋膜皮下组织瓣加植皮术修复足部创面的应用情况。方法：应用小腿逆行筋膜皮下组织瓣加植皮术修复13例足部创面缺损,筋膜皮下组织瓣面积为12cm×7cm～8cm×4cm。结果：1例筋膜瓣边缘坏死面积1.5cm2,经换药处理后愈合,12例筋膜瓣全部成活。结论：应用小腿逆行筋膜皮下组织瓣加植皮术修复足部创面缺损,不损伤主要血管,操作方便,皮瓣成活率高,值得推广。     

The postauricular fasciocutaneous flap with an adipofascial extension: A case report

IntroductionA complex defect on the anterior surface of the ear requires flap cover; such as the postauricular skin flap. The postauricular skin flap has never been used with an adipofascial extension.Presentation of caseA 5-year old boy was involved in a car accident resulting in an exposed cartilage of the upper part of the right ear. The defect was covered with a post-auricular fasciocutaneous flap with an adipofascial extension. The adipofascial part of the flap was covered with a skin graft.DiscussionThe adipofascial extension serves two purposes: Firstly, it allows easier primary closure of the donor site. Secondly, it is less bulky and hence it does not observe the definition of the ear cartilage.ConclusionOur case is the first case reported in literature using the post-auricular fasciocutaneous flap with an adipofascial extension.     

股前外侧脂肪筋膜瓣血管三维结构的研究及应用

目的 研究股前外侧脂肪筋膜瓣的血供模式以便合理应用于临床。方法 对8具16侧成人下肢标本灌注后解剖观察股前外侧脂肪筋膜瓣的血供特点，并作血管结构的三维分析。在此基础上，采用吻合血管的股前外侧游离脂肪筋膜瓣移植矫治进行性半侧颜面萎缩瘢痕挛缩或发育不良15例，双侧隆乳术1例。结果 16例股前外侧脂肪筋膜瓣血管三维结构特点相同，由轴型血管营养，逐层发布，血供丰富。临床应用16例17块组织瓣全部成活，随访6个月－11年，远期效果稳定，无吸收，形态满意。供区无功能障碍，外观影响不大。结论 股前外侧脂肪筋膜瓣血供丰富，可即期修薄塑形，是软组织缺损用带血运的组织充填修复较理想的材料。     

预制扩张耳后乳突区复合筋膜皮瓣在全耳再造中的应用研究

目的：研究采用预制扩张耳后乳突区复合筋膜皮瓣行全耳廓再造的方法和效果。方法：手术分二期完成。I期手术：设计带有颞浅动静脉蒂的颞顶筋膜瓣,移植入残耳乳突区皮下腔穴,然后置入皮肤扩张器,与耳后皮瓣进行同时同步扩张I;I期手术：将预制扩张的耳后乳突区复合筋膜皮瓣掀起,覆盖于Medpor支架上,进行全耳廓再造术。结果：36例患者经6个月～3年的随访,再造耳廓外形逼真,立体感强,与周围皮肤颜色相同,微细结构清晰。结论：采用预制扩张的耳后乳突区复合筋膜皮瓣＋Medpor支架行全耳再造,具有创伤小,操作方便,效果满意。既可避免支架外露,又可避免取自体肋软骨增加的创伤和痛苦或肤色差异等优点,是目前全耳廓再造术较为理想的选择方法。     

游离腓动脉穿支筋膜瓣修复手部皮肤缺损

目的 探讨应用游离腓动脉穿支筋膜瓣修复手部软组织缺损,减少供区损伤的方法和临床效果.方法 2007年12月至2009年10月,对6例手部皮肤缺损患者,应用游离腓动脉肌皮穿支筋膜瓣进行修复,切取面积为5.0 cm×4.5 cm～10.0 cm×7.0 cm,以肌皮穿支为蒂.动脉血管蒂与受区血管采用端侧吻合,受区筋膜瓣行断层植皮覆盖.供区创面直接缝合.结果 术后6例筋膜瓣全部存活;术后7 d,筋膜表面植皮成活大于90%4例,80%2例.随访时间为3～12个月,1例皮瓣臃肿,术后3个月行皮瓣修整术;5例皮瓣略臃肿,外观满意.小腿供区仅留线条瘢痕.结论 腓动脉穿支筋膜瓣是在腓动脉穿支皮瓣基础上的改良,目的 是减少供区创伤,改善小腿外观.筋膜瓣本身可以填充组织缺损,为功能重建提供条件.     

Iliac crest free flap and submental island flap for maxillary reconstruction

Abstract

The iliac crest free flap is one of the most reliable flaps for maxillary reconstruction because of the large amount of bone provided and the chance to harvest both muscle and skin. However, reconstruction of maxillary through-and-through defects requires special skills to be managed. Simultaneous replacement of oral lining and external tissue with the same features as the resected skin is difficult to achieve with conventional techniques and the use of flaps association is often necessary to ensure acceptable cosmetic and functional results. In the case presented the submental island flap was a good choice to overcome these difficulties.     

Immediate reconstruction using a modified thoracodorsal adipofascial cutaneous flap after partial mastectomy

The treatment of early breast cancer using breast conservation therapy (BCT) usually ensures local control and acceptable cosmetic results. We report a useful technique involving the use of a thoracodorsal adipofascial cutaneous flap for reconstructing defects in the upper-outer quadrant area after partial mastectomy that has achieved excellent results. We developed this procedure as an oncoplastic technique for treating a Japanese woman with a similar defect and a relatively slim body. In this procedure, partial mastectomy is followed by raising the anterior half of the flap via the same skin incision, and the posterior half is raised via an additional incision posterior to the axillary area to produce a crescent of de-epithelialized skin. A C-shaped flap containing a crescent of de-epithelialized skin composed of subcutaneous fat and the fascia of the latissimus dorsi muscle is then rotated, gathered, and inset into the breast defect.     

颞顶筋膜瓣与扩张皮瓣联合覆盖Medpor支架外耳再造术

目的探讨颞顶筋膜瓣与扩张皮瓣联合覆盖Medpor支架再造外耳的效果。方法手术分两期进行:一期手术在乳突区置入皮肤软组织扩张器,并定时注水扩张;第二期手术将扩张器取出并形成蒂在前的扩张皮瓣、掀起以颞浅血管为蒂的颞顶筋膜瓣,应用颞顶筋膜瓣和乳突区扩张皮瓣双重由里至外覆盖Medpor耳支架完成耳廓再造。结果临床应用22例,随访半年至2年半,无耳支架外露发生,再造的耳廓外形逼真,轮廓分明,肤色与周围正常皮肤一致。结论应用乳突区扩张皮瓣及颞顶筋膜瓣双层组织瓣包被Medpor耳支架,可以提高Medpor耳支架置入的安全性,避免发生外露,又不影响支架外形和轮廓的显现,再造耳表面皮肤的色泽与周围皮肤一致。     

小隐静脉-腓肠神经逆行筋膜瓣的临床应用

目的 探讨应用小隐静脉-腓肠神经筋膜瓣联合全厚皮片移植修复小腿远段及足踝部软组织缺损的临床疗效. 方法 在小腿后侧设计小隐静脉-腓肠神经的筋膜瓣联合全厚皮片移植治疗小腿远段及足踝部单纯软组织缺损12例,软组织缺损伴胫骨骨髓炎3例、跟骨骨髓炎2例,皮肤缺损范围3cm×5 cm～9 cm×13 cm,切取筋膜瓣最大13 cm×18 ca.供筋膜瓣区保留皮肤及髂腹股沟取皮区皮肤均直接缝合. 结果 术后17例筋膜瓣联合全厚植皮均完全成活,成功治愈软组织缺损及骨髓炎,筋膜瓣供区、受区以及髂腹股沟取皮区均一期愈合,所有病例获得随访,随访时间为6～12个月,平均9个月,外形平整美观,供区保留皮肤感觉正常. 结论 带小隐静脉-腓肠神经筋膜瓣联合全厚皮片移植既能充分治愈小腿远段及足踝区软组织缺损以及骨髓炎,同时也能最大程度保护患肢功能及整体外观.     

Contralateral unaffected breast augmentation using zone IV as a SIEA flap during unilateral DIEP flap breast reconstruction

BackgroundContralateral breast augmentation during unilateral breast reconstruction is a good option for women with small breasts. In patients with adequate lower abdominal tissues, the deep inferior epigastric perforator (DIEP) flap is often the first choice for unilateral autologous breast reconstruction. We use Zone IV, which is usually excised owing to its insufficient blood circulation, as a superficial inferior epigastric artery (SIEA) flap for contralateral breast augmentation.MethodsBetween October 2004 and January 2016, 32 patients underwent unilateral breast reconstruction using a DIEP flap and an attempted simultaneous contralateral breast augmentation with an SIEA flap. The unilateral DIEP flap attached to the contralateral SIEA flap was split into two separate flaps after indocyanine green angiography. In all patients, ipsilateral internal mammary vessels were used as recipient vessels for DIEP flap breast reconstruction. The SIEA flap pedicle was anastomosed to several branches of the deep inferior epigastric vessels. The SIEA flap was inset beneath the contralateral breast through the midline.ResultsOf 32 patients, 27 underwent DIEP flap breast reconstruction and simultaneous unaffected breast augmentation using 25 SIEA or 2 superficial circumflex iliac artery perforator (SCIP) flaps. All DIEP flaps survived, and total necrosis occurred in one SIEA flap. The mean weight of the final inset for DIEP flap reconstruction and SIEA or SCIP flap augmentation was 416 g and 112 g, respectively.ConclusionsUnilateral DIEP flap breast reconstruction and contralateral SIEA flap breast augmentation may be safely performed with satisfactory results.     

Plantar flap reconstruction for acral lentiginous melanoma

Background: Acral lentiginous melanoma continues to be difficult to diagnose despite an overall trend toward early identification of smaller and thin lesions. The insidious nature of this lesion often precludes primary closure of the surgical defect once it is excised, adding to the reconstructive complexity. Local flaps on the plantar foot offer an option for reconstruction when the defect is of intermediate size. Methods: Eight patients (5 men and 3 women, with an average age of 58 years) who underwent plantar flap reconstruction for defects isolated to the weight-bearing heel were retrospectively reviewed. Results: The average depth of the melanoma was 2.82 mm. Surgical margins were 2 cm or less in seven of the eight patients. Partial flap necrosis occurred in one patient, and loss of part or all of the skin grafts was noted in two patients. Currently five patients are alive with no evidence of disease. Conclusion: The plantar flap can provide local well-vascularized tissue for weight-bearing areas where skin grafting alone may not be appropriate. Coverage of these areas with well-padded flaps led to ambulation in all of the patients studied. We believe this flap offers durable coverage for medium-sized defects in acral lentiginous melanoma.     

Reversed anterolateral thigh adipofascial flap for knee and proximal calf defects

BACKGROUND: Reconstruction of defects involving the knee and proximal one third of the lower leg presents a challenging problem in plastic surgery. AIM: To evaluate the reversed anterolateral thigh adipofascial flap for covering such defects. METHODS: Between September 2006 and May 2007, one man and four women with defects around the knee and upper calf underwent reconstruction with reversed anterolateral thigh adipofascial flaps. The patients' average age was 45 years (25-72 years). The size of the transferred flap ranged from 6cmx8cm to 12cmx13cm. RESULTS: Four flaps with overlying skin grafts healed uneventfully; one skin graft showed minor necrosis due to haematoma, but the adipofascial flap survived well. Postoperatively the appearance of the reconstructive flap was acceptable. CONCLUSIONS: The reversed anterolateral thigh adipofascial flap is an effective option for covering defects of the knee and proximal calf.     

颞筋膜瓣和E-PTFE在面部皮下软组织缺损修复中的应用

目的：探讨颞筋膜瓣、e—PTFE在面部皮下软组织缺损修复中的应用价值。方法：应用颞筋膜瓣、e-PTFE并采用不同切口入路对面部软组织缺损进行修复。软组织充填多在皮下脂肪层下潜行分离，行颞筋膜、e—PTFE充填。结果：本组修复的患者术后均Ⅰ期愈合，面部轮廓改善理想，触诊手感自然，其中1例患者1月后修复区有一直径5mm大的皮肤坏死，其余均无其他并发症发生。结论：应用颞筋膜瓣、e—PTFE进行面部皮下软组织缺损充填是理想而损伤小且效果明显的修复方法。     

Immediate reconstruction using inframammary adipofascial flap of the anterior rectus sheath after partial mastectomy

Treatment of early breast cancer using breast conservative therapy (BCT) usually ensures local control and acceptable cosmetic results. To repair defects caused by partial mastectomy in the lower region of the breast, some reconstruction should be used. We developed a procedure involving the cranial based adipofascial (anterior rectus sheath) flap from immediately below the inframammary area for the reconstruction of defect due to partial mastectomy for patients with early breast cancer. In this procedure, a skin incision is made at the inframammary line, and the inframammary skin area is undermined. A tongue shaped flap composed of the subcutaneous fat and the anterior sheath of rectus abdominis muscle is pulled up and a C-shaped flap is rotated, gathered, and inserted to reconstruct the breast defect.     

改良小腿筋膜蒂皮瓣修复皮肤缺损的临床应用

目的 探讨改良的小腿筋膜蒂皮瓣修复皮肤缺损的临床应用.方法 对6例小腿皮肤缺损钢板或骨外露创面患者,缺损面积：1.8 cm×3.0 cm～3.2 cm×6.5 cm,分别以改良的小腿筋膜蒂转移皮瓣修复,经过精确测量,将皮瓣通过皮下隧道转移至受区覆盖皮肤缺损创面,供区直接缝合.结果 6例皮瓣全部成活,供区仅线性瘢痕.术后随访2个月～2年,平均7个月,小腿功能良好,皮瓣外观满意,皮肤质地好.结论 改良的小腿筋膜蒂皮瓣在修复皮肤缺损的临床应用中是一种简单、安全、理想的手术方式.     

Anterolateral thigh flap

The anterolateral thigh (ALT) flap is a versatile soft tissue flap. It can be harvested as a fasciocutaneous or myocutaneous flap. Vascularized fascia can be included or the pedicle may be harvested as a flow‐through flap. The flap can also be harvested incorporating multiple skin islands or as a chimeric flap incorporating separate skin and muscle components. When a large flap is needed, the entire lateral thigh can be harvested by combining the ALT with either the tensor fascia lata or the anteromedial thigh flap as a conjoined flap. Morbidity is remarkably minimal despite the availability of such generous amounts of tissue. The purported difficulty with the use of this flap is because of the anatomical variations that may render this flap unreliable. This paper clarifies the vascular anatomy of the flap and elaborates an approach to flap harvest that can be used to reliably harvest the flap in spite of the anomalies that may be encountered. © 2009 Wiley Periodicals, Inc. Head Neck, 2010