Freestyle perforator flaps: an innovative approach to soft tissue reconstruction

Resurfacing of soft tissue defects consequent to skin cancer, melanoma, or sarcoma excision in different anatomical districts represents a difficult challenge for the plastic surgeon. Classic reconstructive procedures are frequently charged by unsatisfactory results. The introduction of perforator flaps in the clinical practice represented a revolution in the field of reconstructive plastic surgery. The technique further evolved with the introduction of the freestyle concept, allowing one to harvest a skin flap from any region of the body where an appropriate and detectable Doppler signal is present and to resurface soft tissue defects mobilizing the surrounding tissues, which present similar features compared with the recipient site in terms of color and texture, on a consistent vascular source and in a tension‐free manner. The authors present their personal approach to the reconstruction of soft tissue defects after excision for a basal cell carcinoma involving the medial tibial region.     

Aesthetic reconstruction of retroauricular keloid: Creating a keystone flap from the mastoid‐helix area

Advances in aesthetic rhinoplasty using conchal cartilage grafts have led to a high occurrence of retroauricular keloids. The purpose of this study is to introduce our surgical experiences using a keystone flap in retroauricular keloids following conchal cartilage grafts. The present study is a retrospective review of patients with pathologically confirmed retroauricular keloids following conchal cartilage grafts. These cases were surgically excised and we covered the defect with a keystone flap followed by one‐time steroid injection at postoperative day 14 and silicone gel sheeting application for 3 months. Treatment outcome was recorded as recurrence or non‐recurrence. In all patients, a follow‐up period of minimum 12 months was required. Of these patients, 90.0% had successful treatment of their auricular keloids, whereas 10.0% had recurrences. The postoperative course was uneventful. In conclusion, our aesthetic reconstruction using a keystone flap created from the mastoid‐helix area is a useful treatment strategy in terms of retroauricular keloids following conchal cartilage grafts.     

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.     

Surgical gem: Island advancement flaps for lip reconstruction

Island advancement flaps provide specific advantages for repairing certain defects on the upper lip. We discuss the design and execution of this flap for defects on the alar sill and philtrum.     

Reconstruction of the upper lip with lip switch (Abbe flap reconstruction)

The lip switch operation (Abbe) is useful for full thickness defects of the upper lip. Careful design of the flap with pedicle take-down and inset of the flap after 2 weeks, leads to a predictably good reconstructive result. The flap is most useful for 30-50% full thickness defects of the upper lip.     

Total and near‐total lower eyelid reconstruction with prefabricated orbicularis oculi musculocutaneous island flap

Full thickness lower lid defects are frequently encountered during daily practice. The unique anatomy of the eyelids hinders reconstructive efforts. The aim of the study is to develop an effective and easy procedure for the reconstruction of full thickness defects of the lower eyelid. Here we present six cases, which we treated with an orbicularis oculi musculocutaneous island flap prefabricated with a chondrocutaneous graft. Five of the six cases suffered from tumors, while one had congenital coloboma of the lower lid. A chondrocutaneous graft harvested from the ear was placed under the orbicularis oculi musculocutaneous flap. Three weeks later, the defect was created and the prefabricated flap was transposed to the defect. Two cases had superficial distal skin loss and one had prolonged oedema. No major complication or tumor recurrence was seen. Using this method, the principle “replace with like” is fulfilled. Orbicularis oculi musculocutaneous island flap prefabricated with postauricular chondrocutaneous composite graft seems to be a feasible method for the reconstruction of full thickness defects of the lower eyelid with its low donor morbidity and good outcomes.     

随意皮瓣在面部病损修复中的应用

目的：探讨随意皮瓣法在面部中等面积以上皮肤缺损修复中的应用。方法：在局麻下，切除病变组织，根据缺损的形态制作邻位随意皮瓣（旋转皮瓣、滑行皮瓣及岛状皮瓣等），通过旋转、滑行、皮下蒂转移等方式移动到缺损处，修复创面。结果：56例患者，行此手术充分利用了周围正常皮肤，避免了切除丢弃，使瘢痕局限，组织平坦，不造成周围器官的移位，均获得比较理想的手术效果。结论：随意皮瓣法是修复中等面积以上皮肤缺损比较理想的方法。     

改良式Koyanagi尿道阴茎成形术联合高压氧辅助治疗先天性重型尿道下裂的临床效果分析

目的:探索改良式Koyanagi尿道阴茎成形术联合高压氧辅助治疗先天性重型尿道下裂的临床治疗效果。方法:采集绵阳四○四医院和绵阳市中心医院小儿外科收治的42例先天性重型尿道下裂患儿作为观察对象,随机将其分为对照组和试验组,每组各21例,对比组采用Koyanagi尿道阴茎成形术治疗,试验组采用改良式Koyanagi尿道阴茎成形术(Koyanagi尿道阴茎成形术+睾丸鞘膜覆盖技术)并联合高压氧辅助治疗,对比两组患者术后其阴茎下曲矫正效果、尿道重建成功率、阴茎外观满意度、转移包皮皮瓣存活率及术后并发症发生率等情况。结果:经统计分析发现,试验组患儿阴茎下曲矫正成功率为85.71%,明显高于对照组(χ~2=5.459,P=0.019);两组尿道重建总成功率比较,试验组同样具有明显优势(χ~2=4.200,P=0.040);两组术后阴茎外观满意度比较,试验组总满意度为85.71%,明显高于对照组的57.14%(χ~2=4.200,P=0.040);此外,试验组患儿术后经高压氧治疗后转移包皮皮瓣存活率显著高于对照组(χ~2=6.035,P=0.014),且并发症的发生率显著低于对照组(χ~2=4.725,P=0.030)。结论:改良式Koyanagi尿道阴茎成形术联合高压氧辅助治疗先天性重型尿道下裂有极好的临床治疗效果,同时降低了患者的并发症的发生率,患儿家属满意度较高,有较高的临床参考价值。     

颊部滑行瓣一期修复唇缺损

目的探讨应用颊部滑行瓣修复唇缺损的方法。方法对于唇缺损1/3者采用单侧颊部滑行瓣或带黏膜瓣的鼻唇沟瓣修复;对于唇缺损1/2者采用双侧颊部滑行瓣修复;对于全下唇缺损者则采用双侧颊部滑行瓣加延长颊黏膜瓣修复。结果本组13例患者术后伤口均一期愈合,唇外形及功能恢复满意。结论应用颊部滑行瓣修复唇缺损,操作较简便。术后唇的外形和功能的恢复较远位皮瓣或皮管修复好,尤其适用于中老年唇缺损患者。     

游离皮瓣移植即时修复中晚期舌癌根治性切除后的舌缺损

目的总结中晚期舌癌根治性切除即时进行舌再造的经验。方法对12例中晚期舌癌患者应用前臂皮瓣(11例)和股前外侧皮瓣(1例)即时修复中晚期舌癌根治性切除后的舌缺损。结果12例皮瓣全部(100%)成活。其中11例再造舌形态良好,功能满意;1例再造舌形态功能欠佳。结论以游离皮瓣修复中晚期舌癌根治性切除后的舌缺损,可较好恢复舌的形态和功能, 提高生存质量。     

Partial nasal reconstruction with titanium mesh: report of five cases

The nasal pyramid is frequently affected by nonmelanoma skin cancer. Sometimes the aggressiveness of tumours entails the extirpation of the mucosa, the cartilage, and the nasal skin. Reconstruction of the cartilaginous portion can be a surgical challenge. We demonstrate that titanium mesh can be an effective substitute for the cartilaginous portion of the nose in nasal reconstruction. We present five patients with nasal basal cell carcinoma who were treated by Mohs micrographic surgery. The partial loss of the cartilaginous structure was replaced by a 0·1 mm fenestrated titanium mesh. We have not observed any rejection or other complication in any of our patients. Good functional and aesthetic results have been obtained. Because of its biocompatibility, titanium mesh is a useful substitute for nasal cartilage. It avoids harvesting natural cartilage, reduces the risk of graft necrosis, and prevents morbidity in the donor area.     

Three cases of reconstruction with a simply designed bilobed flap after excision of squamous cell carcinomas of the lateral eyebrow areas

Squamous cell carcinoma is frequently observed on the lateral eyebrow, one of the most difficult sites for one‐stage reconstruction because of its location close to the eyelids. The reconstruction of defects by the single‐stage flap is advantageous for elderly patients because of its good functional and aesthetic outcome. We surgically treated three cases of squamous cell carcinoma on this area and performed reconstruction with a simply designed bilobed flap, all of which resulted in favorable outcomes. We therefore report on the usefulness of this reconstructive method for the lateral eyebrow defects.     

Colgajo crescéntico nasoyugal en la reconstrucción de defectos de punta nasal: una serie de 13 casos

Reconstruction of the tip of the nose following the excision of skin cancer is a cosmetic and surgical challenge. We propose using a crescentic nasojugal flap, also known as a perialar crescentic advancement flap, to repair such defects. We present a series of 13 cases in which cutaneous carcinoma (mostly basal cell carcinoma) was excised from the lateral nasal tip with clear margins and the defect repaired with a crescentic nasojugal flap. The technique was successful in all cases. None of the patients developed notable surgical complications and the postoperative outcomes were satisfactory, with no significant functional or cosmetic problems. The crescentic nasojugal flap is therefore a good option for repairing medium-sized defects on the tip of the nose.     

The keystone flap and its simplified version for malignant skin tumor defects of the lower limbs: A review of 25 cases

BackgroundSkin tumors commonly occur on the legs and are treated in first line by surgery. Several techniques are available to repair lower limb defects: secondary-intention healing, partial closure, primary closure with or without an s-plasty, or a skin graft. The lack of tissue laxity of the surrounding skin does not allow several local flaps (advancement, rotation, or transposition). Closing large skin defects at this site may be challenging.Patients and methodsWe retrospectively reviewed a series of consecutive patients undergoing malignant tumor wide excision on lower limbs, with a keystone flap or its simplified technique (releasing incision) for closure of a skin defect.ResultsTwenty-five patients, 17 women and 8 men, ranging from 19 to 95 years old (mean age: 70 years) were included. Keystone flap reconstruction on the lower limbs was performed in 19 cases and the simplified technique in 6. The excised tumors were as follows: squamous cell carcinoma (n = 6), basal cell carcinoma (n = 9), melanoma (n = 9) and Bowen's disease (n = 1). Three local complications were observed. No cases of recurrence were observed.ConclusionKeystone flap is a reliable surgical method for reconstruction of lower limb skin defects. Aesthetic results are better than when a skin graft is used, complications are uncommon, and prolonged operative time is avoided.     

Transverse twist flap for lip reconstruction in patient with lentigo maligna of the labial mucosa

The transverse twist flap technique is used for secondary reconstruction of asymmetric volume-deficits of the cleft lip. We present a patient with lentigo maligna of the labial mucosa who underwent reconstruction using this technique. The result was excellent and there was no postoperative complications. The transverse twist flap is a useful and effective option for the reconstruction of lip defects after excision of lentigo maligna.     

Flexible application of scar tissue flaps in scar contracture release surgery: A retrospective study

Background

Complete release of scar contracture often relies on surgery, but if the surgery injures normal skin tissue triggers new wounds and scarring, which adds insult to injury for the patient.

Objective

To explore a method that uses scar tissue to repair the defect after the release of scars and try to avoid damage to normal skin tissue.

Materials and Methods

Forty-eight scar contracture patients admitted to our hospital from October 2014 to October 2019 were treated with scar tissue flaps (including Subcutaneous pedicle rhomboid flap, Z-plasty flap, 5-flap, and their combination model) and minor defects in combination with little scattered skin grafts. Medical and demographic data were collected on each patient. Assessed the joint range of motion (ROM) preoperatively and postoperatively, and complication was recorded. The rate of scar contracture recurrence was recorded at a follow-up of 6–24 months.

Results

Twenty-eight cases of scar contracture located in the joint sites, 20 in the trunk. All the surgical outcomes were satisfied, with significant improvement in contracture scarring and joint status. Postoperative joint range of motion (ROM) showed a significant improvement in comparison with preoperative mobility, whereas the difference was statistically significant (p < 0.05). After 24 months of follow-up, five joints showed recontraction, with a recurrence rate of 10.42%.

Conclusion

Scar contracture could be efficiently treated by properly designing incisions and making the most of the scar tissue flap, to minimize and avoid damage to the normal skin.