Bilobed fasciocutaneous flap closure of large meningomyeloceles

BACKGROUND: Closure of large meningomyelocele defects presents a challenging problem. In this paper, the procedure and outcome of bilobed fasciocutaneous flap closure of large meningomyeloceles have been discussed. MATERIALS AND METHODS: Bilobed fasciocutaneous flap was used in 20 patients with large meningomyelocele defects, the largest of which was 77 cm2. A fasciocutaneous dissection was performed and the defect area was covered by tension-free closure. RESULTS: In the follow-up period of 6 weeks, partial flap loss in a patient and cerebrospinal fluid leak inferior to the flap in another 2 were observed. These patients recovered by dressing without flap loss. CONCLUSIONS: Utilization of bilobed flaps for closure of large meningomyelocele defects seems to be an effective and reliable procedure, with advantages of decreased operative time, minimal bleeding, the suture lines for dura and flap not superimposed, and low morbidity.     

Myelomeningocele repair by a combined fasciocutaneous flap closure

Summary The principles of myelomeningocele repair have been clearly described in the literature^1–5 and generally delineate a technique that calls for the dissection and closure of five separate layers: arachnoid, dura, fascia a subcutaneous layer, and skin. We should like to describe our technique of repairing the myelomeningocele defect following dural separation and closure by shifting complete fasciocutaneous tissue blocks from either side of the defect to the midline following dural closure. A full thickness primary closure can be obtained even in large defects.     

Bilobed fasciocutaneous flap

The use of a bilobed fasciocutaneous flap in the reconstruction of lower leg defects is described. Two successful cases and the advantages of the bilobed fasciocutaneous flap in lower leg reconstruction are emphasised.     

A new incision for surgery on tendo Achillis using a distally-based fasciocutaneous flap

The consequences of breakdown of the wound after surgery to tendo Achillis are considerable. Complex surgery is often required to reconstruct the tendon and to provide soft-tissue cover. We describe a new incision which approaches the tendon by using a distally-based fasciocutaneous flap. This reduces the risk of breakdown of the wound since it avoids making an incision directly over the tendon, provides good exposure, and maintains the vascularity of the skin overlying the tendon.     

Perforator-based fasciocutaneous flap for pressure sore reconstruction

Abstract

Pressure sore reconstruction is always a challenge for plastic surgeons due to its high recurrence rate. In addition to the myocutaneous flap, the perforator-based fasciocutaneous flap has become a new entity used for pressure sore reconstruction. This study presents a series of 26 perforator-based fasciocutaneous flaps for pressure sore reconstruction, with good outcomes in 21 patients from July 2008 to April 2011. The flaps were advanced, transposed, or rotated to obliterate the defects. Twenty of 26 flaps healed uneventfully without complication. One patient had a flap that totally necrosed, one had partial flap necrosis (flap rotated 180° in the above two cases), one had infection and healed by a secondary flap, one had minor wound dehiscence, one died of pneumonia 1 week postoperatively, and recurrence developed in one patient. The perforator-based fasciocutaneous flap is a reliable method and produced good results in this series. These flaps are well vascularised, have enough soft tissue bulk, and have a high degree of mobilisation freedom.     

耳前窄蒂侧颌颈皮瓣修复面部缺损

目的探讨侧颌颈皮瓣的设计应用及血供类型.方法设计蒂部位于耳前的由颌缘走向颏下的窄蒂皮瓣,用于中老年面部恶性肿瘤切除后软组织缺损的修复.皮瓣最大10 cm×6 cm,蒂宽2.5～3.0 cm,长2～4 cm.结果本组4例,面部恶性肿瘤切除后应用改进设计的侧颌颈皮瓣修复创面,全部获得成功,术后外形良好,供区直接松解缝合,肿瘤无复发.结论侧颌颈部皮瓣应属于跨区供血皮瓣.设计时宜斜行走向,蒂部不宜过窄,供区可直接闭合,解剖层次表浅,手术时间短,同时为患者提供术后及早的综合性治疗,如放疗,是中老年患者面部恶性肿瘤切除创面修复的理想选择.     

Free vertical abdominal fasciocutaneous flap

The use of a free vertical fasciocutaneous flap in total cheek reconstruction is described. The technique has been successfully used in three patients and the advantage of such a free flap in head and neck reconstruction is described.     

Local flap coverage following posteromedial release in clubfoot surgery in older children

We present our experience of avoiding skin problems in older children with severe clubfoot deformity. We used a local transpositional flap coverage during wound closure following posteromedial release. We present our experience in five cases.

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Résumé Nous présentons une façon de régler les problème cutanés dans la chirurgie du pied bot sévère chez les grands enfants. Nous utilisons un lambeau local de couverture lors de la fermeture cutanée après la libération posteromediale. Nous présentons notre expérience dans cinq cas.

     

Supraclavicular bilobed fasciocutaneous flap for postburn cervical contractures

Anterior cervical contractures after burn are a common problem in the treatment of sequelae in burnt patients. The contracture itself and the hypertrophic scarring can cause functional limitation and aesthetic disfigurement. As a consequence, the reconstruction of this area is a challenge to surgeons that must choose a procedure, which improves functionality and aesthetic appearance in addition to reversing the contracture, the surgical goal of avoiding a new scar band over time is added. We present three patients with moderate (grade II) cervical contractures caused by suicide attempt and reconstructed by means of a bilobed flap based on the supraclavicular axis with the purpose of avoiding grafts in the donor area and performing it in a single procedure. This flap is useful and reliable for reconstruction of defects caused by cervical scars in non-collaborative and psychologically unstable patients. The anatomy, surgical procedure and results in our series are presented in this article.     

The cone flap: a fasciocutaneous flap option for plantar heel ulcers

Plantar heel wounds are often difficult to epithelialize in a timely manner. When healing is achieved through secondary intention, the results are often fragile and prone to reulceration. The cone flap provides a surgical option to allow plantar skin coverage for these difficult-to-heal wounds. The fasciocutaneous nature of the flap provides a well-vascularized pedicle for wound coverage. Following this simple method, a durable primary closure is available to all surgeons who work with chronic foot wounds.     

《整形外科手术图谱》出版

《整形外科手术图谱》出版由著名整形外科专家张涤生、辛时林、易传勋等教授主编，国内十余所医学院校的二十余位专家教授共同编著的大型专业参考书《整形外科手术图谱》已由湖北科技出版社出版发行。该书以其普及性与实用性为特点，通过近３０００幅精细逼真的线条图和彩...     

Ulnar fasciocutaneous flap of the wrist

An ulnar fasciocutaneous flap has been developed to provide skin cover of the donor defect after elevating radial forearm flaps and used for that purpose in 55 patients. A case is reported in which the same type of flap was used to cover a traumatic skin defect on the front of the wrist.     

The random fasciocutaneous flap for upper extremity coverage.

Rapid and appropriate healing of any upper extremity wound is essential for preservation of normal hand function. If vascularized tissue must be used, local cutaneous flaps nourished by the multiple perforators to the fasciocutaneous plexus avoid the complexity of microsurgical tissue transfers or prolonged immobilization required for distant pedicled flaps. For small or moderate-sized defects, assuming that adequate adjacent deep fascia has remained intact, these simple, rapidly elevated, so-called random fasciocutaneous flaps deserve initial consideration, as demonstrated in all 11 cases in this reported series.     

The radial recurrent fasciocutaneous flap: reverse upper arm flap

We have recently designed and developed a radial recurrent fasciocutaneous flap based on the radial recurrent artery. This artery supplies the supinator, brachialis and elbow joint, ascending to the fascia, subcutaneous tissues and skin over the lateral aspect of the upper arm, and anastomoses with the radial collateral artery. We describe the use of this fasciocutaneous flap in the repair of elbow lesions.     

Large transverse fasciocutaneous leg flap: whole leg flap.

Large defects of leg and sole often need massive tissue transfer. As an alternative to microvascular transfer, we have developed a fasciocutaneous flap in which almost the whole of the skin of the opposite leg is transferred based just on the septocutaneous perforators of the posterior tibial artery. The flap has been used as a cross-leg fasciocutaneous flap with potential for use as a free flap by taking a segment of the posterior tibial artery. Our experience with 11 cases is presented. Two patients suffered marginal necrosis while donor site problems were seen in another two patients. We have found this flap to be safe, technically easy and with minimal donor-site morbidity.     

颞浅筋膜蒂耳后扩张皮瓣全耳再造术

目的探索使再造耳轮廓清晰、耳轮缘无毛发生长,又可同期处理残耳的全耳再造方法.方法应用经皮肤扩张的颞蒂耳后筋膜皮瓣,向前上方旋转包裹整个耳支架进行全耳再造.结果1999年2月至2000年10月共完成全耳再造18例,术后随访期平均9个月,均取得满意效果.[HT5”H结论颞蒂耳后筋膜皮瓣厚薄适中,无发区皮肤面积较大,应用该皮瓣再造的耳廓肤色均匀一致,耳轮缘无毛发,外耳轮及耳甲腔等细微结构清晰,颅耳角保持较稳定,其不失为一种较为理想的全耳再造方法,尤其适用于发际较低者及耳上部组织残缺较多者的全耳再造.