Perineal and posterior vaginal wall reconstruction with a superior gluteal artery dual perforator‐pedicled propeller flap

Gluteal artery perforator flaps are a good option to reconstruct perineal and posterior vaginal wall defects after abdominoperineal resection. The bulkiness of the folded flap may compromise the results by obliterating the introitus and vaginal cavity. In this report, we present a case of the use of a superior gluteal artery dual perforator‐pedicled propeller flap to reconstruct the posterior vaginal wall and perineum in a 60‐year‐old female who had an abdominoperineal resection of a locally progressive anal squamous cell carcinoma. Two perforators were completely skeletonized through gluteus maximus muscle fibers. The vascularization of the skin flap was based on the first perforator, whereas the aponeurotic flap was vascularized by the second perforator. The vaginal defect was reconstructed with a gluteus maximus aponeurotic flap, and the perineal reconstruction was based on a superior gluteal artery perforator skin flap. No postoperative infection or necrosis occurred. Skin healing was completed in 3 weeks. Vaginal opening was controlled using lubricant and graduated vaginal dilators during 6 weeks. The patient began sexual intercourse 2 months postoperatively. No revision was needed. Perineal and posterior vaginal wall defects may be reconstructed with a gluteal artery perforator flap. The thickness of the flap allows a complete filling of the full perineal cavity. The gluteus maximus aponeurosis may be suitable for the reconstruction of the posterior vaginal wall. © 2014 Wiley Periodicals, Inc. Microsurgery 35:64–67, 2015.     

The propeller flap: A one-stage procedure for nipple-areola reconstruction

The advantages of the propeller flap combined with tattooing for nipple-areola reconstruction include the fact that it is a simple one-stage procedure, a secondary procedure after creation of the nipple-areola complex is eliminated, and a skin graft and the possibility of a skin graft and second wound are eliminated. The propellar flap technique offers the ability to produce a nipple of adequate size, good color match, and satisfactory projection over an 18-month followup. The preliminary results of this flap operation are promising. A long-term evaluation of this operation has begun.     

The propeller flap method

We report a method of elevating and rotating a flap, like a propeller, for the release of scar contractures. We have obtained satisfactory results in the repair of scar contractures in the cubital and axillary regions. This flap may be applied to the flexor side in other regions, for example the groin, popliteal fossa and fingers where burn contractures are common.     

The reversed dermal graft concept in abdominal wall reconstruction

The authors report the use of the reversed free graft of dermis for reconstruction of the musculo-aponeurotic element of the anterior abdominal wall, including peritoneum, in four clinical cases. Three were for correction of postoperative incision hernias of the supra and infraumbilical regions and one with a periumbilical defect of the entire thickness of the abdominal wall following resection of an intraparietal metastasis from an adenocarcinoma of the sigmoid colon. A V-Y pedicle myocutaneous rectus abdominis flap was used to provide overlying cover for the graft.     

The fully rotated tensor fasciae latae perforator propeller flap in reconstruction of trochanteric pressure sores

Reconstruction of trochanteric pressure sores continues to challenge reconstructive surgeons because recurrence is not uncommon and patients typically have undergone previous surgery. We herein report on the use of a large adipocutaneous TFLPP rotated for 180° facilitating reconstruction of a recurring trochanteric decubital ulcer in a 37-year-old male morbidly obese patient with diabetes mellitus. The postoperative period showed no adverse events, and no recurrence was observed to date. The TFLPP is a valuable option because skin grafts are usually not needed for donor-site closure, the muscle is spared, and minimal donor-site morbidity as well as a less bulky appearance is observed.Level of evidence: Level V, therapeutic study.     

The sandwich omental flap for abdominal wall defect reconstruction.

We present a case of a large full thickness abdominal wall defect following excision of a huge basal cell carcinoma, uniquely reconstructed with a sandwich omental flap, vicryl/prolene (vypro II) mesh and split thickness skin graft.     

The partial gluteus maximus musculocutaneous turnover flap. An alternative concept for simultaneous reconstruction of combined defects of the posterior perineum/sacrum and the posterior vaginal wall.

Three cases with posterior perineo-sacral defects are presented. One is a 57-year-old white female following amputation of her rectum for carcinoma, radiation and chemotherapy with a significant residual sacral/perineal defect and loss of the posterior vaginal wall. The two other patients had radical pelvic exenteration after recurrent rectum carcinoma. A new myocutaneous turnover flap as a modification of the conventional gluteus maximus flap was designed to solve the particular reconstructive problems. The flap is based on branches of the inferior gluteal artery. The posterior cutaneous femoral nerve and the motor branches of the inferior gluteal nerve not leading into the muscle portion of the flap are left intact. The skin island can be used for vaginal reconstruction or can be de-epithelialised to fill perineal cavities. This new flap eventually enabled the successful reconstruction of the posterior vaginal wall and appropriate sacral/perineal soft tissue coverage in the first case. In the other patients the flap was used to achieve closure of the deep through-and-through defect acutely in one case, and after a 3-week interval in the other.     

The propeller flap for postburn elbow contractures

Flexion contracture of the elbow is a common sequela of burn injury. Numerous methods have been suggested for release, including grafting, Z-plasty, Y-V flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. In this article the authors present their experience with the propeller flap method in seven cases of elbow flexion contracture. Sufficient extension and an acceptable aesthetic outcome were obtained. Other benefits include easy design and rapid flap elevation that permits a single stage correction of the deformity without further sacrificing an artery or muscle. We think that the main disadvantage of the propeller flap is using the same skin that has suffered from the burn insult which has a poorer cosmetic result. Other than this and excluding deep burn injuries, we believe that the propeller flap is a useful alternative for elbow contracture release.