Flag flap - Kite flap Dorsal metacarpal flap

The flag flap is a pedicled dorsal digital flap, combining a skin paddle (the “flag”) and a vascular pedicle (the flag “pole”). Its vascularisation depends on the dorsal metacarpal arteries (DMCA). It has been described in 1963, by Holevitch [1] with harvest of a cutaneovascular pole; it has been brilliantly modified in 1979 by Foucher et al. [2–4] under the form of a unipedicled “kite” flap, although we would like to point out that Vilain has been using it since 1952 [5]. Usually harvested from the dorsum of the metacarpophalangeal region of the index finger, this flap is reliable, but it is more uncertain and less movable at the level of the other digits. Owing to its small size, it proves useful in hand traumatology because it does not sacrifice any major vascular axis. The kite flap is considered as a sensory flap (presence of a nerve supply) with a two-point discrimination, which can be assessed from 11 to 16 mm [1–6].     

V-Y advancement flap out of an existing flap

A case is reported in which a large V-Y flap was fashioned out of a flap already present over the dorsum of the hand, to cover a defect created adjacent to it. The V-Y advancement appeared more effective to fill the defect than the traditional method of mobilisation of a part of the flap achieved by dissecting it from its base.     

Recycling a flap: making a perforator flap from a previous gluteal fasciocutaneous flap

We report a case of raising a previous gluteal fasciocutaneous flap again as a perforator-based flap to cover a recurrent defect. This case illustrates that conventional flap tissue with a preserved perforator can be recycled as a perforator flap, and that this method can be an efficient surgical option for recurrent defects.     

吻合血管的足底内侧及足内侧双叶皮瓣的临床应用

目的 报道游离足底内侧及足内侧双叶皮瓣修复手部皮肤缺损的手术方法及临床效果,方法,在解剖研究的基础上设计以足底内侧血管为主干,带其主干支及足内侧区皮穿支构成足底内侧非负重区,足内侧区双叶皮瓣,游离移植同时修复手或手指两处皮肤缺损。     

Medial plantar artery (instep flap) flap

Provision of sensation to the weightbearing surface of the heel is very vital in the sensate foot. Hence, resurfacing the weightbearing surface of the heel requires provision of stable skin cover and sensation. We have many options to fulfill the above requirements. Skin of the instep area can be raised as an island fasciocutaneous flap based on medial plantar vessels, with the branch of medial plantar nerve supplying the instep skin to provide the sensation. Medial plantar artery (instep) flap provides similar tissue with sensation and reaches the posteriormost part of the weightbearing surface of the heel with ease. We present in this article the relevant surgical anatomy, technique, and the clinical experience of 12 patients.     

Accordion flap

The accordion flap is proposed as a means of covering a rhombic defect. A prominent feature of the method presented is in the preparation of a flap on one side of the skin defect, resulting in little dog ear.     

Recycling a flap: Making a perforator flap from a previous gluteal fasciocutaneous flap

Abstract

We report a case of raising a previous gluteal fasciocutaneous flap again as a perforator-based flap to cover a recurrent defect. This case illustrates that conventional flap tissue with a preserved perforator can be recycled as a perforator flap, and that this method can be an efficient surgical option for recurrent defects.     

McGregor flap

Since it has been described in the early seventies [1], this flap has become an essential tool in reconstructive surgery, primarily due to the wide cutaneous surface it may replace. Its pediculate form is useful and it may be employed with significant benefit as free flap; it may even provide composite tissues. Also known as McGregor’s flap, groin flap, or iliofemoral flap, this axial pattern flap is based on the superficial iliac circumflex artery.     

Atasoy flap

Fingertip tissue loss is frequent. It often requires a reconstruction with a flap in case of exposure of the distal phalanx. We will present the technique of reconstruction by means of a local pedicle flap described by Atasoy. It is a local bipedicled flap harvested from the fingertip. The incision is triangular or volar without exceeding the palmar fold of the distal interphalangeal. Laterally, it is located 2 millimetres from the lateral nail folds. The flap is detached from the phalanx on its deep aspect. When the flap is released it can protrude from 5 to 7 millimetres. The flap covering the phalanx is then fixed by means of an intradermic needle and sutured laterally. The needle and the stitches are removed between the 2^nd and the 3^rd postoperative week. Physiotherapy will start the day following the surgery. There should be a relative abundance of remaining fingertip tissue so that it will be able to cover the phalanx; this technique is recommended in both the strictly transverse and dorsal oblique amputations. Among the most common undesired effects we have sensory changes, temporary pains in the fingertip pulp space and the palmar retraction of the flap if not properly fixed. However, this flap is still reliable and can be reproduced; it gives excellent cosmetic appearance if it is set correctly.     

Suprapopliteal flap

To investigate the cutaneous artery in the popliteal region, cadaver dissections were performed on 16 lower limbs. Two types of the cutaneous vessel have been found. One is the direct cutaneous vessel from the popliteal vessels; the other is the cutaneous vessel branching from the muscular vessel to the semimembranous muscle from the popliteal vessels. In our cadaver dissections, the latter was found consistently in the 16 lower limbs. The location of the vascular pedicle is 12.5 to 24.0 cm from the tibial condyle. The newly developed suprapopliteal flap supplied by this vessel is described. We applied this flap in four clinical patients: in one as a free flap, in the others as an island flap. Three (one free, two pedicled) flaps survived completely. The upper part of a pedicled flap partially necrosed. The operative procedure and the characteristics of the suprapopliteal flap are discussed. This flap can be used as a free flap and is also a versatile way to reconstruct soft tissue defects around the knee joint.     

Accordion flap

The accordion flap is proposed as a means of covering a rhombic defect. A prominent feature of the method presented is in the preparation of a flap on one side of the skin defect, resulting in little dog ear.     

Thoracodorsal artery perforator flap: Indeed a versatile flap

Introduction:

The thoracodorsal artery perforator (TDAP) flap has emerged as one of the ideal perforator flaps. We, hereby, describe its versatility in indications (free/pedicled), methods of harvest (patient position and paddle orientation) and perforator consistency.

Materials and Methods:

We have performed a total of six TDAP flaps-five free and one pedicled, over a period of 1-year from March 2014 to February 2015 at a single centre. Our indications have been: Reconstruction of oral cavity, breast and upper and lower extremities.

Results:

We had neither any failures nor any re-explorations. The average perforator length is about 6 cm and the pedicle length can be extended to 12-14 cm by including the thoracodorsal artery. There is inconsistency in perforator position; however, the presence of a perforator is certain. It can be harvested in lateral, prone or supine position, thus, does not require any position change allowing a two-team approach to reconstruction. The paddle can be oriented vertically or horizontally, both healing with scars in inconspicuous locations. Apart from providing a good colour match for extremities, this flap can be thinned primarily.

Conclusion:

The versatility of TDAP has several advantages that make it a workhorse flap for most reconstructions requiring soft tissue cover. Further, the ease of harvest makes it a good perforator flap for beginners. Its use in chimerism with the underlying latissimus dorsi muscle provides reconstruction for coverage and volume replacement.KEY WORDS: Ideal perforator flap, septocutaneous perforator, versatile, chimerism     

The shamrock flap: a three-paddle radial forearm flap

The radial forearm flap has been well described for reconstruction of the oral cavity. The flap is most commonly used as a single-paddle flap with or without a segment of vascularised radius. Double-paddle radial flaps may be required to reconstruct defects of intraoral lining and overlying skin following excision of extensive tumours. We wish to report the first described case of reconstruction using a triple-paddle radial forearm flap including a segment of vascularised radius.     

Upper transverse rectus abdominis flap: the flag flap

A flap is described that consists of skin from the upper abdomen, based on the ipsilateral rectus muscle and fed by the inferior epigastric vessel (the " flag flap"). The flap has an arc of rotation of 360 degrees, and its safety appears to be equal, and perhaps superior, to the lower transverse rectus abdominis flap. In addition, the " flag flap" avoids the potential disadvantage of creating a hernia below the semicircular line in the lower abdomen. The secondary defect is also acceptable. In all cases direct closure was possible by performing a reverse type of abdominoplasty and placing the scar at the submammary fold. The flap has been used in 8 patients for coverage of postradiation and postexcisional tumor defects in the lower trunk and extremities. The complications have been few, although it is not advised that the flap be used for reconstruction of the upper chest area by stretching the pedicle.     

Anterolateral thigh flap: an ideal soft tissue flap

Microsurgical reconstruction has evolved to a stage where a nearly 100% success rate has been achieved. Therefore, refinement of the functional and aesthetic result, as well as a decrease in donor site morbidity have become the major concerns. The anterolateral thigh flap meets these requirements; its wide application to various fields is based on the following charateristics. Its reliable vascularity. Its vascular pedicle is long and large, at least 8 cm (can be 20 cm). Flap territory is large and easy to design. The pedicle can be at the periphery of the flap. Its length can be 40 cm and its width can be half of the thigh, with the maximal dimension as large as 40 x 20 cm (800 cm2). Primary trimming of the flap to 3 mm to 5 mm in thickness does not compromise its vascularity. The subcutaneous fat can be included to facilitate gliding of the underlying tendons. To harvest chimeric flaps, the following components can be included: muscles, fascia and bone (an osseous flap can be joined to the flap with microvascular anastomoses). A two-team approach is possible, because the recipient site is usually far away from the donor site. Usually it does not require that the patient change position. It can be closed primarily without skin graft if its width is less than 8 cm. The donor site is easily covered with clothes, and the motor function is least affected. Care should be taken in flap dissection, inset, and postoperative care, as well as strategies for re-exploration.