The saphenous flap called the Acland's flap. Report of 2 cases]

The authors present two cases of Acland's flap. This flap described and published in 1981, is a very good flap, but the myocutaneous flaps have limited its use. However, the authors believe that there are indications for this saphenous flap. The vascular supply for this flap is a saphenous artery, the last branch of the femoral artery, before it becomes the popliteal artery. The authors report two cases: one neurovascular island flap for the posterior side of the knee, and the other case is a free flap for forearm. This flap is part of a particularly rich arterial network on the medial side of the thigh and of the knee. Masquelet, in 1986, showed that it is possible to raise a periosteal flap or a vascularized tendon flap.     

Indication and practice of reverse flow extensor digitorum brevis muscle flap transfer

Although the pedicled extensor digitorum brevis (EDB) muscle flap is a versatile flap, there are not many reports about it. Furthermore, there are few reports about the reverse vascular flow EDB muscle flap. The lateral tarsal artery coming from the dorsalis pedis artery nourishes the EDB muscle flap. Cutting the dorsalis pedis artery proximal to the flap can elevate this flap with reverse vascular flow. The authors treated eight patients with a reverse vascular flow EDB muscle flap. All flaps survived, with minor repair in two cases. The follow-up period ranged from 4 months to 1 year. This flap has two pivot points for creating a reverse vascular flow pedicled flap and a large arc of rotation for coverage of the dorsal foot. The authors confirmed that this flap is very versatile for soft-tissue reconstruction of the distal dorsum of the foot. The blood supply is reliable and the operative procedure is not complicated and can be performed under regional anesthesia. With this flap, a well-vascularized bed can be prepared for coverage with a skin graft. The major disadvantage is numbness in the first web of the foot, but this does not cause problems in daily life.     

Free gluteal artery perforator flap with a short,small perforator

The introduction of supermicrosurgery has led to the development of a new gluteal perforator flap nourished only by a musculocutaneous perforator of the superficial gluteal artery system. This flap has a perforator that is short (3-4 cm in length) and small (less than 1 mm). The successful transference of a free gluteal perforator flap for the coverage of soft-tissue defects in the foot and face in two patients is described in this article. With this flap, deeper and longer dissection for a pedicle vessel is unnecessary, flap elevation time is shorter, thinning of the flap with primary defatting and creation of an adiposal flap with customized thickness for tissue augmentation are possible, the donor site is in a concealed area with minimal donor site morbidity, and application of the flap as a scarred flap for previous operations in the gluteal region is possible. The disadvantages of this flap are necessity of dissection for a smaller perforator and of anastomosis of small-caliber vessels of less than 1.0 mm.     

Lateral thigh free flap with flow-through vascular pedicle

The lateral thigh flap based on the second and third perforator of profunda femoris vessel has not become very popular. We describe a technique of flow-through pedicle for this flap. The flow-through technique makes this flap very simple to transfer. The flap was used successfully in 6 cases for reconstruction for defects in the leg and forearm. The flow-through pedicle is ideal for lower limb reconstruction. The anastomosis becomes very easy and safe, even if the recipient vessels are deep in the intermuscular septum. We had no flap failures. The flap has a very predictable anatomy. Large flaps from anteriolateral and posterior part of midthigh can be safely elevated. The flap can meet a variety of requirements as it can be thin skin-alone flap, a fasciocutaneous flap, or even a musculocutaneous flap. A simple pinch test gives a fair idea of expected flap thickness. The dissection requires strong retraction of the anterior thigh muscles, but the dissection is safe and simple. The donor-site morbidity is very minimal.     

A single tensor fasciae latae musculocutaneous and fascia flap for composite reconstruction of urogenital and groin defect.

The tensor fasciae latae flap is a well known musculocutaneous flap used for many indications in the field of plastic surgery. The flap has some modifications to fit different reconstructive requirements of the defects. Osseous-muscle flap, osseous musculocutaneous flap, muscle flap, muscle-fascial flap and musculocutaneous-fasciocutaneous flap are some known alternatives. We used a modification of this well-known flap as musculocutaneous and fascia flap for a composite reconstruction of groin and urogenital defect. We reconstructed the groin defect with musculocutaneous part of the flap, and the defect over neourethra with the fascial extension and grafting. The aim of this modification was to reconstruct a genital defect with a thin and more pliable tissue to overcome the problem of distortion, kinking and thickness of the flap.     

The free or pedicled anteromedial thigh flap

The anteromedial thigh flap first described by Song is a septocutaneous artery flap based on the septocutaneous perforator originating from the lateral circumflex femoral vessels and long saphenous vein. The use of this flap for 3 patients who required soft tissue coverage is reported herein. The most important advantage of this flap is that it can be used not only as a skin flap but also as a vascularized fascia graft and fasciocutaneous free flap for the full-thickness defect of the abdominal wall and cranial region.     

Extended trapezius myocutaneous free flap for the reconstruction of a foot defect lacking adjacent recipient vessels

Foot reconstruction requires tissue that is durable and can withstand the extremes of pressure and stress. The trapezius myocutaneous flap has not been used previously as a free flap for foot reconstruction. In this report, the trapezius was used as an extended myocutaneous free flap for the reconstruction of a foot wound lacking adjacent and adequate recipient vessels. The extended trapezius flap may be one of the longest free flaps that can be harvested. The indications for the use of this flap are limited. In an extremity that lacks adequate recipient vessels adjacent to the defect, this flap can be extended such that more proximal vessels in the leg can be used as the recipient vessels without the need for vein grafts to bridge the distance. The donor-site morbidity of this flap is minimal when the superior fibers of the trapezius muscle and its innervation are preserved.     

The pedicled thoraco-umbilical flap: A versatile technique for upper limb coverage

Injuries to upper limb has been on the increase and is invariably associated with significant soft tissue loss requiring a flap cover. Local tissue may not be available for cover in a majority of situations, necessitating import of tissue from a distant source. We have utilized the thoraco-umbilical flap taken from the trunk for this purpose. This flap is based on the perforators of the deep inferior epigastric artery that are maximally centred on the periumbilical region. This flap was used in 83 patients. The patients were observed for at least 3 weeks and any flap or donor site complications were recorded. The patients were again followed up at 3 months interval and the donor site scar was assessed. The flaps survived in 81 patients; there was marginal flap necrosis in five patients and partial flap necrosis in two patients. None of these patients required any additional procedure for coverage. The flap is technically easy to plan, almost effortless to drape around upper limb defects, with no significant donor site morbidity and also the post operative immobilization was fairly comfortable. The thoraco-umbilical flap thus is a very useful technique for coverage of the upper limb and is recommended as a first line flap for this purpose.     

Soft tissue reconstruction with the superior gluteal artery perforator flap

The development of the perforator flap technique revolutionized the practice of soft tissue transfer. The main goal of this technique is muscle sparing at the donor site for function and strength. Meanwhile, this concept is being widely applied for reconstruction of tissues throughout the entire body. Perforator flaps are the ultimate upgrade of the well-known myocutaneous flaps. Theoretically, any myocutaneous flap can be harvested as a perforator flap if skin resurfacing is needed. Although the DIEP flap, the anterolateral thigh flap, and the TAP flap are probably more frequently used for breast, trunk, and upper and lower limb reconstruction, as well as head and neck reconstruction, the SGAP flap takes its own position in the large group of perforator flaps and has its own specific indications.     

Treatment of wide scar contracture of antecubital fossa with bipedicle flap from scar tissue

Many surgical techniques exist for reconstruction of burn scar contracture of the antecubital fossa, such as Z plasty, VY plasty, lateral arm flap, and medial arm flap. Another option is direct release of the scar contracture and skin graft of the defect area, which requires prolonged splinting and risk of graft failure. Additionally, in the areas with exposed tendons or vessels, we cannot use grafts. Recurrence of contracture remains another drawback of this treatment, in this article we present a new, simple alternative method for treatment of these cases. In this clinical trial we introduce a new technique of bipedicle flap from scar tissue for coverage of the antecubital fossa with skin grafting of the proximal and distal parts of this bipedicle flap. From July 2002 to July 2005 we used this flap in 12 patients and efficacy and versatility of this flap was studied. Seven patients were female and 5 were male with mean age of 23.7 years. The mean time between burn and our reconstructive operation was 3.2 years. The mean surface area of antecubital burn scar tissue was 77.5%. Mean extension lag before operation was 66.5 degrees , mean extension lag during operation was 4.5 degrees and after operation was 5.4 degrees . Minor complication was observed in two cases with necrosis of the flap margin. Mean follow-up period was 17 months and the appearance of operated site in antecubital fossa was acceptable in all patients. The advantage of this bipedicle flap is its simple surgical technique. The risk of flap necrosis is negligible and it is a reliable flap. Splinting time is short and the risk of recurrence of contracture with this technique is minimal.     

Cheek flaps for reconstruction of full-thickness lip defects

Two patients with full-thickness defect of the lip reconstructed by a cheek flap are presented. The cheek flap was split into two flaps preserving subcutaneous vascular networks, one for external skin cover and the other for coverage of the oral lining. With this flap, an adequate intraoral vestibulum and easy denture-fitting could be maintained. Disadvantages of the flap described here are that whiskered men cannot use this flap for coverage of the oral lining, and that this cheek flap cannot be used for the reconstruction of full-thickness defects of the lower lip due to potential postoperative downward tendency, unless a simultaneous sling procedure or sphincter reconstruction is performed.     

Neurovaskuläre Lappen zur Rekonstruktion von Fingerendglieddefekten

The fingertip is an extremely specialized end organ with a highly developed sense of touch. In this article, we present the different ways of reconstructing a traumatized fingertip. Additionally, we systematically explain the differential indications for the different techniques available. The whole spectrum of fingertip reconstruction is discussed, starting from local neurovascular flaps (palmar VY-Atasoy flap, Kutler flap, palmar Moberg flap, lateral Venkataswami and Subramanian flap, palmar Hueston flap), distant flaps (Littler flap, Foucher flap, dorsal metacarpal artery flap, cross-finger flap, reversed cross-finger flap) and finally free flap transfer (free toe-pulp transfer, spare-part transplantation). The advantages and disadvantages of each flap are highlighted. We develop an algorithm to facilitate finding the correct type of reconstruction.     

Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction

BACKGROUND: Although the anterolateral thigh flap has been extensively used for head and neck reconstruction in Asia, reported variations of vascular anatomy seem confusing and may have contributed to the unpopularity of this flap in the United States. The purposes of this study are to classify the vascular anatomy and to assess the suitability of this flap for head and neck reconstruction in a Western population. METHODS: Seventy-two consecutive anterolateral thigh flaps for head and neck reconstruction was retrospectively reviewed. RESULTS: The number of cutaneous perforators for the anterolateral thigh flap ranged from one to three. On the basis of their location and origin, a simple classification system is introduced to assist flap dissection. Of the 72 thighs explored, 68 flaps (94%) were raised successfully. CONCLUSIONS: The vascular anatomy of the flap follows predictable patterns. The anterolateral thigh flap is well suited for head and neck reconstruction in Westerners.     

轴型皮瓣再造阴道126例经验体会

目的：总结6种皮瓣再造阴道的临床经验，方法：应用下腹部皮瓣，脐旁皮瓣、小脐唇皮瓣、阴囊皮瓣、阴茎皮瓣和阴股沟皮瓣再造阴道126例，结果：下腹部皮瓣坏死1例，其余皮瓣全部成活，阴茎皮瓣法发生阴道口狭窄1例，阴股沟皮瓣法有3例阴道变浅，结论：阴股沟皮瓣法距受区最近，转移方便，皮瓣薄，血管神经分丰富，再造的阴道柔软，弹性好，有会阴部部感觉，供区极隐蔽并可直接缝合，是阴道再嘉宾 首选皮瓣。     

The anatomy and histology of the cranially based dorsal musculocutaneous flap of the rat

The cranially based dorsal musculocutaneous flap of the rat is commonly used to study the effects of various pharmacological compounds of flap survival. In the present study the anatomy and histology of the flap are described. It is shown that the central vessel of the flap is a vein and that this vein can be used for injection of substances into the capillary network of the flap. The sensory innervation of the flap is studied using indirect immunohistochemical technique.     

Forehead flag flap.

We present a modification of the Okada and Maruyama's flap for forehead reconstruction, based solely on the supratrochlear vessels. The flap is raised extra-periosteally but in the area of the pedicle the periosteum is included in the flap to protect the vessels. The flap is advanced and rotated to cover full thickness defects on the contralateral hemi-forehead, like a flag on its flagpole. We have treated six patients with large malignant tumours of the forehead which required excision including the periosteum. The flap survived in all cases and no necrosis was observed in any. The main advantage of this flap is that it is relatively straightforward to raise, being a good solution in selected cases (elderly patients). The main disadvantages of this flap are that the supraorbital nerve is sacrificed and some distortion of the eyebrows occurs.     

Coverage of pelvis and thigh region by pedicled perforator flap like deep inferior epigastric perforator (DIEP)

The deep inferior epigastric perforator flap (DIEP) is a variation of the transverse rectus abdominis myocutaneous flap (TRAM). This flap was used as a pedicled flap to reconstruct the pelvis and thigh region after resection for cancer (four cases). Various flaps have been described for covering theses tissue defects but we prefer this perforator flap for its many advantages. This flap is very reliable and generates minimal functional sequelae on donor site. This flap is useful to cover soft tissue defects after vascular and oncologic surgery, a situation that was rarely reported to our knowledge.     

Nasalis Myocutaneous Island Pedicle Flap with Bilevel Undermining for Repair of Lateral Nasal Defects

BACKGROUND: The superiorly based nasalis myocutaneous island pedicle flap with bilevel undermining is a recently described bipedicled flap used for repair of nasal tip and supratip defects. This flap was used for the repair of small to medium-size defects of the nasal tip and supratip regions. OBJECTIVE: To describe a single-pedicled modification of this flap for the reconstruction of lateral nasal defects at or above the alar groove. METHODS: With the use of diagrams and fresh cadaver dissection, we demonstrate the method of preparing, raising, and placement of this new flap. We further elucidate in an illustrative way the efficacy of bilevel undermining as it is used for achieving greater flap mobility. Finally, we show representative cases with pre- and postoperative results. RESULTS: We describe the senior author's 4-year experience in the development of this flap. CONCLUSION: The nasalis myocutaneous island pedicle flap with bilevel undermining, a new method for repair of lateral nasal defects at or above the alar groove, yields excellent functional and cosmetic results. Bilevel undermining is a new and valuable method of achieving greater tissue mobility in muscle-based flaps.