Skin flap survival after superficial and deep partial-thickness burn injury

Whether a flap can be raised successfully in a body region that has been subjected to burn injury remains an issue. The aim of this study was to investigate the survival of skin flaps that were elevated after superficial and deep partial-thickness burn injury in a rat model. Sixty-five rats were divided into five groups: Group 1 (N = 15) was the control group, group 2 (N = 10) included rats with superficial partial-thickness burns that had flaps elevated on day 0, group 3 (N = 15) was comprised up of rats with superficial partial-thickness burns that had flaps elevated on day 4, group 4 (N = 10) included rats with deep partial-thickness burns that had flaps elevated on day 0, and group 5 (N = 15) was comprised of rats with deep partial-thickness burns that had flaps elevated on day 4. Caudally based dorsal flaps consisting of skin and panniculus carnosus were elevated in all groups, and the amount of surviving tissue on each flap was quantified. The surviving areas of flaps elevated on postburn days 0 and 4 in superficial partial-thickness burn zones (groups 2 and 3) were larger than those of flaps that were elevated on postburn days 0 and 4 in deep partial-thickness burn zones (groups 4 and 5). The surviving portions of flaps that were elevated on day 4 in superficial partial-thickness burn zones (group 3) were similar to the surviving areas of flaps in the control group (group 1), and were larger than those of all other groups (groups 2, 4, and 5). In this rat model, flaps were elevated in superficial dermal burn zones with successful outcomes. However, raising flaps in deep dermal burn zones was not a reliable method.     

局部筋膜皮瓣修复四肢功能部位深度烧伤创面

目的 探讨局部筋膜皮瓣在四肢功能部位深度烧伤创面中的应用。方法 对98例烧伤患者126个功能部位,彻底清创后用局部筋膜皮瓣转位修复。结果 临床应用162块皮瓣,全部成活率达93．2％,126个部位中,关节恢复正常活动者112个(88．9％),活动轻度受限者14个(11.1％),无一例关节严重活动障碍。结论 本法操作简单,效果满意,可降低烧伤后肢体残废率。     

游离腹壁浅动脉筋膜穿支皮瓣修复手部创面

目的 报告应用游离腹壁浅动脉筋膜穿支皮瓣修复手部创面的临床效果.方法 对10例手部皮肤软组织缺损的患者,采用游离腹壁浅动脉筋膜穿支皮瓣进行修复,皮瓣切取面积为8cm×6cm～16cm×9cm.结果 术后1例皮瓣发生血管危象,经探查后存活,其余皮瓣全部顺利存活.经4～12个月的随访,皮瓣质地、外形优良,手功能恢复满意.术后供区伤口均Ⅰ期愈合,外形满意.结论 应用游离腹壁浅动脉筋膜穿支皮瓣可以一期修复创面,供区损伤小,是修复手部创面的理想选择.     

The superficial temporal venous island flap for eyebrow reconstruction

A case in which a venous island flap was used for eyebrow reconstruction is presented. This flap was based on the anterior superficial temporal vein.     

Immediate fascial flap reconstruction of joints and use of Biobrane in the burned limb

There is a small percentage of burned patients who would benefit from early excision of burns and coverage of exposed large joints to prevent septic arthritis and preserve movement. There are many reports in the literature on flap coverage of exposed joints or delayed primary excision of burns with subsequent flap coverage, but the immediate excision of burn to fascia with use of local vascularized fascial flaps to cover open knee and ankle joints has not apparently been described. This case report illustrates the basic plastic surgery techniques involved and the rationale behind such aggressive management. Biobrane is an extremely useful dressing for the coverage of such wounds in the interim period before autografting and provides ideal temporary coverage of vascularized fascial flaps and the excised burn bed.     

The use of innervated radial artery superficial palmar branch perforator free flap for complex digital injuries reconstruction

Loco-regional flaps have been widely used for the reconstruction of digital injuries without requiring microvascular anastomosis, however, they result in scarring and compromised functional outcomes. This study demonstrates our experience utilizing the innervated radial artery superficial palmar branch (RASPB) perforator free flap for complex digital injury reconstruction. From May 2007 to March 2014, the innervated RASPB perforator free flap was used to reconstruct 79 distal complex hand and digital soft tissue defects of which 14 were used to re-vascularise the distal digit in a flow-through fashion. All free flaps were innervated by the palmar cutaneous branch of the median nerve. All 79 free flaps survived and all 14 digits re-vascularized successfully. One flow-through free flap developed distal skin necrosis which healed uneventfully without further procedure. The average follow-up was 21.5 months. Measurement of two-point discrimination ranged from 7 to 13?mm. All patients were satisfied with the aesthetic results. The innervated RASPB perforator free flap is a feasible and effective option for the reconstruction of complex digital defects and the flow-through concept, when utilized in cases with compromised vascularity, provides reliable re-vascularization. Level III, therapeutic study.     

应用背阔肌岛状肌皮瓣修复烧伤后乳房畸形

目的 介绍应用背阔肌岛状肌皮瓣修复前胸壁烧伤后所致乳房瘢痕挛缩畸形的临床效果.方法 应用扩张或未扩张的背阔肌岛状肌皮瓣修复烧伤后乳房瘢痕、部分缺损畸形,其中轻、中度烧伤后乳房缺失2例,采用背阔肌岛状肌皮瓣修复重度乳房缺失5例,采用扩张的背阔肌岛状肌皮瓣修复.结果 共治疗7例,术后肌皮瓣完全成活,乳房形态明显改善,无肌皮瓣坏死、背部伤口感染、裂开及肩部功能障碍等并发症发生.供区无明显后遗畸形及功能障碍.结论 背阔肌岛状肌皮瓣血运良好,操作简便易行,是修复烧伤乳房畸形的较好方法.     

Repair of inferior iridodialysis using a partial-thickness scleral flap

We present a technique of inferior iridodialysis repair using a partial-thickness scleral flap, which, in turn, employs a modification of the technique currently used to suture posterior chamber intraocular lenses under scleral flaps.     

腹部深浅两层吸脂术

目的　介绍腹部深浅两层吸脂术的经验。方法　选择有轻、中度腹部皮肤松弛者,采用包括除深层外还有浅层的两层脂肪吸脂术。用３ｍｍ以下的吸引管在浅层脂肪中进行细致、均匀和交叉抽吸,术后放置引流、加压包扎。结果　经６～１８个月的随访,效果良好。结论　该术式是传统吸脂术的合理扩展,术后皮肤回缩好,从而避免了腹壁皮肤切除术,使求术者更易接受。     

The use of combined latissimus-serratus free flap for soft tissue coverage in the hand

Summary A case report is presented on the successful use of a combined latissimus-serratus free muscle transfer in a farmer whose hand was degloved in corn husking bin. There have been no previous reports of the use of such a flap for soft tissue coverage on the hand. The patient was transferred eight days post-injury with an infected wound, a gangrenous thumb and viable fingers. Flap coverage was undertaken four days later. The latissimus dorsi and the lower four slips of the serratus anterior muscle were anastomosed via a common vascular pedicle to the radial artery. The post-operative course was uneventful and donor site morbidity minimal.     

Local perforator flap for reconstruction of deep tissue defects in the elbow area

Limited deep tissue defects in the elbow area can occur after burns, advanced bursitis, and inflammatory processes, to name a few. Reconstruction is complicated because sufficient tissue with adequate elasticity and strength has to be transferred. Often major surgical procedures such as free tissue transfer are considered. A novel method for reconstruction of deep tissue defects in the elbow area, based on a single perforator artery and vein, is described. Perforator vessels are identified preoperatively using color Doppler ultrasonography, and a flap from the upper arm is rotated 180 degrees. The authors describe the successful treatment of two patients. The surgical technique is comparatively simple and can be performed with regional anesthesia. Postoperative recovery is short and skin sensibility is retained. The authors suggest that local, single perforator flaps can be considered as a first alternative in treatment of limited, deep tissue defects in the elbow area, especially for elderly or severely ill patients.     

Arterialized venous free flap for reconstruction of burned face

In this study, a forearm arterialized venous free flap (23 cm x 14 cm) was used in a 25-year-old male with facial burns sequels to reconstruct both cheeks, chin, lips, nose, columnella, nasal tip, and nostrils. It was arterialized by the facial artery to an afferent vein anastomosis. The venous flow was drained by four efferent vein to vein anastomoses. Although it developed small inferior marginal necrosis in the lower lip, the rest of the flap survived with good quality of the skin in both texture and color, with self-delimitation of the different esthetics units of the center of the face such as the nasogenian folds, nostrils, and upper lip filtrum, without the need of additional thinning surgical procedures. From all of the above, the arterialized venous free flap is an alternative reconstructive option for the treatment of burn sequels especially those that include the centrofacial region.     

Expanded occipito-cervico-pectoral flap for reconstruction of burned cervical contracture

Postburn neck contracture and hypertrophic scarring can cause functional limitation and aesthetic disfigurement. Reconstruction of severe deformities and scar of neck following healing from burns confronts the surgeon with some of the most challenging problems in reconstructive surgery. Through knowledge of available reconstructive technique accurate diagnosis of tissue deficiency and secondary distortion, imaginative planning and definitive, careful execution of ones surgical plan are the bare minimum items for achieving improvement in a burned deformed neck. The aim of this article is to assess the role of expanded occipito-cervico-pectoral (o-c-p) flap for reconstruction in a series of four patients with severe burn scar of neck and involvement of shoulder back but intact anterior aspect of chest. This is an alternative method of reconstruction burn scar of neck area.