New experimental flap model in the rat: free flow-through epigastric flap

This study describes a free flow-through flap model in the rat for use in the evaluation of the physiologic and hemodynamic characteristics of this type of flap in clinical practice. The rat is a preferred animal model because it is inexpensive, readily available, and reliable. There is no free flow-through flap model available for laboratory animals, although this model gained popularity in clinical use recently. Twenty Wistar rats weighing 200-250 g were used in our experiment. In 5 rats, the vascular anatomy of the groin and proximal thigh region was determined by anatomic dissection. The experimental design consisted of two groups. In the experimental group (N = 5), a flow-through epigastric skin flap was harvested based on the femoral artery, preparing both its proximal and distal stumps. The flap was transferred to the contralateral groin, and end-to-end vascular anastomosis was performed between a proximal and distal stump of the femoral arteries of the flap and recipient site. The proximal stump of the femoral vein of the flap was anastomosed to the femoral vein of the recipient site. The control group was divided into two subgroups. In all control group rats (N = 10), the flap was harvested in the same manner, and transferred to the contralateral groin, but standard free-flap procedure with one artery and one vein anastomosis was performed in 5 rats (conventional free-flap subgroup), and anastomosis was not performed between the flap and the recipient site in the remaining 5 rats (graft subgroup). Survival of the flap was evaluated on postoperative day 7 by direct observation, and microangiography was performed to delineate the vascularity of the flow-through flap. The results showed that all flaps survived in the experimental group and the conventional free-flap subgroup of the control group, whereas in the graft subgroup, all flaps underwent total necrosis. The authors conclude that the flow-through epigastric flap for the rat is a simple and reliable model for future physiologic and pharmacologic studies.     

Peninsular Conchal Axial Flap to Reconstruct the Upper or Middle Third of the Auricle

BACKGROUND: The reconstruction of partial amputations of the auricle is a continuous subject of publications, in particular, the techniques of ear reconstruction with postauricular flaps. OBJECTIVE: To present in detail the surgical procedure of a new peninsular conchal transposition flap. MATERIALS AND METHODS: This new conchal transposition flap has been used since 1998 to reconstruct seven partial amputations of the upper or middle third of the auricle. If we compare the flap to a tennis racket, the head corresponds to a skin-cartilage-skin flap harvested from the concha and the shaft to a post- and supra-auricular cutaneous and subcutaneous pedicle based around the posterior auricular artery and the superior auricular branch of the superficial temporal artery. The blood supply is reliable because the superior branch of the posterior auricular artery anastomoses with the superior auricular branch of the superficial temporal artery. RESULTS: There have been no significant complications, except one case of partial rim necrosis, which responded well to wound healing by secondary intention. CONCLUSION: Our peninsular flap could be an alternative to more complex procedures involving costal cartilage harvesting, provided that auricle amputations are confined to the upper or middle third of the peripheral structures and spare the concha.     

Double reverse-flow island flaps for two adjacent finger tissue defect

INTRODUCTION: Soft-tissue reconstruction of fingertip injuries remains a challenge for hand surgery. Tissue loss of multiple digits is a serious problem for hand surgeons. Surgical possibilities include regional, distant and local flaps. In this study, five patients presented with tissue loss of two adjacent fingers and were treated by double reverse-flow island flaps. MATERIALS AND METHODS: The surgical technique is an application of the reverse-flow homodigital island flap for two adjacent finger tissue defects. Instead of one flap, double island flaps are applied to two adjacent finger tissue defects. The flaps are raised from the lateral or medial palmar surface of the proximal phalanx level. Anastomoses between the radial and ulnar digital arteries at the distal interphalangeal joint level are preserved. RESULTS: Three of the patients had tissue defects at the fingertip. In these cases, digital nerve anastomosis with the counter lateral digital nerve made the flaps sensitive. In two patients, the tissue defect was on the dorsum of the middle phalanx level. In these cases, the flaps were non-sensitive. Neither infection nor flap failure was seen in the patients. Sensitive function was satisfactory in fingertip applications. CONCLUSION: The reverse-flow homodigital island flap is a commonly used surgical technique for tissue defects in the fingers. The double reverse-flow island flaps involve the application of this technique for two adjacent fingers. The important point in the surgical technique is that the vascular supply of the two flaps should originate from the same common palmar digital artery. This technique offers a possibility to repair the defects of two adjacent fingers.     

Reverse-flow postauricular arterial flap for auricular reconstruction

Two patients with an ear defect, each reconstructed with a reverse-flow postauricular arterial flap are presented; one defect was caused by accidental exposure of bare cartilage at the posterior helix and the other by traumatic loss of earlobe. After the flaps were transposed, a line of auditory signals was dictated by Doppler probing, which suggested the presence of reverse blood flow in the flaps from the anteroauricular vessels. We believe that the reverse-flow postauricular arterial flap is a reliable and convenient optional tool in the reconstruction of auricular defects.     

耳后游离皮瓣移植修复鼻部分缺损

目的 应用能携带耳廓软骨，色泽与鼻部相近的小型游离皮瓣修复鼻部分缺损。方法 采用以耳后动、静脉为血管蒂的耳后游离皮瓣行吻合血管的移植，对5例鼻部缺损进行了修复。结果 3例术后皮瓣血运完全正常，2例术后1－4d内有不同程度的静脉回流障碍。5例皮瓣最终全部成活，术后效果较为满意。结论 本手术供区隐藏，皮瓣不臃肿，色泽与鼻部相近，1次手术即可达到较满意的修复效果，是修复鼻尖、鼻翼大部缺损可供选择的一种方法。     

Reconstruction of traumatic auricular defect]

Auricle is liable to be injured, owing to its position and structural conditions. Since 1977, 48 cases (52 ears) with traumatic auricular defect have been reconstructed by the use of different operative techniques. The results have been satisfactory for most of them. Loss of a major portion of the auricle or the entire ear itself can be reconstructed by use of framework of costal cartilage graft (autologous or homologous). The joint between remaining auricle and framework must be smooth and secure. Helical defect can be repaired by the use of advancement of auricular skin and cartilage, composite graft, free skin graft with subdermal vascular plexus or tube flap according to specific conditions. Unnecessary injury to tissue should be avoided during the operation. Earlobe defect can be repaired by the use of double subcutaneous pedicle skin flaps. The retroauricular subcutaneous pedicle composite flap including conchal cartilage and the pretragus subcutaneous skin flap are formed. They pass through respective subcutaneous tunnels to reach the defect area. The two flaps and remained auricular fresh edge are sutured together. A flat, new earlobe is reconstructed. The earlobe reconstructed by the use of this technique overcomes the unsightly "spherical earlobe". This technique is an ideal operative method. In brief, there are many forms of traumatic auricular defects. According to the size and extent of defect, careful planning is essential before the actual surgery takes place.     

Retroauricular flap: its clinical application and safety.

We report the application and safety of the retroauricular flap in 38 cases. The flap was used on the anterior auricular surface in 21 cases, in the peri-auricular region in five cases, in the region of the preauricular sideburn area in two cases, in the malar region in six cases, in the eyelid in three cases and in the intraorbital region in one case. When this flap was used in the auricular or periauricular region, the blood circulation was safe and the appearance was aesthetically good in flaps pedicled by the postauricular vessels or by the superficial temporal vessels. However, when the defect was more remote from the auricle, the blood circulation of the flaps pedicled by superficial temporal vessels, whether subcutaneous pedicle flaps or free flaps, was unstable. In some cases there was extensive or partial necrosis of the distal area of the flap. On the other hand, the free flaps pedicled by the postauricular vessels had satisfactory blood circulation, but the vessels were sometimes short, narrow and difficult to find, especially the veins. In these cases, we were obliged to use the superficial temporal vessels. A further problem is that some of the patients, especially younger women, were dissatisfied when the retroauricular flap was used in the malar region because of the reddish colour of the flap.     

乳突筋膜皮瓣在临床外耳再造术中的应用

目的:探讨利用乳突筋膜瓣进行外耳再造的可行性。方法:在耳后乳突区设计一个以耳后动脉为蒂的扇形乳突筋膜瓣,用于术中包裹耳支架,行外耳再造术。结果:应用本方法行外耳再造术500例,其中自体肋软骨支架外耳再造483例,Medpor支架外耳再造17例,皮瓣成活良好,外耳形态逼真。结论:应用以耳后动脉为蒂的乳突筋膜瓣替代以颞浅动脉为蒂的颞浅筋膜瓣行外耳再造术,操作简单,再造外耳不臃肿、形态逼真,是外耳再造术中筋膜瓣的最佳选择。     

Surgical correction of congenital cryptotia

From 1983 to 1988, we have operated on eight cases of cryptotia. The method of operation was to deepen the cephalo-auricular sulcus and to obtain a normal position of the ear. 1. The local flap usually used is either a V-Y advancement flap or a rotated flap. The author designs two V flaps, the upper one near the auricle is rotated to provide tissue between the upper part of the auricle and temporal region which should be dissected deep enough. The other V-Y advancement flap is used to increase the transverse length of the auricle. 2. The contracted transverse, oblique and superior auricular muscular fibres are dissected. In children the insertion of the superior auricular muscle is transposed and sutured to the eminentia fossae. 3. The repair of the cartilagenous deformity of the auricle includes placing two to three parallel incisions on the back of the superior part and elevating and suturing the angulated superior third helix to the cut edge of the back of the auricle. Good results were obtained in all cases.     

局部皮瓣在耳廓部分缺损修复术中的应用

目的:探讨局部皮瓣在耳廓部分缺损修复术中的应用。方法:选择耳前局部皮瓣、皮下蒂皮瓣、改良菱形皮瓣及耳后局部皮瓣修复耳廓组织缺损。结果:本组患者术后伤口均Ⅰ期愈合,皮瓣移植成活,无坏死,肤色及质地正常,瘢痕较隐蔽。随访6个月以上,耳廓外形满意,瘢痕不明显。结论:局部皮瓣在耳廓部分缺损修复术中的应用,效果理想,值得临床应用。     

Neuromuscular and neuromusculocutaneous flaps in the rat.

Since the introduction of flaps based on the vascular structures of the cutaneous nerves, these have gained increasing popularity in reconstructive surgery. The purpose of this study is to describe a new concept in which the flap is supplied solely by the intrinsic vasculature of a motor nerve. A total of 94 Wistar rats weighing 200-250 g were used in this experiment, which was divided into three sections. In section I, the neural anatomy of the posterior thigh region was investigated. In section II, the flap study using experimental and control groups, was performed. In the experimental group neuromuscular and neuromusculocutaneous flaps were created. The biceps femoris muscle was harvested based solely on its motor nerve as a neuromuscular flap, and together with its overlying skin it was similarly raised as a neuromusculocutaneous flap. In the control group, conventional muscle and musculocutaneous flaps were harvested based on the caudal femoral-popliteal artery vascular axis, and a graft subgroup was created ligating both the constant vascular structure and the motor nerve. In section III, with the intention of augmenting the survival areas of neuromuscular and neuroumusculocutaneous flaps, a surgical delay procedure was applied. On postoperative day 7, the viability of all flaps was evaluated using direct observation, microangiography, and tetrazolium blue stain techniques. The results of the anatomic studies demonstrated a consistent motor nerve arising from the sciatic nerve to the biceps femoris muscle with evident perineural vasculature. Average muscle viability levels of neuromuscular, neuromusculocutaneous, delayed neuromuscular, delayed neuromusculocutaneous, conventional muscle and musculocutaneous flaps were 20.6 +/-7.58, 22.4 +/- 4.21, 86.4 +/- 6.14, 85 +/- 4.21, 89.6 +/- 4.48, and 88.0 +/- 5.51%, respectively. Survival levels of the skin paddles of the neuromusculocutaneous, delayed neuromusculocutaneous, and conventional musculocutaneous flaps were calculated as 13 +/- 17.51, 67 +/- 30.29, and 97+/-4.21%, respectively. In the graft subgroup the viability of muscle and skin paddle was almost nil. In conclusion, our new flap model in a favored laboratory animal is of benefit to researchers in providing a means for future various types of investigations into this new concept. The technique might be considered in further experimental research studies and appropriate clinical situations.     

A composite osteomusculocutaneous free flap from the medial femoral condyle for reconstruction of complex defects

This combined anatomic and clinical study illustrates the first experiences of an osteomyocutaneous flap from the medial femoral condyle for reconstruction of composite tissue defects. We analyzed the anatomic consistency and the vascular distribution of this flap and showed that muscle tissue can easily be added as a composite flap. Twenty-one flaps were harvested from fresh adult cadavers with careful identification of the origin and the course of the three different branches of the descending genicular artery. The corresponding skin areas and muscle portion were identified. The clinical application of this flap was described for closure of complex calcaneal defects. The cadaveric study presented a constant pedicle length and diameter of the arteries, combined with a constant venous drainage. Furthermore, the medial condyle provided a corticocancellous segment and separate vascularity for skin and muscle portions. In the case reports, satisfying results of bone union and soft tissue contouring were achieved. The medial femur condyle region is a reliable donor site for composite flaps, providing a good corticocancellous bony structure and a separate skin paddle, as well as a muscle portion. Its vascular distribution shows anatomic consistency. Despite long-term atrophy of muscle transplants, we believe the additional muscle tissue improves the reconstruction results and provides better soft tissue contouring.     

逆行皮瓣中浅静脉干的形态学与血流动力学观察

目的：通过对浅静脉干的形态学和血流动力学观察，探索浅静脉干促进逆行皮瓣静脉回流的机理，进一步指导带浅静脉千逆行皮瓣的临床应用。方法：用小鼠耳制成带浅静脉干的逆行皮瓣模型共48例，每个皮瓣内只有一条浅静脉干，用微循环观察仪对浅静脉干进行形态学和血流动力学观察。结果：根据形态可将逆行皮瓣中的浅静脉千分为3种类型：“I”形，“Y”形和树枝形，各种类型的浅静脉干都是皮瓣静脉逆向回流的主要通道，如果在蒂部将浅静脉干闭塞，皮瓣的静脉回流基本停滞。结论：浅静脉千的存在有助于逆行皮瓣的静脉逆向回流，并在回流中起类似“枢纽”的重要作用，临床应尽量选用“I”形浅静脉干。     

Reverse-flow latissimus dorsi myocutaneous flap in a multi-step approach for complex back defect reconstruction: A case report

Reconstruction of complex back defects is challenging for reconstructive surgeons, as it should preserve function, provide adequate coverage, and minimize morbidity. We present a case of multiple-step reconstruction after resection of a large squamous cell carcinoma recurrence in a 68-year-old man, with local perforator flaps and a reverse-flow latissimus dorsi myocutaneous flap. After radical excision, four propeller perforator flaps were harvested to cover a 30 × 25 cm defect, based on the dorsal branch of the fifth posterior intercostal arteries (right 20 × 9 cm, left 17 × 9 cm) and on the superior gluteal arteries (right 20 × 11 cm, left 21 × 12 cm) bilaterally. In the second step, bilateral propeller perforator flaps based on the fourth lumbar arteries (right 18 × 13 cm, left 23 × 11 cm) were transposed to cover the residual loss of tissues. After 5 months, a recurrence occurred on the left midback. A wide en bloc excision of the last three ribs and pulmonary pleura was performed, and the synthetic mesh used for thoracic wall reconstruction was covered with an ipsilateral 20 × 10 cm reverse-flow latissimus dorsi myocutaneous flap based on the serratus anterior branch. All the flaps healed uneventfully and there were no donor-site complications. Two years postoperatively, the patient had a cosmetically acceptable result without any functional impairment. The reverse-flow latissimus dorsi myocutaneous flap can represent a salvage procedure in back complex defects reconstruction, especially when other local flaps have already been harvested in previous reconstructive procedures.     

应用矩形皮瓣法修复先天性隐耳畸形

目的 探讨应用矩形皮瓣法修复先天性隐耳畸形的可行性.方法 2001至2004年,对9例共15侧行矩形皮瓣法隐耳整复术,其中双侧6例,单侧3例.将患耳的上半部从头皮中牵出,参照:Hyakusoku矩形皮瓣法,在耳廓上后方设计由2个三角形皮瓣和1个矩形皮瓣组成的"三瓣"(故也可称为三瓣法).按设计切口切开皮肤,游离皮瓣,对耳横肌、耳斜肌的短缩切开分离松解,并切开松解耳上肌纤维组织,最后转移皮瓣,缝合皮肤.结果 所有皮瓣均未出现血运障碍,手术切口愈合良好.随访3个月至2年,患耳功能和外形均较满意.结论 矩形皮瓣法适用于轻、中度隐耳畸形,可给患耳上后部提供足够的皮肤组织,颅耳沟成形好,供区损伤轻.     

Reconstruction of Nonhelical Auricular Defects with Local Flaps

BACKGROUND The integrity of each of the components of the auricle is important for its overall aesthetic appearance. Cartilage-exposing nonhelical defects that are too large to be closed primarily without distorting the auricle may be reconstructed with local flaps.
OBJECTIVE The objective was to present our experience with the reconstruction of nonhelical medium-sized defects using a variety of simple, one-stage local flaps.
PATIENTS AND METHODS Eighteen patients who underwent reconstruction of nonhelical auricular defects with local flaps at our center from 2003 to 2006. Defect size ranged from about 10 to 20 mm. Various methods were used for reconstruction as follows: conchal defect ( n =11)—pull-through postauricular flap or cutaneous rotation flap from the concha itself; triangular fossa defect ( n =3)—transposition-rotation flap from the concha or cutaneous periauricular pull-through flap via the root of the helix; antihelical defect ( n =2)— V-Y advancement flap from the skin of the antihelix; and tragus defect ( n =2)—periauricular cutaneous flap.
RESULTS All flaps survived. Transient congestion was noted in four patients. The aesthetic results were good, with no auricular deformation.
CONCLUSION It is important that reconstructive surgeons be familiar with a variety of basic flaps for reconstruction of nonhelical defects. An algorithm for nonhelical flap reconstruction is suggested.     

Fat prefabrication using a fascial flap in the rat model.

Prefabrication of fat tissue using a fascial flap based on the superficial inferior epigastric artery was studied in rats. First, the superficial inferior epigastric fascia was transposed over the inguinal fat pad. Two weeks later fascia and fat were elevated together as a prefabricated composite flap. At this stage, a pilot study was done in ten rats and perfusion of the flaps was tested with fluorescein. After confirming fluorescein staining of the prefabricated flaps, the study continued with experimental and control groups of rats. In the experimental group, prefabricated flaps were transposed to the subcostal area. In the control group, the pedicles of the flaps were severed, creating composite grafts. These grafts were transferred to the subcostal area in the same manner as in the experimental group. One week later the flaps were re-elevated and grafts were exposed. Fluorescein tests and Indian ink microangiography were carried out. In the experimental group, the flaps were stained, while grafts in the control group were not stained. Fat and fascia were found to be viable in the experimental group, while they were necrotic in the control group on histopathological examination. Based on these findings, we can conclude that the prefabrication of fat by vascular fascia is successful and may have application in plastic surgery.     

耳轮脚复合组织瓣游离移植修复外伤性部分耳郭缺损

目的介绍一种修复外伤性小面积耳郭缺损的手术方法。方法根据外伤性部分耳郭缺损患者的耳郭形态,尤其是耳轮脚明显、耳郭缺损位于耳轮部,面积约2cm×0.8cm以下的外伤后患者,采用耳轮脚复合组织瓣游离移植进行缺损修复。结果本组7例患者,术后伤口一期愈合,缺损修复满意,耳郭外形良好。结论耳轮脚复合组织瓣游离移植,治疗外伤性小面积耳郭缺损,尤其是耳轮部缺损,可取得满意效果。     

颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损

目的 探讨应用颢浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损的方法.方法 对16例鼻翼缺损患者,应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣移植修复.结果 全部病例移植的带蒂耳廓复合组织瓣完全成活,伤口一期愈合.最长随访4年,最短半年,移植的耳廓复合组织瓣的形态、颜色和质地与正常鼻翼相似,效果满意.结论 应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损,是一种理想的修复方法.     

颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损

目的 探讨应用颢浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损的方法.方法 对16例鼻翼缺损患者,应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣移植修复.结果 全部病例移植的带蒂耳廓复合组织瓣完全成活,伤口一期愈合.最长随访4年,最短半年,移植的耳廓复合组织瓣的形态、颜色和质地与正常鼻翼相似,效果满意.结论 应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损,是一种理想的修复方法.