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.     

The medial femoral trochlea flap with a monitor skin island—Report of two cases

In this report, we present two cases of the bony reconstruction with the medial trochlea (MFT) flap including a skin island that was used to monitor the perfusion of flap in the postoperative period. Between March 2013 and April 2015, we performed surgery on two patients who suffered from scaphoid and talus non‐union after trauma and initial treatment by osteosynthesis. A skin island (1 cm × 1 cm and 3 cm × 1 cm, respectively) was included with the osseous flap (1.6 cm × 1 cm × 1 cm and 2 cm × 3 cm × 2 cm, respectively) to assess the perfusion of the flap. The design of the skin island was based on either the saphenous artery perforator or a cutaneous perforator of the descending genicular artery. Both flaps remained viable throughout the postoperative period, and there were no donor site complications. After a follow‐up of 36 and 11 months, bony union was observed in both patients with a high degree of satisfaction. Thus, a MFT flap with a skin island could be a tool to assess the perfusion of the flap in the early postoperative period. © 2016 Wiley Periodicals, Inc. Microsurgery 37:431–435, 2017.     

Reconstruction of a degloved thumb

We present two cases of degloving injuries of the thumb with amputation of the distal phalanx. The first one was treated with an osteocutaneous flap from the first toe, giving effective function to the thumb, and the second by a fasciocutaneous interosseous flap around the segment of the exposed thumb, with a satisfactory result.     

Closure of a tracheocutaneous fistula by two hinged turnover skin flaps and a muscle flap: A case report

INTRODUCTIONTracheocutaneous fistula is a complication of tracheostomy. Tracheocutaneous fistulectomy followed by primary closure carries a high possibility of complications.PRESENTATION OF CASEAn 11-year-old boy underwent surgery to repair a tracheocutaneous fistula, using skin and muscle flaps. A vertical incision was made around the fistula and 3 skin flaps were prepared: 2 hinge flaps, and 1 to cover the skin defect (advanced flap). The 2 hinged turnover flaps were invaginated by multiple layered sutures, and a strap muscle flap was placed over the resulting tracheal closure. An advanced skin flap was used to cover the area of the previous defect. The patient was extubated immediately after surgery. He was discharged on the sixth postoperative day without tracheal leakage or subcutaneous emphysema. The patient is currently doing well, with no respiratory symptoms and no recurrence at the postoperative 5 months.DISCUSSIONOur technique is minimally invasive and has a low risk of lumen stenosis, other complications, or recurrence.CONCLUSIONThis technique demonstrates the multiple-layered closure of a tracheocutaneous fistula, using skin flaps and a muscle flap.     

Alternative techniques for pedicle transfer of an island flap and a free flap

Alternative techniques for pedicle transfer of a reverse radial forearm flap for hand coverage, and a latissimus dorsi myocutaneous free flap for pelvic wound coverage, are illustrated. Exteriorization of the vascular pedicle of a reverse radial forearm flap allows a greater arc of movement of the flap for more distal coverage, and avoids the potential vascular compromise of tunnelling under a tight skin bridge. Two-stage transfer of a latissimus dorsi myocutaneous free flap on a wrist carrier pedicle may be useful in circumstances when local recipient vessels are inadequate for free flap transfer. Although both of these vascular pedicle modifications have drawbacks, they may be of value in limited circumstances. Their advantages and limitations are discussed.     

Unusual case of a free anterolateral thigh flap partial necrosis in a COVID-19 positive young male following extremity reconstruction

Free flap procedure provides an overall success rate of 97%, which decreases to 85% in hypercoagulable states. COVID-19, as a pro-thrombotic disorder, therefore seems detrimental to free flap survival. We encountered a case of unique pattern of free flap partial failure in a young male who underwent extremity reconstruction. The patient was diagnosed as COVID-19 positive on the 3rd day post-reconstruction. The flap survived well for the first 7 days post-operatively, but gradually the skin got necrosed and the subcutaneous fat layer was preserved when debriding. To our knowledge, this is the only case in which the skin of the free flap of a COVID-19 positive patient was necrosed almost entirely subsequently, while the subcutaneous fat was relatively preserved.     

膝上逆行皮瓣修复（月国）窝部瘢痕挛缩

目的　探讨膝上逆行皮瓣血供及临床应用的可靠性。方法　对 8具 16侧成人尸体下肢新鲜标本灌注后 ,解剖观察大腿中下段皮肤血供情况 ,并应用膝上逆行皮瓣 5 6块修复 5 2例窝部瘢痕挛缩畸形。结果　膝上前内、外侧区皮肤有丰富的血管网 ,并与髌周围血管网广泛吻合。于该区设计向上的逆行皮瓣 ,修复窝部瘢痕挛缩松解后创面 ,5 6块皮瓣成活良好 ,远期效果满意。结论　膝上逆行皮瓣修复窝部瘢痕挛缩是一种安全可靠的方法。     

Flap reconstruction of the knee: A review of current concepts and a proposed algorithm

A literature search focusing on flap knee reconstruction revealed much controversy regarding the optimal management of around the knee defects. Muscle flaps are the preferred option, mainly in infected wounds. Perforator flaps have recently been introduced in knee coverage with significant advantages due to low donor morbidity and long pedicles with wide arc of rotation. In the case of free flap the choice of recipient vessels is the key point to the reconstruction. Taking the published experience into account, a reconstructive algorithm is proposed according to the size and location of the wound, the presence of infection and/or 3-dimensional defect.     

Soft tissue coverage of bone —a historical perspective and review

Summary Coverage of bony nonunions and osteomyelitis with either cross-leg flaps or muscle flaps dates back to before the turn of the century. Although today many surgeons prefer muscle flaps there are reports of successful treatment with cutaneous cross-leg flaps. Because of its rich blood supply muscle may have a greater ability to tolerate infection and promote revascularization of bone. A history of these techniques and reports of clinical results are presented.     

The Limberg flap for cutaneous defects — a two year experience

Aim  

To evaluate the Limberg or rhomboid flap done during the past 2 years with regard to applicability, reliability and complications.     

Monitoring a free anterolateral thigh flap for pharyngeal reconstruction

Aim: To describe a novel way of monitoring a buried fasciocutaneous anterolateral thigh (ALT) flap used for pharyngeal reconstruction. Methods: A tubed ALT flap was used to reconstruct a circumferential pharyngeal defect following resection of a carcinoma. An island of skin based on a separate perforator and externalized through the neck incision was used to monitor the flap. It was removed as a bedside procedure on the fifth postoperative day. Results: The externalized skin island allowed easy monitoring of the buried tubed free‐flap used to reconstruct the pharynx. Simple clinical parameters such as temperature, colour and capillary refill were used to monitor the flap instead of more complex and invasive methods. Conclusion: When feasible, a second skin island based on a separate set of perforator vessels provides an easy, safe and simple method of monitoring a buried free‐flap.     

The Combined Use of a Pedicled Superficial Inferior Epigastric Artery Flap and a Groin Flap for Reconstruction of a Dorsal and Volar Hand Blast Injury

A hand blast injury case causing a large through-and-through composite tissue loss is presented. This injury resulted in a dorsal and a palmar hand defect with segmental bone loss. Soft tissue coverage of both dorsal and palmar wounds was achieved by two separate pedicle flaps with pedicles closely arising from the femoral artery: a superficial inferior epigastric artery (SIEA) flap and a groin flap. Simultaneously, a large iliac corticocancellous bone graft was harvested from the same incision to be used for the wrist fusion procedure. This approach uses two separate pedicled flaps with robust independent blood supply to cover simultaneously a dorsal and a volar hand wound. A large through-and-through hand defect can be reconstructed readily with this approach, and it is associated with much less perioperative morbidity compared to free composite tissue transfer options. The dissection of both the groin flap and the SIEA flap is straightforward and can be easily performed by a single surgeon. The combined use of these two flaps allows stable coverage of sizable dorsal and palmar wounds of the hand.     

Use of groin flap in the closure of through and through defect of a forearm: A case report

The groin flap is a vascularized axial flap based on the superficial circumflex iliac artery arising from the femoral artery just below the inguinal ligament. It is used regularly by many reconstructive surgeons for covering soft tissue defects of the hand. Although the development of various fasciocutaneous free flaps during the 1980s decreased the attractiveness of the groin flap, these flaps can be used in reconstructing significant defects of the forearm and hand where free tissue transfer is not feasible.     

The subcutaneous adipose turnover flap: successful coverage of a difficult electrical burn wound of the wrist

Skin-grafted subcutaneous adipose turnover flaps can be very useful in providing cover of exposed joints especially in critically ill patients. An exposed wrist joint due to a full-thickness electrical burn was successfully covered with a large turnover pure subcutaneous flap harvested from the forearm. Stable cover and good function with minimal donor site morbidity was achieved (22 months follow-up). The planning and the anatomical bases of this useful flap are discussed.C. Tremolada     

Reconstruction of the foot and lower leg by a fasciocutaneous cross-leg flap after traumatic amputation and circumferential soft-tissue loss

Summary The use of a fasciocutaneous cross-leg flap in two cases to cover severe soft-tissue injuries with circumferential degloving of the lower leg and foot is presented. This was preceded by local treatment with topical agents and debridement, followed by application of a mesh skin graft. The functional and aesthetic defect of the donor site is minimal.     

Two-stage reconstruction of a massive gun-shot wound of the midface with a free radial forearm flap and a parietal osteofasciocutaneous flap

Treatment of midface gunshot injuries and their reconstruction remains one of the difficult problems of reconstructive surgery. Several flaps have been described for the reconstruction of total lip and nasal defects. We present a case of a gunshot wound to the midface in which a two-stage procedure was performed. In the first stage, a free radial forearm flap was successfully transferred for the reconstruction of the total nose. In the second stage, total upper lip reconstruction was achieved using a parietal osteofasciocutaneous flap pedicled to the parieto-temporal fascia based on the superficialis temporal artery. At a mean follow-up period of 18 months, near-normal functional and cosmetic results were obtained.