Secondary reconstruction by temporoparietal free fascial flap for ring avulsion injury

We report the secondary reconstruction of an amputated finger following a ring avulsion injury using a temporoparietal fascial flap (TPFF). There have been reports of preserving degloved fingers using a cross-finger flap and an abdominal flap, but it is difficult to obtain good results with these procedures. The TPFF is an ideal, thin flap that gives excellent results, preserving movement of the phalangeal joint.     

Total nasal reconstruction using a prelaminated free radial forearm flap and porous polyethylene implants

Reconstruction of total nasal defects remains one of the most difficult problems in plastic surgery as the nose combines aesthetics and function. Standard techniques using either forehead or nasolabial flaps do not have a place in the case of extensive scarring on the face or areas with high risk of cancer recurrence on the face. In these cases, microsurgical free tissue transfer for the soft tissue reconstruction in combination with bone grafts or implants for the nasal skeleton are ideal. We report the use of prelaminated radial forearm flap with porous polyethylene implants for total nasal reconstruction.     

颞浅筋膜瓣联合中厚植皮法修复外耳再造术后软骨支架外露

目的 探讨外耳再造术后出现皮瓣坏死、软骨支架外露后,应用颞浅血管为蒂的颞浅筋膜瓣联合中厚皮片植皮的方法进行修复的效果.方法 沿颞部发际内行垂直切口,以颞浅血管为蒂,沿颞肌筋膜表面剥离,形成颞浅筋膜瓣,向下旋转包裹支架外露部位,筋膜瓣表面行游离中厚皮片移植,术后给予抗感染治疗3d.结果 10例患者术后伤口均愈合良好,无支架外露、皮片坏死现象.随访3～12个月,其再造耳耳轮、对耳轮、三角窝等表面结构清晰,有明显的立体形态,不显臃肿,效果满意.结论 对外耳再造术后出现软骨支架外露,利用颞浅筋膜瓣联合游离移植中厚皮片法可获得较满意的修复效果.     

Endoscopic-assisted harvest of the temporoparietal fascial flap

Elevation of the temporoparietal fascial flap by conventional T or Y incisions in the temporal region frequently leaves conspicuous scarring, hair thinning, or baldness. To avoid such undesirable effects, endoscopic-assisted harvest of the temporoparietal fascial flap was performed in 9 patients with microtia. Through two horizontal incisions in the temporal region, the temporoparietal fascia was dissected, and the flap was harvested using bipolar scissors and coagulating shears. Flaps were dissected and harvested successfully without any complications in 7 patients, although extra incisions were required to facilitate coagulation in 2 patients. The authors introduce this harvesting technique and describe some representative cases. Using endoscopic guidance, this is a versatile, safe procedure with minimal morbidity, and is applicable to other reconstructive procedures that require a temporoparietal fascial flap, including the free flap.     

Use of temporoparietal fascia free flap in digital reconstruction

Temporoparietal fascia free flap is an excellent source for resurfacing soft tissue defects of the hand and fingers. Because of the reliable anatomical bifurcation of the superficial temporal vessels, this flap can be very useful in simultaneous reconstruction of more than one digit without having to create a temporary syndactyly.     

Secondary ear reconstruction using deep temporal fascia after temporoparietal fascial reconstruction in microtia

As anatomical study of the temporoparietal fascia (TPF) has advanced, there have been several reports on one-stage reconstruction of microtia using the TPF. To our knowledge, however, no report has described how to do secondary reconstruction if partial necrosis occurs, exposing the cartilage frame. Recently we treated a case of microtia that had become partially necrotic after the patient underwent one-stage reconstruction using the TPF. The deep temporal fascia was elevated to cover the necrotic portion and ensure successful placement of the skin graft. This technique greatly enhances one-stage reconstruction of the auricle using a TPF flap.     

Free temporoparietal flap in burn reconstruction

A series of 12 patients with deep burns resulting in exposed bones, joints, and tendons, in whom temporoparietal free flaps were used for reconstruction, are presented. Flap loss was 8.3%; good and satisfactory results were achieved in 91.7% of healed defects. Patients with large total body surface area burns are severely compromised, and the use of free flaps requiring prolonged periods of anesthesia and surgery should be a judicious decision. Prior to the availability of free flaps, most of these patients are left with chronic wounds and compromised functional results. Although our experience is limited, we think that in well-selected cases a one-stage reconstruction with free tissue transfer is expeditious, safe, and economical.     

The free fascial forearm flap

The unpleasant appearance of the donor site after harvesting a forearm flap limits its use in many centers. In this paper, the author records his experience with a modification of the standard fasciocutaneous forearm flap. Such modification involves the utilization of the fascial component of the flap sparing the skin of the forearm, which is closed as a longitudinal line. This fascial forearm flap (FFF) was used as a free flap in eight cases. All the flaps survived well, and the donor site appearance was excellent. The fascial forearm flap advantages and limitations are discussed with recommendations for further utilization of other fascial flaps.     

Primary reconstruction of a degloved middle finger with a temporoparietal free flap.

The treatment of complete ring avulsion injuries is very demanding, and frequently the results are less than optimal. We present a case of a degloved middle finger reconstructed with a temporoparietal fascial free flap and skin grafting. This produced an aesthetic and functional finger.     

Eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap

Although various reconstructive procedures for the eyebrow have been reported, few have proved satisfactory for large-tissue defects. The authors describe two cases of eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap (TPF flap) after malignant tumor resection. The first patient was a 24-year-old man with an adnexal carcinoma of the left eyebrow. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. The second patient was a 48-year-old woman with Bowen's disease of the left eyebrow. Tumor resection was performed on the frontal muscle with a 5-mm surgical margin. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. Both reconstructed eyebrows have maintained their shapes well. There have been several reports of the use of a TPF flap for eyebrow reconstruction, but none have used intermediate hair from the hairline. The authors are convinced that use of intermediate hair from the hairline of the forehead on the pedicled TPF flap is effective for reconstruction of the eyebrow and large defects extending to nonhairy subbrow skin.     

额部扩张皮瓣法半鼻再造术修复部分鼻缺损

目的：探讨应用扩张额部皮瓣行半鼻再造术修复部分鼻缺损的效果。方法：2008年6月～2010年12月,收治部分鼻缺损患者5例,男1例,女4例,均采用额部扩张皮瓣法半鼻再造术修复。手术分3期进行：Ⅰ期行额部额肌下扩张器置入术皮肤扩张;Ⅱ期行额部扩张皮瓣转移半鼻再造术;Ⅲ期行鼻根部皮瓣断蒂修整术。结果：术后患者均愈合良好,无明显并发症发生。5例患者均获随访,随访时间6月～1年。再造鼻形态满意,颜色、质地与周围皮肤较为匹配,额部供区无明显瘢痕及畸形。结论：额部扩张皮瓣法行半鼻再造术修复鼻缺损,手术方法简单可靠,术后效果满意。     

扩张的额部复合皮瓣预制法鼻再造术

目的：探讨一种应用扩张的额部复合皮瓣预制进行鼻再造的手术方法。方法：2008年7月～2010年1月,对7例鼻缺损患者分四期行鼻再造术。一期：埋植额部扩张器,同时额部皮下移植自体软骨,额肌深面中厚植皮;二期：取扩张器,行额部扩张复合皮瓣转移鼻再造术;三期断蒂;四期修整。结果：7例患者手术后随访6～12个月,手术均取得较好的效果。结论：扩张的额部复合皮瓣预制法鼻再造术为修复鼻全层缺损提供了一种新的术式选择。     

Achilles tendon cover using a free lateral arm fascial flap

Cover of an exposed Achilles tendon is a rare but difficult surgical problem. Two cases are presented in which a free lateral arm fascial flap covered with a split-thickness skin graft was used. The morbidity of the donor site was very low, and the functional result was good. Surgical techniques and results are presented. Received: 30 April 1997 / Accepted: 29 January 1998     

Bilateral temporoparietal fascial free flaps for reconstruction of bilateral hand defects: A report of two cases

Bilateral temporoparietal fascial free flaps were used for reconstruction of bilateral hand defects in two male patients. A 42‐year‐old man sustained crushed injury to both hands with avulsion defects and exposed bones and tendons. The two separate procedures were performed under general anesthesia. The temporoparietal fascial free flap was skin grafted on the ward on the following day after the operation. The other patient was a 61‐year‐old leprosy patient who had bilateral high ulnar nerve palsy for 28 years. One simultaneous procedure was performed under local anesthesia for harvesting the temporoparietal fascial free flaps and under brachial block for preparation of the recipient sites. The free flaps were used for augmentation of the atrophic first web spaces. The postoperative results of the two cases were satisfactory. The functions of both hands were restored with normal gliding mechanism of the tendons in the first case, and permanent correction of the atrophic web spaces was demonstrated in the second case. The temporoparietal fascial free flap is an ideal flap for coverage of hand defects as well as augmentation of first web space atrophy. © 2009 Wiley‐Liss, Inc. Microsurgery 2009.     

One-stage reconstruction of both the biceps brachii and triceps brachii tendons using a free anterolateral thigh flap with a fascial flap

An avulsed elbow with severe degloving and crush injury was reconstructed in a 66-year-old man. The biceps brachii was completely transected, and the triceps brachii tendon was partly transected. In addition, the skin around the elbow had become totally necrotic. Four weeks after the injury, a free anterolateral thigh flap with a fascial flap was transplanted to reconstruct both the biceps brachii and triceps brachii tendons simultaneously. Six months after the initial injury, the range of elbow motion had recovered to almost the same level as that before injury.