Pedicled anterolateral thigh flap for contralateral groin composite defect

Pedicled anterolateral thigh flap has been well described for ipsilateral groin defects. Its versatility depends on the intact femoral vessels. When the external iliac and the femoral vessels are absent, especially secondary to wide surgical tumour ablations in the groin region, ipsilateral ALT flap is not an option. Free flaps also are difficult because of lack of recipient vessels. We report a case of composite groin defect following wide resection of recurrent liposarcoma along with encased vessels which was covered with a pedicled anterolateral thigh flap from the opposite thigh. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine without vascular compromise, is described.     

岛状皮瓣在面部较大面积皮肤软组织缺损修复中的应用

目的探讨应用岛状皮瓣I期修复面部较大面积皮肤软组织缺损的可行性及优越性。方法针对各类面部较大面积皮肤软组织缺损患者,无合适局部带蒂皮瓣可供利用者,根据缺损部位、面积大小设计应用耳前皮下蒂侧颌颈岛状皮瓣、颏下动脉岛状皮瓣、内眦动脉岛状皮瓣、眼轮匝肌蒂岛状皮瓣及鼻唇沟皮下蒂岛状皮瓣等进行I期修复。结果共48例面部较大面积皮肤软组织缺损患者,采用上述岛状皮瓣修复,术后皮瓣全部成活,其中35例患者随访1～36个月,均获得良好的外形和功能恢复,效果满意。结论上述岛状皮瓣血供可靠,肤色质地好,供区多较隐蔽,手术操作也较为简单,安全快速,是I期修复面部较大面积皮肤软组织缺损的理想方法。     

颏下岛状瓣修复口腔癌术后缺损的临床应用

目的:探讨颏下岛状瓣修复口腔癌术后缺损的临床效果。方法:2010年6月～2011年12月收治的8例口腔癌患者,其中舌癌5例,舌根癌1例,口咽癌1例,下颌牙龈癌1例,全部采用颏下岛状瓣修复根治术后缺损,皮瓣最小5.5cm×4cm,最大8cm×4cm。结果:8例患者中6例皮瓣成功,2例坏死。患者言语、吞咽功能均正常,颈部瘢痕隐蔽,活动正常,外形满意。结论:颏下岛状瓣制备简单,成活率高,适合同期修复舌癌口咽癌及舌根癌术后缺损。     

The pedicled anterolateral thigh island flap for inguinal defects

The interpolated anterolateral thigh flap islanded on its vascular pedicle, is a durable local flap option for large skin and soft tissue defects caused by inguinal block dissections. So far, this flap has not been described for resurfacing such defects. Two cases are presented to highlight the technique. Received: 5 March 1999 / Accepted: 7 July 1999     

Iliac crest free flap and submental island flap for maxillary reconstruction

Abstract

The iliac crest free flap is one of the most reliable flaps for maxillary reconstruction because of the large amount of bone provided and the chance to harvest both muscle and skin. However, reconstruction of maxillary through-and-through defects requires special skills to be managed. Simultaneous replacement of oral lining and external tissue with the same features as the resected skin is difficult to achieve with conventional techniques and the use of flaps association is often necessary to ensure acceptable cosmetic and functional results. In the case presented the submental island flap was a good choice to overcome these difficulties.     

Primary skin closure of large groin defects after inguinal lymphadenectomy for penile cancer using an abdominal cutaneous advancement flap

PURPOSE Large groin defects may be created after inguinal lymphadenectomy for bulky metastatic penile cancer. We describe a new method of primary closure of a large groin skin defect.MATERIALS AND METHODS In 3 patients with large volume inguinal lymph node metastases with skin breakdown and secondary infection extensive inguinal lymphadenectomy was done with wide surgical excision of skin and subcutaneous tissue. The procedures resulted in a large groin defect. Sartorius muscle was transferred to cover the femoral vessels. An abdominal advancement cutaneous flap was placed for soft tissue and skin coverage of the wound.RESULTS Primary closure of a large skin defect was possible using an abdominal advancement flap. In all patients the wound healed primarily with good cosmesis. A single patient underwent postoperative external beam radiation therapy to the flap site with no untoward effect on graft survival.CONCLUSIONS Large groin skin defects can be closed primarily using an abdominal advancement flap. This technique may also be used for bilateral groin defects. Compared with other types of flaps advocated for this purpose the main advantages of the procedure are simplicity, lower morbidity and superior cosmetic results.     

反流轴型岛状耳廓瓣修复大面积鼻翼缺损

目的：寻求耳廓复合组织片游离移植时面积受限之解决方法。方法：于29具成人灌注尸体标本，进行额、鼻、颞部血管解剖观测，并进行临床实践。结果：颈内动脉的血流，可自滑车上动脉、框上动脉→前额动脉吻合网→颞浅动脉额支→颞浅动脉主干→颞浅动脉耳支而营养耳廓。根据解剖结果，可设计以滑车上、眶上动脉为血管蒂的跨区供血的反流轴型耳廓复合组织岛状瓣，修复大面积鼻翼缺损，临床上已应用16例，取得满意效果，结论：来自颈内动脉的血液可经前额动脉吻合网进入颈外动脉分布的耳廓及耳前，耳后组织，提供血供，可据以设计岛状耳廓复合组织瓣，修复大面积鼻翼缺损。     

颏下岛状皮瓣在舌癌术后组织缺损修复中的临床应用

目的：总结颏下岛状皮瓣修复舌癌术后组织缺损的临床经验。方法：对我科收治的11例舌癌术后缺损患者进行颏下岛状瓣修复,其中男性7例,女性4例,全部病例行舌癌扩大切除术,舌缺损采用颏下动脉岛状皮瓣同期修复。术后观察组织瓣生长情况以及修复效果。结果：10例皮瓣存活,皮瓣形态自然美观,舌活动灵活,基本恢复解剖形态和生理功能。术后随访12个月,未发现复发和转移。1例男性患者组织瓣上有胡须生长。1例出现皮瓣远端部分坏死,二期愈合。结论：应用颏下岛状皮瓣修复舌癌术后缺损操作简单,修复效果良好,是一种有效的修复方法。     

指动脉岛状皮瓣在手指软组织缺损中的应用

目的探讨指动脉岛状皮瓣修复手指软组织缺损的疗效。方法2003年8月~2004年11月,我科应用指动脉岛状皮瓣修复手指软组织缺损25例,皮瓣面积(2.0~3.0)cm×(1.5~3.0)cm。结果25例皮瓣全部成活。手术时间60~90 m in,平均75 m in。术中出血量25~40 m l,平均32 m l。2例植皮面1/3面积坏死,换皮后愈合。23例随访6~18个月,平均13.5月,皮瓣色泽红润,质地正常,外形佳,皮瓣两点分辨觉为6.5~8.8 mm,平均7.5 mm,温、痛觉恢复良好,手指感觉运动功能均满意。结论指动脉岛状皮瓣手术操作简单,疗效满意,是修复手指软组织缺损的理想术式。     

Propeller flap: Orthoplastic approach for coverage of distal leg and ankle defects

BackgroundCovering soft tissue defects of the distal one-third of the leg and the Achilles tendon region and is a challenging problem for an orthopedic surgeon. With recent advancements in the anatomical knowledge of perforating vessels, perforator-pedicled propeller flaps have become increasingly popular in recent decades. We aimed to evaluate the clinical outcomes of our patients whose soft tissue defects in the distal leg were reconstructed with propeller flaps and assessed association of complications with age, gender, flap size and arc of rotation.MethodsPatients that had a reconstruction with a propeller flap at the ankle from 2013 to 2019 were retrospectively reviewed. The main indications for the propeller flap were small- and medium-sized soft tissue defects of the distal lower limb. 20 propeller flaps were applied to 19 patients (14 male, 5 female) for various lower extremity defects.ResultsThe mean follow-up duration was 2 years (range, 6 months to 6 years). The average flap size was 82 cm² (range, 48–125 cm²). The flap was rotated 180 degrees in nine patients The source of the perforator vessel was the tibialis posterior artery in 14 cases, the peroneal artery in 4 cases, both the tibialis posterior and peroneal arteries in 1 case. Four complications (20 %) occured postoperatively. Two patients developed partial necrosis at the tip of the flap, and two patients developed superficial epidermolysis. No correlations were found between complications and flap size and the arc of rotation.ConclusionsThe propeller flap is a reliable option for reconstruction of small to moderate defects in the lower extremity with good clinical results and minimal donor-site morbidity. It is applicable for orthopedic surgeons who do not have microsurgical experience or an available microscope in the operating room.     

指动脉逆行岛状皮瓣修复63例69指指端缺损

目的分析、探讨指动脉逆行岛状皮瓣修复指端缺损的临床效果。方法1990～1999年应用指动脉逆行岛状皮瓣治疗63例69指指端缺损。结果除1例皮瓣坏死外,其余均存活。术后经1～28个月随访,外形满意,效果良好。结论指动脉逆行岛状瓣是一种修复指端缺损的可行方法。     

颏下蒂岛状皮瓣在口腔癌术后口内缺损修复中的应用

目的:探讨颏下蒂岛状皮瓣在口腔癌术后口内缺损一期修复中的应用效果。方法:对我科2010年9月~2014年6月应用颏下蒂岛状皮瓣修复24例口腔癌术后口内软组织缺损患者的临床资料进行回顾性分析,观察皮瓣的存活情况及近、远期临床效果。结果:1例下牙龈癌患者术后皮瓣出现静脉危象坏死,予以清除,创面拉拢缝合。23例皮瓣全部存活。术后随访6~36个月,该组病例均未见肿瘤复发与转移。组织瓣血运丰富,皮瓣形态良好,无臃肿,外观和功能满意。结论:颏下岛状皮瓣具有血管蒂恒定、制备简单、可旋转幅度大,厚度适中、易于成活及供区隐蔽等优点,是口腔癌切除后软组织缺损修复的较理想选择。     

Osteomyocutaneous peroneal artery perforator flap for reconstruction of composite maxillary defects

BACKGROUND: Composite maxillary defects often involve the maxilla, nasal mucosa, palate, and maxillary sinus. We presented the surgical techniques and outcome of the osteomyocutaneous peroneal artery perforator (PAP) flap for reconstruction of composite maxillary defects. METHODS: Six patients underwent an osteomyocutaneous PAP flap reconstruction of composite maxillary defects. The average age was 52 years. The defects were Cordeiro type II in three patients and type IV midfacial defects in another three patients. RESULTS: No total or partial flap failures occurred. At a mean 12-month follow-up, five patients had a normal speech and were able to eat a regular diet. One patient tolerated a soft diet and had intelligible speech. One patient had ectropion develop. Excellent cosmesis was found in five patients. CONCLUSIONS: The osteomyocutaneous PAP flap represents a further refinement of the fibula flap and increases its versatility, with multiple skin paddles, bone segments, and soleus muscle independently isolated. It is a comparable reconstruction option for composite maxillary defects.     

Contralateral rectus abdominis muscle flap coverage for a radionecrotic groin defect

An inferiorly based contralateral rectus abdominis muscle flap was utilized to reconstruct an infected, radionecrotic wound in the groin. The selection criteria for this particular flap are discussed, comparing it to other reconstructive choices. It is believed that the contralateral rectus muscle flap is a good reconstructive choice, since its blood supply is distant to the site of the radiation-induced vascular insufficiency.     

Bernard瓣修复下唇癌术后缺损的临床观察

目的：探讨应用Bernard瓣修复下唇癌术后缺损的临床疗效。方法：对我院5例下唇癌患者分别行传统和改良的Bernard瓣即刻修复缺损,并进行术后随访观察其形态和功能恢复情况。结果：5例患者中3例应用传统的bernard瓣手术方法,2例使用改良的Bernard瓣修复。术后形态和功能恢复良好,无并发症发生。结论：Bernard瓣修复下唇癌术后1/2～2/3的缺损可取得满意效果。其中传统Bernard瓣主要适用于缺损更接近于1/2的病例,而改良的Bernard瓣主要用于缺损更接近于2/3的病例。     

携带腹外斜肌腱膜的髂腹股沟皮瓣修复足背肌腱及皮肤缺损北大核心CSCD

目的探讨携带腹外斜肌腱膜的髂腹股沟皮瓣修复足背肌腱及皮肤缺损的疗效。方法 2016年10月—2020年1月,收治12例外伤导致的足背复合组织缺损。男9例,女3例;年龄32~65岁,中位年龄42岁。足背皮肤软组织缺损范围为8 cm×5 cm~12 cm×8 cm;创面均伴伸肌腱损伤,其中踇长伸肌腱缺损6例,趾长伸肌腱缺损5例,趾长、短伸肌腱缺损3例。受伤至入院时间为1~6 h,平均3 h。入院后急诊彻底清创,二期采用携带腹外斜肌腱膜的髂腹股沟皮瓣修复足背创面及肌腱缺损。皮瓣切取范围为10 cm×6 cm~13 cm×9 cm,腹外斜肌腱膜切取范围为5.5 cm×3.0 cm~8.0 cm×5.0 cm。供区直接缝合关闭。结果术后12例皮瓣全部成活,供、受区创面均Ⅰ期愈合。患者均获随访,随访时间16~24个月,平均18个月。皮瓣外形满意、质地柔软。末次随访时,根据美国矫形足踝协会(AOFAS)跖趾-趾间关节量表评分获优9例、良3例;伸趾功能重建满意。供区仅遗留线性瘢痕,未出现腹壁疝等并发症。结论髂腹股沟皮瓣供区隐蔽,切取位置表浅、易于修薄,可携带腹外斜肌腱膜修复肌腱缺损,是一期修复足背肌腱及皮肤缺损的理想皮瓣。     

携血管化阔筋膜的股前外侧皮瓣动力性修复下唇大型缺损

目的探讨应用携血管化阔筋膜的股前外侧皮瓣修复下唇大型复杂缺损的临床效果。方法回顾性分析2013年1月至2020年6月,上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科同一课题组应用携血管化阔筋膜的股前外侧皮瓣修复的下唇大型复杂缺损患者的临床资料。股前外侧皮瓣用于恢复缺损的组织,重建下唇外形,阔筋膜与余留的口轮匝肌形成"闭环"结构进行动力性重建。术后每2~3个月随访1次,观察皮瓣存活情况、唇部外形、张闭口及饮水等情况。结果共纳入4例患者,均为男性,年龄26~63岁,2例为下颌骨鳞状细胞癌侵犯下唇,1例为下唇动静脉畸形栓塞术后,1例为下唇鳞状细胞癌。4例患者均顺利完成下唇的修复重建,移植皮瓣面积18 cm×7 cm~26 cm×8 cm,两端携带(5~8)cm×1 cm的阔筋膜,皮瓣均全部存活。术后随访时间6~80个月,患者下唇外形良好,张口度2~3横指,闭口时能完全密封,饮水达到基本不漏水。结论携血管化阔筋膜的股前外侧皮瓣可对下唇大型复杂缺损进行外形修复及动力性重建,能达到较好的临床效果。     

颞浅血管蒂额部岛状皮瓣修复鼻部分缺损

目的　研究颞浅血管蒂额部岛状皮瓣修复鼻部分缺损的方法。方法　自 1992年以来采用颞浅血管蒂额部岛状皮瓣修复鼻部分缺损 17例 ,全层缺损以皮瓣远端折叠法或局部翻转皮瓣法制作衬里。皮瓣最小面积 1.5cm× 3cm ,最大面积 8cm× 10cm。结果　 17例中 ,移植皮瓣完全成活 12例 ,经随访 1～ 11年 ,鼻缺损修复后轮廓形态逼真 ,移植皮瓣颜色和周围肤色差别小 ,外形和功能良好。皮瓣供区痕迹不明显。移植皮瓣回流障碍 3例 ,术后局部遗留色素改变。移植皮瓣部分坏死 2例 ,皮瓣部分坏死后 3周 ,用对侧鼻唇沟带蒂皮瓣移植修复。结论　颞浅血管蒂额部岛状皮瓣修复鼻部分缺损 ,是一种良好的选择。