A medially based cervical transposition flap for soft tissue coverage of the cheek

A new flap for cheek reconstruction is presented. It is a medially based axial pattern flap that is elevated on the SMAS or including the SMAS and thus is of good thickness and stability for coverage of even large defects of the cheek without significant contour irregularities. It is planned like a traditional transposition flap and harvested in such a way that the scar of the secondary defect lies under the edge of the mandible and, thus, on the border between two aesthetic units and along the relaxed tension lines. The donor site scar is aesthetically acceptable.     

The faciocervicopectoral flap for non-oncological cases of cheek reconstruction

IntroductionMajor facial defect has been a challenging case for plastic surgeons in terms of wound healing and covering technique for a long time.MethodsEight faciocervicopectoral (FCP) flaps were performed for reconstruction of major cheek defects due to handmade explosive and gun injuries. They were evaluated perioperatively and postoperatively with regard to operative time and operative blood loss as well as the function and cosmetic appearance.ResultsThe technique showed marvellous cosmetic results but encountered minor postoperative flap complications.ConclusionsThe FCP flap is one of the best solutions for coverage of a simple or complex cheek defect. Application of the FCP flap is easy and rapid.     

斧形皮瓣在修复面颊部不同区域组织缺损中的应用

目的 探讨斧形皮瓣修复面颊部不同区域组织缺损的设计原则、效果和意义.方法 利用内外眦垂直线,把面颊部分为3个区域:PⅠ、PⅡ、PⅢ.在不同区域内,参照面颊部自然曲线走向特征,在组织缺损一侧设计不同形式的斧形皮瓣,修复组织缺损.2005年8月至2009年8月,共修复面颊部中小面积组织缺损29例.其中男性17例,女性12例;年龄19～81岁,平均(45±16)岁.组织缺损面积最小者1.5 cm×1.5 cm,最大者2.5 cm×3.5 cm.术后6个月问卷调查患者对色泽和质地匹配、瘢痕隐蔽性、术区外形和功能的满意度.结果 皮瓣全部成活良好.随访6～18个月,皮瓣色泽和质地匹配好,瘢痕隐蔽,术区无明显畸形,功能良好.术后6个月患者对各评价项目的满意度较高.组织缺损位于PⅠ区患者对瘢痕的满意度低于位于PⅢ区患者,两者差异有统计学意义(P=0.028).结论 参照面颊部不同区域自然曲线特征,设计不同形式的斧形皮瓣修复组织缺损,能够取得较佳的视觉效果和功能恢复.     

Dermoglandular rotation flap with subaxillary advancement flap as an oncoplastic technique for breast cancer

We propose a novel oncoplastic surgical technique, dermoglandular rotation flap with subaxillary advancement flap, as a feasible one‐stage operation. Breast conserving surgery, incorporating the dermoglandular rotation flap with subaxillary advancement flap, was performed in 49 female patients with breast cancer, between January and December 2015. After a full‐thickness fibroglandular resection including the tumor, an inferior‐ or a superior‐based rotation flap was performed according to the location of the defect. The subaxillary flap consisted of skin, dermis, and subcutaneous fat tissue and was mobilized from the chest wall musculature. Since subaxillary skin has greater redundancy, it can be easily moved to reach the lateral aspect of the breast. Approximation of the subaxillary flap to the lateral side of rotated dermoglandular flap served to relieve skin tension and avoid displacement of the nipple‐areola complex (NAC). Consequently, there was wider dermoglandular tissue rotation and efficient filling of defect without any significant postoperative deformity. The mean follow‐up period was 46.5 ± 3.1 months (range, 42.4‐52.1 months). Mean tumor size, on pathology, was 2.1 cm (range, 0.4‐6.0). Mean excised breast tissue weight was 78.4 g (range, 28.6‐195.0). More than half of the patients (51%) studied had excised breast tissue weighing more than 80 g. None of the included patients had positive surgical margins in final pathologic reports. Most patients answered excellent or good for self‐estimated cosmetic outcomes including symmetry of the breast and NAC, breast shape, scarring, and overall satisfaction. A modified dermoglandular rotation flap technique along with subaxillary advancement flap is a feasible and effective oncoplastic technique for breast cancers.     

Reconstruction of the breast by advancement of abdominal skin

Summary In 106 of our patients, breast cancer has been detected early, and a modified radical mastectomy was possible. Reconstruction could be carried out replacing the missing skin by wide advancement of abdominal skin. Fixation of the tightened abdominal skin to the thoracic wall with a continuous suture creates a new inframammary fold and a skin pocket big enough for any size of prosthesis. Among all methods for reconstruction of the nipple-areola complex, we found three to be the best: 1) preservation of the nipple-areola from the amputated breast, 2) combination of nipple graft and areola tattoo, 3) sharing the areola and nipple of the other breast.     

Integrated treatment of wrinkles on the forehead and glabellar region

Some techniques to improve forehead and glabellar region wrinkles are described. The zone of the scalp is undermined below the galea to protect the hair follicles. On the forehead, the undermining is made above the frontal muscle. In the cheek and zygomatic region, the undermining is made in the fat which allows leaving a neurovascular pedicle or mesotemporalis so as not to paralyze the frontal muscle. The glabellar depressions are filled with dermo-fat, fascia grafts, or with sheets of Silicone. The tunnel below the wrinkle, for introducing the grafts, is made using a lengthened scalpel designed by the author. Results have been extremely satisfactory.     

Reconstruction of large intraoral and adjacent cheek defects by free radial forearm flap

Summary Eighteen patients with intraoral and oropharyngeal carcinoma were treated by radical excision for extensive infiltration of tumour into adjacent tissue. Defects were repaired by free radial forearm flaps. Three patients had bony defects in addition to mucosal and skin defects. The free flap can be easily folded to repair skin and mucosa simultaneously. We consider the free forearm flap to be the procedure of choice in selected cases of large intraoral and adjacent cheek defects.     

面部旋转皮瓣治疗眶下区基底细胞癌疗效观察

目的 探讨眶下部位的肿瘤切除术后创面的修复方法。方法 应用面部旋转皮瓣为28例下睑及眶下区基底细胞癌病人进行手术后创面的即时修复。结果 28例术后创面均得到即时修复，效果较好。结论 该方法供区隐蔽，可减少新创面，修复后创面瘢痕不明显，值得推广。     

Fabricating Flaps in the Forearm Prior to Tracheal Reconstruction

Background  The process of reconstruction of tracheal defects is complex and still not optimum. Options range from using staged reconstructions, combining flaps with autologous or alloplastic implants, as well as use of tissue-engineered constructs combined with vascularized tissues which are lined with cell cultures. Staged reconstructions using prelaminated epithelium, and prefabricated flaps, help in reconstruction of this complex structure. Prefabricating the flap at a different site allows for integration of the tissues prior to its transfer. Method  This article reports two patients planned for tracheal reconstruction for the purpose of advanced papillary carcinoma of the thyroid invading the trachea. Staged reconstruction using a prefabricated radial artery forearm flap (RAFF) and split rib cartilage was performed. In the second patient, a young girl, a similar construct of the RAFF, prelaminated with buccal mucosa, was performed. However, in the latter case, an intraoperative decision by the head and neck team to limit excision of the trachea sparing the mucosa was taken; the reconstruct in the forearm was redundant and needed to be discarded, replacing the defect with a free superficial circumflex iliac artery perforator (SCIP) flap. Result  At 3 years follow-up, both the patients are free of disease, with the construct serving its purpose in the older female.