Modified Texier mediodorsal transposition island skin flap of the nose. Report of four cases of ala nasi reconstruction

First described by Texier in 1994, the mediodorsal transposition flap of the nose is an island flap. The paramedian dorsal arteries (anastomosed to the interdomal plexus) ensured the axial vascularisation in SMAS plane. The authors will discuss their personal approach to the surgical procedure for the improvement of final result, with four clinical cases. This flap can be used for aesthetic unit reconstruction of cutaneous or mucosal different alar defect (partial or complete, full-thickness or not). This reliable flap represents an alternative technique of composed grafts, of different nasolabial flaps, and of forehead flap.     

The complete dorsum nasal island flap based on the superior alar artery

The complete dorsal nasal aesthetic unit can be raised in a vascular island flap based on the superior alar artery, at the level of the nasalis muscle. This flap uses the vertical glabellar cutaneous laxity. It hides scars between the nasal aesthetics units and its distal rotation point allows a pure translation of the nasal skin without distortions encountered when using medial canthal rotation flaps. This local flap is reliable and had been successfully used for four patients without complications or secondary procedures. It allows large reconstructions for up to 25 mm defects leaving minimal scars. It represents an interesting alternative for the reconstruction of defects of the nasal tip or supra tip of the nose, and has also been used for alar reconstructions.     

Single-stage reconstruction of alar defect of the nose by subcutaneous island nasolabial and remnant alar flap

A single-stage technique for reconstruction of the medial nasal ala with a nasolabial flap and an inferiorly based remnant alar flap is presented in this article. The technique has been used in four cases. All the flaps healed uneventfully with aesthetically pleasing results using the one-stage technique. The subcutaneous nasolabial island flap and alar remnant flap have become the method of choice in the author’s clinic for partial medial nasal ala reconstruction. It allows one-stage reconstruction with very similar tissue and a concealed scar in the natural groove. The remnant ala as an inferiorly based flap has been used by the author to cover the subcutaneous pedicle of the nasolabial flap to provide better shape to the alar base without its lateral drift during healing. Level of Evidence: Level V, therapeutic study.     

阴茎海绵体延伸加带蒂皮瓣转移治疗不完全性阴茎缺损(附42例报告)

目的　探讨具有感觉与勃起功能的阴茎修复方法治疗阴茎不完全性缺损。　方法　①手术方法 :离断全部浅、深悬韧带 ,分离部分海绵体脚 ,使阴茎更为延伸 ;用含血运的脂肪瓣转移填塞耻骨前间隙 ,保证术后远期阴茎的有效长度 ;选用合适的带蒂皮瓣转移覆盖海绵体 ,塑造外形更为美观的阴茎体部 ;阴茎残端整形塑造逼真的阴茎头和冠状沟样外观。②术后随访方法 :对术后患者取移植皮瓣全层皮肤 ,分别进行光镜、免疫组化、透射电镜和扫描电镜等检测 ,观察皮肤神经再生情况 ;通过对修复阴茎皮肤的触觉、痛觉及两点分辨觉 (复合感觉 )的检测 ,了解感觉功能恢复情况 ;采用夜间阴茎勃起测定系统检测阴茎修复后的勃起功能。　结果　①修复阴茎 4 2例 ,术前残留阴茎常态下长度 0 .5～ 4 .0cm ,勃起时长度 1.5～ 5 .0cm ;术后常态下长度 5 .0～ 8.0cm ,勃起时长度 7.0～ 12 .5cm ;随访 1年以上者 2 8例 ,已婚 2 3例 ,性生活基本满意 ,已育 18例。②移植皮瓣术后 12个月光镜观察 ,真皮层内可见末梢神经束 ;免疫组化标记神经纤维束的细胞浆内可见神经纤维细丝蛋白阳性颗粒 ;透射电镜和扫描电镜均可见再生的神经纤维束及相关组织。修复阴茎已有触觉、痛觉及两点分辨觉。③勃起功能测定 :术后 12个月以上患者夜间 8～ 12h内勃     

颏下岛状瓣修复面部组织缺损

目的探讨颏下岛状瓣修复面部组织缺损的应用效果。方法6例面部病变患者,其中男4例,女2例;最小年龄44岁,最大78岁。病变部位:左面部2例,左腮腺区1例,右腮腺区1例,右面部2例。病变性质:皮样囊肿感染伴皮肤坏死1例,皮脂腺囊肿感染伴皮肤坏死1例,皮肤上皮瘤恶变1例,鳞状细胞癌3例。良性病变切除后,恶性病变扩大切除同期行颈淋巴清扫术后,面部缺损均以颏下岛状瓣即时修复。组织缺损范围最小4.0cm×3.0cm,最大6.0cm×6.0cm。组织瓣最小面积4.5cm×3.0cm,最大6.0cm×4.5cm。组织瓣以颏下动脉为蒂3例,颏下动脉联合面动脉为蒂3例。蒂的长度:6cm3例,9cm2例,11cm1例。结果6例组织瓣均存活良好,肤色与面部无明显差异;未发生任何并发症。供区伤口Ⅰ期愈合,平视位时,供区瘢痕不显露。结论颏下岛状瓣修复面部组织缺损是一种可供选择的良好方法。     

Efficiency of the combination of Mersilene-musculocutaneous flap in the reconstruction of full-thickness chest wall defects. A retrospective study of 14 cases

SUBJECT: The tumors of chest wall can be responsible of large full-thickness defects. The skeletal stabilization by different synthetic materials with numerous modalities of use and the superficial coverage of the defect by a musculocutaneous flap are the two imperatives parts of this reconstruction. PATIENTS AND METHODS: From January 1997 to January 2006, 14 patients, 10 males and 4 females, aged between 17 and 63 years old and suffering from full-thickness chest wall defects secondary to tumor resection have benefited from a simple reconstruction, wherever the defect, by a Mersilene Mesh and a muscular or musculocutaneous flap. These defects measured between 8 x 12 cm and 14 x 16 cm and were located in the anterior part of the chest in 3 cases, with resection of the upper half of the sternum and the internal part of both clavicles and the first three ribs, and in the lateral part of the chest in 11 cases with resection between 3 and 5 ribs. The histological diagnoses of these tumors were 3 chondrosarcomas, 3 sternum and 1 rib metastases, 2 desmoid tumors, 1 Ewing's sarcoma, 4 benign tumors. The flaps used were pedicled in 13 cases and based on the latissimus dorsi muscle, the serratus muscle and the pectoralis major muscle; in 1 case, the latissimus dorsi musculocutaneous flap was free. RESULTS: The skeletal stabilisation seems satisfying. There was no problems with the pulmonary function except in 4 cases where a dyspnea appears in sustained effort. No vascular complication on these flaps was noted. With a mean follow up of 46 months, there was no local recurrence of the malignant tumors. Two patients were deceased 1 year after surgery.0. CONCLUSION: The Mersilene mesh associated with a locoregional musculocutaneous flap represent a simple and efficient solution for the treatment of such defects.     

Breast reconstruction with pedicled TRAM flap (a retrospective study of 115 consecutive cases)

Purpose of the study

The purpose of this study is to analyse the advantages, disadvantages and results of the unipediculed TRAM flap.

Patients and method

This retrospective study concerns 115 consecutive unipediculed TRAM flaps realised by two surgeons between 1994 and January 2007. These reconstructions were all realised for oncologic pathology and were either immediate or delayed surgery. Concerning the immediate reconstruction, a skin sparing mastectomy has been realised as often as possible for intraductal carcinomas and small invasive carcinomas. For the immediate reconstruction the study takes into account complications and oncologic recurrences with an average backward of 45 months.

Results

The unipediculed TRAM flap offers a good reliability and the esthetics results are stable at long-term for immediate breast reconstruction and delayed breast reconstruction. The major complications are flap necrosis (12,2%) and parietal complications (6%). The recurrence rate after mastectomy and unipediculed TRAM flap is equivalent of the recurrence rate expected for mastectomy alone. There were never late diagnostic for recurrence after unipediculed TRAM flap. The esthetic improvement by surgery concerns the opposite breast for 31,3%, it was a mastopexy or reduction. The esthetic improvement of the TRAM flap concerns 14 patients (12,1%). The improvement of inframammary crease was the most frequent improvement (9/115–8%).

Conclusion

The TRAM flap unipediculed allows a delayed, immediate breast reconstruction or bilateral synchronised breast reconstruction. The long-term disadvantages are the abdominal complications and the impossibility to realise the same technique for a later controlateral reconstruction.     

The use of otherwise redundant skin to provide nasal lining in the reconstruction of full-thickness alar defects by nasolabial flap repair.

The use of otherwise redundant nasolabial flap skin is described for lining in reconstruction of full-thickness alar defects. The techniques have been successfully used to reconstruct full-thickness alar defects in four patients. The overall procedure has the advantage of providing well-vascularised tissue of appropriate colour, texture and thickness for external skin and nasal lining in one-stage reconstruction.     

半趾甲瓣移植修复手指末节半侧缺损

目的：探索对拇手指末节半侧缺损最佳再造、修复的方法。方法：根据手指缺损程度的范围，切取趾腓侧及第二趾胫侧部分趾甲瓣移植，采用吻合趾-指血管的方法重建血液循环进行修复和重建。结果：拇指半侧缺损采用趾腓侧趾甲瓣3例，手指半侧缺损采用第二趾部分甲瓣2例，拇指及中指末节背侧缺损采用拇趾及第二趾背侧甲瓣各1例进行移植修复，全部成功。术后经2个月-8年随访，手指外形基本恢复，外观较好，出汗有罗纹。结论：采用拇趾腓侧第二趾部分趾甲瓣移植修复是治疗外伤后拇手指半侧和部分缺损比较理想的方法。     

游离股前外筋膜瓣修复手部软组织缺损

目的设计游离股前外筋膜瓣修复手背、掌侧皮肤缺损。方法本组14例手部软组织缺损患者,肌腱移植修复后采用游离股前外筋膜瓣覆盖修复,筋膜瓣上游离植皮。结果筋膜瓣全部成活,植皮9例成活,其余5例部分出现坏死,经换药或点状植皮愈合。经6个月～2年随访,外观和功能满意。结论应用肌腱移植联合游离股前外筋膜瓣,一次手术完成手部肌腱、软组织、皮肤及感觉神经重建,术后外形、功能恢复满意,尤其对供区损伤降至最小,为手掌、背部皮肤软组织缺损提供了一种较好的修复方法。     

Reconstruction with distally based dorsalis pedis fasciocutaneous flap for the coverage of distal toe-plantar defects

Reconstruction of small defects in the distal portion of the foot has always been a difficult problem. A case involving a young man with a deep electric burn of the distal lateral side of the big toe, successfully treated with a distally based dorsalis pedis fasciocutaneous flap, is presented. The donor site area of the dorsum of the foot was grafted, and deambulation was reassumed three weeks later. Advantages, limits and anatomical consideration regarding the viability of the flap are also discussed.     

全长手指再造10例报告

目的 介绍全长手指再造的概念和3种再造的方法.方法 采用3种方法:①急诊取一侧足第二足做桥接远端部分完整的手指再造手指;②用双侧第二足趾移植再造手指;③取携带同足跖、背侧皮瓣和第一、三趾侧方皮瓣并将移植的第二跖趾关节旋转90°再造手指. 结果 临床应用10例.再造手指均一期成活,术后按中华医学会手外科学会拇、手指再造功能评定试用标准法评定,优1例.良5例,可4例. 结论 3种方法进行全长手指再造,方法可行,在一定程度上解决了手外科中长指再造的难题.